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Why do I get so anxious after drinking? Here’s the science behind ‘hangxiety’

<a href="https://theconversation.com/profiles/blair-aitken-1510537">Blair Aitken</a>, <a href="https://theconversation.com/institutions/swinburne-university-of-technology-767">Swinburne University of Technology</a> and <a href="https://theconversation.com/profiles/rebecca-rothman-2231560">Rebecca Rothman</a>, <a href="https://theconversation.com/institutions/swinburne-university-of-technology-767">Swinburne University of Technology</a> You had a great night out, but the next morning, anxiety hits: your heart races, and you replay every conversation from the night before in your head. This feeling, known as hangover anxiety or “<a href="https://adf.org.au/insights/what-is-hangxiety/">hangxiety</a>”, <a href="https://onlinelibrary.wiley.com/doi/10.1002/hup.2623">affects around 22%</a> of social drinkers. While for some people, it’s mild nerves, for others, it’s a wave of anxiety that feels impossible to ride out. The “Sunday scaries” may make you feel panicked, filled with dread and unable to relax. Hangover anxiety can make even simple tasks feel overwhelming. Here’s why it happens, and what you can do about it. <h2>What does alcohol do to our brains?</h2> A hangover is the body’s way of recovering after drinking alcohol, bringing with it a range of symptoms. <a href="https://www.mdpi.com/2077-0383/10/23/5691">Dehydration and disrupted sleep</a> play a large part in the pounding headaches and nausea many of us know too well after a big night out. But hangovers aren’t just physical – there’s a strong mental side too. Alcohol is a nervous system depressant, meaning it alters how certain chemical messengers (or neurotransmitters) behave in the brain. Alcohol relaxes you by increasing <a href="https://my.clevelandclinic.org/health/articles/22857-gamma-aminobutyric-acid-gaba">gamma-aminobutyric acid</a> (GABA), the neurotransmitter that makes you feel calm and lowers inhibitions. It decreases <a href="https://my.clevelandclinic.org/health/articles/22839-glutamate">glutamate</a> and this also slows down your thoughts and helps ease you into a more relaxed state. Together, this interaction affects your mood, emotions and alertness. This is why when we drink, we often feel more sociable, carefree and willing to let our guard down. As the effects of the alcohol wear off, your brain works to rebalance these chemicals by <a href="https://www.sciencedirect.com/science/article/pii/S0191886918305762">reducing GABA and increasing glutamate</a>. This shift has the opposite effect of the night before, causing your brain to become more excitable and overstimulated, which can lead to feelings of anxiety. So why do some people get hangxiety, while others don’t? There isn’t one clear answer to this question, as several factors can play a role in whether someone experiences hangover-related anxiety. <h2>Genes play a role</h2> For some, a hangover is simply a matter of how much they drank or how hydrated they are. But genetics may also play a significant role. <a href="https://onlinelibrary.wiley.com/doi/10.1111/add.12699">Research</a> shows your genes can explain almost half the reason why you wake up feeling hungover, while your friend might not. Because genes influence how your body processes alcohol, some people may experience more intense hangover symptoms, such as headaches or dehydration. These stronger physical effects can, in turn, <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1002/hup.2623">trigger anxiety during a hangover</a>, making you more susceptible to “hangxiety.” <h2>Do you remember what you said last night?</h2> But one of the most common culprits for feeling anxious the next day is often <a href="https://journals.sagepub.com/doi/pdf/10.1177/0091450915604988">what you do while drinking</a>. Let’s say you’ve had a big night out and you can’t quite recall a conversation you had or something you did. Maybe you acted in ways that you now regret or feel embarrassed about. You might fixate on these thoughts and get trapped in a cycle of worrying and rumination. This cycle can be hard to break and can make you feel more anxious. <a href="https://doi.org/10.1016/j.addbeh.2023.107619">Research</a> suggests people who already struggle with feelings of anxiety in their day-to-day lives are especially vulnerable to hangxiety. Some people drink alcohol to unwind after a stressful day or to make themselves feel more comfortable at social events. This often leads to <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC9756407">heavier consumption</a>, which can make hangover symptoms more severe. It can also begin a cycle of drinking to feel better, making hangxiety even harder to escape. <h2>Preventing hangover anxiety</h2> The best way to prevent hangxiety is to limit your alcohol consumption. The <a href="https://adf.org.au/reducing-risk/alcohol/alcohol-guidelines">Australian guidelines</a> recommend having no more than ten standard drinks per week and no more than four standard drinks on any one day. Generally, the more you drink, the more intense your hangover symptoms might be, and the worse you are likely to feel. Mixing other drugs with alcohol can also increase the risk of hangxiety. This is especially true for party drugs, such as ecstasy or MDMA, that give you a temporary high but can lead to anxiety as they wear off and you are <a href="https://adf.org.au/insights/drug-comedowns">coming down</a>. If you do wake up feeling anxious: <ul> <li> focus on the physical recovery to help ease the mental strain </li> <li> drink plenty of water, eat a light meal and allow yourself time to rest </li> <li> try <a href="https://www.headspace.com/mindfulness/mindfulness-101">mindfulness meditation</a> or deep breathing exercises, especially if anxiety keeps you awake or your mind races </li> <li> consider journalling. This can help re-frame anxious thoughts, put your feelings into perspective and encourage self-compassion </li> <li> talk to a close friend. This can provide a safe space to express concerns and feel less isolated. </li> </ul> Hangxiety is an unwelcome guest after a night out. Understanding why hangxiety happens – and how you can manage it – can make the morning after a little less daunting, and help keep those anxious thoughts at bay.<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/240991/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/blair-aitken-1510537">Blair Aitken</a>, Postdoctoral Research Fellow in Psychopharmacology, <a href="https://theconversation.com/institutions/swinburne-university-of-technology-767">Swinburne University of Technology</a> and <a href="https://theconversation.com/profiles/rebecca-rothman-2231560">Rebecca Rothman</a>, PhD Candidate in Clinical Psychology, School of Health Sciences, <a href="https://theconversation.com/institutions/swinburne-university-of-technology-767">Swinburne University of Technology</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/why-do-i-get-so-anxious-after-drinking-heres-the-science-behind-hangxiety-240991">original article</a>.

Mind

What is methanol? How does it get into drinks and cause harm?

<a href="https://theconversation.com/profiles/ian-musgrave-1808">Ian Musgrave</a>, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a> Melbourne teenager Bianca Jones <a href="https://www.abc.net.au/news/2024-11-21/bianca-jones-dead-laos-methanol-poisoning/104630384">has died</a> and her friend Holly Bowles remains severely ill in hospital in Thailand, after experiencing suspected methanol poisoning while they were travelling in Laos. The pair are reportedly among <a href="https://x.com/Smartraveller/status/1858850858227954118">several foreign nationals</a> who became ill after unknowingly consuming alcoholic drinks containing methanol in the south-east Asian country. So what is methanol, and how does it make people sick? <h2>Methanol versus ethanol</h2> <a href="https://en.wikipedia.org/wiki/Methanol">Methanol</a> is an <a href="https://en.wikipedia.org/wiki/Alcohol_(chemistry)">alcohol</a>, like the familiar <a href="https://en.wikipedia.org/wiki/Ethanol">ethanol</a> we consume in alcoholic beverages. Like ethanol, methanol is a colourless, flammable liquid. It has a smell similar to ethanol as well. But the two have different chemical structures. Methanol is composed of only one carbon atom, while ethanol has two. <figure class="align-center "><img src="https://images.theconversation.com/files/633188/original/file-20241120-15-i7wr12.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/633188/original/file-20241120-15-i7wr12.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/633188/original/file-20241120-15-i7wr12.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/633188/original/file-20241120-15-i7wr12.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/633188/original/file-20241120-15-i7wr12.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/633188/original/file-20241120-15-i7wr12.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/633188/original/file-20241120-15-i7wr12.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" alt="Models of methanol and ethanol depicted with balls and sticks." /><figcaption>Methanol (left) and ethanol (right) have differing chemical structures. Wikimedia Commons, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></figcaption></figure> That one carbon atom makes all the difference. It means methanol is processed differently in our bodies and is much more toxic than ethanol. Methanol is used in a <a href="https://pubchem.ncbi.nlm.nih.gov/compound/Methanol">variety of industrial and household products</a>, such as windshield cleaning fluids, antifreeze and fuel. It’s not safe for human consumption. <h2>What makes methanol toxic?</h2> The difference is in how methanol is metabolised, or broken down in our bodies. Ethanol is metabolised into a chemical compound called acetaldehyde. Acetaldehyde is toxic, but is rapidly converted to acetate (also known as acetic acid, found in vinegar). Generating an acid may sound bad, but acetate actually <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC6699882/">produces energy and makes important molecules</a> in the body. By contrast, methanol is metabolised into <a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/substances/formaldehyde">formaldehyde</a> (a chemical used in <a href="https://www.safework.nsw.gov.au/hazards-a-z/hazardous-chemical/priority-chemicals/formaldehyde">industrial glues</a> and for embalming corpses, for example) and then to <a href="https://pubchem.ncbi.nlm.nih.gov/compound/Formic-Acid">formic acid</a> (the chemical in some ant bites that makes them hurt so much). Unlike acetate, which the body uses, formic acid <a href="https://pubmed.ncbi.nlm.nih.gov/1665561/">poisons the mitochondria</a>, the powerhouses of the cells. As a result, a person exposed to methanol can go into severe <a href="https://www.ncbi.nlm.nih.gov/books/NBK482121/">metabolic acidosis</a>, which is when too much acid builds up in the body. Methanol poisoning can cause nausea, vomiting, and abdominal pain. The acidosis then causes depression of the central nervous system which can cause people with methanol poisoning to fall unconscious and go into a coma, as well as retinal damage leading to vision loss. This is because the retinas are full of active mitochondria and sensitive to them being damaged. Death is not inevitable if only a small amount of methanol has been consumed, and rapid treatment will greatly reduce damage. However, permanent vision damage can occur even at <a href="https://www.ncbi.nlm.nih.gov/books/NBK482121/">non-lethal doses</a> if treatment is not administered quickly. <h2>What does treatment involve?</h2> <a href="https://www.ncbi.nlm.nih.gov/books/NBK482121/">Treatment</a> is mainly supportive care, such as intubation and mechanical ventilation to help the patient to breathe. But it can also involve drugs such as <a href="https://go.drugbank.com/drugs/DB01213">fomepizole</a> (which inhibits the generation of toxic formic acid) and dialysis to remove methanol and its metabolites from the body. <h2>How does methanol get into alcoholic drinks?</h2> Methanol can turn up in any alcoholic beverage, but it’s most likely in beverages with higher alcohol content, such as spirits, and traditionally brewed drinks, such as fruit wines. Methanol can get into alcoholic beverages in a number of ways. Sometimes it’s added <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC8303512/">deliberately and illegally</a> during or after manufacturing as a cheaper way to increase the alcohol content in a drink. <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC5028366/">Traditional brewing methods</a> can also inadvertently generate methanol as well as ethanol and produce toxic levels of methanol depending on the microbes and the types of plant materials used in the fermentation process. We don’t yet know how the Australian teenagers came to be poisoned in this tragedy. But it is a good idea when travelling (particularly in areas with traditionally fremented drinks, such as south-east Asia, the Indian subcontinent and parts of Africa) to always be careful. The Australian government’s <a href="https://www.smartraveller.gov.au/before-you-go/safety/partying#methanol">Smartraveller website</a> advises that to avoid methanol poisoning you should be careful drinking cocktails and drinks made with spirits, drink only at reputable licensed premises and avoid home-made alcoholic drinks. Drinking only mass-produced commercial brews can be safer, though understandably people often want to try locally made drinks as part of their adventure.<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/244151/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ian-musgrave-1808">Ian Musgrave</a>, Senior lecturer in Pharmacology, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-is-methanol-how-does-it-get-into-drinks-and-cause-harm-244151">original article</a>.

Body

What causes the itch in mozzie bites? And why do some people get such a bad reaction?

<a href="https://theconversation.com/profiles/cameron-webb-6736">Cameron Webb</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Are you one of these people who loathes spending time outdoors at dusk as the weather warms and mosquitoes start biting? Female mosquitoes <a href="https://www.annualreviews.org/content/journals/10.1146/annurev-ento-120811-153618">need blood</a> to develop their eggs. Even though they take a tiny amount of our blood, they can leave us with itchy red lumps that can last days. And sometimes something worse. So why does our body react and itch after being bitten by a mosquito? And why are some people more affected than others? <h2>What happens when a mosquito bites?</h2> Mosquitoes are attracted to warm blooded animals, including us. They’re attracted to the <a href="https://www.cambridge.org/core/journals/bulletin-of-entomological-research/article/abs/role-of-carbon-dioxide-in-hostfinding-by-mosquitoes-diptera-culicidae-a-review/2506B86EF63852B2D02EC3FCEE1E3B8B">carbon dioxide</a> we exhale, our body temperatures and, most importantly, <a href="https://www.abc.net.au/news/2024-11-08/mosquitoes-climate-change-skin/104548122">the smell of our skin</a>. The <a href="https://www.cell.com/trends/parasitology/abstract/S1471-4922(21)00237-3">chemical cocktail</a> of odours from bacteria and sweat on our skin <a href="https://www.cell.com/current-biology/fulltext/S0960-9822(23)00532-8">sends out a signal</a> to hungry mosquitoes. <a href="https://www.sciencedirect.com/science/article/pii/S2667114X21000522">Some people’s</a> skin smells more appealing to mosquitoes, and they’re more likely to be bitten than others. Once the mosquito has made its way to your skin, things get a little gross. The mosquito pierces your skin with their “proboscis”, their feeding mouth part. But the proboscis isn’t a single, straight, needle-like tube. There are multiple tubes, <a href="https://www.npr.org/sections/health-shots/2016/06/07/480653821/watch-mosquitoes-use-6-needles-to-suck-your-blood">some designed</a> for sucking and some for spitting. Once their mouth parts have been inserted into your skin, the mosquito will inject some saliva. This contains a mix of chemicals that gets the blood flowing better. There has even been a suggestion that future medicines could be inspired by the <a href="https://www.sydney.edu.au/news-opinion/news/2018/03/29/mosquito-saliva-vital-to-the-discovery-of-future-drugs.html">anti-blood clotting properties</a> of mosquito saliva. It’s not the stabbing of our skin by the mosquito’s mouth parts that hurts, it’s the mozzie spit our bodies don’t like. <h2>Are some people allergic to mosquito spit?</h2> Once a mosquito has injected their saliva into our skin, a variety of reactions can follow. For the lucky few, nothing much happens at all. For most people, and irrespective of the type of mosquito biting, <a href="https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2022.1024559/full">there is some kind of reaction</a>. Typically there is <a href="https://www.sciencedirect.com/science/article/abs/pii/S0161589023002304?via%3Dihub">redness and swelling of the skin</a> that appears within a few hours, but often more quickly, after just a few minutes. Occasionally, the reaction can cause pain or discomfort. Then comes the <a href="https://www.abc.net.au/news/health/2023-01-20/mosquito-bites-itchy-calamine-heat-ice-antihistamine-toothpaste/101652608">itchiness</a>. Some people do suffer severe reactions to mosquito bites. It’s a condition often referred to as “<a href="https://www.webmd.com/allergies/what-is-skeeter-syndrome">skeeter syndrome</a>” and is an allergic reaction caused by the protein in the mosquito’s saliva. This can cause large areas of swelling, blistering and fever. The chemistry of mosquito spit hasn’t really been well studied. But it has been shown that, for those who do suffer allergic reactions to their bites, the <a href="https://www.sciencedirect.com/science/article/abs/pii/S0091674904022183">reactions may differ</a> depending on the type of mosquito biting. We all probably get more tolerant of mosquito bites as we get older. Young children are certainly more likely to suffer more following mosquito bites. But as we get older, the reactions are less severe and may pass quickly without too much notice. <h2>How best to treat the bites?</h2> Research into treating bites <a href="https://linkinghub.elsevier.com/retrieve/pii/S0161589023002304">has yet to provide</a> a single easy solution. There are many <a href="https://www.healthline.com/health/outdoor-health/home-remedies-for-mosquito-bites">myths and home remedies</a> about what works. But there is little scientific evidence supporting their use. The best way to treat mosquito bites is by applying a cold pack to reduce swelling and to keep the skin clean to avoid any secondary infections. Antiseptic creams and lotions may also help. There is some evidence that <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC10309056/">heat may alleviate</a> some of the discomfort. It’s particularly tough to keep young children from scratching at the bite and breaking the skin. This can form a nasty scab that may end up being worse than the bite itself. Applying an anti-itch cream may help. If the reactions are severe, <a href="https://www.healthdirect.gov.au/insect-bites-and-stings">antihistamine medications</a> may be required. <h2>To save the scratching, stop the bites</h2> Of course, it’s better not to be bitten by mosquitoes in the first place. Topical <a href="https://theconversation.com/insect-repellents-work-but-there-are-other-ways-to-beat-mosquitoes-without-getting-sticky-171805">insect repellents</a> are a safe, effective and affordable way to reduce mosquito bites. Covering up with loose fitted long sleeved shirts, long pants and covered shoes also provides a physical barrier. <a href="https://theconversation.com/are-mosquito-coils-good-or-bad-for-our-health-88548">Mosquito coils and other devices</a> can also assist, but should not be entirely relied on to stop bites. There’s another important reason to avoid mosquito bites: millions of people around the world suffer from mosquito-borne diseases. More than <a href="https://www.who.int/news-room/fact-sheets/detail/malaria">half a million people die</a> from malaria each year. In Australia, <a href="https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1005070">Ross River virus</a> infects more than 5,000 people every year. And in recent years, there have been cases of serious illnesses caused by <a href="https://www.science.org/content/article/how-rains-pigs-and-waterbirds-fueled-shocking-disease-outbreak-australia">Japanese encephalitis</a> and <a href="https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1256149/full">Murray Valley encephalitis</a> viruses. <a href="https://theconversation.com/profiles/cameron-webb-6736">Cameron Webb</a>, Clinical Associate Professor and Principal Hospital Scientist, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-causes-the-itch-in-mozzie-bites-and-why-do-some-people-get-such-a-bad-reaction-243044">original article</a>.

Body

Hotel booking sites actually make it hard to get cheap deals, but there’s a way around it

<a href="https://theconversation.com/profiles/peter-martin-682709">Peter Martin</a>, <a href="https://theconversation.com/institutions/crawford-school-of-public-policy-australian-national-university-3292">Crawford School of Public Policy, Australian National University</a> Booking a place to stay on holidays has become a reflex action. The first thing many of us do is open a site such as <a href="https://www.wotif.com/">Wotif</a>, <a href="https://au.hotels.com/?locale=en_AU">Hotels.com</a> or <a href="https://www.trivago.com.au/">trivago</a> (all of which are these days owned by the US firm <a href="https://www.accc.gov.au/media-release/accc-will-not-oppose-expedia%E2%80%99s-proposed-acquisition-of-wotif">Expedia</a>), or their only big competitor, <a href="https://www.booking.com/">Booking.com</a> from the Netherlands. Checking what rooms are available – anywhere – is wonderfully easy, as is booking, at what usually seems to be the lowest available price. But Australia’s Assistant Competition Minister Andrew Leigh is concerned there might be a reason the price seems to be the lowest available. It might be an <a href="https://ministers.treasury.gov.au/ministers/andrew-leigh-2022/media-releases/supporting-tourism-and-accommodation-providers-set-their">agreement not to compete</a>, or the fear of reprisals against hotel owners who offer better prices. <h2>Agreements to not compete</h2> Leigh has asked the treasury to investigate, and if that’s what it finds, it may be the booking sites have the perverse effect of keeping prices high, especially when the substantial fees they charge hotels are taken into account. For now, the treasury is seeking information. It has set a deadline of <a href="https://treasury.gov.au/consultation/c2022-338978">January 6</a> for hotel operators and booking sites to tell it: <ul> <li> the typical fees charged by online booking platforms </li> <li> the details of any agreements not to compete on price </li> <li> whether hotels that try to compete get ranked lower on booking sites. </li> </ul> What’s likely to come out of it is a ban on so-called price-parity clauses that prevent discounting, or a ban on “algorithmic punishment,” whereby hotels that do discount get pushed way down the rankings on the sites. But in the meantime, there are things we can do to get better prices, and they’ll help more broadly, as I’ll explain. <h2>Flight Centre precedent</h2> <figure class="align-right zoomable"></figure> Back in 2018, in a case that went all the way to the High Court, the Australian Competition and Consumer Commission (ACCC) forced <a href="https://www.accc.gov.au/media-release/flight-centre-ordered-to-pay-125-million-in-penalties">Flight Centre</a> to pay a penalty of A$12.5 million for attempting to induce airlines not to undercut it on ticket prices. That the ACCC eventually won the case might be an indication price-parity clauses are already illegal under Australian law. But it’s a difficult law to enforce. This is why the treasury is considering special legislation of the kind in force in France, Austria, Italy and Belgium. The ACCC has known for some time that Expedia and Booking.com have included clauses in their contracts preventing hotels offering the same room for any less than they do, even directly. Rather than take the big two to court, in 2016 the ACCC “reached agreement” with them to delete the clauses that prevented hotels offering better deals <a href="https://www.accc.gov.au/media-release/expedia-and-bookingcom-agree-to-reinvigorate-price-competition-by-amending-contracts-with-australian-hotels">face-to-face</a>. <h2>The concession that conceded little</h2> From then on, hotels were able to offer better deals than the sites over the phone or in person, but not on their own websites. Given we are less and less likely to walk in off the street or even use the phone to book a hotel, it wasn’t much of a concession. Then, in 2019, with the Commission under renewed pressure from hotel owners for another investigation, Expedia (but not Booking.com) reportedly <a href="https://www.smartcompany.com.au/business-advice/competition/expedia-allow-hotels-undercut-prices-online/">waived</a> the rest of the clauses, giving hotel owners the apparent freedom to advertise cheaper prices wherever they liked including on their own sites without fear of retribution. Except several appear to fear retribution, and very few seem to have jumped at the opportunity. <h2>Algorithmic punishment</h2> An Expedia spokesman gave an indication of what might be in store when he was quoted as saying a hotel that undercut Expedia might “find itself ranked <a href="https://www.smartcompany.com.au/business-advice/competition/expedia-allow-hotels-undercut-prices-online/">below its competitors</a>, just as it would if it had worse reviews or fewer high-quality pictures of its property”. Being ranked at the bottom of a site is much the same as not being ranked at all, something Leigh refers to as “algorithmic punishment”. It’s not at all clear the present law prevents it, which is why Leigh is open to the idea of legislating against it. Although you and I may not often think about what hotels are paying to be booked through sites such as Wotif and Booking.com, and although what’s charged to the hotel isn’t publicised, it appeard to be a large chunk of the cost of providing the room. One figure quoted is <a href="https://www.smartcompany.com.au/industries/tourism/online-travel-booking-fed-up-small-businesses-call-accc-action/">20%</a>. Leigh says hotel owners have told him the fees are in the “<a href="https://ministers.treasury.gov.au/ministers/andrew-leigh-2022/transcripts/interview-geraldine-doogue-abc-saturday-extra">double digits</a>”, something he says is quite a lot when you consider the sites don’t need to clean the toilets, change the sheets or help on the front desk. <h2>‘Chokepoint capitalism’</h2> What this seems to mean (the treasury will find out) is almost all bookings are more expensive than they need to be because firms that sit at the “<a href="https://theconversation.com/chokepoint-capitalism-why-well-all-lose-unless-we-stop-amazon-spotify-and-other-platforms-squeezing-cash-from-creators-194069">chokepoint</a>” between buyers and sellers are squeezing sellers. A hotel could always abandon the sites and offer much cheaper prices, but for a while – perhaps forever – it will be much harder to find. In their defence, the operators of the platforms might say they need to get the best offers from hotels in order to make it worthwhile for the operators to invest in their sites, an argument the treasury is inviting them to put. In the meantime, with some hotels reluctant to put their best rates on their websites, but with them perfectly able to offer better rates over the phone, there’s a fairly simple way we can all get a better deal – and help fix the broader problem by weight of numbers. If we look up the best deal wherever we want online, and then phone and ask for a better one (or a better room), we might well find we get it. We might be saving the owner a lot of money. Leigh reckons the more we do ring up, the more the sites might feel pressure to discount their own fees, helping bring prices down even before he starts to think about writing legislation.<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/196460/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/peter-martin-682709">Peter Martin</a>, Visiting Fellow, <a href="https://theconversation.com/institutions/crawford-school-of-public-policy-australian-national-university-3292">Crawford School of Public Policy, Australian National University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/hotel-booking-sites-actually-make-it-hard-to-get-cheap-deals-but-theres-a-way-around-it-196460">original article</a>.

Travel Trouble

Original Bee Gees star passes away aged 78

Colin ‘Smiley’ Petersen has passed away aged 78. News of his death was posted on the official Facebook page of tribute band Best of the Bee Gees. “It is with a heavy heart we announce the passing of our dear friend Colin ‘Smiley’ Petersen,” they began. “He enriched our lives and bound our group with love, care and respect. “Not sure how we can go on without his glowing smile and deep friendship. We love you Col. Rest in Peace.” Petersen who was one of the original members of Australian band Bee Gees was born in Kingaroy, Queensland, has been credited for contributing to the band's rise to global superstardom. He was the band's first drummer and performed some of their most beloved songs including Massachusetts, To Love Somebody and Words. Petersen attended the same school in Redcliffe, Queensland as bandmates and brothers Barry Robin and Maurice Gibb, where he first developed an interest in music. After graduating, Petersen moved to the UK to break into the film industry, before he joined the Bee Gees in the 60's becoming the first non-Gibb brother to join the group. “There was an understanding that when the Gibbs’ arrived in England, that if the film thing didn’t work out, I’d join their band,” Petersen told Geelong Independent in 2022. “So I became the fourth Bee Gee, and that was obviously a big turning point in my life.” He left the band after the first phase of their career, just before they reached peak stardom in the '70s disco era, due to conflicts with the group's then-manager Robert Stigwood. Petersen moved back to Australia with his family in 1974, and in 2019 he joined the tribute group Best of the Bee Gees. His death comes after Maurice's sudden death in 2003, which prompted the Bee Gees to retire after 45 years. Robin later died in 2012 aged 62, leaving Barry, Vince Melouney and Geoff Bridgford as the last surviving members of the group. Petersen is survived by his ex-wife Joanne Newfield and their sons Jaime, born in 1971, and Ben, born in 1976. Image: Everett Collection/ Shutterstock Editorial

Caring

How to complain about aged care and get the result you want

<a href="https://theconversation.com/profiles/jacqueline-wesson-1331752">Jacqueline Wesson</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/lee-fay-low-98311">Lee-Fay Low</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> It can be hard to know what to say, or who to talk to, if you notice something isn’t right for you or a loved one in residential aged care. You might have concerns about personal or medical care, being adequately consulted about changes to care, or be concerned about charges on the latest bill. You could also be concerned about theft, neglect or abuse. Here’s how you can raise issues with the relevant person or authority to improve care and support for you or your loved one. <h2>Keep records</h2> You can complain about any aspect of care or service. For instance, if medical care, day-to-day support or financial matters do not meet your needs or expectations, you can complain. It is best to act as soon as you notice something isn’t right. This may prevent things from escalating. Good communication helps get better results. Make written notes about what happened, including times and dates, and take photos. Try to focus on facts and events. You can also keep a record of who was involved and their role. Keep track of how the provider responded or steps taken to resolve the issue. Write notes of conversations and keep copies of emails. <h2>Who do I complain to?</h2> Potential criminal matters If you have concerns about immediate, serious harm of a criminal nature then you should contact the police, and your provider immediately. These types of serious incidents include unreasonable use of force or other serious abuse or neglect, unlawful sexual contact, stealing or unexpected death. The provider may have already contacted you about this. They are required to report such <a href="https://www.agedcarequality.gov.au/consumers/serious-incident-response-scheme">serious incidents</a> to both the Aged Care Quality and Safety Commission within 24 hours, and to the police. Other matters For other matters, talk to the care staff involved. Try to find out more detail about what happened and why things went wrong. Think about what you expect in the situation. Then talk to the most senior person in charge, to see if they can make changes so things don’t go wrong in the future. This person may be called the nursing unit manager, care manager or care director. Providers must acknowledge and investigate your complaint, tell you their findings and actions taken, and follow up to see if you are satisfied. If you would like support to talk to the provider, the <a href="https://opan.org.au">Older Persons Advocacy Network</a> can help. This free service provides independent and confidential support to help find solutions with the aged-care provider. The network can also help you lodge a formal complaint. <h2>How to I lodge a formal complaint?</h2> If you are not satisfied with the way your provider responded, you can lodge a complaint with the <a href="https://www.agedcarequality.gov.au">Aged Care Quality and Safety Commission</a>. Be prepared to submit the facts and events, plus emails and correspondence, you have already collected. Think about what you want to happen to resolve the complaint. Each complaint is handled individually and prioritised depending on the risks to you or your loved one. The commission will start its processes within one business day when complaints are urgent. The resolution process took <a href="https://www.agedcarequality.gov.au/sites/default/files/media/acqsc-annual-report-2020-21.pdf">an average 40 days</a> in 2020-21. You can complain confidentially, or anonymously if you feel safer. But the commission may not be able to investigate fully if it’s anonymous. Also, there are limits to what the commission can do. It cannot ask providers to terminate someone’s employment, or provide direct clinical advice about treatment. Sometimes the commission has issued a “non-compliance” notice to the provider (for a failure to meet quality standards), and action may again <a href="https://www.abc.net.au/news/2022-05-02/aged-care-complaint-about-southern-cross-care-young/101009716">be limited</a>. So it is a good idea to check the <a href="https://www.myagedcare.gov.au/non-compliance-checker">non-compliance register</a> beforehand to see if your provider is listed. <h2>What do others complain about?</h2> From October to December 2021, <a href="https://www.agedcarequality.gov.au/sites/default/files/media/acqs-sector-performance-data-oct-dec-2021.pdf">about a third</a> of Australian nursing homes had a complaint made to the commission against them. Some had more than one complaint. More than half of these complaints were lodged by family, friends or other consumers. The top reasons for complaints were about: <ul> <li> adequacy of staffing </li> <li> medication administration or management </li> <li> infectious diseases or infection control </li> <li> personal and oral hygiene </li> <li> how falls are prevented and managed </li> <li> consultation or communication with representatives and/or family members. </li> </ul> <h2>What if I’m still not happy?</h2> If you’re not happy when you receive the commission’s outcome, you can request a review with 42 days. You can also request the <a href="https://www.ombudsman.gov.au">Commonwealth Ombudsman</a> to review the complaint if you’re not satisfied with the commission’s decision or the way the commission handled your complaint. <h2>Remember, you have a right to complain</h2> The <a href="https://agedcare.royalcommission.gov.au">Aged Care Royal Commission</a> spotlighted the neglect and substandard care that can occur in nursing homes. Despite attempts to <a href="https://www.health.gov.au/resources/publications/concepts-for-a-new-framework-for-regulating-aged-care">lift the standard of aged care</a>, we know residents and carers still have concerns. Residents, and their representatives or families, have a legal <a href="https://www.agedcarequality.gov.au/consumers/standards/resources">right to speak up and complain</a>, free from reprisal or negative consequences. This right is also reflected in the <a href="https://www.agedcarequality.gov.au/consumers/consumer-rights">Charter of Aged Care Rights</a>, which providers are legally required to discuss with you and help you understand. <h2>Moving to another facility</h2> If you have exhausted all avenues of complaint or feel conditions have not improved, you may decide to move to another provider or facility, if available. This option may not be possible in rural areas. This is a difficult decision. It takes time, as well as financial and emotional resources. Starting again with a new provider can also be disruptive for everyone, but sometimes it may be the right choice. <hr /> Contact the <a href="https://opan.org.au">Older Persons Advocacy Network</a> on 1800 700 600, the <a href="https://www.agedcarequality.gov.au">Aged Care Quality and Safety Commission</a> on 1800 951 822 or the <a href="https://www.ombudsman.gov.au">Commonwealth Ombudsman</a> on 1300 362 072.<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/180036/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/jacqueline-wesson-1331752">Jacqueline Wesson</a>, Senior Lecturer (Teaching and Research), Discipline of Occupational Therapy, School of Health Sciences, Faculty of Medicine and Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/lee-fay-low-98311">Lee-Fay Low</a>, Professor in Ageing and Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-to-complain-about-aged-care-and-get-the-result-you-want-180036">original article</a>.

Retirement Life

Fitness influencer gets lifetime ban from NYC marathon for filming content

A Texas social media influencer has been disqualified and banned from future races at the New York City marathon. Last weekend, fitness influencer Matthew Choi ran the race with his camera crew on e-bikes, endangering other runners. He finished the 42.2-kilometre course with a time of 2:57:15, about 50 minutes behind Abdi Nageeye, the winner of the men's race. Choi issued an apology to his 400,000 followers after receiving the lifetime ban. "I have no excuses, full-stop," he said on Wednesday AEDT. "I was selfish on Sunday to have my brother and my videographer follow me around on e-bikes, and it had serious consequences. "We endangered other runners, we impacted people going for PBs, we blocked people from getting water and with the New York City Marathon being about everyone else and the community, I made it about myself. "And for anyone I impacted, I'm sorry." He added that the decision "was 100 per cent on me" as he did not receive pressure to film content from any partners or sponsors. New York Road Runners, the organisers of the race, said in a statement that Choi's actions violated the code of conduct and competition rules. "One of the incidents brought to NYRR's attention was that Choi ran with the assistance of two unauthorised people riding the course on electric bicycles, obstructing runners," the group said. The fitness influencer posted several videos of him running the marathon on social media, which immediately drew backlash. "As a runner, seeing him was amazing. Gave me extra motivation to pass him and make sure I never had to see him and his dumb crew for the rest of the race," wrote one user on Reddit. He has since acknowledged the criticism and has vowed to stop the practice. "It won't happen again. My word is my bond." Images: Instagram

Travel Trouble

"I’m coming home from a party, and I don’t want to end up getting arrested": do driving apps help people break road rules?

<a href="https://theconversation.com/profiles/verity-truelove-1237331">Verity Truelove</a>, <a href="https://theconversation.com/institutions/university-of-the-sunshine-coast-1068">University of the Sunshine Coast</a>; <a href="https://theconversation.com/profiles/michelle-nicolls-1299069">Michelle Nicolls</a>, <a href="https://theconversation.com/institutions/university-of-the-sunshine-coast-1068">University of the Sunshine Coast</a>, and <a href="https://theconversation.com/profiles/oscar-oviedo-trespalacios-1417150">Oscar Oviedo-Trespalacios</a>, <a href="https://theconversation.com/institutions/delft-university-of-technology-1040">Delft University of Technology</a> Apps such as Google Maps, Apple Maps and Waze can tell drivers when they are approaching speed cameras or random breath testing stations. Countries such as Germany, France and Switzerland have banned apps from displaying these enforcement locations. But what effect are these apps having in Australia – are they helping drivers break road rules? Our new <a href="https://www.sciencedirect.com/science/article/pii/S0925753524002972">paper</a>, published in the journal Safety Science, examined this question. We found this technology can, in some cases, contribute to people thinking they are invincible on the roads. However, we also found they can sometimes help people drive more safely. <h2>Being made aware of enforcement can help road safety</h2> We conducted focus groups and interviews with a total of 58 drivers from Queensland, to understand how the use of this technology influences perceptions of being caught for breaking road rules. One driver told us: "If I know it’s coming up, I’ll put my phone down. If I was, say, texting or checking something, but then like once a good few 100 metres away, I sort of pick it up again, depending though." Another said: "It sort of depends where I am driving, I guess. Like, if I am driving on a country road and there is a speed camera there I would probably slow down for the speed camera and then sort of speed up again once I am sort of past that; it sort of depends on the circumstances." We also found that, for some people, being made aware of enforcement locations can help drivers better regulate their speed. This helped them comply with road rules more consistently. Waze also shows the speed limit in the area, which further assisted some drivers to stick to the speed limit. One driver told us: "I’m a bit careful if I just look at the speedo and just double check that I’m on the right amount of speed." Another said: "It just gives you a warning like, ‘OK, you need to check your speed.’ Just to double-check you’re going on the right speed perhaps or when it’s a camera coming up." <h2>Concerning behaviours</h2> Concerningly, we also found some drivers who use these apps are looking at and touching their screens more than they otherwise would. This can distract drivers and increase their <a href="https://www.sciencedirect.com/science/article/pii/S0925753524001097">risk of crashing</a>. One driver told us they post traffic updates on the app they use while driving, “which I know is wrong.” Another said: "Just hit the button on the phone. Just two steps after I go past the camera." Another driver told us: "It’s so helpful […] Especially if it’s, say, late night and I’m coming home from a party, and I don’t want to end up getting arrested." One driver said: "I probably feel slightly more invincible, which is probably not a good thing." When asked why these apps are used, one driver said: "I guess the drug and the drink-driving." <h2>Apps can help and hinder road safety</h2> We know breaking road rules significantly contributes to <a href="https://www.who.int/teams/social-determinants-of-health/safety-and-mobility/global-status-report-on-road-safety-2023">crashes and road fatalities</a>, with deaths on Australian roads continuing to <a href="https://www.bitre.gov.au/publications/ongoing/road_deaths_australia_monthly_bulletins">increase</a> over time. On the one hand, when drivers are aware of enforcement measures like cameras and police, they are more likely to stop breaking the rules in those areas. That’s particularly true for behaviours such as speeding and using a phone while driving, we found. Using apps that flag where cameras and police are located also means drivers would be more exposed to enforcement activities than they otherwise would be on a normal drive. On the other hand, our results suggest some drivers are using these applications to break road rules more often in places where they think they won’t be caught. These apps are also not always completely accurate. For instance, even though Waze can display some police operation locations such as roadside breath testing, it can’t capture all on-road police activities. Further, camera locations are not always up to date or accurate. <h2>Weighing benefits against risks</h2> While these apps do have some benefits, it’s important to weigh these against the risks. It’s also important to recognise traffic enforcement isn’t just there to make you comply with road rules at a specific point; it is meant to remind you of the constant risk of being caught and to encourage consistent rule compliance. The goal is to ensure that drivers are following the traffic rules across the entire network, not just in isolated spots. With road fatalities at some of the <a href="https://www.bitre.gov.au/publications/ongoing/road_deaths_australia_monthly_bulletins">highest rates we’ve seen in recent years</a>, we need everyone to work together to stop more preventable deaths and injuries.<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/237664/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/verity-truelove-1237331">Verity Truelove</a>, Senior Research Fellow in Road Safety Research, <a href="https://theconversation.com/institutions/university-of-the-sunshine-coast-1068">University of the Sunshine Coast</a>; <a href="https://theconversation.com/profiles/michelle-nicolls-1299069">Michelle Nicolls</a>, PhD Candidate, <a href="https://theconversation.com/institutions/university-of-the-sunshine-coast-1068">University of the Sunshine Coast</a>, and <a href="https://theconversation.com/profiles/oscar-oviedo-trespalacios-1417150">Oscar Oviedo-Trespalacios</a>, A/Professor Responsible Risk Management, <a href="https://theconversation.com/institutions/delft-university-of-technology-1040">Delft University of Technology</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/im-coming-home-from-a-party-and-i-dont-want-to-end-up-getting-arrested-do-driving-apps-help-people-break-road-rules-237664">original article</a>.

Legal

Beloved Friends, Tootsie and Mr Mom star passes away

Teri Garr, the beloved actress known for her iconic roles in classic films such as Young Frankenstein and Tootsie and her appearances on Friends, has passed away at the age of 79. Her death, confirmed by her publicist Heidi Schaeffer, occurred on Tuesday in Los Angeles, surrounded by family and friends. Garr's passing follows a long battle with multiple sclerosis, a condition she publicly disclosed in 2002 to raise awareness about the disease and its impact on daily life. Born Terry Ann Garr in Lakewood, Ohio, in 1944, Teri grew up in a theatrical family; her father was a vaudeville performer and her mother a Rockette. This background set the stage for Garr's early career, which began as a background dancer in Elvis Presley films during the 1960s. Her breakout role came in 1974 when she starred as Inga, the charming lab assistant to Gene Wilder's character in Mel Brooks' Young Frankenstein. The film became a cornerstone of American comedy, showcasing Garr's unique blend of humour and warmth. Garr further solidified her place in cinematic history with her performance in Tootsie in 1982, where she portrayed the vulnerable actress friend of Dustin Hoffman’s character. This role earned her an Academy Award nomination for Best Supporting Actress. Critics praised her ability to balance comedy with emotional depth, with film critic Pauline Kael calling her "the funniest neurotic dizzy dame on the screen" at that time. Despite her success, Garr faced significant challenges due to her health. She was diagnosed with multiple sclerosis during the filming of Tootsie, a struggle she detailed in her memoir, Speedbumps: Flooring It Through Hollywood. In it, she described MS as a "sneaky disease," one that complicated her life and career but did not define it. “My body had a trick or two up its sleeve," she wrote. "A stumble here, a tingling finger there. I was trained as a dancer and knew better than to indulge the random aches and pains that visited now and then. Being a successful Hollywood actress may be challenging, but little did I know that the very body that had always been my calling card would betray me.” Garr became an advocate for the National Multiple Sclerosis Society, using her platform to inspire others facing similar challenges. Throughout her career, Garr appeared in over 140 film and TV projects. She was known for her roles in Mr. Mom, Close Encounters of the Third Kind, and various television shows including Friends, where she played Phoebe's birth mother. Her playful spirit and comedic timing made her a favourite among audiences and fellow actors alike. In recent years, Garr had limited her appearances due to health issues but remained an influential figure in Hollywood. Tributes have poured in from fans and colleagues alike, celebrating her legacy as a pioneer for women in comedy and an inspiration for those battling chronic illnesses. Teri Garr leaves behind a rich legacy filled with laughter and heart. She is survived by her daughter Molly O'Neil and grandson Tyryn. Her contributions to film and television will be remembered fondly by generations to come. Images: CNN \ Fox Studios

Caring

How to choose a legal decision-maker as you get older – 3 things to consider

<a href="https://theconversation.com/profiles/joseph-ibrahim-252671">Joseph Ibrahim</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/amelia-grossi-1280226">Amelia Grossi</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> “It’s my life and I’ll do what I want,” <a href="https://www.youtube.com/watch?v=HNzmrEgz_GI">sang</a> Eric Burdon of The Animals to the baby boomer generation. Unfortunately, that’s not always the case. As we get older, sometimes we are no longer capable of making our own decisions. Diseases that affect the brain such as dementia, stroke and head injury can impair cognition and thinking. Some people may choose to appoint a <a href="https://www.legislation.vic.gov.au/in-force/acts/medical-treatment-planning-and-decisions-act-2016/008">medical treatment decision-maker</a> or an <a href="https://www.legislation.vic.gov.au/in-force/acts/powers-attorney-act-2014/007">enduring power of attorney</a> to make certain decisions on their behalf. Alternatively, a legal tribunal or court may appoint <a href="https://www.legislation.vic.gov.au/in-force/acts/guardianship-and-administration-act-2019/005">a guardian or trustee</a> to help guide decisions about health care, finances, accommodation and lifestyle. Who is the right person to take on this important role? Is it the family member or partner who knows you best? Or someone with time and energy? Perhaps someone who understands the services you need – like a nurse, accountant or real estate agent? The role of a decision-making representative has <a href="https://www.alrc.gov.au/publication/equality-capacity-and-disability-in-commonwealth-laws-alrc-report-124/3-national-decision-making-principles-2/will-preferences-and-rights-2/#:%7E:text=The%20'best%20interests'%20principle%20is,an%20equal%20basis%20with%20others">changed significantly</a> in recent years, shifting from a paternalistic approach to a more person-centred focus. Our <a href="https://pubmed.ncbi.nlm.nih.gov/35157838/">research</a> looks at the differences between these approaches and how subconscious bias can influence decision-making. <h2>Taking care</h2> These days, guardianship has <a href="https://www.legislation.vic.gov.au/in-force/acts/guardianship-and-administration-act-2019/005">moved</a> from deciding what’s deemed to be in the individual’s “best interests” to what best reflects their “will and preferences”. While <a href="https://www.legislation.vic.gov.au/repealed-revoked/acts/guardianship-and-administration-act-1986/089">previously</a>, decisions were made for the person by their guardian or representative, new laws require representatives to enact the person’s “will and preferences”. That is, to make decisions with them. This is an important difference. The newer model gives the represented person more autonomy over personal, financial and other decisions. It recognises that even though a person may struggle with aspects of decision-making, they should not be excluded from decisions about how they live their life. This fundamental shift was <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313688/">earlier adopted</a> by the United Nations in the <a href="https://www.ohchr.org/en/hrbodies/crpd/pages/conventionrightspersonswithdisabilities.aspx">Convention on the Rights of Persons with Disability</a>, to which Australia is a signatory. <h2>Challenging in real world situations</h2> The will and preferences <a href="https://supporteddecisionmaking.com.au/wp-content/uploads/sites/4/2021/08/Realising-will-preferences-and-rights-reconciling-differences-on-best-practice-support-for-decision-making.pdf">framework</a> may sound simple, but it can be <a href="https://www.tandfonline.com/doi/full/10.1080/09687599.2021.1941781">challenging in practice</a>, when concepts of empowerment are tricky to define and the will of someone with cognitive difficulties is hard to discern. Representatives <a href="https://supporteddecisionmaking.com.au/wp-content/uploads/sites/4/2021/08/Realising-will-preferences-and-rights-reconciling-differences-on-best-practice-support-for-decision-making.pdf">bring their own biases, perceptions and lived experience</a> to the role of supporting another person to make decisions. This subjectivity is a natural and an inherent part of decision-making. The representative faces the challenge of setting aside their own opinion and, instead, stepping into the shoes of the represented person to give effect to what they want. A mismatch between the age, gender, ethnicity, religion or socioeconomic status of the representative and the represented person can exacerbate this challenge. An older able-bodied female, who is deeply religious and from a middle-to-high income background might find it difficult to represent a young man with a disability who is an atheist and from a working-class background. Now, imagine a scenario where the young man expresses a desire to go bungee-jumping or parachuting, despite previously showing a fear of heights. What’s his representative to do? Older people and women generally <a href="https://www.tandfonline.com/doi/abs/10.1080/1366987032000105315?journalCode=rjrr20">have a lower appetite for risk</a>, as do those who have a faith and with a high socioeconomic status. A heightened perception of danger or a feeling the activity as frivolous, may lead to the representative reframing the situation with their subconscious bias. They may fail to respect the younger person’s will and preferences. Understanding what might shape a representative’s approach to decision-making is essential. Especially when decisions involve <a href="https://theconversation.com/do-you-want-to-be-resuscitated-this-is-what-you-should-think-about-before-deciding-105506">health</a> or <a href="https://theconversation.com/theres-no-need-to-lock-older-people-into-nursing-homes-for-their-own-safety-73954">living arrangements</a>. <h2>3 things to look for when selecting a legal decision-making representative</h2> 1. Deep understanding An intimate understanding of your situation is crucial. An ideal representative is someone who actively listens and has a holistic view of your circumstances. This may come from discussions with you and your loved ones. The representative must be careful your views are not outweighed by those of family or friends who are often more vocal. They should have a deep sense of who you are as an individual. 2. Self-awareness The person you choose should be able to describe their personal views and values and understand how their perspective may influence their decisions. This is vital to mitigate the effects of pre-existing bias. They should be able to reflect on their own lived experiences, to understand how their history shapes their approach to decision-making. They should be able to assess whether what you would do is the same as what they think you should do, and why. 3. Effective documentation A record of conversations between the representative and represented person often helps to illuminate a person’s will and preferences. Writing or recording compels us to commit to an idea and explain what we mean. It helps to clarify what is intended far better than a one-time conversation that may be remembered differently by participants. Further research is needed to better match representatives with represented persons. Improved tools are needed to identify the role of bias in decision-making and evaluate whether the represented person’s wills and preferences are being respected.<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/177631/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/joseph-ibrahim-252671">Joseph Ibrahim</a>, Professor, Health Law and Ageing Research Unit, Department of Forensic Medicine, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/amelia-grossi-1280226">Amelia Grossi</a>, , <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-to-choose-a-legal-decision-maker-as-you-get-older-3-things-to-consider-177631">original article</a>.

Legal

One Direction star passes away aged 31

Former One Direction star Liam Payne has reportedly been found dead outside a hotel in Buenos Aires, in Argentina, according to local newspaper La Nacion. The 31-year-old is believed to have fallen from the third floor of a hotel at around 5pm local time the newspaper said, citing emergency services. According to La Nacion the local police station was called by the hotel manager who reported "an aggressive man who could be under the influence of drugs or alcohol". It is reported that Payne fell from around 13 or 14 metres and suffered "very serious injuries incompatible with life." Alberto Crescenti, head of the state emergency medical system SAME (El Sistema de Atención Médica de Emergencias), told local TV that Payne had fallen into a courtyard of the Casa Sur Hotel in the Palermo neighbourhood. “At 17.11, a SAME team arrived and confirmed the man’s death. We later learned that he was a singer in a musical group. “Unfortunately, he had injuries incompatible with life as a result of his fall, so we had to confirm his death. There was no possibility of resuscitation.” Payne was one of the founding members of One Direction, one of the most loved boy bands of the past decade. He auditioned first as a solo act for the UK reality series The X Factor in 2008, before being eliminated. In 2010 he auditioned again and was grouped with Harry Styles, Niall Horan, Louis Tomlinson and Zayn Malik by the judges to form One Direction. Image: SplashNews.com/ Shutterstock Editorial

Caring

The internet is worse than it used to be. How did we get here, and can we go back?

<a href="https://theconversation.com/profiles/marc-cheong-998488">Marc Cheong</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> and <a href="https://theconversation.com/profiles/wonsun-shin-1300054">Wonsun Shin</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> When it comes to our experience of the internet, “the times, <a href="https://en.wikipedia.org/wiki/The_Times_They_Are_a-Changin%27_(song)">they are a-changin’</a>”, as Bob Dylan would say. You can’t quite recall how, but the internet certainly feels different these days. To some, it is “<a href="https://www.npr.org/2024/01/16/1224878097/everyday-users-are-complaining-that-the-internet-is-more-chaotic-than-ever">less fun and less informative</a>” than it used to be. To others, online searches are made up of “<a href="https://www.theverge.com/c/23998379/google-search-seo-algorithm-webpage-optimization?src=longreads">cookie cutter</a>” pages that drown out useful information and are saturated with scams, spam and content generated by artificial intelligence (AI). Your social media feeds are full of eye-catching, provocative, hyper-targeted, or anger-inducing content, from <a href="https://theconversation.com/the-dead-internet-theory-makes-eerie-claims-about-an-ai-run-web-the-truth-is-more-sinister-229609">bizarre AI-generated imagery</a> to robot-like comments. You’re lucky if your video feeds are not solely made up of exhortations to “subscribe”. How did we get here? And can we claw our way back? <h2>Commercial interests rule</h2> One major factor contributing to the current state of the internet is its over-commercialisation: financial motives drive much of the content. This has arguably led to the prevalence of sensationalism, prioritising virality over information quality. Covert and deceptive advertising is widespread, blurring the line between commercial and non-commercial content to attract more attention and engagement. Another driving force is the dominance of tech giants like Google, Meta and Amazon. They reach billions worldwide and wield immense power over the content we consume. Their platforms use advanced tracking technologies and opaque algorithms to generate hyper-targeted media content, powered by extensive user data. This creates <a href="https://www.campaignasia.com/article/the-echo-chamber-effect-how-algorithms-shape-our-worldview/491762">filter bubbles</a>, where users are exposed to limited content that reinforces their existing beliefs and biases, and <a href="https://philarchive.org/archive/NGUECA">echo chambers</a> where other viewpoints are actively discredited. Bad actors like <a href="https://abcnews.go.com/Technology/ai-fuel-financial-scams-online-industry-experts/story?id=103732051">cyber criminals and scammers</a> have been an enduring problem online. However, evolving technology like generative AI has further empowered them, enabling them to create highly realistic fake images, deepfake videos and <a href="https://www.newyorker.com/science/annals-of-artificial-intelligence/the-terrifying-ai-scam-that-uses-your-loved-ones-voice">voice cloning</a>. AI’s ability to automate content creation has also flooded the internet with low-quality, misleading and harmful material at an unprecedented scale. In sum, the accelerated commercialisation of the internet, the dominance of media tech giants and the presence of bad actors have infiltrated content on the internet. The rise of AI further intensifies this, making the internet more chaotic than ever. <h2>Some of the ‘good’ internet remains</h2> So, what was the “good internet” some of us long for with nostalgia? At the outset, the internet was meant to be a free egalitarian space people were meant to “surf” and “browse”. Knowledge was meant to be shared: sites such as Wikipedia and The Internet Archive are continuing bastions of knowledge. Before the advent of filter bubbles, the internet was a creative playground where people explored different ideas, discussed varying perspectives, and collaborated with individuals from “outgroups” – those outside their social circles who may hold opposing views. Early social media platforms were built on the ethos of reconnecting with long-lost classmates and family members. Many of us have community groups, acquaintances and family we reach out to via the internet. The “connection” aspect of the internet remains as important as ever – as we all saw during the COVID pandemic. What else do we want to preserve? Privacy. A New Yorker cartoon joke in 1993 stated that “<a href="https://web.archive.org/web/20051029045942/http://www.unc.edu/depts/jomc/academics/dri/idog.html">on the internet, nobody knows you’re a dog</a>”. Now everyone – especially advertisers – wants to know who you are. To quote the <a href="https://www.oaic.gov.au/privacy/your-privacy-rights/your-personal-information/what-is-privacy">Office of the Australian Information Commissioner</a>, one of the tenets of privacy is “to be able to control who can see or use information about you”. At the very least, we want to control what big tech knows about us, especially if they could stand to profit from it. <h2>Can we ever go back?</h2> We can’t control “a changin’” times, but we can keep as much of the good parts as we can. For starters, we can vote with our feet. Users can enact change and bring awareness to problems on existing platforms. In recent times, we have seen this with the <a href="https://theconversation.com/thinking-of-breaking-up-with-twitter-heres-the-right-way-to-do-it-195002">exodus of users</a> from X (formerly Twitter) to other platforms, and the <a href="https://www.economist.com/the-economist-explains/2023/06/26/why-reddit-users-are-protesting-against-the-sites-leadership">platform-wide protest against Reddit</a> for changing its third-party data access policies. However, voting with our feet is only possible when there’s competition. In the case of X, various other platforms – from Mastodon to Threads to Bluesky – enable users to pick one that aligns with their preferences, values and social circles. Search engines have alternatives, too, such as DuckDuckGo or Ecosia. But competition can only be created by moving to decentralised systems and removing monopolies. This actually happened in the early days of the internet during the 1990s “<a href="https://thehistoryoftheweb.com/browser-wars/">browser wars</a>”, when Microsoft was eventually accused of illegally monopolising the web browser market in <a href="https://en.wikipedia.org/wiki/United_States_v._Microsoft_Corp.">a landmark court case</a>. As users of technology, all of us must remain vigilant about threats to our privacy and knowledge. With cheap and ubiquitous generative AI, misleading content and scams are more realistic as ever. We must exercise healthy scepticism and ensure those most at risk from online threats – such as children and older people – are educated about potential harms. Remember, the internet is not optimised for your best interests. It’s up to you to decide how much power you give to the tech giants who are fuelling theirs.<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/236513/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/marc-cheong-998488">Marc Cheong</a>, Senior Lecturer of Information Systems, School of Computing and Information Systems; and (Honorary) Senior Fellow, Melbourne Law School, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> and <a href="https://theconversation.com/profiles/wonsun-shin-1300054">Wonsun Shin</a>, Associate Professor in Media and Communications, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/the-internet-is-worse-than-it-used-to-be-how-did-we-get-here-and-can-we-go-back-236513">original article</a>.

Technology

Outrage as Paralympian gets disqualified for "unfair" reason

Elena Congost, had just finished the T12/B2 run in third place, but was disqualified and had the bronze medal taken from her, for this one simple move. The 36-year-old was running in the vision-impaired category with guide Mia Carol Bruguera. When her guide faltered with a cramp in the final metres before the finish line, Congost instinctively helped him from falling over and let go of the rope that binds them together. This is not allowed within Paralympic rules as all runners must be connected to their guide via a tether. As a result, Japan’s Misato Michishita was elevated to the bronze medal after finishing fourth. In a heartbreaking interview after the race, a devastated Congost said: “It’s unfair, surreal.” “The next athlete was three minutes behind me. It was just a reflex action that any human being would have done – holding on to someone who is falling.” “But that doesn’t mean that there is any kind of benefit or help. In fact, it is clear that I stop dead. “I can’t find any explanation for this. It’s sad because, in addition, I had just been without a scholarship. And I’m not going to get one now. They will leave me out of everything again when I have shown everything I can do. “I have not been disqualified for cheating, but for being a person, for helping someone.” In a separate interview with Spanish outlet Marca, she said that despite being disqualified, she is proud of her actions. “I would like everyone to know that I have not been disqualified for cheating, but rather I have been disqualified for being a person and for an instinct that comes to you when someone is falling and is to help or support them,” she said. “I’m devastated, to be honest, because I had the medal. I’m super proud of everything I’ve done and in the end they disqualify me because 10 metres from the finish line I let go of the rope for a second because a person next to me fell face first to the ground and I grabbed the rope again and we crossed the finish line. “The next athlete is three minutes away from me, so it was a reflex action of any human being to hold on to a person who is falling next to you.” Fans around the world were outraged at the disqualification verdict and have called for officials to overturn it. “Shame on you. Give the medal back to Elena Congost,” one fan wrote on X, formerly Twitter. “Where is the Olympic spirit? Elena Congost was disqualified after running 42km and helping her guide not to fall to the ground. She has lost the bronze medal and her sports scholarship. Disgusting," another wrote. "Give the medal to Elena Congost. This decision ruins the paralympics. How can you be called inclusive if you can’t help a person from falling?” a third added. Image: X

Caring

I’m feeling run down. Why am I more likely to get sick? And how can I boost my immune system?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/sathana-dushyanthen-1169328">Sathana Dushyanthen</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> It has been a long winter, filled with many viruses and cost-of-living pressures, on top of the usual mix of work, study, life admin and caring responsibilities. Stress is an inevitable part of life. In short bursts, our stress response has evolved as a survival mechanism to help us be more alert in <a href="https://theconversation.com/no-you-cant-blame-all-your-health-issues-on-high-cortisol-heres-how-the-hormone-works-203162">fight or flight situations</a>. But when stress is chronic, it weakens the immune system and makes us more vulnerable to illnesses such as the <a href="https://www.healthline.com/health/can-stress-make-you-sick#:%7E:text=The%20common%20cold&text=Inflammation%20has%20been%20linked%20to,to%20the%20cold%2Dcausing%20germs.">common cold</a>, <a href="https://journals.lww.com/psychosomaticmedicine/abstract/1999/03000/psychological_stress,_cytokine_production,_and.9.aspx">flu</a> and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/smi.3017">COVID</a>. <h2>Stress makes it harder to fight off viruses</h2> When the immune system starts to break down, a virus that would normally have been under control starts to flourish. Once you begin to feel sick, the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465119/">stress response</a> rises, making it harder for the immune system to fight off the disease. You may be sick more often and for longer periods of time, without enough immune cells primed and ready to <a href="https://link.springer.com/chapter/10.1007/978-3-030-16996-1_6">fight</a>. In the 1990s, American psychology professor Sheldon Cohen and his colleagues conducted a number of <a href="https://www.cmu.edu/common-cold-project/">studies</a> where healthy people were exposed to an upper respiratory infection, through drops of virus placed directly into their <a href="https://www.nejm.org/doi/full/10.1056/NEJM199108293250903">nose</a>. These participants were then quarantined in a hotel and monitored closely to determine who became <a href="https://theconversation.com/stress-less-it-might-protect-you-from-covid-153361">ill</a>. One of the most important factors predicting who got sick was prolonged psychological <a href="https://journals.sagepub.com/doi/full/10.1177/1745691620942516">stress</a>. <h2>Cortisol suppresses immunity</h2> “Short-term stress” is stress that lasts for a period of minutes to hours, while “chronic stress” persists for several hours per day for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5964013/#:%7E:text=Therefore%2C%20a%20major%20distinguishing%20characteristic,weeks%20or%20months%20%5B9%5D.">weeks or months</a>. When faced with a perceived threat, psychological or physical, the hypothalamus region of the brain sets off an alarm system. This signals the release of a surge of hormones, including adrenaline and <a href="https://www.embopress.org/doi/full/10.15252/msb.20209510">cortisol</a>. <figure class="align-center "><img src="https://images.theconversation.com/files/616892/original/file-20240903-18-blrqoz.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/616892/original/file-20240903-18-blrqoz.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=472&fit=crop&dpr=1 600w, https://images.theconversation.com/files/616892/original/file-20240903-18-blrqoz.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=472&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/616892/original/file-20240903-18-blrqoz.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=472&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/616892/original/file-20240903-18-blrqoz.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=593&fit=crop&dpr=1 754w, https://images.theconversation.com/files/616892/original/file-20240903-18-blrqoz.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=593&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/616892/original/file-20240903-18-blrqoz.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=593&fit=crop&dpr=3 2262w" alt="Human brain illustration" /><figcaption>The hypothalamus sets off an alarm system in response to a real or perceived threat. <a class="source" href="https://www.shutterstock.com/image-illustration/hypothalamus-causes-vasoconstriction-illustration-medical-brain-435142264">stefan3andrei/Shutterstock</a></figcaption></figure> In a typical stress response, <a href="https://www.sciencedirect.com/science/article/abs/pii/S147149060300173X">cortisol levels</a> quickly increase when stress occurs, and then rapidly drop back to normal once the stress has subsided. In the short term, cortisol suppresses inflammation, to ensure the body has enough energy available to respond to an <a href="https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2019.00245/full">immediate threat</a>. But in the longer term, chronic stress can be harmful. A Harvard University study <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2796097">from 2022</a> showed that people suffering from psychological distress in the lead up to their COVID infection had a greater chance of experiencing long COVID. They <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2796097">classified</a> this distress as depression, probable anxiety, perceived stress, worry about COVID and loneliness. Those suffering distress had close to a <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2796097">50% greater risk</a> of long COVID compared to other <a href="https://theconversation.com/being-stressed-out-before-you-get-covid-increases-your-chances-of-long-covid-heres-why-190649">participants</a>. Cortisol has been shown to be high in the most severe cases of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102614/">COVID</a>. <h2>Stress causes inflammation</h2> <a href="https://stories.uq.edu.au/imb/the-edge/inflammation/what-is-inflammation/index.html">Inflammation</a> is a short-term reaction to an injury or infection. It is responsible for trafficking immune cells in your body so the right cells are present in the right locations at the right times and at the right <a href="https://link.springer.com/article/10.1007/s12026-014-8517-0">levels</a>. The immune cells also store a memory of that threat to respond faster and more effectively the next <a href="https://theconversation.com/being-stressed-out-before-you-get-covid-increases-your-chances-of-long-covid-heres-why-190649">time</a>. Initially, circulating immune cells detect and flock to the site of <a href="https://www.nature.com/articles/ni1275">infection</a>. Messenger proteins, known as pro-inflammatory cytokines, are released by immune cells, to signal the danger and recruit help, and our immune system responds to neutralise the <a href="https://stories.uq.edu.au/imb/the-edge/inflammation/what-is-inflammation/index.html">threat</a>. During this response to the infection, if the immune system produces too much of these inflammatory chemicals, it can trigger symptoms such as nasal congestion and runny <a href="https://journals.sagepub.com/doi/full/10.1177/1745691620942516">nose</a>. <h2>What about chronic stress?</h2> Chronic stress causes persistently high cortisol secretion, which remains high even in the absence of an immediate <a href="https://theconversation.com/no-you-cant-blame-all-your-health-issues-on-high-cortisol-heres-how-the-hormone-works-203162">stressor</a>. The immune system becomes desensitised and unresponsive to this <a href="https://www.sciencedirect.com/science/article/abs/pii/S1043661816307435">cortisol suppression</a>, increasing low-grade “silent” inflammation and the production of pro-inflammatory cytokines (the messenger proteins). Immune cells become exhausted and start to <a href="https://www.fxmedicine.com.au/blog-post/adrenal-immune-connection">malfunction</a>. The body loses the ability to turn down the inflammatory <a href="https://journals.sagepub.com/doi/full/10.1177/1745691620942516">response</a>. Over time, the immune system changes the way it responds by reprogramming to a “<a href="https://www.unimelb.edu.au/newsroom/news/2021/april/how-stress-can-stop-immune-cells-in-their-tracks">low surveillance mode</a>”. The immune system misses early opportunities to destroy threats, and the process of recovery can take <a href="https://theconversation.com/being-stressed-out-before-you-get-covid-increases-your-chances-of-long-covid-heres-why-190649">longer</a>. <h2>So how can you manage your stress?</h2> We can actively strengthen our immunity and natural defences by managing our <a href="https://theconversation.com/stuck-in-fight-or-flight-mode-5-ways-to-complete-the-stress-cycle-and-avoid-burnout-or-depression-218599">stress levels</a>. Rather than letting stress build up, try to address it early and frequently by: 1) Getting enough sleep Getting enough sleep reduces <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3132857/">cortisol levels</a> and inflammation. During sleep, the immune system <a href="https://link.springer.com/chapter/10.1007/978-1-4939-6578-6_12">releases</a> <a href="https://theconversation.com/sleep-wont-cure-the-coronavirus-but-it-can-help-our-bodies-fight-it-134674">cytokines</a>, which help fight infections and inflammation. 2) Taking regular exercise Exercising helps the lymphatic system (which balances bodily fluids as part of the immune system) circulate and allows immune cells to monitor for threats, while sweating flushes <a href="https://www.healthline.com/nutrition/does-exercise-boost-immune-system">toxins</a>. Physical activity also lowers stress hormone levels through the release of positive brain <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387807/">signals</a>. 3) Eating a healthy diet Ensuring your diet contains enough nutrients – such as the B vitamins, and the full breadth of minerals like magnesium, iron and zinc – during times of stress has a positive impact on overall stress <a href="https://www.ncbi.nlm.nih.gov/pubmed/22782571">levels</a>. Staying hydrated helps the body to flush out <a href="https://theconversation.com/a-strong-immune-system-helps-ward-off-colds-and-flus-but-its-not-the-only-factor-99512">toxins</a>. 4) Socialising and practising meditation or mindfulness These activities increase endorphins and serotonin, which improve mood and have <a href="https://www.sciencedirect.com/science/article/pii/S2949834123000351">anti-inflammatory effects</a>. Breathing exercises and meditation stimulate the parasympathetic nervous system, which calms down our stress responses so we can “reset” and reduce <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940234/">cortisol levels</a>.<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/237456/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/sathana-dushyanthen-1169328">Sathana Dushyanthen</a>, Academic Specialist & Lecturer in Cancer Sciences & Digital Health| Superstar of STEM| Science Communicator, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/im-feeling-run-down-why-am-i-more-likely-to-get-sick-and-how-can-i-boost-my-immune-system-237456">original article</a>. </div>

Body

Heartbreaking final message as world's oldest woman passes away

Maria Branyas Morera, the world's oldest woman, has died aged 117. The centurion, who has lived through two world wars and a global pandemic, passed away “peacefully and without pain”, according to her family members who announced her tragic passing on X, formerly Twitter. “Maria Branyas has left us. “She died as she wished: in her sleep, peacefully and without pain. “We will always remember her for her advice and her kindness.” In a heartbreaking final message shared to X on Tuesday, Morera shared that she felt "weak" and that the "time is near". “The time is near. Don’t cry, I don’t like tears. And above all, don’t suffer for me," she wrote. “Wherever I go, I will be happy.” Morera became the world's oldest living person after French nun Lucile Randon passed away aged 118 in January last year. Before her death, Morera agreed to undergo scientific testing by researchers who collected samples of her saliva, blood and urine, in hopes to gain insight into the secrets to a long life. They will compare them with those of her 80-year-old daughter and hope that by studying her genes they may develop drugs which could combat diseases associated with ageing. Morera is survived by her two daughters, 11 grandchildren and 11 great-grandchildren. Images: news.com.au/ Guinness Book of Records

Caring

Strength training has a range of benefits for women. Here are 4 ways to get into weights

<a href="https://theconversation.com/profiles/erin-kelly-1497598">Erin Kelly</a>, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a> Picture a gym ten years ago: the weights room was largely a male-dominated space, with women mostly doing cardio exercise. Fast-forward to today and you’re likely to see women of all ages and backgrounds confidently navigating weights equipment. This is more than just anecdotal. According to data from the <a href="https://app.powerbi.com/view?r=eyJrIjoiZGU1YWFhZDgtMmRhZi00YTgyLThhMzItYjc2ODk5NTg0MTg1IiwidCI6IjhkMmUwZjRjLTU1ZjItNGNiMS04ZWU3LWRhNWRkM2ZmMzYwMCJ9">Australian Sports Commission</a>, the number of women <a href="https://www.clearinghouseforsport.gov.au/research/ausplay/results#portal">participating in weightlifting</a> (either competitively or not) grew nearly five-fold between 2016 and 2022. Women are discovering what research has long shown: strength training offers benefits beyond sculpted muscles. <h2>Health benefits</h2> <a href="https://www.womenshealth.gov/a-z-topics/osteoporosis">Osteoporosis</a>, a disease in which the bones become weak and brittle, affects more women than men. Strength training increases <a href="https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/strength-training/art-20046670">bone density</a>, a crucial factor for <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-8-47">preventing osteoporosis</a>, especially for women negotiating menopause. Strength training also improves <a href="http://link.springer.com/10.1007/s40279-015-0379-7">insulin sensitivity</a>, which means your body gets better at using insulin to manage blood sugar levels, reducing the risk of type 2 diabetes. Regular strength training contributes to better <a href="https://doi.org/10.1139/apnm-2020-0245">heart health</a> too. There’s a mental health boost as well. Strength training has been linked to reduced symptoms of <a href="https://doi.org/10.1001/jamapsychiatry.2018.0572">depression</a> and <a href="http://link.springer.com/10.1007/s40279-017-0769-0">anxiety</a>. <h2>Improved confidence and body image</h2> Unlike some forms of exercise where progress can feel elusive, strength training offers clear and tangible measures of success. Each time you add more weight to a bar, you are reminded of your ability to meet your goals and <a href="https://www.tandfonline.com/doi/full/10.1080/2159676X.2019.1634127">conquer challenges</a>. This sense of achievement doesn’t just stay in the gym – it can change how women see themselves. A <a href="https://linkinghub.elsevier.com/retrieve/pii/S1755296623000194">recent study</a> found women who regularly lift weights often feel more empowered to make positive changes in their lives and feel ready to face life’s challenges outside the gym. Strength training also has the potential to positively impact <a href="https://journals.lww.com/nsca-jscr/abstract/2002/11000/Relations_of_Strength_Training_to_Body_Image_Among.25.aspx">body image</a>. In a world where women are often judged on appearance, lifting weights can shift the focus <a href="http://journals.sagepub.com/doi/10.1177/0193732502238256">to function</a>. Instead of worrying about the number on the scale or fitting into a certain dress size, women often come to appreciate their bodies for what they can do. “Am I lifting more than I could last month?” and “can I carry all my groceries in a single trip?” may become new measures of physical success. Lifting weights can also be about challenging outdated ideas of how women “should” be. Qualitative <a href="https://journals.humankinetics.com/view/journals/wspaj/aop/article-10.1123-wspaj.2022-0088/article-10.1123-wspaj.2022-0088.xml">research</a> I conducted with colleagues found that, for many women, strength training becomes a powerful form of rebellion against unrealistic beauty standards. As one participant told us: <blockquote> I wanted something that would allow me to train that just didn’t have anything to do with how I looked. </blockquote> Society has long told women to be small, quiet and not take up space. But when a woman steps up to a barbell, she’s pushing back against these outdated rules. One woman in our study said: <blockquote> We don’t have to […] look a certain way, or […] be scared that we can lift heavier weights than some men. Why should we? </blockquote> This shift in mindset helps women see themselves differently. Instead of worrying about being objects for others to look at, they begin to see their bodies as capable and strong. Another participant explained: <blockquote> Powerlifting changed my life. It made me see myself, or my body. My body wasn’t my value, it was the vehicle that I was in to execute whatever it was that I was executing in life. </blockquote> This newfound confidence often spills over into other areas of life. As one woman said: <blockquote> I love being a strong woman. It’s like going against the grain, and it empowers me. When I’m physically strong, everything in the world seems lighter. </blockquote> <h2>Feeling inspired? Here’s how to get started</h2> 1. Take things slow Begin with bodyweight exercises like squats, lunges and push-ups to build a foundation of strength. Once you’re comfortable, add external weights, but keep them light at first. Focus on mastering <a href="https://theconversation.com/what-are-compound-exercises-and-why-are-they-good-for-you-228385">compound movements</a>, such as deadlifts, squats and overhead presses. These exercises engage multiple joints and muscle groups simultaneously, making your workouts more efficient. 2. Prioritise proper form Always prioritise proper form over lifting heavier weights. Poor technique can lead to injuries, so learning the correct way to perform each exercise is crucial. To help with this, consider working with an exercise professional who can provide personalised guidance and ensure you’re performing exercises correctly, at least initially. 3. Consistency is key Like any fitness regimen, consistency is key. Two to three sessions a week are plenty for most women to see benefits. And don’t be afraid to occupy space in the weights room – remember you belong there just as much as anyone else. 4. Find a community Finally, join a community. There’s nothing like being surrounded by a group of strong women to inspire and motivate you. Engaging with a supportive community can make your strength-training journey more enjoyable and rewarding, whether it’s an in-person class or an online forum. <h2>Are there any downsides?</h2> Gym memberships can be expensive, especially for specialist weightlifting gyms. Home equipment is an option, but quality barbells and weightlifting equipment can come with a hefty price tag. Also, for women juggling work and family responsibilities, finding time to get to the gym two to three times per week can be challenging. If you’re concerned about getting too “bulky”, it’s very difficult for <a href="https://journals.sagepub.com/doi/epub/10.1177/0031512520967610">women</a> to bulk up like male bodybuilders without pharmaceutical assistance. The main risks come from poor technique or trying to lift too much too soon – issues that can be easily avoided with some guidance.<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/221307/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/erin-kelly-1497598">Erin Kelly</a>, Lecturer and PhD Candidate, Discipline of Sport and Exercise Science, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/strength-training-has-a-range-of-benefits-for-women-here-are-4-ways-to-get-into-weights-221307">original article</a>.

Body

No, your aches and pains don’t get worse in the cold. So why do we think they do?

<a href="https://theconversation.com/profiles/manuela-ferreira-161420">Manuela Ferreira</a>, <a href="https://theconversation.com/institutions/george-institute-for-global-health-874">George Institute for Global Health</a> and <a href="https://theconversation.com/profiles/leticia-deveza-1550633">Leticia Deveza</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> It’s cold and wet outside. As you get out of bed, you can feel it in your bones. Your right knee is flaring up again. That’ll make it harder for you to walk the dog or go to the gym. You think it must be because of the weather. It’s a common idea, but a myth. When we looked at the evidence, <a href="https://www.sciencedirect.com/science/article/pii/S0049017224000337">we found</a> no direct link between most common aches and pains and the weather. In the first study of its kind, we found no direct link between the temperature or humidity with most joint or muscle aches and pains. So why are so many of us convinced the weather’s to blame? Here’s what we think is really going on. <h2>Weather can be linked to your health</h2> The weather is often associated with the risk of new and ongoing health conditions. For example, cold temperatures <a href="https://pubmed.ncbi.nlm.nih.gov/27021573/">may worsen</a> asthma symptoms. Hot temperatures <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(22)00117-6/fulltext">increase the risk</a> of heart problems, such as arrhythmia (irregular heartbeat), cardiac arrest and coronary heart disease. Many people are also convinced the weather is linked to their aches and pains. For example, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1479-8077.2004.00099.x?casa_token=jvpSbA4szqoAAAAA%3ATyHyGaqXmfevWyuJe6LW_3Pap3IPHC8HSMTl3RN63mFzNO0X7ozQjBb6Bi3yVFuPjqkrf-WlB-J5A1q1">two in every three</a> people with knee, hip or hand osteoarthritis <a href="https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-15-66">say</a> cold temperatures trigger their symptoms. Musculoskeletal conditions affect more than <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/musculoskeletal-conditions-comorbidity-australia/summary">seven million Australians</a>. So we set out to find out whether weather is really the culprit behind winter flare-ups. <h2>What we did</h2> Very few studies have been specifically and appropriately designed to look for any direct link between weather changes and joint or muscle pain. And ours is the first to evaluate data from these particular studies. We looked at data from more than 15,000 people from around the world. Together, these people reported more than 28,000 episodes of pain, mostly back pain, knee or hip osteoarthritis. People with rheumatoid arthritis and gout were also included. We then compared the frequency of those pain reports between different types of weather: hot or cold, humid or dry, rainy, windy, as well as some combinations (for example, hot and humid versus cold and dry). <h2>What we found</h2> We found changes in air temperature, humidity, air pressure and rainfall do not increase the risk of knee, hip or lower back pain symptoms and are not associated with people seeking care for a new episode of arthritis. The results of this study suggest we do not experience joint or muscle pain flare-ups as a result of changes in the weather, and a cold day will not increase our risk of having knee or back pain. In order words, there is no direct link between the weather and back, knee or hip pain, nor will it give you arthritis. It is important to note, though, that very cold air temperatures (under 10°C) were rarely studied so we cannot make conclusions about worsening symptoms in more extreme changes in the weather. The only exception to our findings was for gout, an inflammatory type of arthritis that can come and go. Here, pain increased in warmer, dry conditions. Gout has a very different underlying biological mechanism to back pain or knee and hip osteoarthritis, which may explain our results. The combination of warm and dry weather may lead to increased dehydration and consequently increased concentration of uric acid in the blood, and deposition of uric acid crystals in the joint in people with gout, resulting in a flare-up. <h2>Why do people blame the weather?</h2> The weather can influence other factors and behaviours that consequently shape how we perceive and manage pain. For example, some people may change their physical activity routine during winter, choosing the couch over the gym. And we know <a href="https://pubmed.ncbi.nlm.nih.gov/28700451/">prolonged sitting</a>, for instance, is directly linked to worse back pain. Others may change their sleep routine or sleep less well when it is either too cold or too warm. Once again, a bad night’s sleep can trigger your <a href="https://link.springer.com/article/10.1007/s00586-021-06730-6">back</a> and <a href="https://www.sciencedirect.com/science/article/pii/S1063458421007020">knee</a> pain. Likewise, changes in mood, often experienced in cold weather, trigger increases in both <a href="https://link.springer.com/article/10.1007/s00586-021-06730-6">back</a> and <a href="https://www.sciencedirect.com/science/article/pii/S1063458421007020">knee</a> pain. So these changes in behaviour over winter may contribute to more aches and pains, and not the weather itself. Believing our pain will feel worse in winter (even if this is not the case) may also make us feel worse in winter. This is known as the <a href="https://link.springer.com/article/10.1186/s12891-018-1943-8">nocebo effect</a>. <h2>What to do about winter aches and pains?</h2> It’s best to focus on risk factors for pain you can control and modify, rather than ones you can’t (such as the weather). You can: <ul> <li> become more physically active. This winter, and throughout the year, aim to walk more, or talk to your health-care provider about gentle exercises you can safely do at home, with a physiotherapist, personal trainer or at the pool </li> <li> lose weight if obese or overweight, as this is linked to <a href="https://jamanetwork.com/journals/jama/article-abstract/2799405">lower levels</a> of joint pain and better physical function </li> <li> keep your body warm in winter if you feel some muscle tension in uncomfortably cold conditions. Also ensure your bedroom is nice and warm as we tend to sleep <a href="https://www.sciencedirect.com/science/article/pii/S0033350623003359">less well</a> in cold rooms </li> <li> maintain a healthy diet and <a href="https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(23)00098-X/fulltext">avoid smoking</a> or drinking high levels of alcohol. These are among <a href="https://ard.bmj.com/content/annrheumdis/82/1/48.full.pdf">key lifestyle recommendations</a> to better manage many types of arthritis and musculoskeletal conditions. For people with back pain, for example, a healthy lifestyle is linked with <a href="https://pubmed.ncbi.nlm.nih.gov/36208321/">higher levels</a> of physical function.<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/235117/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> </li> </ul> <a href="https://theconversation.com/profiles/manuela-ferreira-161420">Manuela Ferreira</a>, Professor of Musculoskeletal Health, Head of Musculoskeletal Program, <a href="https://theconversation.com/institutions/george-institute-for-global-health-874">George Institute for Global Health</a> and <a href="https://theconversation.com/profiles/leticia-deveza-1550633">Leticia Deveza</a>, Rheumatologist and Research Fellow, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/no-your-aches-and-pains-dont-get-worse-in-the-cold-so-why-do-we-think-they-do-235117">original article</a>.

Body

Readers response: What are you starting to like more as you get older?

As we age, we start to have a whole new appreciation for things we previously overlooked in our younger years. We asked our reader what of life's simple pleasures they are starting to enjoy more as they get older, and the response was overwhelming. Here's what you said. Wendy Turner - The beauty and companionship of dogs, the wildness of a garden, the treasured times between physical pain, and the love of family and treasured friends. SE Rosenberg - Being on my own away from people but hanging out with my cats. Lynette Miller - Taking time to enjoy sunrise and sunsets, smelling the roses and just little things that sometimes pass you by because you're too busy to enjoy them. Antoinette Devlin - Peace and quiet. Robert Edward Fleming - Not having to work for the man anymore. Janine Sarai George - Putting my feet up, a good book and my wildlife. Maureen Brown Montgomery - Finally starting not to mind living a solo life and enjoying my own company without drama. Liz Lewis - Not having to set the alarm but being able to wake up naturally and usually not having to be anywhere in a hurry. Roselyn Reincastle - Appreciating life more now that I have had the experience. Frances Bradshaw - Peace and hearing the birds sing. Margie Buckingham - Serenity, that my opinions matter, travelling, spare time & being a grandparent. Rob Anderson - Time with the grandchildren, and reflection. Wendy Hope - Travel and wonder at the diversity of people. Maya Richardson - Staying as far away from people as possible. Christine Tully - Not having to commit to anything if I don’t want to. Margaret Inglis - Doing what I want to do, although my 4 legged mate still wants to get me out of the house each morning. Image credits: Shutterstock

Retirement Life

What happens in my brain when I get a migraine? And what medications can I use to treat it?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/mark-slee-1343982">Mark Slee</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> and <a href="https://theconversation.com/profiles/anthony-khoo-1525617">Anthony Khoo</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> Migraine is many things, but one thing it’s not is “just a headache”. “Migraine” <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1029040/">comes from</a> the Greek word “hemicrania”, referring to the common experience of migraine being predominantly one-sided. Some people experience an “aura” preceding the headache phase – usually a visual or sensory experience that evolves over five to 60 minutes. Auras can also involve other domains such as language, smell and limb function. Migraine is a disease with a <a href="https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(18)30322-3/fulltext">huge personal and societal impact</a>. Most people cannot function at their usual level during a migraine, and anticipation of the next attack can affect productivity, relationships and a person’s mental health. <h2>What’s happening in my brain?</h2> The biological basis of migraine is complex, and varies according to the phase of the migraine. Put simply: The earliest phase is called the prodrome. This is associated with activation of a part of the brain called the hypothalamus which is thought to contribute to many symptoms such as nausea, changes in appetite and blurred vision. <figure class="align-center "><img src="https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=485&fit=crop&dpr=1 600w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=485&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=485&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=610&fit=crop&dpr=1 754w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=610&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=610&fit=crop&dpr=3 2262w" alt="" /><figcaption>The hypothalamus is shown here in red. <a class="source" href="https://www.shutterstock.com/image-vector/brain-cross-section-showing-basal-ganglia-329843930">Blamb/Shutterstock</a></figcaption></figure> Next is the aura phase, when a wave of neurochemical changes occur across the surface of the brain (the cortex) at a rate of 3–4 millimetres per minute. This explains how usually a person’s aura progresses over time. People often experience sensory disturbances such as flashes of light or tingling in their face or hands. In the headache phase, the trigeminal nerve system is activated. This gives sensation to one side of the face, head and upper neck, leading to release of proteins such as CGRP (calcitonin gene-related peptide). This causes inflammation and dilation of blood vessels, which is the basis for the severe throbbing pain associated with the headache. Finally, the postdromal phase occurs after the headache resolves and commonly involves changes in mood and energy. <h2>What can you do about the acute attack?</h2> A useful way to conceive of <a href="https://www.migraine.org.au/factsheets">migraine treatment</a> is to compare putting out campfires with bushfires. Medications are much more successful when applied at the earliest opportunity (the campfire). When the attack is fully evolved (into a bushfire), medications have a much more modest effect. <iframe id="Pj1sC" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/Pj1sC/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> Aspirin For people with mild migraine, non-specific anti-inflammatory medications such as high-dose aspirin, or standard dose non-steroidal medications (NSAIDS) can be very helpful. Their effectiveness is often enhanced with the use of an anti-nausea medication. Triptans For moderate to severe attacks, the mainstay of treatment is a class of medications called “<a href="https://assets.nationbuilder.com/migraineaus/pages/595/attachments/original/1678146819/Factsheet_15_2023.pdf?1678146819">triptans</a>”. These act by reducing blood vessel dilation and reducing the release of inflammatory chemicals. Triptans vary by their route of administration (tablets, wafers, injections, nasal sprays) and by their time to onset and duration of action. The choice of a triptan depends on many factors including whether nausea and vomiting is prominent (consider a dissolving wafer or an injection) or patient tolerability (consider choosing one with a slower onset and offset of action). As triptans constrict blood vessels, they should be used with caution (or not used) in patients with known heart disease or previous stroke. Gepants Some medications that block or modulate the release of CGRP, which are used for migraine prevention (which we’ll discuss in more detail below), also have evidence of benefit in treating the acute attack. This class of medication is known as the “gepants”. Gepants come in the form of injectable proteins (monoclonal antibodies, used for migraine prevention) or as oral medication (for example, rimegepant) for the acute attack when a person has not responded adequately to previous trials of several triptans or is intolerant of them. They do not cause blood vessel constriction and can be used in patients with heart disease or previous stroke. Ditans Another class of medication, the “ditans” (for example, lasmiditan) have been approved overseas for the acute treatment of migraine. Ditans work through changing a form of serotonin receptor involved in the brain chemical changes associated with the acute attack. However, neither the gepants nor the ditans are available through the Pharmaceutical Benefits Scheme (PBS) for the acute attack, so users must pay out-of-pocket, at a <a href="https://www.migraine.org.au/cgrp#:%7E:text=While%20the%20price%20of%20Nurtec,%2D%24300%20per%208%20wafers.">cost</a> of approximately A$300 for eight wafers. <h2>What about preventing migraines?</h2> The first step is to see if <a href="https://assets.nationbuilder.com/migraineaus/pages/595/attachments/original/1677043428/Factsheet_5_2023.pdf?1677043428">lifestyle changes</a> can reduce migraine frequency. This can include improving sleep habits, routine meal schedules, regular exercise, limiting caffeine intake and avoiding triggers such as stress or alcohol. Despite these efforts, many people continue to have frequent migraines that can’t be managed by acute therapies alone. The choice of when to start preventive treatment varies for each person and how inclined they are to taking regular medication. Those who suffer disabling symptoms or experience more than a few migraines a month <a href="https://www.nejm.org/doi/full/10.1056/NEJMra1915327">benefit the most</a> from starting preventives. Almost all migraine <a href="https://assets.nationbuilder.com/migraineaus/pages/595/attachments/original/1708566656/Factsheet_16_2024.pdf?1708566656">preventives</a> have existing roles in treating other medical conditions, and the physician would commonly recommend drugs that can also help manage any pre-existing conditions. First-line preventives include: <ul> <li>tablets that lower blood pressure (candesartan, metoprolol, propranolol)</li> <li>antidepressants (amitriptyline, venlafaxine)</li> <li>anticonvulsants (sodium valproate, topiramate).</li> </ul> Some people have none of these other conditions and can safely start medications for migraine prophylaxis alone. For all migraine preventives, a key principle is starting at a low dose and increasing gradually. This approach makes them more tolerable and it’s often several weeks or months until an effective dose (usually 2- to 3-times the starting dose) is reached. It is rare for noticeable benefits to be seen immediately, but with time these drugs <a href="https://pubmed.ncbi.nlm.nih.gov/26252585/">typically reduce</a> migraine frequency by 50% or more. <hr /> <iframe id="jxajY" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/jxajY/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> <h2>‘Nothing works for me!’</h2> In people who didn’t see any effect of (or couldn’t tolerate) first-line preventives, new medications have been available on the PBS since 2020. These medications <a href="https://pubmed.ncbi.nlm.nih.gov/8388188/">block</a> the action of CGRP. The most common PBS-listed <a href="https://assets.nationbuilder.com/migraineaus/pages/595/attachments/original/1708566656/Factsheet_16_2024.pdf?1708566656">anti-CGRP medications</a> are injectable proteins called monoclonal antibodies (for example, galcanezumab and fremanezumab), and are self-administered by monthly injections. These drugs have quickly become a game-changer for those with intractable migraines. The convenience of these injectables contrast with botulinum toxin injections (also <a href="https://www.migraine.org.au/botox">effective</a> and PBS-listed for chronic migraine) which must be administered by a trained specialist. Up to half of adolescents and one-third of young adults are <a href="https://deepblue.lib.umich.edu/bitstream/handle/2027.42/147205/jan13818.pdf">needle-phobic</a>. If this includes you, tablet-form CGRP antagonists for migraine prevention are hopefully not far away. Data over the past five years <a href="https://pubmed.ncbi.nlm.nih.gov/36718044/">suggest</a> anti-CGRP medications are safe, effective and at least as well tolerated as traditional preventives. Nonetheless, these are used only after a number of cheaper and more readily available <a href="https://assets.nationbuilder.com/migraineaus/pages/595/attachments/original/1677043425/Factsheet_2_2023.pdf?1677043425">first-line treatments</a> (all which have decades of safety data) have failed, and this also a criterion for their use under the PBS.<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/227559/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/mark-slee-1343982">Mark Slee</a>, Associate Professor, Clinical Academic Neurologist, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> and <a href="https://theconversation.com/profiles/anthony-khoo-1525617">Anthony Khoo</a>, Lecturer, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-happens-in-my-brain-when-i-get-a-migraine-and-what-medications-can-i-use-to-treat-it-227559">original article</a>. </div>

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"We should give back": Bill Gates' ex-wife on giving away her $16bn fortune

Melinda French Gates has opened up on her decision to give away her fortune after leaving the Bill & Melinda Gates Foundation in June. Melinda, who is reportedly worth $16.8 billion, said that she will stick with her decision to give away her fortune on The Late Show with Stephen Colbert, as it's "the right thing to do for society". "If we grew up in the United States, anybody who has grown up in this country has been really lucky and I don't care who you are," she explained. "To be able to go to a decent school, grow up and pursue your career, and if so you are a billionaire, my gosh, you have benefited from this country, right? "So we should give back." She also feels there is "a responsibility and to do it in a way that's incredibly thoughtful". Melinda, who divorced the Microsoft founder Bill Gates back in 2021, has announced her plans to focus on her organisation Pivotal Ventures, which she founded in 2015. The organisation's aim is to "advance social progress by removing barriers that hold people back." She said that she is determined to ensure that "women's rights are not only on the agenda, but that women are setting the agenda" – especially after watching women's rights be rolled back internationally over the last few years." "What I saw, part of why our women's rights got rolled back in the United States is that those organisations were starved for funding, and they were playing defense," she explained. Melinda has pledged to donate $1 billion to this end over the next two years. Image: Julien De Rosa/EPA/ Shutterstock Editorial

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"We should give back": Bill Gates' ex-wife on giving away her $16bn fortune