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Strangers raise almost $50,000 for sick stray dog

Cindy was so overweight she could barely move when Lana Chapman found her lying in the dirt outside a 7-Eleven. Chapman, an Australian living in Koh Samui, Thailand, immediately decided to take the dog in, and her kind act has inspired hundreds of people online. The Aussie woman has been helping local street dogs for years and was determined to give Cindy a better life. Weighing in at almost 45kgs when Chapman found her, she has helped the pup lose weight and tracked her progress online where she went viral. It was all going well until a few weeks ago Cindy stopped eating and had a lump on her neck. "Usually she runs around the house with excitement [but] it took her about two minutes before she started to eat. That was really out of the norm," Chapman told 9news.com.au. After a few vet visits she was diagnosed with lymphoma, a common cancer in dogs. "We started chemo the same day," Chapman said. "It was awful as the vet didn't think she would live for four weeks, but we wanted to try anything we could to help her." Initial tests alone cost almost $2,500, and Cindy needed at least 19 weeks of chemotherapy to survive. With pet insurance not an option as most vets on the island did not accept insurance claims, Chapman relied on the help of strangers and started a <a href="https://www.gofundme.com/f/cindys-lymphoma-fight" target="_blank" rel="noopener">GoFundMe</a> in Cindy's name, hoping to raise $10,000 to cover for the cost of her care. "$10,000 still wouldn't cover the costs but I thought it would really assist us," she said. To her surprise, strangers flocked to help raising almost $50,000 for Cindy in a matter of days, with the highest donation so far being $5,000. The fundraising page was also filled with messages of support, with one writing: "Cindy you are the sweetest girl! I am sending you all the love, you can do this." "Wishing you well with your treatment Cindy, hoping for a speedy recovery. Sending lots of love to your humans too x," added another. Chapman said she was blown away by people's generosity, and never imagined that so many strangers would be willing to help the stray pup. "People have been following her from the day she was rescued off the streets so they have a major soft spot for her," she said. "We definitely would have struggled to pay for this [without donations]." Chapman added that the donations received so far will cover all of Cindy's cancer treatment, and the left over cash will be used to help other street dogs on the island. Images: GoFundMe/ Lana Chapman

Family & Pets

Parents under fire for taking their sick toddler on a long-haul flight

A couple has come under fire after documenting their experience online of boarding a long-haul flight with their toddler, despite the child being sick. Alina and her husband were excited to go on their long-awaited holiday to Thailand with their one-year-old son in tow, taking off on their first big family trip. However, shortly before they were set to take off, their child developed a raging fever, and they decided to go on the trip anyway. Taking the experience to social media, Alina said her son’s temperature soared to around 40 degrees, with their little boy’s condition escalating so rapidly that the parents were considering calling off their entire trip. “My husband and I even wanted to cancel the flight,” she confessed in the video, which has received around 1.4 million views. However, after realising they would be out of pocket by several thousands of dollars if they cancelled the trip at such short notice, they decided to take the risk and board the plane. “Our tickets would have been wasted, and the trip that cost us $3,000 would have been wasted,” the mum wrote. "One plus of this flight was that the flight was at night, and the child could sleep and recover.” In the clip, the parents were seen walking their son around the plane, cradling the sick toddler as he cried uncontrollably. Luckily, the parents “managed to bring down the temperature”, but they weren’t convinced their son would keep quiet for the rest of the trip. “We were so worried about how the baby would feel on an eight-hour flight,” she continued, walking the baby up and down the corridors of the airport, trying to calm him down. As they tried to settle the child, they realised that their hopes that he would sleep the whole way were misguided. “The flight turned out to be difficult,” Alina confessed. “The baby kept waking and crying.” In the middle of the night, their son’s fever returned, which forced the parents to “bring the temperature down again” and left them “very worried” about their son’s health. Their baby’s fever took a toll on the parents as well, who complained of feeling “squeezed like a lemon” while trying to keep his temperature down, as Alina recalled, “We took turns looking after the baby so each of us could sleep.” In a later video, the parents defended their choice to take their son on the flight despite his intense fever and blamed it on his teething, not sickness. “Our baby wasn’t sick, he was teething, and that’s why he had a fever,” she said. “If our child had been sick, we would have cancelled everything … I consider myself a wonderful mother.” Despite the mother's clarification of her son's fever, the parents were slammed for even considering taking a sick child on such a long flight. “It’s OK, don’t worry about making anyone else on that flight sick,” a sarcastic comment read. “This is so tremendously selfish, you are appalling for doing this to him and others.” “I was in the same situation,” another parent said. “I lost all bookings, but who cares, my daughter comes first always and forever, no matter the amount of money!” “Trips come and go; your baby’s health is priceless!” read another comment. “Forty degrees is a hospital admission! Not a flight to Thailand!” However, not everyone was as judgmental, with many parents extending their sympathies to the first-time parents, as one person wrote, “You know what’s best for your baby. Everyone will say things. But only you will know when you are in that situation.” “Everyone is a first-time parent,” another defended. “This was a lesson learned. A baby’s health is of utmost importance. No holiday is more important than that. I hope he is OK now.” Image credits: TikTok

Travel Trouble

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

I’ve recovered from a cold but I still have a hoarse voice. What should I do?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/yeptain-leung-1563747">Yeptain Leung</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Cold, flu, COVID and <a href="https://theconversation.com/rsv-is-everywhere-right-now-what-parents-need-to-know-about-respiratory-syncytial-virus-208855">RSV</a> have been <a href="https://www.abc.net.au/news/2024-06-21/flu-whooping-cough-rsv-cases-up-as-covid-cases-unkown/104002964">circulating across Australia this winter</a>. Many of us have caught and recovered from <a href="https://theconversation.com/i-feel-sick-how-do-i-know-if-i-have-the-flu-covid-rsv-or-something-else-234266">one of these</a> common upper respiratory tract infections. But for some people their impact is ongoing. Even if your throat isn’t <a href="https://theconversation.com/sore-throats-suck-do-throat-lozenges-help-at-all-184454">sore</a> anymore, your voice may still be hoarse or croaky. So what happens to the voice when we get a virus? And what happens after? Here’s what you should know if your voice is still hoarse for days – or even weeks – after your other symptoms have resolved. <h2>Why does my voice get croaky during a cold?</h2> A healthy voice is normally clear and strong. It’s powered by the lungs, which push air past the vocal cords to make them vibrate. These vibrations are amplified in the throat and mouth, creating the voice we hear. The vocal cords are two elastic muscles situated in your throat, around the level of your laryngeal prominence, or Adam’s apple. (Although everyone has one, it tends to be more pronounced in males.) The vocal cords are small and delicate – around the size of your fingernail. Any small change in their structure will affect how the voice sounds. When the vocal cords become inflamed – known as laryngitis – your voice will sound different. Laryngitis is a common part of upper respiratory tract infections, but can also be caused through misuse. <figure class="align-center "><img src="https://images.theconversation.com/files/614706/original/file-20240821-17-nzg1mc.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/614706/original/file-20240821-17-nzg1mc.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=366&fit=crop&dpr=1 600w, https://images.theconversation.com/files/614706/original/file-20240821-17-nzg1mc.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=366&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/614706/original/file-20240821-17-nzg1mc.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=366&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/614706/original/file-20240821-17-nzg1mc.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=460&fit=crop&dpr=1 754w, https://images.theconversation.com/files/614706/original/file-20240821-17-nzg1mc.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=460&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/614706/original/file-20240821-17-nzg1mc.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=460&fit=crop&dpr=3 2262w" alt="Two drawn circles comparing normal vocal cords with inflamed, red vocal cords." /><figcaption>Viruses such as the common cold can inflame the vocal cords. <a class="source" href="https://www.shutterstock.com/image-vector/dry-sore-loss-cough-virus-viral-1821458117">Pepermpron/Shutterstock</a></figcaption></figure> Catching a virus triggers the body’s defence mechanisms. White blood cells are recruited to kill the virus and heal the tissues in the vocal cords. They become inflamed, but also stiffer. It’s harder for them to vibrate, so the voice comes out hoarse and croaky. In some instances, you may find it hard to speak in a loud voice or have a reduced pitch range, meaning you can’t go as high or loud as normal. You may even “lose” your voice altogether. Coughing can also make things worse. It is the body’s way of trying to clear the airways of irritation, including your own mucus dripping onto your throat (<a href="https://www.health.harvard.edu/staying-healthy/treatments-for-post-nasal-drip">post-nasal drip</a>). But coughing slams the vocal cords together with force. Chronic coughing can lead to persistent inflammation and even thicken the vocal cords. This thickening is the body trying to protect itself, similar to developing a callus when a pair of new shoes rubs. Thickening on your vocal cords can lead to physical changes in the vocal cords – such as developing a growth or “nodule” – and further deterioration of your voice quality. <figure class="align-center "><img src="https://images.theconversation.com/files/614707/original/file-20240821-21-vizs73.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/614707/original/file-20240821-21-vizs73.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/614707/original/file-20240821-21-vizs73.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/614707/original/file-20240821-21-vizs73.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/614707/original/file-20240821-21-vizs73.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=473&fit=crop&dpr=1 754w, https://images.theconversation.com/files/614707/original/file-20240821-21-vizs73.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=473&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/614707/original/file-20240821-21-vizs73.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=473&fit=crop&dpr=3 2262w" alt="Diagram compares healthy vocal cords with cords that have nodules, two small bumps." /><figcaption>Coughing and exertion can cause inflamed vocal cords to thicken and develop nodules. <a class="source" href="https://www.shutterstock.com/image-vector/dry-sore-loss-cough-virus-viral-1821458126">Pepermpron/Shutterstock</a></figcaption></figure> <h2>How can you care for your voice during infection?</h2> People who use their voices a lot professionally – such as teachers, call centre workers and singers – are often desperate to resume their vocal activities. They are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7478078/">more at risk</a> of forcing their voice before it’s ready. The good news is most viral infections resolve themselves. Your voice is usually restored within five to ten days of recovering from a cold. Occasionally, your pharmacist or doctor may prescribe cough suppressants to limit additional damage to the vocal cords (among other reasons) or mucolytics, which break down mucus. But the most effective treatments for viral upper respiratory tract infections are hydration and rest. Drink plenty of water, avoid alcohol and exposure to cigarette smoke. <a href="https://www.healthdirect.gov.au/laryngitis#:%7E:text=You%20can%20help%20your%20voice%20recover%20by%3A%201,avoid%20nasal%20decongestants%20%28these%20make%20your%20throat%20drier%29">Inhaling steam</a> by making yourself a cup of hot water will also help clear blocked noses and hydrate your vocal cords. Rest your voice by talking as little as possible. If you do need to talk, don’t whisper – this <a href="https://www.sciencedirect.com/science/article/abs/pii/S0892199704001730">strains the muscles</a>. Instead, consider using “<a href="https://www.instagram.com/reel/C0d-oNIMM1y/">confidential voice</a>”. This is a soft voice – not a whisper – that gently vibrates your vocal cords but puts less strain on your voice than normal speech. Think of the voice you use when communicating with someone close by. During the first five to ten days of your infection, it is important not to push through. Exerting the voice by talking a lot or loudly will only exacerbate the situation. Once you’ve recovered from your cold, you can speak as you would normally. <h2>What should you do if your voice is still hoarse after recovery?</h2> If your voice hasn’t returned to normal after <a href="https://www.healthdirect.gov.au/laryngitis">two to three weeks</a>, you should seek medical attention from your doctor, who may refer you to an ear nose and throat specialist. If you’ve developed a nodule, the specialist would likely refer you to a speech pathologist who will show you how to take care of your voice. Many nodules can be <a href="https://britishvoiceassociation.org.uk/voicecare_vocal-nodules.htm">treated</a> with voice therapy and don’t require surgery. You may have also developed a habit of straining your vocal cords, if you forced yourself to speak or sing while they were inflamed. This can be a reason why some people continue to have a hoarse voice even when they’ve recovered from the cold. In those cases, a speech pathologist may play a valuable role. They may teach you to exercises that make voicing more efficient. For example, <a href="https://www.youtube.com/watch?v=fwNPp-RS4IY">lip trills</a> (blowing raspberries) are a fun and easy way you can learn to relax the voice. This can help break the habit of straining your voice you may have developed during infection.<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/236398/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/yeptain-leung-1563747">Yeptain Leung</a>, Postdoctoral Research and Lecturer of Speech Pathology, School of Health Sciences, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> 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/ive-recovered-from-a-cold-but-i-still-have-a-hoarse-voice-what-should-i-do-236398">original article</a>. </div>

Body

I’ve been sick. When can I start exercising again?

<a href="https://theconversation.com/profiles/ken-nosaka-169021">Ken Nosaka</a>, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> You’ve had a cold or the flu and your symptoms have begun to subside. Your nose has stopped dripping, your cough is clearing and your head and muscles no longer ache. You’re ready to get off the couch. But is it too early to go for a run? Here’s what to consider when getting back to exercising after illness. <h2>Exercise can boost your immune system – but not always</h2> Exercise <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6523821/">reduces the chance</a> of getting respiratory infections by increasing your immune function and the ability to fight off viruses. However, an acute bout of endurance exercise may temporarily increase your susceptibility to upper respiratory infections, such as colds and the flu, via the short-term suppression of your immune system. This is known as the “open window” theory. A <a href="https://pubmed.ncbi.nlm.nih.gov/20839496/">study</a> from 2010 examined changes in trained cyclists’ immune systems up to eight hours after two-hour high-intensity cycling. It found important immune functions were suppressed, resulting in an increased rate of upper respiratory infections after the intense endurance exercise. So, we have to be more careful after performing harder exercises than normal. <h2>Can you exercise when you’re sick?</h2> This depends on the severity of your symptoms and the intensity of exercise. Mild to moderate exercise (reducing the intensity and length of workout) may be OK if your symptoms are a runny nose, nasal congestion, sneezing and minor sore throat, without a fever. Exercise may help you feel better by opening your nasal passages and temporarily relieving nasal congestion. However, if you try to exercise at your normal intensity when you are sick, you risk injury or more serious illness. So it’s important to listen to your body. If your symptoms include chest congestion, a cough, upset stomach, fever, fatigue or widespread muscle aches, avoid exercising. Exercising when you have these symptoms may worsen the symptoms and prolong the recovery time. If you’ve had the flu or another respiratory illness that caused a high fever, make sure your temperature is back to normal before getting back to exercise. Exercising raises your body temperature, so if you already have a fever, your temperature will become high quicker, which makes you sicker. If you have COVID or other contagious illnesses, stay at home, rest and isolate yourself from others. When you’re sick and feel weak, don’t force yourself to exercise. Focus instead on getting plenty of rest. This may actually shorten the time it takes to recover and resume your normal workout routine. <h2>I’ve been sick for a few weeks. What has happened to my strength and fitness?</h2> You may think taking two weeks off from training is disastrous, and worry you’ll lose the gains you’ve made in your previous workouts. But it could be just what the body needs. It’s true that almost all training benefits are <a href="https://journals.lww.com/acsm-csmr/fulltext/2019/04000/sports_training_principles.2.aspx">reversible</a> to some degree. This means the physical fitness that you have built up over time can be lost without regular exercise. To study the effects of de-training on our body functions, researchers have undertaken “bed rest” studies, where healthy volunteers spend up to 70 days in bed. They <a href="https://journals.physiology.org/doi/full/10.1152/japplphysiol.00415.2017">found</a> that V̇O₂max (the maximum amount of oxygen a person can use during maximal exercise, which is a measure of <a href="https://my.clevelandclinic.org/health/articles/7050-aerobic-exercise">aerobic</a> fitness) declines 0.3–0.4% a day. And the higher pre-bed-rest V̇O₂max levels, the <a href="https://journals.physiology.org/doi/full/10.1152/japplphysiol.00415.2017">larger</a> the declines. In terms of skeletal muscles, upper thigh muscles <a href="https://doi.org/10.1152/japplphysiol.00363.2020">become smaller by</a> 2% after five days of bed rest, 5% at 14 days, and 12% at 35 days of bed rest. <a href="https://journals.physiology.org/doi/full/10.1152/japplphysiol.00363.2020">Muscle strength declines more</a> than muscle mass: knee extensor muscle strength gets weaker by 8% at five days, 12% at 14 days and more than 20% after around 35 days of bed rest. This is why it feels harder to do the same exercises after resting for even five days. But in <a href="https://iaaspace.org/product/guidelines-for-standardization-of-bed-rest-studies-in-the-spaceflight-context/">bed rest studies</a>, physical activities are strictly limited, and even standing up from a bed is prohibited during the whole length of a study. When we’re sick in bed, we have some physical activities such as sitting on a bed, standing up and walking to the toilet. These activities could reduce the rate of decreases in our physical functions compared with study participants. <h2>How to ease back into exercise</h2> Start with a lower-intensity workout initially, such as going for a walk instead of a run. Your first workout back should be light so you don’t get out of breath. Go low (intensity) and go slow. Gradually increase the volume and intensity to the previous level. It may take the same number of days or weeks you rested to get back to where you were. If you were absent from an exercise routine for two weeks, for example, it may require two weeks for your fitness to return to the same level. If you feel exhausted after exercising, take an extra day off before working out again. A day or two off from exercising shouldn’t affect your performance very much.<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/233130/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ken-nosaka-169021">Ken Nosaka</a>, Professor of Exercise and Sports Science, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/ive-been-sick-when-can-i-start-exercising-again-233130">original article</a>.

Body

I feel sick. How do I know if I have the flu, COVID, RSV or something else?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> You wake with a sore throat and realise you are sick. Is this going to be a two-day or a two-week illness? Should you go to a doctor or just go to bed? Most respiratory illnesses have very similar symptoms at the start: sore throat, congested or runny nose, headache, fatigue and fever. This may progress to a dry cough. Best case scenario is that you have “<a href="https://lungfoundation.com.au/wp-content/uploads/2018/09/Factsheet-Common-Cold-Mar2016.pdf">a cold</a>” (which can be any one of hundreds of viruses, most commonly rhinovirus), which is short-lived and self-limiting. But some respiratory illnesses can be much more serious. Here is a brief guide to some important bugs to know about that are circulating this winter, and how to work out which one you have. <h2>Respiratory syncytial virus (RSV)</h2> For most people an RSV infection will feel like “a cold” – annoying, but only lasting a few days. However, for babies, older adults and people with immune issues, it can lead to <a href="https://www.rch.org.au/kidsinfo/fact_sheets/bronchiolitis/">bronchiolitis</a> or pneumonia, and even become life-threatening. RSV isn’t seasonal, which means you are just as likely to get it in summer as in winter. However, it is highly contagious so we noticed it <a href="https://pubmed.ncbi.nlm.nih.gov/32986804">disappearing almost completely</a> during COVID lockdowns. There is now a <a href="https://www.tga.gov.au/sites/default/files/2024-02/covid-19-rapid-antigen-self-tests-are-approved-australia-ifu-406813.PDF">rapid-antigen test (RAT) for RSV</a> which also checks for influenza and COVID, and is the best way of finding out if RSV is what is causing symptoms. Recently, a preventative immune therapy has become available for high risk babies (<a href="https://www.schn.health.nsw.gov.au/respiratory-syncytial-virus-rsv-monoclonal-antibody-factsheet">nirsevimab</a>) and there are also <a href="https://ncirs.org.au/ncirs-fact-sheets-faqs-and-other-resources/respiratory-syncytial-virus-rsv-frequently-asked">vaccines for higher risk adults</a>. Nirsevimab is also available to all babies for free in <a href="https://www.health.wa.gov.au/Articles/N_R/Respiratory-syncytial-virus-RSV-immunisation">Western Australia</a> and <a href="https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases-infection/immunisation/paediatric-rsv-prevention-program">Queensland</a>. But there are no specific treatments. Adults who get it simply have to ride it out (using whatever you need to <a href="https://www.mayoclinic.org/diseases-conditions/common-cold/diagnosis-treatment/drc-20351611">manage symptoms</a>). Babies and higher risk patients need to present to an emergency department if they test positive for RSV and are also looking or feeling very unwell (this might mean rapid shallow breathing, fevers not coming down with paracetamol or ibuprofen, a baby not feeding, mottled-looking skin, or going blue around the mouth). If a patient has developed a bronchiolitis or pneumonia, they may need to be hospitalised. <h2>Influenza</h2> Once you have had the “true flu” (influenza), you will find it frustrating when people call their sniffly cold-like symptoms a “flu”. Influenza infections generally start with a sore throat and headache which quickly turns into high fevers, generalised aches and excessive fatigue. You feel like you have been hit by a truck and may struggle to get out of bed. This can last a week or more, even in people who are generally fit and healthy. Influenza is a major public health issue internationally, with 3–5 million cases of severe illness and <a href="https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)">290,000 to 650,000 respiratory deaths annually</a>. People who are at <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/influenza-flu">greater risk of complications</a> from influenza include pregnant women, children under five, adults aged 65 and over, First Nations peoples, and people with chronic or immunosuppressive medical conditions. For this reason, annual vaccination is <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">recommended and funded</a> for vulnerable people. Vaccination is also readily available for <a href="https://www.health.gov.au/topics/immunisation/immunisation-contacts">all Australians who want it</a>, through pharmacies as well as medical clinics, usually at a cost of less than A$30. In <a href="https://www.vaccinate.initiatives.qld.gov.au/what-to-vaccinate-against/influenza#:%7E:text=The%20flu%20vaccine%20is%20free,.qld.gov.au">some states</a>, it’s free for all residents. Influenza is seasonal, with definite peaks in the winter months. This is why vaccines are offered from early autumn. If you think you may have influenza, there are now home-testing RATs: all current influenza RATs are in combination with COVID RATs, as the symptoms overlap. Treatment for most people is to manage symptoms and try to avoid spreading it around. Doctors can also <a href="https://theconversation.com/i-think-i-have-the-flu-should-i-ask-my-gp-for-antivirals-210457">prescribe antivirals</a> to vulnerable patients; these work best if started within 48 hours of symptoms. <h2>COVID</h2> It has been less than five years since COVID-19, caused by SARS-CoV-2, started to spread around the world in pandemic proportions. Although COVID is no longer a <a href="https://www.health.gov.au/news/ahppc-statement-end-of-covid-19-emergency-response">public health emergency</a>, it still causes <a href="https://www.abs.gov.au/articles/deaths-due-covid-19-influenza-and-rsv-australia-2022-may-2024">more deaths than influenza and RSV combined</a>. Unlike RSV and influenza, only those <a href="https://www.health.gov.au/topics/covid-19/protect-yourself-and-others/high-risk-groups">aged over 70</a> are in a high-risk age group for COVID. Other <a href="https://www.cdc.gov/covid/risk-factors/?CDC_AAref_Val=https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html">factors besides age</a> may put you at higher risk of becoming very unwell when infected by this virus. This includes having other respiratory diseases (such as asthma or chronic obstructive pulmonary disease, also known as COPD), diabetes, cancer, kidney disease, obesity or heart disease. Unlike most respiratory viruses, SARS-CoV-2 tends to set off inflammation beyond the respiratory system. This can involve a range of other organs including the heart, kidneys and blood vessels. Although most people are back to their usual work or study after a week or two, a significant proportion go on to experience extended symptoms such as fatigue, breathlessness, brain fog and mood changes. When these last <a href="https://aci.health.nsw.gov.au/statewide-programs/critical-intelligence-unit/post-acute-sequelae">more than 12 weeks</a>, without any other explanation for symptoms, it’s called <a href="https://www.healthdirect.gov.au/covid-19/post-covid-symptoms-long-covid">long COVID</a>. COVID vaccines can prevent serious illness and have been <a href="https://pubmed.ncbi.nlm.nih.gov/38282394/">monitored</a> for several years now for their safety and effectiveness. Current vaccination recommendations are <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-covid-19-vaccines-in-2024?language=en">based on age and immune status</a>. It’s worth discussing them with your doctor if you are unsure whether you would benefit or not. <a href="https://www.health.gov.au/topics/covid-19/oral-treatments">Antivirals</a> can treat COVID in higher-risk people who contract it, whether vaccinated or not. Specific advice about what to do if you test positive on a RAT will vary according to your current state guidelines and workplace, however the <a href="https://www.health.gov.au/topics/covid-19/testing-positive">general principles</a> are always: avoid spreading the virus to others, and give yourself time to rest and recover. <hr /> <iframe id="ConNR" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/ConNR/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> <h2>What if it’s not one of those?</h2> So you’ve done your combined RSV/flu/COVID RAT and the result is negative. But you still have symptoms. What else could it be? More than 200 different viruses can cause cold and flu symptoms, including rhinovirus (mentioned above), adenovirus and sometimes even <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2130424/">undefined pathogens</a>. If an illness progresses to a cough which will not go away, and/or you start coughing up sputum, this could be a bacterial infection, such as pertussis (whooping cough), streptococcus pneumoniae, haemophilus influenzae or moraxella catarrhalis. So it’s worth <a href="https://www.racgp.org.au/getattachment/0a637812-c8f0-45a2-af9c-fa215b64f8e4/attachment.aspx">getting assessed by a GP</a> who may do a chest Xray and/or <a href="https://www.rcpa.edu.au/Manuals/RCPA-Manual/Pathology-Tests/M/MCS-sputum">test your sputum</a>, particularly if they suspect pneumonia. You also may also start out with what is clearly a viral infection but then get a secondary bacterial infection later. So if you are getting more unwell over time, it’s worth getting tested, in case antibiotics will help. However, taking antibiotics for a purely viral illness will not only be useless, it can contribute to harmful <a href="https://www.nps.org.au/consumers/antibiotic-resistance-the-facts">antibiotic resistance</a> and give you unwanted side effects.<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/234266/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, General Practitioner, PhD Candidate, <a href="https://theconversation.com/institutions/bond-university-863">Bond 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/i-feel-sick-how-do-i-know-if-i-have-the-flu-covid-rsv-or-something-else-234266">original article</a>. </div>

Body

What’s the difference between ‘man flu’ and flu? Hint: men may not be exaggerating

<a href="https://theconversation.com/profiles/thea-van-de-mortel-1134101">Thea van de Mortel</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> The term “man flu” takes a <a href="https://www.oxfordlearnersdictionaries.com/definition/english/man-flu">humorous poke</a> at men with minor respiratory infections, such as colds, who supposedly exaggerate their symptoms. According to the stereotype, a man lies on the sofa with a box of tissues. Meanwhile his female partner, also with a snotty nose, carries on working from home, doing the chores and looking after him. But is man flu real? Is there a valid biological reason behind men’s symptoms or are men just malingering? And how does man flu differ from flu? <h2>What are the similarities?</h2> Man flu could refer to a number of respiratory infections – a cold, flu, even a mild case of COVID. So it’s difficult to compare man flu with flu. But for simplicity, let’s say man flu is actually a cold. If that’s the case, man flu and flu have some similar features. Both are caused by viruses (but different ones). Both are improved with rest, fluids, and if needed painkillers, throat lozenges or decongestants to <a href="https://activities.nps.org.au/nps-order-form/Resources/NPS-Cold-and-Flu-Brochure-May-2014.pdf">manage symptoms</a>. Both <a href="https://www.cdc.gov/flu/symptoms/coldflu.htm">can share</a> similar symptoms. Typically, more severe symptoms such as fever, body aches, violent shivering and headaches are more common in flu (but sometimes occur in colds). Meanwhile sore throats, runny noses, congestion and sneezing are more common in colds. A cough is common in both. <h2>What are the differences?</h2> <a href="https://www.cdc.gov/flu/about/keyfacts.htm">Flu</a> is a more serious and sometimes fatal respiratory infection caused by the influenza virus. Colds are caused by various viruses such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3553670/">rhinoviruses</a>, <a href="https://www.cdc.gov/adenovirus/about/?CDC_AAref_Val=https://www.cdc.gov/adenovirus/symptoms.html">adenoviruses</a>, and common cold <a href="https://journals.lww.com/pidj/citation/2022/03000/proving_etiologic_relationships_to_disease_.18.aspx">coronaviruses</a>, and are rarely serious. Colds tend to <a href="https://www.cdc.gov/flu/symptoms/coldflu.htm">start gradually</a> while flu tends to start abruptly. Flu can be <a href="https://www.cdc.gov/flu/professionals/diagnosis/overview-testing-methods.htm">detected</a> with laboratory or at-home tests. Man flu is not an official diagnosis. Severe flu symptoms may be prevented with <a href="https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm">a vaccine</a>, while cold symptoms cannot. Serious flu infections may also be <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/racf-antiviral-treatments-and-prophylaxis.aspx">prevented or treated</a> with antiviral drugs such as Tamiflu. There are no antivirals for colds. <h2>OK, but is man flu real?</h2> Again, let’s assume man flu is a cold. Do men really have worse colds than women? The picture is complicated. <a href="https://www.sciencedirect.com/science/article/pii/S0022399922003324?via%3Dihub">One study</a>, with the title “Man flu is not a thing”, did in fact show there were differences in men’s and women’s symptoms. This study looked at symptoms of acute rhinosinusitis. That’s inflammation of the nasal passages and sinuses, which would explain a runny or stuffy nose, a sinus headache or face pain. When researchers assessed participants at the start of the study, men and women had similar symptoms. But by days five and eight of the study, women had fewer or less-severe symptoms. In other words, women had recovered faster. But when participants rated their own symptoms, we saw a somewhat different picture. Women rated their symptoms worse than how the researchers rated them at the start, but said they recovered more quickly. All this suggests men were not exaggerating their symptoms and did indeed recover more slowly. It also suggests women feel their symptoms more strongly at the start. <h2>Why is this happening?</h2> It’s not straightforward to tease out what’s going on biologically. There are <a href="https://www.nature.com/articles/nri.2016.90">differences</a> in immune responses between men and women that provide a plausible reason for worse symptoms in men. For instance, women generally produce antibodies more efficiently, so they <a href="https://www.nature.com/articles/nri.2016.90">respond more effectively</a> to vaccination. Other aspects of women’s immune system also appear to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2735332/">work more strongly</a>. So why do women tend to have <a href="https://www.nature.com/articles/nri.2016.90">stronger immune responses</a> overall? That’s probably partly because women have two X chromosomes while men have one. X chromosomes carry important <a href="https://www.nature.com/articles/nri.2016.90#Tab3">immune function genes</a>. This gives women the benefit of immune-related genes from two different chromosomes. Oestrogen (the female sex hormone) also seems to <a href="https://www.nature.com/articles/nri.2016.90">strengthen</a> the immune response, and as levels vary throughout the lifespan, so does <a href="https://www.science.org/doi/10.1126/sciimmunol.aan2946">the strength</a> of women’s immune systems. Men are certainly more likely to die from some infectious diseases, such as <a href="https://www.aihw.gov.au/reports/life-expectancy-deaths/deaths-in-australia/contents/covid-10-deaths">COVID</a>. But the picture is less clear with other infections such as the flu, where the incidence and mortality between men and women <a href="https://iris.who.int/bitstream/handle/10665/44401/9789241500111_eng.pdf?sequence=1&isAllowed=y">varies widely</a> between countries and particular flu subtypes and outbreaks. Infection rates and outcomes in men and women can also depend on the way a virus is <a href="https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2021.712688/full">transmitted</a>, the person’s age, and social and behavioural factors. For instance, women seem to be more likely to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077589/#R20">practice protective behaviours</a> such as washing their hands, wearing masks or avoiding crowded indoor spaces. Women are also <a href="https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-016-0440-0">more likely</a> to seek medical care when ill. <h2>So men aren’t faking it?</h2> Some evidence suggests men are not over-reporting symptoms, and may take longer to clear an infection. So they may experience man flu more harshly than women with a cold. So cut the men in your life some slack. If they are sick, gender stereotyping is unhelpful, and may discourage men from seeking medical advice.<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/231161/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/thea-van-de-mortel-1134101">Thea van de Mortel</a>, Professor, Nursing, School of Nursing and Midwifery, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith 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/whats-the-difference-between-man-flu-and-flu-hint-men-may-not-be-exaggerating-231161">original article</a>.

Body

3 common travel illnesses (and how to avoid them)

Nobody wants to fall sick when they’re on holidays but it happens and is actually quite common. Not every travel illness is foreseeable, but the most prevalent ones usually can be managed if you’re prepared and know what to look out for. Here are three of the most common illnesses travellers experience and what you can do to avoid them. Traveller’s diarrhoea It may be an unpleasant topic of conversation, but as diarrhoeais the most common travel sickness, it’s important to be prepared. It is estimated diarrhoeais experienced by almost half of travellers at some point on their holiday, but mainly by those visiting developing countries. It’s contracted by eating or drinking contaminated food and water and in severe cases can last for days. How to avoid it: Stick to bottled or purified water, freshly cooked meals and fruits and vegetables you can peel yourself. Talk to your doctor for antibiotics you can take in case you are struck with traveller’s diarrhoea. Motion sickness Whether it’s by boat, plane, or car, many travellers experience motion sickness. This occurs when your eyes see motion but your body doesn’t register it, leading to a conflict of the senses. It often results in nausea, vomiting, headaches, and sweating. How to avoid it: If flying, try to sit near the wings of plane. If cruising, get an outside cabin in the middle of ship, and if in a car, sit up front. Don’t play with your devices, as looking at a small screens often exacerbates the problem; instead try to look far to the horizon. Have a light meal before travelling and avoid spicy, greasy or rich foods. You can talk to your doctor about over-the-counter medication that can help motion sickness as well. Bug bites There are all sorts of infectious diseases like malaria, dengue, chikungunya and yellow fever you can pick up from bug bites, especially in developing nations. While you should always talk to your doctor about the types of vaccines you need to take for your travel destination, it is always advisable to protect against insect bites. How to avoid it: Apply insect repellent, wear long sleeves and pants where possible and try to avoid outside activity around dust and dawn when mosquitos are active. If sleeping outdoors, it is advisable to use curtain nettings. Image credits: Getty Images

Travel Tips

Here’s why having chocolate can make you feel great or a bit sick – plus 4 tips for better eating

<a href="https://theconversation.com/profiles/saman-khalesi-366871">Saman Khalesi</a>, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a> Australians are <a href="https://www.retail.org.au/media/sweet-spending-boon-predicted-for-easter-retail">predicted</a> to spend around A$1.7 billion on chocolates, hot cross buns and other special foods this Easter season. Chocolate has a long history of production and consumption. It is made from cacao beans that go through processes including fermentation, drying, roasting and grounding. What is left is a rich and fatty liquor that is pressed to remove the fat (cocoa butter) and the cacao (or “cocoa”) powder which will then be mixed with different ingredients to produce dark, milk, white and other types of chocolates. There are several health benefits and potential problems that come in these sweet chocolatey packages. <h2>The good news</h2> Cacao beans contain <a href="https://foodstruct.com/food/cocoa-bean">minerals</a> like iron, potassium, magnesium, zinc and phosphorus and some vitamins. They are also rich in beneficial chemicals called <a href="https://pubmed.ncbi.nlm.nih.gov/23150750/">polyphenols</a>. These are great antioxidants, with the potential to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5465250/">improve heart health</a>, increase <a href="https://pubmed.ncbi.nlm.nih.gov/25164923/">nitric oxide</a> (which dilates blood vessels) and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488419/">reduce blood pressure</a>, provide food for gut microbiota and <a href="https://www.mdpi.com/2072-6643/12/7/1908">promote gut health</a>, boost the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5465250/">immune system</a> and reduce inflammation. However, the concentration of polyphenols in the chocolate we eat depends largely on the cocoa solid amounts used in the final product. In general terms, the darker the chocolate, the more cocoa solids, minerals and polyphenols it has. For example, dark chocolates may have around <a href="https://www.tandfonline.com/doi/full/10.1080/10942912.2011.614984">seven times more polyphenols</a> compared to white chocolates and <a href="https://www.tandfonline.com/doi/full/10.1080/10942912.2011.614984">three times more polyphenols</a> compared to milk chocolates. <h2>But also some bad news</h2> Unfortunately, the <a href="https://theconversation.com/treat-or-treatment-chocolate-is-good-but-cocoa-is-better-for-your-heart-3084">health benefits of cocoa solids</a> are easily offset by the high sugar and fat content of modern-day chocolates. For example, milk and white chocolate eggs are on average 50% sugar, 40% fat (mostly saturated fats) – which means a lot of added kilojoules (calories). Also, there may be some side effects that come with ingesting chocolate. Cocoa beans include a compound called theobromine. While it has the anti-inflammatory properties responsible for some of the health benefits of chocolate, it is also a mild brain stimulant that acts in a similar way to caffeine. The mood boost it offers may also be partly responsible for how much we <a href="https://www.frontiersin.org/articles/10.3389/fphar.2015.00030/full?crsi=662496658&cicada_org_src=healthwebmagazine.com&cicada_org_mdm=direct">like chocolate</a>. Dark chocolate has higher theobromine compared to milk and white chocolate. But accordingly, overindulging in chocolate (and therefore theobromine) may lead to feeling restless, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3672386/">headaches</a> and nausea. <h2>What else is in your chocolate?</h2> Milk and dairy-based chocolates may also cause stomach upset, abdominal pain and bloating in people with <a href="https://dietitiansaustralia.org.au/health-advice/lactose-intolerance">lactose intolerance</a>. This happens when we don’t produce enough lactase enzymes to digest milk sugar (lactose). People with lactose intolerance can usually tolerate up to 6 grams of lactose without showing symptoms. Milk chocolate can have around <a href="https://www.ncbi.nlm.nih.gov/books/NBK310258/">3 grams of lactose</a> per 40 grams (the size of a standard chocolate bar). So two chocolate bars (or the equivalent in milk chocolate eggs or bunnies) may be enough to cause symptoms. It’s worth noting that lactase enzyme activity dramatically declines as we age, with the highest activity in newborns and children. So lactose sensitivity or intolerance may not be such an issue for your kids and your symptoms may increase over time. Genetics also plays a major role in how sensitive people are to lactose. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6815241/">Allergic reactions</a> to chocolate are usually due to the added ingredients or cross-contamination with potential allergens such as nuts, milk, soy, and some sweeteners used in the production of chocolate. Symptoms can be mild (acne, rashes and stomach pain) or more severe (swelling of the throat and tongue and shortness of breath). If you or your family members have known allergic reactions, make sure you read the label before indulging – especially in a whole block or basket of the stuff. And if you or your family members do experience symptoms of an allergic reaction after eating chocolate, <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/allergic-reactions-emergency-first-aid">seek medical attention</a> immediately. <h2>4 take home tips</h2> So, if you are like me and have a weakness for chocolate there are a few things you can do to make the experience a good one.<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/202848/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <ol> <li>keep an eye out for the darker chocolate varieties with higher cocoa solids. You may notice a percentage on labelling, which refers to how much of its weight is from cocoa beans. In general, the higher this percentage, the lower the sugar. White chocolate has almost no cocoa solid, and mostly cocoa butter, sugar and other ingredients. Dark chocolate has 50–100% cocoa beans, and less sugar. Aim for at least 70% cocoa</li> <li>read the fine print for additives and possible cross-contamination, especially if allergies might be an issue</li> <li>the ingredients list and nutrition information panel should tell you all about the chocolate you choosing. Go for varieties with lower sugar and less saturated fat. Nuts, seeds and dried fruits are better ingredients to have in your chocolate than sugar, creme, syrup, and caramel</li> <li>finally, treat yourself – but keep the amount you have within sensible limits!</li> </ol> <a href="https://theconversation.com/profiles/saman-khalesi-366871">Saman Khalesi</a>, Postdoctoral Fellow of the National Heart Foundation & Senior Lecturer and Discipline Lead in Nutrition, School of Health, Medical and Applied Sciences, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/heres-why-having-chocolate-can-make-you-feel-great-or-a-bit-sick-plus-4-tips-for-better-eating-202848">original article</a>.

Food & Wine

Altitude sickness is typically mild but can sometimes turn very serious − a high-altitude medicine physician explains how to safely prepare

<a href="https://theconversation.com/profiles/brian-strickland-1506270">Brian Strickland</a>, <a href="https://theconversation.com/institutions/university-of-colorado-anschutz-medical-campus-4838">University of Colorado Anschutz Medical Campus</a> Equipped with the latest gear and a thirst for adventure, mountaineers embrace the perils that come with conquering the world’s highest peaks. Yet, even those who tread more cautiously at high altitude are not immune from the health hazards waiting in the thin air above. Altitude sickness, which most commonly refers to <a href="https://medlineplus.gov/ency/article/000133.htm">acute mountain sickness</a>, <a href="https://doi.org/10.1016/j.pcad.2010.02.003">presents a significant challenge</a> to those traveling to and adventuring in high-altitude destinations. Its symptoms can range from <a href="https://doi.org/10.1089/ham.2017.0164">mildly annoying to incapacitating</a> and, in some cases, may progress to more <a href="https://doi.org/10.1183/16000617.0096-2016">life-threatening illnesses</a>. While <a href="https://doi.org/10.18111/9789284424023">interest in high-altitude tourism is rapidly growing</a>, general awareness and understanding about the hazards of visiting these locations <a href="https://doi.org/10.1089/ham.2022.0083">remains low</a>. The more travelers know, the better they can prepare for and enjoy their journey. As an <a href="https://som.cuanschutz.edu/Profiles/Faculty/Profile/36740">emergency physician specializing in high-altitude illnesses</a>, I work to improve health care in remote and mountainous locations around the world. I’m invested in finding ways to allow people from all backgrounds to experience the magic of the mountains in an enjoyable and meaningful way. <h2>The science behind altitude sickness</h2> Altitude sickness is rare in locations lower than 8,200 feet (2,500 meters); however, <a href="https://www.ncbi.nlm.nih.gov/books/NBK430716/">it becomes very common</a> when ascending above this elevation. In fact, it affects about <a href="https://wwwnc.cdc.gov/travel/yellowbook/2024/environmental-hazards-risks/high-elevation-travel-and-altitude-illness">25% of visitors to the mountains of Colorado</a>, where I conduct most of my research. The risk rapidly increases with higher ascents. Above 9,800 feet (3,000 meters), up to <a href="https://www.ncbi.nlm.nih.gov/books/NBK430716/">75% of travelers</a> may develop symptoms. Symptoms of altitude sickness are usually mild and consist of <a href="https://doi.org/10.1089/ham.2017.0164">headache, dizziness, nausea, fatigue and insomnia</a>. They usually <a href="https://doi.org/10.1016/j.rceng.2019.12.009">resolve after one to two days</a>, as long as travelers stop their ascent, and the symptoms quickly resolve with descent. When travelers do not properly acclimatize, they can be susceptible to life-threatening altitude illnesses, such as <a href="https://doi.org/10.1016/j.resp.2007.05.002">high-altitude pulmonary edema</a> or <a href="https://doi.org/10.1089/1527029041352054">high-altitude cerebral edema</a>. These conditions are characterized by fluid accumulation within the tissues of the lungs and brain, respectively, and are the <a href="https://wwwnc.cdc.gov/travel/yellowbook/2024/environmental-hazards-risks/high-elevation-travel-and-altitude-illness">most severe forms of altitude sickness</a>. Altitude sickness symptoms are thought to be caused by <a href="https://doi.org/10.1093%2Fbjaceaccp%2Fmks047">increased pressure surrounding the brain</a>, which results from the failure of the body to acclimatize to higher elevations. As people enter into an environment with lower air pressure and, therefore, <a href="https://doi.org/10.1001/jamanetworkopen.2023.18036">lower oxygen content</a>, their <a href="https://doi.org/10.1093%2Fbjaceaccp%2Fmks047">breathing rate increases</a> in order to compensate. This causes an increase in the amount of <a href="https://doi.org/10.1016/s1357-2725(03)00050-5">oxygen in the blood as well as decreased CO₂ levels</a>, which then increases blood pH. As a result, the <a href="https://doi.org/10.1093%2Fbjaceaccp%2Fmks047">kidneys compensate</a> by removing a chemical called bicarbonate from the blood into the urine. This process makes people urinate more and helps correct the acid and alkaline content of the blood to a more normal level. <figure><iframe src="https://www.youtube.com/embed/iv1vQPIdX_k?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Tips for preventing or reducing the risk of altitude sickness.</figcaption></figure> <h2>The importance of gradual ascent</h2> High-altitude medicine experts and other physicians <a href="https://doi.org/10.1016/s0140-6736(76)91677-9">have known for decades</a> that <a href="https://doi.org/10.1089/ham.2010.1006">taking time to slowly ascend is the best way</a> to prevent the development of altitude sickness. This strategy gives the body time to complete its natural physiologic responses to the changes in air pressure and oxygen content. In fact, spending just <a href="https://doi.org/10.1089/ham.2010.1006">one night at a moderate elevation</a>, such as Denver, Colorado, which is at 5,280 feet (1,600 meters), has been shown to <a href="https://doi.org/10.7326/0003-4819-118-8-199304150-00003">significantly reduce the likelihood of developing symptoms</a>. People who skip this step and travel directly to high elevations are <a href="https://doi.org/10.1093/jtm/taad011">up to four times more likely</a> to develop altitude sickness symptoms. When going to elevations greater than 11,000 feet, multiple days of acclimatization are necessary. Experts generally recommend ascending <a href="https://doi.org/10.1089/ham.2010.1006">no more than 1,500 feet per day</a> once the threshold of 8,200 feet of elevation has been crossed. Workers at high altitude, such as <a href="https://doi.org/10.1089/ham.2020.0004">porters in the Nepali Himalaya</a>, are at <a href="https://doi.org/10.1016/j.wem.2018.06.002">particular risk of altitude-related illness</a>. These workers often do not adhere to acclimatization recommendations in order to maximize earnings during tourist seasons; as a result, they are more likely to experience <a href="https://www.cdc.gov/travel/yellowbook/2024/environmental-hazards-risks/high-elevation-travel-and-altitude-illness">severe forms of altitude sickness</a>. <h2>Effective medications</h2> For more than 40 years, <a href="https://doi.org/10.1056/nejm196810172791601">a medicine called acetazolamide</a> has been used to <a href="https://medlineplus.gov/druginfo/meds/a682756.html">prevent the development of altitude sickness</a> and to treat its symptoms. Acetazolamide is <a href="https://www.ncbi.nlm.nih.gov/books/NBK557838/">commonly used as a diuretic</a> and for the <a href="https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma">treatment of glaucoma</a>, a condition that causes increased pressure within the eye. If started <a href="https://doi.org/10.1378/chest.09-2445">two days prior</a> to going up to a high elevation, acetazolamide can <a href="https://doi.org/10.1378/chest.09-2445">prevent symptoms of acute illness</a> by speeding up the acclimatization process. Nonetheless, it does not negate the recommendations to ascend slowly, and it is <a href="https://doi.org/10.1016/j.wem.2019.04.006">routinely recommended only</a> when people cannot slowly ascend or for people who have a history of severe altitude sickness symptoms even with slow ascent. Other medications, including ibuprofen, have <a href="https://doi.org/10.1016/j.wem.2012.08.001">shown some effectiveness</a> in treating acute mountain sickness, although <a href="https://doi.org/10.1016/j.amjmed.2018.10.021">not as well as acetazolamide</a>. A <a href="https://pubmed.ncbi.nlm.nih.gov/2028586/">steroid medication called dexamethasone</a> is effective in both treating and preventing symptoms, but it does not improve acclimatization. It is <a href="https://doi.org/10.1016/j.wem.2019.04.006">recommended only when acetazolamide is not effective</a> or cannot be taken. Additionally, it is important to <a href="https://wwwnc.cdc.gov/travel/page/travel-to-high-altitudes">avoid alcohol during the first few days at higher altitudes</a>, as it impairs the body’s ability to acclimatize. <h2>Unproven therapies and remedies are common</h2> As high-altitude tourism becomes increasingly popular, multiple commercial products and remedies have emerged. Most of them are not effective or provide no evidence to suggest they work as advertised. Other options have mixed evidence, making them difficult to recommend. Medications such as <a href="https://doi.org/10.1089/ham.2007.1037">aspirin</a>, <a href="https://doi.org/10.1183/13993003.01355-2017">inhaled steroids</a> and <a href="https://doi.org/10.1089/ham.2011.0007">sildenafil</a> have been proposed as possible preventive agents for altitude sickness, but on the whole they have not been found to be effective. <a href="https://doi.org/10.1093/qjmed/hcp026">Supplements and antioxidants have no proven benefit</a> in preventing or treating altitude sickness symptoms. Both normal and high-altitude exercise are popular ways to prepare for high elevations, especially among athletes. However, beyond <a href="https://doi.org/10.1097/jes.0b013e31825eaa33">certain pre-acclimatization strategies</a>, such as brief sojourns to high altitude, <a href="https://doi.org/10.1016/j.tmaid.2013.12.002">physical fitness and training is of little benefit</a>. <a href="https://missouripoisoncenter.org/canned-oxygen-is-it-good-for-you">Canned oxygen</a> has also exploded in popularity with travelers. While <a href="https://doi.org/10.1016/0140-6736(90)93240-p">continuously administered medical oxygen</a> in a health care setting can alleviate altitude sickness symptoms, portable oxygen cans <a href="https://doi.org/10.1016/j.wem.2019.04.006">contain very little oxygen gas</a>, casting doubt on their effectiveness. Some high-altitude adventure travelers sleep in <a href="https://doi.org/10.2165/00007256-200131040-00002">specialized tents</a> that simulate increased elevation by lowering the quantity of available oxygen in ambient air. The lower oxygen levels within the tent are thought to accelerate the acclimatization process, but the tents aren’t able to decrease barometric pressure. This is an important part of the high-altitude environment that induces acclimatization. Without modifying ambient air pressure, these <a href="https://doi.org/10.1016/j.wem.2014.04.004">tents may take multiple weeks</a> to be effective. Natural medicines, such as <a href="https://doi.org/10.1580/08-weme-br-247.1">gingko</a> and <a href="https://doi.org/10.1186/s40794-019-0095-7">coca leaves</a>, are touted as natural altitude sickness treatments, but few studies have been done on them. The modest benefits and significant side effects of these options makes their use <a href="https://doi.org/10.1016/j.wem.2019.04.006">difficult to recommend</a>. <a href="https://pubmed.ncbi.nlm.nih.gov/8469948/">Staying hydrated</a> is very important at high altitudes due to fluid losses from increased urination, dry air and increased physical exertion. <a href="https://doi.org/10.1186%2Fs12889-018-6252-5">Dehydration symptoms</a> can also mimic those of altitude sickness. But there is <a href="https://doi.org/10.1580/1080-6032(2006)17%5B215:AMSIOF%5D2.0.CO;2">little evidence that consuming excessive amounts of water</a> can prevent or treat altitude sickness. The mountains have something for visitors of all interests and expertise and can offer truly life-changing experiences. While there are health risks associated with travel at higher elevations, these can be lessened by making basic preparations and taking time to slowly ascend.<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/222057/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/brian-strickland-1506270">Brian Strickland</a>, Senior Instructor in Emergency Medicine, <a href="https://theconversation.com/institutions/university-of-colorado-anschutz-medical-campus-4838">University of Colorado Anschutz Medical Campus</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/altitude-sickness-is-typically-mild-but-can-sometimes-turn-very-serious-a-high-altitude-medicine-physician-explains-how-to-safely-prepare-222057">original article</a>.

Travel Trouble

From COVID to gastro, why are cruise ships such hotbeds of infection?

<a href="https://theconversation.com/profiles/thea-van-de-mortel-1134101">Thea van de Mortel</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> Dual outbreaks of <a href="https://www.abc.net.au/news/2023-11-12/grand-princess-ship-adelaide-covid-19-gastroenteritis/103095704">gastro and COVID</a> on the Grand Princess cruise ship that docked in Adelaide on Monday <a href="https://www.theguardian.com/australia-news/2023/nov/13/grand-princess-cruise-ship-covid-gastro-outbreak-docks-adelaide-south-australia">have now been declared over</a> by the <a href="https://www.canberratimes.com.au/story/8421009/cruise-ship-doctor-declares-dual-virus-outbreaks-over/">doctor on board</a>. A spokesperson for Princess Cruises, which operates the ship, said a number of passengers had presented with symptoms <a href="https://www.9news.com.au/national/grand-princess-no-double-covid19-gastro-outbreak-on-ship-cruise-line-says/5d02d423-3289-4a2b-a580-1ed565b78027">on a previous voyage</a>. But the ship has since been disinfected and the number of people who were ill when the ship arrived into Adelaide was said to be in single digits. While this is positive news, reports of infectious outbreaks on cruise ships evoke a sense of deja vu. We probably all remember the high-profile COVID outbreaks that occurred on cruise ships in 2020. So what is it about cruise ships that can make them such hotspots for infection? <h2>First, what causes these outbreaks?</h2> Respiratory infectious outbreaks on cruise ships may be caused by <a href="https://wwwnc.cdc.gov/travel/yellowbook/2024/air-land-sea/cruise-ship-travel">a range of pathogens</a> including SARS-CoV-2 (the virus that causes COVID) and influenza viruses. These can be spread by <a href="https://www.pnas.org/doi/10.1073/pnas.2015482118">respiratory droplets and aerosols</a> released when people breathe, talk, laugh, cough and sneeze. Historically, <a href="https://jmvh.org/article/the-navy-and-the-1918-19-influenza-pandemic/">troop transport ships</a> also helped to spread the lethal 1918 flu virus between continents. Gastro outbreaks on cruise ships are similarly well documented. More than 90% of cruise ship gastro outbreaks are caused by <a href="https://wwwnc.cdc.gov/travel/yellowbook/2024/air-land-sea/cruise-ship-travel#infectious">norovirus</a>, which is spread from person to person, and through contaminated objects or contaminated food or water. Gastro can also be caused by other pathogens such as <a href="https://wwwnc.cdc.gov/travel/yellowbook/2024/air-land-sea/cruise-ship-travel">bacteria in contaminated food or water</a>. <h2>What is the risk?</h2> In 2020, around 19% of <a href="https://www.bmj.com/content/369/bmj.m1632">Diamond Princess</a> passengers and crew docked in Japan tested positive to COVID. Ultimately, nearly one in four <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8739343/">Ruby Princess</a> passengers and crew docked in Sydney tested positive. However, COVID generally presents a lesser risk nowadays, with most people having some level of immunity from vaccination or previous infection. The outbreak on the Grand Princess appears to have been much smaller in scale. A <a href="https://www.sciencedirect.com/science/article/abs/pii/S1477893916300680">three-year study</a> before COVID of influenza-like illness (which includes fever), acute respiratory illness (which <a href="https://www.cdc.gov/flu/about/glossary.htm">doesn’t require fever</a> to be present) and gastro on cruise ships found these were diagnosed in 32.7%, 15.9% and 17% of ill passengers, and 10.9%, 80% and 0.2% of ill crew, respectively. An <a href="https://www.cdc.gov/mmwr/volumes/70/ss/ss7006a1.htm">analysis</a> of data from 252 cruise ships entering American ports showed the overall incidence of acute gastro halved between 2006 and 2019. Passenger cases decreased from 32.5 per 100,000 travel days to 16.9, and crew cases from 13.5 per 100,000 travel days to 5.2. This decline may be due to a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382806/">combination</a> of improved hygiene and sanitation standards. The risk of getting sick with gastro was significantly higher on <a href="https://www.cdc.gov/mmwr/volumes/70/ss/ss7006a1.htm">bigger ships and longer voyages</a>. This is because the longer you are in close contact with others, the greater the chance of exposure to an infectious dose of viruses or bacteria. <h2>Why are cruise ships infection hotspots?</h2> On cruise ships, people tend to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8739343/">crowd together</a> in confined spaces for extended periods. These include dining halls, and during social activities in casinos, bars and theatres. The risk goes up when the environment is noisy, as more droplets and aerosols are shed when people are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382806/">laughing, shouting or talking loudly</a>. Passengers may come from <a href="https://www.sciencedirect.com/science/article/abs/pii/S1477893916300680?via%3Dihub">multiple countries</a>, potentially bringing variants from different parts of the world. Influenza, which is usually seasonal (late autumn to early spring) onshore, can occur at any time <a href="https://academic.oup.com/cid/article/31/2/433/295546">on a cruise ship</a> if it has international passengers or is calling at international ports. Human behaviour also contributes to the risk. Some passengers <a href="https://academic.oup.com/jtm/article/15/3/172/1821220">surveyed</a> following cruise ship gastro outbreaks indicated they were ill when they boarded the ship, or they became ill but didn’t disclose this because they didn’t want to pay for a doctor or be made to isolate, or they thought it wasn’t serious. Those who became ill were more likely than those who did not to think that hand hygiene and isolation were not effective in preventing infection transmission, and were less likely to wash their hands after using the toilet. Given <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/norovirus.aspx">faecal contamination</a> is a major source of norovirus transmission, this is concerning. While there are usually a la carte dining options on board, many people will choose a buffet option. From personal experience, food tongs are handled by multiple people, some of whom may not have cleaned their hands. <h2>What can help?</h2> The <a href="https://www.health.gov.au/news/ahppc-statement-advice-to-support-safe-cruising">Department of Health and Aged Care</a> recommends cruise companies encourage crew and passengers to be up-to-date with flu and COVID vaccinations, and encourage anyone who becomes ill to stay in their cabin, or at least avoid crowded spaces and wear a mask in public. They also recommend cruise ships have a plan to identify and contain any outbreaks, including testing and treatment capacity, and communicate to passengers and crew how they can reduce their transmission risk. All passengers and crew should report any signs of infectious illness, and practice good hand hygiene and <a href="https://www.cdc.gov/oralhealth/infectioncontrol/faqs/respiratory-hygiene.html">respiratory etiquette</a>, such as covering their mouth if coughing or sneezing, disposing of used tissues, and washing or sanitising hands after touching their mouth or nose. South Australia’s chief health officer has <a href="https://www.abc.net.au/news/2023-11-13/grand-princess-ship-covid-gastro-docks-in-adelaide/103096836">commended</a> the Grand Princess crew for their infection protection and control practices, and for getting the outbreak under control.<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/217534/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/thea-van-de-mortel-1134101">Thea van de Mortel</a>, Professor, Nursing, School of Nursing and Midwifery, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith 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/from-covid-to-gastro-why-are-cruise-ships-such-hotbeds-of-infection-217534">original article</a>.

Cruising

You’ve heard of long COVID, but did you know there might also be a long cold?

<a href="https://theconversation.com/profiles/giulia-vivaldi-1476903">Giulia Vivaldi</a>, <a href="https://theconversation.com/institutions/queen-mary-university-of-london-1745">Queen Mary University of London</a> At least <a href="https://www.nature.com/articles/s41579-022-00846-2">10% of people</a> infected with SARS-CoV-2, the virus that causes COVID, have symptoms that last more than four weeks after the infection. With more than <a href="https://covid19.who.int/">770 million infections</a> to date, this translates to tens of millions of people living with the long-term consequences of COVID, known as “long COVID”. <a href="https://www.nature.com/articles/s41579-022-00846-2">More than 200 symptoms</a> of long COVID have been studied, with some of the most common being fatigue, breathlessness and cognitive difficulties, such as memory problems or “brain fog”. The condition can be debilitating – many people have to <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00387-5/fulltext">reduce their working hours</a> or are <a href="https://ifs.org.uk/publications/long-covid-and-labour-market">unable to work entirely</a>. But COVID may not be alone in causing long-lasting symptoms. In a <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00428-5/fulltext">new paper</a>, my colleagues and I report the findings of a study comparing long-term symptoms reported by people who experienced different types of acute respiratory infection. We asked more than 10,000 people to report on 16 symptoms commonly found in long COVID, such as fatigue, breathlessness, aches and pains, and dizziness. We then compared how common these symptoms were among three groups: people who had reported COVID, those who had reported another acute respiratory infection (but had tested negative for COVID), and those who had not reported either infection. We focused on long-term symptoms by only including people who had been infected more than four weeks earlier. We also took into account people’s general health before they were infected, and whether they had any existing respiratory conditions. Our study showed that all the symptoms considered were more common in people with previous COVID than in people with no infections, regardless of whether they reported long COVID. But this finding wasn’t unique to COVID. Almost all the symptoms we looked at were also more common in people with non-COVID respiratory infections than in those with no infection. In other words, our findings hinted towards the existence of a “long cold”: long-lasting health effects from other respiratory infections, such as colds, flu, or pneumonia, that are currently going unrecognised. Some of the most common symptoms of the long cold include coughing, stomach pain, and diarrhoea. These symptoms were reported an average of 11 weeks after the infection. While a severe initial infection seems to increase the risk of long-term symptoms, our research does not yet tell us why some people suffer extended symptoms while others do not. <h2>Important differences</h2> Importantly, we have no evidence that symptoms of the long cold have the same severity or duration as long COVID. In fact, we saw some important differences in the symptoms reported in the two groups, with those recovering from COVID more likely to experience light-headedness or dizziness and problems with taste and smell. These findings shine a light not only on the impact of long COVID on people’s lives, but also other respiratory infections. A lack of awareness, or even the lack of a common term, such as “long cold” or “long flu”, prevents both reporting and diagnosis of these conditions. And people who do report their long cold may still struggle to get a diagnosis, owing to the wide range of symptoms and <a href="https://www.nature.com/articles/s41591-022-01810-6">lack of diagnostic tests</a>. Long-lasting symptoms after respiratory infections are not a new phenomenon. Studies in survivors of two previous coronavirus outbreaks – the severe acute respiratory syndrome (Sars) pandemic and the Middle East respiratory syndrome (Mers) outbreak – have found long-term impacts on <a href="https://www.rcpjournals.org/content/clinmedicine/21/1/e68">lung function, quality of life and mental health</a>. And some people hospitalised with influenza A have experienced <a href="https://www.nature.com/articles/s41598-017-17497-6">respiratory and psychological problems</a> at least two years after being discharged from hospital. But most of the research so far has focused on people with severe disease, often severe enough to be hospitalised. Little is known about the long-term effects respiratory infections might have among people whose acute disease episode is less severe. Long COVID has bucked this trend, being studied in people with all levels of severity of the initial infection. This is in large part due to <a href="https://www.sciencedirect.com/science/article/pii/S0277953620306456">strong patient advocacy</a>, showing that it can affect even those with mild initial symptoms. In demanding recognition of their condition, people with long COVID have cast a much-needed spotlight on post-infection syndromes more generally. Now is the time to improve our understanding, diagnosis and treatment of these conditions. Let’s not wait for another pandemic.<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/214995/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/giulia-vivaldi-1476903">Giulia Vivaldi</a>, , <a href="https://theconversation.com/institutions/queen-mary-university-of-london-1745">Queen Mary University of London</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/youve-heard-of-long-covid-but-did-you-know-there-might-also-be-a-long-cold-214995">original article</a>.

Body

Why do I crave sugar and carbs when I’m sick?

<a href="https://theconversation.com/profiles/hayley-oneill-1458016">Hayley O'Neill</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Your nose is running, your head hurts and you feel like you’re coming down with a cold. You’re settling in on the couch for a sick day. Then you reach for the snacks. When you’re sick, your appetite often decreases. So why, at other times, do you crave sugary treats and carbohydrate-loaded comfort foods? A food <a href="https://pubmed.ncbi.nlm.nih.gov/28375878/">craving</a> goes beyond a mere desire to eat, it encompasses a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7399671/#CR1">complex mix</a> of emotional, behavioural, cognitive and physiological processes. Whether it’s the need for a quick energy source or a temporary relief from discomfort, our bodies and minds work in tandem to drive our food preferences. Here we’ll explore the science behind why our bodies crave sugar and carbs – especially when we’re sick. <h2>Fuelling the immune system</h2> When sickness strikes, our immune system springs into action, requiring additional energy to combat invaders. This heightened activity often leads to an increase in our <a href="https://pubmed.ncbi.nlm.nih.gov/36505552/">metabolic rate</a>, energy demands and nutritional requirements. Sugary treats and carbs are quick sources of energy, satisfying this increased demand. But while a high sugar diet during times of illness may help meet increased metabolic demands, it could also exacerbate the immune and inflammatory response, potentially impeding recovery. In the longer term, high-sugar diets promote chronic <a href="https://pubmed.ncbi.nlm.nih.gov/33339337/">inflammation</a>, <a href="https://www.science.org/doi/10.1126/scitranslmed.aay6218?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">alter gut microbiota</a> composition, and are associated with chronic disease. For a <a href="https://www.mdpi.com/2072-6643/12/4/1181">well-functioning immune system</a>, aim for a <a href="https://www.who.int/news-room/fact-sheets/detail/healthy-diet">balanced intake</a> of <a href="https://pubmed.ncbi.nlm.nih.gov/31267783/">fruits, vegetables</a>, fibre, protein, and low-glycaemic carbohydrates. <h2>The stress response</h2> Being sick is stressful for the body. Acute mild or intense stress, like we’d see if we’re sick, boosts the “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5921333/">flight or fight</a>” hormones adrenaline and cortisol. This mobilises stored energy to meet increased demands, but it can also curb appetite. <a href="https://pubmed.ncbi.nlm.nih.gov/31125634/">Prolonged stress</a> can disrupt energy balance, and cause nutritional deficiencies and alterations in gut and brain functions. This can reduce a person’s threshold for craving sugar and salt, increasing their preferences towards energy-dense foods. The stress hormone cortisol can also increase your <a href="https://pubmed.ncbi.nlm.nih.gov/24123563/">preference</a> for high-calorie, comfort foods, which can <a href="https://pubmed.ncbi.nlm.nih.gov/36615866/">temporarily alleviate stress</a>. <h2>The brain’s reward system</h2> Comfort foods trigger your brain’s reward system, releasing feel-good neurotransmitters like <a href="https://pubmed.ncbi.nlm.nih.gov/30595479/">dopamine</a> and serotonin. But “<a href="https://pubmed.ncbi.nlm.nih.gov/30951762/">sugar rushes</a>” are often short-lived and can lead to decreased alertness and heightened fatigue within an hour of consumption. The link between carbohydrates (which the body converts to sugar) and serotonin can be traced back to 1971 when <a href="https://www.science.org/doi/10.1126/science.174.4013.1023?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">researchers</a> found elevated tryptophan levels (serotonin’s precursor) in rats’ plasma and brains after a carbohydrate-rich diet. Subsequent studies in humans established connections between carbohydrates and mood, especially in relation to <a href="https://pubmed.ncbi.nlm.nih.gov/2903717/">obesity, depression and seasonal affective disorder</a>. Therapies enhancing serotonin have since been shown to <a href="https://pubmed.ncbi.nlm.nih.gov/2903717/">reduce carbohydrate intake</a>. Remarkably, around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8911970/pdf/molecules-27-01680.pdf">90% of serotonin</a> production occurs in the gut. The vast microbial population in our gut exerts a potent influence on <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8106557/">immunity, metabolism</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8293578/pdf/40168_2021_Article_1093.pdf">appetite</a>. Recent mouse studies have even identified specific microbes linked to <a href="https://www.cell.com/current-biology/fulltext/S0960-9822(22)01750-X">sugar binges after antibiotic treatment</a>. <h2>Some people eat less when they’re sick</h2> Not everyone craves sugar and carbs when they are sick. Some people eat less for a few reasons: <ul> <li> they have less of an appetite. While <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5610818/pdf/JDR2017-4527980.pdf">ghrelin</a> (the “hunger” hormone) levels might initially rise, prolonged illness can suppress appetite due to nausea, fatigue and discomfort. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5921333/">Critically ill</a> patients have reduced food intake and are at risk of malnutrition </li> <li> <a href="https://pubmed.ncbi.nlm.nih.gov/30777142/">metabolic adaptation</a>. The body might slow specific metabolic processes to conserve energy, reducing overall calorie requirements </li> <li> altered taste perception. <a href="https://pubmed.ncbi.nlm.nih.gov/32195512/#:%7E:text=The%20ability%20of%20an%20individual%20to%20perceive%20tastes,intake%2C%20playing%20an%20important%20role%20in%20promoting%20satiation%2Fsatiety.">Taste</a> is an important component that affects both appetite and energy intake. Alterations in taste and smell is a common symptom when we are sick and was common with <a href="https://doi.org/10.1101/2020.04.05.20048421">COVID</a> </li> <li> consuming fluids like water, tea or broths might be more appealing and manageable than solid foods. These fluids provide hydration but contribute minimally to calorie intake.<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/210565/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> </li> </ul> <a href="https://theconversation.com/profiles/hayley-oneill-1458016">Hayley O'Neill</a>, Assistant Professor, Faculty of Health Sciences and Medicine, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/why-do-i-crave-sugar-and-carbs-when-im-sick-210565">original article</a>.

Body

Why we’re more prone to car-sickness when we set off on holiday

<a href="https://theconversation.com/profiles/william-emond-1431510">William Emond</a>, <a href="https://theconversation.com/institutions/universite-de-technologie-de-belfort-montbeliard-2637">Université de Technologie de Belfort-Montbéliard</a> Travel sickness isn’t just hearsay. Nearly <a href="https://www.autonomicneuroscience.com/article/S1566-0702(06)00212-8/fulltext">a third of people</a> experience motion sickness – and to this day we don’t exactly know what causes it. The prevailing theory suggests it is triggered by a <a href="https://onlinelibrary.wiley.com/doi/10.1111/cns.12468">poor perception of movement</a>. Departure to and return from summer holidays seem moments especially prone to this sickness’ stealthy advances. We (or at least those of us inclined to travel sickness) are more often ill during these particular journeys than during our normal comings and goings. Let’s note too that lots of travellers feel a sense of fatigue, drowsiness, apathy or lack of energy without having done any particularly exhausting activity. These are in fact symptoms of <a href="https://www.sciencedirect.com/science/article/abs/pii/S0094576598001532">mild motion sickness</a>, which show that many more people are affected by the condition than you’d think. Why this apparent heightened susceptibility during holiday trips? There are many reasons. Compared to normal travel, these journeys feature certain conditions, all with the potential to increase the incidence and severity of symptoms. Here are some pieces of explanation, and advice to minimise the risk. <h2>Long journeys – repetition of movements that make you queasy</h2> In a car, the further one travels, the more likely one is to feel ill, as shown by a number of <a href="https://journals.sagepub.com/doi/10.1243/0954407042580093">mathematical models which predict motion sickness</a>. It’s the adding up of unpleasant movements which takes us over the threshold where we feel symptoms. For certain people, this <a href="https://www.sciencedirect.com/science/article/abs/pii/S1566070206002128">can happen after just a few minutes</a>); for others it develops more slowly. Only on long journeys, after several hours on the road, in the air or on a boat, will this latter group be pushed over their limit and start feeling unwell. Activities undertaken to pass the time during a long journey could add to feelings of queasiness. Often people do something to occupy and entertain themselves: read a book, watch a film, play a video game or scroll through social media. Except, these visually stimulating activities absorb our attention to the point that we’re not tuned in to the visual cues that allows our brain to assess the movement of the vehicle. This creates a confusion in the perception of movement. As a result, it becomes <a href="https://www.sciencedirect.com/science/article/abs/pii/S0141938214000043?via%3Dihub">much easier to feel sick</a>. <h2>Journey conditions: risks adding up</h2> In summer, the temperature inside a vehicle is difficult to control, with the sun often imposing a stifling heat; conditions which <a href="https://www.ingentaconnect.com/content/asma/asem/2013/00000084/00000005/art00004">tend to accentuate the symptoms of motion sickness</a>. When it’s hot, <a href="https://theconversation.com/lesquels-de-nos-organes-sont-les-plus-menaces-par-la-canicule-119563">our body has to make an effort to regulate its temperature</a>, through sweat or breathing for example. These various signals amount to ‘primary symptoms’ as they can contribute to the appearance of other more substantive symptoms: dilation of the blood vessels, sickness, nausea or vomiting, as applicable. To counter these effects, one is tempted to switch the air conditioning on, which could itself, perversely, <a href="https://www.francetvinfo.fr/sante/environnement-et-sante/la-climatisation-rend-elle-malade_2885673.html">worsen the situation for passengers highly susceptible to motion sickness</a>. Ventilation and cabin air systems also push people toward their nausea thresholds. Unpleasant smells are another factor that can <a href="https://www.ingentaconnect.com/content/asma/asem/2013/00000084/00000005/art00004">accentuate car sickness symptoms</a>: traffic fumes, cigarette smoke, fetid air or even <a href="https://link.springer.com/article/10.1007/s00221-015-4209-9">the smell of leather</a> were identified as <a href="https://www.sciencedirect.com/science/article/pii/S1369847819306539">second most common cause of car sickness</a>! These are bigger risk factors at the start of holiday season, when <a href="https://www.francetvinfo.fr/economie/transports/trafic/vacances-les-vagues-de-departs-massifs-sont-associees-a-de-fortes-emissions-de-polluants_2839361.html">air pollution peaks regularly</a> and the sun’s rays heat up materials. It’s also known that there is a region of the brain – the area postrema or chemoreceptor trigger zone – which can trigger over-production of saliva and nausea specifically when certain smells are detected – a protective reflex against toxins and other poisonous substances. <h2>Traffic: a physical and mental imposition</h2> In a car, it isn’t speed that makes one ill but <a href="https://www.tandfonline.com/doi/abs/10.1080/001401399184730">changes in speed</a>, especially abrupt ones. Acceleration and breaking movements aggravate the human body, even more than turning corners. In practice, variations in speed are often forced on the driver by road design (speed limits, crossings, traffic lights), but also by the state of the traffic. A car stuck in jams will be forced to speed up and slow down at random intervals, <a href="https://www.researchgate.net/publication/366836220_Effect_of_Horizontal_Acceleration_and_Seat_Orientation_on_Motion_Sickness_in_Passenger_Cars">which grates, even at low speeds</a>. Traffic jams also have a psychological element. Delays to a journey (which might already have been very long), anxiousness about arriving at the arranged time, which is looking less and less likely, tiredness, stress and irritation can all cause the passengers’ mood to crash. It’s been observed that these factors <a href="https://journals.sagepub.com/doi/10.1177/0018720819876139">significantly impact the degree of motion sickness symptoms</a>. It would be better to take these setbacks calmly and stay in a relaxed frame of mind but that’s of course easier said than done. <h2>Some tips to limit the damage</h2> If you’re driving with passengers with a tendency to be car sick, or you’re susceptible yourself, some adjustments to your travel habits might help you. For the driver: <ul> <li> Take regular breaks. This allows passengers to take a breather, and to reduce to a significant extent or even get over their symptoms. Sometimes symptoms can take a while to disappear but <a href="https://content.iospress.com/articles/journal-of-vestibular-research/ves7-6-01">generally 15-30 minutes is enough</a>. </li> <li> Try to cut down the amount of hard acceleration and braking you do. Keep as far as possible to the same speed and adopt a smooth driving style, including when you overtake or brake. </li> <li> Avoid taking corners too sharply on winding roads. Passengers should be <a href="https://www.tandfonline.com/doi/abs/10.1080/00140139.2015.1109713">jolted in their seats as little as possible</a>. </li> </ul> For passengers <ul> <li> <a href="https://www.tandfonline.com/doi/abs/10.1080/001401399184730">Sit as far forward in the vehicle as possible</a>. Any movement while travelling is better absorbed by the body from this position. <a href="https://www.tandfonline.com/doi/abs/10.1080/00140139108964831">It’s in the driver’s seat that people are least affected by car sickness</a>, since one has control over the vehicle’s movement. </li> <li> Avoid looking at screens and other visual content (books, etc.), particularly when the vehicle isn’t moving at a constant speed. Instead, <a href="https://bpspsychub.onlinelibrary.wiley.com/doi/abs/10.1348/000712699161594">try and look forward out of the window</a>, towards the horizon. </li> <li> <a href="https://www.tandfonline.com/doi/abs/10.1080/00140139.2015.1109713">Shut your eyes</a> or <a href="https://psycnet.apa.org/record/1976-12574-000">try to sleep</a>. Slowing down activity soothes the body. </li> <li> <a href="https://link.springer.com/chapter/10.1007/978-3-030-27928-8_26">Tilt your seat back</a>. This allows you to be less destabilised by the vehicle’s movements </li> <li> Go for car games with the other passengers if you get bored: play “I Spy”, <a href="https://theses.gla.ac.uk/80069/1/13905209.pdf">sing songs</a>, count cars of a particular colour or make, and other old favourites of proven effectiveness to help pass the time and, above all, <a href="http://iospress.com/articles/journal-of-vestibular-research/ves00541">take your attention away from the queasiness</a>. The emergence and disappearance of symptoms is mainly a psychological phenomenon. </li> </ul> Finally, given the role of the mind in car sickness symptoms, note that passengers experiencing queasiness can feel better with a placebo (something with no proven medicinal value but presented to them as a magic cure). Simple tips <a href="https://academic.oup.com/jtm/article/5/2/89/1801039">have been shown to be particularly effective</a>. For example, <a href="https://link.springer.com/article/10.1007/s00221-021-06303-5">offering a sweet, a piece of chewing gum</a>, <a href="https://link.springer.com/article/10.1007/s00221-017-5009-1">a sip of water or a breath of fresh air</a> while talking up their effectiveness will give your fellow travellers a little boost. We wish you happy travels, hoping your journey conditions are as good as they can be. <hr /> Translation from French to English by <a href="https://twitter.com/JoshNeicho">Joshua Neicho</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/210338/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/william-emond-1431510">William Emond</a>, Doctorant en mal des transports (PhD Student on carsickness mitigation), <a href="https://theconversation.com/institutions/universite-de-technologie-de-belfort-montbeliard-2637">Université de Technologie de Belfort-Montbéliard</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-were-more-prone-to-car-sickness-when-we-set-off-on-holiday-210338">original article</a>.

Travel Tips

Sickness or health: Healthy life split along gender, education lines

Australians are living and working longer than ever, but the number of healthy years they’re enjoying with this added longevity isn’t shared equally between the sexes, or by those who finished school before Year 12. <div class="copy"> A paper recently <a href="https://doi.org/10.1016/S2468-2667(23)00129-9" target="_blank" rel="noreferrer noopener" data-type="URL" data-id="https://doi.org/10.1016/S2468-2667(23)00129-9">published</a> in The Lancet Public Health from the Ageing Futures Institute at the University of New South Wales shows an increase in longevity in Australia. Other data in the publication reveal detail about “healthy years”. Men, and those with higher levels of education, worked about 2 years longer in good health. For women and those with lower education, the years of healthy life expectancy have gone backwards. The report, led by statistician Dr Kim Kiely who is now based at The University of Wollongong, compared representative cohorts of people aged 50-100 who participated in the Household Income and Labour Dynamics in Australia survey (HILDA). Those cohorts were measured over decade long periods – the first from 2001-2010 and the second from 2011-2020. Men added an extra 11 months of healthy life between the cohorts, while women lost a month. Similarly those of any gender who had completed year 12 added about 10 months to their healthy life expectancy, while the same amount of time was lost by those who hadn’t. “Everyone’s increasing their working life expectancy, so the years they’re expected to be working,” Kiely says. “What is different is how long they’re expected to be living in good health: women and people with low education didn’t have an improvement in healthy life expectancy. “Everyone’s also living longer than ever before, but for women, those extra years seem to be years of poor health. People with lower education – they end up going backwards, they’re losing years of healthy life.” Australia’s working life trends are similar to those in Europe and the UK, though this research suggests the Australian labour force works longer in poor health than their antipodean counterparts. Kiely says the findings are important considerations for policymakers pondering questions of retirement and pension ages: the demands of some labour may not be evenly spread when it comes to considering health implications. “We have a pension age that has been rising steadily over the past couple of decades – it’s not rising anymore – but there is a strong expectation for people to be working longer,” Kiely says. “And if that is the case, then we need opportunities for work for mature age, older adults, and those work opportunities have to be suitable for their capacity to work. “We do need to address things like age and gender discrimination in the workforce. And we need to think about how we support people who are unable to work before they reach the pension age.” Kiely is extending his research into how the nature of work in Australia influences these high-level findings. He hopes this can explain why gender and education influence healthy working years. Further drilling down into other subgroups is important, say Dr Marty Lynch and Dr Ross Wilkie from Keele University, UK. They investigated healthy working life expectancy as part of Britain’s Independent State Pension Age Review last year. They too found Briton were working longer, but not at a rate that keeps pace with the national pension age. In a Lancet editorial accompanying the Australian research, they point out that the HILDA data evaluation only shows changes in average ages on gender and education lines. “The extent of HWLE [Healthy Working Life Expectancy] inequalities between subpopulations with multiple specific characteristics are likely to be even wider and will also indicate targets and interventions to increase the number of years that people can be healthy and in work,” they say. The impact of socioeconomic status on life expectancy and disease burden was recently highlighted in a large-scale review of Australia’s 30-year health data. <a href="https://cosmosmagazine.com/people/society/australias-life-expectancy-is-up-but-healthy-years-are-a-different-story/">It found</a> while Australians have added 6 years to their life expectancy since 1990, those with lower socioeconomic backgrounds had a higher risk of death-causing disease. Image credits: Getty Images <a href="https://cosmosmagazine.com/people/society/sickness-or-health-healthy-life-split-along-gender-education-lines/">This article</a> was originally published on <a href="https://cosmosmagazine.com">Cosmos Magazine</a> and was written by <a href="null">Cosmos</a>. </div>

Retirement Life

What happens in our body when we encounter and fight off a virus like the flu, SARS-CoV-2 or RSV?

<a href="https://theconversation.com/profiles/lara-herrero-1166059">Lara Herrero</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> and <a href="https://theconversation.com/profiles/wesley-freppel-1408971">Wesley Freppel</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> <a href="https://www.labcorp.com/coronavirus-disease-covid-19/covid-news-education/covid-19-vs-flu-vs-rsv-how-tell-difference">Respiratory viruses</a> like influenza virus (flu), SARS-CoV-2 (which causes COVID) and respiratory syncytial virus (RSV) can make us sick by infecting our respiratory system, including the nose, upper airways and lungs. They spread from person to person through respiratory droplets when someone coughs, sneezes, or talks and can cause death in serious cases. But what happens in our body when we first encounter these viruses? Our immune system uses a number of strategies to fight off viral infections. Let’s look at how it does this. <h2>First line of defence</h2> When we encounter respiratory viruses, the <a href="https://www.sciencedirect.com/science/article/pii/S193131281600038X?via%3Dihub/">first line of defence</a> is the physical and chemical barriers in our nose, upper airways, and lungs. Barriers like the mucus lining and hair-like structures on the surface of cells, work together to trap and remove viruses before they can reach deeper into our respiratory system. Our defence also includes our behaviours such as coughing or sneezing. When we blow our nose, the mucus, viruses, and any other pathogens that are caught within it are expelled. But sometimes, viruses manage to evade these initial barriers and sneak into our respiratory system. This activates the cells of our innate immune system. <h2>Patrolling for potential invaders</h2> While our acquired immune system develops over time, our innate immune system is present at birth. It generates “non-specific” immunity by identifying what’s foreign. The cells of innate immunity act like a patrol system, searching for any invaders. These innate cells patrol almost every part of our body, from our skin to our nose, lungs and even internal organs. Our respiratory system has different type of innate cells such – as macrophages, neutrophils and natural killer cells – which patrol in our body looking for intruders. If they recognise anything foreign, in this case a virus, they will initiate an attack response. Each cell type plays a slightly different role. Macrophages, for example, will not only engulf and digest viruses (phagocytosis) but also release a cocktail of different molecules (cytokines) that will warn and recruit other cells to <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/cmi.12580">fight against the danger</a>. In the meantime, natural killer cells, aptly named, attack infected cells, and stop viruses from multiplying and <a href="https://www.nature.com/articles/s41577-021-00558-3">invading our body further</a>. Natural killer cells also promote inflammation, a <a href="https://www.hindawi.com/journals/jir/2018/1467538/">crucial part of the immune response</a>. It helps to recruit more immune cells to the site of infection, enhances blood flow, and increases the permeability of blood vessels, allowing immune cells to reach the infected tissues. At this stage, our immune system is fighting a war against viruses and the result can cause inflammation, fevers, coughs and congestion. <h2>Launching a specific attack</h2> As the innate immune response begins, another branch of the immune system called the adaptive immune system is <a href="https://www.ncbi.nlm.nih.gov/books/NBK21070/">activated</a>. The adaptive immune system is more specific than the innate immune system, and it decides on the correct tools and strategy to fight off the viral invaders. This system plays a vital role in eliminating the virus and providing long-term protection against future infections. Specialised cells called T cells and B cells are key players in acquired immunity. T cells (specifically, helper T cells and cytotoxic T cells) recognise viral proteins on the surface of infected cells: <ul> <li> helper T cells release molecules that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3764486/">further activate immune cells</a> </li> <li> cytotoxic T cells directly kill infected cells with a very great precision, <a href="https://www.frontiersin.org/articles/10.3389/fimmu.2018.00678/full">avoiding any healthy cells around</a>. </li> </ul> B cells produce antibodies, which are proteins that can bind to viruses, neutralise them, and mark them for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247032/">destruction by other immune cells</a>. B cells are a critical part of memory in our immune system. They will remember what happened and won’t forget for years. When the same virus attacks again, B cells will be ready to fight it off and will neutralise it faster and better. Thanks to the adaptive immune system, vaccines for respiratory viruses such as the COVID mRNA vaccine keep us protected from <a href="https://www.health.gov.au/our-work/covid-19-vaccines/our-vaccines/how-they-work">being sick or severely ill</a>. However, if the same virus became mutated, our immune system will act as if it was a new virus and will have to fight in a war again. <h2>Neutralising the threat</h2> As the immune response progresses, the combined efforts of the innate and adaptive immune systems helps control the virus. Infected cells are cleared, and the virus is neutralised and eliminated from the body. As the infection subsides, symptoms gradually improve, and we begin to feel better and to recover. But recovery varies depending on the specific virus and us as individuals. Some respiratory viruses, like rhinoviruses which cause the common cold, may cause relatively mild symptoms and a quick recovery. Others, like the flu, SARS-CoV-2 or severe cases of RSV, may lead to more severe symptoms and a longer recovery time. Some viruses are very strong and too fast sometimes so that our immune system does not have the time to develop a proper immune response to fight them off. <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/207023/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/lara-herrero-1166059">Lara Herrero</a>, Research Leader in Virology and Infectious Disease, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> and <a href="https://theconversation.com/profiles/wesley-freppel-1408971">Wesley Freppel</a>, Research Fellow, Institute for Glycomics, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-happens-in-our-body-when-we-encounter-and-fight-off-a-virus-like-the-flu-sars-cov-2-or-rsv-207023">original article</a>.

Body

“My heart is breaking”: The Wiggles perform for dying young fan

The Wiggles have made a young girl’s dreams come true, as they stood by her and performed just hours before she died. Purple Wiggle Lachlan Gillespie, new Blue Wiggle Lucia Field, and Dorothy the Dinosaur visited young Zahra’s bedside in Westmead Children’s Hospital, just before she passed away last month to perform a sweet rendition of Twinkle Twinkle. Earlier this week, Zahra’s mum posted the sweet video on TikTok, while sharing the story of how Zahra was diagnosed with Leigh syndrome, a rare neurometabolic disorder that affects the central nervous system. “On Zahra’s last day, she got a special visit from her fav Wiggles,” Zahra’s mum wrote in the video shared on her TikTok account. <div class="embed" style="font-size: 16px; box-sizing: inherit; margin: 0px; padding: 0px; border: 0px; vertical-align: baseline; outline: none !important;"><iframe class="embedly-embed" style="box-sizing: inherit; margin: 0px; padding: 0px; border-width: 0px; vertical-align: baseline; width: 611px; max-width: 100%; outline: none !important;" title="tiktok embed" src="https://cdn.embedly.com/widgets/media.html?src=https%3A%2F%2Fwww.tiktok.com%2Fembed%2Fv2%2F7254527205701733633&display_name=tiktok&url=https%3A%2F%2Fwww.tiktok.com%2F%40keish_el%2Fvideo%2F7254527205701733633&image=https%3A%2F%2Fp16-sign-sg.tiktokcdn.com%2Fobj%2Ftos-alisg-p-0037%2FoACeAheW25teaIoFQJHPEC2YgpcNAKrzDgaksj%3Fx-expires%3D1689325200%26x-signature%3D8aPR7s6As4g3eiheXA%252B7PmnZSBk%253D&key=59e3ae3acaa649a5a98672932445e203&type=text%2Fhtml&schema=tiktok" width="340" height="700" frameborder="0" scrolling="no" allowfullscreen="allowfullscreen"></iframe></div> In the caption, she added, “This day was so special to us, Zahra was obsessed with the Wiggles and for them to come and see her is a memory we will never forget.” She went on to say that on her last day on earth, her doctors and parents gave her “one full day” off the tube where she got to do “all her favourite things with family and friends”, including the Wiggles. Lucia, who is the daughter of original Blue Wiggle Anthony Field, commented, “Lachy and I were so grateful to have met your beautiful family. May your beautiful little girl be happily resting”. The video has racked up over two million views, with many sharing their condolences for the grieving family. One user said, “I can't handle it. I'm so sorry… my heart breaks for you.” Another emotional viewer wrote, “RIP you little angel, you have earned your wings.” One person wrote that they were praying for Zahra and her family, and her grieving mother responded, “Thank you so much for those prayers. I know they would have kept her with us for as long as she could.” Image credits: TikTok

Caring

6 habits of people who don’t get sick

Winter is a dangerous time. Although cold temperatures themselves don’t cause us to get sick, our winter habits invite the spread of germs and risk of contagion is high. If you find yourself sick every winter, here are some useful habits of those healthy people to take up. 1. They get enough sleep It’s easy to experience disrupted sleep during winter. When air is too cold, it will negatively affect melatonin production and cause the body's sleep cycle to be disrupted. However, research shows that people who sleep only five to six hours a night have a 30 per cent chance of catching a cold when exposed to the virus; those who get more than seven hours reduce their risk to 17 per cent. 2. They pay extra attention to hygiene With more germs in the air, now is the time to stay conscious about where they may be festering. Key areas include bathroom door handles, taps, fridges, elevator buttons and public transport. Keep antibacterial wipes on you so whenever you touch a high risk surface, you can cleanse you hand before eating, or touching your face and eyes. 3. They exercise regularly Winter is notorious for zapping our work-out motivation. However, exercise strengthens the immune system and makes you less likely to catch upper respiratory infections. 4. The get their flu shot Flu shots, approved for all adults, are effective 50 to 60 per cent of the time in preventing the flu and may also reduce the severity of symptoms. 5. They don’t smoke Cigarette smoke appears to damage the mucus membranes, which act as the frontline barrier to infectious agents, making smokers twice as likely to catch a cold and several times more likely to develop the flu. 6. They enjoy a drink Harvard University School of Public Health researchers found that red wine was particularly protective against colds, probably due to the anti-inflammatory action of the phenol, resveratrol. Just keep in mind that drinking more than two glasses a day raises the risk for infections. Image credit: Shutterstock

Body

Why does my back get so sore when I’m sick? The connection between immunity and pain

<a href="https://theconversation.com/profiles/joshua-pate-1399299">Joshua Pate</a>, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> and <a href="https://theconversation.com/profiles/mark-hutchinson-105409">Mark Hutchinson</a>, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a> Have you ever wondered why your back aches when you’re down with the flu or a cold? Or COVID? This discomfort, common during many illnesses, is not just a random symptom. It’s a result of complex interactions between your immune system and your brain called the “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3314453/">neuroimmune synapse</a>”. A fascinating and yet-to-be-understood consequence of this conversation between the immune and brain systems during sickness is that it is particularly noticeable in the <a href="https://academic.oup.com/brain/article/145/3/1098/6370954">lower back</a>. This is thought to be one of the body’s most sensitive regions to neuroimmune threats. <h2>Immunology basics</h2> Our immune system is a double-edged sword. Yes, it fights off infections for us – but it also makes us acutely aware of the job it is doing. When our body detects an infection, our immune system releases molecules including signalling proteins called <a href="https://www.researchgate.net/publication/227831648_The_functions_of_cytokines_and_their_uses_in_toxicology">cytokines</a>. These proteins coordinate our immune system to fight off the infection and talk to our brain and spinal cord to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2740752/#:%7E:text=Production%20of%20proinflammatory%20cytokines%20induces,to%20depression%20in%20vulnerable%20individuals.">change our behaviour</a> and physiology. This can result in symptoms like fatigue, loss of appetite, fever and increased sensitivity to pain. Classically, we think of this as a beneficial behavioural change to help us conserve energy to fight off the infection. It’s why we often feel the need to rest and withdraw from our usual activities when we’re sick – and also why we are grumpier than usual. <h2>Invisibly small changes</h2> Part of this self-protective response is a change in how we perceive threats, including sensory stimuli. When we are sick, touch can become painful and muscles can ache. Many changes in behaviour and sensory systems are <a href="https://doi.org/10.1159/000521476">believed</a> to have origins at the nanoscale. When molecular changes occur in part of the brain linked to cognition or mood, we think and feel differently. If these neuroimmune synapse changes happen in the sensory processing regions of the brain and spinal cord, we feel more pain. Such sensory changes, known as <a href="https://www.iasp-pain.org/resources/fact-sheets/allodynia-and-hyperalgesia-in-neuropathic-pain/#:%7E:text=Allodynia%20is%20pain%20due%20to,stimulus%20that%20normally%20provokes%20pain.">allodynia and hyperalgesia</a>, can lead to heightened pain sensitivity, even in areas not directly affected by the infection – <a href="https://www.sciencedirect.com/science/article/abs/pii/S0889159114001731?via%3Dihub">such as the lower back</a>. <h2>Immune memories</h2> This immune response happens with a range of bacterial infections and viruses like COVID or the flu. In fact, the sick feeling we sometimes get after a vaccination is the good work our immune system is doing to contribute to <a href="https://theconversation.com/you-cant-get-influenza-from-a-flu-shot-heres-how-it-works-118916">a protective immune memory</a>. Some of that immune-cellular conversation also alerts our brains that we are sick, or makes us think we are. After some viral infections, the sick feeling persists longer than the virus. We are seeing a long-term response to COVID in some people, termed <a href="https://theconversation.com/when-does-covid-become-long-covid-and-whats-happening-in-the-body-when-symptoms-persist-heres-what-weve-learnt-so-far-188976">long COVID</a>. Women, who generally have a <a href="https://www.nature.com/articles/nri.2016.90">stronger immune response</a> than men, may be more likely to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7937378/">experience pain symptoms</a>. Their heightened immune response (while beneficial in resisting infections) also predisposes women to a higher risk of inflammatory conditions like <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7980266/">autoimmune diseases</a>. <h2>When to worry and what to do</h2> If the pain is severe, persistent, or accompanied by other concerning symptoms, seek medical attention. Mild to moderate pain is a common symptom during illness and we often notice this in the lower back. The good news is it usually subsides as the infection clears and the sickness resolves. While treating the underlying infection is crucial, there are also ways to dial down sickness-induced neuroimmune pain. Maintaining a diverse microbiome (the collection of microorganisms living in and on your body) by <a href="https://pubmed.ncbi.nlm.nih.gov/31704402/">eating well and getting outside</a> can help. Getting quality sleep, staying hydrated and minimising inflammation <a href="https://karger.com/bbe/article/97/3-4/197/821576/Sickness-and-the-Social-Brain-How-the-Immune">helps too</a>. Amazingly, there is <a href="https://pubmed.ncbi.nlm.nih.gov/34404209/">research</a> suggesting your grandmother’s traditional chicken broth recipe decreases the immune signals at the neuroimmune synapse. Scientists are also <a href="https://pubmed.ncbi.nlm.nih.gov/24799686/">showing</a> mindfulness meditation, cold water therapy and controlled breathing can drive profound cellular and molecular changes to help activate bodily systems like the autonomic nervous system and alter the immune response. These practices might not only help manage pain but also add an anti-inflammatory component to the immune response, reducing the severity and duration of sickness. Heat treatment (with a pack or hot water bottle) might <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8401625/">provide some relief</a> due to increased circulation. Over-the-counter pain relief maybe also be helpful but seek advice if you are taking other medications. <h2>All in the mind?</h2> Is this all mind over matter? A little of yes and a lot of no. The little of yes comes from <a href="https://pubmed.ncbi.nlm.nih.gov/26194270/">research</a> supporting the idea that if you expect your breathing, meditation and cold bath therapy to work, it may well make a difference at the cellular and molecular level. But by understanding the mechanisms of back pain during illness and by using some simple strategies, there is hope to manage this pain effectively. Always remember to seek medical help if your symptoms are severe or persist longer than expected. Your health and comfort are paramount.<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/207222/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/joshua-pate-1399299">Joshua Pate</a>, Senior Lecturer in Physiotherapy, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> and <a href="https://theconversation.com/profiles/mark-hutchinson-105409">Mark Hutchinson</a>, Professor, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/why-does-my-back-get-so-sore-when-im-sick-the-connection-between-immunity-and-pain-207222">original article</a>.

Caring

Breaking the mould: why rental properties are more likely to be mouldy and what’s needed to stop people getting sick

<a href="https://theconversation.com/profiles/rebecca-bentley-173502">Rebecca Bentley</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a>; <a href="https://theconversation.com/profiles/nicola-willand-441807">Nicola Willand</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>, and <a href="https://theconversation.com/profiles/tim-law-1438482">Tim Law</a> Rental properties are more <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8835129/">likely be mouldy</a> than other homes. This is a concern as excessive mould growth is known to <a href="https://www.who.int/publications/i/item/9789289041683">harm human health</a>. Once buildings are infested with mould, the difficult and costly issue of remediation arises. Landlords and tenants are caught in the middle of a tussle over who is responsible for fixing the problem. As one Melbourne renter and research participant told our colleague Maria Gatto, during a study validating mould reporting: <blockquote> The landlord came around [and] walked [into] every room where there’s black mould on the ceiling – like it’s freaking [something out of the TV series] Stranger Things – and she’s like, ‘Oh, a little bit of mould in winter, it’s very normal, it’s fine […] this happens every winter, it’s not a big deal’. </blockquote> Heading into winter, after <a href="https://theconversation.com/la-nina-3-years-in-a-row-a-climate-scientist-on-what-flood-weary-australians-can-expect-this-summer-190542">three consecutive La Niñas</a>, <a href="https://theconversation.com/sudden-mould-outbreak-after-all-this-rain-youre-not-alone-but-you-are-at-risk-177820">conditions are ripe</a> for a mega-mould season. Combining our expertise in health, law, building and construction, we examine the problem of mould in homes and offer guidance for both renters and landlords. <h2>Ideal conditions for growth</h2> Mould is a <a href="https://www.cdc.gov/niosh/topics/indoorenv/whatismold.html">fungal growth</a> that reproduces via tiny airborne particles called spores. When these spores settle on moist, plant-based construction materials such as wood, wallpaper or plasterboard, they can form a new colony. Growth is more likely when homes are cold, humid, lack air flow, or suffer from water damage. Outbreaks have been reported in flooded parts of southeastern Australia. <figure><iframe src="https://www.youtube.com/embed/sD2Ij_QlzwA?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Black mould an invisible threat growing behind walls of flood-affected homes (ABC News)</figcaption></figure> So why is the problem of household mould worse in rentals? <a href="https://www.ahuri.edu.au/research/final-reports/338">Weak regulation of tenancy legislation</a> is just one of many factors. Rental properties tend to be poorly maintained, with <a href="https://www.ahuri.edu.au/research/final-reports/338">structural problems</a> such as leaks. Given this, they can be expensive to heat. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/526246/original/file-20230515-19465-odirz2.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/526246/original/file-20230515-19465-odirz2.png?ixlib=rb-1.1.0&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/526246/original/file-20230515-19465-odirz2.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=422&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526246/original/file-20230515-19465-odirz2.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=422&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526246/original/file-20230515-19465-odirz2.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=422&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526246/original/file-20230515-19465-odirz2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=531&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526246/original/file-20230515-19465-odirz2.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=531&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526246/original/file-20230515-19465-odirz2.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=531&fit=crop&dpr=3 2262w" alt="A chart showing the percentage of homes with structural defects in each category" /></a><figcaption>Rental homes have more structural defects than owner-occupied homes. <a class="source" href="https://www.ahuri.edu.au/research/final-reports/338">Nicola Willand, using data from Moore et. al., (2020), Warm, cool and energy-affordable housing policy solutions for low-income renters, AHURI Final Report, vol. no. 338. Appendix 2</a>, Author provided</figcaption></figure> <h2>How mould makes people sick</h2> The <a href="https://www.who.int/publications/i/item/9789289041683">World Health Organization</a> recognises mould can be harmful. A 2022 Asthma Australia <a href="https://asthma.org.au/what-we-do/advocacy/housing/">report</a> revealed people living in mouldy homes were more likely to have asthma and allergies. A systematic review of peer-reviewed research found <a href="https://erj.ersjournals.com/content/38/4/812">children living in mouldy homes</a> were more likely to experience asthma, wheeze and allergic irritation of the eyes, nose, throat and mouth (allergic rhinitis). Living with mould is a source of stress. People worry about the consequences for their health and there is a growing body of evidence describing the <a href="https://jech.bmj.com/content/50/1/56">negative mental health effects</a> of mouldy, damp homes. <h2>Problems with managing mould in the rental sector</h2> There is a gap between building and residential tenancies legislation. A building deemed to meet the minimum standards of the construction code with respect to mould may not meet the minimum standards for rental. That’s because there’s ambiguity in the <a href="https://ncc.abcb.gov.au/">National Construction Code</a> around “minimum standards of health”. For example the Victorian <a href="https://www.legislation.vic.gov.au/in-force/acts/building-act-1993/136">Building Act 1993</a> contains some provisions for the relevant surveyor to serve a notice on the basis of a health circumstance affecting a user. However, there is no guidance on how to assess the health of the indoor environment, or to deliver a building direction that will address the root cause for mould. This varies by state and territory. Mould remediation can be costly. A <a href="https://www.vba.vic.gov.au/about/research/examining-indoor-mould-and-moisture-damage-in-victorian-residential-buildings">study</a> by Victoria University found half the defects causing mould were water-related. These were more expensive to fix than other problems, by an average of A$7,000. Each winter, <a href="https://tenantsvic.org.au/advice/common-problems/mould-and-damp/">Tenants Victoria</a> deals with a spike in renters seeking legal help to resolve their mould problems. This led to the service launching an annual winter Mould Clinic in 2021. Despite increased legal protections, renters are still struggling to get mould fixed. For these reasons, many renters find the legal process doesn’t offer a solution to their problem, and instead move to a new property, with all its attendant costs and stresses. Others can’t afford to leave, or live in social housing with limited transfer options. <h2>Charting mould in homes across Australia</h2> <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/525848/original/file-20230512-21-xb83ft.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/525848/original/file-20230512-21-xb83ft.jpg?ixlib=rb-1.1.0&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/525848/original/file-20230512-21-xb83ft.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525848/original/file-20230512-21-xb83ft.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525848/original/file-20230512-21-xb83ft.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525848/original/file-20230512-21-xb83ft.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525848/original/file-20230512-21-xb83ft.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525848/original/file-20230512-21-xb83ft.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" alt="A bar chart comparing the prevalence of mould in homes across Australian states and territories" /></a><figcaption>Mould is more prevalent in rentals compared to owner-occupied dwellings. Mould is most commonly reported in New South Wales. The difference between owners and renters is greatest in the ACT. Australian Housing Conditions Dataset 2022 doi:10.26193/SLCU9J, Author provided</figcaption></figure> <h2>Where does the responsibility lie?</h2> Tenancy legislation varies by state and territory. Renters should familiarise themselves with the regulations in their jurisdiction. In Victoria, <a href="https://www.legislation.vic.gov.au/in-force/acts/residential-tenancies-act-1997/101">residential tenancies legislation</a> has set the criteria that “each room in the rented premises must be free from mould and damp caused by or related to the building structure”. Landlords now must disclose if they have treated mould in the past three years. Similarly, <a href="https://www.rta.qld.gov.au/rental-law-changes">new legislation in Queensland</a> (coming into effect in September) states rental properties should be free from vermin, damp and mould where this is caused by issues with the structural soundness of the property. In New South Wales, the landlord needs to <a href="https://www.fairtrading.nsw.gov.au/housing-and-property/renting/during-a-tenancy/health,-safety-and-security">disclose signs of mould</a> and dampness in the condition report (but not necessarily have fixed it). Mould is not mentioned in the <a href="https://www.legislation.act.gov.au/a/1997-84/">ACT residential tenancies legislation</a>. For the most part, the responsibility for mould in rental properties lies with landlords if the cause is structural –- for example, if a broken or faulty window frame has let rainwater inside. Requests for urgent repairs can be accompanied by an assessment report by an occupational hygienist, environmental health professional or expert from the local council. People with an existing health condition such as asthma can include a doctor’s report. <h2>What next?</h2> To achieve change across all relevant domains of regulation, construction, natural disaster response and government policy, we need a sustainable, broad healthy <a href="https://www.healthyhousing-cre.org">housing agenda in Australia</a>. We also need to consider options for immediate action. As one Victorian renter noted: <blockquote> When we buy a car for the purpose of driving on the roads, we’re required to get a roadworthy certificate to make sure it’s safe, because of the risk to other people […] Ideally it would be great if there was [some] kind of ‘rentworthy’ certificate […] to demonstrate that the property has been inspected, to identify any structural issues that might affect the tenant’s health and wellbeing. And that that be available to tenants […] before they enter into a lease or before (the property is) even able to be advertised. </blockquote> Quotes in this article were collected by Maria Gatto as part of her Masters of Public Health, conducted at the Melbourne School of Population and Global Health in 2022.<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/205472/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/rebecca-bentley-173502">Rebecca Bentley</a>, Professor of Social Epidemiology and Director of the Centre of Research Excellence in Healthy Housing at the Melbourne School of Population and Global Health, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a>; <a href="https://theconversation.com/profiles/nicola-willand-441807">Nicola Willand</a>, Senior Lecturer, School of Property, Construction and Project Management, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>, and <a href="https://theconversation.com/profiles/tim-law-1438482">Tim Law</a>, Guest lecturer and Practice Lead — Building Sciences, at Restoration Industry Consultants Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/breaking-the-mould-why-rental-properties-are-more-likely-to-be-mouldy-and-whats-needed-to-stop-people-getting-sick-205472">original article</a>.

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