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Why do I need to take some medicines with food?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/mary-bushell-919262">Mary Bushell</a>, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a> Have you ever been instructed to take your medicine with food and wondered why? Perhaps you’ve wondered if you really need to? There are varied reasons, and sometimes complex science and chemistry, behind why you may be advised to take a medicine with food. To complicate matters, some similar medicines need to be taken differently. The antibiotic amoxicillin with clavulanic acid (sold as Amoxil Duo Forte), for example, is recommended to be taken with food, while amoxicillin alone (sold as Amoxil), can be taken with or without food. Different brands of the same medicine may also have different recommendations when it comes to taking it with food. <h2>Food impacts drug absorption</h2> Food can affect how fast and how much a drug is absorbed into the body in up to <a href="https://academic.oup.com/jpp/article-abstract/71/4/510/6122024?login=false">40% of medicines</a> taken orally. When you have food in your stomach, the makeup of the digestive juices change. This includes things like the fluid volume, thickness, pH (which becomes less acidic with food), surface tension, movement and how much salt is in your bile. These changes can impair or enhance drug absorption. Eating a meal also delays how fast the contents of the stomach move into the small intestine – this is known as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9505616/">gastric emptying</a>. The small intestine has a large surface area and rich blood supply – and this is the primary site of drug absorption. Eating a larger meal, or one with lots of fibre, delays gastric emptying more than a smaller meal. Sometimes, health professionals will advise you to take a medicine with food, to help your body absorb the drug more slowly. But if a drug can be taken with or without food – such as paracetamol – and you want it to work faster, take it on an empty stomach. <h2>Food can make medicines more tolerable</h2> Have you ever taken a medicine on an empty stomach and felt nauseated soon after? Some medicines can cause stomach upsets. Metformin, for example, is a drug that reduces blood glucose and treats type 2 diabetes and polycystic ovary syndrome. It commonly causes gastrointestinal symptoms, with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4452716/">one in four users affected</a>. To combat these side effects, it is generally recommended to be taken with food. The same <a href="https://amhonline.amh.net.au/auth">advice</a> is given for corticosteroids (such as prednisolone/prednisone) and certain antibiotics (such as doxycycline). Taking some medicines with food makes them more tolerable and improves the chance you’ll take it for the duration it’s prescribed. <h2>Can food make medicines safer?</h2> Ibuprofen is one of the most widely used over-the-counter medicines, with around one in five Australians reporting use <a href="https://www.abs.gov.au/statistics/health/health-conditions-and-risks/medications/latest-release">within a two-week period</a>. While effective for pain and inflammation, ibuprofen can impact the stomach by inhibiting protective prostaglandins, increasing the risk of <a href="https://www.tandfonline.com/doi/full/10.1586/14737175.6.11.1643#d1e212">bleeding, ulceration and perforation</a> with long-term use. But there <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4574824/">isn’t enough research</a> to show taking ibuprofen with food reduces this risk. Prolonged use may also affect kidney function, particularly in those with pre-existing conditions or dehydration. The <a href="https://amhonline.amh.net.au/auth">Australian Medicines Handbook</a>, which guides prescribers about medicine usage and dosage, advises taking ibuprofen (sold as Nurofen and Advil) with a glass of water – or with a meal if it upsets your stomach. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4574824/">A systematic review published in 2015</a> found food delays the transit of ibuprofen to the small intestine and absorption, which delays therapeutic effect and the time before pain relief. It also found taking short courses of ibuprofen without food reduced the need for additional doses. To reduce the risk of ibuprofen causing damage to your stomach or kidneys, use the lowest effective dose for the shortest duration, stay hydrated and avoid taking other <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/medications-non-steroidal-anti-inflammatory-drugs">non-steroidal anti-inflammatory medicines</a> at the same time. For people who use ibuprofen for prolonged periods and are at higher risk of gastrointestinal side effects (such as people with a history of ulcers or older adults), your prescriber may start you on a <a href="https://australianprescriber.tg.org.au/articles/peptic-ulcer-disease-and-non-steroidal-anti-inflammatory-drugs.html">proton pump inhibitor</a>, a medicine that reduces stomach acid and protects the stomach lining. <h2>How much food do you need?</h2> When you need to take a medicine with food, how much is enough? Sometimes a full glass of milk or a couple of crackers may be enough, for medicines such as prednisone/prednisolone. However, most head-to-head studies that compare the effects of a medicine “with food” and without, usually use a heavy meal to define “with food”. So, a cracker may not be enough, particularly for those with a sensitive stomach. A more substantial meal that includes a mix of fat, protein and carbohydrates is generally advised. Your health professional can advise you on which of your medicines need to be taken with food and how they interact with your digestive system.<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/235782/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/mary-bushell-919262">Mary Bushell</a>, Clinical Associate Professor in Pharmacy, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/why-do-i-need-to-take-some-medicines-with-food-235782">original article</a>. </div>

Body

"I don't call that a life": Couple sign up to die in double suicide pod

Warning: This article contains sensitive content that some readers may find distressing. A couple from the UK has signed up to be the first to die in a double suicide pod, invented by an Australian doctor, after 46 years of marriage. Peter and Christine Scott, from Suffolk in England’s east, have shared their plans to travel to Switzerland to die together after Ms Scott, a former nurse, was diagnosed with early-stage vascular dementia. After meeting at a jazz club, the pair married 46 years ago, and shared that they have opted out of potentially years of hospital treatment and the crippling costs of care which could eat into their life savings. “We have had long, happy, healthy, fulfilled lives but here we are in old age and it does not do nice things to you,” Mr Scott, 86, told<a title="www.dailymail.co.uk" href="https://www.dailymail.co.uk/news/article-13825105/Former-RAF-engineer-nurse-wife-sign-British-couple-use-double-suicide-pod-Switzerland-dementia.html"> The Daily Mail</a>. “The idea of watching the slow degradation of Chris’s mental abilities in parallel to my own physical decline is horrific to me,” the former Royal Air Force pilot added. “Obviously I would care for her to the point I could not, but she has nursed enough people with dementia during her career to be adamant she wants to remain in control of herself and her life”. “I would not want to go on living without her,” he said of his 80-year-old wife. “I don’t want to go into care, to be lying in bed dribbling and incontinent – I don’t call that a life”. As English law does not allow for euthanasia, the couple have planned their trip to Switzerland for the procedure, where Ms Scott has planned out her final days with her husband. “I’d like to go walking with Peter in the Swiss Alps, by a river. I’d have a beautiful plate of fish for my last supper, and enjoy a great bottle of Merlot,” she said. “I’d make a playlist including Wild Cat Blues and The Young Ones by Cliff Richard and I’ve found a poem called Miss Me But Let Me Go, which sums up exactly how I feel”. The suicide pod, known as Sarco, can be turned on with a simple flick of a switch from inside the futuristic capsule that resembles a modern car. The machine was invented by Australian Dr Philip Nitschke, who has long been behind a number of initiatives to allow legal euthanasia in Australia. The 3D printed Sarco capsule ends the lives of those inside by pumping the pod with nitrogen which replaces the oxygen in the pod, which renders the occupants unconscious within about a minute without, its claimed, any panic or distress. With falling oxygen, the person eventually suffocates. Dr Nitschke said the machine is activated by a button from inside the pod. “The capsule for two people works exactly the same as the single Sarco but there is only one button so they will decide between them who will push it,” he told <a title="www.dailymail.co.uk" href="https://www.dailymail.co.uk/news/article-13825105/Former-RAF-engineer-nurse-wife-sign-British-couple-use-double-suicide-pod-Switzerland-dementia.html">The Daily Mail</a>. “Then they’ll be able to hold each other”. Image credits: Courtesy of Exit International

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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’m iron deficient. Which supplements will work best for me and how should I take them?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/alannah-mckay-1548258">Alannah McKay</a>, <a href="https://theconversation.com/institutions/australian-catholic-university-747">Australian Catholic University</a> Iron deficiency is common and can be debilitating. It mainly affects women. One in three premenopausal women <a href="https://static1.squarespace.com/static/57bfc0498419c24a01318ae2/t/607fc2e06ace2f22d5ca9a43/1618985699483/20210421+-+IDC+-+economic+impact+of+iron+deficiency+-+FINAL.pdf">are low in iron</a> compared to just 5% of Australian men. Iron deficiency particularly affects teenage girls, women who do a lot of exercise and those who are pregnant. The <a href="https://pubmed.ncbi.nlm.nih.gov/11160590/">body needs iron</a> to make new red blood cells, and to support energy production, the immune system and cognitive function. If you’re low, you may experience a range of symptoms including fatigue, weakness, shortness of breath, headache, irregular heartbeat and reduced concentration. If a blood test shows you’re iron deficient, your doctor may recommend you start taking an oral iron supplement. But should you take a tablet or a liquid? With food or not? And when is the best time of day? Here are some tips to help you work out how, when and what iron supplement to take. <h2>How do I pick the right iron supplement?</h2> The iron in your body is called “elemental iron”. Choosing the right oral supplement and dose will depend on how much elemental iron it has – your doctor will advise exactly how much you need. The sweet spot is between <a href="https://www.sciencedirect.com/science/article/pii/S0098299720300364?via%3Dihub">60-120 mg of elemental iron</a>. Any less and the supplement won’t be effective in topping up your iron levels. Any higher and you risk gastrointestinal symptoms such as diarrhoea, cramping and stomach pain. In Australia, iron salts are the most common oral supplements because they are cheap, effective and come in different delivery methods (tablets, capsules, liquid formulas). <a href="https://www.ncbi.nlm.nih.gov/books/NBK557376/">The iron salts</a> you are most likely to find in your local chemist are ferrous sulfate (~20% elemental iron), ferrous gluconate (~12%) and ferrous fumarate (~33%). These formulations <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3867244/">all work similarly</a>, so your choice should come down to dose and cost. Many multivitamins may look like an iron supplement, but it’s important to note they usually have too little iron – usually less than 20 mg – to correct an iron deficiency. <h2>Should I take tablets or liquid formulas?</h2> Iron contained within a tablet is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3867244/">just as well absorbed</a> as iron found in a liquid supplement. Choosing the right one usually comes down to personal preference. The main difference is that liquid formulas tend to contain less iron than tablets. That means you might need to take more of the product to get the right dose, so using a liquid supplement could work out to be more expensive in the long term. <h2>What should I eat with my iron supplement?</h2> Research <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajh.26987">has shown</a> you will absorb more of the iron in your supplement if you take it on an empty stomach. But this can cause more gastrointestinal issues, so might not be practical for everyone. If you do take your supplement with meals, it’s important to think about what types of food will boost – rather than limit – iron absorption. For example, taking the supplement alongside vitamin C improves your body’s ability to absorb it. Some supplements already contain vitamin C. Otherwise you could take the supplement along with a glass of orange juice, or other <a href="https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/">vitamin C-rich foods</a>. On the other hand, tea, coffee and calcium all <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajh.26987">decrease the body’s ability to absorb iron</a>. So you should try to limit these close to the time you take your supplement. <h2>Should I take my supplement in the morning or evening?</h2> The best time of day to take your supplement is in the morning. The body can <a href="https://journals.lww.com/acsm-msse/fulltext/2019/10000/the_impact_of_morning_versus_afternoon_exercise_on.20.aspx">absorb significantly more</a> iron earlier in the day, when concentrations of hepcidin (the main hormone that regulates iron) are at their lowest. Exercise also affects the hormone that regulates iron. That means taking your iron supplement after exercising can <a href="https://journals.humankinetics.com/view/journals/ijsnem/32/5/article-p359.xml">limit your ability to absorb it</a>. Taking your supplement in the hours following exercise will mean significantly poorer absorption, especially if you take it between two and five hours after you stop. <a href="https://journals.lww.com/acsm-msse/fulltext/2024/01000/iron_absorption_in_highly_trained_male_runners_.14.aspx">Our research</a> has shown if you exercise every day, the best time to take your supplement is in the morning before training, or immediately after (within 30 minutes). <h2>My supplements are upsetting my stomach. What should I do?</h2> If you experience gastrointestinal side effects such as diarrhoea or cramps when you take iron supplements, you may want to consider taking your supplement every second day, rather than daily. Taking a supplement every day is still the fastest way to restore your iron levels. But a recent study <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00463-7/fulltext#%20">has shown</a> taking the same total dose can be just as effective when it’s taken on alternate days. For example, taking a supplement every day for three months works as well as every second day for six months. This results in fewer side effects. Oral iron supplements can be a cheap and easy way to correct an iron deficiency. But ensuring you are taking the right product, under the right conditions, is crucial for their success. It’s also important to check your iron levels prior to commencing iron supplementation and do so only under medical advice. In large amounts, <a href="https://www.ncbi.nlm.nih.gov/books/NBK430862/">iron can be toxic</a>, so you don’t want to be consuming additional iron if your body doesn’t need it. If you think you may be low on iron, talk to your GP to find out your best options.<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/235315/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/alannah-mckay-1548258">Alannah McKay</a>, Postdoctoral Research Fellow, Sports Nutrition, <a href="https://theconversation.com/institutions/australian-catholic-university-747">Australian Catholic 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/im-iron-deficient-which-supplements-will-work-best-for-me-and-how-should-i-take-them-235315">original article</a>. </div>

Body

I’m due for a cervical cancer screening. What can I expect? Can I do it myself? And what happened to Pap smears?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/karen-canfell-22668">Karen Canfell</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/deborah-bateson-16105">Deborah Bateson</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/megan-smith-131901">Megan Smith</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Cervical screening in Australia has <a href="https://pubmed.ncbi.nlm.nih.gov/34499374/">changed</a> over the past seven years. The test has changed, and women (and people with a cervix) now have much more choice and control. Here’s why – and what you can expect if you’re aged 25 to 74 and are <a href="https://www.health.gov.au/our-work/national-cervical-screening-program">due for a test</a>. <h2>When and why did the test change?</h2> In 2017, Australia became one of the first two countries to transition from Pap smears to tests for the presence of the human papillomavirus (HPV). HPV causes virtually all cervical cancers, so testing for the presence of this virus is a very good indicator of a person’s current and future risk of the disease. This contrasts with the older Pap smear technology, which involved inspection of cells every two years for the changes resulting from HPV infection. The change to screening was supported by a very large body of <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62218-7/abstract">international</a> and <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002388">Australian</a> data showing primary testing for HPV is more accurate than Pap smears. Women and people with a cervix who do not have HPV detected on their test are at a very low risk of developing cervical cancer over the next five years, or even longer. This was the basis for lengthening the screening interval when HPV screening was introduced. Australia now <a href="https://www.health.gov.au/our-work/national-cervical-screening-program">recommends</a> five-yearly HPV screening, starting at age 25 up to the age of 74 for eligible people, whether or not they have been vaccinated against HPV. Many other countries are following suit to transition to HPV screening. All established screening tests – which are conducted in people without any symptoms – are associated with health benefits but also with some harms. These can include the psychological and clinical consequences of receiving a “positive” screening result, which needs to be investigated further. However, recent World Health Organization (WHO) <a href="https://www.nejm.org/doi/full/10.1056/NEJMsr2030640">reviews of the evidence</a> have found: <ul> <li>HPV is a more effective screening test than Pap smears or any other method</li> <li>it substantially reduces incidence and death rates from cervical cancer</li> <li>it is the method of cervical screening that has the <a href="https://www.nature.com/articles/s41591-023-02600-4">best balance</a> of benefits to harms.</li> </ul> As a consequence, the WHO now unequivocally <a href="https://www.who.int/publications/i/item/9789240030824">recommends</a> HPV screening as the best-practice method. <h2>Now you can collect your own sample</h2> One of the major benefits of switching to HPV screening is it opened the door for a person being able to <a href="https://www.health.gov.au/self-collection-for-the-cervical-screening-test">collect their own sample</a> (which was impossible with the Pap smear). If HPV is present, it can be detected in the vagina rather than having to directly sample the cervix. In 2022, Australia became one of the <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/landmark-changes-improving-access-to-life-saving-cervical-screenings">first countries</a> in the world to introduce a universal option to choose self-collection within a major national-level screening program. This means people eligible for screening, under the guidance of a primary care practitioner, can now choose to collect their own vaginal sample, in privacy, using a simple swab. By the end of 2023, <a href="https://www.ncsr.gov.au/about-us/news-and-media/self-collection-for-cervical-screening--at-an-all-time-high.html">27% of people</a> were choosing to take the test this way, but this is on an upward trajectory and is likely to increase further, with an <a href="https://acpcc.org.au/self-collection-campaign/">awareness campaign</a> due to start next month. <h2>So what happens when I have a test?</h2> You’ll receive an invitation from the <a href="https://www.ncsr.gov.au/information-for-participants/participant-forms-and-guides.html#cervical-forms">National Cancer Screening Register</a> to attend your first screen when you turn 25. If you’re older, you’ll receive reminders when you are due for your next test. You will be invited to visit your GP or community health service for the test. You should be asked whether you would prefer to have a clinician collect the test or whether you would prefer to take the sample yourself. There’s no right or wrong way. The accuracy of testing has been <a href="https://www.bmj.com/content/363/bmj.k4823">shown</a> to be equivalent for clinician or self-collected sampling. This is a matter of choice. If the clinician does the test, they will undertake a pelvic examination with a speculum inserted into the vagina. This enables the doctor or nurse to view the cervix and take a sample. If you are interested in the self-collection option, check whether the practice is offering it when making an appointment. If you opt for self-collection, you’ll be able to do so in private. You’ll be given a swab (which looks like a COVID test swab with a longer stem), and you’ll be given instructions about how to insert and rotate the swab in the vagina to take the sample. It takes only a few minutes. <h2>What does it mean if my test detects HPV?</h2> If your test detects HPV, this means you have an HPV infection. These are very common and by itself doesn’t mean you have cancer, or even pre-cancer (which involves changes to cervical cells that make them more likely to develop into cancer over time). It does mean, however, that you are at higher risk of having a pre-cancer, or developing one in future, and that you will benefit from further follow-up or diagnostic testing. Your doctor or nurse will <a href="https://www.cancer.org.au/clinical-guidelines/cervical-cancer/cervical-cancer-screening">guide you</a> on the next steps in line with national guidelines. If you require a diagnostic examination, this will involve a procedure called colposcopy, where the cervix is closely examined by a gynaecologist or other specially trained healthcare practitioner, and a small sample may be taken for detailed examination of the cells. If you have a pre-cancer, you can be treated simply and quickly, usually without needing to be admitted to hospital. Treatment involves ablating or removing a small area of the cervix. This treatment will drastically reduce your risk of ever developing cervical cancer. <h2>What does this mean for cervical cancer rates?</h2> Cervical screening for HPV is a very effective method of preventing cervical cancer. Because of Australia’s HPV screening, combined with HPV vaccination in younger people, Australia is <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30183-X/fulltext">expected</a> to achieve such low rates of cervical cancer by 2035 that it will be considered eliminated. Last year, the government launched a <a href="https://www.health.gov.au/sites/default/files/2023-11/national-strategy-for-the-elimination-of-cervical-cancer-in-australia.pdf">national strategy for cervical cancer elimination</a> which provides key recommendations for eliminating cervical cancer, and for doing so equitably in all groups of women and people with a cervix. One of the best things you can do to protect yourself is to have your cervical screening test when you become eligible, whether or not you have been vaccinated against HPV. Marion Saville, a pathologist and Executive Director at the Australian Centre for the Prevention of Cervical Cancer, co-authored this article.<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/229495/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/karen-canfell-22668">Karen Canfell</a>, Professor & Director, Daffodil Centre, A Joint Venture with Cancer Council NSW, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/deborah-bateson-16105">Deborah Bateson</a>, Professor of Practice, The Daffodil Centre, a joint venture with Cancer Council NSW, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/megan-smith-131901">Megan Smith</a>, Principal Research Fellow, The Daffodil Centre, a joint venture with Cancer Council NSW, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/im-due-for-a-cervical-cancer-screening-what-can-i-expect-can-i-do-it-myself-and-what-happened-to-pap-smears-229495">original article</a>. </div>

Body

Is white rice bad for me? Can I make it lower GI or healthier?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Rice is a <a href="http://www.ipni.net/publication/bci.nsf/0/42A2EA40E95CBD1385257BBA006531E9/$FILE/Better%20Crops%20International%202002-3%20p03.pdf">culinary staple</a> in Australia and around the world. It might seem like a given that brown rice is healthier than white and official <a href="https://www.eatforhealth.gov.au/eating-well/healthy-recipes/recipe-modification-tips">public health resources</a> often recommend brown rice instead of white as a “healthy swap”. But <a href="https://pubmed.ncbi.nlm.nih.gov/34441728/">Australians definitely prefer white rice</a> over brown. So, what’s the difference, and what do we need to know when choosing rice? <h2>What makes rice white or brown?</h2> Rice “grains” are technically seeds. A complete, whole rice seed is called a “paddy”, which has <a href="https://www.fao.org/4/t0567e/t0567e07.htm">multiple parts</a>: <ol> <li>the “hull” is the hard outer layer which protects the seed</li> <li>the “bran”, which is a softer protective layer containing the seed coat</li> <li>the “germ” or the embryo, which is the part of the seed that would develop into a new plant if was germinated</li> <li>the “endosperm”, which makes up most of the seed and is essentially the store of nutrients that feeds the developing plant as a seed grows into a plant.</li> </ol> Rice needs to be <a href="https://www.tandfonline.com/doi/pdf/10.1080/87559128509540778">processed</a> for humans to eat it. Along with cleaning and drying, the hard hulls are removed since we can’t digest them. This is how <a href="https://ift.onlinelibrary.wiley.com/doi/abs/10.1111/1541-4337.12449">brown rice is made</a>, with the other three parts of the rice remaining intact. This means brown rice is regarded as a “wholegrain”. White rice, however, is a “refined” grain, as it is <a href="https://ift.onlinelibrary.wiley.com/doi/abs/10.1111/1541-4337.12449">further polished</a> to remove the bran and germ, leaving just the endosperm. This is a mechanical and not a chemical process. <h2>What’s the difference, nutritionally?</h2> Keeping the bran and the germ means <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/cche.10322">brown rice has more</a> magnesium, phosphorus, potassium B vitamins (niacin, folate, riboflavin and pyridoxine), iron, zinc and fibre. The germ and the bran also contain more bioactives (compounds in foods that aren’t essential nutrients but have health benefits), like <a href="https://www.mdpi.com/1420-3049/28/2/532#:%7E:text=Brown%20rice%20(BR)%20is%20obtained,and%20phenolic%20compounds%20%5B3%5D.">oryzanols and phenolic compounds</a> which have antioxidant effects. But that doesn’t mean white rice is just empty calories. It <a href="https://www.glnc.org.au/wp-content/uploads/2011/04/GLNC_Rice-factsheet_WEB.pdf">still contains</a> vitamins, minerals and some fibre, and is low in fat and salt, and is naturally gluten-free. White and brown rice actually have <a href="https://ift.onlinelibrary.wiley.com/doi/abs/10.1111/1541-4337.12449">similar</a> amounts of calories (or kilojoules) and total carbohydrates. There are studies that show eating more white rice is linked to <a href="https://diabetesjournals.org/care/article/43/11/2625/35820/A-Global-Perspective-on-White-Rice-Consumption-and">a higher risk</a> of type 2 diabetes. But it is difficult to know if this is down to the rice itself, or other related factors such as socioeconomic variables or other dietary patterns. <h2>What about the glycaemic index?</h2> The higher fibre means brown rice has a <a href="https://www.sciencedirect.com/science/article/pii/S0002916523314862">lower glycaemic index</a> (GI), meaning it raises blood sugar levels more slowly. But this is highly variable between different rices within the white and brown categories. The <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/carbohydrates-and-the-glycaemic-index#:%7E:text=The%20glycaemic%20index%20(GI)%20is,simple'%20or%20'complex'.">GI system</a> uses low (less than 55), medium (55–70) and high (above 70) categories. <a href="https://glycemicindex.com/gi-search/?food_name=rice&product_category=&country=&gi=&gi_filter=&serving_size_(g)=&serving_size_(g)_filter=&carbs_per_serve_(g)=&carbs_per_serve_(g)_filter=&gl=&gl_filter=">Brown rices</a> fall into the low and medium categories. <a href="https://glycemicindex.com/gi-search/?food_name=rice&product_category=&country=&gi=&gi_filter=&serving_size_(g)=&serving_size_(g)_filter=&carbs_per_serve_(g)=&carbs_per_serve_(g)_filter=&gl=&gl_filter=">White rices</a> fall in the medium and high. There are specific <a href="https://www.gisymbol.com/low-gi-products/sunrice-doongara-low-gi-white-clever-rice-1kg/">low-GI types available</a> for both white and brown types. You can also lower the GI of rice by <a href="https://pubs.acs.org/doi/abs/10.1021/jf503203r">heating and then cooling it</a>. This process converts some of the “available carbohydrates” into “resistant starch”, which then functions like dietary fibre. <h2>Are there any benefits to white rice?</h2> The <a href="https://www.realsimple.com/brown-rice-vs-white-rice-8417468#:%7E:text=The%20eating%20experience%20between%20these,chewier%20texture%20and%20nuttier%20flavor.">taste and textural qualities</a> of white and brown rices differ. White rice tends to have a softer texture and more mild or neutral flavour. Brown rice has a chewier texture and nuttier flavour. So, while you can technically substitute brown rice into most recipes, the experience will be different. Or other ingredients may need to be added or changed to create the desired texture. Removing more of the outer layers may also reduce the levels of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10375490/">contaminants</a> such as pesticides. <h2>We don’t just eat rice</h2> Comparing white and brown rice seems like an easy way to boost nutritional value. But just because one food (brown rice) is more nutrient-dense doesn’t make the other food (white rice) “bad”. Ultimately, it’s not often that we eat just rice, so we don’t need the rice we choose to be the perfect one. Rice is typically the staple base of a more complex dish. So, it’s probably more important to think about what we eat with rice. Adding vegetables and lean proteins to rice-based dishes can easily add the micronutrients, bioactives and fibre that white rice is comparatively lacking, and this can likely do more to contribute to diet quality than eating brown rice instead.<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/236767/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, Adjunct Senior Lecturer, Nutrition, Dietetics & Food Innovation - School of Health Sciences, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Image credits: 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/is-white-rice-bad-for-me-can-i-make-it-lower-gi-or-healthier-236767">original article</a>. </div>

Food & Wine

"I was going to die": Grant Denyer's brutal wake up call

Grant Denyer has spoken candidly about a brutal wake up call he received from a doctor, when he was told he would die if he didn't start looking after himself. The TV host opened up on the Mental As Anyone podcast about how he would repeatedly push himself too far, and the moment he was forced to reevaluate his priorities. “I was skinny as a rake and unhealthy as hell and the doctor said my organs were running at about seven per cent,” Denyer told the podcast. “He goes, ‘if you don’t do something about this in the next four weeks, you’re going to die. It took two lessons for me to realise that I had to change my mindset and how I was approaching life and what I prioritised as important until I learned the lesson and I feel like if I hadn’t learned it the second time, it would have been fatal the third.” The first lesson came to Denyer in the form of a brutal car crash, and the second being chronic fatigue telling him his body needed to stop. “I broke my back, which I firmly now believe was not as a result of jumping seven cars in a monster truck but as a result of ignoring all my bodily signs, ignoring all the signals my body was trying to give me to slow the hell down,” he said. “You can’t sustain this pace and this grind and this aggressive chase for the next rung of the ladder, because you will die. As my body was deteriorating and my mental health was deteriorating, the monster truck crash came along to sit me on my arse.” Denyer also opened up about having to rely on prescription painkillers after his car accident, and how he struggled battling the pain and the effects of the medication. “It messed with me instantly and majorly,” he said. “To give you an idea, the moment you close your eyes at night time, you fall into your worst nightmares every time instantly and you can’t differentiate between dream and reality so when you wake up, you firmly believed what you have just dreamt, indeed actually just did happen. It was horrible.” "It is important to reflect on because it is the lows that make the highs and those euphoric moments feel high and that was one of the lows. I think in recognising (and) giving voice to those moments of low, that you can celebrate mediocre a lot more and enjoy that.” Image credits: Instagram

Caring

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

Does free-to-air TV really need gambling ads to survive?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/andrew-hughes-2728">Andrew Hughes</a>, <a href="https://theconversation.com/institutions/australian-national-university-877">Australian National University</a> If anything is a sure bet right now, it’s corporate Australia’s willingness to use some variation of the “for society’s good” argument. The most recent example of this is the claim being made, including by federal minister <a href="https://www.theguardian.com/australia-news/article/2024/aug/13/gambling-ad-ban-labor-bill-shorten-tv-media-advertising-revenue">Bill Shorten</a>, that an outright ban on gambling advertising would be disastrous for free-to-air TV. To be clear, Labor still supports new restrictions on gambling advertisements, including hourly caps and bans during kids’ TV and during and around sports broadcasts. But it has rejected the idea of a total ban, prompting a <a href="https://www.smh.com.au/politics/federal/labor-mps-say-total-ban-is-the-only-way-on-gambling-ads-20240812-p5k1q0.html">backlash</a> extending as far as some of its own backbench MPs. Speaking on ABC’s Q&A on Monday night, Shorten said Australia’s free-to-air TV broadcasters were in “diabolical trouble”, with many needing gambling ad revenue “in order just to stay afloat”. “I’m not convinced that complete prohibition works,” he said. So would our commercial TV networks really fall over tomorrow without gambling ad revenue? Or is something else at play? <h2>Who is buying ads in Australia?</h2> Let’s start by building a bigger picture of where advertising spend more broadly comes from in Australia. Global analytics firm Nielsen regularly compiles <a href="https://www.nielsen.com/news-center/2024/top-20-categories-by-ad-spend-for-2023-revealed-in-latest-nielsen-ad-intel-report/#:%7E:text=Retail%20topped%20the%20list%20with,significant%20investment%20of%20%24596m.">top 20</a> lists of both the categories and individual companies spending the most on ads here. In 2023 the top category, retail, accounted for A$2.56 billion in advertising spend. Gambling and gaming, in contrast, represented just $239 million, less than a tenth of this figure. Harvey Norman topped the list of <a href="https://www.nielsen.com/news-center/2024/australias-top-20-highest-spending-advertisers-of-2023-revealed-in-latest-nielsen-ad-intel-report/">individual companies</a> in 2023. The first we see of any gambling brand is Sportsbet, which came in at 16th. For gambling companies, it’s fair to assume the lion’s share of this goes to TV. <a href="https://www.acma.gov.au/publications/2023-10/report/gambling-advertising-australia-placement-and-spending">Research</a> by the Australian Communications and Media Authority (ACMA) found 68% of gambling companies’ ad spend went to free-to-air TV markets. As for the remainder, 9% went to radio, 15% to social media and 8% to other online platforms. <h2>How much is actually getting spent?</h2> But how do we estimate the gambling industry’s total annual advertising spend? There are certainly a lot of numbers getting thrown around. One <a href="https://www.afr.com/companies/media-and-marketing/tv-networks-to-demand-fee-relief-as-40m-wagering-hole-opens-up-20240804-p5jzav">source</a> put it at $300.5 million for 2022. More recently, ACMA published detailed figures for the period between May 2022 and April 2023 which put it at just over <a href="https://www.acma.gov.au/publications/2023-10/report/gambling-advertising-australia-placement-and-spending">$238 million</a>, with $162 million of this going to free-to-air TV networks. But the way advertising is classified – what defines an advertisement – can sometimes differ between agencies. Then there is the <a href="https://www.acma.gov.au/check-if-gambling-operator-legal#register-licensed-gambling">number of brands operating</a>, which is constantly changing. In a market with so many competitors, any new entrant needs to spend big on advertising just to capture enough market share to be viable. This is why I argue that the actual figure for financial year 2023 may be slightly higher than ACMA’s widely quoted figure, accounting for the big ad spend of new entrants that may have fallen outside the time window assessed. Based on average company ad spend as a percentage of revenue and the size of the gambling industry, I estimate it could be higher, in the ballpark of $275 million. <h2>How much is that to the networks?</h2> This exercise is all about putting these figures in context. Channel Seven, for example, brought in <a href="https://www.sevenwestmedia.com.au/assets/Uploads/Final-2023-Annual-Report.pdf">$1.5 billion in revenue in 2023</a>. Even if it had received the gambling industry’s entire ad spend at my higher estimate of $275 million, this would still only account for less than 20% of its annual turnover. If that money all went to TV ads, Channel Seven’s stated 38.5% share of television advertising revenue would put its revenue from the estimated sports betting advertising at about $106 million in this example, around 7% of its total annual revenue. Losing most of that would hurt, but wouldn’t mortally threaten the business. A total ban would most likely be <a href="https://www.abc.net.au/news/2024-08-13/peta-murphy-left-online-gambling-legacy-why-isn-t-labor-adopting/104217328">phased in</a> over a number of years, not enacted overnight. Australia’s free-to-air networks would adapt, restrategise, and find and develop new markets to replace that revenue. Their management teams are far too smart to just shrug their shoulders and take a revenue hit on the corporate chin. <h2>Networks have had plenty of time to adapt</h2> Just a refresher. LinkedIn is now more than 20 years old. Facebook is 20. YouTube is 19. X (formerly known as Twitter) is 18. TikTok is seven. If free-to-air TV’s business model is so glacial it can’t function in the digital age, it probably doesn’t deserve to be operating in the big leagues. Digital is here and has been for a while now. The media industry has borne the brunt of this change, but has also had the most time to adapt to the disruptors, who are now more established oligopolies and duopolies than “cool start-ups” out of Silicon Valley. The argument that we need to protect sports gambling ads to protect the big media brands – has little to no basis. It’s a worn out argument we’ve seen time and time again – <a href="https://theconversation.com/how-the-push-to-end-tobacco-advertising-in-the-1970s-could-be-used-to-curb-gambling-ads-today-200915">big tobacco</a>, I’m looking at you. Protecting the interests of corporate Australia at the cost of society itself is a gamble none of us should be prepared to take.<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/236686/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/andrew-hughes-2728">Andrew Hughes</a>, Lecturer, Research School of Management, <a href="https://theconversation.com/institutions/australian-national-university-877">Australian National University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/does-free-to-air-tv-really-need-gambling-ads-to-survive-236686">original article</a>. </div>

Money & Banking

Your legacy. Their future. Will you be the difference in an uncertain world?

Connection. Safety. Friendship. Family. When you <a href="https://www.redcross.org.au/donate-funds/bequest/pass-it-on/will-planning-checklist-social/?utm_medium=digital&utm_source=edm&utm_campaign=bequests&utm_content=over60s" target="_blank" rel="noopener">leave a gift in your Will for Australian Red Cross</a>, there’s no end to the difference you can make. Just ask Elsie. At 95 years old, Elsie has been transformed by weekly visits from Fiona, her Red Cross volunteer. For Fiona, her visits to see 95-year-old nursing home resident Elsie quickly turned into a family affair. "My children, Tom and Meg, have become very attached to her and vice versa. They're like, 'Are you going to see Elsie, can we come too?' They see how lovely it is to be kind to someone like Elsie," says Fiona. "Elsie tells me, 'You're my special family.'" Fiona's dog, Mia, is even a regular visitor at the Tasmanian nursing home. "Mia's like a celebrity. All the residents love her." The family marks all the big milestones with Elsie, like Christmas Day when they brought her home for a special morning tea. "When she turned 95 in December, we took her to a café. She said that was the best birthday she'd had for a long time." <img src="https://oversixtydev.blob.core.windows.net/media/2024/08/RedCross_01.jpg" alt="" width="1280" height="720" /> Elsie celebrating her birthday with Fiona's children, Tom and Meg. It is very much a two-way friendship, says Fiona. "I wasn't expecting it to be like that. I thought it was going to be more me doing lots of things for Elsie. But she gives back a lot." Like when Fiona's daughter, Meg, didn't pass her driver's license test. "Meg was quite upset. Elsie goes to her, 'That's why they invented pencils with rubbers at the end. They are there for you to rub out your mistakes, and then you can have another go.' "She's wise. She gives them little bits of advice and words of wisdom, and they listen to what she says … I can't believe she's 95 years old. Her mind is so unbelievably sharp." Fiona says that, lately, Elsie has not been as mobile as she was, and so they often spend their time together at the nursing home. "We find a nice spot and have a cuppa … She likes telling stories about her life. She talks a lot about her husband, her upbringing, people she's met. "Often, I'll bring her some magazines, or she will have asked me to get some stamps. And my kids have been great with her with technology, how to do this and how to do that. "We chat with other residents as well. Even though Elsie's our person, there are other people we've got to know. She introduces us as 'This is my family.'" Fiona says the first time they met, she and Elsie discovered they had much in common. They both grew up in the same country town and had travelled around Australia managing hotels. They care a lot about each other, she says. "I think it's given her more of a will to live. That sounds pretty deep, but I know how much she looks forward to seeing us; it's giving her more purpose in life. "Elsie always says, 'You make me feel so happy. I love seeing you, it's such a highlight.' I say it back to her because it's the same for me, 'I get so much joy out of seeing you.'" Fiona says she hopes her story inspires other people to volunteer, too. Your generosity, captured in your Will, can help fund programs like our Aged Care Volunteer Visitors Scheme and foster social connections like Elsie and Fiona’s. The program supports more than 1000 participants across the country with the majority between the ages of 78 and 89. Everybody deserves the warmth of kindness and friendship, and your Will can help Australian Red Cross share that with people for generations to come. <a href="https://www.redcross.org.au/donate-funds/bequest/pass-it-on/will-planning-checklist-social/?utm_medium=digital&utm_source=edm&utm_campaign=bequests&utm_content=over60s" target="_blank" rel="noopener"><img src="https://oversixtydev.blob.core.windows.net/media/2024/08/RedCross_02_wQRCode.jpg" alt="" width="1280" height="638" /></a> If you would like a free <a href="https://www.redcross.org.au/donate-funds/bequest/pass-it-on/will-planning-checklist-social/?utm_medium=digital&utm_source=edm&utm_campaign=bequests&utm_content=over60s" target="_blank" rel="noopener">Will Planning Checklist</a>, or more information, our <a href="mailto:litran@redcross.org.au" target="_blank" rel="noopener">Gifts in Wills Specialist</a> would love to help. You <a style="font-family: -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, Oxygen, Ubuntu, Cantarell, 'Open Sans', 'Helvetica Neue', sans-serif;" href="mailto:litran@redcross.org.au" target="_blank" rel="noopener">get in touch here</a> or call 1800 733 276. All images: Supplied. This is a sponsored article produced in partnership with Australian Red Cross.

Caring

What if I discover mould after I move into a rental property? What are my rights?

<div class="theconversation-article-body"><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> and <a href="https://theconversation.com/profiles/tim-law-1438482">Tim Law</a>, <a href="https://theconversation.com/institutions/victoria-university-1175">Victoria University</a> A startling number of Australian rental homes come with an unwanted housemate: mould. If you discover mould in a rented home, who is responsible and what can you do if the landlord seems unwilling to fix it? <h2>Find the cause</h2> The landlord is responsible if the mould is caused by the structural condition of the property. This can include things like leaking pipes, gutters, roofs or windows. Tenants are responsible for mould remediation if the way they occupy a home has promoted mould growth. For example, if they have not been using exhaust fans in bathrooms, have been failing to ventilate their home or have been storing wet clothes in a cupboard. This means establishing the cause of the mould is crucial to working out who’s responsible for repairs. <h2>Why are so many rentals mouldy?</h2> Australia has a rental home mould problem chiefly because much of our housing hasn’t been built to suit our climate. Houses tend not to be built with sufficient consideration of: <ul> <li> efficient energy consumption to regulate indoor temperature </li> <li> the orientation of homes </li> <li> the use of double glazing and insulation to regulate temperature and humidity. </li> </ul> It is estimated that nearly 17% of privately rented homes and 22% of social housing dwelling require <a href="https://www.abs.gov.au/statistics/people/housing/housing-mobility-and-conditions/2019-20">major repairs</a>. This includes structural defects, such as large cracks in walls or leaking gutters, that can generate mould growth. Tenant representatives have said in the past there is also a problem of weak enforcement of laws concerning the <a href="https://www.ahuri.edu.au/sites/default/files/documents/2022-11/AHURI-Final-Report-391-Regulation-of-residential-tenancies-and-impacts-on-investment.pdf">condition of rental homes</a>. <h2>4 ways to cut mould risk</h2> To reduce your mould risk, you need to manage indoor moisture and temperature. Try to: <ul> <li> keep the home well ventilated </li> <li> open windows and use exhaust fans in the bathroom and kitchen </li> <li> in humid climates, use air conditioning or a dehumidifier </li> <li> in cold climate, use a dehumidifier (desiccant dehumidifiers might more appropriate in very cold places) </li> <li> reduce moisture in the home by wiping up spills and condensation on surfaces </li> <li> dry washing outside </li> <li> if buying a dryer, opt for a condensing dryer instead of a conventional dryer (condensing driers put out much less vapour) </li> <li> report any structural issues (such as leaking pipes or windows that don’t close properly) to the agent or landlord as soon as you notice them. </li> </ul> <h2>Rental minimum standards differ by state or territory</h2> In New South Wales, adequate ventilation is one of the <a href="https://www.fairtrading.nsw.gov.au/housing-and-property/renting/new-residential-tenancy-laws">minimum standards</a> properties must meet to be considered fit to live in. If the rental provider has been notified about mould problems in the house but has failed to act, you might consider getting advice from the <a href="https://www.tenants.org.au/?gclid=CjwKCAiAjfyqBhAsEiwA-UdzJEj1YE27QhWKv2W5hPiiFTXMeX5Yqe61X4WlsHwRcq5kh5qDnU-MEBoC2LgQAvD_BwE">Tenants’ Union of NSW</a>. Its <a href="https://www.tenants.org.au/factsheet-24-mould">fact sheet on mould</a> also explains what to do if you’d like to contact the <a href="https://www.ncat.nsw.gov.au">NSW Civil and Administrative Tribunal</a> to apply for repairs, rent reduction or compensation. In Victoria, <a href="https://www.consumer.vic.gov.au/housing/renting/repairs-alterations-safety-and-pets/minimum-standards/minimum-standards-for-rental-properties">rental minimum standards</a> say “all rooms must be free from mould and damp caused by or related to the building structure.” The <a href="https://tenantsvic.org.au/advice/common-problems/mould-and-damp/">Tenants Victoria</a> website has information on how to ask a landlord to fix a mould problem or structural problems leading to mould and how to apply to the <a href="https://www.vcat.vic.gov.au">Victorian Civil and Administrative Tribunal</a> if the landlord fails to act. In Queensland, it depends on when you signed the lease. If you signed after September 1 this year (after new <a href="https://www.housing.qld.gov.au/about/initiatives/rental-law-reform">standards</a> were introduced) tenants should notify the landlords of <a href="https://www.rta.qld.gov.au/during-a-tenancy/maintenance-and-repairs/mould">mould as soon as they discover it</a>. If mould is a result of problems with the property and the landlord doesn’t undertake repairs, tenants can contact the <a href="https://www.qcat.qld.gov.au">Queensland Civil and Administrative Tribunal</a>. The guidelines in <a href="https://www.legislation.wa.gov.au/legislation/statutes.nsf/main_mrtitle_821_homepage.html">Western Australia</a> say the landlord must ensure the premises is “in a reasonable state of cleanliness and a reasonable state of repair […] and must conduct any repairs within a reasonable period after the need for the repair arises.” And in <a href="https://www.commerce.wa.gov.au/publications/maintenance-your-rental-property-who-responsible-landlord-bulletin-issue-12-september">Western Australia</a>, mould caused by faults in gutters or other fixtures is the responsibility of the rental provider. Further information on <a href="https://www.commerce.wa.gov.au/consumer-protection/resolving-rental-property-issues">what to do</a> if a dispute over the premises can’t be resolved amicably is available on the state government website. In <a href="https://www.housingsafetyauthority.sa.gov.au/minimum-housing-standards/whole-property">South Australia</a> rental properties must be “reasonably free from mould or other irritants [and] reasonably free from the adverse effects of moisture or damp.” If a landlord refuses to fix something after being asked, the tenant can <a href="https://www.sa.gov.au/topics/housing/renting-and-letting/renting-privately/during-a-tenancy/Repairs-and-maintenance">apply to the South Australian Civil and Administrative Tribunal</a>. In <a href="https://www.cbos.tas.gov.au/topics/housing/renting/rental-maintenance-repairs-changes/requesting-repairs">Tasmania</a>, rental properties must be clean and in good repair when leased out. <a href="https://www.cbos.tas.gov.au/topics/housing/renting/beginning-tenancy/minimum-standards/types">According to</a> the Tasmanian government website on the issue, <blockquote> ‘Clean’ includes having no […] serious mould/rising damp issues. </blockquote> If the tenant requests repairs and the landlord doesn’t act, the tenant can lodge a repair order with the <a href="https://www.cbos.tas.gov.au/topics/housing/renting/rental-maintenance-repairs-changes/requesting-repairs">Commisioner’s office</a>. In the Australian Capital Territory, the Tenants’ Union ACT has guidance on what to do if you discover <a href="https://www.tenantsact.org.au/what-can-i-do-about-mould/">mould</a> in a property you rent. In the Northern Territory, tenants may wish to seek advice from the <a href="https://www.dcls.org.au/tenants-advice/">Tenants’ Advice Service</a> if there is a mould problem in a property they rent. <h2>What policy change could help?</h2> If the cause of indoor mould is related to the design and construction of the house, rental providers should act. But tenants may not have the information they need to determine and substantiate this claim and can’t do much to get rental providers to act on mould if it’s not clear what’s causing it. Also, renters often worry asking for repairs could lead to a rent increase or eviction. Solutions include strengthening tenants rights to compel landlords to investigate the cause of mould in a house (given that knowing the cause is essential to assign responsibility for repairs). There should also be more stringent enforcement of current minimum standards relating to mould in rental properties. Given the scale of problems like mould in Australian homes, policymakers may wish to consider whether a parliamentary inquiry on home environments and health is needed. This would give Australians a chance to speak about their experiences – something that could help policy makers improve regulation in the rental sector. <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/215146/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> and <a href="https://theconversation.com/profiles/tim-law-1438482">Tim Law</a>, Adjunct lecturer, <a href="https://theconversation.com/institutions/victoria-university-1175">Victoria University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-if-i-discover-mould-after-i-move-into-a-rental-property-what-are-my-rights-215146">original article</a>. </div>

Legal

"I am a woman": Boxer launches legal action after gold medal win

Imane Khelif has filed an official complaint over online bullying and harassment she has been subject to throughout the course of the Paris Olympics. The Algerian boxer, who took home the gold medal in the women's competition, has been at the centre of a wave of abuse over her gender, with misinformation circulating over her gender. According to Khelif's lawyer Nabil Boudi, the gold medallist has filed a legal complaint in France for online harassment. “The boxer Imane Khelif has decided to begin a new fight, a fight for justice, dignity and honour,” Boudi said in a statement, saying Khelif had filed the complaint for “aggravated online harassment … to Paris prosecutors”. He added, “The investigation will determine who was behind this misogynist, racist and sexist campaign, but will also have to concern itself with those who fed the online lynching.” The “iniquitous harassment” the boxing champion had been subjected to would remain “the biggest stain on these Olympic Games”, said Boudi. On Saturday, Khelif emerged victorious in the women’s 66kg final against China’s Yang Liu in a unanimous points decision, having been the focus of intense scrutiny in the French capital for the duration of the Games. After her victory, Khelif said the gold medal she had won was the best response to her critics. Asked by reporters about the row over her eligibility, she said, “I am fully qualified to take part, I am a woman like any other. I was born a woman, lived a woman and competed as a woman.” Image credits: Ulrik Pedersen/CSM/Shutterstock Editorial

Legal

"I think I knew for years": Andy Lee spills on proposal

In their first photoshoot and interview as an engaged couple, Andy Lee and Rebecca Harding have revealed how the sweet proposal unfolded. The couple are the cover stars on this week's Stellar magazine and featured as guests on the Something To Talk About podcast. In the interview, Andy explained that he'd known "for a long time" that he wanted to marry his girlfriend of 10 years. “I think six, maybe to eight months [beforehand] was when I really started thinking about it. I think I knew for years. Then getting the ring, and hoping Bec liked it – that would have been the most nerve-racking part. And getting her there on time to the actual proposal,” he said. Andy popped the question in May, and proposed at the couple's home in the Melbourne suburb of Hawthorn. He recalled how Rebecca was running late on the day and kept him anxiously waiting for more than an hour before she showed up. “It doesn’t matter. The important thing is, we went home together,” she told the publication. While their proposal was nothing glamorous, it had sentimental value, as he handed her a napkin asking for her hand in marriage, a callback to their first meeting when she was working as a waitress at a Melbourne cafe and he wrote his number on a napkin for her. “It was just happiness,” Rebecca said of the proposal. “It’s such a nice feeling to know someone has gone and put all of this effort into something, to ask you to spend the rest of your life with them. I mean, we’d been dating for 10 years, so I kind of was like, maybe getting married is not for us. There was enough in our life that I knew he was serious about me.” She also shared the external pressure she felt over the years for the couple to get engaged, and explained why it took them so long. “Andy doesn’t like being told what to do. So in my mind, I was like, can everyone please stop pressuring him to propose? Because he’s not going to do it,” she said. Images: Instagram

Relationships

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

<div class="theconversation-article-body"> <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>. </div>

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

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

Body

“I tried my best”: Heartbreaking scenes as famous dad consoles Aussie Olympic teen

Chloe Covell, the 14-year-old skateboard sensation, was left in tears midway through the final round of the street skateboarding event in Paris, when she struggled to land her tricks and repeatedly fell. At 14 years and 170 days, the teen was striving to become the youngest Australian to win a gold medal, and was even competing with a splint on her left hand after breaking two of her fingers. The record for the youngest Australian to win a gold medal is still held by Sandra Morgan, who was 14 years old and 183 days when she was was a member of the victorious 4x100m freestyle team at the 1956 Melbourne Olympics. The teen made a promising start with her first run, but struggled with her attempts after that. After conceding her third trick, the teen was in tears but pushed on, and despite the cheers from the crowd she struggled to smash her final two attempts as she fell on the concrete. Covell finished on 70.33, and although she was unable to realise her Olympics dream in Paris, the teen is looking on the bright side. “I tried my best and I just couldn’t land much. But it’s all good,” Covell said. “I just wanted to keep trying and not give up. “It was very hard work to get here ... I just have to come back better and stronger for the next time.” <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/C9-7a1eSFYt/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/C9-7a1eSFYt/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Skate Australia (@skate.australia)</a> </div> </blockquote> Her father, former NRL player Luke Covell, immediately embraced his daughter on the course and shielded her further by taking over media duties. He said he was proud of her for not giving up, even tough she struggled in the first round where she rallied to qualify fourth. “It’s not always someone’s day,” Luke said. “We knew if you wanted to go for a medal, that you just had to go for it. “She did her best, it wasn’t her day, I’m just glad she backed herself and didn’t take the easy option.” He added that the splint on her hand was “definitely not” a factor. “When you get to the Olympic final, no one remembers who comes fourth,” he said. “All the girls were going for their best tricks.” Japan’s Coco Yoshizawa won the gold medal with a total score of 272.75, beating compatriot Liz Akama’s 265.95. Australians Liv Lovelace and Haylie Powell also missed out on spots in a final where the ages ranged from 14 to 19. Images: Nine/ Instagram / Skate Australia

Family & Pets

"I really thought he would kill me": Erin Molan opens up about abusive relationship

Warning: This article contains discussions of domestic violence which some readers may find confronting Radio and TV presenter Erin Molan has opened up for the first time about horrific abuse she endured at the hands of an ex-partner. Speaking candidly to the <a href="https://www.dailytelegraph.com.au/news/nsw/exclusive-interview-erin-molan-opens-up-about-horrific-abuse-she-suffered-from-a-man-she-dated/news-story/d2921145ef5010a413bab6c9a830f3bc" target="_blank" rel="noopener">Sunday Telegraph</a>, the 40-year-old presenter recalled many of her "worst" moments with her former boyfriend, sharing how she feared for her life when he became physically abusive. '“He came in drunk and dragged me out of bed and started stamping his foot into my head over and over and over,” she told the publication. “I was lying on the floor screaming and normally if I screamed really loudly he would stop because neighbours would hear. But that time he just kept going and going and it felt like my skull was going to crack open.” She said the relentless physical violence became a pattern of behaviour, and she would regularly be brutally injured. “One time he smashed a bottle over my head,” she says. “Another time I was terrified he’d throw me off a balcony. Once I ran to hide in my car and he got a rubbish bin and started smashing it against the windscreen and I feared I would be killed by glass shattering over me. “Another time he covered my face with a pillow so I couldn’t breathe. I was crying for my mum. I really thought he would kill me.” Molan said she chose not publicly discuss the abuse while her beloved dad, Senator Jim Molan, was alive because she didn’t want to break his heart, but now she wants others to know what she went through. In sharing her heartbreaking story, she also hopes she can give other victims of domestic violence the courage to come forward. “I’m not sharing my story because I want to. My preference would be for this part of my life to never be shared but with every single death I see in this space, a part of me wonders whether I could have made a difference,” she says. “Could my experience have made these beautiful, innocent women feel less alone, less ashamed, less scared and could that have been the tiny thing that may have empowered them to ask for help, the thing that might have helped to save their lives?” Molan added that while it’s confronting for her to speak out, she wants things to change, not just for her generation but for her daughter’s. As she says, “I want to worry about my daughter’s first boyfriend breaking her heart, not her bones.” Image credits: for AWAPAC/Shutterstock Editorial

Caring

"I just got shot": Trump gives first interview after assassination attempt

In his first interview since a <a href="https://www.oversixty.com.au/finance/legal/attempted-assassination-of-trump-the-long-history-of-violence-against-u-s-presidents" target="_blank" rel="noopener">failed assassination attempt</a> at a campaign rally in Pennsylvania, Donald Trump provided new insights into his harrowing experience and "miraculous" survival. The incident occurred on Saturday afternoon when 20-year-old Thomas Matthew Crooks fired upon the former president during his speech. Speaking aboard his private jet to a <a href="https://nypost.com/2024/07/14/us-news/grateful-defiant-trump-recounts-surreal-assassination-attempt-at-rally-im-supposed-to-be-dead/" target="_blank" rel="noopener">New York Post journalist</a>, Trump described the weekend’s events as a “very surreal experience". “The doctor at the hospital said he never saw anything like this, he called it a miracle,” Trump, wearing a white bandage over his right ear, told the Post. “I’m not supposed to be here, I’m supposed to be dead.” Trump recounted that his survival was due to a slight turn of his head to the right to read a chart on illegal immigrants. At that precise moment, what could have been a fatal shot tore off a small piece of his ear, splattering blood on his forehead and cheek. As Secret Service agents quickly led him off stage, Trump expressed his desire to continue speaking to his supporters. However, agents insisted it wasn’t safe and rushed him to a hospital. He marvelled at how the agents reacted, comparing them to "linebackers" as they shielded him. Unbuttoning his long-sleeve white shirt, Trump revealed a large bruise on his right forearm, evidence of the forceful protection provided by the agents. Trump had previously posted on his social media account, Truth Social, to thank the Secret Service and law enforcement. “The agents hit me so hard that my shoes fell off, and my shoes are tight,” he said. Microphones at the podium captured the urgent commands from security telling Trump to “get down, get down” before he was helped back up. In the commotion, Trump was heard saying, “let me get my shoes,” before being escorted to a waiting car. In a powerful photograph that has since circulated widely, Trump, after being shot, stood and raised his fist, shouting “fight” three times to the crowd as Secret Service agents tried to move him offstage. “A lot of people say it’s the most iconic photo they’ve ever seen,” Trump said of the image. “They’re right and I didn’t die. Usually, you have to die to have an iconic picture. I just wanted to keep speaking, but I just got shot.” The rally saw two people killed, including the shooter, and two others injured. Reflecting on his survival, Trump told reporters that “by luck or by God” he was still here. Images: Xinhua News Agency/Shutterstock Editorial

Legal

"I love you forever": Novak Djokovic celebrates 10 year anniversary

Novak Djokovic has celebrated his 10-year wedding anniversary with Jelena Djokovic. The tennis star took to Instagram to share an adorable tribute honouring their anniversary, with a video of the couple dancing, singing and laughing together set to Dolly Parton and Kenny Rogers' Islands In The Stream. "Ten years of joy," Novak began in the caption. "Ten years as parents. Ten years as one. Ten years of dancing. Ten years of fun," he wrote. "Ten years of flying. Ten years at sea. Ten years of you. The best part of me." "Ten years of tennis. Ten years of balls. Ten years of triumph. Ten years of falls. "Ten years as teammates. Ten years together. Ten years Jelena. I love you forever." <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-permalink="https://www.instagram.com/reel/C9O8uaeoMZF/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/reel/C9O8uaeoMZF/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Novak Djokovic (@djokernole)</a> </div> </blockquote> The couple first met in high school in the 90s but didn't start dating until a few years later, when Novak finally kicked off his professional tennis career. The high-school sweethearts tied the knot in a ceremony held at Aman Sveti Stefan resort almost a decade later in July 2014, and they were also expecting their first child at the time. The couple now share two children together, Stefan, nine, and Tara, Six. Images: Instagram

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"I was going to die": Grant Denyer's brutal wake up call

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Is white rice bad for me? Can I make it lower GI or healthier?

"I was going to die": Grant Denyer's brutal wake up call

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

Does free-to-air TV really need gambling ads to survive?

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What if I discover mould after I move into a rental property? What are my rights?

"I am a woman": Boxer launches legal action after gold medal win

"I think I knew for years": Andy Lee spills on proposal

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

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

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

“I tried my best”: Heartbreaking scenes as famous dad consoles Aussie Olympic teen

"I really thought he would kill me": Erin Molan opens up about abusive relationship

"I just got shot": Trump gives first interview after assassination attempt

"I love you forever": Novak Djokovic celebrates 10 year anniversary

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