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Australian beachgoers are told to always ‘swim between the flags’ – but what if there aren’t any?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/rob-brander-111027">Rob Brander</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> This summer, millions of people will flock to Australia’s beaches – and tragically, not all will survive. Last summer, 54 people <a href="https://issuu.com/surflifesavingaustralia/docs/slsa_summerdrowningreport_2022.23">drowned</a> along the Australian coast. This included 28 people in New South Wales – the highest number in the state’s recorded history. About 80% of the drownings occurred at beaches and almost half were due to people caught in offshore flowing <a href="https://www.sciencedirect.com/science/article/pii/S0012825216303117">rip currents</a>. Crucially, all of these drownings occurred in locations not patrolled by professional lifeguards or volunteer surf lifesavers. That is a stark statistic. The core safety message promoted to beachgoers is to always “swim between the flags” on patrolled beaches. But clearly, unpatrolled beaches represent the major beach safety challenge in Australia – and this must be addressed. <h2>All drownings are preventable</h2> A <a href="https://www.sciencedirect.com/science/article/pii/S1326020023000961">recent study</a> showed coastal drowning rates in Australia did not change between 2004 and 2021. This was despite significant financial investment into coastal safety by all levels of government during this time. And in 2023, the NSW government <a href="https://www.nsw.gov.au/media-releases/splash-for-surf-life-saving-as-patrol-season-begins">announced</a> the biggest ever funding commitment to Surf Life Saving NSW (SLSNSW) – A$23 million over four years. This raises important questions for both beach safety providers and their funding bodies. Are we doing enough to address the issue of drowning on unpatrolled beaches? Why aren’t we seeing a decrease in the number and rate of beach drowning? Is the current approach working? Are we doing enough evaluation? These questions need to be answered because beach drowning, like all types of drowning, is preventable. <h2>The ‘swim between the flags’ message is not enough</h2> The safest place to swim on Australian beaches is between the red and yellow flags, under the supervision of trained lifeguards and surf lifesavers. This is the core safety message promoted to beachgoers, and should always take precedent. But it’s unrealistic to assume beachgoers will always adhere to the message – in part, because the flags and lifeguards aren’t everywhere at all times. <a href="https://www.theguardian.com/australia-news/2023/dec/02/ai-rip-detection-technology-australia-beach-safety-drownings#:%7E:text=Fewer%20than%205%25%20of%20Australia%27s,is%20unpatrolled%20or%20temporarily%20unpatrolled.">Less than 5%</a> of Australia’s 11,000 beaches are patrolled, and most of those are patrolled only seasonally. Patrols rarely cover early mornings and evenings when many people choose to swim, and the supervised flagged area may only cover a tiny percentage of the length of the beach. A <a href="https://nhess.copernicus.org/articles/22/909/2022/">recent study</a> documented why beachgoers swim at unpatrolled beaches. The reasons included proximity to their holiday accommodation and because the location is quieter and less crowded than patrolled beaches. So while most Australians know they should swim between the flags, many choose not to, or simply don’t have the option. This can have fatal consequences. Surf Life Saving Australia’s latest National Coastal Safety Report <a href="https://issuu.com/surflifesavingaustralia/docs/ncsr23?fr=xKAE9_zU1NQ">report</a> reported that 75% of the 902 coastal drowning deaths over the previous decade occurred more than 1km from a surf lifesaving service. <h2>Getting it right</h2> There’s an obvious need in Australia for a beach safety campaign that directly addresses safety on unpatrolled beaches. But we have to get it right – and taking an evidence-based approach is crucial. For example, it seems logical to teach beachgoers how to identify dangerous rip currents. But <a href="https://www.sciencedirect.com/science/article/pii/S0278434322000760?casa_token=pYdktxnHyagAAAAA:mBxg-eaXyKJUNDOCJWFSntEcDV7jE6uDEg0bRxugetG7rHelw-_v8zuEXPwUKoGxkL-DNYI">research has shown</a> that people armed with this knowledge might become emboldened to swim at unpatrolled beaches. In 2018, Surf Life Saving Australia launched the “<a href="https://www.youtube.com/watch?v=j47ML57SPyk">Think Line</a>” campaign, which encourages beachgoers to spend a few minutes thinking about beach safety when they arrive at the beach. It’s a simple concept that could become generational over time. But it requires more promotion, more collaboration between beach safety providers, and more research into whether the message is changing beachgoer behaviour in a positive way. Other efforts to improve safety on unpatrolled beaches include investment in technology such as <a href="https://www.surflifesaving.com.au/emergency-response-beacons/#:%7E:text=The%20ERB%20uses%20the%20latest,reassurance%20in%20an%20emergency%20situation.">emergency response beacons</a>. However, to date there’s been little to no evidence-based evaluation of their effectiveness. Research into beach safety is a powerful tool. It provides evidence that can identify which educational approaches are working and which are not. Yet, funding of beach safety research pales in comparison to the amounts invested in untested safety interventions, or upgrades to existing surf club facilities and equipment. It’s globally accepted that lifeguards are the best beach safety intervention. So why aren’t we directing more funding into increasing the presence of local government lifeguard services? This expansion should involve extending lifeguard patrol hours during the summer on patrolled beaches and adding seasonal lifeguards on popular but hazardous unpatrolled beaches. <h2>Staying safe this summer</h2> Preventing drownings on our beaches requires a new approach – and some serious questions about where funding should be best directed. Otherwise, the terrible drowning death toll will continue. In the meantime, you might find yourself wanting to swim at an unpatrolled beach this summer, or to swim early in the morning before lifeguards start duty. To help you understand the hazards and stay safe, UNSW Sydney has developed a new <a href="https://news.unsw.edu.au/en/if-in-doubt--don-t-go-out">educational resource</a>, including a <a href="https://youtu.be/3qXDBvO8mdc">video</a>. They are both worth a look; in fact, they may just save a life.<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/220043/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <figure><iframe src="https://www.youtube.com/embed/3qXDBvO8mdc?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <a href="https://theconversation.com/profiles/rob-brander-111027">Rob Brander</a>, Professor, UNSW Beach Safety Research Group, School of Biological, Earth & Environmental 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/australian-beachgoers-are-told-to-always-swim-between-the-flags-but-what-if-there-arent-any-220043">original article</a>. </div>

Travel Trouble

Woman rescued after getting stuck in between two boulders

A NSW woman found herself stuck in between two boulders after trying to retrieve her phone from a rocky abyss in the Hunter Valley. Emergency services were called to the wine region after reports the woman slipped and got stuck between two boulders down a three-metre crevice. Her friends initially tried to rescue her for an hour before calling Triple Zero for help. Photos shared by NSW Ambulance on Facebook showed the woman's feet poking out as she was wedged inside the crevice. Paramedics had to remove the heavy rocks, including winching out a massive 500kg boulder to create a safe exit. The entire process took around seven hours as the woman had been stuck in a tight "S" bend which made it challenging for the rescue team. "In my 10 years as a rescue paramedic I had never encountered a job quite like this, it was challenging but incredibly rewarding," NSW Ambulance Specialist Rescue Paramedic Peter Watts said. "Every agency had a role, and we all worked incredibly well together to achieve a good outcome for the patient." NSW Ambulance confirmed that the woman was unable to get her phone back. Image: NSW Ambulance/ Facebook

Travel Trouble

3 key differences between an ocean and river cruise

People often have a personal preference when it comes to ocean cruises or river cruises, so if you’re not sure what to go for, it’s best to know how they really differ before booking your next trip. Here are the three key differences between an ocean and river cruise. 1. Cost River cruises are initially more expensive, and travellers can expect the price to be from $200-500 per person per night. Ocean ships can cost less than $100 per night if you get a good deal. However, once onboard your ocean cruise there will be a likelihood that you splurge on extra costs such as drinks, tours and souvenirs. 2. Inclusions Only the most upmarket ocean cruises are all-inclusive but on an ocean cruise if you want mealtime alcohol, Wi-Fi and other extras, you will be expected to pay up. All these extras are included in river-cruise fares and sometimes airport transfers are included too. River cruises require you to pay a heftier sum upon booking but if you are going on an ocean cruise, be sure to keep track of your spending. 3. Ship amenities On river cruises, expect your onboard entertainment to be a massage room, fitness room or hot tub as most of the focus is on the destination. However, ocean cruises are lined with Broadway-styled shows, casinos, kids’ clubs, water parks, spas and various pools. If you prefer a quiet, intimate setting then river cruises would suit your desires but if you want a wide-range of entertainment, ocean cruises are for you. Image credits: Shutterstock

Cruising

What’s the difference between a psychopath and a sociopath? Less than you might think

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/bruce-watt-1486350">Bruce Watt</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> and <a href="https://theconversation.com/profiles/katarina-fritzon-402205">Katarina Fritzon</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Articles about badly behaved people and how to spot them are common. You don’t have to Google or scroll too much to find headlines such as <a href="https://psychologyeverywhere.com/articles/7-signs-your-boss-is-a-psychopath/">7 signs your boss is a psychopath</a> or <a href="https://www.elephantjournal.com/2022/08/how-to-avoid-the-sociopath-next-door-erica-leibrandt/">How to avoid the sociopath next door</a>. You’ll often see the terms psychopath and sociopath used somewhat interchangeably. That applies to perhaps the most famous badly behaved fictional character of all – Hannibal Lecter, the cannibal serial killer from <a href="https://www.imdb.com/title/tt0102926/">The Silence of the Lambs</a>. In the book on which the movie is based, Lecter is described as a “pure sociopath”. But in the movie, he’s described as a “pure psychopath”. Psychiatrists have diagnosed him with <a href="https://psychiatryonline.org/doi/pdf/10.1176/appi.psychotherapy.2002.56.1.100">something else</a> entirely. So what’s the difference between a psychopath and a sociopath? As we’ll see, these terms have been used at different times in history, and relate to some overlapping concepts. <h2>What’s a psychopath?</h2> Psychopathy has been mentioned in the psychiatric literature <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4059069/#:%7E:text=The%20term%20psychopathy%20comes%20from,which%20literally%20means%20suffering%20soul.">since the 1800s</a>. But the latest edition of the Diagnostic Statistical Manual of Mental Disorders (known colloquially as the DSM) <a href="https://www.psychiatry.org/psychiatrists/practice/dsm">doesn’t list</a> it as a recognised clinical disorder. <a href="https://www.psychiatry.org/psychiatrists/practice/dsm/about-dsm/history-of-the-dsm#section_5">Since the 1950s</a>, labels have changed and terms such as “sociopathic personality disturbance” have been replaced with <a href="https://www.ncbi.nlm.nih.gov/books/NBK546673/">antisocial personality disorder</a>, which is what we have today. Someone with antisocial personality disorder has a persistent disregard for the rights of others. This includes breaking the law, repeated lying, impulsive behaviour, getting into fights, disregarding safety, irresponsible behaviours, and indifference to the consequences of their actions. To add to the confusion, the section in the DSM on antisocial personality disorder mentions psychopathy (and sociopathy) traits. In other words, according to the DSM the traits are part of antisocial personality disorder but are not mental disorders themselves. US psychiatrist <a href="https://psycnet.apa.org/record/2018-37736-001">Hervey Cleckley</a> provided the first formal description of psychopathy traits in his 1941 book <a href="https://gwern.net/doc/psychology/personality/psychopathy/1941-cleckley-maskofsanity.pdf">The Mask of Sanity</a>. He based his description on his clinical observations of nine male patients in a psychiatric hospital. He identified several key characteristics, including superficial charm, unreliability and a lack of remorse or shame. <a href="https://psych.ubc.ca/profile/robert-hare/">Canadian psychologist</a> Professor <a href="http://www.hare.org/">Robert Hare</a> refined these characteristics by emphasising interpersonal, emotional and lifestyle characteristics, in addition to the antisocial behaviours listed in the DSM. When we draw together all these strands of evidence, we can say a psychopath manipulates others, shows superficial charm, is grandiose and is persistently deceptive. Emotional traits include a lack of emotion and empathy, indifference to the suffering of others, and not accepting responsibility for how their behaviour impacts others. Finally, a psychopath is easily bored, sponges off others, lacks goals, and is persistently irresponsible in their actions. <h2>So how about a sociopath?</h2> The term sociopath first appeared <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4059069/#:%7E:text=The%20term%20psychopathy%20comes%20from,which%20literally%20means%20suffering%20soul.">in the 1930s</a>, and was attributed to US psychologist George Partridge. He <a href="https://psychiatryonline.org/doi/abs/10.1176/ajp.85.6.1053?journalCode=ajp">emphasised</a> the societal consequences of behaviour that habitually violates the rights of others. Academics and clinicians often used the terms sociopath and psychopath interchangeably. But some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4059069/#:%7E:text=The%20term%20psychopathy%20comes%20from,which%20literally%20means%20suffering%20soul.">preferred the term sociopath</a> because they said the public sometimes confused the word psychopath with psychosis. “Sociopathic personality disturbance” <a href="https://www.turkpsikiyatri.org/arsiv/dsm-1952.pdf">was the term</a> used in the first edition of the DSM in 1952. This aligned with the <a href="https://journals.sagepub.com/doi/epdf/10.1177/0306624X01453005">prevailing views</a> at the time that antisocial behaviours were largely the product of the social environment, and that behaviours were only judged as deviant if they broke social, legal, and/or cultural rules. Some of these early descriptions of sociopathy are more aligned with what we now call antisocial personality disorder. Others relate to emotional characteristics similar to Cleckley’s 1941 <a href="https://pubmed.ncbi.nlm.nih.gov/26618655/">definition</a> of a psychopath. In short, different people had different ideas about sociopathy and, even today, sociopathy is less-well defined than psychopathy. So there is no single definition of sociopathy we can give you, even today. But in general, its antisocial behaviours can be similar to ones we see with psychopathy. Over the decades, the term sociopathy fell out of favour. From the late 60s, psychiatrists used the term antisocial personality disorder instead. <h2>Born or made?</h2> Both “sociopathy” (what we now call antisocial personality disorder) and psychopathy have been associated with a wide range of developmental, biological and psychological causes. For example, people with psychopathic traits have <a href="https://www.theguardian.com/science/2013/may/12/how-to-spot-a-murderers-brain">certain brain differences</a> especially <a href="https://psycnet.apa.org/record/2006-01001-014">in regions</a> associated with emotions, inhibition of behaviour and problem solving. They also appear to have differences associated with their <a href="https://www.psypost.org/psychopathic-women-exhibit-low-cardiac-defense-responses-study-finds/">nervous system</a>, including a <a href="https://www.sciencedirect.com/science/article/pii/S0301051123001345?via%3Dihub">reduced heart rate</a>. However, sociopathy and its antisocial behaviours are a product of someone’s social environment, and tends to <a href="https://www.aic.gov.au/sites/default/files/2020-05/19-1415-FinalReport.pdf">run in families</a>. These behaviours has been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4801766/#:%7E:text=Childhood%20abuse%20is%20a%20risk,and%20psychopathic%20traits%20remain%20unclear">associated with</a> physical abuse and parental conflict. <h2>What are the consequences?</h2> Despite their fictional portrayals – such as Hannibal Lecter in Silence of the Lambs or Villanelle in the TV series <a href="https://www.imdb.com/title/tt7016936/">Killing Eve</a> – <a href="https://www.psychologytoday.com/au/blog/making-evil/201902/what-we-get-wrong-about-psychopaths#:%7E:text=Most%20psychopaths%20are%20not%20offenders,extreme%20violence%20or%20serial%20killing.">not all people</a> with psychopathy or sociopathy traits are serial killers or are physically violent. But psychopathy <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4059069/">predicts</a> a wide range of harmful behaviours. In the criminal justice system, psychopathy is strongly linked with re-offending, particularly of a violent nature. In the general population, psychopathy is <a href="https://www.sciencedirect.com/science/article/abs/pii/S0160252709000028?casa_token=5lSd35qRO7oAAAAA:CTu-KkDXxsoYEPvpceItex9go1Fn_YlfBQSW9O9_MwNEX6NxlZ23GRcWnS5YYV_kAig24E4Ahdj7">associated with</a> drug dependence, homelessness, and other personality disorders. Some research even showed psychopathy predicted <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250605/">failure to follow</a> COVID restrictions. But sociopathy is less established as a key risk factor in identifying people at heightened risk of harm to others. And sociopathy is not a reliable indicator of future antisocial behaviour. <h2>In a nutshell</h2> Neither psychopathy nor sociopathy are classed as mental disorders in formal psychiatric diagnostic manuals. They are both personality traits that relate to antisocial behaviours and are associated with certain interpersonal, emotional and lifestyle characteristics. Psychopathy is thought to have genetic, biological and psychological bases that places someone at greater risk of violating other people’s rights. But sociopathy is less clearly defined and its antisocial behaviours are the product of someone’s social environment. Of the two, psychopathy has the greatest use in identifying someone who is most likely to cause damage to others.<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/226714/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/bruce-watt-1486350">Bruce Watt</a>, Associate Professor in Psychology, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> and <a href="https://theconversation.com/profiles/katarina-fritzon-402205">Katarina Fritzon</a>, Associate Professor of Psychology, <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/whats-the-difference-between-a-psychopath-and-a-sociopath-less-than-you-might-think-226714">original article</a>. </div>

Mind

What’s the difference between a heart attack and cardiac arrest? One’s about plumbing, the other wiring

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/michael-todorovic-1210507">Michael Todorovic</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> and <a href="https://theconversation.com/profiles/matthew-barton-1184088">Matthew Barton</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> In July 2023, rising US basketball star Bronny James collapsed on the court during practice and was sent to hospital. The 18-year-old athlete, son of famous LA Lakers’ veteran LeBron James, had experienced a <a href="https://apnews.com/article/bronny-james-cardiac-arrest-3953eee8789e83f3cccfb6dd798bc54e">cardiac arrest</a>. Many media outlets incorrectly referred to the event as a “<a href="https://en.as.com/nba/lebron-james-son-bronny-plays-for-the-usc-trojans-for-the-first-time-since-suffering-a-heart-attack-n/">heart attack</a>” or used the terms interchangeably. A cardiac arrest and a heart attack are distinct yet overlapping concepts associated with the heart. With some background in <a href="https://www.youtube.com/watch?v=uKrgEv7-rVM&t=16s">how the heart works</a>, we can see how they differ and how they’re related. <h2>Understanding the heart</h2> The heart is a muscle that contracts to work as a pump. When it contracts it pushes blood – containing oxygen and nutrients – to all the tissues of our body. For the heart muscle to work effectively as a pump, it needs to be fed its own blood supply, delivered by the coronary arteries. If these arteries are blocked, the heart muscle doesn’t get the blood it needs. This can cause the heart muscle to become injured or die, and results in the heart not pumping properly. <h2>Heart attack or cardiac arrest?</h2> Simply put, a heart attack, technically known as a myocardial infarction, describes injury to, or death of, the heart muscle. A cardiac arrest, sometimes called a sudden cardiac arrest, is when the heart stops beating, or put another way, stops working as an effective pump. In other words, both relate to the heart not working as it should, but for different reasons. As we’ll see later, one can lead to the other. <h2>Why do they happen? Who’s at risk?</h2> Heart attacks typically result from blockages in the coronary arteries. Sometimes this is called coronary artery disease, but in Australia, we tend to refer to it as ischaemic heart disease. The underlying cause in about <a href="https://www.ncbi.nlm.nih.gov/books/NBK507799/#:%7E:text=It%20has%20been%20reported%20that,increases%20beyond%20age%2050%20years.">75% of people</a> is a process called <a href="https://youtu.be/jwL4lkSlvSA?si=H2as7dQkhbIqWWkU">atherosclerosis</a>. This is where fatty and fibrous tissue build up in the walls of the coronary arteries, forming a plaque. The plaque can block the blood vessel or, in some instances, lead to the formation of a blood clot. Atherosclerosis is a long-term, stealthy process, with a number of risk factors that can sneak up on anyone. High blood pressure, high cholesterol, diet, diabetes, stress, and your genes have all been implicated in this plaque-building process. Other causes of heart attacks include spasms of the coronary arteries (causing them to constrict), chest trauma, or anything else that reduces blood flow to the heart muscle. Regardless of the cause, blocking or reducing the flow of blood through these pipes can result in the heart muscle not receiving enough oxygen and nutrients. So cells in the heart muscle can be injured or die. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/597616/original/file-20240531-17-o2j0w.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/597616/original/file-20240531-17-o2j0w.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/597616/original/file-20240531-17-o2j0w.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/597616/original/file-20240531-17-o2j0w.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/597616/original/file-20240531-17-o2j0w.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/597616/original/file-20240531-17-o2j0w.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/597616/original/file-20240531-17-o2j0w.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/597616/original/file-20240531-17-o2j0w.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" alt="Heart attack vs cardiac arrest" /></a><figcaption>Here’s a simple way to remember the difference. Author provided</figcaption></figure> But a cardiac arrest is the result of heartbeat irregularities, making it harder for the heart to pump blood effectively around the body. These heartbeat irregularities are generally due to <a href="https://www.youtube.com/watch?v=M_soKG-Tzh0&t=903s">electrical malfunctions</a> in the heart. There are four distinct types: <ul> <li> ventricular tachycardia: a rapid and abnormal heart rhythm in which the heartbeat is more than <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10541285/">100 beats per minute</a> (normal adult, resting heart rate is generally 60-90 beats per minute). This fast heart rate prevents the heart from filling with blood and thus pumping adequately </li> <li> ventricular fibrillation: instead of regular beats, the heart quivers or “fibrillates”, resembling a bag of worms, resulting in an irregular heartbeat greater than 300 beats per minute </li> <li> pulseless electrical activity: arises when the heart muscle fails to generate sufficient pumping force after electrical stimulation, resulting in no pulse </li> <li> asystole: the classic flat-line heart rhythm you see in movies, indicating no electrical activity in the heart. </li> </ul> Cardiac arrest can arise from numerous underlying conditions, both heart-related and not, such as drowning, trauma, asphyxia, electrical shock and drug overdose. James’ cardiac arrest was attributed to a <a href="https://www.espn.com.au/mens-college-basketball/story/_/id/38260006/bronny-james-cardiac-arrest-caused-congenital-heart-defect">congenital heart defect</a>, a heart condition he was born with. But among the many causes of a cardiac arrest, ischaemic heart disease, such as a heart attack, stands out as the most common cause, accounting <a href="https://pubmed.ncbi.nlm.nih.gov/11898927/">for 70%</a> of all cases. So how can a heart attack cause a cardiac arrest? You’ll remember that during a heart attack, heart muscle can be damaged or parts of it may die. This damaged or dead tissue can disrupt the heart’s ability to conduct electrical signals, increasing the risk of developing arrhythmias, possibly causing a cardiac arrest. So while a heart attack is a common cause of cardiac arrest, a cardiac arrest generally does not cause a heart attack. <h2>What do they look like?</h2> Because a cardiac arrest results in the sudden loss of effective heart pumping, the most common signs and symptoms are a sudden loss of consciousness, absence of pulse or heartbeat, stopping of breathing, and pale or blue-tinged skin. But the common signs and symptoms of a heart attack include chest pain or discomfort, which can show up in other regions of the body such as the arms, back, neck, jaw, or stomach. Also frequent are shortness of breath, nausea, light-headedness, looking pale, and sweating. <h2>What’s the take-home message?</h2> While both heart attack and cardiac arrest are disorders related to the heart, they differ in their mechanisms and outcomes. A heart attack is like a blockage in the plumbing supplying water to a house. But a cardiac arrest is like an electrical malfunction in the house’s wiring. Despite their different nature both conditions can have severe consequences and require immediate medical attention.<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/229633/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/michael-todorovic-1210507">Michael Todorovic</a>, Associate Professor of Medicine, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> and <a href="https://theconversation.com/profiles/matthew-barton-1184088">Matthew Barton</a>, Senior lecturer, School of Nursing and Midwifery, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/whats-the-difference-between-a-heart-attack-and-cardiac-arrest-ones-about-plumbing-the-other-wiring-229633">original article</a>. </div>

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What’s the difference between miscarriage and stillbirth?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/gita-mishra-286486">Gita Mishra</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>; <a href="https://theconversation.com/profiles/chen-liang-1356342">Chen Liang</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>, and <a href="https://theconversation.com/profiles/jenny-doust-12412">Jenny Doust</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> Former US First Lady Michelle Obama <a href="https://www.pbs.org/newshour/nation/michelle-obama-reveals-she-had-a-miscarriage-used-ivf-to-conceive-daughters">revealed</a> in her memoir she had a miscarriage. UK singer-songwriter and actor Lily Allen has <a href="https://www.usmagazine.com/celebrity-news/news/lily-allen-shares-details-about-delivering-a-stillborn-baby/#:%7E:text=Lily%20Allen%20was%20six%20months,named%20George%20%E2%80%94%20did%20not%20survive.">gone on the record</a> about her stillbirth. Both miscarriage and stillbirth are sadly familiar terms for pregnancy loss. They can be traumatic life events for the prospective parents and family, and their impacts can be long-lasting. But the terms can be confused. Here are some similarities and differences between miscarriage and stillbirth, and why they matter. <h2>Let’s start with some definitions</h2> In broad terms, a miscarriage is when a pregnancy ends while the fetus is not yet viable (before it could survive outside the womb). This is the loss of an “intra-uterine” pregnancy, when an embryo is implanted in the womb to then develop into a fetus. The term miscarriage excludes ectopic pregnancies, where the embryo is implanted outside the womb. However, stillbirth refers to the end of a pregnancy when the fetus is normally viable. There may have been sufficient time into the pregnancy. Alternatively, the fetus may have grown large enough to be normally expected to survive, but it dies in the womb or during delivery. The Australian Institute of Health and Welfare <a href="https://www.aihw.gov.au/reports/mothers-babies/stillbirths-and-neonatal-deaths-in-australia/contents/technical-notes/definitions-used-in-reporting">defines stillbirth</a> as a fetal death of at least 20 completed weeks of gestation or with a birthweight of at least 400 grams. Internationally, definitions of stillbirth <a href="https://www.nhs.uk/conditions/stillbirth/">vary</a> <a href="https://www.cdc.gov/nchs/data/misc/itop97.pdf">depending on</a> <a href="https://www.who.int/data/gho/indicator-metadata-registry/imr-details/2444">the jurisdiction</a>. <h2>How common are they?</h2> It is difficult to know how common miscarriages are as they can happen when a woman doesn’t know she is pregnant. There may be no obvious symptoms or something that looks like a heavier-than-normal period. So miscarriages are likely to be more common than reported. <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00682-6/abstract">Studies</a> from Europe and North America suggest a miscarriage occurs in about one in seven pregnancies (15%). More than one in eight women (13%) will have a miscarriage at some time in her life. Around <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00682-6/abstract">1–2%</a> of women have recurrent miscarriages. <a href="https://miscarriageaustralia.com.au/understanding-miscarriage/recurrent-miscarriage/">In Australia</a> this is when someone has three or more miscarriages with no pregnancy in between. Australia has one of the lowest rates of stillbirth in the world. The rate has been relatively steady over the past 20 years at 0.7% <a href="https://www.aihw.gov.au/reports/mothers-babies/stillbirths-and-neonatal-deaths">or around</a> seven per 1,000 pregnancies. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/608102/original/file-20240719-17-4ynpp.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/608102/original/file-20240719-17-4ynpp.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/608102/original/file-20240719-17-4ynpp.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=456&fit=crop&dpr=1 600w, https://images.theconversation.com/files/608102/original/file-20240719-17-4ynpp.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=456&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/608102/original/file-20240719-17-4ynpp.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=456&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/608102/original/file-20240719-17-4ynpp.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=573&fit=crop&dpr=1 754w, https://images.theconversation.com/files/608102/original/file-20240719-17-4ynpp.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=573&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/608102/original/file-20240719-17-4ynpp.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=573&fit=crop&dpr=3 2262w" alt="" /></a><figcaption></figcaption></figure> <h2>Who’s at risk?</h2> Someone who has already had a miscarriage or stillbirth has an increased risk of that outcome again in a subsequent pregnancy. Compared with women who have had a live birth, those who have had a stillbirth have <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-04355-7">double the risk</a> of another. For those who have had recurrent miscarriages, the risk of another miscarriage is <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00682-6/abstract">four-fold</a> higher. Some factors have a u-shaped relationship, with the risk of miscarriage and stillbirth lowest in the middle. For instance, maternal age is a risk factor for both <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00682-6/abstract">miscarriage</a> and <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00528-X/fulltext">stillbirth</a>, especially if under 20 years old or older than 35. Increasing age of the male is only a <a href="https://link.springer.com/article/10.1007/s10654-017-0237-z">risk factor</a> for stillbirth, especially for fathers over 40. Similarly for maternal bodyweight, women with a body mass index or BMI in the normal range have the lowest risk of <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00682-6/abstract">miscarriage</a> and <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00837-5/abstract?code=lancet-site&rss=yes=">stillbirth</a> compared with those in the obese or underweight categories. Lifestyle factors such as smoking and heavy alcohol drinking while pregnant are also risk factors for both miscarriage and stillbirth. So it’s important to not only avoid smoking and alcohol while pregnant, but before getting pregnant. This is because early in the pregnancy, women may not know they have conceived and could unwittingly expose the developing fetus. <h2>Why do they happen?</h2> Miscarriage often results from chromosomal problems in the developing fetus. However, genetic conditions or birth defects <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00837-5/abstract?code=lancet-site&rss=yes=">account for</a> only <a href="https://jamanetwork.com/journals/jama/fullarticle/1104720">7-14%</a> of stillbirths. Instead, stillbirths <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00837-5/abstract?code=lancet-site&rss=yes=">often relate</a> directly to <a href="https://jamanetwork.com/journals/jama/fullarticle/1104720">pregnancy complications</a>, such as a prolonged pregnancy or problems with the umbilical cord. <a href="https://www.nichd.nih.gov/health/topics/factsheets/pregnancyloss">Maternal health</a> at the time of pregnancy is another contributing factor in the risk of both miscarriage and stillbirths. Chronic diseases, such as high blood pressure, diabetes, hypothyroidism (underactive thyroid), polycystic ovary syndrome, problems with the immune system (such as an autoimmune disorder), and some bacterial and viral infections are among factors that can <a href="https://www.nichd.nih.gov/health/topics/factsheets/pregnancyloss">increase the risk</a> of miscarriage. Similarly mothers with diabetes, high blood pressure, and untreated infections, such as malaria or syphilis, face an <a href="https://www.nichd.nih.gov/health/topics/factsheets/stillbirth">increased risk</a> of stillbirth. In many cases, however, the specific cause of pregnancy loss is not known. <h2>How about the long-term health risks?</h2> Miscarriage and stillbirth can be <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00682-6/abstract">early indicators</a> of health issues later in life. For instance, women who have had recurrent miscarriages or recurrent stillbirths are at higher risk of <a href="https://pubmed.ncbi.nlm.nih.gov/33028606/">cardiovascular disease</a> (such as heart disease or stroke). Our <a href="https://www.bmj.com/content/377/bmj-2022-070603.abstract">research</a> has also looked at the increased risk of stroke. Compared with women who had never miscarried, we found women with a history of three or more miscarriages had a 35% higher risk of non-fatal stroke and 82% higher risk of fatal stroke. Women who had a stillbirth had a 31% higher risk of a non-fatal stroke, and those who had had two or more stillbirths were at a 26% higher risk of a fatal stroke. We saw similar patterns in chronic obstructive pulmonary disease or COPD, a progressive lung disease with respiratory symptoms such as breathlessness and coughing. Our data showed women with a history of recurrent miscarriages or stillbirths were at a <a href="https://thorax.bmj.com/content/79/6/508.abstract">36% or 67% higher risk</a> of COPD, respectively, even after accounting for a history of asthma. <h2>Why is all this important?</h2> Being well-informed about the similarities and differences between these two traumatic life events may help explain what has happened to you or a loved one. Where risk factors can be modified, such as smoking and obesity, this information can be empowering for individuals who wish to reduce their risk of miscarriage and stillbirth and make lifestyle changes before they become pregnant. <hr /> More information and support about miscarriage and stillbirth is available from <a href="https://www.sands.org.au">SANDS</a> and <a href="https://www.pinkelephants.org.au">Pink Elephants</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/225660/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/gita-mishra-286486">Gita Mishra</a>, Professor of Life Course Epidemiology, Faculty of Medicine, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>; <a href="https://theconversation.com/profiles/chen-liang-1356342">Chen Liang</a>, PhD student, reproductive history and non-communicable diseases in women, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>, and <a href="https://theconversation.com/profiles/jenny-doust-12412">Jenny Doust</a>, Clinical Professorial Research Fellow, School of Public Health, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/whats-the-difference-between-miscarriage-and-stillbirth-225660">original article</a>. </div>

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What’s the difference between ‘strep throat’ and a sore throat? We’re developing a vaccine for one of them

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/kim-davis-1535254">Kim Davis</a>, <a href="https://theconversation.com/institutions/murdoch-childrens-research-institute-1027">Murdoch Children's Research Institute</a>; <a href="https://theconversation.com/profiles/alma-fulurija-1535255">Alma Fulurija</a>, <a href="https://theconversation.com/institutions/telethon-kids-institute-1608">Telethon Kids Institute</a>, and <a href="https://theconversation.com/profiles/myra-hardy-1535253">Myra Hardy</a>, <a href="https://theconversation.com/institutions/murdoch-childrens-research-institute-1027">Murdoch Children's Research Institute</a> the time of the year for coughs, colds and sore throats. So you might have heard people talk about having a “strep throat”. But what is that? Is it just a bad sore throat that goes away by itself in a day or two? Should you be worried? Here’s what we know about the similarities and differences between strep throat and a sore throat, and why they matter. <h2>How are they similar?</h2> It’s difficult to tell the difference between a sore throat and strep throat as they look and feel similar. People usually have a fever, a bright red throat and sometimes painful lumps in the neck (swollen lymph nodes). A throat swab can help diagnose strep throat, but the results can take a few days. Thankfully, both types of sore throat usually get better <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8655103/">by themselves</a>. <h2>How are they different?</h2> Most sore throats are caused by viruses such as common cold viruses, the flu (influenza virus), or the virus that causes glandular fever (Epstein-Barr virus). These viral sore throats can occur at any age. Antibiotics don’t work against viruses so if you have a viral sore throat, you won’t get better faster if you take antibiotics. You might even have some unwanted <a href="https://www.ncbi.nlm.nih.gov/books/NBK401243/#:%7E:text=People%20may%20then%20wonder%20whether,infection%2C%20such%20as%20bacterial%20tonsillitis.">antibiotic side-effects</a>. But strep throat is caused by Streptococcus pyogenes bacteria, also known as strep A. Strep throat is most common in <a href="https://www.tandfonline.com/doi/full/10.2217/fmb-2021-0077">school-aged children</a>, but can affect other age groups. In some cases, you may need antibiotics to avoid some rare but serious complications. In fact, the potential for complications is one key difference between a viral sore throat and strep throat. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/605956/original/file-20240710-19-irooun.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/605956/original/file-20240710-19-irooun.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/605956/original/file-20240710-19-irooun.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=405&fit=crop&dpr=1 600w, https://images.theconversation.com/files/605956/original/file-20240710-19-irooun.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=405&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/605956/original/file-20240710-19-irooun.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=405&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/605956/original/file-20240710-19-irooun.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=508&fit=crop&dpr=1 754w, https://images.theconversation.com/files/605956/original/file-20240710-19-irooun.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=508&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/605956/original/file-20240710-19-irooun.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=508&fit=crop&dpr=3 2262w" alt="" /></a><figcaption></figcaption></figure> Generally, a viral sore throat is <a href="https://www.bmj.com/content/347/bmj.f6867">very unlikely</a> to cause complications (one exception is those caused by Epstein-Barr virus which has been associated with illnesses such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3893202/">chronic fatigue syndrome</a>, <a href="https://www.science.org/doi/10.1126/science.abj8222">multiple sclerosis</a> and certain <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00404-7/fulltext">cancers</a>). But strep A can cause invasive disease, a rare but serious complication. This is when bacteria living somewhere on the body (usually the skin or throat) get into another part of the body where there shouldn’t be bacteria, such as the bloodstream. This can make people extremely sick. Invasive strep A infections and deaths have been <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON429">rising in recent years</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10786649/">around the world</a>, especially in young children and older adults. This may be due to a number of factors such as increased social mixing at this stage of the COVID pandemic and an increase in circulating common cold viruses. But overall the reasons behind the increase in invasive strep A infections are not clear. Another rare but serious side effect of strep A is autoimmune disease. This is when the body’s immune system makes antibodies that react against its own cells. The most common example is <a href="https://www.who.int/news-room/fact-sheets/detail/rheumatic-heart-disease">rheumatic heart disease</a>. This is when the body’s immune system damages the heart valves a few weeks or months after a strep throat or skin infection. <a href="https://www.nejm.org/doi/10.1056/NEJMoa2102074?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">Around the world</a> more than 40 million people live with rheumatic heart disease and more than 300,000 die from its complications every year, mostly in developing countries. However, parts of Australia have some of the <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.50682">highest rates</a> of rheumatic heart disease in the world. <a href="https://www.aihw.gov.au/reports/heart-stroke-vascular-diseases/hsvd-facts/contents/all-heart-stroke-and-vascular-disease/arf-and-rhd">More than 5,300</a> Indigenous Australians live with it. <h2>Why do some people get sicker than others?</h2> We know strep A infections and rheumatic heart disease <a href="https://link.springer.com/chapter/10.1007/82_2012_280">are more common</a> in low socioeconomic communities where poverty and overcrowding lead to increased strep A transmission and disease. However, we don’t fully understand why some people only get a mild infection with strep throat while others get very sick with invasive disease. We also don’t understand why some people get rheumatic heart disease after strep A infections when most others don’t. Our research team is trying to find out. <h2>How about a vaccine for strep A?</h2> There is no strep A vaccine but <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6028081/">many</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8545125/">groups</a> in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6495378/">Australia</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902606/">New Zealand</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3620221/">and</a> <a href="https://www.clinicalkey.com.au/#!/content/playContent/1-s2.0-S0264410X19316457?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0264410X19316457%3Fshowall%3Dtrue&referrer=https:%2F%2Fpubmed.ncbi.nlm.nih.gov%2F">worldwide</a> are working towards one. For instance, Murdoch Children’s Research Institute and Telethon Kids Institute have formed the <a href="https://www.asavi.org.au">Australian Strep A Vaccine Initiative</a> to develop strep A vaccines. There’s also a <a href="https://savac.ivi.int/">global consortium</a> working towards the same goal. Companies such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10747066/">Vaxcyte</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7696035/">GlaxoSmithKline</a> have also been developing strep A vaccines. <h2>What if I have a sore throat?</h2> Most sore throats will get better by themselves. But if yours doesn’t get better in a few days or you have ongoing fever, see your GP. Your GP can examine you, consider running some tests and help you decide if you need antibiotics.<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/230292/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/kim-davis-1535254">Kim Davis</a>, General paediatrician and paediatric infectious diseases specialist, <a href="https://theconversation.com/institutions/murdoch-childrens-research-institute-1027">Murdoch Children's Research Institute</a>; <a href="https://theconversation.com/profiles/alma-fulurija-1535255">Alma Fulurija</a>, Immunologist and the Australian Strep A Vaccine Initiative project lead, <a href="https://theconversation.com/institutions/telethon-kids-institute-1608">Telethon Kids Institute</a>, and <a href="https://theconversation.com/profiles/myra-hardy-1535253">Myra Hardy</a>, Postdoctoral Researcher, Infection, Immunity and Global Health, <a href="https://theconversation.com/institutions/murdoch-childrens-research-institute-1027">Murdoch Children's Research Institute</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/whats-the-difference-between-strep-throat-and-a-sore-throat-were-developing-a-vaccine-for-one-of-them-230292">original article</a>. </div>

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

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/thea-van-de-mortel-1134101">Thea van de Mortel</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> The term “man flu” takes a <a href="https://www.oxfordlearnersdictionaries.com/definition/english/man-flu">humorous poke</a> at men with minor respiratory infections, such as colds, who supposedly exaggerate their symptoms. According to the stereotype, a man lies on the sofa with a box of tissues. Meanwhile his female partner, also with a snotty nose, carries on working from home, doing the chores and looking after him. But is man flu real? Is there a valid biological reason behind men’s symptoms or are men just malingering? And how does man flu differ from flu? <h2>What are the similarities?</h2> Man flu could refer to a number of respiratory infections – a cold, flu, even a mild case of COVID. So it’s difficult to compare man flu with flu. But for simplicity, let’s say man flu is actually a cold. If that’s the case, man flu and flu have some similar features. Both are caused by viruses (but different ones). Both are improved with rest, fluids, and if needed painkillers, throat lozenges or decongestants to <a href="https://activities.nps.org.au/nps-order-form/Resources/NPS-Cold-and-Flu-Brochure-May-2014.pdf">manage symptoms</a>. Both <a href="https://www.cdc.gov/flu/symptoms/coldflu.htm">can share</a> similar symptoms. Typically, more severe symptoms such as fever, body aches, violent shivering and headaches are more common in flu (but sometimes occur in colds). Meanwhile sore throats, runny noses, congestion and sneezing are more common in colds. A cough is common in both. <h2>What are the differences?</h2> <a href="https://www.cdc.gov/flu/about/keyfacts.htm">Flu</a> is a more serious and sometimes fatal respiratory infection caused by the influenza virus. Colds are caused by various viruses such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3553670/">rhinoviruses</a>, <a href="https://www.cdc.gov/adenovirus/about/?CDC_AAref_Val=https://www.cdc.gov/adenovirus/symptoms.html">adenoviruses</a>, and common cold <a href="https://journals.lww.com/pidj/citation/2022/03000/proving_etiologic_relationships_to_disease_.18.aspx">coronaviruses</a>, and are rarely serious. Colds tend to <a href="https://www.cdc.gov/flu/symptoms/coldflu.htm">start gradually</a> while flu tends to start abruptly. Flu can be <a href="https://www.cdc.gov/flu/professionals/diagnosis/overview-testing-methods.htm">detected</a> with laboratory or at-home tests. Man flu is not an official diagnosis. Severe flu symptoms may be prevented with <a href="https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm">a vaccine</a>, while cold symptoms cannot. Serious flu infections may also be <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/racf-antiviral-treatments-and-prophylaxis.aspx">prevented or treated</a> with antiviral drugs such as Tamiflu. There are no antivirals for colds. <h2>OK, but is man flu real?</h2> Again, let’s assume man flu is a cold. Do men really have worse colds than women? The picture is complicated. <a href="https://www.sciencedirect.com/science/article/pii/S0022399922003324?via%3Dihub">One study</a>, with the title “Man flu is not a thing”, did in fact show there were differences in men’s and women’s symptoms. This study looked at symptoms of acute rhinosinusitis. That’s inflammation of the nasal passages and sinuses, which would explain a runny or stuffy nose, a sinus headache or face pain. When researchers assessed participants at the start of the study, men and women had similar symptoms. But by days five and eight of the study, women had fewer or less-severe symptoms. In other words, women had recovered faster. But when participants rated their own symptoms, we saw a somewhat different picture. Women rated their symptoms worse than how the researchers rated them at the start, but said they recovered more quickly. All this suggests men were not exaggerating their symptoms and did indeed recover more slowly. It also suggests women feel their symptoms more strongly at the start. <h2>Why is this happening?</h2> It’s not straightforward to tease out what’s going on biologically. There are <a href="https://www.nature.com/articles/nri.2016.90">differences</a> in immune responses between men and women that provide a plausible reason for worse symptoms in men. For instance, women generally produce antibodies more efficiently, so they <a href="https://www.nature.com/articles/nri.2016.90">respond more effectively</a> to vaccination. Other aspects of women’s immune system also appear to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2735332/">work more strongly</a>. So why do women tend to have <a href="https://www.nature.com/articles/nri.2016.90">stronger immune responses</a> overall? That’s probably partly because women have two X chromosomes while men have one. X chromosomes carry important <a href="https://www.nature.com/articles/nri.2016.90#Tab3">immune function genes</a>. This gives women the benefit of immune-related genes from two different chromosomes. Oestrogen (the female sex hormone) also seems to <a href="https://www.nature.com/articles/nri.2016.90">strengthen</a> the immune response, and as levels vary throughout the lifespan, so does <a href="https://www.science.org/doi/10.1126/sciimmunol.aan2946">the strength</a> of women’s immune systems. Men are certainly more likely to die from some infectious diseases, such as <a href="https://www.aihw.gov.au/reports/life-expectancy-deaths/deaths-in-australia/contents/covid-10-deaths">COVID</a>. But the picture is less clear with other infections such as the flu, where the incidence and mortality between men and women <a href="https://iris.who.int/bitstream/handle/10665/44401/9789241500111_eng.pdf?sequence=1&isAllowed=y">varies widely</a> between countries and particular flu subtypes and outbreaks. Infection rates and outcomes in men and women can also depend on the way a virus is <a href="https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2021.712688/full">transmitted</a>, the person’s age, and social and behavioural factors. For instance, women seem to be more likely to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077589/#R20">practice protective behaviours</a> such as washing their hands, wearing masks or avoiding crowded indoor spaces. Women are also <a href="https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-016-0440-0">more likely</a> to seek medical care when ill. <h2>So men aren’t faking it?</h2> Some evidence suggests men are not over-reporting symptoms, and may take longer to clear an infection. So they may experience man flu more harshly than women with a cold. So cut the men in your life some slack. If they are sick, gender stereotyping is unhelpful, and may discourage men from seeking medical advice.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/231161/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/thea-van-de-mortel-1134101">Thea van de Mortel</a>, Professor, Nursing, School of Nursing and Midwifery, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/whats-the-difference-between-man-flu-and-flu-hint-men-may-not-be-exaggerating-231161">original article</a>. </div>

Body

What’s the difference between Alzheimer’s and dementia?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/nikki-anne-wilson-342631">Nikki-Anne Wilson</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Changes in thinking and memory as we age can occur for a variety of reasons. These changes are <a href="https://www.nia.nih.gov/health/memory-loss-and-forgetfulness/memory-problems-forgetfulness-and-aging#changes">not always cause for concern</a>. But when they begin to disrupt daily life, it could indicate the first signs of dementia. Another term that can crop up when we’re talking about dementia is Alzheimer’s disease, or Alzheimer’s for short. So what’s the difference? <h2>What is dementia?</h2> Dementia is an umbrella term used to describe a range of syndromes that result in changes in memory, thinking and/or behaviour due to degeneration in the brain. To meet the <a href="https://alz-journals.onlinelibrary.wiley.com/doi/epdf/10.1016/j.jalz.2011.03.005">criteria</a> for dementia these changes must be sufficiently pronounced to interfere with usual activities and are present in at least two different aspects of thinking or memory. For example, someone might have trouble remembering to pay bills and become lost in previously familiar areas. It’s less-well known that dementia can also occur in <a href="https://www.childhooddementia.org/what-is-childhood-dementia">children</a>. This is due to progressive brain damage associated with more than 100 rare genetic disorders. This can result in similar cognitive changes as we see in adults. <h2>So what’s Alzheimer’s then?</h2> <a href="https://www.alz.org/alzheimers-dementia/what-is-alzheimers">Alzheimer’s</a> is the most common type of dementia, accounting for <a href="https://alz-journals.onlinelibrary.wiley.com/doi/full/10.1002/alz.12068">about 60-80%</a> of cases. So it’s not surprising many people use the terms dementia and Alzheimer’s interchangeably. Changes in memory are the most common sign of Alzheimer’s and it’s what the public <a href="https://alzres.biomedcentral.com/articles/10.1186/s13195-023-01219-4">most often</a> associates with it. For instance, someone with Alzheimer’s may have trouble recalling recent events or keeping track of what day or month it is. We still don’t know exactly what <a href="https://link.springer.com/article/10.1134/s002689332104004x">causes Alzheimer’s</a>. However, we do know it is associated with a build-up in the brain of two types of protein called <a href="https://www.dementiasplatform.uk/news-and-media/blog/amyloid-and-tau-the-proteins-involved-in-dementia">amyloid-β and tau</a>. While we all have some amyloid-β, when too much builds up in the brain it clumps together, forming plaques in the spaces between cells. These plaques cause damage (inflammation) to surrounding brain cells and leads to disruption in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6468450/">tau</a>. Tau forms part of the structure of brain cells but in Alzheimer’s tau proteins become “tangled”. This is toxic to the cells, causing them to die. A <a href="https://content.iospress.com/articles/journal-of-alzheimers-disease/jad180583">feedback loop</a> is then thought to occur, triggering production of more amyloid-β and more abnormal tau, perpetuating damage to brain cells. Alzheimer’s can also occur with other forms of dementia, such as <a href="https://www.mayoclinic.org/diseases-conditions/vascular-dementia/symptoms-causes/syc-20378793">vascular dementia</a>. This combination is the most common example of a <a href="https://www.dementiauk.org/information-and-support/types-of-dementia/mixed-dementia/">mixed dementia</a>. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/592838/original/file-20240508-18-6msd4.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/592838/original/file-20240508-18-6msd4.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/592838/original/file-20240508-18-6msd4.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=456&fit=crop&dpr=1 600w, https://images.theconversation.com/files/592838/original/file-20240508-18-6msd4.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=456&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/592838/original/file-20240508-18-6msd4.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=456&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/592838/original/file-20240508-18-6msd4.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=573&fit=crop&dpr=1 754w, https://images.theconversation.com/files/592838/original/file-20240508-18-6msd4.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=573&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/592838/original/file-20240508-18-6msd4.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=573&fit=crop&dpr=3 2262w" alt="" /></a><figcaption></figcaption></figure> <h2>Vascular dementia</h2> The second most common type of dementia is <a href="https://www.mayoclinic.org/diseases-conditions/vascular-dementia/symptoms-causes/syc-20378793">vascular dementia</a>. This results from disrupted blood flow to the brain. Because the changes in blood flow can occur throughout the brain, signs of vascular dementia can be more varied than the memory changes typically seen in Alzheimer’s. For example, vascular dementia may present as general confusion, slowed thinking, or difficulty organising thoughts and actions. Your <a href="https://www.mayoclinic.org/diseases-conditions/vascular-dementia/symptoms-causes/syc-20378793">risk of vascular dementia</a> is greater if you have heart disease or high blood pressure. <h2>Frontotemporal dementia</h2> Some people may not realise that dementia can also affect behaviour and/or language. We see this in different forms of frontotemporal dementia. The behavioural variant of <a href="https://neuro.psychiatryonline.org/doi/10.1176/appi.neuropsych.20090238#:%7E:text=The%20behavioral%20variant%20of%20frontotemporal,often%20delayed%20for%20several%20years.">frontotemporal dementia</a> is the second most common form (after Alzheimer’s disease) of <a href="https://www.healthdirect.gov.au/younger-onset-dementia">younger onset dementia</a> (dementia in people under 65). People living with this may have difficulties in interpreting and appropriately responding to social situations. For example, they may make uncharacteristically rude or offensive comments or invade people’s personal space. <a href="https://www.sciencedirect.com/topics/neuroscience/semantic-dementia">Semantic dementia</a> is also a type of frontotemporal dementia and results in difficulty with understanding the meaning of words and naming everyday objects. <h2>Dementia with Lewy bodies</h2> <a href="https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/dementia-with-lewy-bodies">Dementia with Lewy bodies</a> results from dysregulation of a different type of protein known as α-synuclein. We often see this in people with Parkinson’s disease. So people with this type of dementia may have altered movement, such as a stooped posture, shuffling walk, and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428504/">changes in handwriting</a>. Other symptoms include changes in alertness, visual hallucinations and significant <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6029467/">disruption to sleep</a>. <h2>Do I have dementia and if so, which type?</h2> If you or someone close to you is concerned, the first thing to do is to <a href="https://cdpc.sydney.edu.au/research/clinical-guidelines-for-dementia/">speak to your GP</a>. They will likely ask you some questions about your medical history and what changes you have noticed. Sometimes it might not be clear if you have dementia when you first speak to your doctor. They may suggest you watch for changes or they may refer you to a specialist for <a href="https://www.nia.nih.gov/health/alzheimers-and-dementia/what-dementia-symptoms-types-and-diagnosis#diagnosis">further tests</a>. There is no single test to clearly show if you have dementia, or the type of dementia. A diagnosis comes after multiple tests, including brain scans, tests of memory and thinking, and consideration of how these changes impact your daily life. Not knowing what is happening can be a challenging time so it is important to speak to someone about how you are feeling or to reach out to <a href="https://www.dementia.org.au/get-support/national-dementia-helpline">support services</a>. <h2>Dementia is diverse</h2> As well as the different forms of dementia, everyone experiences dementia in different ways. For example, the speed dementia progresses varies a lot from person to person. Some people will continue to <a href="https://livingwellwithdementia.org.au">live well with dementia</a> for some time while others may decline more quickly. There is still significant <a href="https://academic.oup.com/gerontologist/article-abstract/64/5/gnad130/7281753">stigma</a> surrounding dementia. So by learning more about the various types of dementia and understanding differences in how dementia progresses we can all do our part to create a more <a href="https://www.dementiafriendly.org.au/">dementia-friendly community</a>. <hr /> The <a href="https://www.dementia.org.au/get-support/national-dementia-helpline">National Dementia Helpline</a> (1800 100 500) provides information and support for people living with dementia and their carers. To learn more about dementia, you can take this <a href="https://www.utas.edu.au/wicking/understanding-dementia">free online course</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/225271/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/nikki-anne-wilson-342631">Nikki-Anne Wilson</a>, Postdoctoral Research Fellow, Neuroscience Research Australia (NeuRA), <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/whats-the-difference-between-alzheimers-and-dementia-225271">original article</a>. </div>

Mind

What’s the difference between vegan and vegetarian?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/katherine-livingstone-324808">Katherine Livingstone</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> Vegan and vegetarian diets are <a href="https://link.springer.com/article/10.1007/s00394-023-03086-z">plant-based diets</a>. Both include plant foods, such as fruits, vegetables, legumes and whole grains. But there are important differences, and knowing what you can and can’t eat when it comes to a vegan and vegetarian diet can be confusing. So, what’s the main difference? <h2>What’s a vegan diet?</h2> A <a href="https://link.springer.com/article/10.1007/s00394-023-03086-z">vegan diet</a> is an entirely plant-based diet. It doesn’t include any meat and animal products. So, no meat, poultry, fish, seafood, eggs, dairy or honey. <h2>What’s a vegetarian diet?</h2> A <a href="https://link.springer.com/article/10.1007/s00394-023-03086-z">vegetarian diet</a> is a plant-based diet that generally excludes meat, poultry, ﬁsh and seafood, but can include animal products. So, unlike a vegan diet, a vegetarian diet can include eggs, dairy and honey. But you may be wondering why you’ve heard of vegetarians who eat fish, vegetarians who don’t eat eggs, vegetarians who don’t eat dairy, and even vegetarians who eat some meat. Well, it’s because there are variations on a vegetarian diet: <ul> <li> a lacto-ovo vegetarian diet excludes meat, poultry, fish and seafood, but includes eggs, dairy and honey </li> <li> an ovo-vegetarian diet excludes meat, poultry, fish, seafood and dairy, but includes eggs and honey </li> <li> a lacto-vegetarian diet excludes meat, poultry, fish, seafood and eggs, but includes dairy and honey </li> <li> a pescatarian diet excludes meat and poultry, but includes eggs, dairy, honey, fish and seafood </li> <li> a flexitarian, or semi-vegetarian diet, includes eggs, dairy and honey and may include small amounts of meat, poultry, fish and seafood. </li> </ul> <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/594474/original/file-20240516-16-wjg71m.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/594474/original/file-20240516-16-wjg71m.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/594474/original/file-20240516-16-wjg71m.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=456&fit=crop&dpr=1 600w, https://images.theconversation.com/files/594474/original/file-20240516-16-wjg71m.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=456&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/594474/original/file-20240516-16-wjg71m.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=456&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/594474/original/file-20240516-16-wjg71m.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=573&fit=crop&dpr=1 754w, https://images.theconversation.com/files/594474/original/file-20240516-16-wjg71m.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=573&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/594474/original/file-20240516-16-wjg71m.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=573&fit=crop&dpr=3 2262w" alt="" /></a><figcaption></figcaption></figure> <h2>Are these diets healthy?</h2> A <a href="https://academic.oup.com/eurheartj/article/44/36/3423/7224412">2023 review</a> looked at the health effects of vegetarian and vegan diets from two types of study. Observational studies followed people over the years to see how their diets were linked to their health. In these studies, eating a vegetarian diet was associated with a lower risk of developing cardiovascular disease (such as heart disease or a stroke), diabetes, hypertension (high blood pressure), dementia and cancer. For example, in a <a href="https://www.sciencedirect.com/science/article/pii/S0002916523054497?via%3Dihub">study</a> of 44,561 participants, the risk of heart disease was 32% lower in vegetarians than non-vegetarians after an average follow-up of nearly 12 years. Further evidence came from randomised controlled trials. These instruct study participants to eat a specific diet for a specific period of time and monitor their health throughout. These studies showed eating a vegetarian or vegan diet led to reductions in weight, blood pressure, and levels of unhealthy cholesterol. For example, one <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1832195">analysis</a> combined data from seven randomised controlled trials. This so-called meta-analysis included data from 311 participants. It showed eating a vegetarian diet was associated with a systolic blood pressure (the first number in your blood pressure reading) an average 5 mmHg lower compared with non-vegetarian diets. It seems vegetarian diets are more likely to be healthier, across a number of measures. For example, a 2022 <a href="https://link.springer.com/article/10.1007/s00394-022-02942-8">meta-analysis</a> combined the results of several observational studies. It concluded a vegetarian diet, rather than vegan diet, was recommended to prevent heart disease. There is also <a href="https://link.springer.com/article/10.1007/s13668-024-00533-z">evidence</a> vegans are more likely to have bone fractures than vegetarians. This could be partly due to a lower body-mass index and a lower intake of nutrients such as calcium, vitamin D and protein. <h2>But it can be about more than just food</h2> Many vegans, where possible, do not use products that directly or indirectly involve using animals. So vegans would not wear leather, wool or silk clothing, for example. And they would not use soaps or candles made from beeswax, or use products tested on animals. The motivation for following a vegan or vegetarian diet can vary from person to person. Common motivations <a href="https://www.sciencedirect.com/science/article/pii/S2475299123157957">include</a> health, environmental, ethical, religious or economic reasons. And for many people who follow a vegan or vegetarian diet, this forms a central part of their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9231820/">identity</a>. <h2>So, should I adopt a vegan or vegetarian diet?</h2> If you are thinking about a vegan or vegetarian diet, here are some things to consider: <ul> <li> eating more plant foods does not automatically mean you are eating a healthier diet. Hot chips, biscuits and soft drinks can all be vegan or vegetarian foods. And many <a href="https://theconversation.com/we-looked-at-700-plant-based-foods-to-see-how-healthy-they-really-are-heres-what-we-found-222991">plant-based alternatives</a>, such as plant-based sausages, can be high in added salt </li> <li> meeting the <a href="https://www.eatforhealth.gov.au/nutrient-reference-values/nutrients">nutrient intake targets</a> for vitamin B12, iron, calcium, and iodine requires more careful planning while on a vegan or vegetarian diet. This is because meat, seafood and animal products are good sources of these vitamins and minerals </li> <li> eating a plant-based diet doesn’t necessarily mean <a href="https://theconversation.com/why-you-should-eat-a-plant-based-diet-but-that-doesnt-mean-being-a-vegetarian-78470">excluding</a> all meat and animal products. A healthy flexitarian diet prioritises eating more whole plant-foods, such as vegetables and beans, and less processed meat, such as bacon and sausages </li> <li> the <a href="https://www.eatforhealth.gov.au/guidelines/australian-dietary-guidelines-1-5">Australian Dietary Guidelines</a> recommend eating a wide variety of foods from the five food groups (fruit, vegetables, cereals, lean meat and/or their alternatives and reduced-fat dairy products and/or their alternatives). So if you are eating animal products, choose lean, reduced-fat meats and dairy products and limit processed meats.<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/225275/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> </li> </ul> <a href="https://theconversation.com/profiles/katherine-livingstone-324808">Katherine Livingstone</a>, NHMRC Emerging Leadership Fellow and Senior Research Fellow at the Institute for Physical Activity and Nutrition, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/whats-the-difference-between-vegan-and-vegetarian-225275">original article</a>. </div>

Food & Wine

What’s the difference between shyness and social anxiety?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/kayla-steele-1042011">Kayla Steele</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> and <a href="https://theconversation.com/profiles/jill-newby-193454">Jill Newby</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> The terms “shyness” and “social anxiety” are often used interchangeably because they both involve feeling uncomfortable in social situations. However, <a href="https://theconversation.com/shyness-isnt-nice-but-shyness-shouldnt-stop-you-28010">feeling shy</a>, or having a shy personality, is not the same as experiencing <a href="https://theconversation.com/explainer-what-is-social-anxiety-disorder-36601">social anxiety</a> (short for “social anxiety disorder”). Here are some of the similarities and differences, and what the distinction means. <h2>How are they similar?</h2> It can be normal to feel nervous or even stressed in new social situations or when interacting with new people. And everyone differs in how comfortable they feel when interacting with others. For people who are shy or socially anxious, social situations can be very uncomfortable, stressful or even threatening. There can be a strong desire to avoid these situations. People who are shy or socially anxious may <a href="https://theconversation.com/paralysed-with-fear-why-do-we-freeze-when-frightened-60543">respond with</a> “flight” (by withdrawing from the situation or avoiding it entirely), “freeze” (by detaching themselves or feeling disconnected from their body), or “<a href="https://theconversation.com/what-is-fawning-how-is-it-related-to-trauma-and-the-fight-or-flight-response-205024">fawn</a>” (by trying to appease or placate others). A complex interaction of biological and environmental factors is also thought to influence the development of shyness and social anxiety. For example, both <a href="https://link.springer.com/article/10.3758/s13415-021-00916-7">shy children</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5428215/">adults with social anxiety</a> have neural circuits that respond strongly to stressful social situations, such as being excluded or left out. People who are shy or socially anxious commonly report physical symptoms of stress in certain situations, or even when anticipating them. These include sweating, blushing, trembling, an increased heart rate or hyperventilation. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/592825/original/file-20240508-22-heev7f.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/592825/original/file-20240508-22-heev7f.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/592825/original/file-20240508-22-heev7f.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=456&fit=crop&dpr=1 600w, https://images.theconversation.com/files/592825/original/file-20240508-22-heev7f.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=456&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/592825/original/file-20240508-22-heev7f.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=456&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/592825/original/file-20240508-22-heev7f.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=573&fit=crop&dpr=1 754w, https://images.theconversation.com/files/592825/original/file-20240508-22-heev7f.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=573&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/592825/original/file-20240508-22-heev7f.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=573&fit=crop&dpr=3 2262w" alt="" /></a><figcaption></figcaption></figure> <h2>How are they different?</h2> Social anxiety is a diagnosable mental health condition and is an example of an anxiety disorder. For people who struggle with social anxiety, social situations – including social interactions, being observed and performing in front of others – trigger intense fear or anxiety about being judged, criticised or rejected. To be diagnosed with social anxiety disorder, social anxiety needs to be persistent (lasting more than six months) and have a significant negative impact on important areas of life such as work, school, relationships, and identity or sense of self. Many adults with social anxiety report feeling shy, timid and lacking in confidence when they were a child. However, not all shy children go on to develop social anxiety. Also, feeling shy does not necessarily mean a person meets the criteria for social anxiety disorder. People vary in how shy or outgoing they are, depending on where they are, who they are with and how comfortable they feel in the situation. This is particularly true for children, who sometimes appear reserved and shy with strangers and peers, and outgoing with known and trusted adults. Individual differences in temperament, personality traits, early childhood experiences, family upbringing and environment, and parenting style, can also influence the extent to which people feel shy across social situations. However, people with social anxiety have overwhelming fears about embarrassing themselves or being negatively judged by others; they experience these fears consistently and across multiple social situations. The intensity of this fear or anxiety often leads people to avoid situations. If avoiding a situation is not possible, they may engage in safety behaviours, such as looking at their phone, wearing sunglasses or rehearsing conversation topics. The effect social anxiety can have on a person’s life can be far-reaching. It may include low self-esteem, breakdown of friendships or romantic relationships, difficulties pursuing and progressing in a career, and dropping out of study. The impact this has on a person’s ability to lead a meaningful and fulfilling life, and the distress this causes, differentiates social anxiety from shyness. Children can show similar signs or symptoms of social anxiety to adults. But they may also feel upset and teary, irritable, have temper tantrums, cling to their parents, or <a href="https://theconversation.com/what-is-selective-mutism-and-is-it-a-lifelong-condition-219930">refuse to speak</a> in certain situations. If left untreated, social anxiety can set children and young people up for a future of missed opportunities, so early intervention is key. With professional and <a href="https://theconversation.com/back-to-school-blues-how-to-help-your-child-with-shyness-90228">parental support</a>, patience and guidance, children can be taught <a href="https://theconversation.com/7-tips-to-help-kids-feeling-anxious-about-going-back-to-school-139207">strategies</a> to overcome social anxiety. <h2>Why does the distinction matter?</h2> Social anxiety disorder is a mental health condition that <a href="https://link.springer.com/article/10.1186/s12916-017-0889-2?utm_source=getftr&utm_medium=getftr&utm_campaign=getftr_pilot">persists</a> for people who do not receive adequate support or treatment. Without treatment, it can lead to <a href="https://pubmed.ncbi.nlm.nih.gov/22306132/">difficulties</a> in education and at work, and in developing meaningful relationships. Receiving a diagnosis of social anxiety disorder can be validating for some people as it recognises the level of distress and that its impact is more intense than shyness. A diagnosis can also be an important first step in accessing appropriate, evidence-based treatment. Different people have different support needs. However, <a href="https://www.nice.org.uk/guidance/cg159/chapter/Recommendations">clinical practice guidelines</a> recommend cognitive-behavioural therapy (a kind of psychological therapy that teaches people practical coping skills). This is often used with <a href="https://theconversation.com/explainer-what-is-exposure-therapy-and-how-can-it-treat-social-anxiety-64483#:%7E:text=Exposure%20therapy%20is%20where%20people,addresses%20the%20underlying%20unhelpful%20thoughts.">exposure therapy</a> (a kind of psychological therapy that helps people face their fears by breaking them down into a series of step-by-step activities). This combination is effective <a href="https://theconversation.com/explainer-what-is-exposure-therapy-and-how-can-it-treat-social-anxiety-64483#:%7E:text=Exposure%20therapy%20is%20where%20people,addresses%20the%20underlying%20unhelpful%20thoughts.">in-person</a>, <a href="https://www.semanticscholar.org/paper/Computer-therapy-for-the-anxiety-and-depression-is-Andrews-Basu/25e9ee98a1af8d2780ac3e1f687ebc40ebd1b47c">online</a> and in <a href="https://pubmed.ncbi.nlm.nih.gov/34534800/">brief treatments</a>. <h2>For more support or further reading</h2> Online resources about social anxiety include: <ul> <li> This Way Up’s <a href="https://thiswayup.org.au/programs/social-anxiety-program/">online program</a> for managing excessive shyness and fear of social situations </li> <li> Beyond Blue’s <a href="https://www.beyondblue.org.au/mental-health/anxiety/types-of-anxiety/social-anxiety-disorder">resources</a> on social anxiety </li> <li> a guide to <a href="https://www.cci.health.wa.gov.au/Resources/Looking-After-Yourself/Social-Anxiety">looking after yourself</a> if you have social anxiety, from the Western Australian health department </li> <li> social anxiety <a href="https://brave4you.psy.uq.edu.au/">online program for children and teens</a> from the University of Queensland </li> <li> inroads, a <a href="https://inroads.org.au/">self-guided online program</a> for young adults who drink alcohol to manage their anxiety. </li> </ul> <hr /> We thank the Black Dog Institute <a href="https://www.blackdoginstitute.org.au/about/who-we-are/lived-experience/">Lived Experience Advisory Network</a> members for providing feedback and input for this article and our research.<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/225669/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/kayla-steele-1042011">Kayla Steele</a>, Postdoctoral research fellow and clinical psychologist, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> and <a href="https://theconversation.com/profiles/jill-newby-193454">Jill Newby</a>, Professor, NHMRC Emerging Leader & Clinical Psychologist, <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/whats-the-difference-between-shyness-and-social-anxiety-225669">original article</a>. </div>

Mind

Are young people smarter than older adults? My research shows cognitive differences between generations are diminishing

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/stephen-badham-1531316">Stephen Badham</a>, <a href="https://theconversation.com/institutions/nottingham-trent-university-1338">Nottingham Trent University</a> We often assume young people are smarter, or at least quicker, than older people. For example, we’ve all heard that scientists, and even more so mathematicians, <a href="https://www.forbes.com/sites/nextavenue/2014/08/07/who-says-scientists-peak-by-age-50/">carry out their most important work</a> when they’re comparatively young. But my new research, <a href="https://www.sciencedirect.com/science/article/pii/S027322972400008X#:%7E:text=Highlights&text=Three%20review%20studies%20measure%20secular,%2C%20education%2C%20and%20overall%20health.">published in Developmental Review</a>, suggests that cognitive differences between the old and young are tapering off over time. This is hugely important as stereotypes about the intelligence of people in their sixties or older may be holding them back – in the workplace and beyond. Cognitive ageing is often measured by comparing young adults, aged 18-30, to older adults, aged 65 and over. There are a variety of tasks that older adults do not perform well on compared to young adults, such as memory, spatial ability and speed of processing, which often form the basis of <a href="https://theconversation.com/the-iq-test-wars-why-screening-for-intelligence-is-still-so-controversial-81428">IQ tests</a>. That said, there are a few tasks that older people do better at than younger people, such as reading comprehension and vocabulary. Declines in cognition are driven by a process called <a href="https://www.nature.com/collections/cbjacdabdf">cognitive ageing</a>, which happens to everyone. Surprisingly, age-related cognitive deficits start very early in adulthood, and declines in cognition have been measured as dropping in adults as young as just 25. Often, it is only when people reach older age that these effects add up to a noticeable amount. Common complaints consist of walking into a room and forgetting why you entered, as well as difficulty remembering names and struggling to drive in the dark. <h2>The trouble with comparison</h2> Sometimes, comparing young adults to older adults can be misleading though. The two generations were brought up in different times, with different levels of education, healthcare and nutrition. They also lead different daily lives, with some older people having lived though a world war while the youngest generation is growing up with the internet. Most of these factors favour the younger generation, and this can explain a proportion of their advantage in cognitive tasks. Indeed, much existing research shows that <a href="https://theconversation.com/iq-tests-are-humans-getting-smarter-158837">IQ has been improving</a> globally throughout the 20th century. This means that later-born generations are more cognitively able than those born earlier. This is even found when both generations are tested in the same way at the same age. Currently, there is growing evidence that <a href="https://www.pnas.org/doi/10.1073/pnas.1718793115">increases in IQ are levelling off,</a> such that, in the most recent couple of decades, young adults are no more cognitively able than young adults born shortly beforehand. Together, these factors may underlie the current result, namely that cognitive differences between young and older adults are diminishing over time. <h2>New results</h2> My research began when my team started getting strange results in our lab. We found that often the age differences we were getting between young and older adults was smaller or absent, compared to prior research from early 2000s. This prompted me to start looking at trends in age differences across the psychological literature in this area. I uncovered a variety of data that compared young and older adults from the 1960s up to the current day. I plotted this data against year of publication, and found that age deficits have been getting smaller over the last six decades. Next, I assessed if the average increases in cognitive ability over time seen across all individuals was a result that also applied to older adults specifically. Many large databases exist where groups of individuals are recruited every few years to take part in the same tests. I analysed studies using these data sets to look at older adults. I found that, just like younger people, older adults were indeed becoming more cognitively able with each cohort. But if differences are disappearing, does that mean younger people’s improvements in cognitive ability have slowed down or that older people’s have increased? I analysed data from my own laboratory that I had gathered over a seven-year period to find out. Here, I was able to dissociate the performance of the young from the performance of the older. I found that each cohort of young adults was performing to a similar extent across this seven-year period, but that older adults were showing improvements in both processing speed and vocabulary scores. <figure class="align-center "><img src="https://images.theconversation.com/files/591482/original/file-20240501-24-esxcic.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/591482/original/file-20240501-24-esxcic.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=333&fit=crop&dpr=1 600w, https://images.theconversation.com/files/591482/original/file-20240501-24-esxcic.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=333&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/591482/original/file-20240501-24-esxcic.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=333&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/591482/original/file-20240501-24-esxcic.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=418&fit=crop&dpr=1 754w, https://images.theconversation.com/files/591482/original/file-20240501-24-esxcic.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=418&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/591482/original/file-20240501-24-esxcic.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=418&fit=crop&dpr=3 2262w" alt="The figure shows data for a speed-based task where higher scores represent better performance." /><figcaption>The figure shows data for a speed-based task where higher scores represent better performance. <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></figcaption></figure> I believe the older adults of today are benefiting from many of the factors previously most applicable to young adults. For example, the number of children who went to school <a href="https://education-uk.org/history/chapter12.html">increased significantly</a> in the 1960s – with the system being more similar to what it is today than what it was at the start of the 20th century. This is being reflected in that cohort’s increased scores today, now they are older adults. At the same time, young adults have hit a ceiling and are no longer improving as much with each cohort. It is not entirely clear why the young generations have stopped improving so much. Some research has <a href="https://doi.org/10.1016/j.intell.2016.10.002">explored maternal age, mental health and even evolutionary trends</a>. I favour the opinion that there is just a natural ceiling – a limit to how much factors such as education, nutrition and health can improve cognitive performance. These data have important implications for research into dementia. For example, it is possible that a modern older adult in the early stages of dementia might pass a dementia test that was designed 20 or 30 years ago for the general population at that time. Therefore, as older adults are performing better in general than previous generations, it may be necessary to revise definitions of dementia that depend on an individuals’ expected level of ability. Ultimately, we need to rethink what it means to become older. And there’s finally some good news. Ultimately, we can expect to be more cognitively able than our grandparents were when we reach their age.<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/229132/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/stephen-badham-1531316">Stephen Badham</a>, Professor of Psychology, <a href="https://theconversation.com/institutions/nottingham-trent-university-1338">Nottingham Trent University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/are-young-people-smarter-than-older-adults-my-research-shows-cognitive-differences-between-generations-are-diminishing-229132">original article</a>. </div>

Mind

What’s the difference between ADD and ADHD?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/kathy-gibbs-1392051">Kathy Gibbs</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> Around <a href="https://www.healthdirect.gov.au/attention-deficit-disorder-add-or-adhd#:%7E:text=Around%201%20in%20every%2020,have%20symptoms%20as%20an%20adult.">one in 20 people</a> has attention-deficit hyperactivity disorder (ADHD). It’s one of the most common neurodevelopmental disorders in childhood and often continues into adulthood. ADHD is <a href="https://www.psychiatry.org/psychiatrists/practice/dsm">diagnosed</a> when people experience problems with inattention and/or hyperactivity and impulsivity that negatively impacts them at school or work, in social settings and at home. Some people call the condition attention-deficit disorder, or ADD. So what’s the difference? In short, what was previously called ADD is now known as ADHD. So how did we get here? <h2>Let’s start with some history</h2> The <a href="https://www.guilford.com/books/Attention-Deficit-Hyperactivity-Disorder/Russell-Barkley/9781462538874">first clinical description</a> of children with inattention, hyperactivity and impulsivity was in 1902. British paediatrician Professor George Still <a href="https://pubmed.ncbi.nlm.nih.gov/26740929/">presented</a> a series of lectures about his observations of 43 children who were defiant, aggressive, undisciplined and extremely emotional or passionate. Since then, our understanding of the condition evolved and made its way into the Diagnostic and Statistical Manual of Mental Disorders, known as the DSM. Clinicians use the DSM to diagnose mental health and neurodevelopmental conditions. The first DSM, published in 1952, did not include a specific related child or adolescent category. But the <a href="https://dsm.psychiatryonline.org/doi/abs/10.1176/appi.books.9780890420355.dsm-ii">second edition</a>, published in 1968, <a href="https://www.tandfonline.com/doi/full/10.1080/00207411.2015.1009310">included a section</a> on behaviour disorders in young people. It referred to ADHD-type characteristics as “hyperkinetic reaction of childhood or adolescence”. This described the excessive, involuntary movement of children with the disorder. In the early 1980s, the <a href="https://www.psychiatry.org/psychiatrists/practice/dsm/about-dsm/history-of-the-dsm">third DSM</a> added a condition it called “attention deficit disorder”, listing two types: attention deficit disorder with hyperactivity (ADDH) and attention deficit disorder as the subtype without the hyperactivity. However, seven years later, a revised DSM (DSM-III-R) replaced ADD (and its two sub-types) with ADHD and three sub-types we have today: <ul> <li>predominantly inattentive</li> <li>predominantly hyperactive-impulsive</li> <li>combined.</li> </ul> <h2>Why change ADD to ADHD?</h2> ADHD replaced ADD in the DSM-III-R in 1987 for a number of reasons. First was the controversy and debate over the presence or absence of hyperactivity: the “H” in ADHD. When ADD was <a href="https://www.guilford.com/books/Attention-Deficit-Hyperactivity-Disorder/Russell-Barkley/9781462538874">initially named</a>, little research had been done to determine the similarities and differences between the two sub-types. The next issue was around the term “attention-deficit” and whether these deficits were similar or different across both sub-types. Questions also arose about the extent of these differences: if these sub-types were so different, were they actually different conditions? Meanwhile, a new focus on inattention (an “attention deficit”) recognised that children with inattentive behaviours <a href="https://academic.oup.com/shm/article/30/4/767/2919401">may not necessarily be</a> disruptive and challenging but are more likely to be forgetful and daydreamers. <h2>Why do some people use the term ADD?</h2> There was a <a href="https://academic.oup.com/shm/article/30/4/767/2919401">surge of diagnoses</a> in the 1980s. So it’s understandable that some people still hold onto the term ADD. Some may identify as having ADD because out of habit, because this is what they were originally diagnosed with or because they don’t have hyperactivity/impulsivity traits. Others who don’t have ADHD may use the term they came across in the 80s or 90s, not knowing the terminology has changed. <h2>How is ADHD currently diagnosed?</h2> The three sub-types of ADHD, outlined in the DSM-5 are: <ul> <li> predominantly inattentive. People with the inattentive sub-type have difficulty sustaining concentration, are easily distracted and forgetful, lose things frequently, and are unable to follow detailed instructions </li> <li> predominantly hyperactive-impulsive. Those with this sub-type find it hard to be still, need to move constantly in structured situations, frequently interrupt others, talk non-stop and struggle with self control </li> <li> combined. Those with the combined sub-type experience the characteristics of those who are inattentive and hyperactive-impulsive. </li> </ul> ADHD diagnoses <a href="https://www.aihw.gov.au/reports/children-youth/australias-children/contents/health/children-mental-illness">continue to rise</a> among children and adults. And while ADHD was commonly diagnosed in boys, more recently we have seen growing numbers of girls and women seeking diagnoses. However, some international experts <a href="https://academic.oup.com/shm/article/30/4/767/2919401">contest</a> the expanded definition of ADHD, driven by clinical practice in the United States. They argue the challenges of unwanted behaviours and educational outcomes for young people with the condition are uniquely shaped by each country’s cultural, political and local factors. Regardless of the name change to reflect what we know about the condition, ADHD continues to impact educational, social and life situations of many children, adolescents and adults.<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/225162/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/kathy-gibbs-1392051">Kathy Gibbs</a>, Program Director for the Bachelor of Education, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/whats-the-difference-between-add-and-adhd-225162">original article</a>. </div>

Mind

How much stress is too much? A psychiatrist explains the links between toxic stress and poor health − and how to get help

<a href="https://theconversation.com/profiles/lawson-r-wulsin-1493655">Lawson R. Wulsin</a>, <a href="https://theconversation.com/institutions/university-of-cincinnati-1717">University of Cincinnati </a> COVID-19 taught most people that the line between tolerable and toxic stress – defined as persistent demands that lead to disease – varies widely. But some people will age faster and die younger from toxic stressors than others. So how much stress is too much, and what can you do about it? I’m a <a href="https://researchdirectory.uc.edu/p/wulsinlr">psychiatrist specializing in psychosomatic medicine</a>, which is the study and treatment of people who have physical and mental illnesses. My research is focused on people who have psychological conditions and medical illnesses as well as those whose stress exacerbates their health issues. I’ve spent my career studying mind-body questions and training physicians to treat mental illness in primary care settings. My <a href="https://www.cambridge.org/core/books/toxic-stress/677FA62B741540DBDB53E2F0A52A74B1">forthcoming book</a> is titled “Toxic Stress: How Stress is Killing Us and What We Can Do About It.” A 2023 study of stress and aging over the life span – one of the first studies to confirm this piece of common wisdom – found that four measures of stress all speed up the pace of biological aging in midlife. It also found that persistent high stress ages people in a comparable way to the <a href="https://doi.org/10.1097/PSY.0000000000001197">effects of smoking and low socioeconomic status</a>, two well-established risk factors for accelerated aging. <figure><iframe src="https://www.youtube.com/embed/yiglpsqv5ik?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Children with alcoholic or drug-addicted parents have a greater risk of developing toxic stress.</figcaption></figure> <h2>The difference between good stress and the toxic kind</h2> Good stress – a demand or challenge you readily cope with – is good for your health. In fact, the rhythm of these daily challenges, including feeding yourself, cleaning up messes, communicating with one another and carrying out your job, helps to regulate your stress response system and keep you fit. Toxic stress, on the other hand, wears down your stress response system in ways that have lasting effects, as psychiatrist and trauma expert Bessel van der Kolk explains in his bestselling book “<a href="https://www.penguinrandomhouse.com/books/313183/the-body-%20keeps-the-score-by-bessel-van-der-kolk-md/">The Body Keeps the Score</a>.” The earliest effects of toxic stress are often persistent symptoms such as headache, fatigue or abdominal pain that interfere with overall functioning. After months of initial symptoms, a full-blown illness with a life of its own – such as migraine headaches, asthma, diabetes or ulcerative colitis – may surface. When we are healthy, our stress response systems are like an orchestra of organs that miraculously tune themselves and play in unison without our conscious effort – a process called self-regulation. But when we are sick, some parts of this orchestra struggle to regulate themselves, which causes a cascade of stress-related dysregulation that contributes to other conditions. For instance, in the case of diabetes, the hormonal system struggles to regulate sugar. With obesity, the metabolic system has a difficult time regulating energy intake and consumption. With depression, the central nervous system develops an imbalance in its circuits and neurotransmitters that makes it difficult to regulate mood, thoughts and behaviors. <h2>‘Treating’ stress</h2> Though stress neuroscience in recent years has given researchers like me <a href="https://doi.org/10.1097/PSY.0000000000001051">new ways to measure and understand stress</a>, you may have noticed that in your doctor’s office, the management of stress isn’t typically part of your treatment plan. Most doctors don’t assess the contribution of stress to a patient’s common chronic diseases such as diabetes, heart disease and obesity, partly because stress is complicated to measure and partly because it is difficult to treat. In general, doctors don’t treat what they can’t measure. Stress neuroscience and epidemiology have also taught researchers recently that the chances of developing serious mental and physical illnesses in midlife rise dramatically when people are exposed to trauma or adverse events, especially during <a href="https://www.cdc.gov/violenceprevention/aces/ace-brfss.html">vulnerable periods such as childhood</a>. Over the past 40 years in the U.S., the alarming rise in <a href="https://www.cdc.gov/diabetes/health-equity/diabetes-by-the-numbers.html">rates of diabetes</a>, <a href="https://www.cdc.gov/nchs/data/hestat/obesity-child-17-18/overweight-obesity-child-H.pdf">obesity</a>, depression, PTSD, <a href="https://www.cdc.gov/nchs/products/databriefs/db433.htm">suicide</a> and addictions points to one contributing factor that these different illnesses share: toxic stress. Toxic stress increases the risk for the onset, progression, complications or early death from these illnesses. <h2>Suffering from toxic stress</h2> Because the definition of toxic stress varies from one person to another, it’s hard to know how many people struggle with it. One starting point is the fact that about 16% of adults report having been exposed to <a href="https://www.cdc.gov/violenceprevention/aces/fastfact.html">four or more adverse events in childhood</a>. This is the threshold for higher risk for illnesses in adulthood. Research dating back to before the COVID-19 pandemic also shows that about 19% of adults in the U.S. have <a href="https://doi.org/10.7249/TL221">four or more chronic illnesses</a>. If you have even one chronic illness, you can imagine how stressful four must be. And about 12% of the U.S. population <a href="https://blogs.worldbank.org/opendata/introducing-second-edition-world-banks-global-subnational-atlas-poverty">lives in poverty</a>, the epitome of a life in which demands exceed resources every day. For instance, if a person doesn’t know how they will get to work each day, or doesn’t have a way to fix a leaking water pipe or resolve a conflict with their partner, their stress response system can never rest. One or any combination of threats may keep them on high alert or shut them down in a way that prevents them from trying to cope at all. Add to these overlapping groups all those who struggle with harassing relationships, homelessness, captivity, severe loneliness, living in high-crime neighborhoods or working in or around noise or air pollution. It seems conservative to estimate that about 20% of people in the U.S. live with the effects of toxic stress. <figure><iframe src="https://www.youtube.com/embed/WuyPuH9ojCE?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Exercise, meditation and a healthy diet help fight toxic stress.</figcaption></figure> <h2>Recognizing and managing stress and its associated conditions</h2> The first step to managing stress is to recognize it and talk to your primary care clinician about it. The clinician may do an assessment involving a <a href="https://doi.org/10.1097/PSY.0000000000001051">self-reported measure of stress</a>. The next step is treatment. Research shows that it is possible to retrain a dysregulated stress response system. This approach, <a href="https://lifestylemedicine.org/">called “lifestyle medicine</a>,” focuses on improving health outcomes through changing high-risk health behaviors and adopting daily habits that help the stress response system self-regulate. Adopting these lifestyle changes is not quick or easy, but it works. The <a href="https://www.cdc.gov/diabetes/prevention/index.html">National Diabetes Prevention Program</a>, the <a href="https://www.ornish.com/">Ornish “UnDo” heart disease program</a> and the <a href="https://www.ptsd.va.gov/understand_tx/tx_basics.asp">U.S. Department of Veterans Affairs PTSD program</a>, for example, all achieve a slowing or reversal of stress-related chronic conditions through weekly support groups and guided daily practice over six to nine months. These programs help teach people how to practice personal regimens of stress management, diet and exercise in ways that build and sustain their new habits. There is now strong evidence that it is possible to treat toxic stress in ways that improve health outcomes for people with stress-related conditions. The next steps include finding ways to expand the recognition of toxic stress and, for those affected, to expand access to these new and effective approaches to treatment.<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/222245/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/lawson-r-wulsin-1493655">Lawson R. Wulsin</a>, Professor of Psychiatry and Family Medicine, <a href="https://theconversation.com/institutions/university-of-cincinnati-1717">University of Cincinnati</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-much-stress-is-too-much-a-psychiatrist-explains-the-links-between-toxic-stress-and-poor-health-and-how-to-get-help-222245">original article</a>.

Mind

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

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

Mind

Supermarket worker finds 2000 Olympics relic between the shelves

A worker at an Aussie supermarket has discovered a relic of Australian culture that is over two decades old. While moving some old shelves in the grocery store as they prepared for renovations, the supermarket worker was shocked to discover a long-expired chocolate bar that was released for the 2000 Sydney Olympics. Posting about the discovery on a Facebook page called Old Shops Australia, a man posted about his wife’s unusual find. “My wife works in a supermarket and they were moving the shelving around and this was stuck between two shelves. Still wrapped up with chocolate inside,” the man said. The 'Sydney 2000 Games Story Block' had the three characters, Syd the platypus, Millie the echidna and Olly the Kookaburra on the front. It also had one of six collectable Olympic Games story book inside the wrapper, with the chocolate expiring on July 30th 2001. Images of the almost-forgotten treat have been circulating online triggering old memories in thousands of Aussies. One person noted the wrapper was made out of paper and foil rather than the plastic used today. Others pointed out the generous size of the chocolate block which is 250g compared to the 180g bars available now. “Oh wow!! This brings back memories!! A near 24 year old block of chocolate!! Would anyone be up for tasting it?! Wonder how much it's worth?! How long since the supermarket had a good clean and update?! So many questions!” one woman asked. “Partly want this to go to a museum, partly just wanna see it unwrapped,” a second wrote. “Oof, right in the nostalgia,” a third said and another chimed in, “Mouldy as hell. I wonder what the story book looks like.” Image credits: Facebook

Food & Wine

What’s the difference between memory loss and dementia?

When it comes to memory loss, it's normal to become a little more forgetful as we age. However, it’s important to know the difference between a standard level of memory loss, and the early signs of dementia. Researchers at the University of New South Wales (UNSW) say it is crucially important to distinguish between the physical decline of ageing, and the more sinister reality of cognitive decline. Associate Professor Simone Reppermund from the Centre for Healthy Brain Ageing says, “As we age, we get more frail, and it may be difficult to walk longer distances or to have the range of motion to drive a car.” “But that's unrelated to cognitive decline, and this is where dementia or cognitive impairment comes in. A person with dementia at some point will not be able to do the things they once could do without thinking, such as drive a car, because they get confused and are no longer able to process the sensory information required to do this.” Prof. Brodaty went on to say that some cognitive decline is part of normal ageing. “As we age, we become slower in our processing speed. We’re not as good at remembering things, particularly when they’re not able to be logically sorted and connected.” But it’s not all bad for older folks, as some things are known to improve with age. “As we age our vocabulary improves, our judgement improves, our ability to organise things improves. In everyday tests where we can sort, say, 10 grocery items into different categories, we do just as well as the younger person because we can use those strategies to compensate. There is also evidence that we become wiser as we get older.” According to <a href="https://www.dementia.org.au" target="_blank" rel="noopener">Dementia Australia</a>, it’s when people encounter difficulties with the following on a regular basis that there could be some underlying cognitive cause worth investigating. These difficulties include: <ul> <li dir="ltr" aria-level="1"> Trouble remembering recent events </li> <li dir="ltr" aria-level="1"> Trouble finding the right word </li> <li dir="ltr" aria-level="1"> Trouble remembering the day and date </li> <li dir="ltr" aria-level="1"> Forgetting where things are usually kept </li> <li dir="ltr" aria-level="1"> Difficulty adjusting to changes in routine </li> <li dir="ltr" aria-level="1"> Trouble understanding written content or a story on television </li> <li dir="ltr" aria-level="1"> Difficulty following conversations in groups </li> <li dir="ltr" aria-level="1"> Problems handling finances </li> <li dir="ltr" aria-level="1"> Difficulty with everyday activities </li> <li dir="ltr" aria-level="1"> Losing interest in activities that were previously enjoyable </li> </ul> Researchers and medical experts say that even if encountering these difficulties has not become a huge hurdle, it is important to be assessed by a doctor. Some conditions can cause symptoms similar to illnesses of cognitive decline, and can be reversed and prevented if caught early enough. While Professor Brodaty says there is no cure for most types of dementia and no known way to prevent it, we can certainly delay the onset of it. “There are certain risk factors that make it more or less likely to develop cognitive decline and dementia, including physical and social inactivity. Being inactive, not engaging in social activities, a poor diet and too much alcohol are all risk factors.” Even then, Professor Brodaty says, “it’s never too late to start, and never too early to start” making changes that maintain and protect your brain health into old age. Image credits: Getty Images

Mind

Heated argument between economy passengers reignites plane etiquette debate

A 12-second clip of two passengers arguing on a plane has reignited the age-old debate of whether it is acceptable to recline your seat on a plane. The viral video which was originally posted on TikTok and then re-shared on X, has racked up over 8 million views since Thursday. In the video, a frustrated woman was calling out another female passenger for pushing her seat the entire flight, right after they landed. “The whole trip she pushed my seat,” the woman said to a male passenger seated next to the female passenger accused of kicking her seat. “You seen it. You know she did.” “I’m allowed to put my seat back," she yelled repeatedly. Ian Miles Cheong, the user who posted the video on X, defended the woman saying: “She’s allowed to put her seat back. You don’t get to kick it repeatedly just because you want more space.” A few were on the woman's side and praised her for standing up for herself. “You are allowed! Period! You want space in front of you instead of pushing the seat, buy a seat with extra space or get your a** to business class. Reclining was put there for a reason,” one person wrote. “She was patient enough to wait till flight landed," they added. “If the seat is reclinable, recline it,” another commented. "What she’s saying is right. The woman has a right to put her seat back without someone kicking it," a third agreed. <blockquote class="twitter-tweet"> She’s allowed to put her seat back. You don’t get to kick it repeatedly just because you want more space. <a href="https://t.co/WELD7Qh4Re">pic.twitter.com/WELD7Qh4Re</a> — Ian Miles Cheong (@stillgray) <a href="https://twitter.com/stillgray/status/1719881310351863952?ref_src=twsrc%5Etfw">November 2, 2023</a></blockquote> However, others claimed that there was an unwritten rule that you shouldn't recline your seat, especially on a short-haul flight, adding that the recline feature should be scrapped from airplanes. “Putting your seat back in coach is an unspoken thing most people don’t do. It’s really the airline’s fault because they’ve made coach so cramped and tight that putting the seat back shouldn’t even be an option,” one commented. “Airline seats simply shouldn’t be able to recline. It intrudes on the already very little space a person has on the plane for the person behind them,” another added. “Really it’s the airline’s fault for cramming so many people in such a small space. They don’t call it cattle class for nothing,” a third wrote. One user understood both sides of the argument, and blamed the airlines for making the seats so cramped. "It can be annoying sometimes to be behind someone with their seat all the way, but if the airlines didn't want to allow that, it wouldn't happen," they wrote. "You don't kick the seat like a baby. Blame the airline, not the person doing what the airline says is fine." Images: Twitter

Travel Trouble

How biological differences between men and women alter immune responses – and affect women’s health

<a href="https://theconversation.com/profiles/helen-mcgettrick-1451122">Helen McGettrick</a>, <a href="https://theconversation.com/institutions/university-of-birmingham-1138">University of Birmingham</a> and <a href="https://theconversation.com/profiles/asif-iqbal-1451123">Asif Iqbal</a>, <a href="https://theconversation.com/institutions/university-of-birmingham-1138">University of Birmingham</a> Most people will have heard the term “man flu”, which refers to men’s perceived tendency to exaggerate the severity of a cold or a similar minor ailment. What most people may not know is that, generally speaking, women mount stronger <a href="https://pubmed.ncbi.nlm.nih.gov/36121220/">immune responses</a> to infections than men. Men are <a href="https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1005374">more susceptible</a> to infections from, for example, HIV, hepatitis B, and Plasmodium falciparum (the parasite responsible for malaria). They can also have more severe symptoms, with evidence showing they’re more likely to be <a href="https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1005374">admitted to hospital</a> when infected with hepatitis B, tuberculosis, and Campylobacter jejuni (a bacteria that causes gastroenteritis), among others. While this may be positive for women in some respects, it also means women are at <a href="https://www.nature.com/articles/nri2815">greater risk</a> of developing chronic diseases driven by the immune system, known as immune-mediated inflammatory diseases. Here we will explore how biological factors influence immune differences between the sexes and how this affects women’s health. While we acknowledge that both sex and gender may affect immune responses, this article will focus on biological sex rather than gender. <h2>Battle of the sexes</h2> There are differences <a href="https://www.nature.com/articles/nri.2016.90">between the sexes</a> at every stage of the immune response, from the number of immune cells, to their degree of activation (how ready they are to respond to a challenge), and beyond. However, the story is more complicated than that. Our immune system evolves throughout our lives, learning from past experiences, but also responding to the physiological challenges of getting older. As a result, <a href="https://www.nature.com/articles/nri.2016.90">sex differences</a> in the immune system can be seen from birth through puberty into adulthood and <a href="https://academic.oup.com/jleukbio/advance-article/doi/10.1093/jleuko/qiad053/7190870">old age</a>. Why do these differences occur? The first part of answering this question involves the X chromosome. Females have two X chromosomes, while males have one X and one Y chromosome. The <a href="https://pubmed.ncbi.nlm.nih.gov/20651746/">X chromosome</a> contains the largest number of immune-related genes. The X chromosome also has <a href="https://link.springer.com/article/10.1007/s00018-020-03526-7">around 118 genes</a> from a gene family that are able to stop the expression of other genes, or change how proteins are made, including those required for immunity. These gene-protein regulators are known as microRNA, and there are only <a href="https://pubmed.ncbi.nlm.nih.gov/24808907/">two microRNA genes</a> on the Y chromosome. The X chromosome has <a href="https://www.genome.gov/about-genomics/fact-sheets/X-Chromosome-facts">more genes overall</a> (around 900) than the Y chromosome (around 55), so female cells have evolved to switch off one of their X chromosomes. This is not like turning off a light switch, but more like using a dimmer. Around <a href="https://bmcgenomics.biomedcentral.com/articles/10.1186/s12864-019-5507-6">15-25% of genes</a> on the silenced X chromosome are expressed at any given moment in any given cell. This means female cells can often express more immune-related genes and gene-protein regulators than males. This generally means a faster clearance of pathogens in females than males. Second, men and women have <a href="https://www.frontiersin.org/articles/10.3389/fimmu.2020.604000/full">varying levels</a> of different sex hormones. Progesterone and testosterone are broadly considered to limit immune responses. While both hormones are produced by males and females, progesterone is found at higher concentrations in non-menopausal women than men, and testosterone is much higher in men than women. The role of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6533072/">oestrogen</a>, one of the main female sex hormones, is more complicated. Although generally oestrogen <a href="https://www.sciencedirect.com/science/article/abs/pii/S000887491500026X?via%3Dihub">enhances immune responses</a>, its levels vary during the menstrual cycle, are high in pregnancy and low after menopause. Due in part to these genetic and hormonal factors, pregnancy and the years following are associated with heightened immune responses to external challenges such as infection. This has been regarded as an <a href="https://www.nature.com/articles/nri.2016.90">evolutionary feature</a>, protecting women and their unborn children during pregnancy and enhancing the mother’s survival throughout the child-rearing years, ultimately ensuring the survival of the population. We also see this pattern in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628977/">other species</a> including insects, lizards, birds and mammals. <h2>What does this all mean?</h2> With women’s heightened immune responses to infections comes an increased risk of certain diseases and prolonged immune responses after infections. An <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3328995/">estimated 75-80%</a> of all immune-mediated inflammatory diseases <a href="https://pubmed.ncbi.nlm.nih.gov/32542149/">occur in females</a>. Diseases more common in women include multiple sclerosis, <a href="https://www.nature.com/articles/nri2815">rheumatoid arthritis</a>, lupus, Sjogren’s syndrome, and <a href="https://www.nature.com/articles/nri.2016.90">thyroid disorders</a> such as Graves disease. In these diseases, the immune system is continuously fighting against what it sees as a foreign agent. However, often this perceived threat is not a foreign agent, but cells or tissues from the host. This leads to tissue damage, pain and immobility. Women are also prone to chronic inflammation following infection. For example, after infections with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5818468/">Epstein Barr virus</a> or <a href="https://www.liebertpub.com/doi/10.1089/jwh.2008.1193">Lyme disease</a>, they may go on to develop <a href="https://www.nhs.uk/conditions/chronic-fatigue-syndrome-cfs/">chronic fatigue syndrome</a>, another condition that affects more women than men. This is one possible explanation for the heightened risk among <a href="https://www.frontiersin.org/articles/10.3389/fresc.2023.1122673/full">pre-menopausal women</a> of developing long COVID following infection with SARS-CoV-2, the virus that causes COVID. Research has also revealed the presence of auto-antibodies (antibodies that attack the host) in patients with long COVID, suggesting it might be an <a href="https://www.sciencedirect.com/science/article/pii/S1568997221000550">autoimmune disease</a>. As women are more susceptible to autoimmune conditions, this could potentially explain the sex bias seen. However, the exact causes of long COVID, and the reason women may be at greater risk, are yet to be defined. This paints a bleak picture, but it’s not all bad news. Women typically mount <a href="https://pubmed.ncbi.nlm.nih.gov/24966191/">better vaccine responses</a> to several common infections (for example, influenza, measles, mumps, rubella, hepatitis A and B), producing higher antibody levels than men. One study showed that women vaccinated with half a dose of flu vaccine produced the same amount of antibodies compared to men vaccinated with <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/773453">a full dose</a>. However, these responses <a href="https://www.nature.com/articles/nri.2016.90">decline as women age</a>, and particularly <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3954964/">after menopause</a>. All of this shows it’s vital to consider sex when designing studies examining the immune system and treating patients with immune-related diseases.<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/208802/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/helen-mcgettrick-1451122">Helen McGettrick</a>, Reader in Inflammation and Vascular Biology, <a href="https://theconversation.com/institutions/university-of-birmingham-1138">University of Birmingham</a> and <a href="https://theconversation.com/profiles/asif-iqbal-1451123">Asif Iqbal</a>, Associate Professor in Inflammation Biology, <a href="https://theconversation.com/institutions/university-of-birmingham-1138">University of Birmingham</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-biological-differences-between-men-and-women-alter-immune-responses-and-affect-womens-health-208802">original article</a>.

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How a garden hose dispute between neighbours ended with a 30-year jail sentence

An Aussie man has been sentenced to 30 years in jail after shooting two of his neighbours, in a months-long dispute that began over a disagreement over a garden hose. Rodney John Lee, a 74-year-old from Melbourne's south-east, was sentenced to 30 years behind bars in court on Monday, after showing little remorse for pulling out a shotgun and murdering Saumoto Gasio and Tibor Laszlo, who lived in the same unit block. The dispute between the neighbours began several months ago, with tensions escalating quickly in the lead up to the shooting, which occurred on January 13th 2022. Lee had accused one neighbour's grandson of being a drug dealer, and was angry others would turn off a hose he used to water a communal garden. On the day of the killings, Lee left the hose running and went inside his apartment, later screaming in anger when he realised that the water had been shut off. According to court documents, Lee yelled to his neighbours, "You turn the hose off again you bastards, I'll f***ing kill you." Later that night, Lee confronted residents in the garden when he got into an argument with Mr Gasio, who told him he would ignore demands about the hose because he was wasting water by leaving the hose running unattended. Lee then went back to his apartment and armed himself with his grandfather's shotgun, before he headed back to the group and from close range fired at Mr Gasio, who was sitting on a bench. Other residents of the building fled the scene looking for safety, while a badly injured Mr Gasio stumbled into a neighbour's unit. As neighbours tried to help Mr Gasio, Lee came through the door and fired the shotgun again, this time hitting Mr Laszlo. Both men died at the scene. Before handing down the sentencing, Justice James Elliott described the killer's actions as "senseless and brutally violent". "Nothing could justify the disproportionate, senseless and brutally violent way in which you responded," Justice Elliott said. <div data-component="EmphasisedText"> "You murdered two people in their places of residence, where they were entitled to feel safe, in the presence of other residents of the unit complex." </div> "Both victims were completely defenceless against you." Lee is likely to die in jail, as he will be aged 97 by the time he is eligible for parole in early 2046. "You'll almost certainly be imprisoned for the remainder of your life," Justice Elliott said. Image credits: ABC News

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