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

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/blair-aitken-1510537">Blair Aitken</a>, <a href="https://theconversation.com/institutions/swinburne-university-of-technology-767">Swinburne University of Technology</a> and <a href="https://theconversation.com/profiles/rebecca-rothman-2231560">Rebecca Rothman</a>, <a href="https://theconversation.com/institutions/swinburne-university-of-technology-767">Swinburne University of Technology</a> You had a great night out, but the next morning, anxiety hits: your heart races, and you replay every conversation from the night before in your head. This feeling, known as hangover anxiety or “<a href="https://adf.org.au/insights/what-is-hangxiety/">hangxiety</a>”, <a href="https://onlinelibrary.wiley.com/doi/10.1002/hup.2623">affects around 22%</a> of social drinkers. While for some people, it’s mild nerves, for others, it’s a wave of anxiety that feels impossible to ride out. The “Sunday scaries” may make you feel panicked, filled with dread and unable to relax. Hangover anxiety can make even simple tasks feel overwhelming. Here’s why it happens, and what you can do about it. <h2>What does alcohol do to our brains?</h2> A hangover is the body’s way of recovering after drinking alcohol, bringing with it a range of symptoms. <a href="https://www.mdpi.com/2077-0383/10/23/5691">Dehydration and disrupted sleep</a> play a large part in the pounding headaches and nausea many of us know too well after a big night out. But hangovers aren’t just physical – there’s a strong mental side too. Alcohol is a nervous system depressant, meaning it alters how certain chemical messengers (or neurotransmitters) behave in the brain. Alcohol relaxes you by increasing <a href="https://my.clevelandclinic.org/health/articles/22857-gamma-aminobutyric-acid-gaba">gamma-aminobutyric acid</a> (GABA), the neurotransmitter that makes you feel calm and lowers inhibitions. It decreases <a href="https://my.clevelandclinic.org/health/articles/22839-glutamate">glutamate</a> and this also slows down your thoughts and helps ease you into a more relaxed state. Together, this interaction affects your mood, emotions and alertness. This is why when we drink, we often feel more sociable, carefree and willing to let our guard down. As the effects of the alcohol wear off, your brain works to rebalance these chemicals by <a href="https://www.sciencedirect.com/science/article/pii/S0191886918305762">reducing GABA and increasing glutamate</a>. This shift has the opposite effect of the night before, causing your brain to become more excitable and overstimulated, which can lead to feelings of anxiety. So why do some people get hangxiety, while others don’t? There isn’t one clear answer to this question, as several factors can play a role in whether someone experiences hangover-related anxiety. <h2>Genes play a role</h2> For some, a hangover is simply a matter of how much they drank or how hydrated they are. But genetics may also play a significant role. <a href="https://onlinelibrary.wiley.com/doi/10.1111/add.12699">Research</a> shows your genes can explain almost half the reason why you wake up feeling hungover, while your friend might not. Because genes influence how your body processes alcohol, some people may experience more intense hangover symptoms, such as headaches or dehydration. These stronger physical effects can, in turn, <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1002/hup.2623">trigger anxiety during a hangover</a>, making you more susceptible to “hangxiety.” <h2>Do you remember what you said last night?</h2> But one of the most common culprits for feeling anxious the next day is often <a href="https://journals.sagepub.com/doi/pdf/10.1177/0091450915604988">what you do while drinking</a>. Let’s say you’ve had a big night out and you can’t quite recall a conversation you had or something you did. Maybe you acted in ways that you now regret or feel embarrassed about. You might fixate on these thoughts and get trapped in a cycle of worrying and rumination. This cycle can be hard to break and can make you feel more anxious. <a href="https://doi.org/10.1016/j.addbeh.2023.107619">Research</a> suggests people who already struggle with feelings of anxiety in their day-to-day lives are especially vulnerable to hangxiety. Some people drink alcohol to unwind after a stressful day or to make themselves feel more comfortable at social events. This often leads to <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC9756407">heavier consumption</a>, which can make hangover symptoms more severe. It can also begin a cycle of drinking to feel better, making hangxiety even harder to escape. <h2>Preventing hangover anxiety</h2> The best way to prevent hangxiety is to limit your alcohol consumption. The <a href="https://adf.org.au/reducing-risk/alcohol/alcohol-guidelines">Australian guidelines</a> recommend having no more than ten standard drinks per week and no more than four standard drinks on any one day. Generally, the more you drink, the more intense your hangover symptoms might be, and the worse you are likely to feel. Mixing other drugs with alcohol can also increase the risk of hangxiety. This is especially true for party drugs, such as ecstasy or MDMA, that give you a temporary high but can lead to anxiety as they wear off and you are <a href="https://adf.org.au/insights/drug-comedowns">coming down</a>. If you do wake up feeling anxious: <ul> <li> focus on the physical recovery to help ease the mental strain </li> <li> drink plenty of water, eat a light meal and allow yourself time to rest </li> <li> try <a href="https://www.headspace.com/mindfulness/mindfulness-101">mindfulness meditation</a> or deep breathing exercises, especially if anxiety keeps you awake or your mind races </li> <li> consider journalling. This can help re-frame anxious thoughts, put your feelings into perspective and encourage self-compassion </li> <li> talk to a close friend. This can provide a safe space to express concerns and feel less isolated. </li> </ul> Hangxiety is an unwelcome guest after a night out. Understanding why hangxiety happens – and how you can manage it – can make the morning after a little less daunting, and help keep those anxious thoughts at bay.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/240991/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/blair-aitken-1510537">Blair Aitken</a>, Postdoctoral Research Fellow in Psychopharmacology, <a href="https://theconversation.com/institutions/swinburne-university-of-technology-767">Swinburne University of Technology</a> and <a href="https://theconversation.com/profiles/rebecca-rothman-2231560">Rebecca Rothman</a>, PhD Candidate in Clinical Psychology, School of Health Sciences, <a href="https://theconversation.com/institutions/swinburne-university-of-technology-767">Swinburne University of Technology</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/why-do-i-get-so-anxious-after-drinking-heres-the-science-behind-hangxiety-240991">original article</a>. </div>

Mind

Can you die from long COVID? The answer is not so simple

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/rose-shiqi-luo-1477061">Rose (Shiqi) Luo</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/catherine-itsiopoulos-14246">Catherine Itsiopoulos</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/kate-anderson-1412897">Kate Anderson</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/magdalena-plebanski-1063786">Magdalena Plebanski</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>, and <a href="https://theconversation.com/profiles/zhen-zheng-1321031">Zhen Zheng</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a> Nearly five years into the pandemic, COVID is feeling less central to our daily lives. But the virus, SARS-CoV-2, is still around, and for many people the effects of an infection can be long-lasting. When symptoms persist for more than three months after the initial COVID infection, this is generally referred to as <a href="https://www.who.int/europe/news-room/fact-sheets/item/post-covid-19-condition">long COVID</a>. In September, Grammy-winning Brazilian musician <a href="https://www.abc.net.au/news/2024-09-07/brazilian-musician-sergio-mendez-dies-at-83/104323360">Sérgio Mendes</a> died aged 83 after reportedly having long COVID. <a href="https://www.abs.gov.au/articles/covid-19-mortality-australia-deaths-registered-until-31-july-2023">Australian data</a> show 196 deaths were due to the long-term effects of COVID from the beginning of the pandemic up to the end of July 2023. In the United States, the Centers for Disease Control and Prevention reported 3,544 <a href="https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20221214.htm">long-COVID-related deaths</a> from the start of the pandemic up to the end of June 2022. The symptoms of <a href="https://www.healthdirect.gov.au/long-covid">long COVID</a> – such as fatigue, shortness of breath and “brain fog” – can be debilitating. But can you die from long COVID? The answer is not so simple. <h2>How could long COVID lead to death?</h2> There’s still a lot we don’t understand about what causes long COVID. A popular theory is that “zombie” <a href="https://www.pnas.org/doi/full/10.1073/pnas.2300644120">virus fragments</a> may linger in the body and cause inflammation even after the virus has gone, resulting in long-term health problems. Recent research suggests a reservoir of <a href="https://www.sciencedirect.com/science/article/abs/pii/S1198743X24004324?via%3Dihub">SARS-CoV-2 proteins</a> in the blood might explain why some people experience ongoing symptoms. We know a serious COVID infection can damage <a href="https://covid19.nih.gov/news-and-stories/long-term-effects-sars-cov-2-organs-and-energy#:%7E:text=What%20you%20need%20to%20know,main%20source%20of%20this%20damage">multiple organs</a>. For example, severe COVID can lead to <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/covid-long-haulers-long-term-effects-of-covid19">permanent lung dysfunction</a>, persistent heart inflammation, neurological damage and long-term kidney disease. These issues can in some cases lead to death, either immediately or months or years down the track. But is death beyond the acute phase of infection from one of these causes the direct result of COVID, long COVID, or something else? Whether long COVID can directly cause death continues to be a topic of debate. Of the <a href="https://www.cdc.gov/nchs/data/vsrr/vsrr025.pdf">3,544 deaths</a> related to long COVID in the US up to June 2022, the most commonly recorded underlying cause was COVID itself (67.5%). This could mean they died as a result of one of the long-term effects of a COVID infection, such as those mentioned above. COVID infection was followed by heart disease (8.6%), cancer (2.9%), Alzheimer’s disease (2.7%), lung disease (2.5%), diabetes (2%) and stroke (1.8%). Adults aged 75–84 had the highest rate of death related to long COVID (28.8%). These findings suggest many of these people died “with” long COVID, rather than from the condition. In other words, long COVID may not be a direct driver of death, but rather a contributor, likely exacerbating existing conditions. <h2>‘Cause of death’ is difficult to define</h2> Long COVID is a relatively recent phenomenon, so mortality data for people with this condition are limited. However, we can draw some insights from the experiences of people with post-viral conditions that have been studied for longer, such as myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS). Like long COVID, <a href="https://bmjopen.bmj.com/content/12/5/e058128">ME/CFS</a> is a complex condition which can have significant and varied effects on a person’s physical fitness, nutritional status, social engagement, mental health and quality of life. Some research indicates people with ME/CFS are at <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5218818/">increased risk</a> of dying from causes including heart conditions, infections and suicide, that may be triggered or compounded by the debilitating nature of the syndrome. So what is the emerging data on long COVID telling us about the potential increased risk of death? Research from 2023 has suggested adults in the US with long COVID were at <a href="https://jamanetwork.com/journals/jama-health-forum/fullarticle/2802095">greater risk</a> of developing heart disease, stroke, lung disease and asthma. Research has also found <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC9721155/">long COVID</a> is associated with a higher risk of <a href="https://www.tandfonline.com/doi/full/10.1080/21642850.2022.2164498#abstract">suicidal ideation</a> (thinking about or planning suicide). This may reflect common symptoms and consequences of long COVID such as sleep problems, fatigue, chronic pain and emotional distress. But long COVID is more likely to occur in people who have <a href="https://www.aihw.gov.au/reports/covid-19/long-covid-in-australia-a-review-of-the-literature/summary">existing health conditions</a>. This makes it challenging to accurately determine how much long COVID contributes to a person’s death. Research has long revealed <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302107/">reliability issues</a> in cause-of-death reporting, particularly for people with chronic illness. <h2>So what can we conclude?</h2> Ultimately, long COVID is a <a href="https://www.health.gov.au/topics/chronic-conditions/about-chronic-conditions">chronic condition</a> that can significantly affect quality of life, mental wellbeing and overall health. While long COVID is not usually immediately or directly life-threatening, it’s possible it could exacerbate existing conditions, and play a role in a person’s death in this way. Importantly, many people with long COVID around the world lack access to appropriate support. We need to develop <a href="https://www.mja.com.au/journal/2024/221/9/persistent-symptoms-after-covid-19-australian-stratified-random-health-survey">models of care</a> for the optimal management of people with long COVID with a focus on multidisciplinary care. Dr Natalie Jovanovski, Vice Chancellor’s Senior Research Fellow in the School of Health and Biomedical Sciences at RMIT University, contributed to this article.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/239184/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/rose-shiqi-luo-1477061">Rose (Shiqi) Luo</a>, Postdoctoral Research Fellow, School of Health and Biomedical Sciences, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/catherine-itsiopoulos-14246">Catherine Itsiopoulos</a>, Professor and Dean, School of Health and Biomedical Sciences, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/kate-anderson-1412897">Kate Anderson</a>, Vice Chancellor's Senior Research Fellow, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/magdalena-plebanski-1063786">Magdalena Plebanski</a>, Professor of Immunology, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>, and <a href="https://theconversation.com/profiles/zhen-zheng-1321031">Zhen Zheng</a>, Associate Professor, STEM | Health and Biomedical Sciences, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT 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/can-you-die-from-long-covid-the-answer-is-not-so-simple-239184">original article</a>. </div>

Body

"So ashamed": John Farnham opens up about years of abuse

John Farnham has shared explosive claims that he suffered years of abuse at the hands of his former manager at the beginning of his career. Revealing all in his new memoir The Voice Inside, which is set to be released on October 30th, the Aussie music legend opened up about the mistreatment he endured from former manager Darryl Sambell when he was a teen pop idol in the 1960s with hits like Sadie the Cleaning Lady. In an excerpt of the book published by <a href="https://www.theaustralian.com.au/subscribe/news/1/?sourceCode=TAWEB_WRE170_a_NEW&dest=https%3A%2F%2Fwww.theaustralian.com.au%2Farts%2Freview%2Fhe-drugged-me-for-years-john-farnham-reveals-predatory-industry-life-after-cancer-in-memoir-finding-the-voice%2Fnews-story%2Fc1dfc413b3bee553a0bda380bc3bec01&memtype=anonymous&mode=premium&v21=HIGH-Segment-2-SCORE&V21spcbehaviour=appendend" target="_blank" rel="noopener">The Australian</a>, Farnham wrote that Sambell “drugged me for years and I had no f**king idea,” until he found a half-dissolved pill at the bottom of a cup of coffee. Asked what it was, Sambell told Farnham: “That’s just something to keep you awake.” Farnham also writes that his manager, who was openly gay, was “aggressively sexual” towards him and he was constantly fending off his advances. He wrote, “I said it often enough that I can see now that this rejection turned his attraction into jealousy, hatred and a desire for control.” The toxic relationship went on for years, with Sambell controlling “where and when I worked, what I sang, what I wore, what I ate,” as Farnham ended up “isolated from friends and family,” even from wife Jill, who he married in 1973. Farnham finally sacked Sambell in 1976, later forming one of Australian music’s most successful partnerships with music manager Glenn Wheatley, who helped Farnham become a household name with his major hits of the 1980s and 90s. After Sambell died in 2001, Farnham wrote that he was forced to reflect on the early years of his career, and was overcome with a mixture of sorrow and shame: “I feel so ashamed of myself for not realising what Darryl was up to or speaking up more often to put him back in his place.” He admitted he had found it hard to “unpick” what had happened to him, until forced to confront it while writing his memoir. “But now that I’ve confronted it, I look back on that time with sorrow. I’m annoyed at myself for being so gullible and trusting,” he writes. Image credits: news.com.au / Facebook

Caring

We know parents shape their children’s reading – but so can aunts, uncles and grandparents, by sharing beloved books

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/emily-grace-baulch-1399683">Emily Grace Baulch</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> <a href="https://creative.gov.au/news/media-releases/revealing-reading-a-survey-of-australian-reading-habits/">Over 80%</a> of Australians with children encourage them to read. Children whose parents enjoy reading are <a href="https://www.booktrust.org.uk/news-and-features/news/news-2023/new-research-from-booktrust-reveals-the-impact-of-parental-reading-enjoyment-on-childrens-reading-habits/">20% more likely</a> to enjoy it too. My research has found parents aren’t the only family members who play an important role in developing a passion for reading – extended family, from grandparents to siblings, uncles and great-aunts, also influence readers’ connections to books. I surveyed 160 Australian readers about their home bookshelves and reading habits. More than 80% of them acknowledged the significant influence of family in what and how they read. Reading to children is often <a href="https://www.booktrust.org.uk/globalassets/resources/research/booktrust-family-survey-research-briefing-2-reading-influencers.pdf">the invisible workload of mothers</a>: 95% of mothers read to children, compared to 67% of fathers. Yet intriguingly, those I surveyed – whose ages ranged from their early 20s to their 70s – collectively talked about books being passed down across eight generations. Family members were associated with their most valued books – and their identities as readers. <h2>Treasured possessions</h2> Books passed down through generations often become treasured possessions, embodying a shared family history. One person discussed an old hardcover copy of <a href="https://www.harpercollins.com.au/9780732284350/blinky-bill/">Blinky Bill</a> by Dorothy Wall. Originally given to her father and his siblings by their great-aunt in 1961, the book’s pages are now discoloured and falling out. “Although I always think of my mother as having been my reading role model,” she wrote, “actually my father had an equally big impact, just in another way.” Her father is a central organising figure on her home bookshelf: she has dedicated a whole shelf to the books he liked. The story she tells about his old copy of Blinky Bill, however, crosses generations. The book’s battered state is a testament to its longevity and well-loved status. Its inscription to her family members makes the copy unique and irreplaceable. Another person remembered a set of Dickens’ novels, complete with margin notes and century-old newspaper clippings, carefully stored with her most special books. These volumes, initially owned by her great-great-grandmother and later gifted by her great-aunt, represent a reading bond passed down through generations. Such books can never be replaced, no matter how many copies might be in circulation. These books are closely associated with memories and experiences – they are invaluable for who they represent. A third person has her father’s “old” Anne McCaffrey’s <a href="https://www.goodreads.com/series/40323-dragonriders-of-pern">Dragonriders of Pern</a> series: he read it to her as a teenager, then passed it down. The book “sparked” her interest in science-fiction, and she now intends to pass it on to her own teenager. Her book, too, is “battered”, with “chunks falling out when you read it”. The cover is falling off. The deteriorating state of a book is part of the book’s legacy. It shows how loved it has been. Reading passions can be deliberately cultivated through family, but their value is less connected to reading comprehension or literacy than a sense of connection through sharing. Inherited, much-loved books bind families together. They can anchor absent family members to the present. These books can come to symbolise love, connection and loss. The family members who’ve passed down their books might not be physically present in children’s lives – they may not be reading aloud to them at bedtime – but through their books, they can have a strong presence in their loved ones’ memories. That indelible trace can be sustained into adulthood. <h2>Buying books for the next generation</h2> Another way relatives contribute to a family reading legacy is by buying new copies of much-loved books for the next generation. Theresa Sheen, from The Quick Brown Fox, a specialist children’s bookstore in Brisbane, notes that customers often ask for copies of books they had when they were younger. They may have read them to their children and now want them for their grandchildren. For example, <a href="https://www.goodreads.com/series/40767-the-baby-sitters-club">The Babysitters Club series</a> by Ann M. Martin was mentioned multiple times as a nostalgic favourite, now being sought after by grandparents. Readers’ habits of re-buying favourite books can affect the publishing industry. With older children’s classics still selling, publishers seek to update the text to reflect contemporary cultural mores. Enid Blyton is one author who endures through intergenerational love and nostalgia. However, her work is regularly <a href="https://www.news.com.au/entertainment/books-magazines/books/enid-blytons-famous-five-books-edited-to-remove-offensive-words/news-story/47a63bb79a5d870f19aed58b19469bb5">edited and bowdlerised</a> to update it. Books can be imbued with the voices and emotions of others. They are more than just physical objects – they are vessels of shared experiences that can be passed down, up and across generations. This enduring bond between family members does more than preserve individual stories. It actively shapes and sustains a vibrant reading culture.<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/232372/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/emily-grace-baulch-1399683">Emily Grace Baulch</a>, Producer at Ludo Studio & Freelance Editor, <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/we-know-parents-shape-their-childrens-reading-but-so-can-aunts-uncles-and-grandparents-by-sharing-beloved-books-232372">original article</a>. </div>

Family & Pets

"So precious!" Kochie celebrates arrival of his 9th grandchild

David Koch has shared the happy news that his tribe of grandchildren has grown by one, posting a photo of his 9th grandchild. Kochie announced the safe arrival of baby girl Heidi, who is the first child of his daughter Georgie and her husband Alex. The former Sunrise host posted a photo of the moment his wife Libby met the new arrival for the first time in London, as his friends and colleagues shared their congratulations. “When Libby meets Heidi… grandchild #9… in London for the first time. First child for Georgie and Alex,” he wrote alongside the image. Former colleague Melissa Doyle commented, "Just gorgeous 😍", while Seven sports reporter Mark Beretta added, "Congratulations and what a beautiful moment!!👏". Fans also shared their congratulations to Kochie, celebrating the happy news of his latest grandchild’s arrival. “Congratulations to you all,” one wrote, while another said, “Gorgeous photo. So precious!” Kochie first shared the news of his growing family when Georgie was halfway through her pregnancy with Heidi, telling The Morning Show hosts Larry Emdur and Kylie Gillies that he and Libby were planning a trip to London to partake in a family tradition. "We have a family tradition, we buy the first pram for each of the families. (We're) very excited. It's number nine for us," he said in April. Heidi is David's ninth grandchild, as his three eldest children have eight kids between them. His son AJ welcomed his first child - a daughter called Catalina May - with his wife Carolina in 2021. The little one was born weeks after Samantha welcomed a daughter called Florence May with her partner Toby. They also share three other children - Lila, Oscar, and Matilda. David's other daughter Brianna, who lives in Perth, also has three children - Jax, Teddy and Ella - with her partner CJ Jayasinghe. Image credits: Instagram / Sunrise

Family & Pets

Medicare is covering less of specialist visits. But why are doctors’ fees so high in the first place?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/susan-j-mendez-2219444">Susan J. Méndez</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Fees for medical specialists are going up faster than <a href="https://www.abc.net.au/news/2024-09-25/medicare-rebates-only-covering-half-of-specialist-costs/104389360">Medicare rebates</a>, leading to a bigger gap for patients to pay. Recent data from the <a href="https://www.aihw.gov.au/reports/medicare/mbs-funded-services-data/contents/summary">Australian Institute of Health and Welfare</a> shows that in the first quarter of this year, Medicare rebates covered just over half (52%) of the total fees. This is <a href="https://www.abc.net.au/news/2024-09-25/medicare-rebates-only-covering-half-of-specialist-costs/104389360">down from 72%</a> two decades ago, and the lowest proportion on record. Doctors can charge what they like, while the government determines the Medicare rebate. The difference between the two, or the gap, is what impacts patients. For GPs, the government provides an incentive for doctors to <a href="https://www.health.gov.au/our-work/increases-to-bulk-billing-incentive-payments#1-november-2023-changes">bulk bill</a>, but there’s no such incentive for other specialists. Doctors blame large gap payments on rebates being too low, and they’re partly right. After adjusting for inflation and increasing demand, the average dollar amount one person receives in Medicare rebates annually dropped from <a href="https://www.aihw.gov.au/reports/medical-specialists/referred-medical-specialist-attendances">A$349 to $341</a> over the past decade. But this is only a part of the problem. When many people can’t afford hundreds (if not thousands) of dollars for essential specialist care, we need to look at why fees are so high. <h2>How do specialists set their fees?</h2> Although general practice is technically a speciality, when we talk about medical specialists in this article, we’re talking about non-GP specialists. These might include paediatricians, oncologists, psychiatrists and dermatologists, among many others. In determining fees, specialists consider a combination of patient-level, doctor-level and system-level factors. Patient characteristics, such as the complexity of the patient’s medical condition, may increase the price. This is because more complex patients may require more time and resources. Specialists, based on their experience, perceived skill level, or ethical considerations, may charge more or less. For example, <a href="https://www.sciencedirect.com/science/article/pii/S0277953623007104?via%3Dihub">some specialists report</a> they offer discounts to certain groups, such as children or pensioners. System-level factors including the cost of running a practice (such as employing staff) and practice location also play a role. Problems arise when prices vary considerably, as this often signals limited competition or excessive market power. This holds true for medical services, where patients have little control over prices and rely heavily on their doctors’ recommendations. In <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4909881">recent research</a>, my colleagues and I found fees varied significantly between specialists in the same field. In some cases the most expensive specialist charged more than double what the cheapest one did. <h2>Doctor characteristics influence fee-setting</h2> My colleagues and I <a href="https://doi.org/10.1016/j.healthpol.2024.105119">recently analysed</a> millions of private hospital claims from 2012 to 2019 in Australia. We found the wide variation in fees was largely due to differences between individual doctors, rather than factors such as patient complexity or the differences we’d expect to see between specialties. Up to 65% of the variance in total fees and 72% in out-of-pocket payments could be attributed to differences between doctors in the same field. To understand what doctor-level factors drive high fees, <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4909881">we looked at</a> data from a representative survey of specialists. We found older specialists have lower fees and higher rates of bulk billing. Practice owners tended to charge higher fees. We also found doctors’ personalities affect how much they charge and how often they bulk bill patients. Doctors who scored more highly on the personality trait of agreeableness were more likely to bulk bill patients, while those who scored more highly on neuroticism tended to charge higher fees. What we couldn’t show is any evidence fees were associated with competition. <h2>Effects on patients</h2> This is not a competitive market. On the contrary, it has high entry restrictions (long training requirements) and a limited supply of specialists, particularly in <a href="https://www.aihw.gov.au/reports/workforce/health-workforce">rural and remote areas</a>. Meanwhile, patients’ access is controlled by the need for referrals which expire, generally after a year. Patients are often unable to shop around or make informed decisions about their care due to a lack of information about the true cost and quality of services. For private hospital services, the fee structure is complicated by the fact that several providers (for example, surgeon, anaesthetist, assistant surgeon) bill separately, making it difficult for patients to know the total cost upfront. Despite efforts to introduce price transparency in recent years, such as through the government’s <a href="https://medicalcostsfinder.health.gov.au/">Medical Costs Finder</a> website, the system remains far from clear. Reporting is voluntary and the <a href="https://doi.org/10.1016/j.healthpol.2020.06.001">evidence is mixed</a> on whether these tools effectively reduce prices or increase competition. All of this contributes to high and unpredictable out-of-pocket costs, which can lead to financial strain for patients. About <a href="https://www.abs.gov.au/statistics/health/health-services/patient-experiences/latest-release#barriers-to-health-service-use">10.5% of Australians</a> reported cost was a reason for delaying or avoiding a specialist visit in 2022–23. This raises important questions about equity and the sustainability of Australia’s universal health-care system, which is built on the principle of equitable access to care for all citizens. <h2>What can be done?</h2> Patients can take steps to minimise their costs by proactively seeking information. This includes asking your GP for a range of options when you’re referred to a specialist. Note the referral from your GP can be used for any other doctor in the same specialty. Similarly, ask the specialist’s receptionist what the fee and rebate will be before making an appointment, or for a <a href="https://www.ama.com.au/articles/informed-financial-consent#Two">detailed quote</a> before going to hospital. Shop around if it’s too high. But responsibility doesn’t only lie with patients. For example, the government could seek to address this issue by increasing investment in public hospital outpatient care, which could boost competition for specialists. It could also publish the range of fees compared to the rebate for all Medicare-billed consultations, rather than relying on voluntary reporting by doctors. Price transparency alone is not enough. Patients also need quality information and better guidance to navigate the health-care system. So continued investment in improving health literacy and care coordination is important. If things don’t change, the financial burden on patients is likely to continue growing, undermining both individual health outcomes and the broader goals of equitable health-care access.<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/239827/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/susan-j-mendez-2219444">Susan J. Méndez</a>, Senior Research Fellow, Melbourne Institute of Applied Economic and Social Research, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/medicare-is-covering-less-of-specialist-visits-but-why-are-doctors-fees-so-high-in-the-first-place-239827">original article</a>. </div>

Money & Banking

"You will be so missed": Slain brothers farewelled in emotional funeral

Ben and Russell Smith, who were <a href="https://oversixty.com.au/health/caring/grief-stricken-father-breaks-silence-after-sons-found-dead" target="_blank" rel="noopener">fatally stabbed in their Blue Mountains home</a>, have been farewelled in an emotional funeral. More than 750 people gathered to pay tribute to the young boys, aged 9 and 11, as the boy's father delivered a heartbreaking eulogy. Mourners embraced outside the church, with father Nick Smith saying his children were “the biggest pleasures and joys of our lives”. “Boys, it’s been an absolute, absolute privilege to be your father. I hold you so deeply in my heart,” Mr Smith said. “You are loved by your family, through your friends, through the community, through the school, through your soccer club, through the Panthers, throughout society." “You will be so missed. You had such beautiful little lives, such beautiful, beautiful adventures, and we had so much more adventure to come." He said Russell was "outgoing, kind, determined, caring and thoughtful, adventurous and just a heart of gold, who no matter what wanted to help". Mr Smith described his other son Ben as a "sweet boy", adding, "The one name you gave yourself was Ben Jelly, and it stuck." Mr Smith said he would make sure his sons are “never forgotten”. “You were such wonderful, cheeky, funny, charismatic boys,” he said. “You made the world a better place." “You’re my world. You’re my little Ben, my Russ, you’re my best crew. I’m gonna miss you two so much. Your memories are your legacy. I love you so much. I will never stop loving you. No one else will either.” The boys’ 42-year-old mother, Trish Smith, has been charged with their murder. Image credits: NSW Police

Family & Pets

Why is pain so exhausting?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/michael-henry-1321395">Michael Henry</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/lorimer-moseley-1552">Lorimer Moseley</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> One of the most common feelings associated with persisting pain is fatigue and this fatigue can become overwhelming. People with chronic pain can report being drained of energy and motivation to engage with others or the world around them. In fact, a study from the United Kingdom on people with long-term health conditions found pain and fatigue are the <a href="https://weareundefeatable.co.uk/campaign-hub/latest-from-us/the-bridging-the-gap-report/">two biggest barriers</a> to an active and meaningful life. But why is long-term pain so exhausting? One clue is the nature of pain and its powerful effect on our thoughts and behaviours. <h2>Short-term pain can protect you</h2> Modern ways of thinking about pain emphasise its protective effect – the way it grabs your attention and compels you to change your behaviour to keep a body part safe. Try this. Slowly pinch your skin. As you increase the pressure, you’ll notice the feeling changes until, at some point, it becomes painful. It is the pain that stops you squeezing harder, right? In this way, pain protects us. When we are injured, tissue damage or inflammation makes our pain system become more sensitive. This pain stops us from mechanically loading the damaged tissue while it heals. For instance, the pain of a broken leg or a cut under our foot means we avoid walking on it. The concept that “pain protects us and promotes healing” is one of the most important things people who were in chronic pain tell us <a href="https://pubmed.ncbi.nlm.nih.gov/35934276/">they learned</a> that helped them recover. <h2>But long-term pain can overprotect you</h2> In the short term, pain does a terrific job of protecting us and the longer our pain system is active, the more protective it becomes. But persistent pain can overprotect us and <a href="https://onlinelibrary.wiley.com/doi/10.1111/jabr.12124">prevent recovery</a>. People in pain have called this “<a href="https://www.jpain.org/article/S1526-5900(22)00379-0/fulltext">pain system hypersensitivity</a>”. Think of this as your pain system being on red alert. And this is where exhaustion comes in. When pain becomes a daily experience, triggered or amplified by a widening range of activities, contexts and cues, it becomes a constant drain on one’s resources. Going about life with pain requires substantial and constant effort, and this makes us fatigued. <a href="https://www.aihw.gov.au/reports/chronic-disease/chronic-pain-in-australia/summary">About 80%</a> of us are lucky enough to not know what it is like to have pain, day in day out, for months or years. But take a moment to imagine what it would be like. Imagine having to concentrate hard, to muster energy and use distraction techniques, just to go about your everyday tasks, let alone to complete work, caring or other duties. Whenever you are in pain, you are faced with a choice of whether, and how, to act on it. Constantly making this choice requires thought, effort and strategy. Mentioning your pain, or explaining its impact on each moment, task or activity, is also tiring and difficult to get across when no-one else can see or feel your pain. For those who do listen, it can become tedious, draining or worrying. <h2>No wonder pain is exhausting</h2> In chronic pain, it’s not just the pain system on red alert. Increased inflammation throughout the body (the immune system on red alert), disrupted output of the hormone cortisol (the endocrine system on red alert), and stiff and guarded movements (the motor system on red alert) also go <a href="https://www.noigroup.com/product/explain-pain-supercharged/">hand in hand</a> with chronic pain. Each of these adds to fatigue and exhaustion. So learning how to manage and resolve chronic pain often includes learning how to best manage the over-activation of these systems. Loss of sleep is also a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9289983/">factor</a> in both fatigue and pain. Pain causes disruptions to sleep, and loss of sleep contributes to pain. In other words, chronic pain is seldom “just” pain. No wonder being in long-term pain can become all-consuming and exhausting. <h2>What actually works?</h2> People with chronic pain are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9633893/">stigmatised, dismissed</a> and <a href="https://www.jpain.org/article/S1526-5900(13)01367-9/fulltext">misunderstood</a>, which can lead to them not getting the care they need. Ongoing pain may prevent people working, limit their socialising and impact their relationships. This can lead to a descending spiral of social, personal and economic disadvantage. So we need better access to evidence-based care, with high-quality education for people with chronic pain. There is good news here though. Modern care for chronic pain, which is grounded in first gaining a modern understanding of the underlying biology of chronic pain, <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00441-5/abstract">helps</a>. The key seems to be recognising, and accepting, that a hypersensitive pain system is a key player in chronic pain. This makes a quick fix highly unlikely but a program of gradual change – perhaps over months or even years – promising. Understanding how pain works, how persisting pain becomes overprotective, how our brains and bodies adapt to training, and then learning new skills and strategies to gradually retrain both brain and body, offers scientifically based hope; there’s strong <a href="https://jamanetwork.com/journals/jama/article-abstract/2794765">supportive evidence</a> from <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00441-5/abstract">clinical trials</a>. <h2>Every bit of support helps</h2> The best treatments we have for chronic pain take effort, patience, persistence, courage and often a good coach. All that is a pretty overwhelming proposition for someone already exhausted. So, if you are in the 80% of the population without chronic pain, spare a thought for what’s required and support your colleague, friend, partner, child or parent as they take on the journey. <hr /> More information about chronic pain is available from <a href="https://www.painrevolution.org/painfacts">Pain Revolution</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/238417/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/michael-henry-1321395">Michael Henry</a>, Physiotherapist and PhD candidate, Body in Mind Research Group, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/lorimer-moseley-1552">Lorimer Moseley</a>, Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/why-is-pain-so-exhausting-238417">original article</a>. </div>

Body

"Just so tragic": Grandfather of slain boys speaks out

Warning: This article contains distressing content that readers may find upsetting. The grandfather of the two young boys who were <a href="https://oversixty.com.au/finance/legal/mother-arrested-after-two-boys-found-dead-in-blue-mountains-home" target="_blank" rel="noopener">found dead</a> in their home in the Blue Mountains has spoken out about his profound loss, while also sharing an update on his daughter's mental state while she remains in prison. Geoff Densmore is preparing to bury his grandsons Ben, 9 and Russell, 11, who were found dead in their mother’s Faulconbridge home on September 10th. Mr Densmore is also trying to support his daughter, Trish Smith, who has been charged over the alleged murder of her two children, as she remains under police guard. Ms Smith was rushed to hospital with self-inflicted injuries after the bodies of the two young brothers were discovered in their beds by their father, with both boys suffering fatal stab wounds. Mr Densmore told <a href="https://www.dailytelegraph.com.au/news/nsw/trish-smith-living-a-bad-nightmare-after-allegedly-killing-her-sons-at-their-blue-mountains-home/news-story/b8a91443d155a988155dd5e27410becb" target="_blank" rel="noopener">The </a><a href="https://www.dailytelegraph.com.au/news/nsw/trish-smith-living-a-bad-nightmare-after-allegedly-killing-her-sons-at-their-blue-mountains-home/news-story/b8a91443d155a988155dd5e27410becb" target="_blank" rel="noopener">Daily Telegraph</a> that he is preparing to bury his grandsons, while trying to cope with the devastating loss. “The kids, they were special kids, so special,” Mr Densmore said. “I have to put them under the ground. I’ve got so much to do. So many people are affected by this, the government has got to do something about this.” He went on to clarify that both he and his wife had no idea about their daughter's mental health struggles until it was too late. “We really don’t know what happened. We had no idea she was unwell. Many prayers and private masses have been said for her,” he said. “You can’t imagine what it’s like. Imagine if it happened to your family." “Linda, she’s not good, she’s very religious. She’s praying. I think I might crack one day but I’m trying not to. I’m trying to be strong for everyone. I still can’t understand that Ben … Russell. They’re gone.” Mr Densmore said he was not angry with Ms Smith, instead saying: “There is only one word for it: tragic. It’s just so tragic.” The grandfather has not spoken to his daughter following her charges, however, he did say Ms Smith was in “a bad way”. “We are all dealing with this, the whole community. We have to bury two children, we’ve never been in this situation before. We’re not sure what to do.” Need to talk to someone? Don't go it alone. Call Lifeline on 13 11 14 or visit lifeline.org.au Beyond Blue: 1300 224 636 SANE: 1800 187 263; saneforums.org Image credits: Supplied / NSW Police

Family & Pets

The psychology of retirement: why do so many athletes struggle to call time?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/sarah-tillott-1462234">Sarah Tillott</a>, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> and <a href="https://theconversation.com/profiles/diarmuid-hurley-1462235">Diarmuid Hurley</a>, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> Think back to when you met someone for the first time. One of the first questions you asked, or were asked, was likely: “what do you do for work?” It’s a polite, innocuous and socially ingrained way of getting to know more about a person. But it also demonstrates the central role of our professional lives as part of our personal identities. For professional athletes, their careers, exploits and recognition can become the defining aspect of their identity. So what happens when sporting careers end? The transition to retirement, across professions and countries, can be extremely tough to navigate. It can be especially difficult for elite sportspeople, who can experience retirement as a <a href="https://www.sciencedirect.com/science/article/pii/S1469029221001679?casa_token=L4g3UTN8T78AAAAA:VHqcgJN7jIpW82cp32TXq9gIcKFzD2jtf6Jc_OX-3fjpHVnowlp0p8fcqE01BVF3Qjx0bmiRz4T1">loss of identity</a>, connected to their sense of achievement, meaning and control in life. <h2>How retirement impacts athletes</h2> A common saying with many sportspeople is “<a href="https://www.forbes.com/sites/jannfreed/2024/06/29/athletes-die-twice-retirement-as-a-death/">athletes die twice</a>” – once when they retire and again at their death. Former Wallaby Brendan Cannon <a href="https://www.impact.acu.edu.au/lifestyle/after-the-final-siren-helping-athletes-to-adapt-to-life-after-sport">has spoken of</a> this difficulty: <blockquote> [People] want to talk to you about what you used to be, and all you want to focus on is what you want to become. </blockquote> During the transition to retirement, elite athletes can be affected by how they got into their chosen sport, how long they stayed in the system and the variables that either accelerated or ended their careers. Other factors include whether they played a team or individual sport, male vs female pathways, whether their exit from sport was voluntary or involuntary and their age when retiring. My (Sarah) interviews with former professional athletes demonstrate the complexity of retiring from elite sport. To the public, William Zillman, former NRL star turned vet, seems to have it all together. But it didn’t come without hardship, pain and struggles in navigating the harsh terrain of retirement. When asked about his retirement, Zillman said: “[Being an NRL player was] all I knew.” <blockquote> I turned up to work each day, I was told what to do, how to do it and when to do it […] but when I left the system, I think I lost the ability to think for myself. I went from having all the help in the world to very little – it was tough. </blockquote> Retiring from high-performance sport can have profound effects on an athlete’s <a href="https://journals.lww.com/acsm-csmr/fulltext/2020/10000/the_psychological_burden_of_retirement_from_sport.11.aspx/1000">physical and mental health</a>, as well as their social and professional development. While “regular people” usually retire in their 60s or 70s, an athlete’s retirement often occurs earlier, coinciding with crucial phases of career development and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10513329/">family planning</a>. Some have to adjust from being highly paid and highly managed to surviving on minimum wages with very little support. “It’s a recipe for disaster,” Ryan James, who considers himself one of the lucky ones, said. A former forward for the Gold Coast Titans, James has been working closely with the Rugby League Players Association (RLPA) with the aim to address some of the complex issues with the transition experience. James knows only too well the struggles some people in the system face as their careers begin to wind down: <blockquote> Many of our players come into the system from disadvantaged and vulnerable backgrounds and while we have made a start, there is more we can be doing. Financial literacy and management is just one avenue we need to tackle. I’ve known too many retired, vulnerable players who were homeless, sleeping in cars with their young families. It’s devastating. </blockquote> It took former English captain turned NRL superstar James Graham a good part of 18 months to re-configure his identity: <blockquote> You come out feeling so lost and alone. Most of your life is spent training, connecting with mates, having a lot of routine and structure to almost nothing. It’s strange and confronting. </blockquote> <h2>What are the major codes doing?</h2> Across various sporting codes there are programs that aim to assist athletes to prepare for retirement. For example, <a href="https://www.rlpa.com.au/past-player-and-transition-program">the RLPA has a program</a> to support athletes who are transitioning. Other major professional Australian codes have similar programs, including <a href="https://www.aflplayers.com.au/app/uploads/2021/10/Player-Retirement-Scheme_Booklet_A5_4.pdf">the AFL</a>, <a href="https://www.thepfa.com/players/union-support/pension-scheme">Professional Footballers Association</a> (soccer) and <a href="https://auscricket.com.au/programs-community/past-player-programs/">cricket</a>. However, whether or not athletes choose to participate in these programs is usually at the discretion of the players. <h2>The importance of planning, preparation and support</h2> One of the key factors influencing how an athlete transitions into life after sport is how much they have <a href="https://theconversation.com/its-not-just-retiring-athletes-who-need-mental-health-support-young-sportspeople-need-it-too-230296">prepared for it</a>. Research with elite athletes from <a href="https://elevateaus.com.au/wp-content/uploads/2021/09/The-end-of-a-professional-sport-career-ensuring-a-positive-transition.pdf">the AFL, NRL and A-League</a> shows those who planned and prepared for life after sport and who had goals, direction and identities beyond sport, experienced more acceptance, autonomy (control) and optimism about the future. On the other hand, those who were unprepared or did not plan ahead experienced negative emotional and psychological states, and struggled to move on. This negative effect is even more pronounced for those who were forced to <a href="https://journals.lww.com/acsm-csmr/fulltext/2020/10000/the_psychological_burden_of_retirement_from_sport.11.aspx/1000">end their career due to injury</a>. <hr /> <iframe id="lQixA" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/lQixA/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> <h2>How to improve the situation</h2> A recent <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10513329/">scoping review</a> explored the notion of retirement for professional athletes and their ability to adapt to life after sport. It summarised many areas that need more attention: Make athletes aware of what’s ahead Expect that when you leave, it may be hard. Reach out to your club, coach and support services and surround yourself with people who you can talk to and who may be able to help. Athletes should expect that it will take time to adjust, and this adjustment period is crucial for mitigating the adverse effects of retirement. This adjustment period can also significantly reduce the initial negative impacts on their mental and physical health. Tailored support programs Developing tailored support programs that address the specific needs of different sports and athlete sub-groups can help mitigate the challenges associated with retirement. These programs might include career counselling, mental health support and opportunities for continuous involvement in the sports community. A need for further research There is a pressing need for more research to identify effective support mechanisms for retiring athletes. Understanding the types of support that facilitate a smoother transition can help in designing programs and interventions tailored to the unique needs of elite athletes. Additionally, mapping out the factors that aid or hinder the transition across different sports and athlete sub-groups would provide valuable insights.<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/234559/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/sarah-tillott-1462234">Sarah Tillott</a>, Senior Lecturer, Faculty of Health, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> and <a href="https://theconversation.com/profiles/diarmuid-hurley-1462235">Diarmuid Hurley</a>, Lecturer, Faculty of Health, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross 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/the-psychology-of-retirement-why-do-so-many-athletes-struggle-to-call-time-234559">original article</a>. </div>

Retirement Life

"So Australian": Local trust praised for response to illegal tree cutting

A resident's decision to cut down a tree for a better view of Sydney Harbour has backfired after a sign was erected where the tree once stood, to condemn tree vandalism. Following multiple reports of resident carrying out tree vandalism along affluent streets, the Sydney Harbour Federation Trust has called out the behaviour by setting up the sign in the Sydney lower North Shore suburb of Woolwich. "Tree vandalism has occurred in this area," the sign read. "The Sydney Harbour Federation Trust protects and manages this land for the enjoyment of the public. "Acts of vandalism like this deprive all of us of the natural environment." The sign also warned that offenders could be subject to fines and/or prosecution as punishment, and urged those who notice any suspicious activity to contact 8969 2100. After an image of the sign was shared to a Sydney group on social media, the local trust's actions have been praised, with many saying they "loved how petty this is" and one even declaring the response "so Australian". "I hope they keep this sign, as a reminder to anyone contemplating doing something similar," one commented. "We're petty but we have a right to be. You don't f**n poison or cut down trees. F**n unacceptable behaviour," another added. Others accused the person who cut down the tree of being "entitled". In last November alone, over 300 native trees and shrubs vanished in front of multi-million dollar homes along the Sydney Harbour waterfront strip. Lane Cove Council believe that hand tools were used to silently cut down the trees, which impacts plants, and local wildlife including wallabies, possums and dozens of other species. On Monday, the council put out a statement saying its "pursuit of justice" is now ramping up, referring to the incident as "the largest tree vandalism case in Lane Cove’s recent history". They are trying to obtain permission to put up a sign to block "the harbour view of the property which would most benefit from the mass clearing of the trees." "As the area is classified as a Threatened Ecological Community and contains some items of Aboriginal Heritage, it was important the appropriate approvals were in place before installing the signage," the council added. "The legal case and banner installation are important steps in our commitment to seeking the strongest possible recourse response to send a message that we stand tall against tree vandalism." Images: Reddit

Legal

Why is it so hard to cancel subscriptions or end ‘free’ trials? Report shows how companies trap you into paying

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/katharine-kemp-402096">Katharine Kemp</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Many businesses are trapping Australian consumers in paid subscriptions by making them hard to cancel, hiding important details and offering “free” trials that auto-renew with hefty charges. We need law reform to tackle this continuing problem. <a href="https://cprc.org.au/report/let-me-out">A new report</a> shows 75% of Australian consumers have had negative experiences when trying to cancel a subscription, according to the Consumer Policy Research Centre (CPRC). It shows businesses use “<a href="https://www.wired.com/story/how-to-spot-avoid-dark-patterns/">dark patterns</a>”, which are designs that hinder consumers who try to act in their own best interests. Subscription traps are often called “<a href="https://www.ftc.gov/business-guidance/blog/2022/11/checking-out-ftcs-100-million-settlement-vonage">Hotel California</a>” techniques, referring to The Eagles’ famous lyric: “you can check out any time you want, but you can never leave”. In some of these cases, consumers may have remedies under our existing consumer law, including for misleading conduct. But we need law reform to capture other <a href="https://treasury.gov.au/consultation/c2023-430458">unfair practices</a>. In the meantime, the CPRC’s research also gives examples of businesses with fair, consumer-friendly subscription practices. These also benefit the business. <h2>Examples of unfair subscription traps</h2> <a href="https://www.forbes.com/councils/forbesbusinessdevelopmentcouncil/2022/09/12/the-evolution-of-the-subscription-model-and-whats-on-the-horizon/">Subscription business models</a> have become common – many products are now provided in the form of software, an app or access to a website. Some of these would once have been a physical book, newspaper, CD or exercise class. Most people who use online services have experienced the frustration of finding a credit card charge for an unwanted, unused subscription or spending excessive time trying to cancel a subscription. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/615486/original/file-20240826-16-fp57es.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/615486/original/file-20240826-16-fp57es.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/615486/original/file-20240826-16-fp57es.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=643&fit=crop&dpr=1 600w, https://images.theconversation.com/files/615486/original/file-20240826-16-fp57es.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=643&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/615486/original/file-20240826-16-fp57es.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=643&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/615486/original/file-20240826-16-fp57es.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=808&fit=crop&dpr=1 754w, https://images.theconversation.com/files/615486/original/file-20240826-16-fp57es.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=808&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/615486/original/file-20240826-16-fp57es.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=808&fit=crop&dpr=3 2262w" alt="Infographic with a few statistics from the report." /></a><figcaption><a class="source" href="https://cprc.org.au/wp-content/uploads/2024/08/CPRC_LetMeOut_SubsTraps_Report_FINAL.pdf">CPRC, Let me out – Subscription trap practices in Australia, August 2024</a></figcaption></figure> Businesses can make it difficult for consumers to stop paying for unwanted subscriptions. Some do this by allowing consumers to start a subscription with a single click, but creating multiple obstacles if you want to end the subscription. This can include obscuring cancellation options in the app, requiring consumers to phone during business hours or making them navigate through multiple steps and offers before terminating. The report points out many of the last-ditch discounts offered in this process are only short term. One survey respondent said: <blockquote> I wasn’t able to cancel without having to call up and speak to someone. Their business hours meant I had to call up during my work day and it took some time to action. </blockquote> Other businesses badger consumers with frequent emails or messages after they cancel. One respondent said a business made “the cancellation process impossible by making you call and then judging your reason for cancellation”. <h2>What does consumer law say?</h2> Some subscription traps already fall foul of the Australian Consumer Law and warrant investigation by the <a href="https://www.accc.gov.au/media-release/accc-warns-consumers-to-beware-of-subscription-traps">Australian Competition & Consumer Commission</a> (ACCC). Consumers may have remedies where the business has engaged in misleading conduct or imposes an unfair contract term. For example, the ACCC is <a href="https://www.accc.gov.au/media-release/accc-court-action-against-eharmony-for-alleged-misleading-online-dating-membership-statements#:%7E:text=The%20ACCC%20has%20today%20commenced%20proceedings%20in%20the,the%20pricing%2C%20renewal%20and%20duration%20of%20its%20memberships.">suing dating site eHarmony</a> for its allegedly misleading subscription practices. In the United States, the Federal Trade Commission <a href="https://www.ftc.gov/news-events/news/press-releases/2024/06/ftc-takes-action-against-adobe-executives-hiding-fees-preventing-consumers-easily-cancelling">has filed a complaint against software company Adobe</a> for allegedly using dark patterns in its subscription practices. The Federal Trade Commission has alleged that “Adobe pushed consumers toward the ‘annual paid monthly’ subscription without adequately disclosing that cancelling the plan in the first year could cost hundreds of dollars”. Adobe <a href="https://news.adobe.com/news/news-details/2024/Adobes-Recent-Statement-Regarding-Updated-Federal-Trade-Commission-Complaint-/default.aspx">issued a statement</a> arguing the commission’s complaint “mischaracterises” its business. The litigation is ongoing. <h2>We need an unfair practices prohibition</h2> Some subscription traps would fall outside the existing consumer law. This is because they don’t meet the test for misleading conduct or unfair contract terms, but make it practically very difficult to cancel. The <a href="https://www.accc.gov.au/media-release/accc-welcomes-consultation-on-possible-unfair-trading-practices-regulatory-reforms">ACCC has advocated</a> for Australia to follow other countries such as the United Kingdom and the United States to enact an unfair practices prohibition to capture conduct like this. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/615487/original/file-20240826-16-2j23h7.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/615487/original/file-20240826-16-2j23h7.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/615487/original/file-20240826-16-2j23h7.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=769&fit=crop&dpr=1 600w, https://images.theconversation.com/files/615487/original/file-20240826-16-2j23h7.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=769&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/615487/original/file-20240826-16-2j23h7.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=769&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/615487/original/file-20240826-16-2j23h7.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=966&fit=crop&dpr=1 754w, https://images.theconversation.com/files/615487/original/file-20240826-16-2j23h7.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=966&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/615487/original/file-20240826-16-2j23h7.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=966&fit=crop&dpr=3 2262w" alt="" /></a><figcaption>The shift businesses can make today. <a class="source" href="https://cprc.org.au/wp-content/uploads/2024/08/CPRC_LetMeOut_SubsTraps_Report_FINAL.pdf">CPRC, Let me out – Subscription trap practices in Australia, August 2024</a></figcaption></figure> <h2>Better practices benefit businesses too</h2> The CPRC report also revealed that 90% of Australians would likely purchase from the same organisation if cancelling a subscription process was quick and simple. Businesses focused on a short-sighted cash grab fail to realise that consumers might cancel but later return if treated well. The CPRC highlights businesses that are doing a good job. For instance, the habit change app Atoms (based on James Clear’s book Atomic Habits) has a genuinely free trial. It doesn’t require credit card details, doesn’t auto-renew, and lets consumers know how many trial days remain. The CPRC says the charity World Vision doesn’t auto-renew annual sponsorships, but reminds supporters about when the sponsorship will lapse. Importantly, some businesses – such as Netflix – use their data for good in this context. They notice when users are paying for the service without using it and help them unsubscribe. These practices should be applauded. But we need an unfair practices prohibition for businesses who don’t follow suit and recognise the long-term benefits of treating customers fairly.<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/237236/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/katharine-kemp-402096">Katharine Kemp</a>, Associate Professor, Faculty of Law & Justice; Lead, UNSW Public Interest Law & Tech Initiative, <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/why-is-it-so-hard-to-cancel-subscriptions-or-end-free-trials-report-shows-how-companies-trap-you-into-paying-237236">original article</a>. </div>

Money & Banking

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

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/manuela-ferreira-161420">Manuela Ferreira</a>, <a href="https://theconversation.com/institutions/george-institute-for-global-health-874">George Institute for Global Health</a> and <a href="https://theconversation.com/profiles/leticia-deveza-1550633">Leticia Deveza</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> It’s cold and wet outside. As you get out of bed, you can feel it in your bones. Your right knee is flaring up again. That’ll make it harder for you to walk the dog or go to the gym. You think it must be because of the weather. It’s a common idea, but a myth. When we looked at the evidence, <a href="https://www.sciencedirect.com/science/article/pii/S0049017224000337">we found</a> no direct link between most common aches and pains and the weather. In the first study of its kind, we found no direct link between the temperature or humidity with most joint or muscle aches and pains. So why are so many of us convinced the weather’s to blame? Here’s what we think is really going on. <h2>Weather can be linked to your health</h2> The weather is often associated with the risk of new and ongoing health conditions. For example, cold temperatures <a href="https://pubmed.ncbi.nlm.nih.gov/27021573/">may worsen</a> asthma symptoms. Hot temperatures <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(22)00117-6/fulltext">increase the risk</a> of heart problems, such as arrhythmia (irregular heartbeat), cardiac arrest and coronary heart disease. Many people are also convinced the weather is linked to their aches and pains. For example, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1479-8077.2004.00099.x?casa_token=jvpSbA4szqoAAAAA%3ATyHyGaqXmfevWyuJe6LW_3Pap3IPHC8HSMTl3RN63mFzNO0X7ozQjBb6Bi3yVFuPjqkrf-WlB-J5A1q1">two in every three</a> people with knee, hip or hand osteoarthritis <a href="https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-15-66">say</a> cold temperatures trigger their symptoms. Musculoskeletal conditions affect more than <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/musculoskeletal-conditions-comorbidity-australia/summary">seven million Australians</a>. So we set out to find out whether weather is really the culprit behind winter flare-ups. <h2>What we did</h2> Very few studies have been specifically and appropriately designed to look for any direct link between weather changes and joint or muscle pain. And ours is the first to evaluate data from these particular studies. We looked at data from more than 15,000 people from around the world. Together, these people reported more than 28,000 episodes of pain, mostly back pain, knee or hip osteoarthritis. People with rheumatoid arthritis and gout were also included. We then compared the frequency of those pain reports between different types of weather: hot or cold, humid or dry, rainy, windy, as well as some combinations (for example, hot and humid versus cold and dry). <h2>What we found</h2> We found changes in air temperature, humidity, air pressure and rainfall do not increase the risk of knee, hip or lower back pain symptoms and are not associated with people seeking care for a new episode of arthritis. The results of this study suggest we do not experience joint or muscle pain flare-ups as a result of changes in the weather, and a cold day will not increase our risk of having knee or back pain. In order words, there is no direct link between the weather and back, knee or hip pain, nor will it give you arthritis. It is important to note, though, that very cold air temperatures (under 10°C) were rarely studied so we cannot make conclusions about worsening symptoms in more extreme changes in the weather. The only exception to our findings was for gout, an inflammatory type of arthritis that can come and go. Here, pain increased in warmer, dry conditions. Gout has a very different underlying biological mechanism to back pain or knee and hip osteoarthritis, which may explain our results. The combination of warm and dry weather may lead to increased dehydration and consequently increased concentration of uric acid in the blood, and deposition of uric acid crystals in the joint in people with gout, resulting in a flare-up. <h2>Why do people blame the weather?</h2> The weather can influence other factors and behaviours that consequently shape how we perceive and manage pain. For example, some people may change their physical activity routine during winter, choosing the couch over the gym. And we know <a href="https://pubmed.ncbi.nlm.nih.gov/28700451/">prolonged sitting</a>, for instance, is directly linked to worse back pain. Others may change their sleep routine or sleep less well when it is either too cold or too warm. Once again, a bad night’s sleep can trigger your <a href="https://link.springer.com/article/10.1007/s00586-021-06730-6">back</a> and <a href="https://www.sciencedirect.com/science/article/pii/S1063458421007020">knee</a> pain. Likewise, changes in mood, often experienced in cold weather, trigger increases in both <a href="https://link.springer.com/article/10.1007/s00586-021-06730-6">back</a> and <a href="https://www.sciencedirect.com/science/article/pii/S1063458421007020">knee</a> pain. So these changes in behaviour over winter may contribute to more aches and pains, and not the weather itself. Believing our pain will feel worse in winter (even if this is not the case) may also make us feel worse in winter. This is known as the <a href="https://link.springer.com/article/10.1186/s12891-018-1943-8">nocebo effect</a>. <h2>What to do about winter aches and pains?</h2> It’s best to focus on risk factors for pain you can control and modify, rather than ones you can’t (such as the weather). You can: <ul> <li> become more physically active. This winter, and throughout the year, aim to walk more, or talk to your health-care provider about gentle exercises you can safely do at home, with a physiotherapist, personal trainer or at the pool </li> <li> lose weight if obese or overweight, as this is linked to <a href="https://jamanetwork.com/journals/jama/article-abstract/2799405">lower levels</a> of joint pain and better physical function </li> <li> keep your body warm in winter if you feel some muscle tension in uncomfortably cold conditions. Also ensure your bedroom is nice and warm as we tend to sleep <a href="https://www.sciencedirect.com/science/article/pii/S0033350623003359">less well</a> in cold rooms </li> <li> maintain a healthy diet and <a href="https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(23)00098-X/fulltext">avoid smoking</a> or drinking high levels of alcohol. These are among <a href="https://ard.bmj.com/content/annrheumdis/82/1/48.full.pdf">key lifestyle recommendations</a> to better manage many types of arthritis and musculoskeletal conditions. For people with back pain, for example, a healthy lifestyle is linked with <a href="https://pubmed.ncbi.nlm.nih.gov/36208321/">higher levels</a> of physical function.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/235117/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> </li> </ul> <a href="https://theconversation.com/profiles/manuela-ferreira-161420">Manuela Ferreira</a>, Professor of Musculoskeletal Health, Head of Musculoskeletal Program, <a href="https://theconversation.com/institutions/george-institute-for-global-health-874">George Institute for Global Health</a> and <a href="https://theconversation.com/profiles/leticia-deveza-1550633">Leticia Deveza</a>, Rheumatologist and Research Fellow, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/no-your-aches-and-pains-dont-get-worse-in-the-cold-so-why-do-we-think-they-do-235117">original article</a>. </div>

Body

It’s hard to reach out to old friends, but doing so may help alleviate loneliness

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/lara-b-aknin-1365501">Lara B Aknin</a>, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a>; <a href="https://theconversation.com/profiles/gillian-sandstrom-1283157">Gillian Sandstrom</a>, <a href="https://theconversation.com/institutions/university-of-sussex-1218">University of Sussex</a>, and <a href="https://theconversation.com/profiles/kristina-castaneto-1548733">Kristina Castaneto</a>, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a> Millions of <a href="https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=4510004801">Canadians are lonely</a>. This is worrisome because loneliness, defined by the World Health Organization as “<a href="https://www.who.int/news/item/15-11-2023-who-launches-commission-to-foster-social-connection">the social pain of not feeling connected</a>,” predicts both lower mental and physical health. Research shows that lacking a sense of social connection can pose an <a href="https://doi.org/10.1177/1745691614568352">equivalent health risk to smoking 15 cigarettes per day</a>. To combat loneliness, people are commonly advised to seek out social connection. For many, this guidance brings to mind spending time with loved ones, such as close friends, family and romantic partners. But are there other people we can reach out to? In our research, recently published in Communications Psychology, we examined whether people have “old friends” — individuals that they care about but with whom they have lost touch — and <a href="https://doi.org/10.1038/s44271-024-00075-8">how easily these relationships can be rekindled</a>. We found that certain strategies can help people reconnect — and, in new research, we are getting a sense that certain values and personality traits may make it easier for people to stay in touch far into the future. <h2>Reconnecting with old friends</h2> Across a series of seven studies, we found the majority of people reported having an old friend. Yet, when we asked over 400 participants how willing they would be to reach out to an old friend right now, most said they were neutral or unwilling. In fact, in one study, people reported being no more willing to reach out to an old friend than they were to talk to a stranger or pick up trash. This reluctance was observable in behaviour too. We conducted two experiments in which more than 1,000 people were given several minutes to draft and send a message to an old friend. Only 30 per cent sent the message to their old friend. Given that reaching out to an old friend could boost <a href="https://www.forbes.com/sites/nextavenue/2018/08/19/the-power-and-joy-of-reconnecting-with-old-friends/">feelings of social connection and happiness</a>, we tried designing interventions to encourage reaching out. For instance, we reminded participants that reaching out to an old friend was an act of kindness and that the recipient would appreciate it more than they realize. We also tried telling participants not to overthink it — to just send their message. Unfortunately, neither prompt was effective at encouraging more people to reach out. <h2>Reluctance to reconnect</h2> Why are people reluctant to reach out to old friends? There may be a number of reasons, including the possibility that old friends feel like strangers after time has passed. In one study with over 500 participants we asked people to list between three to five old friends, and tell us how close each one felt to them right now. The more unfamiliar an old friend felt, the less willing people were to reach out. Research has found that when people <a href="https://doi.org/10.1016/j.jesp.2022.104356">practise talking to strangers for a week</a>, they become less anxious about it. If old friends can feel like strangers, might a similar strategy encourage people to reach out to old friends? To find out, we conducted an experiment in which we randomly assigned some people to complete a three-minute warm-up activity in which they messaged current family or friends. Other participants were randomly assigned to a control condition in which they simply browsed social media for three minutes instead. Afterward, all participants were given an opportunity to write and send a message to an old friend. While only 30 per cent of participants sent their message in the control condition, over 50 per cent did so after warming-up, suggesting that practising the behaviour that underlies reaching out may make this act easier. <h2>Personality traits</h2> We are extending this research in a number of new directions. For instance, in some newly conducted and unpublished research, we are examining whether people with certain personality traits or beliefs are more likely to send a message to an old friend. Responses from over 300 people suggest that people who are open to new experiences — <a href="https://www.psychologytoday.com/ca/basics/big-5-personality-traits">one of the five key personality traits studied by psychologists</a> — say they are willing to reach out to an old friend. Despite this inclination, our research found that highly open people do not necessarily communicate with old friends when given the chance. On the other hand, people’s values and beliefs may be important determinants of whether they stay in touch. Our preliminary work shows that people who see friendship as a bond that does not easily break may be more likely to reach out than others. We hope this work helps normalize the fact that friendships can fade and be hard to rekindle. That said, with some practice, people can overcome this reluctance and hit “send” to potentially open a path to connection and less loneliness.<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/234895/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/lara-b-aknin-1365501">Lara B Aknin</a>, Distinguished Professor of Social Psychology, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a>; <a href="https://theconversation.com/profiles/gillian-sandstrom-1283157">Gillian Sandstrom</a>, Senior Lecturer, School of Psychology, <a href="https://theconversation.com/institutions/university-of-sussex-1218">University of Sussex</a>, and <a href="https://theconversation.com/profiles/kristina-castaneto-1548733">Kristina Castaneto</a>, Master's Student, Psychology, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser 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/its-hard-to-reach-out-to-old-friends-but-doing-so-may-help-alleviate-loneliness-234895">original article</a>. </div>

Relationships

Why IBD is so hard to treat – and how scientists are making progress

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/falk-hildebrand-1490022">Falk Hildebrand</a>, <a href="https://theconversation.com/institutions/quadram-institute-5557">Quadram Institute</a>; <a href="https://theconversation.com/profiles/katarzyna-sidorczuk-1490026">Katarzyna Sidorczuk</a>, <a href="https://theconversation.com/institutions/quadram-institute-5557">Quadram Institute</a>, and <a href="https://theconversation.com/profiles/wing-koon-1490274">Wing Koon</a>, <a href="https://theconversation.com/institutions/quadram-institute-5557">Quadram Institute</a> Inflammatory bowel disease (IBD) is a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5478758/">life altering</a> chronic illness that is <a href="https://bmjopen.bmj.com/content/13/3/e065186">rising dramatically globally</a>. It is stubbornly difficult to treat, and many people find the treatments we have just don’t work for them. Over the last 30 years, there has been almost a 50% increase in cases – now affecting around 5 million people. Not to be confused with irritable bowel syndrome (IBS) which is a condition that affects the digestive system, IBD is more serious. It is the term for two severe illnesses called <a href="https://www.nhs.uk/conditions/crohns-disease/">Crohn’s disease</a> and <a href="https://www.nhs.uk/conditions/ulcerative-colitis/">ulcerative colitis</a>. More women are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9958616/#:%7E:text=Male%20predominance%20in%20IBD.,%2C%202.32%3A1%20in%20CD.">diagnosed with Crohn’s disease</a> while more men are affected by ulcerative colitis. People with IBD can experience a variety of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4106026/">symptoms</a>, ranging from diarrhoea and blood in the stool, to weight loss and belly aches. On paper, this may sound no worse than mild food poisoning, however, this is no normal stomach upset. Experiences are often extreme; people with IBD can suffer excruciating pain and in some cases, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9963331/">require surgery</a> to remove parts of the bowel. This is done by redirecting the bowel to a hole in the abdomen, where faeces are collected in a <a href="https://www.nhs.uk/conditions/colostomy/">colostomy bag</a>. However, we still don’t fully understand the cause of IBD. <h2>The impact of inflammation</h2> The main symptom of IBD is excessive and uncontrolled <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5805548/">inflammation</a> – normally a sign of the body fighting off an infection. Although inflammation is an important aspect of our immune system, in IBD it is happening when the body is not under attack. Since we don’t know what causes this over-the-top reaction, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8720971/">treatments</a> are limited to managing the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964397/">derailed immune system</a>. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8373857/">Inflammation is controlled</a> by cell signalling. Our cells detect bacteria using receptors that attach to parts of bacteria. This activates the receptor, causing it to send a signal to proteins, and each protein sends on more signals, creating a signal cascade. This is what tells the body it’s under attack. Many treatments follow the strategy of intercepting signals and preventing the signal cascade from starting. However, they are <a href="https://journals.lww.com/co-gastroenterology/abstract/2022/07000/management_of_refractory_inflammatory_bowel.6.aspx">not effective</a> for many people. Scientists are trying to target a different protein network, called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924159/">NOD2</a>, that often goes haywire in people with IBD but is not targeted by current treatments. A protein, called <a href="https://www.frontiersin.org/articles/10.3389/fphar.2021.650403/full">RIPK2</a>, seems like a promising target since it is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6939834/">only found</a> in this network. Researchers from the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10485824/">European Molecular Biology Laboratory</a> are investigating its structure to help scientists design a new medication that will block the signals from this protein. <h2>Importance of the microbiome</h2> Another inspiration for new treatments comes from the bacteria residing in our guts. This community of bacteria, called the gut microbiome, has been associated with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314516/">all sorts of health conditions</a> ranging from asthma to obesity. Gut bacteria work closely with our bodies and play a vital role in digesting food and managing our <a href="https://www.nature.com/articles/s41422-020-0332-7">immune system</a>. In a healthy person, there is a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4143175/">fine balance</a> between gut bacteria and the immune system. Disruption of this balance can lead to disease, starting from minor discomfort to more severe, long-term conditions. Scientists are trying to understand how our bodies interact with gut bacteria, and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102608/">what changes</a> when people develop IBD. The gut microbiome is an ecosystem. Just like a forest has animals eating different things, microbes can form a <a href="https://www.frontiersin.org/articles/10.3389/fevo.2019.00153/full">food web</a>. Some bacteria will use up one type of food, while others feed off other foods. Some rely on the waste of other bacteria after they’ve eaten. It is now believed that disruption to the gut microbiome is a characteristic of IBD and contributes to its development and progression. It’s a chicken and egg situation. Is there a change in the bacteria and food web that alters our bodies? Or does something else in the body, like our immune system, change the food web, subsequently limiting which bacteria can grow? Scientists aren’t sure of the answer. Instead of trying to figure out what happens first, a team at the <a href="https://www.nature.com/articles/s41467-023-42112-w">Hudson Institute of Medical Research</a> in Australia have focused on investigating which interactions in the food web are the most affected in IBD. This could help scientists to prioritise certain gut bacteria, or their food source, to restore the balance in the microbiome and improve patients’ symptoms. Hopefully, this specialised targeting of the microbiome will lead to more effective and longer lasting treatments. Although we have a long way to go before these ideas for treatments can become a reality, it is a step in the right direction. Targeting a new signalling pathway will hopefully control the inflammation in more patients. And studying the microbiome may reveal how we can reverse changes associated with IBD. Since they are key features of IBD, these developments could allow doctors to stop the disease in the early stages and reduce complications.<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/218307/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/falk-hildebrand-1490022">Falk Hildebrand</a>, Researcher in Bioinformatician, <a href="https://theconversation.com/institutions/quadram-institute-5557">Quadram Institute</a>; <a href="https://theconversation.com/profiles/katarzyna-sidorczuk-1490026">Katarzyna Sidorczuk</a>, Research Scientist in Metagenomics, <a href="https://theconversation.com/institutions/quadram-institute-5557">Quadram Institute</a>, and <a href="https://theconversation.com/profiles/wing-koon-1490274">Wing Koon</a>, PhD student in Bioinformatics, <a href="https://theconversation.com/institutions/quadram-institute-5557">Quadram 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/why-ibd-is-so-hard-to-treat-and-how-scientists-are-making-progress-218307">original article</a>. </div>

Body

What is competition, and why is it so important for prices?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/paul-blacklow-1546097">Paul Blacklow</a>, <a href="https://theconversation.com/institutions/university-of-tasmania-888">University of Tasmania</a> It’s hard to remember a time before the <a href="https://theconversation.com/you-dont-have-to-be-an-economist-to-know-australia-is-in-a-cost-of-living-crisis-what-are-the-signs-and-what-needs-to-change-210373">cost-of-living crisis</a> dominated news headlines. Most of us would certainly like it to be over. But the fundamental question at its heart – which points to the problem we have to solve – seems simple. What determines the prices we pay? The cost of producing goods and services is certainly one big factor in determining how much we pay for them. So, too, is what we’re prepared to fork out. But when we talk about lowering prices, we often also talk about increasing competition – the number of firms vying to sell us a particular offering. It’s so important for efficient pricing that the government body tasked with making our markets fair is called the Australian Competition and Consumer Commission – the “ACCC” for short. But why does having more people trying to sell us things drive down their prices? And can companies find ways to get around this? <h2>More sellers, lower prices</h2> In a free market system, there are a few different types of competition. In the most ideal, a perfectly competitive market, firms must use resources efficiently to produce what we consumers want at the lowest possible cost. In perfect competition: <ul> <li>the products and services traded are identical (or very similar)</li> <li>there are many buyers and sellers</li> <li>information is perfect</li> <li>firms can enter and exit freely.</li> </ul> A firm charging prices well above the minimum cost will sell no goods or services and be forced to leave the market. Why? Because its competitors will be able to steal customers by charging slightly less for exactly the same thing. Only lower-cost firms will remain and compete prices down until they cover the lowest cost of supplying the good or service, plus an average or normal “return on capital”. At a high level, think of this return as an acceptable monetary reward for the business for investing the inputs and taking on the risks required to operate. If ever an industry is earning above-average returns given its level of risk, new firms will enter and charge less, until only normal returns are earned. Conversely, below-normal profits will see firms exit, decreasing supply and raising prices. Do perfectly competitive markets exist? There are arguably some examples that come close, such as casual labour services, some agricultural commodities like grain, livestock and fruit, and financial and currency markets. But there are more examples of less competitive markets. <h2>The winner takes it all</h2> At the opposite extreme, in monopoly markets, there is only one seller of a good or service. Typically, there is some barrier preventing new firms from entering the market and driving prices down. Without government regulation, monopoly firms will reduce supply, increase prices and earn above-normal profit levels. However, sometimes monopolies emerge naturally because it is far more efficient to have a single coordinating supplier of a particular service – such as in letter delivery, rail tracks, or internet infrastructure. To strike a balance, governments typically regulate or own monopolies. <h2>Same same, but different</h2> More common than monopoly is what’s called monopolistic competition, which is the market structure for many of our tech, entertainment and dining goods and services. In monopolistic competition, firms try to make their offering different by investing in R&D and advertising, so that they do not have to compete on price alone. Think Apple’s iPhone versus Samsung’s Galaxy. Both are technically the same kind of product, but have created their own unique markets. Differentiation allows firms to price above minimum cost and earn above-normal rates of return. At least, that is, until new firms enter and imitate them, increasing supply and lowering prices and profits to normal levels. <h2>A few big players hold market power</h2> In Australia, many key goods and services are traded in oligopoly markets. Oligopolies arise when a few large firms dominate a particular industry, such as supermarkets, domestic airlines, banking, mobile telecommunications, and petrol retailing. Some oligopoly markets are very competitive and drive prices down to cost, plus normal return to capital. But in other more concentrated markets with a few powerful firms, firms may have significant market power and be able to keep prices above the competitive level. It is not illegal to possess market power, but according to Australia’s Competition and Consumer Act 2010, it is illegal to use it “for the purpose, effect, or likely effect of substantially lessening competition”. It is illegal, for example, for firms to explicitly work together when setting prices. This is called collusion. Neither can they force suppliers to deal with them exclusively, or set prices below cost when new firms attempt to enter a market. But that doesn’t mean some firms haven’t learned subtle and legal ways of reducing competition. For example, loyalty programs and charging special loss-leading prices can seem at first glance to be good for consumers, but can also increase the <a href="https://theconversation.com/loyalty-programs-may-limit-competition-and-they-could-be-pushing-prices-up-for-everyone-220669">cost of switching</a> to the lowest-priced firm. <h2>Are we getting a good deal?</h2> Still, you may have noticed the prices charged for many goods and services are very similar across different firms in the economy. Have these prices been driven down by competition to their cost plus a normal return to capital? Or are firms abusing their market power to lessen competition in the market? What can we do if firms are reducing competition through legal measures? These are just some of the difficult questions both government and industry are currently grappling with.<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/234082/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/paul-blacklow-1546097">Paul Blacklow</a>, Lecturer in Economics, <a href="https://theconversation.com/institutions/university-of-tasmania-888">University of Tasmania</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-is-competition-and-why-is-it-so-important-for-prices-234082">original article</a>. </div>

Money & Banking

So when should you book that flight? The truth on airline prices

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/yuriy-gorodnichenko-144556">Yuriy Gorodnichenko</a>, <a href="https://theconversation.com/institutions/university-of-california-berkeley-754">University of California, Berkeley</a> and <a href="https://theconversation.com/profiles/volodymyr-bilotkach-145437">Volodymyr Bilotkach</a>, <a href="https://theconversation.com/institutions/newcastle-university-906">Newcastle University</a> How airlines price tickets is a source of many <a href="http://airtravel.about.com/od/travelindustrynews/a/mythticket.htm">myths</a> and urban legends. These include tips about the best day of the week to buy a ticket, last-minute discounts offered by the airlines, and the conspiracy theories suggesting that the carriers use cookies to increase prices for their passengers. None of these three statements is entirely true. Studies have suggested that prices can be higher or lower on a given day of the week – yet, there is no clear consensus on which day that is. Offered prices can in fact drop at any time before the flight, yet they are much more likely to increase than decrease over the last several weeks before the flight’s departure. Further, the airlines prefer to wait for the last-minute business traveler who’s likely to pay full fare rather than sell the seat prematurely to a price conscious traveler. And no, the airlines do not use cookies to manipulate fare quotes – adjusting their inventory for specific customers appears to be beyond their technical capabilities. What is true about pricing in the airline industry is that carriers use complex and sophisticated pricing systems. The airline’s per passenger cost is the lowest when the flight is full, so carriers have incentive to sell as many seats as possible. This is a race against time for an airline and, of course, no company wants to discount its product more than it has to. Hence, the airlines face two somewhat contradictory goals: to maximize revenue by flying full planes and to sell as many full-fare seats as possible. This a process known in the industry as yield or revenue management. <h2>Airlines and their bucket lists</h2> Here is how <a href="http://commons.erau.edu/cgi/viewcontent.cgi?article=1522&context=jaaer">yield management</a> works. For each flight or route (if we are talking about multi-segment itineraries), the airline has a set of available price levels – from the most expensive fully refundable fare to the cheapest deeply discounted non-refundable price. The industry jargon for these prices is “buckets.” Then, seats can be interpreted as balls that are allocated among these buckets. Initial allocation of seats between the price buckets is determined by historical data indicating how well a certain flight sells. For example, fewer deeply discounted seats will be offered on a flight on Thanksgiving week than on the same flight during the third week of February. As the seats on a flight sell, yield managers monitor and adjust the seat allocation. If, for instance, the sales are slower than expected, some of the seats might be moved to lower-priced buckets – this shows up as a price drop. As noted above, such price drops can occur at any time before the flight. However, the general trend of price quotes is upward starting from about two to three weeks before the flight departure date. Of course, an average traveler wants to know when he or she should buy the tickets for the next trip. Another important question is where to buy this ticket. Airlines distribute their inventory on their own websites and on several computer distribution systems, meaning that prices can sometimes differ depending on where one looks. We are not entirely sure what precipitates this phenomenon – likely explanations include differences in contracts between the airlines and the distribution systems/travel agents, implying that different travel agents may not have access to the airline’s entire inventory of available prices. <h2>When to book</h2> The airlines’ yield managers start looking at flight bookings about two months before the departure date. This implies that it generally does not pay to book more than two months in advance: studies show that initially the airlines leave the cheapest price buckets empty, and yield managers may move some seats into those buckets if a couple of months before the departure date the flight is emptier than expected. Between two months and about two to three weeks before the flight date, the fare quotes remain mostly flat, with a slight upward trend. However, and perhaps paradoxically, there is a good chance of a price drop during this period. We tend to monitor prices for several days – sometimes up to a week – hoping for a potentially lower quote. It does not always pay off, but sometimes we do manage to save a considerable amount of money. Two to three weeks before the flight date, the price quotes start increasing. This is the time when business travelers start booking. While price drops are still possible, a chance of a price increase is much higher if you wait to book within this time period. This is also the time when one can find significant differences between price quotes, depending on where one looks and what contract they have with the airlines. Thus, if we book a trip earlier than three weeks before the flight date, we tend not to delay the purchase. At the same time, we check quotes from multiple travel agents, or go directly to a site that allows for a quick comparison of prices (such as <a href="https://www.kayak.com">kayak.com</a> or <a href="http://www.skyscanner.net">skyscanner.net</a>). Or check the airline itself. As for answering the original question we posed, here are some simple tips. First, if you have to travel during a peak period, such as Thanksgiving week, it is generally best not to delay buying that ticket. Otherwise, it might pay to monitor the offered prices for some time before committing. The best strategy for booking within the last couple of weeks before the flight, however, is not to delay the purchase, but to try getting quotes from several agents, which is easy to do in the internet 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/34033/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/yuriy-gorodnichenko-144556">Yuriy Gorodnichenko</a>, Associate Professor of Economics, <a href="https://theconversation.com/institutions/university-of-california-berkeley-754">University of California, Berkeley</a> and <a href="https://theconversation.com/profiles/volodymyr-bilotkach-145437">Volodymyr Bilotkach</a>, Senior Lecturer in Economics, <a href="https://theconversation.com/institutions/newcastle-university-906">Newcastle 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/so-when-should-you-book-that-flight-the-truth-on-airline-prices-34033">original article</a>. </div>

Travel Tips

We know what to eat to stay healthy. So why is it so hard to make the right choices?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/nina-van-dyke-822557">Nina Van Dyke</a>, <a href="https://theconversation.com/institutions/victoria-university-1175">Victoria University</a> A healthy diet <a href="https://www.who.int/initiatives/behealthy/healthy-diet">protects us</a> against a number of chronic diseases, including heart disease, diabetes and cancer. From early childhood, we receive an abundance of <a href="https://cdn.who.int/media/docs/default-source/healthy-diet/healthy-diet-fact-sheet-394.pdf?sfvrsn=69f1f9a1_2&download=true">information</a> about how we <a href="https://www.eatforhealth.gov.au/guidelines/australian-guide-healthy-eating">should eat</a> to be healthy and reduce our risk of disease. And most people have a <a href="https://link.springer.com/content/pdf/10.1186/1479-5868-11-63.pdf">broad understanding</a> of what healthy eating looks like. But this knowledge <a href="https://www.sciencedirect.com/science/article/pii/S0001209216310584?casa_token=6CZgCmT1RMgAAAAA:sSRsj2o6swVfvoBxMIVrMTxqdczSAiFwfTCYzYQ8U3z4ey_WLQ6knpmk8WRH77zugAS3wEAQrA">doesn’t always result</a> in healthier eating. In our new research, we set out to <a href="https://link.springer.com/content/pdf/10.1186/s12889-024-18432-x.pdf">learn more</a> about why people eat the way they do – and what prevents them from eating better. Lack of time was a major <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/obr.12472?casa_token=1D1mi-l0TR0AAAAA:dgebTQx-wgw7jbREfdawxZ5AZSDRztvrt8t1tuKyDy1x2mmXlyLDY8z9NbUf0v4hnh80HY_RbAk08Q">barrier</a> to cooking and eating healthier foods. <h2>How do you decide what to eat?</h2> We spoke with <a href="https://link.springer.com/content/pdf/10.1186/s12889-024-18432-x.pdf">17 adults</a> in a regional centre of Victoria. We chose a regional location because less research <a href="https://link.springer.com/content/pdf/10.1186/s40900-020-0179-6.pdf">has been done</a> with people living outside of metropolitan areas and because rates of obesity and other diet-related health issues are <a href="https://www.aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health">higher</a> in such areas in Australia. Participants included a mix of people, including some who said they were over their “most healthy weight” and some who had previously dieted to lose weight. But all participants were either: <ul> <li>young women aged 18–24 with no children</li> <li>women aged 35–45 with primary school aged children</li> <li>men aged 35–50 living with a partner and with pre- or primary-school aged children.</li> </ul> We selected these groups to target <a href="https://www.sciencedirect.com/science/article/pii/S0022318212803669">ages and life-stages</a> in which shifts in eating behaviours may occur. Previous research has found younger women <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1470-6431.2007.00642.x?casa_token=33QKWwhc2ogAAAAA:ZvJ6wfXiRC_6eoqvoxD121JOSKSPmIRHcrdiGl2uHzkq5pY6VVPL6WI2DhmxQ2q9i6bBGvLiFl8afQ">tend to</a> be particularly concerned about appearance rather than healthy eating, while women with children often shift their focus to providing for their family. Men <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/obr.12472?casa_token=KakMB6hAOQ0AAAAA:fLnpoxZQiiJIdEkg_TOcCq8hBwZef1iZETZKTiG5W6zW2x_PYzK0oLeOg5F9arKThq9RzMWEi4x4Xw">tend to be less interested</a> in what they eat. We asked participants about how they decided what food to eat, when, and how much, and what prevented them from making healthier choices. <h2>It’s not just about taste and healthiness</h2> We found that, although such decisions were determined in part by taste preferences and health considerations, they were heavily influenced by a host of other factors, many of which are outside the person’s control. These included other household members’ food preferences, family activities, workplace and time constraints, convenience and price. <a href="https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2767106">Healthy eating</a> means consuming a balanced diet rich in nutrients, including a variety of fruits, vegetables, whole grains, lean proteins and healthy fats, while limiting processed foods, added sugars and excessive salt. Healthy eating also includes how we eat and <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244292">how we think about</a> food and eating, such as having a positive relationship with food. One 35- to 45-year-old woman, for example, said that time constraints and family preferences made it difficult to prepare healthier food: <blockquote> I love the chance when I can actually get a recipe and get all of the ingredients and make it properly, but that doesn’t happen very often. It’s usually what’s there and what’s quick. And what everyone will eat. </blockquote> One of the 35- to 50-year-old men also noted the extent to which family activities and children’s food preferences dictated meal choices: <blockquote> Well, we have our set days where, like Wednesday nights, we have to have mackie cheese and nuggets, because that’s what the boys want after their swimming lesson. </blockquote> <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/joss.12649?casa_token=gsnU9O_G2GQAAAAA:mV2vtHlnEd0jqBGJPFkfml_ecLIDqwSlH5xksSwt4eQb_FP_UShyAKm9sLNnKy6Mkf2q9aKAlDEixA">Research shows</a> that children are often more receptive to new foods than their parents think. However, introducing new dishes takes additional time and planning. An 18- to 24-year-old woman discussed the role of time constraints, her partner’s activities, and price in influencing what and when she eats: <blockquote> My partner plays pool on a Monday and Wednesday night, so we always have tea a lot earlier then and cook the simple things that don’t take as long, so he can have dinner before he goes rather than buying pub meals which cost more money. </blockquote> Despite popular perceptions, healthy diets are not more expensive than unhealthy diets. A <a href="https://preventioncentre.org.au/wp-content/uploads/2017/03/1702_FB_LEE_4p_final_lr.pdf">study</a> comparing current (unhealthy) diets with what the <a href="https://www.health.gov.au/resources/publications/the-australian-dietary-guidelines">Australian Dietary Guidelines</a> recommend people should eat found that the healthy diet was 12–15% cheaper than unhealthy diets for a family of two adults and two children. However, learning and planning to prepare new types of meals <a href="https://www.mdpi.com/2072-6643/12/3/877">takes effort and time</a>. Simply educating people about what they should eat won’t necessarily result in healthier eating. People want to eat healthier, or at least know they should eat healthier, but other things <a href="https://link.springer.com/content/pdf/10.1007/s00394-017-1458-3.pdf">get in the way</a>. A key to improving people’s eating behaviours is to make it easy to eat more healthily. Policy changes to make healthy eating easier could include subsidising healthier foods such as fresh produce, providing incentives for retailers to offer healthy options, and ensuring access to nutritious meals in schools and workplaces. <h2>So how can you make healthier food choices easier?</h2> Here are five tips for making healthy choices easier in your household: <ol> <li> If certain days of the week are particularly busy, with little time to prepare fresh food, plan to cook in bulk on days when you have more time. Store the extra food in the fridge or freezer for quick preparation. </li> <li> If you’re often pressed for time during the day and just grab whatever food is handy, have healthy snacks readily available and accessible. This could mean a fruit bowl in the middle of the kitchen counter, or wholegrain crackers and unsalted nuts within easy reach. </li> <li> Discuss food preferences with your family and come up with some healthy meals everyone likes. For younger children, <a href="https://healthykids.nsw.gov.au/downloads/file/campaignsprograms/NewFoodsFussyEaters.pdf">try serving</a> only a small amount of the new food, and serve new foods alongside foods they already like eating and are familiar with. </li> <li> If you rely a lot on take-away meals or meal delivery services, try making a list ahead of time of restaurants and meals you like that are also healthier. You might consider choosing lean meat, chicken, or fish that has been grilled, baked or poached (rather than fried), and looking for meals with plenty of vegetables or salad. </li> <li> Remember, fruit and vegetables taste better and are often cheaper when they are in season. Frozen or canned vegetables are a <a href="https://www.sbs.com.au/news/article/the-cost-of-fresh-fruit-and-veggies-is-rising-is-canned-or-frozen-produce-just-as-healthy/tzuhnfrnr">healthy and quick alternative</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/231489/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> </li> </ol> <a href="https://theconversation.com/profiles/nina-van-dyke-822557">Nina Van Dyke</a>, Associate Professor and Associate Director, Mitchell Institute, <a href="https://theconversation.com/institutions/victoria-university-1175">Victoria University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/we-know-what-to-eat-to-stay-healthy-so-why-is-it-so-hard-to-make-the-right-choices-231489">original article</a>. </div>

Food & Wine

Southern Australia is freezing. How can it be so cold in a warming climate?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/andrew-king-103126">Andrew King</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> People living in southern Australia won’t have failed to notice how cold it is. Frosty nights and chilly days have been the weather for many of us since the start of July. As winter continues, we are left wondering how unusual the cold is and whether we can expect several more months of this. Warmer conditions are in the forecast but winter has a long way to go. Further cold snaps could occur. Cold conditions have been in place across southern Australia for the past few days. Temperatures have fallen below zero overnight in many places. It’s not just the nights that have been cold. Maximum temperatures have also been below or well below average across most of the country. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/604809/original/file-20240704-20-l50kpt.gif?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/604809/original/file-20240704-20-l50kpt.gif?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/604809/original/file-20240704-20-l50kpt.gif?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=412&fit=crop&dpr=1 600w, https://images.theconversation.com/files/604809/original/file-20240704-20-l50kpt.gif?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=412&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/604809/original/file-20240704-20-l50kpt.gif?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=412&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/604809/original/file-20240704-20-l50kpt.gif?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=518&fit=crop&dpr=1 754w, https://images.theconversation.com/files/604809/original/file-20240704-20-l50kpt.gif?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=518&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/604809/original/file-20240704-20-l50kpt.gif?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=518&fit=crop&dpr=3 2262w" alt="" /></a><figcaption>Maximum temperatures have been below average across most of the continent since the last day of June. <a class="source" href="http://www.bom.gov.au/jsp/awap/temp/index.jsp">Bureau of Meteorology</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></figcaption></figure> <h2>What’s causing the cold?</h2> A <a href="http://www.bom.gov.au/australia/charts/synoptic_col.shtml">persistent and strong high-pressure system</a> has been hanging around over southeast Australia. The atmospheric pressure was so high it approached the Australian record of 1,044.3 hPa set on June 7 1967. An <a href="https://www.abc.net.au/news/2024-07-04/australias-highest-air-pressure-recorded-weather/104055462">initial observation</a> of a new record has since been disregarded, but nonetheless this is an exceptional, near-record high-pressure pattern. This high-pressure system has kept the weather dry but clear nights have allowed strong cooling of the land surface. The long nights and short days of early July mean that temperatures struggle to rise during the day and can fall quickly in the evenings. In winter we expect cold weather across most of Australia and occasional cold snaps that bring widespread frosty and icy conditions. However, this current cold weather is pretty unusual and we are seeing some records fall. Notably, Tasmania has had its <a href="https://www.weatherzone.com.au/news/tasmanias-2ndcoldest-night-on-record/1889603">lowest July temperature on record</a> and the second-lowest minimum temperature for any time of year with –13.5°C at Liawenee in central Tasmania early on Thursday morning. While Tasmania has produced the most remarkable records, the cold conditions have been unusual elsewhere too. Adelaide recorded its lowest temperature in 18 years on Wednesday morning. And many suburbs of Melbourne experienced a sub-zero night and consecutive nights of <a href="https://www.metoffice.gov.uk/weather/learn-about/weather/types-of-weather/frost-and-ice/frost">ground frost</a>. <h2>Winters are warming but cold spells still occur</h2> As the world is warming, it might seem surprising we can still break cold records. Indeed, across Australia <a href="http://www.bom.gov.au/cgi-bin/climate/change/timeseries.cgi?graph=tmean&area=aus&season=0608&ave_yr=0&ave_period=6190">winters have been warming</a>. The <a href="http://www.bom.gov.au/cgi-bin/climate/change/extremes/trendmaps.cgi?map=CN05&period=1950">frequency</a> and <a href="http://www.bom.gov.au/cgi-bin/climate/change/extremes/trendmaps.cgi?map=TNmn&period=1950">intensity</a> of very low temperatures have been decreasing over the past few decades. We also see many more hot records than cold records being set in Australia and around the globe. This is <a href="https://theconversation.com/why-hot-weather-records-continue-to-tumble-worldwide-86158">due to human-caused climate change</a>. However, when we have the right weather conditions, cold records are still occasionally broken locally. As we continue to warm the planet, it’s getting harder for us to find cold records, particularly over larger regions or longer time periods. While we still see record cold temperatures at individual weather stations, we won’t see another cold record in the global average temperature and probably not even in the Australian average temperature. As this week shows, we still occasionally get daily cold records in the current climate. But it’s much harder to get record cold months, and record cold years at a given location are almost impossible. As we average weather conditions across locations or over time, the climate change signal becomes clearer over background weather variability. It makes new cold records much less likely to occur. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/605048/original/file-20240704-21-7ep1rt.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/605048/original/file-20240704-21-7ep1rt.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/605048/original/file-20240704-21-7ep1rt.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=426&fit=crop&dpr=1 600w, https://images.theconversation.com/files/605048/original/file-20240704-21-7ep1rt.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=426&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/605048/original/file-20240704-21-7ep1rt.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=426&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/605048/original/file-20240704-21-7ep1rt.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=536&fit=crop&dpr=1 754w, https://images.theconversation.com/files/605048/original/file-20240704-21-7ep1rt.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=536&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/605048/original/file-20240704-21-7ep1rt.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=536&fit=crop&dpr=3 2262w" alt="A graphic showing the increase in annual average temperature for Australia from 1910 to 2023" /></a><figcaption>The climate change signal is becoming clearer as Australia’s annual average temperature continues to increase with each decade, widening the difference from the long-term mean. <a class="source" href="http://www.bom.gov.au/climate/current/annual/aus/#tabs=Temperature">Bureau of Meteorology</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></figcaption></figure> <h2>How much longer will this cold snap last?</h2> Southern Australia is experiencing a cold snap at close to the coldest time of year. It’s not long after the winter solstice, when we experience the longest night of the year. We still have a few more cold days and nights ahead in parts of southeastern Australia. By early next week, the forecast suggests <a href="http://www.bom.gov.au/australia/charts/viewer/index.shtml">warmer conditions</a> will return as the high-pressure system moves east and winds turn northerly. The outlook for the rest of winter points firmly to <a href="http://www.bom.gov.au/climate/outlooks/#/overview/summary">above-average daytime and night-time temperatures</a>. This is partly because a historical average (1981–2018) is used and warming since then means above-average temperatures are going to happen most of the time. In any winter, Australia has cold outbreaks. So, even if the next few months are likely to be warmer than normal, we should expect a few cold days and nights at some point. Learning to live with the cold and improving the <a href="https://www.theguardian.com/news/ng-interactive/2024/jul/03/why-so-many-australian-homes-are-either-too-hot-or-too-cold">quality of insulation in Australian homes</a> would help make our winter cold snaps seem a lot less harsh.<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/233977/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/andrew-king-103126">Andrew King</a>, Senior Lecturer in Climate Science, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/southern-australia-is-freezing-how-can-it-be-so-cold-in-a-warming-climate-233977">original article</a>. </div>

Domestic Travel

Breast cancer screening in Australia may change. Here’s what we know so far

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/brooke-nickel-200747">Brooke Nickel</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/katy-bell-134554">Katy Bell</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> The way women are screened for breast cancer in Australia may <a href="https://www.cancer.org.au/about-us/policy-and-advocacy/early-detection/breast-cancer/rosa/key-findings">change</a>. There’s international debate on the <a href="https://www.bmj.com/content/385/bmj.q1353">age</a> women should be invited for screening. But an even larger change being considered worldwide is whether to screen women at <a href="https://www.nature.com/articles/s41416-021-01550-3">high and low risk</a> of breast cancer differently. But what such a “risk-based” approach to screening might look like in Australia is not yet clear. Here’s why researchers and public health officials are floating a change to breast cancer screening in Australia, and what any changes might mean. <h2>Why breast cancer screening may need to change</h2> Mass screening (known as population-based screening) for breast cancer was introduced in Australia and many other developed countries in the 1980s and 90s. This was based on <a href="https://pubmed.ncbi.nlm.nih.gov/26756588/">robust research</a> that found early detection and treatment of cancers before there were symptoms prevented some women from dying from breast cancer. These programs offer regular breast cancer screening to women within a specific age group. For example, <a href="https://www.aihw.gov.au/reports/cancer-screening/national-cancer-screening-programs-participation/contents/breastscreen-australia">in Australia</a>, women aged 40-74 years can have free mammograms (x-rays of the breasts) every two years. The BreastScreen program sends invitations for screening to those aged 50-74. However, evidence has been mounting that mammography screening could be inadvertently causing <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61611-0/abstract">harm</a> for some women. For some, screening causes a false alarm that may cause anxiety, and unnecessary tests and procedures. Even though these tests rule out cancer, these women may remain anxious and perceive something is wrong <a href="https://bmjopen.bmj.com/content/13/4/e072188">for many years</a>. A more insidious harm is <a href="https://theconversation.com/five-warning-signs-of-overdiagnosis-110895">overdiagnosis</a>, where screening detects a non-growing or slow-growing lesion that looks like “cancer” under the microscope, but would not have progressed or caused harm if it had been left alone. This means some women are having unnecessary surgery, radiotherapy and hormone therapy that will not benefit them, but may harm. Although trials have shown screening reduces the risk of dying from breast cancer, questions are being raised about how much it <a href="https://www.bmj.com/content/352/bmj.h6080.abstract">saves lives overall</a>. That is, it’s uncertain how much the reduced risk of dying from breast cancer translates into improvements in a woman’s overall survival. <h2>How about better targeting women?</h2> One idea is to target screening to those most likely to benefit. Under such a “<a href="https://www.nature.com/articles/s41416-021-01550-3">risk-based</a>” approach, a women’s personal risk of breast cancer is estimated. This may be based on her age and many other factors that may include breast density, family history of breast cancer, body-mass index, genetics, age she started and stopped her periods, and the number of children she’s had. Women who are at higher risk would be recommended to start screening at a younger age and to screen more frequently or to use different, more sensitive, imaging tests. Women at lower risk would be recommended to start later and to screen less often. The idea of this more “precise” approach to screening is to direct efforts and resources towards the smaller number of women most likely to benefit from screening via the early detection of cancer. At the same time, this approach would reduce the risk of harm from false positives (detection of an anomaly but no cancer is present) and overdiagnosis (detection of a non-growing or slow-growing cancer) for the larger number of women who are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6230256/">unlikely to benefit</a>. On face value this sounds like a good idea, and could be a favourable change for breast cancer screening. <h2>But there’s much we don’t know</h2> However, it’s uncertain how this would play out in practice. For one thing, someone’s future risk of a cancer diagnosis includes the risk of detecting both <a href="https://www.acpjournals.org/doi/10.7326/m17-2792">overdiagnosed cancers</a> as well as potentially lethal ones. This is proving to be a problem in risk-based screening for <a href="https://www.nature.com/articles/s41698-022-00266-8">prostate cancer</a>, another cancer prone to overdiagnosis. Ideally, we’d want to predict someone’s risk of <a href="https://www.thelancet.com/journals/landig/article/PIIS2589-7500(23)00113-9/fulltext">potentially lethal cancers</a> as these are the ones we want to catch early. It is also still uncertain how many women found to be at <a href="https://pubmed.ncbi.nlm.nih.gov/31701797/">low risk</a> will accept a recommendation for <a href="https://pubmed.ncbi.nlm.nih.gov/23092125/">less screening</a>. These uncertainties mean we need robust evidence the benefits outweigh the harms for Australian women before we make changes to the breast cancer screening program. There are several international <a href="https://www.nature.com/articles/s41416-021-01550-3">randomised controlled trials</a> (the gold standard for research) under way to evaluate the effectiveness of risk-based screening compared to current practice. So it may be prudent to wait for their findings before making changes to policy or practice. Even if such trials did give us robust evidence, there are still a number of issues to address before implementing a risk-based approach. One key issue is having enough staff to run the program, including people with the skills and time to discuss with women any concerns they have about their calculated risk. <h2>How about breast density?</h2> Women with dense breasts are at <a href="https://www.sciencedirect.com/science/article/pii/S0960977622001618#:%7E:text=Mammographic%20density%20is%20a%20well,increased%20risk%20of%20breast%20cancer.">higher risk of breast cancer</a>. So notifying women about their breast density has been proposed as a “first step” on the pathway to risk-based screening. However, this ignores the many other factors that determine a woman’s risk of breast cancer. Legislation in the <a href="https://www.fda.gov/radiation-emitting-products/mammography-quality-standards-act-and-program">United States</a> and changes in some <a href="https://australianbreastcancer.org.au/news-stories/latest-news/breast-density-reporting-at-all-sa-clinics/">Australian states</a> mean some women are already being notified about their breast density. The idea is to enhance their knowledge about their breast cancer risk so they can make informed decisions about future screening. But this has happened before we know what the best options are for such women. An <a href="https://www.mja.com.au/journal/2023/219/9/psychosocial-outcomes-and-health-service-use-after-notifying-women-participating">ongoing Australian trial</a> is investigating the effects that breast density notification has on individual women and the health system. <h2>What next?</h2> Robust evidence and careful planning are needed before risk-based screening or other changes are made to Australia’s breast cancer screening program. Where changes are made, there needs to be early evaluation of both the <a href="https://www.bmj.com/content/350/bmj.h1566.abstract">benefits and harms</a>. Programs also need <a href="https://www.bmj.com/content/374/bmj.n2049.long">independent, regular re-evaluation</a> in the longer term.<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/231917/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/brooke-nickel-200747">Brooke Nickel</a>, NHMRC Emerging Leader Research Fellow, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/katy-bell-134554">Katy Bell</a>, Professor in Clinical Epidemiology, Sydney School of Public Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/breast-cancer-screening-in-australia-may-change-heres-what-we-know-so-far-231917">original article</a>. </div>

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