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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

High-speed rail plans may finally end Australia’s 40-year wait to get on board

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/philip-laird-3503">Philip Laird</a>, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a> Australia has debated and studied high-speed rail for four decades. The High Speed Rail Authority has begun <a href="https://www.hsra.gov.au/project">work on a project</a> that could finally deliver some high-speed rail in the 2030s. The Albanese government set up the authority in 2022. It also committed A$500 million to plan and protect a high-speed rail corridor between Sydney and Newcastle. This corridor was prioritised due to significant capacity constraints on the existing line, among other reasons. The ultimate plan is for a high-speed rail network to connect Brisbane, Sydney, Canberra, Melbourne and regional communities across the east coast. The network would help Australia in its urgent task to reduce greenhouse gas emissions from transport. These <a href="https://www.infrastructure.gov.au/infrastructure-transport-vehicles/towards-net-zero-transport-and-infrastructure">continue to increase</a> even as emissions from other sectors fall. The authority has now publicly outlined plans for the first stage of this east coast network. After a history of failed proposals dating back to 1984, the new plans provide some cause for optimism that Australia could have some high-speed rail by 2037. <h2>What is high-speed rail and why do we need it?</h2> The International Rail Union of Railways <a href="https://uic.org/passenger/highspeed">defines high-speed rail</a> as new lines designed for speeds of 250km/h or more and upgraded lines for speeds of at least 200km/h. High-speed rail could greatly reduce transport emissions by replacing <a href="https://theconversation.com/wondering-how-to-get-from-brisbane-to-melbourne-without-wrecking-the-climate-our-transport-choices-make-a-huge-difference-237396">air travel in particular</a>. For example, the <a href="https://www.bitre.gov.au/publications/ongoing/domestic_airline_activity-monthly_publications">7.92 million passengers</a> flying between Melbourne and Sydney in 2023-24 produced about 1.5 million tonnes of emissions. Including <a href="https://theconversation.com/how-air-travellers-can-cut-their-door-to-door-emissions-right-now-by-as-much-as-13-on-the-sydney-melbourne-route-211099">travel to and from airports</a> and other flight routes along the corridor (Sydney or Melbourne to Canberra, Albury etc), this adds up to about 2% of <a href="https://www.dcceew.gov.au/climate-change/strategies/annual-climate-change-statement-2023">annual domestic transport emissions</a>. A Sydney–Melbourne high-speed rail link could cut emissions to a fraction of those from <a href="https://theconversation.com/wondering-how-to-get-from-brisbane-to-melbourne-without-wrecking-the-climate-our-transport-choices-make-a-huge-difference-237396">air</a> and <a href="https://theconversation.com/we-compared-land-transport-options-for-getting-to-net-zero-hands-down-electric-rail-is-the-best-234092">road</a> transport. If Australia is to achieve <a href="https://www.dcceew.gov.au/climate-change/emissions-reduction/net-zero">net zero by 2050</a>, a <a href="https://theconversation.com/we-compared-land-transport-options-for-getting-to-net-zero-hands-down-electric-rail-is-the-best-234092">shift to rail will be essential</a>. High-speed city-to-city rail services will be needed to become an attractive alternative to air travel. <h2>What is the authority working on?</h2> Early this year the High Speed Rail Authority gained a new CEO, Tim Parker, with extensive experience in delivering mega-projects. In late August, the authority outlined its plans at an industry briefing in Newcastle. The authority has commissioned eight studies, including a business case for a Sydney–Newcastle line. Significantly, it will include the cost of future highway upgrades if high-speed rail does not proceed. This study, along with a report on how high-speed rail will proceed along Australia’s east coast, is due by the end of this year. Also under way is a <a href="https://minister.infrastructure.gov.au/c-king/media-release/all-aboard-high-speed-rail-accelerates-first-investigation-works">geotechnical study</a> that includes drilling 27 boreholes. It will help determine the proposed depths of two long rail tunnels and guide decisions on crossing the Hawkesbury River and the route to the Central Coast and on to Newcastle. All going well, including land acquisition and agreements with the New South Wales government (which could include funding), work could <a href="https://www.newcastleherald.com.au/story/8743698/newcastle-high-speed-rail-possible-by-2037-as-tunnel-plan-emerges">start in 2027 and be completed by 2037</a>. <h2>Many questions remain</h2> Given the time and money required to deliver a Sydney–Newcastle line, bipartisan support will be needed. However, the federal opposition is yet to make a clear commitment to high-speed rail. There are other uncertainties too. Will the trains be operated by the public or private sector? The latter was the intention for projects that were scrapped decades ago, such as the CSIRO-proposed Very Fast Train (<a href="http://www.repositoryofideas.com/VFT_information.html">VFT</a>) linking Sydney, Canberra and Melbourne, and the Sydney–Canberra <a href="https://trid.trb.org/View/1203853">Speedrail</a>. And how will the engineering projects be delivered? The new authority must learn from the project management <a href="https://www.infrastructure.gov.au/department/media/news/independent-review-inland-rail-released">problems in delivering the Inland Rail</a> freight line. The project is running late and costs have blown out. Some major federally funded government projects have worked well. These include upgrades of the national highway system (by state road authorities and contractors) and the new <a href="https://www.westernsydneyairport.gov.au/">Western Sydney International Airport</a>, which is nearing completion. <h2>And what about a full Sydney–Melbourne line?</h2> The big question is when work will start on a Sydney–Melbourne high-speed rail service. In 2019, International High-Speed Rail Association chairman <a href="https://ara.net.au/media-release/ausrailplus-2019-conference-exhibition-3-5-december-2019-in-sydney/">Masafumi Shukuri estimated</a> building this line could take 20 years. The present line is 60km longer than it should be as the route dates back to the steam age. It also has far too many tight curves. This means train travel on this line is slower than cars and trucks. As former NSW State Rail chief Len Harper <a href="https://theconversation.com/more-than-ever-its-time-to-upgrade-the-sydney-melbourne-railway-187169">said</a> in 1995, this railway was already “inadequate for current and future needs” even back then. When the VFT was proposed in 1984, questions were raised as to whether our population was big enough for such a project. Now, more than 15.5 million people live in NSW, Victoria and the Australian Capital Territory. Melbourne–Sydney is the <a href="https://www.smh.com.au/traveller/travel-news/the-world-s-busiest-flight-routes-and-airports-revealed-20231222-p5et7n.html">world’s fifth-busiest flight route</a>. Advocacy group Fastrack Australia <a href="https://www.fastrackaustralia.net/hsr-implementation-plan">has called</a> for a Sydney–Melbourne track built to high-speed standards and able to carry freight. The estimated travel time is four hours. This group and the <a href="https://www.railfutures.org.au/category/submissions/%20July%202024%20reducing%20emissions%20in%20freight">Rail Futures Institute</a> propose the line be built in stages, with priority given to the section from near Macarthur to Mittagong in NSW. This would reduce the current line’s length by about 18km and allow for better Sydney–Canberra train services. Urgent action is needed to protect the rail corridor from encroaching urban development. <h2>Australia needs to catch up</h2> In June 2023, when the new authority started work, I <a href="https://theconversation.com/can-the-new-high-speed-rail-authority-deliver-after-4-decades-of-costly-studies-206287">observed</a> that Australia must surely hold the world record for studies into high-speed rail with no construction. In stark contrast, this October marks the 60th anniversary of the world’s first dedicated high-speed rail line, the Tokaido Shinkansen in Japan linking Tokyo to Shin-Osaka. The network has since grown in stages to about 3,000km of lines. Today, high-speed rail <a href="https://uic.org/passenger/highspeed/article/high-speed-data-and-atlas">operates in 21 countries</a> over about 60,000km of lines – China has about 40,000km. Indonesia’s high-speed rail service between Jakarta and Bandung started running last year. India and Thailand are in the advanced stages of delivering high-speed rail. It’s also under construction in another 11 countries. Australia could finally join them in the next few years if it starts building the Sydney–Newcastle line.<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/238232/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/philip-laird-3503">Philip Laird</a>, Honorary Principal Fellow, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</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/high-speed-rail-plans-may-finally-end-australias-40-year-wait-to-get-on-board-238232">original article</a>. </div>

Domestic Travel

Lollipop man slapped with ban over "innocent" gesture

A beloved lollipop man in Victoria has been banned from high-fiving children after receiving a complaint from a concerned parent. John Goulden is a much-loved elderly lollipop man at the Mount Dandenong Primary School in Greater Melbourne, and will no longer be able to high five kids as they leave and enter the school grounds. Goulden, who was recently crowned one of Victoria’s top crossing supervisors, was reprimanded by Yarra Ranges Council who warned him against “initiating unnecessary physical contact” with the children. Outraged parents in the community have rallied behind the cherished lollipop man, with one parent, Rohan Bradley, even starting a petition to have the ban removed, saying that Mr Goulden has an “infectious joy that leaves a lasting impression on students and parents”. “His high fives in the morning and afternoon have become a tradition that many children look forward to, a small gesture that symbolises the warmth and friendliness of our unique community,” he said. “Sadly, this tradition is under threat. With our children’s happiness and wellbeing hanging in the balance, we need to take action.” Mr Bradley said it was not just about a simple high five but about “preserving our unique community’s spirit”. “We implore those in charge to let John continue to high-five his students, preserving an act that sparks joy and promotes a more positive learning environment,” he said. The petition has already gained more than 500 signatures as parents and students stand with the “community’s morale booster”. In a statement, Yarra Ranges Council confirmed they had received a complaint from a parent at the school about the crossing supervisor dishing out high fives. “Council’s internal policies and the Victorian Standards clearly states that unacceptable behaviours includes: Exhibiting behaviours with children and young people which may be construed as unnecessarily physical,” they told 9News. “Council has reminded the contractor who is currently supervising children at the Mount Dandenong Primary School of expectations of the role regarding interactions with children.” Image credits: Facebook

Legal

Food and exercise can treat depression as well as a psychologist, our study found. And it’s cheaper

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/adrienne-oneil-268324">Adrienne O'Neil</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> and <a href="https://theconversation.com/profiles/sophie-mahoney-1557294">Sophie Mahoney</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> Around <a href="https://www.aihw.gov.au/getmedia/6b19e493-0ebe-420f-a9a3-e48b26aace9f/aihw-aus-249-ib.pdf?v=20240628145747&inline=true">3.2 million</a> Australians live with depression. At the same time, <a href="https://www.aihw.gov.au/getmedia/6b19e493-0ebe-420f-a9a3-e48b26aace9f/aihw-aus-249-ib.pdf?v=20240628145747&inline=true">few</a> Australians meet recommended dietary or physical activity guidelines. What has one got to do with the other? Our world-first trial, <a href="https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065%2824%2900136-6/fulltext">published this week</a>, shows improving diet and doing more physical activity can be as effective as therapy with a psychologist for treating low-grade depression. Previous studies (including <a href="https://link.springer.com/article/10.1186/s12916-017-0791-y">our own</a>) have found “lifestyle” therapies are effective for depression. But they have never been directly compared with psychological therapies – until now. Amid a nation-wide <a href="https://www.health.gov.au/sites/default/files/2023-10/national-mental-health-workforce-strategy-2022-2032.pdf">shortage</a> of mental health professionals, our research points to a potential solution. As we found lifestyle counselling was as effective as psychological therapy, our findings suggest dietitians and exercise physiologists may one day play a role in managing depression. <h2>What did our study measure?</h2> During the prolonged COVID lockdowns, Victorians’ distress levels were <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.50831">high and widespread</a>. Face-to-face mental health services were limited. Our trial targeted people living in Victoria with elevated distress, meaning at least mild depression but not necessarily a diagnosed mental disorder. Typical symptoms included feeling down, hopeless, irritable or tearful. We partnered with our <a href="https://www.barwonhealth.org.au/mhdas/">local mental health service</a> to recruit 182 adults and provided group-based sessions on Zoom. All participants took part in up to six sessions over eight weeks, facilitated by health professionals. Half were randomly assigned to participate in a program co-facilitated by an accredited practising dietitian and an exercise physiologist. That group – called the lifestyle program – developed nutrition and movement goals: <ul> <li>eating a wide variety of foods</li> <li>choosing high-fibre plant foods</li> <li>including high quality fats</li> <li>limiting discretionary foods, such as those high in saturated fats and added sugars</li> <li>doing enjoyable physical activity.</li> </ul> The second group took part in psychotherapy sessions convened by two psychologists. The psychotherapy program used cognitive behavioural therapy (CBT), the gold standard for treating depression in <a href="https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2730724">groups and when delivered remotely</a>. In both groups, participants could continue existing treatments (such as taking antidepressant medication). We gave both groups <a href="https://link.springer.com/article/10.1186/s12888-022-03840-3">workbooks and hampers</a>. The lifestyle group received a food hamper, while the psychotherapy group received items such as a colouring book, stress ball and head massager. <h2>Lifestyle therapies just as effective</h2> We found similar results in each program. At the trial’s beginning we gave each participant a score based on their self-reported mental health. We measured them again at the end of the program. Over eight weeks, those scores showed symptoms of depression reduced for participants in the lifestyle program (42%) and the psychotherapy program (37%). That difference was not statistically or clinically meaningful so we could conclude both treatments were as good as each other. There were some differences between groups. People in the lifestyle program improved their diet, while those in the psychotherapy program felt they had increased their social support – meaning how connected they felt to other people – compared to at the start of the treatment. Participants in both programs increased their physical activity. While this was expected for those in the lifestyle program, it was less expected for those in the psychotherapy program. It may be because they knew they were enrolled in a research study about lifestyle and subconsciously changed their activity patterns, or it could be a positive by-product of doing psychotherapy. There was also not much difference in cost. The lifestyle program was slightly cheaper to deliver: A$482 per participant, versus $503 for psychotherapy. That’s because hourly rates differ between dietitians and exercise physiologists, and psychologists. <h2>What does this mean for mental health workforce shortages?</h2> Demand for mental health services is increasing in Australia, while at the same time the workforce <a href="https://www.health.gov.au/sites/default/files/2023-10/national-mental-health-workforce-strategy-2022-2032.pdf">faces worsening nation-wide shortages</a>. Psychologists, who provide <a href="https://www.aihw.gov.au/getmedia/6b19e493-0ebe-420f-a9a3-e48b26aace9f/aihw-aus-249-ib.pdf?v=20240628145747&inline=true">about half</a> of all mental health services, can have long wait times. Our results suggest that, with the appropriate training and guidelines, allied health professionals who specialise in diet and exercise could help address this gap. Lifestyle therapies can be combined with psychology sessions for multi-disciplinary care. But diet and exercise therapies could prove particularly effective for those on waitlists to see a psychologists, who may be receiving no other professional support while they wait. Many dietitians and exercise physiologists already have advanced skills and expertise in motivating behaviour change. Most accredited practising dietitians are trained in managing <a href="https://link.springer.com/content/pdf/10.1007/978-3-030-67929-3_38-1.pdf">eating disorders</a> or <a href="https://www.nature.com/articles/s41572-020-0200-2">gastrointestinal conditions</a>, which commonly overlap with depression. There is also a cost argument. It is <a href="https://journals.sagepub.com/doi/full/10.1177/1355819616668202">overall cheaper</a> to train a dietitian ($153,039) than a psychologist ($189,063) – and it takes less time. <h2>Potential barriers</h2> Australians with chronic conditions (such as diabetes) can access subsidised dietitian and exercise physiologist appointments under various Medicare treatment plans. Those with eating disorders can also access subsidised dietitian appointments. But mental health care plans for people with depression do not support subsidised sessions with dietitians or exercise physiologists, despite <a href="https://dietitiansaustralia.org.au/sites/default/files/2024-04/Dietitians%20Australia%20Mental%20Health%20Evidence%20Brief%202024.pdf">peak bodies</a> urging them to do so. Increased training, upskilling and Medicare subsidies would be needed to support dietitians and exercise physiologists to be involved in treating mental health issues. <a href="https://foodandmoodcentre.com.au/academy">Our training</a> and clinical <a href="https://www.tandfonline.com/doi/full/10.1080/15622975.2022.2112074">guidelines</a> are intended to help clinicians practising lifestyle-based mental health care within their scope of practice (activities a health care provider can undertake). <h2>Future directions</h2> Our trial took place during COVID lockdowns and examined people with at least mild symptoms of depression who did not necessarily have a mental disorder. We are seeking to replicate these findings and are now running <a href="https://foodandmoodcentre.com.au/projects/the-harmone-trial/">a study</a> open to Australians with mental health conditions such as major depression or bipolar disorder. If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.<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/235952/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/adrienne-oneil-268324">Adrienne O'Neil</a>, Professor, Food & Mood Centre, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> and <a href="https://theconversation.com/profiles/sophie-mahoney-1557294">Sophie Mahoney</a>, Associate Research Fellow, Food and Mood Centre, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/food-and-exercise-can-treat-depression-as-well-as-a-psychologist-our-study-found-and-its-cheaper-235952">original article</a>. </div>

Mind

"Fly high, Bette!": World's longest-serving flight attendant dies aged 88

Bette Nash, the world's longest-serving flight attendant has passed away aged 88, after a short battle with breast cancer. American Airlines, where Nash devoted almost seven decades of her life, announced her death on social media on Saturday. "We mourn the passing of Bette Nash, who spent nearly seven decades warmly caring for our customers in the air," they began their post. “Bette was a legend at American and throughout the industry, inspiring generations of flight attendants. “Fly high, Bette. We’ll miss you.” A spokesperson for the airlines confirmed that she was still an active employee at the time of her death. Nash, who was born on December 31, 1935, began her flight-attendant career with Eastern Airlines in 1957, at just 21-years-old. In January 2022, she was officially recognised as the world’s longest-serving flight attendant by Guinness World Records, after surpassing the previous record a year earlier. She continued to hold the title until her passing. Tributes have poured in from people all over the world on social media, with many praising her for her unwavering dedication and kindness. "Fly high Bette! It was a pleasure being your passenger," wrote one person on X, alongside a selfie he took with her. <blockquote class="twitter-tweet"> Fly high Bette! It was a pleasure being your passenger. <a href="https://t.co/9N63YPB5Ia">pic.twitter.com/9N63YPB5Ia</a> — Jon Kruse (@JonKruseYacht) <a href="https://twitter.com/JonKruseYacht/status/1794459429997273423?ref_src=twsrc%5Etfw">May 25, 2024</a></blockquote> "She was flying as a passenger when she sat next to me, pinned her jacket to the bulkhead, gave me a three minute story of her life then said 'So what's your story?'. She was a dynamo. Rest easy," another added. "She was an absolute delight in my earliest airline life working the USAir shuttle at LGA. Godspeed and eternal silvered wings Bette!" a third wrote. <blockquote class="twitter-tweet"> She was an absolute delight in my earliest airline life working the USAir shuttle at LGA. Godspeed and eternal silvered wings Bette! — Ryan Spellman (@JustJettingThru) <a href="https://twitter.com/JustJettingThru/status/1794480142766531034?ref_src=twsrc%5Etfw">May 25, 2024</a></blockquote> "Rest in Peace Bette Nash," wrote a fourth. "Bette was a class act. Truly a loss for the skies. She was truly an Angel," added another. Image: CBS/ X

Caring

Stuck in fight-or-flight mode? 5 ways to complete the ‘stress cycle’ and avoid burnout or depression

<div class="theconversation-article-body"> Can you remember a time when you felt stressed leading up to a big life event and then afterwards felt like a weight had been lifted? This process – the ramping up of the stress response and then feeling this settle back down – shows completion of the “stress cycle”. Some stress in daily life is unavoidable. But remaining stressed is unhealthy. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2568977/">Chronic stress</a> increases <a href="https://pubmed.ncbi.nlm.nih.gov/32886587/">chronic health conditions</a>, including heart disease and stroke and diabetes. It can also lead to <a href="https://theconversation.com/were-all-exhausted-but-are-you-experiencing-burnout-heres-what-to-look-out-for-164393">burnout</a> or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5137920/">depression</a>. Exercise, cognitive, creative, social and self-soothing activities help us process stress in healthier ways and complete the stress cycle. <h2>What does the stress cycle look like?</h2> Scientists and researchers refer to the “stress response”, often with a focus on the fight-or-flight reactions. The phrase the “stress cycle” has been made popular by <a href="https://www.penguin.co.uk/articles/2019/03/complete-stress-cycle-emotional-exhaustion-burnout">self-help experts</a> but it does have a scientific basis. The <a href="https://www.ncbi.nlm.nih.gov/books/NBK541120/">stress cycle</a> is our body’s response to a stressful event, whether real or perceived, physical or psychological. It could be being chased by a vicious dog, an upcoming exam or a difficult conversation. The stress cycle has three stages: <ul> <li> stage 1 is perceiving the threat </li> <li> stage 2 is the fight-or-flight response, driven by our stress hormones: adrenaline and cortisol </li> <li> stage 3 is relief, including physiological and psychological relief. This completes the stress cycle. </li> </ul> Different people will respond to stress differently based on their life experiences and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181835/#:%7E:text=The%20major%20findings%20regarding%20the,renin%2Dangiotensin%2Daldosterone%20system%20or">genetics</a>. Unfortunately, many people experience <a href="https://www.weforum.org/agenda/2023/01/polycrisis-global-risks-report-cost-of-living/">multiple and ongoing stressors</a> out of their control, including the cost-of-living crisis, extreme weather events and <a href="https://www.aihw.gov.au/family-domestic-and-sexual-violence/types-of-violence/family-domestic-violence">domestic violence</a>. Remaining in stage 2 (the flight-or-flight response), can lead to chronic stress. <a href="https://theconversation.com/how-chronic-stress-changes-the-brain-and-what-you-can-do-to-reverse-the-damage-133194">Chronic stress</a> and high cortisol can increase <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5476783/">inflammation</a>, which damages our brain and other organs. When you are stuck in chronic fight-or-flight mode, you don’t think clearly and are more easily distracted. Activities that provide temporary pleasure, such as eating junk food or drinking alcohol are <a href="https://onlinelibrary.wiley.com/doi/10.1111/acer.14518">unhelpful strategies</a> that do not reduce the stress effects on our brain and body. Scrolling through social media is also not an effective way to complete the stress cycle. In fact, this is associated with an <a href="https://www.apa.org/monitor/2022/11/strain-media-overload">increased stress response</a>. <h2>Stress and the brain</h2> In the brain, chronic high cortisol can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4561403/">shrink the hippocampus</a>. This can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1557684/#:%7E:text=The%20hippocampal%20formation%20plays%20a,%2C%20memory%2C%20motivation%20and%20emotion.&text=Therefore%2C%20reduced%20hippocampal%20volumes%20should,in%20patients%20with%20major%20depression">impair a person’s memory</a> and their capacity to think and concentrate. Chronic high cortisol also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907136/#:%7E:text=The%20prefrontal%20cortex%20(PFC)%20intelligently,brain%20regions%20(BOX%201).">reduces activity</a> in the prefrontal cortex but <a href="https://www.sciencedirect.com/science/article/pii/S2352289514000101">increases activity</a> in the amygdala. The prefrontal cortex is responsible for higher-order control of our thoughts, behaviours and emotions, and is <a href="https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2014.00761/full">goal-directed</a> and rational. The amygdala is involved in reflexive and emotional responses. Higher amygdala activity and lower prefrontal cortex activity explains why we are less rational and more emotional and reactive when we are stressed. There are five <a href="https://www.penguin.co.uk/articles/2019/03/complete-stress-cycle-emotional-exhaustion-burnout">types of activities</a> that can help our brains complete the stress cycle. <figure><iframe src="https://www.youtube.com/embed/eD1wliuHxHI?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>It can help to understand how the brain encounters stress.</figcaption></figure> <h2>1. Exercise – its own complete stress cycle</h2> When we exercise we get a short-term spike in cortisol, followed by a <a href="https://www.health.harvard.edu/staying-healthy/exercising-to-relax">healthy reduction</a> in cortisol and adrenaline. Exercise also <a href="https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/exercise-and-stress/art-20044469#:%7E:text=Exercise%20in%20almost%20any%20form,distract%20you%20from%20daily%20worries.&text=You%20know%20that%20exercise%20does,fit%20it%20into%20your%20routine.">increases endorphins and serotonin</a>, which improve mood. Endorphins cause an elated feeling often called “runner’s high” and have <a href="https://pubmed.ncbi.nlm.nih.gov/33396962/">anti-inflammatory effects</a>. When you exercise, there is more blood flow to the brain and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6721405/">higher activity</a> in the prefrontal cortex. This is why you can often think more clearly after a walk or run. Exercise can be a helpful way to <a href="https://www.healthline.com/health/heart-disease/exercise-stress-relief">relieve feelings of stress</a>. Exercise can also increase the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041121/">volume</a> of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4915811/">hippocampus</a>. This is linked to better short-term and long-term memory processing, as well as reduced stress, depression and anxiety. <h2>2. Cognitive activities – reduce negative thinking</h2> Overly negative thinking can trigger or extend the stress response. In our 2019 research, we found the relationship between stress and cortisol was <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6987429/">stronger in people with more negative thinking</a>. Higher amygdala activity and less rational thinking when you are stressed can lead to <a href="https://pubmed.ncbi.nlm.nih.gov/18628348/">distorted thinking</a> such as focusing on negatives and rigid “black-and-white” thinking. Activities to reduce negative thinking and promote a more realistic view can reduce the stress response. In clinical settings this is usually called <a href="https://www.healthdirect.gov.au/cognitive-behaviour-therapy-cbt">cognitive behaviour therapy</a>. At home, this could be journalling or writing down worries. This engages the logical and rational parts of our brain and helps us think more realistically. Finding evidence to challenge negative thoughts (“I’ve prepared well for the exam, so I can do my best”) can help to complete the stress cycle. <h2>3. Getting creative – a pathway out of ‘flight or fight’</h2> Creative activities can be art, craft, gardening, cooking or <a href="https://heartmindonline.org/resources/10-exercises-for-your-prefrontal-cortex">other activities</a> such as doing a puzzle, juggling, music, theatre, dancing or simply being absorbed in enjoyable work. Such pursuits increase <a href="https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2014.00761/full">prefrontal cortex activity</a> and promote flow and focus. Flow is a <a href="https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2021.645498/full">state of full engagement</a> in an activity you enjoy. It lowers high-stress levels of noradrenaline, the brain’s adrenaline. When you are focussed like this, the brain only processes information relevant to the task and ignores non-relevant information, including stresses. <h2>4. Getting social and releasing feel-good hormones</h2> Talking with someone else, physical affection with a person or pet and laughing can all <a href="https://theconversation.com/what-happens-in-our-brain-and-body-when-were-in-love-198885">increase oxytocin</a>. This is a chemical messenger in the brain that increases social bonding and makes us feel connected and safe. Laughing is also a social activity that <a href="https://neurosciencenews.com/laughter-physical-mental-psychology-17339/">activates parts</a> of the limbic system – the part of the brain involved in emotional and behavioural responses. This increases <a href="https://www.jneurosci.org/content/37/36/8581">endorphins</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/27439375/">serotonin</a> and improves our mood. <h2>5. Self-soothing</h2> Breathing <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6189422/">exercises</a> and meditation stimulate the parasympathetic nervous system (which calms down our stress responses so we can “reset”) via the <a href="https://theconversation.com/our-vagus-nerves-help-us-rest-digest-and-restore-can-you-really-reset-them-to-feel-better-210469">vagus nerves</a>, and <a href="https://www.tandfonline.com/doi/full/10.1080/17437199.2020.1760727">reduce cortisol</a>. A good <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4035568/#:%7E:text=We%20conclude%20that%2C%20in%20addition,self%2Dsoothing%20effects%20of%20crying.">cry can help too</a> by releasing stress energy and increasing oxytocin and endorphins. <a href="https://www.medicalnewstoday.com/articles/319631#:%7E:text=Possible%20benefits%20of%20crying%20include,of%201.9%20times%20a%20month.">Emotional tears</a> also remove cortisol and the hormone prolactin from the body. Our prior research showed <a href="https://pubmed.ncbi.nlm.nih.gov/29096223/">cortisol</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9216608/">prolactin</a> were associated with depression, anxiety and hostility.<a href="https://theconversation.com/profiles/theresa-larkin-952095">Theresa Larkin</a>, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a> and <a href="https://theconversation.com/profiles/susan-j-thomas-1293985">Susan J. Thomas</a>, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a> <h2>Action beats distraction</h2> Whether it’s watching a funny or sad movie, exercising, journalling, gardening or doing a puzzle, there is science behind why you should complete the stress cycle. Doing at least one positive activity every day can also reduce our baseline stress level and is beneficial for good mental health and wellbeing. Importantly, chronic stress and <a href="https://theconversation.com/are-you-burnt-out-at-work-ask-yourself-these-4-questions-118128">burnout</a> can also indicate the need for change, <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/wps.20311">such as in our workplaces</a>. However, not all stressful circumstances can be easily changed. Remember help is always available. If you have concerns about your stress or health, please talk to a doctor. If this article has raised issues for you, or if you’re concerned about someone you know, call <a href="https://www.lifeline.org.au/">Lifeline</a> on 13 11 14 or <a href="https://kidshelpline.com.au/">Kids Helpline</a> on 1800 55 1800.<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/218599/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/theresa-larkin-952095">Theresa Larkin</a>, Associate professor of Medical Sciences, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a> and <a href="https://theconversation.com/profiles/susan-j-thomas-1293985">Susan J. Thomas</a>, Associate professor in Mental Health and Behavioural Science, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/stuck-in-fight-or-flight-mode-5-ways-to-complete-the-stress-cycle-and-avoid-burnout-or-depression-218599">original article</a>. </div>

Mind

"Fly high sweet Nacho": Robert Irwin shares sad loss of beloved pet

In a world often dominated by headlines of turmoil and strife, there's something oddly comforting about the internet rallying around the loss of a beloved pet chicken. Yes, you heard that right – a chicken named Nacho has captured the hearts of thousands, and her departure from this world has left a void in the Irwin family and beyond. Robert Irwin, the perpetually enthusiastic conservationist and wildlife warrior, took to Instagram to break the news of Nacho's sad passing. In a heartfelt video message, he shared the sorrowful tidings with his followers, who had grown fond of the feathery friend through their virtual interactions. “Hi guys, very sad news to report. Unfortunately, our gorgeous little chicken Nacho, who I know you all fell in love with, and we love so much, sadly passed away,” Robert lamented, his voice tinged with genuine sadness. “She was a beautiful old chook who lived a lot of great years and we’re really, really, really, really sad to lose her.” And oh, what a life Nacho must have lived! Robert reminisced about her golden years, filled with clucking adventures and pecking escapades. But, amid the sorrow, there shone a glimmer of hope as Robert introduced two new feathered friends into the Irwin fold – Waffles and Mochi. With names as delightful as their predecessor's, these plucky newcomers are sure to fill the coop with joy once more. In the world of social media condolences, the outpouring of love and support was nothing short of heartwarming. Messages of sympathy flooded Robert's feed, with followers expressing their condolences for the loss of Nacho while warmly welcoming Waffles and Mochi into the fold. "Fly high, sweet Nacho," one commenter bid farewell, echoing the sentiments of many who had come to adore the quirky chicken. There were also words of encouragement and delight for the newest additions to the Irwin menagerie. "Waffles and Mochi are adorable, and I also love their fluffy feet!" exclaimed one enthusiastic follower, proving that even in times of loss, there's always room for a little bit of joy. <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/reel/C4YEoIOill7/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/reel/C4YEoIOill7/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Robert Irwin (@robertirwinphotography)</a> </div> </blockquote> This isn't the first time the Irwins have shared their grief over the loss of a beloved animal companion. Just a couple of years ago, they bid farewell to their cherished echidna, marking the passing of a creature who had been a part of their family for an impressive 38 years. In a world where bad news often seems to dominate the headlines, the simple story of a chicken named Nacho reminds us of the power of love and connection – even in the most unexpected of places. So here's to you, Nacho; may your wings carry you to chicken heaven, where the sun always shines, and the corn is always plentiful. Images: Instagram

Family & Pets

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

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

Travel Trouble

The secret sauce of Coles’ and Woolworths’ profits: high-tech surveillance and control

<a href="https://theconversation.com/profiles/lauren-kate-kelly-1262424">Lauren Kate Kelly</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a> Coles and Woolworths, the supermarket chains that together control <a href="https://www.abc.net.au/news/2024-02-20/woolworths-coles-supermarket-tactics-grocery-four-corners/103405054">almost two-thirds</a> of the Australian grocery market, are facing unprecedented scrutiny. One recent inquiry, commissioned by the Australian Council of Trade Unions and led by former Australian Consumer and Competition Commission chair Allan Fels, found the pair engaged in unfair pricing practices; an ongoing <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Supermarket_Prices/SupermarketPrices">Senate inquiry into food prices</a> is looking at how these practices are linked to inflation; and the ACCC has just begun <a href="https://www.accc.gov.au/inquiries-and-consultations/supermarkets-inquiry-2024-25">a government-directed inquiry</a> into potentially anti-competitive behaviour in Australia’s supermarkets. Earlier this week, the two companies also came under the gaze of the <a href="https://www.abc.net.au/news/2024-02-19/super-power-the-cost-of-living-with-coles-and-woolworths/103486508">ABC current affairs program Four Corners</a>. Their respective chief executives each gave somewhat prickly interviews, and Woolworths chief Brad Banducci <a href="https://www.abc.net.au/news/2024-02-21/woolworths-ceo-brad-banducci-retirement-four-corners/103493418">announced his retirement</a> two days after the program aired. A focus on the power of the supermarket duopoly is long overdue. However, one aspect of how Coles and Woolworths exercise their power has received relatively little attention: a growing high-tech infrastructure of surveillance and control that pervades retail stores, warehouses, delivery systems and beyond. <h2>Every customer a potential thief</h2> As the largest private-sector employers and providers of essential household goods, the supermarkets play an outsized role in public life. Indeed, they are such familiar places that technological developments there may fly under the radar of public attention. Coles and Woolworths are both implementing technologies that treat the supermarket as a “problem space” in which workers are controlled, customers are tracked and profits boosted. For example, in response to a purported spike in shoplifting, a raft of customer surveillance measures have been introduced that treat every customer as a potential thief. This includes <a href="https://www.news.com.au/lifestyle/food/eat/coles-introducing-new-technology-which-will-track-shoppers-every-move/news-story/86ea8d330f76df87f2235eeda4d1136e">ceiling cameras</a> which assign a digital ID to individuals and track them through the store, and <a href="https://www.thenewdaily.com.au/finance/consumer/2023/08/16/smart-gate-technology">“smart” exit gates</a> that remain closed until a purchase is made. Some customers have reported being “<a href="https://7news.com.au/lifestyle/coles-supermarketshoppers-dramatic-checkout-experience-goes-viral-i-was-trapped-c-12977760">trapped</a>” by the gate despite paying for their items, causing significant embarrassment. At least one Woolworths store has <a href="https://www.news.com.au/finance/business/woolies-in-wetherill-park-fitted-with-500-tiny-cameras-to-monitor-stock-levels/news-story/585de8c741ae9f520adcc4005f2a736a">installed 500 mini cameras</a> on product shelves. The cameras monitor real-time stock levels, and Woolworths says customers captured in photos will be silhouetted for privacy. A Woolworths spokesperson <a href="https://www.smh.com.au/national/nsw/up-to-70-cameras-watch-you-buy-groceries-what-happens-to-that-footage-20230819-p5dxtp.html">explained</a> the shelf cameras were part of “a number of initiatives, both covert and overt, to minimise instances of retail crime”. It is unclear whether the cameras are for inventory management, surveillance, or both. Workers themselves are being fitted with body-worn cameras and wearable alarms. Such measures may protect against customer aggression, which is a <a href="https://www.abc.net.au/news/2023-11-22/retail-union-staff-abuse-cost-of-living-christmas/103117014">serious problem facing workers</a>. Biometric data collected this way could also be used to discipline staff in what scholars Karen Levy and Solon Barocas refer to as “<a href="https://ijoc.org/index.php/ijoc/article/view/7041">refractive surveillance</a>” – a process whereby surveillance measures intended for one group can also impact another. <h2>Predicting crime</h2> At the same time as the supermarkets ramp up the amount of data they collect on staff and shoppers, they are also investing in data-driven “crime intelligence” software. Both supermarkets have <a href="https://www.smartcompany.com.au/industries/information-technology/grocery-chains-surveillance-tech-auror/">partnered with New Zealand start-up Auror</a>, which shares a name with the magic police from the Harry Potter books and claims it can predict crime before it happens. Coles also recently began a partnership with Palantir, a global data-driven surveillance company that takes its name from magical crystal balls in The Lord of the Rings. These heavy-handed measures seek to make self-service checkouts more secure without increasing staff numbers. This leads to something of a vicious cycle, as under-staffing, self-checkouts, and high prices are often <a href="https://www.aap.com.au/news/retail-workers-facing-increased-violence-and-abuse/">causes of customer aggression</a> to begin with. Many staff are similarly frustrated by <a href="https://www.theguardian.com/business/2023/jun/05/coles-woolworths-court-accused-of-underpaying-workers">historical wage theft by the supermarkets</a> that totals hundreds of millions of dollars. <h2>From community employment to gig work</h2> Both supermarkets have brought the gig economy squarely <a href="https://theconversation.com/coles-uber-eats-deal-brings-the-gig-economy-inside-the-traditional-workplace-204353">inside the traditional workplace</a>. Uber and Doordash drivers are now part of the infrastructure of home delivery, in an attempt to push last-mile delivery costs onto gig workers. The precarious working conditions of the gig economy are well known. Customers may not be aware, however, that Coles recently increased Uber Eats and Doordash prices by at least 10%, and will <a href="https://7news.com.au/lifestyle/shoppers-slam-coles-over-major-change-to-half-price-buys-that-will-affect-millions-c-12860556">no longer match in-store promotions</a>. Drivers have been instructed to dispose of the shopping receipt and should no longer place it in the customer’s bag at drop-off. In addition to higher prices, customers also pay service and delivery fees for the convenience of on-demand delivery. Despite the price increases to customers, drivers I have interviewed in my ongoing research report they are earning less and less through the apps, often well below Australia’s minimum wage. Viewed as a whole, Coles’ and Woolworths’ high-tech measures paint a picture of surveillance and control that exerts pressures on both customers and workers. While issues of market competition, price gouging, and power asymmetries with suppliers must be scrutinised, issues of worker and customer surveillance are the other side of the same coin – and they too must be reckoned 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/224076/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/lauren-kate-kelly-1262424">Lauren Kate Kelly</a>, PhD Candidate, ARC Centre of Excellence for Automated Decision-Making and Society, <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/the-secret-sauce-of-coles-and-woolworths-profits-high-tech-surveillance-and-control-224076">original article</a>.

Money & Banking

Running or yoga can help beat depression, research shows – even if exercise is the last thing you feel like

<a href="https://theconversation.com/profiles/michael-noetel-147460">Michael Noetel</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> At least <a href="https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.665019/full">one in ten people</a> have depression at some point in their lives, with some estimates <a href="https://www.sciencedirect.com/science/article/pii/S0749379720301793">closer to one in four</a>. It’s one of the worst things for someone’s wellbeing – worse than <a href="https://www.happinessresearchinstitute.com/_files/ugd/928487_4a99b6e23f014f85b38495b7ab1ac24b.pdf">debt, divorce or diabetes</a>. <a href="https://theconversation.com/why-are-so-many-australians-taking-antidepressants-221857">One in seven</a> Australians take antidepressants. Psychologists are in <a href="https://theconversation.com/we-cant-solve-australias-mental-health-emergency-if-we-dont-train-enough-psychologists-here-are-5-fixes-190135">high demand</a>. Still, only <a href="http://dx.doi.org/10.1371/journal.pmed.1003901">half</a> of people with depression in high-income countries get treatment. Our <a href="https://www.bmj.com/content/384/bmj-2023-075847">new research</a> shows that exercise should be considered alongside therapy and antidepressants. It can be just as impactful in treating depression as therapy, but it matters what type of exercise you do and how you do it. <h2>Walk, run, lift, or dance away depression</h2> We found 218 randomised trials on exercise for depression, with 14,170 participants. We analysed them using a method called a network meta-analysis. This allowed us to see how different types of exercise compared, instead of lumping all types together. We found walking, running, strength training, yoga and mixed aerobic exercise were about as effective as <a href="https://theconversation.com/explainer-what-is-cognitive-behaviour-therapy-37351">cognitive behaviour therapy</a> – one of the <a href="https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2018.00004/full">gold-standard treatments</a> for depression. The effects of dancing were also powerful. However, this came from analysing just five studies, mostly involving young women. Other exercise types had more evidence to back them. Walking, running, strength training, yoga and mixed aerobic exercise seemed more effective than antidepressant medication alone, and were about as effective as exercise alongside antidepressants. But of these exercises, people were most likely to stick with strength training and yoga. <iframe id="cZaWb" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/cZaWb/2/" width="100%" height="400px" frameborder="0"></iframe> Antidepressants certainly help <a href="https://www.thelancet.com/article/S0140-6736(17)32802-7/fulltext">some people</a>. And of course, anyone getting treatment for depression should talk to their doctor <a href="https://australia.cochrane.org/news/new-cochrane-review-explores-latest-evidence-approaches-stopping-long-term-antidepressants">before changing</a> what they are doing. Still, our evidence shows that if you have depression, you should get a psychologist and an exercise plan, whether or not you’re taking antidepressants. <h2>Join a program and go hard (with support)</h2> Before we analysed the data, we thought people with depression might need to “ease into it” with generic advice, <a href="https://www.who.int/initiatives/behealthy/physical-activity">such as</a> “some physical activity is better than doing none.” But we found it was far better to have a clear program that aimed to push you, at least a little. Programs with clear structure worked better, compared with those that gave people lots of freedom. Exercising by yourself might also make it hard to set the bar at the right level, given low self-esteem is a symptom of depression. We also found it didn’t matter how much people exercised, in terms of sessions or minutes a week. It also didn’t really matter how long the exercise program lasted. What mattered was the intensity of the exercise: the higher the intensity, the better the results. <h2>Yes, it’s hard to keep motivated</h2> We should exercise caution in interpreting the findings. Unlike drug trials, participants in exercise trials know which “treatment” they’ve been randomised to receive, so this may skew the results. Many people with depression have physical, psychological or social barriers to participating in formal exercise programs. And getting support to exercise isn’t free. We also still don’t know the best way to stay motivated to exercise, which can be even harder if you have depression. Our study tried to find out whether things like setting exercise goals helped, but we couldn’t get a clear result. Other reviews found it’s important to have a <a href="https://pubmed.ncbi.nlm.nih.gov/31923898/">clear action plan</a> (for example, putting exercise in your calendar) and to <a href="https://pubmed.ncbi.nlm.nih.gov/19916637/">track your progress</a> (for example, using an app or smartwatch). But predicting which of these interventions work is notoriously difficult. A <a href="https://www.nature.com/articles/s41586-021-04128-4">2021 mega-study</a> of more than 60,000 gym-goers <a href="https://www.nature.com/articles/s41586-021-04128-4/figures/1">found</a> experts struggled to predict which strategies might get people into the gym more often. Even making workouts fun didn’t seem to motivate people. However, listening to audiobooks while exercising helped a lot, which no experts predicted. Still, we can be confident that people benefit from personalised support and accountability. The support helps overcome the hurdles they’re sure to hit. The accountability keeps people going even when their brains are telling them to avoid it. So, when starting out, it seems wise to avoid going it alone. Instead: <ul> <li> join a fitness group or yoga studio </li> <li> get a trainer or an exercise physiologist </li> <li> ask a friend or family member to go for a walk with you. </li> </ul> Taking a few steps towards getting that support makes it more likely you’ll keep exercising. <h2>Let’s make this official</h2> Some countries see exercise as a backup plan for treating depression. For example, the American Psychological Association only <a href="https://www.apa.org/depression-guideline/">conditionally recommends</a> exercise as a “complementary and alternative treatment” when “psychotherapy or pharmacotherapy is either ineffective or unacceptable”. Based on our research, this recommendation is withholding a potent treatment from many people who need it. In contrast, The Royal Australian and New Zealand College of Psychiatrists <a href="https://www.ranzcp.org/getmedia/a4678cf4-91f5-4746-99d4-03dc7379ae51/mood-disorders-clinical-practice-guideline-2020.pdf">recommends</a> vigorous aerobic activity at least two to three times a week for all people with depression. Given how common depression is, and the number failing to receive care, other countries should follow suit and recommend exercise alongside front-line treatments for depression. I would like to acknowledge my colleagues Taren Sanders, Chris Lonsdale and the rest of the coauthors of the paper on which this article is based. If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.<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/223441/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/michael-noetel-147460">Michael Noetel</a>, Senior Lecturer in Psychology, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/running-or-yoga-can-help-beat-depression-research-shows-even-if-exercise-is-the-last-thing-you-feel-like-223441">original article</a>.

Body

Why prices are so high – 8 ways retail pricing algorithms gouge consumers

<a href="https://theconversation.com/profiles/david-tuffley-13731">David Tuffley</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> The just-released report of the inquiry into <a href="https://pricegouginginquiry.actu.org.au/">price gouging and unfair pricing</a> conducted by Allan Fels for the Australian Council of Trades Unions does more than identify the likely offenders. It finds the biggest are supermarkets, banks, airlines and electricity companies. It’s not enough to know their tricks. Fels wants to give the Australian Competition and Consumer Commission more power to investigate and more power to prohibit mergers. But it helps to know how they try to trick us, and how technology has enabled them to get better at it. After reading the report, I’ve identified eight key maneuvers. <h2>1. Asymmetric price movements</h2> Otherwise known as <a href="https://www.jstor.org/stable/25593733">Rocket and Feather</a>, this is where businesses push up prices quickly when costs rise, but cut them slowly or late after costs fall. It seems to happen for <a href="https://www.sciencedirect.com/science/article/abs/pii/S0140988323002074">petrol</a> and <a href="https://www.sciencedirect.com/science/article/abs/pii/S105905601730240X">mortgage rates</a>, and the Fels inquiry was presented with evidence suggesting it happens in supermarkets. Brendan O’Keeffe from NSW Farmers told the inquiry wholesale lamb prices had been falling for six months before six Woolworths announced a cut in the prices of lamb it was selling as a “<a href="https://pricegouginginquiry.actu.org.au/wp-content/uploads/2024/02/InquiryIntoPriceGouging_Report_web.pdf">Christmas gift</a>”. <h2>2. Punishment for loyal customers</h2> A <a href="https://theconversation.com/simple-fixes-could-help-save-australian-consumers-from-up-to-3-6-billion-in-loyalty-taxes-119978">loyalty tax</a> is what happens when a business imposes higher charges on customers who have been with it for a long time, on the assumption that they won’t move. The Australian Securities and Investments Commission has alleged a big <a href="https://theconversation.com/how-qantas-might-have-done-all-australians-a-favour-by-making-refunds-so-hard-to-get-213346">insurer</a> does it, setting premiums not only on the basis of risk, but also on the basis of what a computer model tells them about the likelihood of each customer tolerating a price hike. The insurer disputes the claim. It’s often done by offering discounts or new products to new customers and leaving existing customers on old or discontinued products. It happens a lot in the <a href="https://www.finder.com.au/utilities-loyalty-costing-australians-billions-2024">electricity industry</a>. The plans look good at first, and then less good as providers bank on customers not making the effort to shop around. Loyalty taxes appear to be less common among mobile phone providers. Australian laws make it easy to switch <a href="https://www.reviews.org/au/mobile/how-to-switch-mobile-carriers-and-keep-your-number/">and keep your number</a>. <h2>3. Loyalty schemes that provide little value</h2> Fels says loyalty schemes can be a “low-cost means of retaining and exploiting consumers by providing them with low-value rewards of dubious benefit”. Their purpose is to lock in (or at least bias) customers to choices already made. Examples include airline frequent flyer points, cafe cards that give you your tenth coffee free, and supermarket points programs. The purpose is to lock in (or at least bias) consumers to products already chosen. The <a href="https://www.accc.gov.au/consumers/advertising-and-promotions/customer-loyalty-schemes">Australian Competition and Consumer Commission</a> has found many require users to spend a lot of money or time to earn enough points for a reward. Others allow points to expire or rules to change without notice or offer rewards that are not worth the effort to redeem. They also enable businesses to collect data on spending habits, preferences, locations, and personal information that can be used to construct customer profiles that allow them to target advertising and offers and high prices to some customers and not others. <h2>4. Drip pricing that hides true costs</h2> The Competition and Consumer Commission describes <a href="https://pricegouginginquiry.actu.org.au/wp-content/uploads/2024/02/InquiryIntoPriceGouging_Report_web.pdf">drip pricing</a> as “when a price is advertised at the beginning of an online purchase, but then extra fees and charges (such as booking and service fees) are gradually added during the purchase process”. The extras can add up quickly and make final bills much higher than expected. Airlines are among the best-known users of the strategy. They often offer initially attractive base fares, but then add charges for baggage, seat selection, in-flight meals and other extras. <h2>5. Confusion pricing</h2> Related to drip pricing is <a href="https://www.x-mol.net/paper/article/1402386414932836352">confusion pricing</a> where a provider offers a range of plans, discounts and fees so complex they are overwhelming. Financial products like insurance have convoluted fee structures, as do electricity providers. Supermarkets do it by bombarding shoppers with “specials” and “sales”. When prices change frequently and without notice, it adds to the confusion. <h2>6. Algorithmic pricing</h2> <a href="https://pricegouginginquiry.actu.org.au/wp-content/uploads/2024/02/InquiryIntoPriceGouging_Report_web.pdf">Algorithmic pricing</a> is the practice of using algorithms to set prices automatically taking into account competitor responses, which is something akin to computers talking to each other. When computers get together in this way they can <a href="https://www.x-mol.net/paper/article/1402386414932836352">act as it they are colluding</a> even if the humans involved in running the businesses never talk to each other. It can act even more this way when multiple competitors use the same third-party pricing algorithm, effectively allowing a single company to influence prices. <h2>7. Price discrimination</h2> Price discrimination involves charging different customers different prices for the same product, setting each price in accordance with how much each customer is prepared to pay. Banks do it when they offer better rates to customers likely to leave them, electricity companies do it when they offer better prices for business customers than households, and medical specialists do it when they offer vastly different prices for the same service to consumers with different incomes. It is made easier by digital technology and data collection. While it can make prices lower for some customers, it can make prices much more expensive to customers in a hurry or in urgent need of something. <h2>8. Excuse-flation</h2> <a href="https://www.bloomberg.com/news/articles/2023-03-09/how-excuseflation-is-keeping-prices-and-corporate-profits-high">Excuse-flation</a> is where general inflation provides “cover” for businesses to raise prices without justification, blaming nothing other than general inflation. It means that in times of general high inflation businesses can increase their prices even if their costs haven’t increased by as much. On Thursday Reserve Bank Governor <a href="https://www.afr.com/policy/economy/inflation-is-cover-for-pricing-gouging-rba-boss-says-20240215-p5f58d">Michele Bullock</a> seemed to confirm that she though some firms were doing this saying that when inflation had been brought back to the Bank’s target, it would be "much more difficult, I think, for firms to use high inflation as cover for this sort of putting up their prices." <h2>A political solution is needed</h2> Ultimately, our own vigilance won’t be enough. We will need political help. The government’s recently announced <a href="https://treasury.gov.au/review/competition-review-2023">competition review</a> might be a step in this direction. The legislative changes should police business practices and prioritise fairness. Only then can we create a marketplace where ethics and competition align, ensuring both business prosperity and consumer wellbeing. This isn’t just about economics, it’s about building a fairer, more sustainable Australia.<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/223310/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/david-tuffley-13731">David Tuffley</a>, Senior Lecturer in Applied Ethics & CyberSecurity, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/why-prices-are-so-high-8-ways-retail-pricing-algorithms-gouge-consumers-223310">original article</a>.

Money & Banking

"I was so scared": Chezzi Denyer's shocking mental health revelation

Chezzi Denyer has opened up about the moment she decided to seek professional help for a debilitating mental health condition. Grant Denyer's wife shared an emotional post on Instagram, marking the 10 year anniversary of the day she made a major change after struggling with post-natal depression and PTSD. In a lengthy caption, she wrote, “Ten years ago, today, I made a very scary step and began professional treatment for Post Traumatic Stress Disorder, and Postnatal Anxiety." “At the time I was unable to articulate what I was feeling, or understand why. For some time I had exhausted myself trying to conceal it.” She said that she felt "scared" to admit she was struggling, out of fear she would be called "crazy". “Scared to sleep most nights because of the night terrors,” she wrote. “The repeated visions of the very things that had scarred me, waking me shaking. I would die graphically in my dreams. Scared to care for my young daughter Sailor at times." “I had never experienced anxiety up to this point so I didn’t know what it was ... but my fear over her becoming unwell or injured left me paralysed at times.” Denyer said that as a seasoned “mask wearer”, she had laughed it off and became used to concealing her mental health battle. “Most people who knew me well had no idea of my personal battle,” she wrote. “While seeking help took me a number of attempts, as many dismissed me at first - my mask was strong - It has become the single most profound thing I have ever done in my life. “My entire world began to change on that day, ten years ago.” After seeking professional help, Chezzi learned the details of her own psychology, and began to forgive herself. “I learnt that I was not the sum of my affliction/ condition, and that there was a path out and to a much better place should I want that, and I did so very very much." “I worked through the pain, and the fear and while sometimes it felt too hard ... I continued to face it." “And today while I quietly smile about how far I’ve come, I wanted to share this quite personal post with you because I know that it will resonate with many people still trying to conceal and wear their masks.” Chezzi’s followers were stunned by the raw honesty of the post, with many thanking her for helping them to feel less alone. “Thank you for sharing so vulnerably,” one follower wrote. “I just know being open about your experience will help others feel less alone and will hopefully help someone to take that first step to ask for help. Thank you. Just thank you.” Image credits: Instagram

Caring

Millions of high-risk Australians aren’t getting vaccinated. A policy reset could save lives

<a href="https://theconversation.com/profiles/peter-breadon-1348098">Peter Breadon</a>, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> and <a href="https://theconversation.com/profiles/ingrid-burfurd-1295906">Ingrid Burfurd</a>, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> Each year, vaccines prevent thousands of deaths and hospitalisations in Australia. But millions of high-risk older Australians <a href="https://grattan.edu.au/report/a-fair-shot-ensuring-all-australians-can-get-the-vaccines-they-need/">aren’t getting</a> recommended vaccinations against COVID, the flu, pneumococcal disease and shingles. Some people are more likely to miss out, such as migrant communities and those in rural areas and poorer suburbs. As our new <a href="https://grattan.edu.au/report/a-fair-shot-ensuring-all-australians-can-get-the-vaccines-they-need/">Grattan report shows</a>, a policy reset to encourage more Australians to get vaccinated could save lives and help ease the pressure on our struggling hospitals. <h2>Adult vaccines reduce the risk of serious illness</h2> Vaccines slash the risk of <a href="https://www.ncirs.org.au/sites/default/files/2021-03/Influenza-fact-sheet_31%20March%202021_Final.pdf">hospitalisation</a> and serious illness, <a href="https://ncirs.org.au/recent-covid-19-vaccination-highly-effective-against-death-caused-sars-cov-2-infection-older">often by more than half</a>. COVID has already caused more than <a href="https://www.abs.gov.au/statistics/health/causes-death/provisional-mortality-statistics/latest-release">3,000 deaths in Australia this year</a>. On average, the flu kills about <a href="https://www.doherty.edu.au/news-events/news/statement-on-the-doherty-institute-modelling">600 people a year</a>, although a bad flu season, like 2017, can mean <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0%7E2017%7EMain%20Features%7EAustralia's%20leading%20causes%20of%20death,%202017%7E2">several thousand deaths</a>. And pneumococcal disease may also kill <a href="https://www.aihw.gov.au/getmedia/49809836-8ead-4da5-81c4-352fa64df75b/aihw-phe-263.pdf?inline=true">hundreds</a> of people a year. Shingles is rarely fatal, but can be extremely painful and cause <a href="https://www.healthdirect.gov.au/shingles#complications">long-term nerve damage</a>. Even before COVID, vaccine-preventable diseases caused tens of thousands of potentially preventable hospitalisations each year – more than <a href="https://www.aihw.gov.au/reports/primary-health-care/disparities-in-potentially-preventable-hospitalisa/data">80,000 in 2018</a>. Vaccines offered in Australia have been tested for safety and efficacy and have been found to be <a href="https://www.health.gov.au/topics/immunisation/about-immunisation/vaccine-safety#:%7E:text=serious%20side%20effects.-,Vaccine%20safety%20monitoring,approved%20for%20use%20in%20Australia.">very safe</a> for people who are <a href="https://www.health.gov.au/topics/immunisation/when-to-get-vaccinated/national-immunisation-program-schedule">recommended to get them</a>. <h2>Too many high-risk people are missing out</h2> Our <a href="https://grattan.edu.au/report/roundabouts-overpasses-carparks-hauling-the-federal-government-back-to-its-proper-role-in-transport-projects">report</a> shows that before winter this year, only 60% of high-risk Australians were vaccinated against the flu. Only 38% had a COVID vaccination in the last six months. Compared to a year earlier, two million more high-risk people went into winter without a recent COVID vaccination. Vaccination rates have fallen further since. Just over one-quarter (<a href="https://www.health.gov.au/sites/default/files/2023-11/covid-19-vaccine-rollout-update-10-november-2023.pdf">27%</a>) of people over 75 have been vaccinated in the last six months. That leaves more than 1.3 million without a recent COVID vaccination. Uptake is also low for other vaccines. Among Australians in their 70s, <a href="https://ncirs.org.au/sites/default/files/2022-12/Coverage%20report%202021%20SUMMARY%20FINAL.pdf">less than half</a> are vaccinated against shingles and only one in five are vaccinated against pneumococcal disease. These vaccination rates aren’t just low – they’re also unfair. The likelihood that someone is vaccinated changes depending on where they live, where they were born, what language they speak at home, and how much they earn. For example, at the start of winter this year, the COVID vaccination rate for high-risk Aboriginal and Torres Strait Islander adults was only 25%. This makes them about one-third less likely to have been vaccinated against COVID in the previous six months, compared to the average high-risk Australian. For more than 750,000 high-risk adults who do not speak English at home, the COVID vaccination rate is below 20% – about half the level of the average high-risk adult. Within this group, 250,000 adults aren’t proficient in English. They were 58% less likely to be vaccinated for COVID in the previous six months, compared to the average high-risk person. High-risk adults who speak English at home have a flu vaccination rate of 62%. But for people from 29 other language groups, who aren’t proficient in English, the rate is less than 31%. These 39,000 people have half the vaccination rate of people who speak English at home. These vaccination gaps contribute to the differences in people’s health. Australians born overseas don’t just have much lower rates of COVID vaccination, they also have much higher rates of death from COVID. Where people live also affects vaccination rates. High-risk people living in remote and very remote areas are less likely to be vaccinated, and even within capital cities there are big differences between different areas. <h2>We need to set ambitious targets</h2> Australia needs a vaccination reset. A new National Vaccination Agreement between the federal and state governments should include ambitious but achievable targets for adult vaccines. This can build on the success of targets for childhood and adolescent vaccination, setting targets for overall uptake and for communities that are falling behind. The federal government should ask the Australian Technical Advisory Group on Immunisation (ATAGI) to advise on vaccination targets for COVID, flu, pneumococcal and shingles for all high-risk older adults. <h2>Different solutions for different barriers</h2> Barriers to vaccination range from the trivial to the profound. A new national vaccination strategy needs to dismantle high and low barriers alike. First, to increase overall uptake, vaccination should be easier, and easier to understand. The federal government should introduce vaccination “surges”, especially in the lead-up to winter, as <a href="https://www.who.int/europe/news/item/09-10-2023-vulnerable--vaccinate.-protecting-the-unprotected-from-covid-19-and-influenza">countries in Europe</a> do. During surges, high-risk people should be able to get vaccinated even if they have had a recent infection or injection. This will make the rules simpler and make vaccination in aged care easier. Surges should be reinforced with advertising explaining who should get vaccinated and why. High-risk people should get SMS reminders. Second, targeted policies are needed for the many people who are happy to use mainstream primary care services, but who don’t get vaccinated – for example, due to <a href="https://theconversation.com/how-can-governments-communicate-with-multicultural-australians-about-covid-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097">language barriers</a>, or living in <a href="https://theconversation.com/over-half-of-eligible-aged-care-residents-are-yet-to-receive-their-covid-booster-and-winter-is-coming-205403">aged care</a>. <a href="https://www.health.gov.au/our-work/phn/what-PHNs-are">Primary Health Networks</a> should get funding to coordinate initiatives such as vaccination events in aged care and disability care homes, workforce training to support culturally appropriate care, and provision of interpreters. Third, tailored programs are needed to reach <a href="https://www.aihw.gov.au/reports/australias-health/health-promotion">people who are not comfortable or able to access mainstream health care</a>, who have the most complex barriers to vaccination – for example, distrust of the health system or poverty. These communities are all very different, so one-size-fits-all programs don’t work. The pandemic showed that vaccination programs can succeed when they are designed and delivered with the communities they are trying to reach. Examples are “<a href="https://pubmed.ncbi.nlm.nih.gov/36366401/">community champions</a>” who challenge misinformation, or health services organising vaccination events where communities work, gather or <a href="https://www.theguardian.com/australia-news/2021/aug/11/hundreds-queue-for-hours-and-some-camp-overnight-at-pop-up-vaccine-clinic-in-sydneys-lakemba">worship</a>. These programs should get ongoing funding, but also be accountable for achieving results. Adult vaccines are the missing piece in Australia’s whole-of-life vaccination strategy. For the health and safety of the most vulnerable members of our community, we need to close the vaccination gap. <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/217915/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/peter-breadon-1348098">Peter Breadon</a>, Program Director, Health and Aged Care, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> and <a href="https://theconversation.com/profiles/ingrid-burfurd-1295906">Ingrid Burfurd</a>, Senior Associate, Health Program, Grattan Institute, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan 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/millions-of-high-risk-australians-arent-getting-vaccinated-a-policy-reset-could-save-lives-217915">original article</a>.

Body

High-profile 2GB host missing feared dead

Roman Butchaski, known as “Butch” from the 2GB Fishing Show, has been missing since Sunday and is feared to be dead after police found his belongings near croc-infested waters. The radio host disappeared while solo-fishing on a river bank in The Cape York Peninsula, in north Queensland. On Tuesday morning, journalist Harry Clark told 2GB's Ben Fordham that Butch's fishing gear had been found, after three days of major search and rescue operations. “The latest is that the search finished yesterday afternoon and there are air and land searches scheduled to continue again this morning,” Clark told Fordham. “He borrowed a buggy from a friend (and) travelled about an hour to go fishing along the banks of the Olive River. "All that they’ve found of Butch is that vehicle and a few personal effects such as a fishing rod that was found on Sunday afternoon, and he hasn’t been seen since. “The Olive River is a tidal saltwater river and like all waterways in that area they are known crocodile habitats so that's certainly one of things search crews are taking into consideration as they look for Butch.” Butch was last seen at 8am on Sunday, and was reported missing when he didn’t return home from the fishing trip. “Emergency services were called to the area late last night night after he failed to return,” Queensland Police said on Monday. “Additional officers are travelling from Bamaga this morning to assist.” Image: 2GB/ Pema Tamang Pakhrin/ news.com.au

Travel Trouble

Bruce Lehrmann revealed as "high-profile" figure accused of rape in Queensland

Former Liberal staffer Bruce Lehrmann has been charged with two counts of rape, relating to an incident alleged to have occurred in Queensland in October 2021. What makes this case even more intriguing is the legal battle over the public identification of the accused. For the first time, the "high-profile man" accused of rape in Toowoomba, west of Brisbane, can be named. This case has raised complex issues surrounding mental health, the administration of justice, and the changing legal landscape in Queensland. The legal saga surrounding Lehrmann's identity took a convoluted path through the Queensland legal system. The matter was first listed in the Toowoomba Magistrates Court in January 2023, but the accused's name remained under wraps. Lehrmann's legal team initially argued for an ongoing suppression order on his name, citing concerns about his mental health. They contended that the risk to his mental health was a fluid and ever-changing factor. However, the Queensland Supreme Court judge, Peter Applegarth, made a pivotal decision on October 26, 2023, rejecting Lehrmann's application for a continued suppression order. He concluded that there was insufficient evidence to establish the necessity of the non-publication order for the defendant's safety. Interestingly, the complainant in the case actively supported the public naming of Lehrmann, contradicting previous laws that prohibited the identification of the accused before committal. This shift allowed media outlets to finally disclose his name as of October 3, 2023. The decision to allow the media to name Lehrmann reflected a growing sentiment in favour of transparency in legal proceedings. Lehrmann's legal team had previously cited concerns about his mental health and submitted a letter from a psychologist mentioning suicidal ideation as part of the suppression order application. While these concerns played a significant role in the legal proceedings, it ultimately was not enough to sway the courts in favour of maintaining the suppression order. This case highlights the intricate interplay between mental health, public safety and the administration of justice. While the legal system must protect the rights of the accused, it also must balance those rights with the public's right to know and the interests of justice. Lehrmann has not yet entered a plea, and he has not been committed for trial, which will play out in the magistrates court. This legal battle will undoubtedly continue to garner attention as it moves forward, both in the courtroom and in the court of public opinion. Image: Getty Images

Legal

2023 Drone Photo Awards fly high as winners are revealed

The winners of the 2023 Drone Photo Awards have been announced, with photographers all around the world recognised for their commitment to aerial photography in the fierce international competition. Thousands of submissions were received for the annual contest across nine different categories: photo of the year, urban, wildlife, sport, people, nature, abstract, wedding, series, and video. The Drone Photo Awards are open to both aerial photography and video, with platforms including “fixed-wing aircraft, helicopters, unmanned aerial vehicles, balloons, blimps and dirigibles, rockets, kites, and parachutes.” The competition’s top award, Photo of the Year, went to a shot by Israeli photographer Or Adar. His submission, ‘Must resist’, presents the image of “protesters holding banners during a demonstration again Israeli Prime Minister Benjamin Netanyahu’s judicial overhaul plans” from an aerial perspective, capturing the moment in Tel Aviv when “tens of thousands of protesters took to the streets of Israeli cities for the ninth straight week, on Saturday March 4th, to fight a government plan to overhaul the country's court system.” <blockquote class="twitter-tweet"> 🏆“𝐃𝐫𝐨𝐧𝐞 𝐏𝐡𝐨𝐭𝐨 𝐀𝐰𝐚𝐫𝐝𝐬 𝟐𝟎𝟐𝟑” 𝐏𝐡𝐨𝐭𝐨 𝐨𝐟 𝐭𝐡𝐞 𝐘𝐞𝐚𝐫 🏆 Congrats to Or Adar for his stunning image “Must resist”. 👏👏👏<a href="https://t.co/leaZw2sazu">https://t.co/leaZw2sazu</a><a href="https://twitter.com/hashtag/sienawards?src=hash&ref_src=twsrc%5Etfw">#sienawards</a> <a href="https://twitter.com/hashtag/dronephotoawards?src=hash&ref_src=twsrc%5Etfw">#dronephotoawards</a> <a href="https://twitter.com/hashtag/photocontest?src=hash&ref_src=twsrc%5Etfw">#photocontest</a> <a href="https://twitter.com/hashtag/dronephotography?src=hash&ref_src=twsrc%5Etfw">#dronephotography</a> <a href="https://t.co/pyReGOTMC9">pic.twitter.com/pyReGOTMC9</a> — Siena Awards (@SIPAContest) <a href="https://twitter.com/SIPAContest/status/1671458317472866313?ref_src=twsrc%5Etfw">June 21, 2023</a></blockquote> Polish photographer Sebastian Piórek took home the win in the Urban category for his shot of Chorzów in southern Poland, which was described by The Siena Awards as a photo that “beautifully juxtaposes the colourful ambiance and harmony of the playground against the backdrop of the city.” Indian photographer Danu Paran won the Wildlife category with his shot of a napping elephant, where “the elephant’s grey and wrinkled skin perfectly merges with the natural landscape, creating a harmonious composition that showcases the beauty of wildlife.” French photographer David Machet won for Sport with his photo of tightrope walker Nathan Paulin in the French Alps, as Paulin traversed a ‘highline’ almost 2.5 km in the air. The People category went to British photographer Simon Heather’s picture of people in Portugal enjoying a sunny day by the sea, while the Series award went to American photographer George Steinmetz for his photo series of farmland. Indian photographer Thomas Vijayan took home the Nature award for his photo of Svalbard, with Vijayan sharing that “it was surprisingly sad to see that the ice had already melted in June, and we were able to reach the ice cap with our ship.” The Abstract winner was Spanish photographer Ignacio Medem for a shot demonstrating how drought and poor water resource management has impacted a river in the American West. Polish photographer Krzysztof Krawczyk found success in the Wedding category, with his snap of newlyweds on a boat in the middle of a lake, while “they are enveloped by voluminous clouds and surrounded by thousands of dry leaves, resembling stars and creating gentle waves.” And last but not least, Bashir Abu won the Video category with “Why I Travel the World Alone”. <iframe title="YouTube video player" src="https://www.youtube.com/embed/Z6t4y3A28uA" width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen"></iframe> And for anyone hoping to check the winners out for themselves, Adar’s image - as well as the top photographs from the other winning categories - will be available for viewing in the Above Us Only Sky exhibition set to take place for the first time at Italy’s San Galgano Abbey from July 8 to November 19. Images: Drone Photo Awards

Art

Do stress and depression increase the risk of Alzheimer’s disease? Here’s why there might be a link

<a href="https://theconversation.com/profiles/yen-ying-lim-355185">Yen Ying Lim</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/ivana-chan-1477100">Ivana Chan</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Dementia affects more than <a href="https://www.who.int/news-room/fact-sheets/detail/dementia">55 million people</a> around the world. A number of factors can increase a person’s risk of developing dementia, <a href="https://link.springer.com/article/10.14283/jpad.2023.119">including</a> high blood pressure, poor sleep, and physical inactivity. Meanwhile, keeping cognitively, physically, and socially active, and limiting alcohol consumption, can <a href="https://www.thelancet.com/article/S0140-6736(20)30367-6/fulltext">reduce the risk</a>. Recently, a <a href="https://alzres.biomedcentral.com/articles/10.1186/s13195-023-01308-4">large Swedish study</a> observed that chronic stress and depression were linked to a higher risk of developing <a href="https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.12638">Alzheimer’s disease</a>, the most common form of dementia. The researchers found people with a history of both chronic stress and depression had an even greater risk of the disease. Globally, around <a href="https://www.who.int/news-room/fact-sheets/detail/depression">280 million people</a> have depression, while roughly <a href="https://www.who.int/news-room/fact-sheets/detail/anxiety-disorders">300 million people</a> experience anxiety. With so many people facing mental health challenges at some stage in their lives, what can we make of this apparent link? <h2>What the study did and found</h2> This study examined the health-care records of more than 1.3 million people in Sweden aged between 18 and 65. Researchers looked at people diagnosed with chronic stress (technically chronic stress-induced exhaustion disorder), depression, or both, between 2012 and 2013. They compared them with people not diagnosed with chronic stress or depression in the same period. Participants were then followed between 2014 and 2022 to determine whether they received a diagnosis of mild cognitive impairment or dementia, in particular Alzheimer’s disease. <a href="https://alz-journals.onlinelibrary.wiley.com/doi/10.1016/j.jalz.2016.07.151">Mild cognitive impairment</a> is often seen as the precursor to dementia, although not everyone who has mild cognitive impairment will progress to dementia. During the study period, people with a history of either chronic stress or depression were around twice as likely to be diagnosed with mild cognitive impairment or Alzheimer’s disease. Notably, people with both chronic stress and depression were up to four times more likely to be diagnosed with mild cognitive impairment or Alzheimer’s disease. <h2>Important considerations</h2> In interpreting the results of this study, there are some key things to consider. First, the diagnosis of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9438479/">chronic stress-induced exhaustion disorder</a> is unique to the Swedish medical system. It is characterised by at least six months of intensive stress without adequate recovery. Symptoms include exhaustion, sleep disturbance and concentration difficulties, with a considerable reduction in ability to function. Mild stress may not have the same effect on dementia risk. Second, the number of people diagnosed with dementia in this study (the absolute risk) was very low. Of the 1.3 million people studied, 4,346 were diagnosed with chronic stress, 40,101 with depression, and 1,898 with both. Of these, the number who went on to develop Alzheimer’s disease was 14 (0.32%), 148 (0.37%) and 9 (0.47%) respectively. These small numbers may be due to a relatively young age profile. When the study began in 2012–2013, the average age of participants was around 40. This means the average age in 2022 was around 50. Dementia is typically diagnosed in <a href="https://www.health.gov.au/topics/dementia/about-dementia">people aged over 65</a> and diagnosis <a href="https://karger.com/dem/article-abstract/34/5-6/292/99009/Overdiagnosis-of-Dementia-in-Young-Patients-A?redirectedFrom=fulltext">in younger ages</a> may be less reliable. Finally, it’s possible that in some cases stress and depressive symptoms may reflect an awareness of an already declining memory ability, rather than these symptoms constituting a risk factor in themselves. This last consideration speaks to a broader point: the study is observational. This means it can’t tell us one thing caused the other – only that there is an association. <h2>What does other evidence say?</h2> <a href="https://link.springer.com/article/10.14283/jpad.2023.119">Many studies</a> indicate that significant symptoms of depression, anxiety and stress are related to higher dementia risk. However, the nature of this relationship is unclear. For example, are depressive and anxiety symptoms a risk factor for dementia, or are they consequences of a declining cognition? It’s likely to be a bit of both. High <a href="https://pubmed.ncbi.nlm.nih.gov/32082139/">depressive and anxiety symptoms</a> are commonly reported in people with mild cognitive impairment. However, studies in middle-aged or younger adults suggest they’re important dementia risk factors too. For example, similar to the Swedish study, other <a href="https://www.sciencedirect.com/science/article/pii/S0165032719323031">studies</a> have suggested people with a history of depression are twice as likely to develop dementia than those without this history. In addition, in middle-aged adults, high anxiety symptoms are associated with <a href="https://pubmed.ncbi.nlm.nih.gov/34648818/">poorer cognitive function</a> and <a href="https://bmjopen.bmj.com/content/8/4/e019399">greater dementia risk</a> in later life. <h2>Why the link?</h2> There are several potential pathways through which stress, anxiety and depression could increase the risk of dementia. Animal studies suggest cortisol (a hormone produced when we’re stressed) can increase risk of Alzheimer’s disease by causing the accumulation of key proteins, <a href="https://pubmed.ncbi.nlm.nih.gov/34159699/">amyloid and tau</a>, in the brain. The accumulation of these proteins can result in increased <a href="https://www.mdpi.com/1422-0067/23/18/10572">brain inflammation</a>, which affects the brain’s nerves and supporting cells, and can ultimately lead to brain volume loss and memory decline. Another potential pathway is through <a href="https://www.sciencedirect.com/science/article/pii/S1087079217300114?via%3Dihub">impaired sleep</a>. Sleep disturbances are common in people with chronic stress and depression. Similarly, people with Alzheimer’s disease commonly report sleep disturbances. Even in people with <a href="https://pubmed.ncbi.nlm.nih.gov/34668959/">early Alzheimer’s disease</a>, disturbed sleep is related to poorer memory performance. Animal studies suggest poor sleep can also enhance accumulation of <a href="https://pubmed.ncbi.nlm.nih.gov/31408876/">amyloid and tau</a>. We still have a lot to learn about why this link might exist. But evidence-based strategies which target chronic stress, anxiety and depression may also play a role in reducing the risk of dementia.<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/215065/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/yen-ying-lim-355185">Yen Ying Lim</a>, Associate Professor, Turner Institute for Brain and Mental Health, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/ivana-chan-1477100">Ivana Chan</a>, PhD candidate, clinical psychology, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/do-stress-and-depression-increase-the-risk-of-alzheimers-disease-heres-why-there-might-be-a-link-215065">original article</a>.

Mind

How to tell if your loved one is depressed

Around one in 10 people suffer from depression and anxiety, meaning it’s likely at some stage in your life someone you know will be suffering and need your help. These are five of the less-obvious signs and symptoms that a friend or family member might be going through a hard time. 1. They seem exhausted all the time Changes to a sleeping patterns can be a sign of depression, whether it’s not sleeping enough or sleeping too much. Tip: Help your loved one by taking them out for the day to re-set their body clock. 2. They never want to socialise anymore If your loved one is finding it difficult to leave the house and attend any social events, even for a catch-up over coffee, that they would normally enjoy, it could be a sign Tip: Recognise that at the time it is very hard for your loved one to go out and socialise. Reassure them that you’d love to catch-up with them, and if it does get too much that you’re happy to do something they’d be happy with. 3. They get frustrated at everything Does your loved one seem to be losing their patience more than usual? Anger and irritability, more than usual, can be a sign of depression. Tip: Chat to your friend about their feelings of frustration and irritability. You will be better placed to see if it’s a passing mood or longer-term change. 4. Their appetite has changed Whether your loved one is constantly and consistently “not hungry” or they’re eating a lot more than usual and gaining weight, changes in appetite are a common sign of depression. Tip: People living with depression are often exhausted, where the thought of making meals or even what to eat, can be an overwhelming decision. Help prepare some meals for your loved one. 5. They’ve suddenly lost self-confidence A loss of self-confidence and self-esteem is a common sign of depression. When a loved one starts to feel like everything they do is rubbish, it can be difficult to feel otherwise. Tip: When a loved one says they feel useless, reassure them with specific examples and evidence that it’s not true at all. Image credits: Getty Images

Caring

"So eloquent": High-schooler's take on The Voice resurfaces

A compelling Q+A video clip originally showcasing a 15-year-old high schooler's insights on "The Voice to Parliament" proposal in 2018 has re-emerged online and gained viral prominence, days before the nation votes on the Voice to Parliament referendum. Recent polling indicates that support for The Voice is waning, and it appears to be heading toward a defeat, with all but two states leaning toward a No vote. This shift in public opinion comes at a critical juncture in the debate surrounding this historical initiative. Dylan Storer, a journalist from Western Australia, took to X (Twitter) to express his support for The Voice. He shared a video clip of his appearance on the ABC's Q+A from five years ago. At the time, he was only 15 years old and was part of a special panel consisting of high school students from across the nation who discussed the pressing issues confronting their communities. In the video, Storer explained, "I come from a predominantly Indigenous school," emphasising the importance of educating young Australians about the American civil rights movement and Australian Aboriginal history. He believed that Australia had a unique opportunity to embrace and acknowledge the cultures that have existed on its land for an astounding 65,000 years, and that this cultural recognition could significantly shape the nation's identity. The episode in which Storer appeared on Q+A took place shortly after former Prime Minister Scott Morrison appointed Tony Abbott as a special envoy for Indigenous affairs in the government. Storer expressed his reservations about this top-down approach, asserting that it was counterintuitive to have Tony Abbott in that role, given the circumstances. In Storer's view, the root causes of racism and misunderstandings about First Nations people in Australia stem from inadequate education about the country's history. He argued that teaching Australians about Indigenous people from a young age could only strengthen the nation. The video clip resurfaced at a time when the Uluru Statement from the Heart, a significant document drafted after extensive consultations with 250 Indigenous representatives from across the country, was still fresh in people's minds. This statement emphasised Indigenous voices being at the forefront of determining their own destiny. According to Storer, this made the government's choice of appointing Abbott seem counterintuitive and at odds with these aspirations. <blockquote class="twitter-tweet"> Dylan Storer impressed the nation with his appearance on the Q&A High School Panel in September, 2018. <a href="https://twitter.com/hashtag/QandA?src=hash&ref_src=twsrc%5Etfw">#QandA</a> <a href="https://t.co/JAZ8Xk75UB">pic.twitter.com/JAZ8Xk75UB</a> — QandA (@QandA) <a href="https://twitter.com/QandA/status/1194493372913684481?ref_src=twsrc%5Etfw">November 13, 2019</a></blockquote> Storer's words in the video have now been viewed over 230,000 times and have ignited a lively discussion online. Praise for his eloquent and insightful statements has poured in, including commendation from former federal MP Tony Windsor, who wished him well and acknowledged his contribution to the national dialogue. Storer's youthful perspective from 2018 continues to resonate and engage audiences, reaffirming the importance of conversations about Indigenous rights and cultural recognition in Australia. Images: X (Twitter)

Legal

Jubilant scenes as High Court hands down judgment against Qantas

In a landmark decision that saw former employees pumping their fists in celebration inside the courtroom, Qantas has issued a formal apology to its workforce after the High Court declared its actions unlawful when it terminated the employment of over 1,700 ground crew members during the COVID-19 pandemic. The court upheld two prior rulings from the Federal Court that deemed the airline's outsourcing of baggage handlers, cleaners and ground staff to be in violation of the law. The judgment delivered by Justices Susan Kiefel, Stephen Gageler, Jacqueline Gleeson, and Jayne Jagot underscores that taking "adverse action against another person for a substantial and operative reason of preventing the exercise of a workplace right by the other person contravenes (part of section 340 of the Fair Work Act) ... regardless of whether that other person has the relevant workplace right at the time the adverse action is taken." In essence, Qantas could not evade the law by taking such actions before the employees possessed the specific workplace rights the airline sought to obstruct. Australian Council of Trade Unions secretary Sally McManus, who was there for the judgment's announcement, posted a celebratory photo on social media, declaring, "The workers win against Qantas in the High Court. We will always have the backs of workers, well done ⁦@TWUAus" <blockquote class="twitter-tweet"> The workers win against Qantas in the High Court. We will always have the backs of workers, well done ⁦<a href="https://twitter.com/TWUAus?ref_src=twsrc%5Etfw">@TWUAus</a>⁩ <a href="https://t.co/wvZr7ouULX">pic.twitter.com/wvZr7ouULX</a> — Sally McManus (@sallymcmanus) <a href="https://twitter.com/sallymcmanus/status/1701749294947291564?ref_src=twsrc%5Etfw">September 13, 2023</a></blockquote> This legal battle began when the Transport Workers' Union brought a case against Qantas in the Federal Court, asserting that the airline had violated the Fair Work Act by outsourcing its ground operations to circumvent enterprise bargaining rights. Qantas, which had laid off workers in 2020, suffered significant financial losses due to the pandemic's severe impact on the aviation sector. In its response to the High Court's decision, Qantas clarified that it made the decision to outsource its remaining ground handling function in August 2020, at a time when borders were closed, lockdowns were widespread, and COVID-19 vaccines were not yet available. The airline stated, "The likelihood of a years-long crisis led Qantas to restructure its business to improve its ability to survive and ultimately recover." Qantas then expressed deep regret for the adverse personal impact this decision had on the affected employees and offered an apology: "As we have said from the beginning, we deeply regret the personal impact the outsourcing decision had on all those affected and we sincerely apologise for that. "A prior decision by the Federal Court has ruled out reinstatement of workers but it will now consider penalties for the breach and compensation for relevant employees, which will factor in redundancy payments already made by Qantas." The airline outsourced the positions of baggage handlers and cleaners at ten airports in response to a drastic decline in business, citing sound commercial reasons as the motivation, as its operations had plummeted by over 90 percent. However, the Transport Workers' Union argued that Qantas had also sought to preempt industrial action once business returned to normal, contending that the dismissals were in violation of the Fair Work Act, which prohibited actions impeding workers' rights. After losing twice in the Federal Court, Qantas escalated the case to the High Court, which was tasked with determining whether the workers possessed the rights claimed by the union at the time of the outsourcing decision. The unanimous decision of the High Court now paves the way for the workers to pursue compensation. Images: Twitter (X)

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