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January 6, 2023

Why Cristiano Ronaldo’s move to Saudi Arabia means so much for the Gulf monarchy’s sporting ambitions | CNN

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CNN
—

It’s a partnership that’s been hailed as “history in the making.”

One of the world’s most famous soccer stars landed in the Saudi capital Riyadh on Tuesday, where Cristiano Ronaldo was received in an extravagant ceremony, with excited children sporting his new club’s yellow and blue jerseys.

Oil-rich Saudi Arabia’s success in luring the five-time Ballon d’Or winner on a two-year contract with the kingdom’s Al Nassr FC is the Gulf monarchy’s latest step in realizing its sporting ambitions – seemingly at any cost.

According to Saudi state-owned media, Ronaldo will earn an estimated $200 million a year with Al Nassr, making him the world’s highest-paid soccer player.

Shortly after the 37-year-old’s signing with Al Nassr, the club’s Instagram page gained over 5.3 million new followers. Its official website was inaccessible after exceeding its bandwidth limit due to the sudden surge in traffic, and the hashtag #HalaRonaldo – Hello, Ronaldo in Arabic – was trending for days across the Middle East on Twitter.

Analysts say that his recruitment in Saudi Arabia is part of a wider effort by the kingdom to diversify its sources of revenue and become a serious player in the international sporting scene.

It is also seen as a move by the kingdom to shore up its image after it was tarnished by the 2018 dismemberment and killing of Washington Post columnist Jamal Khashoggi at the hands of Saudi agents, and a devastating war it started in Yemen in 2015.

Critics have decried the kingdom for “sportswashing,” an attempt to burnish one’s reputation through sport.

“I think Saudi Arabia has recognized a couple of years ago that to be a powerful nation internationally, you cannot just rely on hard power,” Danyel Reiche, a visiting research fellow and associate professor at Georgetown University Qatar, told CNN.

“You also need to invest in soft power, and the case of Qatar shows that this can work pretty well,” he said, adding that Saudi Arabia is following in the Qatari approach with sport, but with a delay of around 25 years.

Neighboring Qatar has also faced immense criticism since it won the bid to hosting last year’s FIFA World Cup in 2010.

Despite the smaller Gulf state facing similar accusations of “sportswashing,” the tournament has largely been viewed as a success, not least in exposing the world to a different view of the Middle East, thanks in part to Morocco’s success in reaching the semifinals and Saudi Arabia beating eventual World Cup champion Argentina in their opening group game.

Gulf nations engage in fierce competition to become the region’s premier entertainment and sporting hubs. The UAE, Saudi Arabia, Qatar and Bahrain, in close proximity to each other, each have their own Formula One racing event. But their competition hasn’t been confined to the region. Qatar, Saudi Arabia and the UAE have also bought trophy European soccer teams.

Riyadh is playing catchup with neighbors who have long realized the importance of investing in sports, said Simon Chadwick, professor of sport and geopolitical economy at SKEMA Business School in Lille, France, especially as its main source of income – oil – is being gradually shunned.

“This is part of an ongoing attempt to create more resilient economies that are more broadly based upon industries other than those that are derived from oil and gas,” Chadwick told CNN.

Ronaldo’s new club Al Nassr is backed by Qiddiya Investment Company (QIC), a subsidiary of the kingdom’s wealth fund, the Public Investment Fund (PIF), which has played a pivotal role in Saudi Arabia’s diversification plans.

“It is also a sign of interconnectedness, of globalization and of opening up to the rest of the world,” said Georgetown University’s Reiche.

The move is part of “several recent high profile moves in the sports world, including hosting the Andy Ruiz Jr. and Anthony Joshua world heavywight boxing championship bout in 2019, and launching the LIV Golf championship,” said Omar Al-Ubaydli, director of research at the Bahrain-based Derasat think tank. “It is a significant piece of a large puzzle that represents their economic restructuring.”

The kingdom has been on a path to not only diversify its economy, but also shift its image amid a barrage of criticism over its human rights record and treatment of women. Saudi Arabia is today hosting everything from desert raves to teaming up with renowned soccer players. Argentina’s Lionel Messi last year signed a lucrative promotional deal with the kingdom.

Hailed as the world’s greatest player, 35-year-old Messi ended this year’s World Cup tournament in Qatar with his team’s win over France, making his ambassadorship of even greater value to the kingdom.

The acquisition of such key global figures will also help combat the monarchy’s decades-long reputation of being “secretive” and “ultra-conservative,” James Dorsey, a senior fellow at the S. Rajaratnam School of International Studies in Singapore and an expert on soccer in the Middle East, told CNN’s Eleni Giokos on Wednesday.

Al-Ubaydli said that the kingdom wants to use high profile international sports “as a vehicle for advertising to the world its openness.”

Saudi Arabia bought the English Premier league club Newcastle United in 2021 through a three-party consortium, with PIF being the largest stakeholder. The move proved controversial, as Amnesty International and other human rights defenders worried it would overshadow the kingdom’s human rights violations.

Ronaldo’s work with Saudi Arabia is already being criticized by rights groups who are urging the soccer player to “draw attention to human rights issues” in Saudi Arabia.

“Saudi Arabia has an image problem,” especially since Khashoggi’s killing, says Reiche. But the kingdom’s recent investments in sports and entertainment are “not about sportswashing but about developing the country, social change and opening up to the world.”

Saudi Arabia is reportedly weighing a 2030 World Cup bid with Egypt and Greece, but the kingdom’s tourism ministry noted in November that it has not yet submitted an official bid. Chadwick believes that Ronaldo’s deal with Al Nassr, however, may help boost the kingdom’s bid should it choose it pursue it.

Another way Saudi Arabia may benefit from Ronaldo’s acquisition is that it will be able to improve commercial performance, says Chadwick, especially if this collaboration attracts further international talent.

“It is important to see Ronaldo not just as a geopolitical instrument,” said Chadwick, “There is still a commercial component to him and to the purpose he is expected to serve in Saudi Arabia.”

What Ronaldo’s move to Saudi Arabia shows is that the kingdom aspires “to be seen as being the best” and that it wants to be perceived as a “contender and a legitimate member of the international football community,” said Chadwick.

UAE FM meets Syria’s Assad in Damascus in further sign of thawing ties

Syrian President Bashar al-Assad received the United Arab Emirates Foreign Minister Sheikh Abdullah bin Zayed in Damascus on Wednesday in the latest sign of thawing relations between Assad and the Gulf state. The meeting addressed developments in Syria and the wider Middle East, according to UAE state news agency WAM.

Background: It was Abdullah bin Zayed’s first visit since a November 2021 meeting with Assad that led to the resumption of relations. Months later, in March 2022, Assad visited the UAE, his first visit to an Arab state since the start of Syria’s civil war.
Why it matters: A number of Assad’s former foes have been trying to mend fences with his regime. Last week, talks between the Syrian and Turkish defense ministers were held in Moscow in the highest-level encounter reported between the estranged sides since the war in Syria began. The regional rapprochement is yet to improve the lives of average Syrians. Syria is still under Western sanctions.

Turkish President Erdogan says he could meet with Assad

Turkish President Recep Tayyip Erdogan said in a speech on Thursday that he could meet the Syrian leader “to establish peace.”

Background: Erdogan’s comments came after the Moscow talks between the two nations’ defense ministers and intelligence chiefs. “Following this meeting… we will bring our foreign ministers together. And after that, as leaders, we will come together,” Erdogan said on Thursday.
Why it matters: The meeting would mark a dramatic shift in Turkey’s decade-long stance on Syria, where Ankara was the prime supporter of political and armed factions fighting to topple Assad. The Turkish military maintains a presence across the Syrian border and within northern Syria, where it backs Syrian opposition forces. Erdogan has also pledged to launch yet another incursion into northern Syria, aiming at creating a 30-km (20-mile) deep “safe zone” that would be emptied of Kurdish fighters.

Iran shuts down French cultural center over Charlie Hebdo’s Khamenei cartoons

Iran announced on Thursday it had ended the activities of a Tehran-based French research institute, in reaction to cartoons mocking Ayatollah Ali Khamenei and fellow Shia Muslim clerics published by French satirical magazine Charlie Hebdo this week.

Background: Iran summoned the French ambassador to Tehran on Wednesday to protest cartoons published by satirical magazine Charlie Hebdo. More than 30 cartoons poking fun at Iran’s supreme leader were published by the magazine on Wednesday, in a show of support for the Iranian people who have been protesting the Islamic Republic’s government and its policies.
Why it matters: French-Iranian relations have deteriorated significantly since protests broke out in Iran late last year. Paris has publicly supported the protests and spoken out against Iran’s response to them. French Foreign Minister Catherine Colonna criticized Iran’s freedom of press and judicial independence on Thursday, saying “press freedom exists, contrary to what is going on in Iran and… it is exercised under the supervision of a judge in an independent judiciary – and there too it’s something that Iran knows little of.”

The prized legacy of iconic Egyptian singer Umm Kulthum re-emerged this year when Rolling Stone magazine featured her in its “200 Greatest Singers of All Time.”

Ranking 61st, Umm Kulthum was the only Arab artist to make it to the list, with the magazine saying that she “has no real equivalent among singers in the West.”

Born in a small village northeast of the Egyptian capital Cairo, Umm Kulthum rose to unmatched fame as she came to represent “the soul of the pan-Arab world,” the music magazine said.

“Her potent contralto, which could blur gender in its lower register, conveyed breathtaking emotional range in complex songs that, across theme and wildly-ornamented variations, could easily last an hour, as she worked crowds like a fiery preacher,” it wrote.

Nicknamed “the lady of Arab singing,” her music featured both classical Arabic poetry as well as colloquial songs still adored by younger generations. Her most famous pieces include “Inta Uumri” (you are my life), “Alf Leila Weileila” (a thousand and one nights), “Amal Hayati” (hope of my life) and “Daret al-Ayyam” (the days have come around). Some of her songs have been remixed to modern beats that have made their way to Middle Eastern nightclubs.

The singer remains an unmatched voice across the Arab World and her music can still be heard in many traditional coffee shops in Old Cairo’s neighborhoods and other parts of the Arab world.

Umm Kulthum’s death in 1975 brought millions of mourners to the streets of Cairo.

By Nadeen Ebrahim

Women athletes aim their air rifles while competing in a local shooting championship in Yemen's Houthi rebel-held capital Sanaa on January 3.

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January 4, 2023

Myths and facts about treating a hangover | CNN

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CNN
—

Are you celebrating the first day of 2023 with a hangover?

If so, you might be looking for a method to ease your misery. There are certainly a lot of so-called hangover cures, some dating back centuries.

“The ancient Greeks believed that eating cabbage could cure a hangover, and the Romans thought that a meal of fried canaries would do the trick,” said Dr. John Brick, former chief of research at the Center of Alcohol Studies, Education and Training Division at Rutgers University in New Jersey, who authored “The Doctor’s Hangover Handbook.”

“Today, some Germans believe that a hearty breakfast of red meat and bananas cures hangovers. You might find some French drinking strong coffee with salt, or some Chinese drinking spinach tea,” he said. “Some of the more unusual hangover cures are used by some people in Puerto Rico, who rub half a lemon under their drinking arm.”

In truth, the only cure for a hangover is time, according to the National Institute on Alcohol Abuse and Alcoholism.

“A person must wait for the body to finish clearing the toxic byproducts of alcohol metabolism, to rehydrate, to heal irritated tissue, and to restore immune and brain activity to normal,” according to the institute. That recovery process can take up to 24 hours.

Are there things you can do to ease your transition? Possibly, experts say, but many common hangover “cures” may make your hangover worse. Here’s how to separate fact from fiction.

Having another drink, or the “hair of the dog that bit you,” is a well-known cure for a hangover, right? Not really, experts say.

The reason some people believe it works is because once the calming effects of alcohol pass, the brain on a hangover is overstimulated. (It’s also the reason you wake up in the middle of the night once your body has metabolized alcohol.)

“You’ve got this hyperexcitability in the brain after the alcohol is gone,” said Dr. Robert Swift, a professor of psychiatry and human behavior at Brown University’s Warren Alpert Medical School in Providence, Rhode Island.

“If you look at the brain of somebody with a hangover, even though the person might feel tired, their brain is actually overexcited,” he said.

Consuming more alcohol normalizes the brain again, “because you’re adding a sedative to your excited brain,” Swift said. “You feel better until the alcohol goes away and the cycle repeats in a way.”

The answer is yes, depending on hangover symptoms, Brick said. If you’re a coffee drinker, skipping your morning cup of joe may lead to caffeine withdrawal on top of your hangover.

But coffee can irritate the stomach lining, which is already inflamed by alcohol, Brick said. So if you are queasy and nauseous, coffee may only make matters worse.

“If you have a hangover, have a quarter of a cup of coffee,” Brick suggested. “See if you feel better — it takes about 20 minutes for the caffeine to start to have some noticeable effect.

“If coffee doesn’t make you feel better, don’t drink anymore. Obviously, that’s not the cure for your hangover.”

Forget eating a greasy breakfast in the wee hours after a night of drinking — you’re adding insult to injury, Swift said: “Greasy food is harder to digest, so it’s probably good to avoid it.”

Eating greasy food also doesn’t make much sense. The alcohol we drink, called ethyl alcohol or ethanol, is the byproduct of fermenting carbohydrates and starches, usually some sort of grain, grape or berry. While it may create some tasty beverages, ethanol is also a solvent, Brick said.

“It cuts through grease in your stomach much the same way it cleans grease off oily car parts,” he said.

Instead, experts suggest using food to prevent hangovers, by eating before you have that first drink.

“Eating food loaded with protein and carbohydrates can significantly slow down the absorption of alcohol,” Brick said. “The slower the alcohol gets to your brain, the less rapid the ‘shock’ to your brain.”

Alcohol dehydrates, so a headache and other hangover symptoms may be partly due to constricted blood vessels and a loss of electrolytes, essential minerals such as sodium, calcium and potassium that your body needs.

If you’ve vomited, you’ve lost even more electrolytes, and all of this can lead to fatigue, confusion, irregular heart rate, digestive problems and more.

Replacing lost fluids with water or a type of sports drink with extra electrolytes can help boost recovery from a hangover, Swift said.

Taking over-the-counter pain meds can be dangerous, especially if you take too many while intoxicated, experts say. Taking an acetaminophen, such as Tylenol, can further damage your overtaxed liver, while aspirin and ibuprofen can irritate your stomach lining.

“You should never, never take alcohol with acetaminophen or Tylenol,” Swift said. “You can actually cause liver damage from an overdose of Tylenol.”

But aspirin, ibuprofen and naproxen are “theoretically” OK, he added.

“Even though they tend to be anti-inflammatory in the body, they can cause inflammation in the stomach,” Swift said. “Don’t take them on an empty stomach; always take anti-inflammatories with food.”

While most alcohol is handled by the liver, a small amount leaves the body unchanged through sweat, urine and breathing.

Get up, do some light stretching and walking, and drink plenty of water to encourage urination, Brick said.

“Before you go to sleep and when you wake up, drink as much water as you comfortably can handle,” he said. You can also take a multivitamin “before you hit the shower in the morning (to) replenish lost vitamins, minerals and other nutrients.”

If you would rather have something warm and soothing, Brick suggested broth or other homemade soups.

“These will also help to replace lost salts, including potassium and other substances,” he said, “but will not make you sober up faster or improve impairment due to intoxication or hangover.”

Store shelves are packed with so-called hangover cures. Unfortunately, there’s no proof they work. In 2020, researchers published what they called the “world’s largest randomised double-blind placebo-controlled” trial of supplements containing vitamins, minerals, plant extracts and antioxidants and found no real improvement in hangover symptoms.

Even if one solution works, it likely won’t fix all your symptoms, experts say.

“The effects of alcohol and alcoholic beverages are so complicated, so complex,” Swift said, “that any solution might address one or two of the symptoms but won’t address them all.”

What does work for a hangover? Time. It will take time for your body to release all the toxins causing your misery, experts say. And the only way to prevent a hangover is to abstain.

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December 31, 2022

Should you attend that New Year’s Eve party? Our medical analyst weighs in | CNN

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CNN
—

At the end of 2020 and 2021, many people greeted the start of the coming year hunkered down due to the risk of Covid-19. But now, New Year’s Eve events and celebrations are back in a big way. A lot of people have plans to attend social functions, whether they are crowded festivities with thousands or house parties with a few relatives and friends.

These gatherings are occurring as the United States is in the midst of a triple threat — a confluence of respiratory syncytial virus or RSV, influenza and Covid-19. All three viral infections are spread from person to person, and gatherings involving many people can increase transmission at a time when hospital capacity nationwide is at near-record levels: More than 70% of inpatient beds are in use across the country, according to the US Department of Health and Human Services.

What should you consider in deciding whether to attend New Year’s Eve parties? How can you gauge the risk of specific events? Are there individuals who may want to take more precautions, and which mitigation measures can reduce risk if they go? If you find out later that an attendee was ill, when should you test afterward to make sure you are in the clear? And what happens if you develop symptoms after an event?

To guide you through these questions, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician, public health expert and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also the author of “Lifelines: A Doctor’s Journey in the Fight for Public Health.”

CNN: What should people consider in deciding whether to attend New Year’s Eve parties?

Dr. Leana Wen: People should start by considering three factors. First, what is your risk and the risk of your household from severe outcomes due to respiratory viruses? If everyone is generally healthy and you have already resumed other aspects of pre-pandemic activities, it might be reasonable to do the same for New Year’s get-togethers. But if someone is elderly or severely immunocompromised, you may wish to take additional precautions.

Second, what’s the importance of these events to you, compared with the importance of avoiding infection? Virtually every in-person interaction has some level of risk. That doesn’t mean everyone should avoid in-person activities permanently, but if you do attend a higher-risk event, know that you have a chance of getting a respiratory infection from it. Whether you go depends on how you weigh the importance of that event versus your desire to not get sick.

Third, is there a specific timing issue for which you really don’t want to get sick heading into the new year? For example, someone who has an operation scheduled the week after New Year’s may wish to be extra careful, so they don’t get an infection and then have to postpone their surgery. Someone else may have an important work event or school exam, and the desire to avoid any infection before that occasion could outweigh the desire to participate in New Year’s Eve celebrations. These are all things to consider and will vary depending on individual preference.

CNN: How can people gauge the risk of different New Year’s Eve events?

Wen: The risk depends on the type of event and what kind of mitigation measures are put into place, if any.

The more people, the higher the risk. A small gathering of, say, 10 close friends means that you could potentially contract respiratory viruses from one of these 10. Especially if these friends have been fairly cautious themselves, chances are low that none of these 10 are infected coming into the party. Compare that with a large party of 1,000 people. In this case, chances are much higher that someone at that party is infectious.

An outdoor event will be lower risk than an indoor event. Indoor events where everyone is spaced out, and where there is good ventilation, will be safer than ones where people are crowded close together.

In addition to space and ventilation, another mitigation measure that can make a difference is testing. If the event requires same-day rapid Covid-19 tests, that reduces risk. And it helps if the organizers emphasize that people who are symptomatic should not attend.

CNN: What are some things people can do to reduce their risk if they do go to an event?

Wen: Flu, RSV and a lot of other respiratory infections are spread through droplets. Washing your hands well and often can reduce your risk. Bring hand sanitizer with you in case it’s not readily available and use it frequently, especially after shaking hands and touching commonly used surfaces like shared serving utensils.

You could also stand near windows and try to stay away from crowds, especially if people are gathering in areas that aren’t well-ventilated.

Covid-19 is airborne in addition to being transmitted through droplets. Studies have shown that masks reduce the risk of Covid-19 transmission. Some venues may require masks, but even if they don’t, if you are someone who is very concerned about Covid-19, you could wear a high-quality N95 or equivalent mask during the event.

If you find out a partygoer at an event you attended had Covid-19, take a test five days after the gathering, Wen advised.

CNN: If you find out that someone at an event had Covid-19, when should you test afterward to make sure you are in the clear?

Wen: If you are asymptomatic, you should test at least five days after the event. If you test earlier than that, the test result might be negative, and you could still have contracted Covid-19, even if the virus in your body hasn’t replicated enough for the test to detect it yet. To be certain, I’d test five days after and then again two days after that.

CNN: What if you saw other people on New Year’s — if you were exposed on New Year’s Eve, could you infect people the day after?

Wen: The incubation period for Covid-19 is at least two days. Even if you did contract Covid-19 on New Year’s Eve, you wouldn’t have enough virus in your system to infect other people the day after. By the next day, two days after exposure, it’s possible.

CNN: What happens if you develop symptoms after an event?

Wen: If you develop symptoms, you should test for Covid-19, and then, if you test positive and you are eligible for Paxlovid, speak with your health care provider about taking the antiviral treatment. Inform the event organizer right away so that they can alert others.

Viral symptoms are not just due to Covid-19, of course. If you are someone who is particularly vulnerable, you should call your health care provider, who can test you for influenza and prescribe the antiviral Tamiflu. Children and other vulnerable people should get tested for RSV, too.

Otherwise, the advice is the same as pre-pandemic: Refrain from going to public places while symptomatic. Use standard measures to treat viral syndromes — such as fluids, rest, fever-reducing medicines and other symptom-based treatment.

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December 29, 2022

What older Americans need to know before undergoing major surgery | CNN

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KHN
—

Larry McMahon is weighing whether to undergo a major surgery. Over the past five years, his back pain has intensified. Physical therapy, muscle relaxants, and injections aren’t offering relief.

“It’s a pain that leaves me hardly able to do anything,” he said.

Should McMahon, an 80-year-old retired Virginia state trooper who now lives in Southport, North Carolina, try spinal fusion surgery, a procedure that can take up to six hours? (Eight years ago, he had a lumbar laminectomy, another arduous back surgery.)

“Will I recover in six months — or in a couple of years? Is it safe for a man of my age with various health issues to be put to sleep for a long period of time?” McMahon asked, relaying some of his concerns to me in a phone conversation.

Older adults contemplating major surgery often aren’t sure whether to proceed. In many cases, surgery can be lifesaving or improve a senior’s quality of life. But advanced age puts people at greater risk of unwanted outcomes, including difficulty with daily activities, extended hospitalizations, problems moving around, and the loss of independence.

I wrote in November about a new study that shed light on some risks seniors face when having invasive procedures. But readers wanted to know more. How does one determine if potential benefits from major surgery are worth the risks? And what questions should older adults ask as they try to figure this out? I asked several experts for their recommendations. Here’s some of what they suggested.

Ask your surgeon, “How is this surgery going to make things better for me?” said Dr. Margaret “Gretchen” Schwarze, an associate professor of surgery at the University of Wisconsin School of Medicine and Public Health. Will it extend your life by removing a fast-growing tumor? Will your quality of life improve by making it easier to walk? Will it prevent you from becoming disabled, akin to a hip replacement?

If your surgeon says, “We need to remove this growth or clear this blockage,” ask what impact that will have on your daily life. Just because an abnormality such as a hernia has been found doesn’t mean it has to be addressed, especially if you don’t have bothersome symptoms and the procedure comes with complications, said Drs. Robert Becher and Thomas Gill of Yale University, authors of that recent paper on major surgery in older adults.

Schwarze, a vascular surgeon, often cares for patients with abdominal aortic aneurysms, an enlargement in a major blood vessel that can be life-threatening if it bursts.

Here’s how she describes a “best case” surgical scenario for that condition: “Surgery will be about four to five hours. When it’s over, you’ll be in the ICU with a breathing tube overnight for a day or two. Then, you’ll be in the hospital for another week or so. Afterwards, you’ll probably have to go to rehab to get your strength back, but I think you can get back home in three to four weeks, and it’ll probably take you two to three months to feel like you did before surgery.”

Among other things people might ask their surgeon, according to a patient brochure Schwarze’s team has created: What will my daily life look like right after surgery? Three months later? One year later? Will I need help, and for how long? Will tubes or drains be inserted?

A “worst case” scenario might look like this, according to Schwarze: “You have surgery, and you go to the ICU, and you have serious complications. You have a heart attack. Three weeks after surgery, you’re still in the ICU with a breathing tube, and you’ve lost most of your strength, and there’s no chance of ever getting home again. Or, the surgery didn’t work, and still you’ve gone through all this.”

“People often think I’ll just die on the operating table if things go wrong,” said Dr. Emily Finlayson, director of the UCSF Center for Surgery in Older Adults in San Francisco. “But we’re very good at rescuing people, and we can keep you alive for a long time. The reality is, there can be a lot of pain and suffering and interventions like feeding tubes and ventilators if things don’t go the way we hope.”

Once your surgeon has walked you through various scenarios, ask, “Do I really need to have this surgery, in your opinion?” and “What outcomes do you think are most likely for me?” Finlayson advised. Research suggests that older adults who are frail, have cognitive impairment, or other serious conditions such as heart disease have worse experiences with major surgery. Also, seniors in their 80s and 90s are at higher risk of things going wrong.

“It’s important to have family or friends in the room for these conversations with high-risk patients,” Finlayson said. Many seniors have some level of cognitive difficulties and may need assistance working through complex decisions.

Make sure your physician tells you what the nonsurgical options are, Finlayson said. Older men with prostate cancer, for instance, might want to consider “watchful waiting” — ongoing monitoring of their symptoms — rather than risk invasive surgery. Women in their 80s who develop a small breast cancer may opt to leave it alone if removing it poses a risk, given other health factors.

Because of McMahon’s age and underlying medical issues (a 2021 knee replacement that hasn’t healed, arthritis, high blood pressure), his neurosurgeon suggested he explore other interventions, including more injections and physical therapy, before surgery. “He told me, ‘I make my money from surgery, but that’s a last resort,” McMahon said.

“Preparing for surgery is really vital for older adults: If patients do a few things that doctors recommend — stop smoking, lose weight, walk more, eat better — they can decrease the likelihood of complications and the number of days spent in the hospital,” said Dr. Sandhya Lagoo-Deenadayalan, a codirector in Duke University Medical Center’s Perioperative Optimization of Senior Health (POSH) program.

When older patients are recommended to POSH, they receive a comprehensive evaluation of their medications, nutritional status, mobility, preexisting conditions, ability to perform daily activities, and support at home. They leave with a “to-do” list of recommended actions, usually starting several weeks before surgery.

If your hospital doesn’t have a program of this kind, ask your physician, “How can I get my body and mind ready” before having surgery, Finlayson said. Also ask: “How can I prepare my home in advance to anticipate what I’ll need during recovery?”

There are three levels to consider: What will recovery in the hospital entail? Will you be transferred to a facility for rehabilitation? And what will recovery be like at home?

Ask how long you’re likely to stay in the hospital. Will you have pain, or aftereffects from the anesthesia? Preserving cognition is a concern, and you might want to ask your anesthesiologist what you can do to maintain cognitive functioning following surgery. If you go to a rehab center, you’ll want to know what kind of therapy you’ll need and whether you can expect to return to your baseline level of functioning.

During the Covid-19 pandemic, “a lot of older adults have opted to go home instead of to rehab, and it’s really important to make sure they have appropriate support,” said Dr. Rachelle Bernacki, director of care transformation and postoperative services at the Center for Geriatric Surgery at Brigham and Women’s Hospital in Boston.

For some older adults, a loss of independence after surgery may be permanent. Be sure to inquire what your options are should that occur.

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December 25, 2022

Experts say the ‘cycle syncing’ workout trend may not be all it’s cracked up to be | CNN

Post By zittrexstore Health diet, domestic alerts, domestic-health and science, exercise and fitness, health and medical, iab-fitness and exercise, iab-healthy living, international alerts, international-health and science, nutrition and fitness No Comments

Editor’s Note: The views expressed in this commentary are solely those of the writers. CNN is showcasing the work of The Conversation, a collaboration between journalists and academics to provide news analysis and commentary. The content is produced solely by The Conversation.

The Conversation
—

If you’re someone who has to deal with a period regularly, you’re probably all too familiar with just how much your energy levels can change throughout your cycle thanks to hormonal fluctuations. Not only can this sometimes make even the simplest daily tasks challenging, it can make it even harder to stay motivated to keep fit and stick to your regular workout routine, especially when noticing a decline in your performance.

But, according to some popular information on social media, a technique called “cycle syncing” may help you avoid feeling this way.

READ MORE: From sharp butt pains to period poos: 5 lesser-known menstrual cycle symptoms

The premise of cycle syncing is relatively simple. Instead of doing the same type of workouts throughout the month, you instead tailor your workouts according to the current phase of your menstrual cycle. Some women also go a step further and tailor their diet to each phase as well. The claim is that, by doing so, it can help “balance” your hormones — which in turn may lead to a range of health benefits, including improved energy levels, fewer PMS symptoms and better health overall.

But while evidence does show that certain phases of your menstrual cycle may be optimal for different types of exercise, there’s currently no evidence showing cycle syncing has any benefits beyond making it easier to keep fit. Not to mention that actually managing to execute cycle syncing properly may be easier said than done.

The menstrual cycle can be split into four phases: menses, follicular, luteal and pre-menses. The concentration of the sex hormones estrogen and progesterone change in each phase.

During the menses phase (your period), estrogen and progesterone are at their lowest levels. But as you move into the follicular phase, estrogen begins to increase. In the luteal phase, which immediately follows, progesterone concentrations also begins to increase. Both hormones reach their peak near the end of the luteal phase, before dropping dramatically during the pre-menstrual phase (days 25-28 of the average cycle).

READ MORE: The US lacks adequate education around puberty and menstruation for young people

Research shows that thanks to these hormones, certain phases of your menstrual cycle are optimized for different types of exercise.

For instance, the luteal phase may be the perfect time for strength training thanks to the boost in both estrogen and progesterone. Research shows there are noticeable increases in strength and endurance during this phase. Energy expenditure (calories burned) and energy intake are also greater during the luteal phase, alongside a slight decrease in body mass. You may also find you feel more energetic and capable of exercise during this phase. The hormone concentrations in the luteal phase may also promote the greatest degree of muscle change.

The folicular phase also shows some increases in strength, energy expenditure and energy intake — albeit smaller.

But when progesterone and estrogen are at their lowest levels during your period (menses phase), you’re likely to see fewer changes when it comes to building muscle. There’s also a greater chance that you will feel fatigued due to low hormone levels, alongside the loss of menstrual blood. This may be a good time to consider adjusting your training, focusing on lower-intensity exercises (such as yoga) and prioritizing your recovery.

READ MORE: Exercising during pregnancy: what to consider

So based on the way hormones change during each phase of the menstrual cycle, if you’re looking to improve strength and fitness you may well want to plan your most intense workouts for the follicular and luteal phases to achieve the greatest gains.

This all seems fantastic, and you may well be wondering why more women are not following this trend. But the answer is that it may all be too good to be true.

While the responses reported do take place, actually putting this all into practice is easier said than done. First, most research on the menstrual cycle’s impact on fitness assume the cycle has a regular pattern of 28 days. But 46% of women have cycle lengths that fluctuate by around seven days — with a further 20% exhibiting fluctuations of up to 14 days. This means a regular cycle varies for each person.

READ MORE: Going home for the holidays? How to navigate conflict and deal with difficult people

The second key assumption is that the responses of progesterone and estrogen, which drive the changes in fitness are constant. But this is often not the case, as both estrogen and progesterone exhibit large variations both between cycles and each person. Some women may also lack estrogen and progesterone due to certain health conditions. These responses make it difficult to track the phases of the cycle precisely through monitoring of hormones alone — and make syncing accurately also very difficult.

So while the idea of syncing your menstrual cycle with your workouts seems logical, the outcomes each person sees are likely to vary. But if you do want to give it a try, menstrual tracking apps — alongside the use of ovulation test strips and temperature monitoring — can help give you a good idea of what stage in your menstrual cycle you’re at.

This article is part of Quarter Life, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.

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December 23, 2022

The year in sport: A fond farewell for some, a glimpse of the future for others | CNN

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CNN
—

An athlete, former jockey AP McCoy said earlier this year, is the only person who dies twice, such is the pain of walking away from the intoxicating, all-consuming nature of professional sport.

McCoy retired from his long, decorated racing career in 2015, and since then has had to learn, in his own words, how to “start again and have another life.”

Based on the past 12 months, there are some notable sports stars who might have been listening extra closely to McCoy’s experience of retirement – or indeed to anyone else who has spoken candidly about the difficulty of ending a successful sporting career.

Among them is Roger Federer, who called time on his trophy-laden tennis career at the Laver Cup in September after years spent trying to recover from two knee surgeries.

In the letter announcing his retirement, Federer, like McCoy, alluded to the heightened emotions of being a professional athlete and how they make saying goodbye so hard.

“I have laughed and cried, felt joy and pain, and most of all I have felt incredibly alive,” Federer wrote. “To the game of tennis,” he signed off the letter, “I love you and will never leave you.”

Those final words were reassuring for fans who have admired Federer’s career for so many years, but also spoke to another issue: namely, of how hard it can be to walk away entirely from professional sport after retirement.

It remains to be seen exactly how Federer will remain involved in tennis moving forward, and the same can be said of Serena Williams, who announced she would “evolve away from tennis” ahead of this year’s US Open – but refused to say she was retiring.

On several occasions over the past three months, the 23-time grand slam champion has even teased fans about a potential return to tennis.

At the 2022 US Open, Serena Williams lost to Australian Ajla Tomlijanovic in the third round.

While Federer and Williams have stepped away from their careers as two of the greatest athletes of all time, other sports stars can’t seem to decide when, or how, to walk away.

Heavyweight boxing champion Tyson Fury has yo-yoed in and out of retirement this year, saying in October that he’s finding it “really hard to let this thing go.”

And earlier this year, Tom Brady announced he would be retiring from the NFL, leaving the sport as a seven-time Super Bowl champion and arguably the greatest quarterback of all time. the 45-year-old then reversed that decision and is still breaking records with the Tampa Bay Buccaneers during his 23rd season in the NFL.

However in September, Brady and Gisele Bündchen announced they were to divorce after 13 years of marriage.

“I think there is a lot of professionals in life that go through things that they deal with at work and they deal with at home,” the Bucs quarterback said on his weekly podcast a few days the couple’s divorce announcement.

“Obviously, the good news is it’s a very amicable situation, and I’m really focused on two things: taking care of my family, and certainly my children, and secondly doing the best job I can to win football games. That’s what professionals do.”

Brady has redefined what most believed to be the average shelf-life of an athlete, and he’s not the only person refusing to let the light dim on his career.

LeBron James is about to turn 38 but is still setting records in the NBA – in February passing Kareem Abdul-Jabbar for the most combined regular season and postseason points in NBA history.

Federer’s rivals Rafael Nadal, 36, and Novak Djokovic, 35, meanwhile, have added to their grand slam tallies this year – the Mallorcan at the Australian Open and French Open, where he became the oldest men’s singles champion, and the Serbian at Wimbledon. Djokovic’s Wimbledon triumph moved him to within one grand slam title of Nadal’s men’s record of 22.

Having been deported from Australia over his vaccination status at the start of the year, Djokovic is set to compete at the Australian Open at the start of 2023 – a tournament he has won on nine previous occasions and is favorite to win again next year off the back of his recent ATP Finals victory.

For Nadal, his future in the sport rests on the amount of strain his injury-ravaged body can continue to withstand.

In golf, Tiger Woods faces similar questions. The 15-time major champion completed a stunning return from serious leg injuries suffered in a car crash at this year’s Masters, scoring a remarkable one-under 71 at Augusta National before making the cut the following day.

Then there’s sprinter Shelly-Ann Fraser-Pryce, who turns 36 later this month but has shown no signs of slowing down. The Jamaican produced a string of consistently fast performances this year, running under 10.7 seconds for the 100 meters a record seven times and claiming her fifth world championship title over the distance in July.

Shelly-Ann Fraser-Pryce celebrates winning the women's 100m final at the World Athletics Championships in Eugene, Oregon, in July.

And it’s not just athletes who have defied the call of retirement this year. In November, 73-year-old Dusty Baker became the oldest ever manager to win the World Series when he guided the Houston Astros to a 4-2 victory against the Philadelphia Phillies.

Many of the athletes who stole the headlines in 2022 have been doing so for years.

No one is sure where an aging Cristiano Ronaldo will play his club football in January after ending his second spell at Manchester United in ignominious fashion, but the 37-year-old still appears to be set on extending his playing career after Portugal’s quarterfinal exit from the World Cup.

His rival Lionel Messi, meanwhile, ended the year on a sensational high, guiding Argentina to a third World Cup trophy. The 35-year-old Messi scored twice in an absorbing final against France and finally got his hands on the World Cup at the fifth time of asking, further staking his claim as the game’s greatest ever player.

That hasn’t been the only recent instance of an established superstar winning silverware. In last season’s NBA Finals, Steph Curry guided the Golden State Warriors to a fourth championship title in eight seasons – in the process picking up his first Finals MVP award as the Warriors beat the Boston Celtics.

In baseball, meanwhile, Aaron Judge enjoyed a season for the ages. The 30-year-old outfielder, who has reportedly just signed a nine-year, $360 million deal with the New York Yankees, hit 62 home runs last season, breaking Roger Maris’ single-season American League (AL) home run record from 1961.

On Wednesday, the Yankees named Judge, the reigning AL MVP, as the 16th captain in the franchise’s history.

Judge (left) hit a record-breaking 62 home runs last season.

But even as familiar faces have continued to shine, the past year has also seen future stars emerge.

The 19-year-old Carlos Alcaraz ends the year as the youngest No. 1 in the history of the men’s tennis having triumphed at the US Open, and in the women’s game, Iga Swiatek, who rose to No. 1 in the world following Ashleigh Barty’s decision to retire after winning the Australian Open, looks set to dominate for years to come.

This year, the 21-year-old Swiatek won her second grand slam title at the French Open – which came in the middle of a 37-match winning streak – and her third at the US Open.

In Formula One, Max Verstappen has cemented his position as the best driver in the sport, comfortably defending his world title with four races to spare, while Erling Haaland, regarded as one of the best strikers in European football, has been scoring goals at a record-breaking rate during his first season at Manchester City.

There was no stopping Max Verstappen this year.

At the Winter Olympics in Beijing, then-18-year-old freestyle skier Eileen Gu stole the headlines, winning two gold medals and a silver for the host nation; she also became the first freestyle skier to earn three medals at a single Olympics.

Another teenager, figure skater Kamila Valieva, had a memorable Games for different reasons. The 16-year-old tested positive for trimetazidine, a heart medication, in December 2021, but the result didn’t come to light until Valieva was already in Beijing and had won gold in the figure skating team event.

In that competition, she became the first woman to land a quadruple jump – which involves four spins in the air – at the Winter Olympics.

The outcome from the positive test remains unresolved, and in November, the World Anti-Doping Agency referred Valieva’s case to the Court of Arbitration for Sport after deeming the Russian Anti-Doping Agency had made no progress.

Eileen Gu performs a trick during the women's freestyle freeski halfpipe final at the Beijing Winter Olympics in February.

Russia’s invasion of Ukraine has cast a shadow over much of this year’s sporting calendar.

Athletes and teams from Russia and Belarus were banned from competitions across various sports, including qualification games for this year’s World Cup and participation at Wimbledon.

The decision from Wimbledon was perhaps the strongest stance taken by a sports organization, resulting in the ATP and WTA Tours removing ranking points from this year’s tournament.

At the start of the war, many Ukrainian athletes – like skeleton racer Vladyslav Heraskevych and MMA fighter Yaroslav Amosov – opted to put their careers on hold and support the country’s military efforts.

Boxer Oleksandr Usyk has also spoken passionately about serving his country, and in the ring has extended his undefeated record, beating Anthony Joshua in August to retain his WBA (Super), IBF, WBO, and IBO heavyweight titles.

Oleksandr Usyk lands a punch on Anthony Joshua during their

Throughout 2022, sport and geopolitics have been closely entwined. This month, WNBA star Brittney Griner returned home to the US having been detained in Russia for nearly 10 months on drug smuggling charges.

Despite her testimony that she had inadvertently packed the cannabis oil that was found in her luggage, Griner was sentenced to nine years in prison in early August and was moved to a penal colony in the Mordovia republic in mid-November after losing her appeal.

The 32-year-old’s arrest in Russia sparked diplomatic drama between the US and the Kremlin which played out alongside Russia’s war in Ukraine.

She was released in a prisoner swap that involved Russian arms dealer Viktor Bout. The exchange, however, did not include another American that the State Department has declared wrongfully detained, Paul Whelan.

Brittney Griner is seen getting off a plane in an undated photo posted to her Instagram.

Perhaps no sport has been as gripped by internal politics this year as much as golf, which was rocked by the launch of the Saudi-backed LIV Golf series in June.

LIV Golf has been criticized by some of the game’s leading players – including Woods and Rory McIlroy – while others – major champions Phil Mickelson and Dustin Johnson – have abandoned the PGA Tour in favor of the lucrative, breakaway series.

It has left the sport divided. Earlier this year, LIV Golf joined an antitrust lawsuit alongside some of its players, alleging that the PGA Tour threatened to place lifetime bans on players who participate in the LIV Golf series.

The suit also alleges that the PGA Tour has threatened sponsors, vendors, and agents to coerce players into abandoning opportunities to play in LIV Golf events.

The PGA Tour filed a countersuit in late September, claiming “tortious interference with the Tour’s contracts with its members.”

The LIV Golf series is backed by Saudi Arabia’s Public Investment Fund (PIF) – a sovereign wealth fund chaired by Mohammed bin Salman, the crown prince of Saudi Arabia and the man who a US intelligence report named as responsible for approving the operation that led to the 2018 murder of journalist Jamal Khashoggi. Bin Salman has denied involvement in Khashoggi’s murder.

LIV Golf’s launch is part of Saudi Arabia’s wider ambition to host and invest in global sports events. This year, it staged the rematch between Usyk and Joshua and even won a bid to host the 2029 Asian Winter Games.

But unquestionably, the most prominent sporting event held in the Gulf region this year has been the World Cup in Qatar.

The four-week-long tournament came to a thrilling conclusion on Sunday as Argentina lifted the trophy, bringing down the curtain on what FIFA president Gianni Infantino argued was the greatest World Cup of all time.

There were upsets, high-scoring games, and brilliant goals throughout – right up to Sunday’s showpiece when Messi reigned supreme and Kylian Mbappé scored a stunning hat-trick in a losing cause.

The match between Argentina and France at Qatar 2022 is being viewed as the greatest ever World Cup final.

It was the first time a country in the Middle East had hosted the World Cup, and Qatar, which has a population of just three million people, invested billions of dollars in building seven new stadiums, as well as new hotels and expansions to the country’s airport, rail networks and highways.

The tournament was also fraught with controversy, particularly when it came to allegations surrounding the country’s poor human rights record and treatment of migrant workers.

Since 2010, many migrant workers in Qatar have faced delayed or unpaid wages, forced labor, long hours in hot weather, employer intimidation, and an inability to leave their jobs because of the country’s sponsorship system, human rights organizations have found.

In the face of such criticism, Qatar has maintained it is an open, tolerant country and has seen the World Cup as a vehicle to accelerate labor reforms.

Elsewhere in international football, England won the Women’s European Championships for the first time in front of a record crowd on home soil, while Senegal claimed the Africa Cup of Nations (AFCON) title in February, also for the first time.

Outside international competitions, Real Madrid won its 14th European crown by defeating Liverpool in the Champions League final – a game that was marred by security issues.

Real Madrid defeated Liverpool in this year's Champions League final in Paris.

The match itself was delayed by more than 35 minutes after Liverpool fans struggled to enter the Stade de France and tear gas was used by French police towards supporters held in tightly packed areas.

Paris police chief Didier Lallement admitted in June that the chaos was “obviously a failure” and said he takes “full responsibility for police management” of the event.

Tragically, football has witnessed multiple serious stadium disasters this year. In October, more than 130 people were killed in a stampede in the Indonesian city of Malang – one of the world’s deadliest stadium disasters of all time.

Indonesia’s President Joko Widodo later said the country would demolish and rebuild the stadium, vowing to “thoroughly transform” the sport in the football-mad nation.

Players and officials from Arema Football Club gather to pray on the pitch for victims of the stampede at Kanjuruhan stadium in Malang.

A stadium crush in the Cameroonian capital of Yaoundé during this year’s AFCON also saw at least eight people killed and 38 injured during the game between Cameroon and Comoros.

Looking ahead to 2023, Australia and New Zealand is scheduled to host the Women’s World Cup in July and August.

The US Women’s National Team (USWNT) could become the first team to win the tournament three times in a row.

This year, the United States Soccer Federation (USSF), the USWNT’s Players Association (USWNTPA) and the United States National Soccer Team Players Association (USNSTPA) forged a landmark equal pay deal – the first federation in the world to equalize prize money awarded to the teams for participating in World Cups.

Next year will be the first time the USWNT has played a major tournament under such a deal.

Among the other major sporting events being held next year are the World Athletics Championshps in Budapest, Hungary, and the Rugby World Cup in France.

In the NFL, Super Bowl LVII in Glendale, Arizona is only weeks away, while the NBA Playoffs begin two months later in April.

With the men’s World Cup over, club football resumes in Europe and tennis’ first grand slam of the year, the Australian Open, begins on January 16.

For sports fans, that will hopefully serve as tonic to stave off the January blues.

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December 23, 2022

Pandemic fueled alcohol abuse, especially among women, but there are treatment options | CNN

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Editor’s Note: In the final two episodes of “This Is Life With Lisa Ling,” the series explores alcoholism in America (at 9 p.m. ET Sunday) and interracial marriages (at 10 p.m. ET Sunday).

CNN
—

Brook was 34 years old when her use of alcohol escalated, a way of coping with a breast cancer diagnosis.

“I just decided I’m not gonna go through this straight,” she told Lisa Lang in an episode of “This Is Life With Lisa Ling,” airing at 9 p.m. ET Sunday on CNN.

“I would drink before I went to my chemo sessions. It became more and more of a coping mechanism,” said Brook, who did not want to use her last name.

Brook survived the bout with cancer but says she became dependent on alcohol — and the pandemic only made it worse.

“When Covid started and I was home, I started drinking more and more and more,” said Brook, now 42. “I started not being able to eat, I started throwing up more often, and then I started throwing up blood.”

She recently ended up in the hospital, diagnosed with cirrhosis of the liver and a bad bleed from ulcers, which doctors said could take her life if not quickly treated.

“When they were talking to me afterwards, they said, ‘If you keep going like this, you’ll be dead in a year,’ ” Brook told Ling.

Alcohol use disorder is defined as compulsively using alcohol despite negative consequences on relationships and one’s ability to function at work, school or in the community. Over time, excessive alcohol use may even rewire the brain, making booze as desirable as natural rewards such as food or sex, experts say.

Researchers at University of California, Los Angeles showed pictures of alcoholic drinks to people who are and are not addicted while scanning their brains. Regions of the brain associated with craving, pleasure and reward lit up significantly more in those with an alcohol use disorder.

“It’s much more of a medical and brain disease than we initially thought,” Lara Ray, a clinical psychologist who runs the UCLA Addictions Lab, told Ling.

In addition, just one pint of beer or average glass of wine a day may begin to shrink the overall volume of the brain. The brains of nondrinkers who began consuming an average of one alcohol unit a day showed the equivalent of half a year of aging, according to a study published in March.

The damage worsens as the number of daily drinks rises, the study found — drinking four alcohol units a day aged a person’s brain by more than 10 years.

Alcohol use disorder is a growing problem in the United States, which experts say has been enhanced by the pandemic, especially among women.

“Last year, I took care of two women who were in their early 20s who had cirrhosis and needed liver transplants, and I’ve never seen that before in my entire career,” Dr. James Burton, medical director of liver transplantation at the University of Colorado School of Medicine in Aurora, told Ling.

A recent study found a significant increase in alcohol-associated liver disease and a 15% higher rate of waiting lists and subsequent liver transplants between 2020 and 2021 — the greatest increase occurred in young adults.

Since the pandemic’s onset, statistics show an overall 14% increase in the number of drinking days per month, but a “41% increase in heavy drinking days among women,” Dr. Sarah Wakeman, medical director of the Substance Use Disorders Initiative at Massachusetts General Hospital, told CNN in January.

Why? Pre-pandemic mom wine culture, which “normalized and even glorified” drinking, is partly to blame, said Dr. Leena Mittal, chief of the women’s mental health division in the department of psychiatry at Brigham and Women’s Hospital in Boston.

In addition, “studies have shown the complexities of balancing home, work and caregiving responsibilities during the pandemic have fallen disproportionately on women,” Mittal said earlier.

Women are especially sensitive to the effects of alcohol, according to the National Institute on Alcohol Abuse and Alcoholism. Alcohol-related problems appear sooner and at lower drinking levels than in men, said the institute, part of the US National Institutes of Health.

Women are more susceptible to alcohol-related brain damage and heart disease than men, and studies show women who have one drink a day increase their risk of breast cancer by 5% to 9% compared with those who abstain.

Pandemic lockdowns also forced many people to live and work from home — sometimes alone. A July study found drinking alone during adolescence and young adulthood can strongly increase the risk for alcohol abuse later in life, especially if you are a woman.

Victoria, who also did not want to use her last name, told Ling she began drinking as a teenager. Now 55, she still “can’t control it. It’s like a tension that builds up. And so then when I do drink, it’s like, ‘Ah! I’m drinking,’ you know, so it’s way too much, way too fast.”

Victoria says she continues to crave alcohol but goes regularly to support meetings for addiction recovery after moving in with her mother during the pandemic.

Binge drinking — defined as more than four drinks for women and five for men within a few hours — is on the rise. According to a study published in June, even older people who consider themselves moderate users of alcohol are downing multiple drinks in one sitting.

People who binged were about five times more likely to experience numerous alcohol problems, including injuries, emotional or psychological issues, and alcohol dependence at work or school or while caring for children, the study found.

“What this means is that an individual whose total consumption is seven drinks on Saturday night presents a greater risk profile than someone whose total consumption is a daily drink with dinner, even though their average drinking level is the same,” study coauthor Charles Holahan, professor of psychology at the University of Texas at Austin, told CNN previously.

The US Food and Drug Administration has approved only three drugs designed to reduce alcohol use since 1951: disulfiram, which causes headaches, nausea and vomiting when mixed with alcohol; acamprosate, which works on the reward centers of the brain to reduce alcohol cravings; and naltrexone, which reduces cravings and appears to help with heavy drinking.

There is help. Find it here

The National Institute on Alcohol Abuse and Alcoholism has a tool called the NIAA Alcohol Treatment Navigator that “helps adults find alcohol treatment for themselves or an adult loved one.” For teens, the institute recommends these resources.

The Substance Abuse and Mental Health Services Administration has a free, confidential National Helpline active 24/7/ 365 days a year to provide information and treatment referrals to local treatment facilities, support groups and community-based organizations: 800-662-HELP (4357) and 800-487-4889 (TTY option).

All three have significant side effects that can deter people from using them consistently.

Researchers continue to experiment with various drugs to see if they can help cure cravings without major side effects. While not FDA-approved, the anticonvulsant drug topiramate has shown promise in some clinical trials but may affect cognition and memory. Other anticonvulsant drugs, such as zonisamide and gabapentin, and a smoking cessation drug called varenicline have shown mixed results.

At Ray’s lab at UCLA, small clinical trials have found promising results from the neuromodulator ibudilast, which hindered cravings and reduced the odds of heavy drinking for some people by 45%.

For Billy Flores, 45, the change happened quickly.

“In the first two days, I was upset in the stomach, but by the third day I was on it, I was off of alcohol, which is pretty amazing I thought,” he told Ling about using ibudilast.

Bill has struggled with alcohol but says he has found hope with a clinical trial.

Additional studies are needed to see if the benefits hold true for larger populations.

In the meantime, there are gold standard treatments for alcohol use disorder that don’t involve medications. Those include Alcoholics Anonymous and Self-Management and Recovery Training 12-step programs, cognitive behavioral treatments and mindfulness-based approaches.

A large 2006 clinical trial found behavioral interventions can be as effective as drugs — in fact, most of the medication clinical trials done to date have also included some form of social or behavioral treatment in combination with drugs.

Having support is critical to keeping a positive mindset that will ultimately win the battle with alcohol, experts say.

Brook agrees.

“When I was doing my therapy intake for rehab, one of the questions was, ‘What made you decide to do this?’ And I said, ‘I’m better than this,’ ” she told Ling.

“I still like to think that even with the relapses, I’m gonna still be that person who gets right back up and tries again.”

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December 14, 2022

Making the case for an underappreciated but full-of-flavor ingredient | CNN

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CNN
—

Among foods that spark a strong reaction, anchovies are at the top of the food chain.

Whether they’re adored or abhorred, it’s difficult to find someone who doesn’t have a strong opinion about these small silvery swimmers.

Food writer Alison Roman wants the haters to think differently. Anchovies are more versatile than most people think and deserve to be approached with an open mind, according to Roman.

She might be biased — anchovies are one of her all-time favorite foods — but she has a strategy to change cooks’ minds.

“They’re more of a condiment than an ingredient,” Roman said. “To cook with them, you don’t need to eat them whole.” She incorporates anchovies into many of her dishes in the same way that she would add garlic, herbs or other flavorful aromatics. “Most of the time when I’m eating (anchovies), I can’t even see them.”

Even if you think your taste buds will rebel if you try an anchovy, your brain and heart will be happier if you do. “Anchovies are a small but mighty fish,” said Michelle Dudash, registered dietitian, nutritionist and author of “The Low-Carb Mediterranean Cookbook.”

“They’re packed with the omega-3 fatty acids DHA and EPA, which are important for brain, cardiovascular and skin health,” she added. Anchovies are on par with salmon and tuna as one of the fish with the highest amounts of omega-3s per serving, and are a good source of protein, niacin and vitamin B12.

Following Roman’s lead of using anchovies as one of many elements in a dish instead of as the spotlight ingredient, cooks who want to incorporate anchovies into meals “can start small,” Roman suggested. “They don’t have to dump a whole jar into their salad.”

Here are three ways Roman likes to introduce anchovies to the wary but curious. Ready to change your “anchoview”? Read on.

Move over, ranch dressing — there’s another dip in town. Bagna cauda, the Italian dipping sauce made from anchovies, garlic, butter and olive oil, is traditionally served with crudités as an appetizer.

Roman loves using bagna cauda as a vehicle to introduce unsuspecting dinner guests to anchovies because it hits the taste trifecta of “salty, buttery, garlicky” flavors. “It’s mostly about garlic and vegetables,” Roman said. In addition to the traditional accompaniment of raw, crunchy vegetables, she likes to include steamed artichoke hearts and tender cooked potato slices.

Bagna cauda is also an answer to the ever-present question about anchovies: What about the bones? “They are so tiny, they mostly all melt” and dissolve into the dish when heat is applied, Roman said. “They’re not going to choke you.”

“High-quality anchovies shouldn’t have many bones,” she added, and they should not be noticeable like they would be in larger fish, such as a salmon fillet. If you happen to see many bones in your anchovies, “spring for a more expensive tin,” Roman said.

If the presence of whole anchovies resting atop a bed of romaine in a Caesar salad has been historically too much to handle, Roman’s Caesar-adjacent salad will be a refreshing revelation.

Roman likes to pair bitter greens from the chicory family, such as radicchio, with a dressing that can stand up to their strong flavors. “I put anchovies in my salads all the time,” she said, but when hidden in the dressing, they add body and nuance without overpowering any of the other ingredients with which they’re paired.

Anchovies in a dressing can add body and nuance to a salad without overpowering other ingredients.

Her preferred dressing blends finely chopped anchovies and capers with lemon, whole grain or Dijon mustard, and good quality olive oil. “It’s anchovy-heavy but more about the mustard and the garlic,” Roman explained, which she finds “meatier and saltier and more interesting” than the usual Caesar dressing.

Finally, the same strategy of dissolving the umami flavors of anchovies in a sauce comes into play when making a rich and comforting pasta. Based on the Venetian dish bigoli in salsa, in which long strands of thick bigoli pasta are tossed with slow-simmered onions and anchovies, Roman’s version can be used with any long, thin pasta.

Pasta alla puttanesca features garlic, olives, capers, tomatoes and anchovies.

Roman adds whole anchovies and chopped dried chili pepper to a skillet of sliced onions, garlic and fennel caramelized in olive oil. The whole fillets might look intimidating, but as with the bagna cauda, the anchovies melt and dissolve as the sauce simmers, leaving only a rich and meaty undertone. Finishing the dish with freshly squeezed lemon juice and parsley brightens up the intense sauce.

A free-form pasta sauce such as this lets you adjust the flavor balance based on what you like best. If you love lemon, squeeze more on. If fennel isn’t your favorite, use more onions instead. If you like it spicy? Amp it up with more chili pepper. “Gauge your own personal preferences,” Roman recommended.

When choosing a tin or jar of anchovies, Roman said to make sure the anchovies are oil-packed, salt-cured anchovy fillets, not brined, pickled or whole anchovies. The former is the most common style of jarred or canned anchovies on the market, but it always pays to double-check the label.

Second, “always try a bunch of brands. They really are all different,” Roman said. Though the ingredients in each container should be the same — anchovies, salt and olive oil — the fillets will vary in saltiness, taste and texture. “Ortiz and Cento are available nationally,” she said, and many other brands are available in brick-and-mortar and online specialty food stores.

One note on the salt-curing: “The only downside of anchovies is the sodium,” Dudash noted, since they are packed in salt during the curing process. “If you are concerned about your sodium intake or if you simply prefer less salty food, briefly rinse the anchovies and pat dry with a paper towel” before using them.

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December 11, 2022

Home delivery of medications can help improve access, especially when time is tight | CNN

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CNN
—

Covid-19 hospitalizations are on the rise in the United States, with more than 34,000 new admissions last week, but millions of vaccines and doses of antiviral treatments that could help prevent severe outcomes from the virus remain unused.

Research has found that many who could benefit most from the Covid-19 medication Paxlovid – including the elderly and Black and Hispanic people, groups that have disproportionately had the most severe illness – are less likely to take it.

As the supply of Paxlovid has grown, efforts have been made to improve timely, equitable access to the treatment.

“The driving distance to the nearest site or the geographic accessibility of the places where Paxlovid is being offered doesn’t seem to be the primary driver of why these populations are not getting the treatments they need,” said Dr. Rohan Khazanchi, a resident at Harvard Medical School and health equity consultant for the New York City health department.

Transportation is one significant barrier to health care access for many people, experts say, but creating equitable outcomes will involve a much more comprehensive approach.

In response to the White House’s call for pharmacies to help make this winter a healthier one for Americans, Walgreens launched a program Thursday in partnership with DoorDash and Uber Health that offers free home delivery of Paxlovid for those with a prescription. The initiative is meant to increase access to Covid-19 treatment, particularly for those in socially vulnerable or medically underserved communities.

Millions of Americans get prescriptions through the mail, a service that research has shown is used more frequently among seniors, adults with poor health and others who are also at high risk of severe outcomes for Covid-19.

But Paxlovid is most effective when taken within five days of symptoms starting, making timely treatment a critical piece of the puzzle and traditional mail-order delivery too slow.

Walgreens also plans to expand the service to include HIV treatment – in line with the Biden administration’s goals to accelerate efforts to end the HIV/AIDS epidemic in the US.

As with Paxlovid, early uptake is key with HIV treatment. And people who miss doses of HIV treatment risk developing drug resistance, making it crucial that they stick with the prescription.

“There are places across the patient journey that would divert a patient from being able to get treated and back to feeling better. But that’s where our teams have been working on really understanding that patient journey and then offering and identifying solutions to help address that,” said Rina Shah, vice president of pharmacy strategy at Walgreens.

Rite Aid adopted a prescription delivery program during the Covid-19 pandemic through a partnership with ScriptDrop. Service fees are currently waived for all eligible prescriptions, which excludes controlled substances and refrigerated medications but includes Paxlovid.

CVS also has one- or two-day delivery in most locations and on-demand delivery at some, which is provided free to people enrolled in the membership program.

In March, the Biden administration launched a federal Test-to-Treat initiative that streamlined access to Paxlovid for people who had Covid-19, with testing and prescribing all happening in one visit. In May, the program was broadened to specifically reach more vulnerable communities.

Khazanchi was author of a study published last month that found that Black and Hispanic people were more likely to live closer to Test-to-Treat sites than White people. But despite the physical proximity, these groups were less likely to get outpatient Covid-19 therapeutics – even though they’re at elevated risk of infection and severe disease.

Even if someone has a car or another way to get to the doctor’s office, pharmacy or other Test-to-Treat location, they’re often challenged by the time required to make that trip, said Dr. Rachel Werner, executive director of the University of Pennsylvania’s Leonard Davis Institute of Health Economics.

“It’s a combination of things that prevent access to care,” said Werner, whose research has focused on health equity. “Often, people have to take time off of work to do that, and they don’t always have paid sick leave. Everyone’s lives are complicated, and sometimes it’s hard to balance competing priorities.”

According to a report from health analytics company IQVIA, 9% of all new prescriptions in 2019 were “abandoned” at pharmacies, representing a gap in physician-recommended care that was not received by the patient. But home delivery programs that have expanded throughout the Covid-19 pandemic may help.

“I think it may be important to think about other medications or conditions where the time to treatment really matters. And those may be the ones that I think would be ripe for this kind of home-based delivery system,” Werner said. “These are urgent things that people might otherwise show up to an urgent clinic or ER for and instead could just get a medication.”

With the expansion of things like telehealth and options for home care, experts say, the Covid-19 pandemic helped widen the picture of what health care can look like.

“For far too long, we’ve been bound by the idea that health care is something that occurs within the four walls of a hospital or clinic,” Werner said. “What the Covid pandemic really did, which is important, is it made people realize that health care should be accessible where and when people need it, and it doesn’t have to be delivered in the physical structure of a health care setting.”

Experts say that while it’s critical to break down barriers in terms of access to medication, it’s important to also address the issue of trust.

In the research about accessibility to Test-to-Treat sites, Khazanchi and his co-authors suggested that programs should leverage trusted community stakeholders like local health-care providers for in-person outreach and other “low-tech, high-touch” methods to ensure equitable use.

Dr. Kedar Mate, president and CEO of the Institute for Healthcare Improvement and assistant professor at Weill Cornell Medical College, thinks about it in terms of supply and demand.

“Getting treatments to people who need them is principally an issue around access and ensuring that the supply goes to where the people are,” he said. “There’s a different problem, though, on the demand side. Are patients willing or interested to get tested and then get treated if they are found to be positive? That has everything to do with a totally different set of challenges which have to do with trust, information, disinformation, misinformation and belief in the health system overall.”

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December 10, 2022

LeBron James and Billie Jean King lead tributes to American journalist Grant Wahl | CNN

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CNN
—

The death of prominent journalist Grant Wahl at the World Cup in Qatar has led to an outpouring of shock and grief across the sports world, with NBA star LeBron James and tennis great Billie Jean King leading the tributes to the American.

Prominent American journalist Grant Wahl has died in Qatar after collapsing while covering the World Cup, sparking an outpouring of shock and grief across the sports world. He was 49.

King said Wahl’s death was “heartbreaking.”

“A talented journalist, Grant was an advocate for the LGBTQ community & a prominent voice for women’s soccer,” King tweeted Saturday. “He used his platform to elevate those whose stories needed telling. Prayers for his family.”

On Friday in Philadelphia, basketball star James said he had been “very fond of Grant.” While Wahl was at Sports Illustrated, he did a cover story on James when James was in high school.

“I’ve always kind of watched from a distance even when I moved up in ranks and became a professional, and he went to a different sport,” said James, speaking at a postgame press conference. “Any time his name would come up I’ll always think back to me as a teenager and having Grant in our building … It’s a tragic loss.”

Tyler Adams, the captain of the US men’s national soccer team, which was knocked out of the World Cup by the Netherlands in the last 16, sent his “deepest sympathy” to Wahl’s wife, Celine Gounder, and to those who knew him.

“As players we have a tremendous amount of respect for the work of journalists, & Grant’s was a giant voice in soccer that has tragically fallen silent,” Adams wrote on Twitter.

Qatar’s World Cup organizers said on Saturday that Wahl “fell ill” in the press area, where he received “immediate medical treatment on site.”

He was then transferred to Hamad General Hospital, said a spokesperson for the Supreme Court Committee for Delivery and Legacy, the body responsible for planning the tournament.

Wahl was treated in the stadium “for about 20-25 minutes” before he was moved to the hospital, Keir Radnedge, a columnist at World Soccer Magazine, told CNN Saturday.

“This was towards the end of extra time in the match. Suddenly, colleagues up to my left started shouting for medical assistance. Obviously, someone had collapsed. Because the chairs are freestanding, people were able to move the chairs, so it’s possible to create a little bit of space around him,” Radnedge said.

He added that the medical team were there “pretty quickly and were able to, as best they could, give treatment.”

White House Press Secretary Karine Jean-Pierre reacted to Wahl’s death on Saturday, adding that senior State Department officials were in touch with Qatari officials and Grant’s family.

“Grant Wahl was an inspiration to many. Our thoughts are with his wife Dr. Céline Gounder and all those who loved him. State Department officials are in touch with Grant’s family and with senior officials in the government of Qatar to ensure his family gets the support they need,” Jean-Pierre wrote on Twitter.

“Only some days ago, Grant was recognized by FIFA and AIPS (the International Sports Press Association) for his contribution to reporting on eight consecutive FIFA World Cups,” said FIFA President Gianni Infantino in a statement.

Infantino and FIFA media director Bryan Swanson were at the hospital on Saturday to offer any kind of support needed for the family, friends, and the journalists who were also his housemates in Qatar.

The co-editors in chief of Sports Illustrated, the publication where Wahl spent the majority of his career, said in a joint statement they were “shocked and devastated at the news of Grant’s passing.”

“We were proud to call him a colleague and friend for two decades – no writer in the history of (Sports Illustrated) has been more passionate about the sport he loved and the stories he wanted to tell,” said the statement.

It added that Wahl had first joined the publication in November 1996. He had volunteered to cover the sport as a junior reporter – back before it reached the heights of global popularity it now enjoys – eventually becoming “one of the most respected soccer authorities in the world,” it said.

The statement said that Wahl also worked with other media outlets including Fox Sports. After leaving Sports Illustrated in 2020, he began publishing his podcast and newsletter.

Other current and former US soccer players, including Ali Krieger and Tony Meola, shared their condolences, as did sporting bodies such as Major League Soccer and the National Women’s Soccer League.

Wittyngham, Wahl’s podcast co-host, told CNN on Saturday the news of his death had been hard to fathom.

“For Americans, Grant Wahl is the first person you read covering soccer. He was kind of the only person for a while … Grant was the first person who really paid genuine attention to this sport in a meaningful way,” Wittyngham said.

Several journalists shared stories of reporting alongside Wahl, and having encountered him at multiple World Cups over the years.

“Before he became the best covering soccer he did hoops and was so kind to me,” wrote famed broadcaster Dick Vitale.

Timmy T. Davis, the US Ambassador to Qatar, tweeted that Wahl was “a well known and greatly respected reporter who focused on the beautiful game.”

“The entire US Soccer family is heartbroken to learn that we have lost Grant Wahl,” US Soccer said in a statement on its official Twitter account.

“Grant made soccer his life’s work, and we are devastated that he and his brilliant writing will no longer be with us.”

US Soccer praised Wahl’s passion and “belief in the power of the game to advance human rights,” and shared its condolences with Wahl’s wife, Celine Gounder, and his loved ones.

Gounder also posted the US Soccer statement on Twitter.

“I am so thankful for the support of my husband Grant Wahl’s soccer family and of so many friends who’ve reached out tonight. I’m in complete shock,” wrote Gounder, a former CNN contributor who served on the Biden-Harris transition Covid-19 advisory board.

US State Department spokesperson Ned Price said the department was in “close communication” with Wahl’s family. The World Cup organizers also said they were in touch with the US embassy “to ensure the process of repatriating the body is in accordance with the family’s wishes.”

Wahl wearing a rainbow-colored t-shirt while working at Qatar 2022.

Wahl had covered soccer for more than two decades, including 11 World Cups — six men’s, five women’s – and authored several books on the sport, according to his website.

He had just celebrated his birthday earlier this week with “a great group of media friends at the World Cup,” according to a post on his official Twitter account, which added: “Very thankful for everyone.”

In an episode of the podcast Futbol with Grant Wahl, published days before his death on December 6, he had complained of feeling unwell.

“It had gotten pretty bad in terms of like the tightness in my chest, tightness, pressure. Feeling pretty hairy, bad,” Wahl told co-host Chris Wittyngham in the episode. He added that he sought help at the medical clinic at the World Cup media center, believing he had bronchitis.

He was given cough syrup and ibuprofen, and felt better shortly afterward, he said.

Wahl also said he experienced an “involuntary capitulation by my body and mind” after the US-Netherlands game on December 3.

“This isn’t my first rodeo. I’ve done eight of these on the men’s side,” he said at the time. “And so like, I’ve gotten sick to some extent at every tournament, and it’s just about trying to find a way to like get your work done.”

He further described the incident in a recent newsletter published on December 5, writing that his body had “broke down” after he had little sleep, high stress and a heavy workload. He’d had a cold for 10 days, which “turned into something more severe,” he wrote, adding that he felt better after receiving antibiotics and catching up on sleep.

Wahl had made headlines in November by reporting that he was detained and briefly refused entry to a World Cup match because he was wearing a rainbow t-shirt in support of LGBTQ rights.

He said security staff had told him to change his shirt because “it’s not allowed,” and had taken his phone. Wahl said he was released 25 minutes after being detained and received apologies from a FIFA representative and a senior member of the security team at the stadium.

Afterward, Wahl told CNN he “probably will” wear the shirt again.

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