Italy"s Five Star Movement blamed for surge in measles cases

An Italian health official has blamed an alarming rise in measles cases on the populist Five Star Movement (M5S), which has campaigned on an anti-vaccination platform and has repeated discredited links between vaccinations and autism.

According to the health ministry, more than 700 cases of the highly contagious disease have been registered so far in 2017, compared with 220 for the same period last year and 844 in the whole of 2016.

The surge in the number of cases follows a drop in the proportion of two-year-olds given vaccinations from 88% in 2013 to 86% in 2014 and 85.3% in 2015 – well below the 95% threshold advised by the World Health Organisation.

In 2015, the M5S proposed a law against vaccinations because of “the link between vaccinations and specific illnesses such as leukaemia, poisoning, inflammation, immunodepression, inheritable genetic mutations, cancer, autism and allergies”.

Writing on his blog the same year, the party’s leader, Beppe Grillo, said: “Vaccines have played a fundamental role in eradicating terrible illnesses such as polio, diphtheria and hepatitis. However, they bring a risk associated with side-effects that are usually temporary and surmountable … but in very rare cases, can be as severe as getting the same disease you’re trying to be immune to.”

The outbreak of measles this year has been mostly concentrated in the wealthy regions of Piedmont, Lazio, Tuscany and Lombardy. Some doctors in these areas have been actively encouraging parents not to give their child the injection. Turin in Piedmont and Rome in Lazio both elected M5S mayors last June.

Raniero Guerra, the director general for preventive health at the ministry of health, told the Guardian: “People from the M5S say measles is normal, and that every three years we have a peak, so why is it dangerous? Well, I say it’s not normal to have peaks or outbreaks – we are supposed to be a measles-free country.”

Italy’s health minister, Beatrice Lorenzin, issued a strong defence of vaccinations. Photograph: Emmanuel Dunand/AFP/Getty Images

Last week, Beatrice Lorenzin, Italy’s health minister, issued a strong defence of vaccinations in response to the new figures.“The only weapon we have against serious diseases such as measles is vaccination: enough with the false information. There is no correlation between vaccines and autism,” she said.

Andrea Liberati, an M5s official in the Umbria region, said the nationwide rise in measles cases was the result of confusing information.

“It’s not that we’re entirely against vaccines, but the government needs to send out a clearer message; parents are very confused by the contradictory information,” he said. Liberati also claimed: “There is obviously [also] a commercial element to this, and need for big pharma companies to make money.”

Asked in November last year about some of the less mainstream theories the party has supported, M5S MEP Laura Ferrara denied it opposed vaccinations, but said it wanted to urge parents to be more vigilant about which vaccines they gave their children.

Italians’ perception of the safety of vaccinations was heavily influenced by now-discredited claims of a connection between the combined measles, mumps and rubella (MMR) vaccination and autism. In a high-profile case in 2012, a court in Rimini awarded compensation to the family of an autistic child after ruling that the child’s autism was probably caused by the MMR jab, which played into parents’ fears even though the judgment was quashed on appeal three years later.

These fears, combined with a lack of trust in mainstream politicians, have left many parents agonising over whether to vaccinate their children.

Michele Marchesani and his wife struggled to decide whether or not to inject their daughter, now 15, against measles. They eventually agreed not to, a decision influenced in part by the seven years Marchesani, a physiotherapist, had spent working with an autistic boy.

“His parents believed that the autism was caused by the measles vaccination,” he said. “They campaigned and tried to take it to court, but didn’t get anywhere with it … I would trust the injection more if, say, a friend convinced me it was the right thing to do, but not when it comes from a politician.”

Elettra De Marches, a mother of 16-year-old twins, also shunned the jab. “My children both had measles,” she said. “It’s a manageable disease. There is no need for an injection, it’s just for commercial purposes.”

Initial symptoms of measles include fever, red eyes and sensitivity to light, greyish white spots in the mouth and throat and cold-like symptoms. The measles rash typically appears after two to four days. The disease can be very debilitating, and although most people recover fully, it can have very serious complications, including blindness and death.

The Italian government is striving to address unfounded fears over vaccinations as part of a new strategy focusing on social media.

“The usual institutional lines of communication do not work,” Guerra said. “The value of immunisation needs to be communicated in a language that is easily understood by younger parents, as that is where the biggest concentration of hesitation is right now.

“We’re talking about letting them know what appropriate information they can access, rather than using whatever rubbish is published on the internet – because that’s another issue.”

The government is also looking into ways of prosecuting doctors who actively persuade parents against the jab. “This is unacceptable … it’s close to being a crime,” added Guerra.

Italy"s Five Star Movement blamed for surge in measles cases

Jakarta"s Rat Eradication Movement: public offered cash reward for live rats

Samin climbed down into the darkness of the sewer, homemade catapult in hand. He wasn’t using stones this time, concerned they might kill his prey. Instead he formed small balls from damp mud, just enough to stun the rats and get them into a rusty wire cage. The plan was to smoke them out. He threw a fistful of lit rags down the tunnel and waited.

That night, despite an evening thunder storm, the square outside Cakung district administrative office in East Jakarta was packed with street cleaners carrying an assortment of old birdcages and traps made from wire or discarded water dispenser bottles. A good haul for one afternoon – 650 live rats – many of them more than two feet long.

Civil servants in khaki uniforms gathered round to record the scene on smartphones as workers in protective suits and masks vigorously shook the squealing contents of each cage into a pair of steel drums to be gassed with sulphur. Shouts and screams went up whenever a rat escaped, zigzagging through the crowd of legs to get back to the sewer. A few made it. Most were stamped to death.

Samin with the homemade catapult he used to stun and catch six rats

Welcome to the Rat Eradication Movement, a fledgling city programme to rid the Indonesian capital of its rodent problem. It’s the idea of deputy governor Djarot Saiful Hidayat, who has offered the public a bounty of 20,000 rupiahs (£1.20) for each live rat – a generous incentive in a country where 40% of the population live on less than $ 2 a day. Collecting the rats alive stops people claiming rewards for dead rodents found in the street, and allows officials to ensure none have been poisoned or shot, which they fear could be dangerous to the public.

Cats used to catch them but now the rats are bigger than them

Murad Husein

Jakarta recorded 40 cases last year of Leptospirosis – a bacterial infection from rat urine which can be deadly to humans – with the situation made worse by the city’s frequent floods. While rodent populations are highest near markets and their ready supply of waste food, they can be seen almost anywhere in the city. Rats have been spotted in courthouses and government offices, exclusive apartment blocks and expensive restaurants. Wander the streets at 3am and rats can be seen scurrying in and out of drains. They don’t seem too scared of people.

The rats gnaw through plastic drainage pipes and electrical wires. It is both a fire hazard and an expensive problem to fix as a broken pipe or chewed through wire could be anywhere – outside, inside or under – that a rat can get.

A resident shows off the 200,000 rupiahs he earned for catching 10 live rats during a pilot programme in Kemayoran, Jakarta, last month. Photograph: Alez Kurniawan

Funding for the programme currently comes from Djarot’s own budget, and full operation will not start until after city elections in February. He is standing on a ticket with Jakarta governor Basuki ‘Ahok’ Tjahaja Purnama, who was last week named as a suspect in a blasphemy investigation.

A similar pilot evening two weeks ago in the sub-district of Kemayoran yielded 200 live rats. Djarot, who was there to supervise the operation and distribute money to the moonlighting cleaners and ojek motorcycle-taxi drivers who caught the rats, said the city’s rodent population had until now been “uncontrollable”. Ojek driver Sutikno earned 100,000 rupiah after catching five rats with fishing nets and traps. “It’s good money. I’ll do it again,” he said.

Some, though, worry the programme could backfire in a phenomenon economists call the Cobra Effect, where cash rewards lead to unintended consequences.

Workers in protective clothing gassed the rats with sulphur. Photograph: Alez Kurniawan

The term was coined by German economist Horst Siebert, whose book of the same name contained an anecdote about attempts by colonial authorities in India to rid Delhi of cobras. When the British official in charge placed a bounty on the snakes, some enterprising locals started farming them. The scheme proved ineffective and was eventually cancelled. At that point the cobra farmers, faced with an unwanted stock of snakes, released them into the countryside around the city. The supposed solution had made the problem worse.

A similar situation has been documented by historian Michael Vann. His account of “the Great Hanoi Rat Massacre” tells of attempts by French colonial rulers to control rat populations in the Vietnamese city. New sewers in the wealthy European section unwittingly created a secret underground transportation network for the rats, where they were protected from predators, and the dark tubes provided an ideal breeding ground. They could make their way across the city, with flushable toilets in the poshest homes acting as a convenient entry point.

Authorities offered a cash reward to the public, paying out on production of a rat tail to make administration of the scheme easier. Soon residents were turning in tails in huge numbers – tens of thousands a day – but it wasn’t long before tail-less rats became an increasingly common sight.

“[Officials realised residents] were catching rats, but merely cutting off the tails and letting the still-living pests go free – perhaps to breed and produce more valuable tails,” Vann said. “Later, things became even more serious as health inspectors discovered a disturbing development in the suburbs of Hanoi. These officials found … individuals were actually raising rats to collect the bounty.” The scheme was declared a failure and scrapped.

Could Jakarta’s Rat Eradication Movement end up creating similar unintended consequences? Currently the scheme is nowhere near the scale of Hanoi’s Great Rat Massacre and there seems no shortage of genuine sewer rats, but Benvika, head of wildlife at the Jakarta Animal Aid Network, is not convinced by the project.

He advocates a return to a more natural balance, with predators such as snakes and owls used to control rodent populations. “The sulphur gas is not immediately lethal and causes unnecessary suffering,” he added. “The people of Jakarta must return to living healthily, and maintain their environment.”

Overseeing the Cakung operation was the vice-mayor of East Jakarta, Murad Husein. “Cats used to catch them but now the rats are bigger than them,” he said. “Without any predators the rat population has got bigger, and so have the rats themselves. We’ve no idea how many there are but you can see them almost anywhere, night or day.”

Additional reporting by Linda Hairani

Jakarta"s Rat Eradication Movement: public offered cash reward for live rats

Your Workout Isn’t Healthy: The Problems With Modern Movement

You’re dedicated. You’ve been working up a sweat five days a week. You’re determined to shift the weight and tone up. You’ve read the articles and booked the personal trainer. But there’s something you should know: fitness isn’t just about your physique. The truth is, there’s a very real possibility that your workout isn’t healthy. The problems with modern movement are just starting to come to the fore.

The fitness industry is worth an estimated 30 billion dollars. Increased availability of neon tennis-shoes, designer lycra, and high-tech fit bands that monitor your heart rate, sleeping patterns and caloric expenditure have made getting pumped both fashionable and lucrative. It’s booming business venture and a cultural obsession.

But it’s not necessarily the Saint of Good health we all thought it was.

Amongst the popular propensity to “work out”, “get fit”, and “shape up”, there is often a lack of consciousness – a disconnect between mind and body – that renders modern movement problematic. Stripped back to the primitive basics, strength isn’t just muscles, and fitness isn’t just physique.

In fact, hard core fitness fanatics may be first in line for injury, adrenal fatigue, and systemic dysregulation.

The relationship between humans and purpose-orientated movement is steeped in biology, history, culture, and vogue appeal. Though it is inextricably linked to health and wellbeing, a sense of separation has been created between our segregated exercise routines and movement as an ongoing practice.

In fact, some believe this detachment has seen the rise of Junk Food Movement; physicality that essential looks and feels like the real deal, but ultimately does not serve the body. This sets the scene to potentially generate patterns and habits that are counter-productive.

Instead of allowing movement to become a form a communication with ourselves, we cut the phone lines, and the brain-body disconnect can lead to serious health issues.

Lack of desired fitness results may encourage a determined, but mindless, tenacity. Though technically fit, this may cause the athlete to get hurt, sick, or deeply discouraged.

The concept of fitness is often misconstrued as – and used interchangeably with – muscular capability. However, true fitness is the marriage of physical, neural, spiritual, and immune strength that compose a singularly adept body.

In order to recognize how to implement a more holistic methodology into your routine, it is imperative that you remove yourself from the established aesthetic that dictates how pop-fitness is practiced. Our intrinsic instinct to move has been taught out of us in favor of the more stylized and clinical approach – based on specific results – that we are familiar with today. It often has very little to do with health.

There is much more to the recipe than bodacious bubble butts and prodigious pectorals.

Chasing this ideal image has become such an integral part of working out, that the pursuit and outcome itself may be at the expense of practical functionality. Basic actions like bending over and kneeling down can be compromised due to muscle mass developed in an impractical structure. The body is trained to accomplish a look, as opposed to a function. General competency decreases with muscular isolation, intense regimen specialization, and competition based fitness. The obvious strength manifests into sneaky, long term weaknesses.

It’s no coincidence that resolve quickly wanes after enthusiastic New Year’s resolutions fade into the (not so distant) past. Achieving glossy magazine fitness goals can be deceptively difficult. The cyclical ebb and flow that so often accompanies the determination to tackle the holiday hips and boost those buns is not simply the annoying subject your mother always brings up over a Sunday dinner.

Calories, treadmills and double helpings of double chocolate brownies aside, there is a distinct lack of several key components to the contemporary exercise model that are likely thwarting best efforts to prove your mother wrong:

• Balance


• Mindfulness


• Stimulus


• Fulfillment and Practicality


• Connective Tissue Support


• Nervous System Integration


• Movement Complexity


• Green space

It is not a simple case of doing things incorrectly or adhering to the wrong denomination of discipline; a gentle shift in perspective is all that is needed. Striving for a particular shape, as opposed to a state of being, is a road rife with stress, disappointment, and unrealistic expectation.

Modern body manipulation has become such a stilted, constructed, and restricted formula. Even the most devoted athletes and enthusiasts will struggle to reconcile their fitness protocol with a genuinely healthful, integral, and sustainable flow.

Instead of seeing living and working out as separate entities, integrating the two into a dynamic life structure is a far more natural and satisfying approach. Contrary to angling for the ultimate abs, consider instead that a capable, lean, healthy, fit body is the byproduct of a holistic venture. Shift the focus from developing absolute abs to mastering movement, and the results will be significant and sustainable.

Fulfillment and Practicality

Stagnation is the mother of dissatisfaction. In order for fitness to transfer over to a sense of sustained fulfillment, reconsider the quest for lethal lats as the acquisition of new skills. Bicep curls may bulk you up, but that basic movement isn’t likely to translate practically into the real world; 50 reps     won’t make picking up the phone any easier than it already is.

Instead, build proficiency, not just muscles. Think about engaging in movement that serves your whole body in multiple ways, over a long period of time – not just during the clinical trial in the gym laboratory.

It is helpful to establish clear goals in this instance. Focus on a specific, practical application or set of actions that you want to be able deftly accomplish. Instead of a built frame, focus on what you need to accomplish; safe manipulation of heavy objects, hiking long distances with a pack of provisions, easily picking up growing     children, or cycling to work instead of driving.

Connective Tissue Support

While sporting the brawn of a Viking god has its advantages, carrying around packs of meat does require some forethought. Without the support of a solid connective tissue network, not only are you more prone to injury, but balance, flexibility, agility, and adaptability are distinctly reduced. Pure strength does not equate to pure fitness, and bulk can become inhibitive to function.

It takes time to build this network, but it is imperative for full fitness realization. An avid routine can affect muscle change within a 90 day window. However, connective tissue functions at 1/10th the metabolic rate of muscle production, and takes between 200 and 210 days to catch up.

Give yourself a literal leg up in this department by implementing a comprehensive and dynamic stretching practice. A complex diet involving plenty of collagen, glucosamine, glutamine, sulfate, and bioflavenoids will fuel your cells and give you the necessary building blocks to ramp up connective tissue production.

Balance

Balance begets balance. By striving for muscular and movement balance, you will also create strength and agility equilibrium. You will be more adaptive, quicker to recover, and create a more capable network of cells.

Think of the human vehicle in three separate sections: top to bottom, left to right, front to back. Developing a sense of awareness about section dominance is the first step to biological equity. Devising a workload that tests all sides of your body in equal measure will provide broad spectrum stability and transferable skill.

The popular tendency to focus on spot reduction/toning is not conducive to comprehensive competency, but reverts back to that less practical aesthetic.

Stimulus

Boredom is the ring bearer of fitness failure. Lack of stimulus will almost certainly result in a shortage of enthusiasm and interest,     while increasing the likelihood of plateauing or abandoning ship altogether. If you begin to suffer from ennui, your workout will become a judgment against yourself, and you will begin to associate movement with punishment. This can launch a cycle of guilt and blame, that ultimately damages self confidence – a strictly     unhelpful and unnecessary addition to the mix.

Diversified and engaged hustle is key to avoiding the stimulus slump. Simply taking an old routine and busting a gut it in an entirely new environment will help to liven up the gaps that repetition creates.

Mindfulness

The spiritual aspect to physical training can be deeply profound. While negative mind-chatter will automatically focus on thoughts of pain and difficulty, choosing to move mindfully engages the     subconscious, emotional self to welcome transformation.

With a sense of kindness and acceptance, use purpose and goals to guide your journey – as opposed to mercilessly slogging to fit the popular mold. Mindless movement denies the natural essence of your physicality, and it also taking a risk; it is perfectly possible to strengthen your deficiencies and dysfunctions if undertaken with the wrong mindset. Consider that some movement may not be best suited to your body. Forcing the issue may just be enforcing incorrect form or action.

Resist the urge to resist. Connect to the beauty and freedom of flow, and find meaning. Listen to your body. If you are chronically fatigued, perpetually plateaued, or dissatisfied, the harder/stronger/faster approach isn’t necessarily your friend.

In fact, a little R&R may be the missing component to your ideal, healthy bod. Tend to the mind, then the body.

Nervous System Integration

Neuro-plasticity is a crucial, and often overlooked component of overall fitness. In the sterility of a gym environment, it is difficult to maintain a diverse routine that challenges both mind and body. However, even if it is capable of building and sustaining muscle mass, repetitive movement will not teach your nervous system to grow and develop with your body.

Instead, expand your physical vernacular.

By engaging in exercises that improve coordination, you encourage and reinforce secondary motor skills that support you during and after a sweet sweat session. By taking an ordinary activity and enhancing it by changing up any number of predictable aspects – shape, weight,     distance from your body, performing on an uneven surface, catching and throwing during an otherwise static exercise – will improve your ability to move effectively in a changing environment.

Movement Complexity

Improve cognitive function with dynamic fitness. Think of it as brain training; the more complex the movement, the more complex the brain activity. Complicated sequences increase synaptogenesis, which is the number of synapses taking place between neurons. This means, the more fireworks set off, the better.

Tree and rock climbing, coordination builders, and quick-fire accuracy based activities will all     provide strong connections to build brain-body vitality. Parkour is an excellent exercise alternative  to explore.

Green Space

The healing aspects of kicking butt in a green space are scientifically proven to boost well-being. Termed “Forest Bathing” by Japanese rangers in the eighties, performing any sort of movement  based activity in a green space will automatically stimulate all of the senses, providing a thoroughly immersive experience.

This heightened awareness also contributes to enhanced neurological connections, teaching and satisfying your brain at the same time. The dynamic, unexpected terrain will further facilitate coordination and reflexes, effectively involving several of the above points in one lithe leap.

Further to this, exposure to phytoncides – which are anti-microbial oils secreted by trees – are proven to boost immunity, fight cancer cells, and combat depression. The effects can last up the 7 days, which means the devotion of an hour or two once a week provides enough of this     powerful potion to keep you in rude health.

Whether it is the local park or full on forest, get verdant landscapes into your weekly schedule.

It’s time for a new paradigm: build a better human, not just bigger muscles.

Harking back to a more primitive way of engaging our biology offers wisdom and insight into how to bring more intelligent movement into your day to day. It isn’t necessary to don plain muslin and snack on twigs; these inclusive, personal, and versatile tips are for everyone.

Applied together, these factors have the potential to lasso your limitations and capitalize on your capabilities. Your fitness will be your health, not just your physique. And you can still wear your leopard print leggings if you want.

Implementing these strategies will take time and patience. Years of mental and cultural conditioning will rail against this line of thought; remember, human biology thrives on this stuff. Once the neuro-pathways have unfolded their wings, beautiful symbiosis will nurture effortless vitality.

And that’s the whole point.

Sources

http://www.ibisworld.com Gym, Health & Fitness Clubs in the US: Market Research Report, IBIS World

http://www.danielvitalis.com Are you Kinesthetically Literate?

http://www.danielvitalis.com A More Capable Human

https://barefootandsoul.com Ingredients for Healthy Connective Tissue
http://www.parkouruk.org Parkour

Your Workout Isn’t Healthy: The Problems With Modern Movement

Free movement of doctors has served the NHS well | Letters

The government, the NHS and the public need to value and support all NHS staff, wherever they are from (Hunt promises to end NHS reliance on overseas doctors, 4 October). The recent announcement of 1,500 extra medical school places is welcome. But, as over a quarter of current NHS doctors are from overseas, the extra places will not in themselves produce a self-sufficient UK medical workforce, and we will still need our overseas doctors.

The announcement has led to our colleagues from overseas feeling that they may not be as valued as UK doctors and is affecting morale. We cannot let this happen.

Currently a quarter of NHS doctors are from overseas, and the NHS has benefited from their talents, their abilities and their will to work with us in the UK. We must continue to support them, despite the insecurity caused by the Brexit situation, and reassure them that they are valued and needed.

Diseases know no borders, and medicine has therefore developed as an international profession, with global cooperation in research, drug development, standards of patient care, and free movement of doctors around the world. This model has served the UK and the NHS well for decades. Moving away from it is a major risk to the success of the NHS.
Professor Jane Dacre
President, Royal College of Physicians
Clare Marx
President, Royal College of Surgeons

• While the government’s proposed ban on UK-trained doctors working overseas may sound appealing, it is a tacit admission of failure.

As part of my training I benefited greatly from working in a rural African setting. Quite apart from what I hope I contributed, I returned to the UK with new skills, greater knowledge and full of enthusiasm for my chosen profession.

Ever since, I have encouraged my junior colleagues to embrace any opportunity to work in a developing country. Many choose to do so after two years of working – the logical time in the highly structured and inflexible (government-imposed) training structure.

I suspect the health secretary imagines doctors are rushing to work in Australia and New Zealand – and of course some do. But a thoughtless blanket four-year ban will have consequences for many developing countries that benefit from UK doctors. The proposed ban is necessary only because the failure to support the NHS has led to it becoming such a stressful place in which to work. People do not choose to go and live thousands of miles from their family and friends if they are enjoying their work.

Rather than yet another negative restriction on junior doctors’ working lives, can I suggest the health secretary reflect on a more carrot-oriented approach: that of making the NHS such a fulfilling and exciting place to work that anyone who chooses to spend some time overseas spends that year moaning about how great it is back in the UK and returns promptly.
Dr Ed Moran
Consultant in infectious disease, Heartlands Hospital, Birmingham

• Jeremy Hunt has proposed that young doctors should be prevented from working overseas for a period of four years after qualifying in order to alleviate the staffing crisis in the NHS, or else face a fine by paying back some of their training costs. Perhaps I could propose that former cabinet ministers be prevented from taking up lucrative directorships or consultancies with private companies for four years after leaving office. After all, much of their expertise and their contacts would have been accrued at taxpayers’ expense while they were in post.
Dr John Nottingham
Ravensthorpe, Northamptonshire

• Jeremy Hunt should also commit himself and his government to ending our reliance on bricklayers, plumbers, joiners and workers in many other trades and industries. How could they do this? By making employers offer decent pay and conditions. That would make such employment attractive to Britons who, justifiably, expect to be treated decently and are not as desperate as others.
David Hibbert
Chadderton, Greater Manchester

• Theresa May’s statement “Our NHS” (Key points, 6 October) needs to be backed up by immediate real-term funding. Her quote is reminiscent of the phrase “the NHS is safe in our hands”. Yet under every Conservative prime minister since 1980 the proportion of the nation’s GDP going to health has fallen.

Who can disagree with Margaret Thatcher’s “we can only have the services we can afford”? But over the years we have not afforded as much as other western nations – currently running at 9.1% compared with Germany’s 10.3% and France’s 11.6%. Yet our research shows that the NHS is still one of the most effective and efficient in reducing feasible adult deaths.

Every prime minister should be held to account so we can test between rhetoric and delivery.
Professor Colin Pritchard
Southampton

• Join the debate – email guardian.letters@theguardian.com

Free movement of doctors has served the NHS well | Letters

Vasectomies: turning an "act of love" into a global movement

“How do we celebrate the best in men when the news is full of stories about their frustration, humiliation, and destructiveness?” That was the question that film-maker Jonathan Stack was pondering back in 2011. The answer, he concluded, was to point out to men that there is a simple and pragmatic way they can personally make a difference to some of the most complex problems of our time – a vasectomy.

“I saw it as a creative challenge,” he says now. “How do we counter that narrative?” In vasectomies Stack saw an opportunity to transform an “act of love” into a global movement – a means “to engage men in the conversation”.

Vasectomies are an act of love, argues Jonathan Stack. Photograph: World Vasectomy Day

Expanding access to vasectomies in developing countries has now become Stack’s life mission. In 2012, he created World Vasectomy Day while working on a documentary about his journey through fatherhood and decision to have a vasectomy. “The plan was to have 100 doctors in 20 countries do 1,000 vasectomies in 24 hours,” he says. “And we came very close to that.”

Men need to share the burden of birth control

Studies indicate that reducing fertility can result in far-reaching benefits – from improvements to maternal and child health to poverty reduction and long-term environmental sustainability. In 2012, the Bill and Melinda Gates Foundation and the UK government’s Department for International Development co-hosted a summit on family planning and outlined an ambitious new goal: to make affordable contraception available to an additional 120 million women and girls in the world’s poorest countries by 2020.

Four years on, important gains have been made: more than half of the 69 countries have delivered on their commitments, and an additional 24.4 million women and girls now have access to modern contraceptive methods. But some experts say progress has been slower than expected because efforts have overlooked a key population: men.

“We need to engage more men to support their partners and spouses,” says Monica Kerrigan. Photograph: World Vasectomy Day

“We’re falling behind,” says Monica Kerrigan, former deputy director of family planning with the Gates Foundation and a senior adviser to FP2020, the global partnership formed after the summit to carry out its objectives. “I think a missing component is the need to engage more men to support their partners and spouses.” Among the many ways they can do that, she says, is by shouldering some of the burden of birth control, including, for those who no longer want to have children, voluntary sterilisation, or vasectomy.

Stack agrees. As it is, he says, men are largely left out. Most family planning programmes target women and girls, and with good reason: globally, the biggest barrier to reducing birth rates is gender inequality – population growth is fastest where female literacy is low, violence against women is common and reproductive rights are not protected.

Still, the reality remains that men tend to dominate decision making about family size and birth control. At the same time, they tend to be detached from or opposed to family planning, and the result is often that their partners discontinue using birth control or never start at all. In fact, of the unmarried women who say they don’t want to get pregnant within the next two years, close to a quarter don’t use contraception because someone close to them opposes it – one reason for the 74m million unintended pregnancies that occur annually.

“We’re now realising that while it’s important to focus on women and girls, we can’t continue with business as usual,” says Kerrigan. “We have to positively disrupt the status quo.” World Vasectomy Day, she says, is just that – an effort to secure men’s engagement, using modern innovations that can accelerate progress.

No scalpels

One of those innovations is the no-scalpel vasectomy. First performed in China in the 1970s, the technique made what was already a safe, simple procedure – a pair of small incisions to sever the duct that delivers sperm from the testicles (the vas deferens) – even more so. Using the no-scalpel approach, a provider need only locate the vas deferens under the skin and make a single needle puncture through which to cut it, minimising the risk of bleeding.

Men equate vasectomy with castration, or believe it will cause them to be impotent

Ricky Lu

“That modification really facilitated the spread of vasectomy across the globe,” says Carmela Cordero, a reproductive health expert with EngenderHealth. “Before, it was only the urologist who could perform a vasectomy. Now, we’re training nurses, midwives, clinical officers. You don’t need sophisticated equipment, you don’t need an operating room. It’s inexpensive, and it takes less than 15 minutes.”

And yet, for all its virtues, vasectomy is still an uncommon practice in the developing world and the least known modern method of contraception in poorer countries. In sub-Saharan Africa, where the unmet need for family planning is greatest, fewer than 100,000 men have had the operation. By comparison, female sterilisation, which is costlier , more time consuming, must be performed in a hospital and can result in serious complications, is among the most widely used methods of contraception worldwide.

Some of the volunteers for WVS 2014. Photograph: World Vasectomy Day

One reason for that, says Ricky Lu, director of family planning and reproductive health at non-profit Jhpiego, is that vasectomy has long been mired in misconception. “Many men equate vasectomy with castration, or believe it will cause them to be impotent,” he says. Where accurate information is lacking, he says, demand for the procedure is very low, and “there are few trained providers offering the service” as a result.

Jhpiego is trying to change that through programmes like Tupange (“let’s plan” in Kiswahili) in Kenya, which aims to make modern contraceptive methods available to the urban poor and to educate men about the benefits of voluntary male sterilisation. The country is one of a long list that will celebrate the fourth annual World Vasectomy Day on 18 November, 2016. Now a global movement, the event is supported by the International Planned Parenthood Federation, Marie Stopes International, FHI 360, and the ministries of health of India, Indonesia, and Kenya.

WVS is celebrated all over the world, including Indonesia. Photograph: World Vasectomy Day

As before, the day will feature an 18-hour “vasectomy-thon” with medical professionals from around the world performing the procedure, as well as a training session for would-be providers in Kenya. “We’ll also have a wellness centre where men can get a general check-up, as well as counselling and testing for HIV and hypertension,” Stack says. “We think that part of being a responsible partner is taking care of one’s health.”

Kerrigan says vasectomy is part of catalysing men to support contraception. “If the majority of men supported their partners in using the contraceptive method that they want, we could go a long way toward preventing the 74m unintended pregnancies that happen every year,” she adds. “We need to change the way we think about men and boys in this space.”

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Vasectomies: turning an "act of love" into a global movement

"Brain training" technique restores feeling and movement to paraplegics

Eight paraplegics – some of them paralysed for more than a decade by severe spinal cord injury – have been able to move their legs and feel sensation, after help from an artificial exoskeleton, sessions using virtual reality (VR) technology and a non-invasive system that links the brain with a computer.

In effect, after just 10 months of what their Brazilian medical team call “brain training” they have been able to make a conscious decision to move and then get a response from muscles that that have not been used for a decade.

Of the octet, one has been able to leave her own house and drive a car. Another has conceived and delivered a child, feeling the contractions as she did so.

The extent of the improvements was unexpected. The scientists – part of the Walk Again Project that unites 100 scientists from 25 countries – had intended to exploit advanced computing and robotic technology to help paraplegics recover a sense of control in their lives. But their patients recovered some feeling and direct command as well.

The implication is that even apparently complete spinal cord injury might leave some connected nerve tissue that could be reawakened after years of inaction.

VR technology is combined with harnesses and other walking aids to get the patients accustomed to making a link between movement, and thinking about movement. Photograph: AASDAP

The patients responded unevenly, but all have reported partial restoration of muscle movement or skin sensation. Some have even recovered visceral function and are now able to tell when they need the lavatory. And although none of them can walk unaided, one woman has been able to make walking movements with her legs, while suspended in a harness, and generate enough force to make a robot exoskeleton move.

“Some of our patients, for the first time, were able to get out of their houses and go back to work,” said Miguel Nicolelis, co-director of the Duke University Centre for Neuroengineering, and based at the Alberto Santos Dumont Association neurorehabilitation laboratory in Sao Paulo.

The study parallels other approaches to spinal cord injury: there are hopes of stem cell therapy that could make possible natural repairs to the nervous system, and of electronic implants that might bypass a spinal cord injury to transmit the brain’s message to the muscles.

The Brazilian trial was originally intended as a test of the third approach: robotic aids driven by brainpower. The scientists gave an example of what they thought possible in 2014 when Juan Pinto, a 25-year-old paraplegic, used a brain-controlled robotic exoskeleton to kick a football during the opening ceremony of the World Cup in Sao Paulo.

The exoskeleton technology existed. Scientists had already demonstrated in a number of ways the capacity of a computer to “read” the electrical signals from a conscious command in the brain, and perform a correct action.

But after the eight patients had performed more than 2,000 sessions of brain training, for a collective total of almost 2,000 hours, the Brazilian team began to see entirely unexpected results.

“We stumbled into this clinical recovery, which is something that is almost like a dream, because it took the approach to a whole new level,” said Dr Nicolelis.

[embedded content]

Dr Miguel Nicolelis describes the research
Credit: AASDAP and Lente Viva Filmes, São Paulo, Brazil

“They have seen on their own terms a very significant improvement in their lives, in terms of mobility, of being able to feel their legs, to feel their skin; improvements in sexual performance for the men for instance. One of the ladies basically decided to deliver a baby because she now had visceral sensation,”

The scientists – 20 in all from Brazil, Switzerland, Germany and the US – describe their approach in the journal Scientific Reports. They fitted patients with electrodes that could register electroencephalogram signals from the brain. Then they asked the patients to “think” about moving their legs. None of them could do so: the motor cortex of the brain has a pronounced apparatus for representing movement, and the patients could “think” hand movements, but the leg connection had been wiped clean.

None of the patients in the experiment had benefited from any traditional rehabilitation before they joined the project. And none of the eight could control any movement below the level of the spinal cord injury.

The next stage was to introduce VR, and off-the-shelf walking devices now used in physical therapy centres for the injured, as well as overhead harnesses to get the patients accustomed to making a link between movement and thinking about movement. The experimenters fed back the sensation of walking to a pressure pad on the patient’s forearm, and used a VR avatar, to help give the patient the illusion of walking, and then the distinctive sensations of walking over grass or sand.

Gradually, and at different rates, they began to experience voluntary muscle function below the injury. They went from a total absence of touch sensation to the capacity to sense pain, pressure and vibration, though not temperature. Gastrointestinal function improved, and those who spent most time upright and walking saw the most improvement in bowel control. Men reported experiencing erections. All had been diagnosed as cases of complete paralysis. Since the training, some of them have now been reclassified as partially paralysed.

None yet can walk unaided, but one has progressed to walking – without any help from a therapist – with crutches and braces from hip to ankle to support the legs. The research paper describes results after the first 10 months of the study. But the training continues, and there is more yet to be published.

“We are already thinking about ways of disseminating this protocol with more affordable technology,” Nicolelis said.

“If you remember your first cellphone, it looked like a brick, and now I am talking to you from a tiny little cellphone in Brazil, so things have evolved very quickly. I think that at the moment we can show clinical benefits. There are about 25 million people in the world paralysed just with spinal cord injuries and when you receive a diagnosis of being a complete paraplegic people usually don’t do anything anymore to you. They just try to get you adapted to life in a wheelchair.”

"Brain training" technique restores feeling and movement to paraplegics

No one mention the war? Medics and the peace movement | Alice Bell

It started, as some issues do, with a letter to the Lancet. It was January 1951, the Korean War was in total force, and the letter sought to draw focus to how military investing was impacting on healthcare. Signed by seven distinguished doctors – including Richard Doll, famous for his perform on the link between lung cancer and smoking – it pulled few punches in its language: “Each pound spent on bombs signifies far more dead babies now.”

As a post from the University of Bradford describes, not absolutely everyone in the profession agreed. These have been political matters, of which there was no area in a largely scientific medical journal. But the unique signatories disagreed, extending their argument to add a deeper overall health frame to the problem: “War is a symptom of psychological unwell overall health. Its results include wounds and condition. Doctors are consequently properly concerned in preventing it.”

A forum was set up to debate this more, and after a meeting in March 1961, the Healthcare Association for the Prevention of War (MAPW) was founded. The present organisation, Medact – who just lately attracted interest for their role in the BMA’s decision to divest from fossil fuels – was founded in 1992, following the merger of MAPW with the comparable Healthcare Campaign Against Nuclear Weapons (MCANW).

The history of MAPW – and a few similar groups – was not too long ago marked at the the Wellcome Trust with the ‘Bed No Bombs’ conference launching their assortment of the history of anti-nuclear health care campaigning and protest. A lively event, it incorporated historical scholarship, personal reflections, photographs, archives of scientific investigation, newsclippings, banners and even song. Wellcome’s Elena Carter introduces her highlights of the collection in a post on Political Science nowadays, and you can see a gallery of far more of the archives as well.

MAPW sits inside of a more substantial neighborhood of folks energetic in the politics of science, technology and medicine of the late 20th century. As properly as MCANW, we heard from Alison Macfarlane from the Radical Statistics Group, who also presented us some historical past of Radical Nursing, Radical Midwives and the British Society for Social Obligation in Science. We learnt of the prestigious archive of Radical Statistics publications from 1975 onwards, and the way they utilized a “fanzine principle” to put their functions out and hope they would be passed on to folks have been interested. We learnt how their “Unsafe in their hands” leaflet – critiquing government’s use of statistics to talk about the NHS – ended up in Parliament, and was later on used for an episode of Channel 4’s Dispatches.

There is also a larger historical past of publish-war scientists towards the bomb (e.g. Pugwash) which was largely connected by physicists but integrated biomedical researchers as well. There is yet another Wellcome website link here. In 2007, they famously paid £250,000 for a Picasso at first drawn on the wall of scientist and peace activist JD Bernal after delegates to the 1950 Planet Peace Congress had been stranded in London. Moreover, as Peter Peter van den Dungen, also speaking at the Bed Not Bombs event noted, there is a significantly longer background of ‘medics for peace’ work, far past nuclear weapons. Georg Friedrich Nicolai created his idea of war as illness booklet in the light of the Initial Globe War, and there have been responses to biological and chemical warfare, as well as the quite notion of war, during the rest of the 20th century. Nuclear weapons brought a greater sense of urgency, as they did across the pacifist movement, but were not the complete story.

As an intriguing presentation from Christoph Laucht noted, anti-nuclear protest was – oddly probably – marked by expert activism. There is the old joke CND badge that ‘taxidermists say stuff the bomb’ but, regardless of whether a consequence of connections among peace and labour movements or one thing else, there was a proliferation of anti-war groups recognized by specific careers. Teachers, musicians, nurses, all sorts.

This left the question of weather such activity could spark again? Could we have accountants for action on climate modify, nurses against international warming, lawyers for a minimal carbon economy? Or are professions too tied up with quick worries of their own operate, and people to active, burdened by debt or just disillusioned by the chance for alter to talk up? Or maybe, the critics of Doll et al in 1951, they basically don’t really feel it is there area.

Alice Bell is a freelance author and researcher at the moment doing work on a history of the radical science movement.

No one mention the war? Medics and the peace movement | Alice Bell

Clinicians, not bed movement, need to dictate discharges

In addition to this, most new hospitals built under PFI (private finance initiatives) have, on average, 30 per cent fewer beds, principally because the companies that run the hospitals are keen to cut costs. This has added further pressure to the remaining accommodation. Most hospitals in Britain currently operate at about 100 per cent occupancy rate. In contrast, most hospitals in Europe operate at 80 per cent.

It’s easy to see why, if the hospital is full and there are sick people waiting, you have to operate a one-in, one-out system. The only option is to turf someone less sick out of their bed and send them home, regardless of the time of night. Meanwhile, rates of the superbug MRSA and the infection Clostridium difficile, which causes vomiting and diarrhoea, are more than 40 per cent higher in hospitals with 90 per cent bed occupancy than in those with less than 85 per cent. And of course an outbreak in a crowded hospital, can result in whole wards being closed. Thus there is further pressure on the remaining beds.

If we stop late-night discharges, there will be a corresponding backlog of patients in A&E. But equally, sending vulnerable people home late at night when there is no guarantee that the social care they need is in place or their families are ready to step in is unacceptable. This needs some clear, sensible direction from those in charge of the health service. I, along with doctors, nurses and countless patients and their relatives, hope that they find a way to put a stop to this practice. Then we can all rest easy in our beds.

Bad news for fraudsters who con the elderly

I’m delighted to hear that the Sentencing Council is introducing guidelines that will see tougher jail sentences handed out to fraudsters who target the elderly and vulnerable.

While working in dementia care and with people with learning disabilities, I have come across heartbreaking cases of people being conned out of their entire life savings. But as the Sentencing Council acknowledges, sometimes even relatively small sums of money can have a devastating impact on the victims.

The guidelines coming into force on October 1 mean that at last judges will now be able to take into account the extent of the victim’s suffering – not just the size of the sums of money involved – when deciding the punishment. About time, too.

Don’t ignore anorexia

It often surprises people to learn that of all the psychiatric conditions, the most deadly is anorexia. Despite high‑profile deaths, such as that of the singer Karen Carpenter, the public still struggles to understand the seriousness of eating disorders.

Although the risks associated with anorexia have long been known, research by Oxford University published last week illustrated the extent of the danger. Life expectancy for those with the condition is worse than for those who smoke 20 cigarettes a day. It’s estimated that between 5 and 20 per cent of sufferers will eventually die from it.

It’s an area I feel passionately about because of the lack of sympathy it garners from other people, including some doctors. There is a sense that – more than with any other mental health condition – sufferers should pull their socks up. Everyone else can eat normally, so why can’t they?

It is more than 20 years since the late Diana, Princess of Wales spoke out about her own eating disorder. More recently, the actress Christina Ricci has followed suit. And yet the level of ignorance is astounding. It’s not simply that sufferers want to be thin, as though it’s some perverse form of vanity; it is a desperate, unconscious attempt to deal with deep-seated emotional problems.

Ensuring that there are adequate services and provision to help these people should be an absolute priority.

Max Pemberton’s latest book, ‘The Doctor Will See You Now’, published by Hodder, is available from Telegraph Books for £8.99 plus £1.10 p&p. To order, call 0844 871 1515 or go to books.telegraph.co.uk

Clinicians, not bed movement, need to dictate discharges

The Reality About Gender Equity In School Sports activities And The School Athletes" Rights Movement

Just lately, opponents of shell out-for-perform in college sports activities have turned to ‘gender equity’ as their newest argument towards making it possible for school athletes to management the rights to their personal likenesses.

These opponents have argued that Title IX serves as a “roadblock” to compensating only income-generating athletes, and that principles of gender equity demand athletic unions to bargain for identical terms for all athletes.

These arguments, however, obscure the correct nature of gender inequity in school sports.  In actuality, university sports activities might have a gender equity dilemma.  However, this dilemma is induced by the NCAA — not by pupil-athletes’ rights groups.

Here are three reasons why:

1.  The current gender shell out gap among college coaches is 1 of the worst in society.  Even without making it possible for university athletes to control the value of their personal likenesses, there is an huge and growing shell out gap amongst male and female school coaches. For example, Duke University pays its men’s basketball coach, Mike Mike Krzyzewski, nearly $ 10 million per year meanwhile Duke pays its women’s basketball coach, Joanne P. McCallie, someplace in the ballpark of $ 729,991.  Making issues worse, salary information obtained by the New York Instances from the U.S. Division of Education indicates that from 2003 to 2010 the typical pay of NCAA Division I men’s group coaches increased by 67 %, whereas the average pay out for NCAA Division I women’s crew coaches elevated just sixteen percent.  Thus, the gender shell out gap between NCAA member coaches is not only huge, but also widening.

2.  There are also disproportionately number of women in crucial athletic director positions.  This glass ceiling that many NCAA member schools have positioned on women in athletic management also can’t be ignored.  For illustration, when Rutgers University employed Julie Hermann as its athletic director final 12 months, Hermann became only the 2nd female athletic director in the Large Ten Conference’s more than 120 year history.  Meanwhile, a February 2011 article written by Libby Sander that was originally published in the Chronicle of Higher Training indicated that at the time, “women [held just] five of 120 athletic-director positions in Division I-A.”

 3.  Finally, a lot of NCAA members implicitly endorse a WNBA minimal age rule that calls for women’s university basketball players to delay their professional hoops dreams longer than guys.  With respect to women’s athletes themselves, several NCAA leaders look to have implicitly endorsed the WNBA’s collectively bargained rule that calls for American women’s basketball players to wait four many years soon after their high school graduation ahead of turning professional, even even though men’s basketball gamers may turn professional following just one particular 12 months of school. Even though the WNBA age rule may be a boon to the revenues of the most effective women’s university basketball plans, the WNBA’s minimal age rule  keeps hopeful female skilled basketball gamers dependent on other individuals for economic support for far longer than their male counterparts.  As a outcome, elite women’s basketball players possibly want manage above their personal publicity rights even far more than their male counterparts.  Without such rights, numerous are forced to financially rely on other individuals properly into their twenties.

Based mostly on these above examples, probably its time to analyze a lot more critically the gender equity arguments against enabling school athletes to earn money.  In the gestalt, pay out-for-play may possibly not be school sports’ correct gender equity dilemma, and these arguments may possibly carry a tad significantly less weight than on very first glance.

____________________________

Marc Edelman is an Associate Professor of Law at the City University of New York’s Baruch School, Zicklin College of Enterprise, where he has published much more than 25 law assessment articles on sports activities law issues.  His most latest articles or blog posts include “A Brief Treatise on Amateurism and Antitrust Law” and “The Long term of Amateurism following Antitrust Scrutiny.”

Adhere to me on Twitter here

The Reality About Gender Equity In School Sports activities And The School Athletes" Rights Movement