tag:theconversation.com,2011:/au/topics/disease-763/articlesDisease – The Conversation2024-03-15T17:34:41Ztag:theconversation.com,2011:article/2131852024-03-15T17:34:41Z2024-03-15T17:34:41ZGut microbiome: meet Roseburia intestinalis — the energy-producing bug that helps us fight diseases<figure><img src="https://images.theconversation.com/files/582161/original/file-20240315-18-p5czjg.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C4872%2C3223&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">_R intestinalis_ makes butyrate from polysaccharides, which are found in starchy foods such as potatoes.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-eating-fish-potatoes-572976808">Photo Oz/ Shutterstock</a></span></figcaption></figure><p>The hundreds of species of microorganisms that comprise the microbiome all have different, unique roles. </p>
<p>One of the important functions that takes place in the gut is the production of short-chain fatty acids. These molecules are derived from the fermentation of <a href="https://pubmed.ncbi.nlm.nih.gov/2902962/">polysaccharides</a> (a type of carbohydrate) which are primarily found in starchy foods. These short-chain fatty acids are then used in a range of processes – including providing cells with the energy they need to grow and multiply and enabling communication between the gut and the brain.</p>
<p>The gut’s microbes mainly make three short-chain fatty acids: acetate, propionate and butyrate. Together, these provide around <a href="https://microbialcellfactories.biomedcentral.com/articles/10.1186/s12934-017-0691-z">60% of all energy used by the intestinal cells</a> – and about 10% of our body’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3735932/">overall calorie requirements</a>. </p>
<p>Arguably, the most important of these short-chain fatty acids is butyrate, which has been widely studied due to its apparent <a href="https://www.sciencedirect.com/science/article/pii/S216183132200833X">links to health and disease</a>. </p>
<p>Butyrate is the primary source of energy used to create and maintain the mucus membrane that lines our digestive tract. This lining is vital for healthy gut function, protecting the body from infection and absorbing nutrients from the foods we eat. </p>
<p>One of the primary producers of butyrate in the gut is the bacterium <em>Roseburia intestinalis</em>.</p>
<h2>Energy production</h2>
<p><em>R intestinalis</em> lives in close contact with the mucus membrane of our gut cells and makes up just over <a href="https://journals.asm.org/doi/10.1128/aem.69.7.4320-4324.2003">2% of the entire population</a> of the human gut microbiome. It creates butyrate from the polysaccharides we eat using a <a href="https://academic.oup.com/gbe/article/6/3/703/580436">special type of enzyme</a>. While it isn’t the only bacterium in the gut that produces butyrate, <em>R intestinalis</em> is one of its <a href="https://www.frontiersin.org/articles/10.3389/fcimb.2021.757718/full">most abundant producers</a>.</p>
<p><em>R intestinalis</em> has been linked to <a href="https://www.frontiersin.org/articles/10.3389/fcimb.2021.757718/full">many health benefits</a>, such as preventing inflammation and restoring good bacterial balance in the microbiome. </p>
<p>This bacterium also seems to regulate some of the communication that happens between the <a href="https://journals.sagepub.com/doi/full/10.1177/17562848211004469">gut and brain</a> – and may even play a role in <a href="https://www.frontiersin.org/articles/10.3389/fcimb.2021.757718/full">protecting against some diseases</a>, such as Crohn’s, ulcerative colitis and both type 1 and type 2 diabetes. </p>
<figure class="align-center ">
<img alt="A digital rendering of the human brain." src="https://images.theconversation.com/files/582167/original/file-20240315-24-crh3oc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582167/original/file-20240315-24-crh3oc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582167/original/file-20240315-24-crh3oc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582167/original/file-20240315-24-crh3oc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582167/original/file-20240315-24-crh3oc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582167/original/file-20240315-24-crh3oc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582167/original/file-20240315-24-crh3oc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">This bacterium helps facilitate communication between the gut and the brain.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/human-brain-floating-on-blue-background-260226050">Fer Gregory/ Shutterstock</a></span>
</figcaption>
</figure>
<p>These health benefits are probably thanks to the fact that the butyrate <em>R intestinalis</em> produces provides nutrients and energy to other bacterial species who have more specialised jobs in the gut. Butyrate also helps regulate many aspects of our <a href="https://www.tandfonline.com/doi/full/10.2147/JIR.S300989">immune system</a>. It does this through promoting or suppressing the production of key immune cells.</p>
<p>Much of these discoveries of <em>R intestinalis’s</em> benefits are very recent and more research will be needed to better confirm what specific roles this bacterium plays in the gut, and how exactly it enhances our own fight against disease. </p>
<p>Butyrate production may also be more complex than it appears, with studies finding a link between low levels of butyrate production <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/obr.12068">and obesity</a>.</p>
<p>But given its key role in promoting a healthy gut – alongside its wider effects on the immune system and body – it’s no wonder <em>R intestinalis</em> is starting to be considered as a potential probiotic. This would mean we could see it <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9493362/">added to supplements</a> in order to promote a healthier microbiome in the future.</p>
<hr>
<p><em>This article is part of <a href="https://theconversation.com/uk/topics/meet-your-gut-microbes-150943?utm_source=InArticleTop&utm_medium=TCUK&utm_campaign=Health2024">Meet Your Gut Microbes</a>, a series about the rich constellation of bacteria, viruses, archaea and fungi that live in people’s digestive tracts. Scientists are increasingly realising their importance in shaping our health – both physical and mental. Each week we will look at a different microbe and bring you the most up-to-date research on them.</em></p>
<hr><img src="https://counter.theconversation.com/content/213185/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Conor Meehan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>R intestinalis is one of the gut’s primary producers of butyrate – a source of energy for many of the gut’s cells.Conor Meehan, Associate Professor of Microbial Bioinformatics, Nottingham Trent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2218362024-03-13T12:37:43Z2024-03-13T12:37:43ZLeprosy cases are rising in the US – what is the ancient disease and why is it spreading now?<figure><img src="https://images.theconversation.com/files/581098/original/file-20240311-22-xteppq.jpg?ixlib=rb-1.1.0&rect=21%2C10%2C7167%2C4031&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Leprosy can be caused by two different bacteria, one of which was only identified in 2008.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/leprosy-bacteria-illustration-royalty-free-illustration/1193685361?phrase=leprosy&adppopup=true">Kateryna Kon/Science Photo Library via Getty Images</a></span></figcaption></figure><p><em>The word “leprosy” conjures images of biblical plagues, but the disease is still with us today. Caused by infectious bacteria, <a href="https://www.who.int/news-room/fact-sheets/detail/leprosy">some 200,000 new cases are reported each year</a>, according to the World Health Organization. In the United States, leprosy has been entrenched for more than a century in parts of the South where people came into contact with armadillos, the principle proven linkage from animal to humans. However, the more recent outbreaks in the Southeast, <a href="https://epi.ufl.edu/2023/10/16/leprosy-in-florida-medical-experts-monitoring-unusual-new-cases-of-hansens-disease/">especially Florida</a>, have not been associated with animal exposure.</em></p>
<p><em>The Conversation talked with <a href="https://www.ae-info.org/ae/Member/Schwartz_Robert">Robert A. Schwartz</a>, professor and head of dermatology at Rutgers New Jersey Medical School, to explain what researchers know about the disease.</em></p>
<h2>What is leprosy and why is it resurfacing in the US?</h2>
<p>Leprosy is caused by two different but similar bacteria — <em>Mycobacterium leprae</em> and <em>Mycobacterium lepromatosis</em> — the latter <a href="https://doi.org/10.1309/AJCPP72FJZZRRVMM">having just been identified in 2008</a>. Leprosy, <a href="https://www.cdc.gov/leprosy/index.html">also known as Hansen’s disease</a>, is avoidable. Transmission among the most vulnerable in society, including migrant and impoverished populations, remains a pressing issue.</p>
<p>This <a href="https://doi.org/10.1111/ijd.15998">age-old neglected tropical disease</a>, which is still <a href="https://www.who.int/news-room/fact-sheets/detail/leprosy">present in more than 120 countries</a>, is now a growing challenge in parts of North America. </p>
<p>Leprosy is beginning to occur regularly within parts of the southeastern United States. Most recently, Florida has seen a heightened incidence of leprosy, accounting for <a href="https://doi.org/10.1001/jama.2023.13938">many of the newly diagnosed cases</a> in the U.S. </p>
<p>The <a href="https://doi.org/10.3201/eid2908.220367">surge in new cases</a> in central Florida highlights the urgent need for health care providers to <a href="https://www.hrsa.gov/sites/default/files/hrsa/hansens-disease/hd-surveillance-form.pdf">report them</a> immediately. Contact tracing is critical to <a href="https://iris.who.int/bitstream/handle/10665/336679/9789290228073-eng.pdf">identifying sources and reducing transmission</a>. </p>
<p>Traditional risk factors include zoonotic exposure and having recently lived in leprosy-endemic countries. Brazil, India and Indonesia have each <a href="https://www.who.int/news-room/fact-sheets/detail/leprosy">noted more than 10,000 new cases</a> since 2019, according to the World Health Organization data, and more than a dozen countries have reported between 1,000 to 10,000 new cases over the same time period.</p>
<h2>Why was leprosy stigmatized in biblical times?</h2>
<p>Evidence suggests that <a href="https://doi.org/10.1556/oh.2011.29038">leprosy has plagued civilization</a> since at least the second millennium B.C. </p>
<p>From that time until the mid-20th century, <a href="https://doi.org/10.1038/jid.1953.65">limited treatments were available</a>, so the bacteria could infiltrate the body and cause prominent physical deformities such as disfigured hands and feet. Advanced cases of leprosy cause facial features resembling that of a lion in humans.</p>
<p>Many mutilating and distressing skin disorders such as skin cancers and deep fungal infections were also confused with leprosy by the general public. </p>
<p>Fear of contagion has led to <a href="https://doi.org/10.53854%2Fliim-2904-18">tremendous stigmatization and social exclusion</a>. It was such a serious concern that the Kingdom of Jerusalem had a specialized hospital to care for those suffering from leprosy.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/581102/original/file-20240311-139405-n6zvdy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Bandaged feet and legs of a person with leprosy." src="https://images.theconversation.com/files/581102/original/file-20240311-139405-n6zvdy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581102/original/file-20240311-139405-n6zvdy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581102/original/file-20240311-139405-n6zvdy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581102/original/file-20240311-139405-n6zvdy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581102/original/file-20240311-139405-n6zvdy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581102/original/file-20240311-139405-n6zvdy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581102/original/file-20240311-139405-n6zvdy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Leprosy has sometimes been confused with other mutilating skin disorders.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/feet-of-a-leper-royalty-free-image/157530061?phrase=leprosy&adppopup=true">visual7/E+ via Getty Images</a></span>
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</figure>
<h2>How infectious is leprosy?</h2>
<p>Research shows that prolonged in-person contact via respiratory droplets is <a href="https://doi.org/10.1186/s12879-023-08627-9">the primary mode of transmission</a>, rather than through normal, everyday contact such as embracing, shaking hands or sitting near a person with leprosy. People with leprosy generally do not transmit the disease once they begin treatment. </p>
<p>Armadillos represent the only known <a href="https://doi.org/10.3201%2Feid2112.150501">zoonotic reservoir</a> of leprosy-causing bacteria that threaten humans. These small mammals are common in Central and South America and in parts of Texas, Louisiana, Missouri and other states, where they are sometimes kept as pets or farmed as meat. Eating armadillo meat is not a clear cause of leprosy, but capturing and raising armadillos, along with preparing its meat, are risk factors.</p>
<p>The transmission mechanism between zoonotic reservoirs and susceptible individuals is unknown, but it is strongly suspected that direct contact with an infected armadillo poses a significant risk of developing leprosy. However, many cases reported in the U.S. have demonstrated an <a href="https://doi.org/10.3201/eid2908.220367">absence of either zoonotic exposure or person-to-person transmission</a> outside of North America, suggesting that transmission may be happening where the infected person lives. But in many cases, the source remains an enigma.</p>
<p>Some people’s genetics might make them <a href="https://doi.org/10.1056/nejmoa0903753">more susceptible to leprosy infections</a>, or their immune systems are less capable of resisting the disease. </p>
<p>Stigma and discrimination have <a href="https://doi.org/10.53854%2Fliim-2904-18">prevented people from seeking treatment</a>, and as a result, “concealed” cases contribute to transmission. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/4mqZvCUtxGg?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The number of leprosy cases in the U.S. has more than doubled over the past decade, and Florida has become a hot spot for it.</span></figcaption>
</figure>
<h2>How do you recognize it?</h2>
<p>Leprosy primarily affects the skin and peripheral nervous system, causing physical deformity and desensitizing one’s ability to feel pain on affected skin. </p>
<p>It may begin with loss of sensation on whitish patches of skin or reddened skin. As the bacteria spread in the skin, they can cause the skin to thicken with or without nodules. If this occurs on a person’s face, it may rarely produce a smooth, attractive-appearing facial contour known as lepra bonita, or “pretty leprosy.” The disease can progress to causing eyebrow loss, enlarged nerves in the neck, nasal deformities and nerve damage. </p>
<p>The onset of symptoms can sometimes take <a href="https://doi.org/10.1128%2FCMR.00079-13">as long as 20 years</a> because the infectious bacteria have a lengthy incubation period and proliferate slowly in the human body. So presumably many people are infected long before they know that they are.</p>
<p>Fortunately, worldwide efforts to screen for leprosy are being enhanced thanks to organizations like the <a href="https://www.st-lazarus.us/">Order of Saint Lazarus</a>, which was originally founded in the 11th century to combat leprosy, and the <a href="https://ahri.gov.et/">Armauer Hansen Research Institute</a>, which conducts immunologic, epidemiological and translational research in Ethiopia. The nongovernmental organization <a href="https://www.bombayleprosy.org/">Bombay Leprosy Project</a> in India does the same.</p>
<h2>How treatable is it?</h2>
<p>Leprosy is not only preventable but treatable. Defying stigma and advancing early diagnosis via proactive measures are critical to the mission of controlling and eradicating it worldwide. </p>
<p>Notably, the World Health Organization and other agencies provide <a href="https://doi.org/10.25259/ijdvl_278_2023">multi-drug therapy</a> at no cost to patients. </p>
<p>In addition, vaccine technology to combat leprosy is <a href="https://doi.org/10.1016/j.vaccine.2019.12.050">in the clinical trials stage</a> and <a href="https://doi.org/10.1021/acsinfecdis.3c00371">could become available</a> in coming years. In studies involving nine-banded armadillos, this protein-based vaccine delayed or diminished leprous nerve damage and <a href="https://doi.org/10.1038/s41541-018-0050-z">kept bacteria at bay</a>. Researchers believe that the vaccine can be produced in a low-cost, highly efficient manner, with the long-term prospect of eradicating leprosy.</p>
<p>If health care professionals, biomedical researchers and lawmakers do not markedly enhance their efforts to eliminate leprosy worldwide, the disease will continue to spread and could become a far more serious problem in areas that have been largely free of leprosy for decades. </p>
<p>The World Health Organization launched a plan in 2021 for achieving <a href="https://iris.who.int/bitstream/handle/10665/340774/9789290228509-eng.pdf?sequence=1">zero leprosy</a>.</p><img src="https://counter.theconversation.com/content/221836/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Prof. Robert A. Schwartz is associated with the Order of Saint Lazarus, an international non-governmental organization committed to the fight against leprosy.</span></em></p>People often think of leprosy as a bygone disease, relevant primarily in biblical times. But in fact, it is still present in more than 120 countries, and the US is seeing an uptick in cases.Robert A. Schwartz, Professor and Head of Dermatology, Rutgers New Jersey Medical School, Rutgers UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2225132024-02-19T19:04:30Z2024-02-19T19:04:30ZHow long does back pain last? And how can learning about pain increase the chance of recovery?<figure><img src="https://images.theconversation.com/files/576603/original/file-20240219-18-edti6b.jpg?ixlib=rb-1.1.0&rect=60%2C60%2C6639%2C4406&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/upset-mature-woman-suffering-backache-after-1504807832">fizkes/Shutterstock</a></span></figcaption></figure><p>Back pain is common. One in thirteen people have it right now and worldwide a staggering 619 million people will <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186678/">have it this year</a>.</p>
<p>Chronic pain, of which back pain is the most common, is the world’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186678/">most disabling</a> health problem. Its economic impact <a href="https://www.ncbi.nlm.nih.gov/books/NBK92510/">dwarfs other health conditions</a>. </p>
<p>If you get back pain, how long will it take to go away? We scoured the scientific literature to <a href="https://www.cmaj.ca/content/cmaj/196/2/E29.full.pdf">find out</a>. We found data on almost 20,000 people, from 95 different studies and split them into three groups: </p>
<ul>
<li>acute – those with back pain that started less than six weeks ago</li>
<li>subacute – where it started between six and 12 weeks ago</li>
<li>chronic – where it started between three months and one year ago. </li>
</ul>
<p>We found 70%–95% of people with acute back pain were likely to recover within six months. This dropped to 40%–70% for subacute back pain and to 12%–16% for chronic back pain.</p>
<p>Clinical guidelines point to graded return to activity and pain education under the guidance of a health professional as the best ways to promote recovery. Yet these effective interventions are underfunded and hard to access.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-cognitive-functional-therapy-how-can-it-reduce-low-back-pain-and-get-you-moving-207009">What is cognitive functional therapy? How can it reduce low back pain and get you moving?</a>
</strong>
</em>
</p>
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<h2>More pain doesn’t mean a more serious injury</h2>
<p>Most acute back pain episodes are <a href="https://www.racgp.org.au/getattachment/75af0cfd-6182-4328-ad23-04ad8618920f/attachment.aspx">not caused</a> by serious injury or disease.</p>
<p>There are rare exceptions, which is why it’s wise to see your doctor or physio, who can check for signs and symptoms that warrant further investigation. But unless you have been in a significant accident or sustained a large blow, you are unlikely to have caused much damage to your spine. </p>
<figure class="align-center ">
<img alt="Factory worker deep-breathes with a sore back" src="https://images.theconversation.com/files/575505/original/file-20240214-24-yvwksc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575505/original/file-20240214-24-yvwksc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575505/original/file-20240214-24-yvwksc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575505/original/file-20240214-24-yvwksc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575505/original/file-20240214-24-yvwksc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575505/original/file-20240214-24-yvwksc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575505/original/file-20240214-24-yvwksc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Your doctor or physio can rule out serious damage.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-man-worker-warehouse-have-accident-2181811499">DG fotostock/Shutterstock</a></span>
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<p>Even very minor back injuries can be brutally painful. This is, in part, because of how we are made. If you think of your spinal cord as a very precious asset (which it is), worthy of great protection (which it is), a bit like the crown jewels, then what would be the best way to keep it safe? Lots of protection and a highly sensitive alarm system.</p>
<p>The spinal cord is protected by strong bones, thick ligaments, powerful muscles and a highly effective alarm system (your nervous system). This alarm system can trigger pain that is so unpleasant that you cannot possibly think of, let alone do, anything other than seek care or avoid movement. </p>
<p>The messy truth is that when pain persists, the pain system becomes more sensitive, so a widening array of things contribute to pain. This pain system hypersensitivity is a result of neuroplasticity – your nervous system is becoming better at making pain. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-pain-and-what-is-happening-when-we-feel-it-49040">Explainer: what is pain and what is happening when we feel it?</a>
</strong>
</em>
</p>
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<h2>Reduce your chance of lasting pain</h2>
<p>Whether or not your pain resolves is not determined by the extent of injury to your back. We don’t know all the factors involved, but we do know there are things that you can do to reduce chronic back pain:</p>
<ul>
<li><p>understand how pain really works. This will involve intentionally learning about modern pain science and care. It will be difficult but rewarding. It will help you work out what you can do to change your pain </p></li>
<li><p>reduce your pain system sensitivity. With guidance, patience and persistence, you can learn how to gradually retrain your pain system back towards normal.</p></li>
</ul>
<h2>How to reduce your pain sensitivity and learn about pain</h2>
<p>Learning about “how pain works” provides the most sustainable <a href="https://www.bmj.com/content/376/bmj-2021-067718">improvements in chronic back pain</a>. Programs that combine pain education with graded brain and body exercises (gradual increases in movement) can reduce pain system sensitivity and help you return to the life you want. </p>
<figure class="align-center ">
<img alt="Physio helps patient use an exercise strap" src="https://images.theconversation.com/files/575501/original/file-20240214-22-gzb0hs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575501/original/file-20240214-22-gzb0hs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575501/original/file-20240214-22-gzb0hs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575501/original/file-20240214-22-gzb0hs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575501/original/file-20240214-22-gzb0hs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=506&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575501/original/file-20240214-22-gzb0hs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=506&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575501/original/file-20240214-22-gzb0hs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=506&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some programs combine education with gradual increases in movement.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-physiotherapist-exercising-senior-patient-physic-2130321380">Halfpoint/Shutterstock</a></span>
</figcaption>
</figure>
<p>These programs have been in development for years, but high-quality clinical trials <a href="https://jamanetwork.com/journals/jama/fullarticle/2794765">are now emerging</a> and it’s good news: they show most people with chronic back pain improve and many completely recover.</p>
<p>But most clinicians aren’t equipped to deliver these effective programs – <a href="https://www.jpain.org/article/S1526-5900(23)00618-1/fulltext">good pain education</a> is not taught in most medical and health training degrees. Many patients still receive ineffective and often risky and expensive treatments, or keep seeking temporary pain relief, hoping for a cure. </p>
<p>When health professionals don’t have adequate pain education training, they can deliver bad pain education, which leaves patients feeling like they’ve just <a href="https://www.jpain.org/article/S1526-5900(23)00618-1/fulltext">been told it’s all in their head</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/opioids-dont-relieve-acute-low-back-or-neck-pain-and-can-result-in-worse-pain-new-study-finds-203244">Opioids don't relieve acute low back or neck pain – and can result in worse pain, new study finds</a>
</strong>
</em>
</p>
<hr>
<p>Community-driven not-for-profit organisations such as <a href="https://www.painrevolution.org/">Pain Revolution</a> are training health professionals to be good pain educators and raising awareness among the general public about the modern science of pain and the best treatments. Pain Revolution has partnered with dozens of health services and community agencies to train more than <a href="https://www.painrevolution.org/find-a-lpe">80 local pain educators</a> and supported them to bring greater understanding and improved care to their colleagues and community. </p>
<p>But a broader system-wide approach, with government, industry and philanthropic support, is needed to expand these programs and fund good pain education. To solve the massive problem of chronic back pain, effective interventions need to be part of standard care, not as a last resort after years of increasing pain, suffering and disability.</p><img src="https://counter.theconversation.com/content/222513/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Wallwork receives payments for lectures on pain and rehabilitation. Sarah was funded by an NHMRC Investigator Grant awarded to GL Moseley (ID 1178444).</span></em></p><p class="fine-print"><em><span>Lorimer Moseley has received support from: Reality Health, ConnectHealth UK, Institutes of Health California, AIA Australia, Workers’ Compensation Boards and professional sporting organisations in Australia, Europe, South and North America. Professional and scientific bodies have reimbursed him for travel costs related to presentation of research on pain and pain education at scientific conferences/symposia. He has received speaker fees for lectures on pain, pain education and rehabilitation. He receives royalties for books on pain and pain education. He is non-paid CEO of the non-profit Pain Revolution, an unpaid Director of Painaustralia and an unpaid Director of Australian Pain Solutions Research Alliance.</span></em></p>Back pain is common. One in thirteen people have it right now and worldwide a staggering 619 million people will have it this year. Chronic pain, of which back pain is the most common, is the world’s most…Sarah Wallwork, Post-doctoral Researcher, University of South AustraliaLorimer Moseley, Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2153112024-02-09T16:50:23Z2024-02-09T16:50:23ZYour unique smell can provide clues about how healthy you are<figure><img src="https://images.theconversation.com/files/574043/original/file-20240207-19-o4ehc8.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5291%2C3516&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-calm-teen-girl-enjoying-good-1325627765">fizkes/Shutterstock</a></span></figcaption></figure><p>Hundreds of chemicals stream from our bodies into the air every second. These chemicals release into the air easily as they have high vapour pressures, meaning they boil and turn into gases at room temperature. They give clues about who we are, and how healthy we are. </p>
<p>Since ancient Greek times, we’ve known that we smell differently when we are unwell. While we rely on blood analysis today, ancient Greek physicians used smell to diagnose maladies. If they took a whiff of your breath and described it as <em>fetor hepaticus</em> (meaning bad liver), it meant you could be headed for liver failure.</p>
<p>If a person’s whiff was sweet or fruity, physicians thought this meant that sugars in the digestive system were not being broken down, and that person had probably diabetes. Science has since shown the ancient Greeks were right – liver failure and <a href="https://tisserandinstitute.org/human-volatilome/">diabetes</a> and many <a href="https://link.springer.com/article/10.1007/s00216-023-04986-z">other diseases</a> including infectious diseases give your breath a distinctive smell.</p>
<p>In 1971, <a href="https://www.nobelprize.org/prizes/peace/1962/pauling/facts/">Nobel Laureate chemist Linus Pauling</a> <a href="https://edu.rsc.org/feature/breath-analysis/2020106.article#:%7E:text=The%20'modern%20era'%20of%20breath,in%20an%20average%20breath%20sample.">counted 250 different</a> gaseous chemicals in breath. These gaseous chemicals are called volatile organic compounds or VOCs. </p>
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<p>Since Pauling’s discovery, other scientists have <a href="https://link.springer.com/article/10.1007/s40291-023-00640-7">discovered hundreds more VOCs</a> in our breath. We have learned that many of these VOCs have distinctive odours, but some have no odour that our noses can perceive. </p>
<p>Scientists believe that whether a VOC <a href="https://tisserandinstitute.org/human-volatilome/">has an odour</a> that our noses can detect or not, they can reveal information about how healthy someone is.</p>
<p>A Scottish man’s Parkinson’s disease onset was <a href="https://www.bbc.co.uk/news/uk-scotland-47627179">identified by his wife</a>, retired nurse Joy Milner, after she was convinced the way he smelled had changed, years before he was diagnosed in 2005. This discovery has <a href="https://www.manchester.ac.uk/discover/news/smell-of-skin-could-lead-to-early-diagnosis-for-parkinsons/">led to research programmes</a> involving Joy Milner to identify <a href="https://www.scientificamerican.com/article/a-supersmeller-can-detect-the-scent-of-parkinsons-leading-to-an-experimental-test-for-the-illness/">the precise smell</a> of this disease. </p>
<p>Dogs can <a href="https://www.nature.com/articles/d41586-022-01629-8">sniff out more diseases</a> than humans because of their more <a href="https://www.understandinganimalresearch.org.uk/news/the-science-of-sniffs-disease-smelling-dogs%20-%20I%20think%20the%20previous%20nature%20link%20has%20more%20credibility%20for%20here%20also">sophisticated olfactory talents</a>. But technological techniques, like <a href="https://www.britannica.com/science/mass-spectrometry">analytical tool mass spectrometry</a>, picks up even more subtle changes in VOC profiles that are being linked to <a href="https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(20)30100-6/fulltext">gut</a>, <a href="https://www-sciencedirect-com.dcu.idm.oclc.org/science/article/pii/S0165993618305168">skin</a> and <a href="https://err.ersjournals.com/content/28/152/190011">respiratory</a> diseases as well as neurological diseases like Parkinson’s. Researchers believe that one day some diseases will be diagnosed simply by breathing into a device. </p>
<figure>
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</figure>
<h2>Where do VOCs come from?</h2>
<p>Breath is not the only source of VOCs in the body. They are also emitted from skin, urine and faeces. </p>
<p>VOCs from skin are the result of millions of skin glands removing metabolic waste from the body, as well as waste generated by bacteria and other microbes that live on our skin. Sweating produces extra nutrients for these bacteria to metabolise which can result in particularly odorous VOCs. Odour from sweat only makes up a fraction of the scents from VOCs though.</p>
<p><a href="https://www.nature.com/articles/nrmicro.2017.157">Our skin</a> and also our gut microbiomes are made up from a delicate balance of these microbes. Scientists think <a href="https://journals.lww.com/co-gastroenterology/abstract/2015/01000/the_gut_microbiome_in_health_and_in_disease.12.aspx">they influence our health</a>, but we don’t yet understand a lot about how this relationship works. </p>
<p>Unlike the gut, the skin is relatively easy to study – you can collect skin samples from living humans without having to go deep into the body. <a href="https://www-sciencedirect-com.dcu.idm.oclc.org/science/article/pii/S1471492221002087">Scientists think</a> skin VOCs can offer insights into how the microbiome’s bacteria and the human body work together to maintain our health and protect us from disease.</p>
<p>In my team’s laboratory, <a href="https://iopscience.iop.org/article/10.1088/1752-7163/abf20a">we are investigating</a> whether the skin VOC signature can reveal different attributes of the person it belongs to. These signals in skin VOC signatures are probably how dogs distinguish between people by smell. </p>
<p>We are at a relatively early stage in this research area but we have shown that you can tell males from females based on how acidic the VOCs from skin are. We use mass spectrometry to see this as the average human nose is not sophisticated enough to detect these VOCs. </p>
<p>We can also predict a person’s age with reasonable accuracy to within a few years from their skin VOC profile. This is not surprising considering that oxidative stress in our bodies increases as we age.</p>
<p><a href="https://www.metabolismjournal.com/article/S0026-0495(00)80077-3/pdf">Oxidative stress</a> happens when your antioxidant levels are low and causes irreversible damage to our cells and organs. <a href="https://pubs.acs.org/doi/10.1021/jasms.3c00315">Our recent research</a> found by-products of this oxidative damage in skin VOC profiles. </p>
<p>Not only are these VOCs responsible for personal scent – they are used by plants, insects and animals as a communication channel. Plants are in a <a href="https://www.nature.com/articles/s41598-017-10975-x">constant VOC dialogue</a> with other organisms including pollinators, herbivores, other plants and their natural enemies such as harmful bacteria and insects. VOCs used for this back and forth dialogue are known as pheromones. </p>
<h2>What has science shown about love pheromones?</h2>
<p>In the animal kingdom, there is good evidence VOCs can act as aphrodisiacs. Mice for example have microbes which contribute to a particularly <a href="https://www.sciencedirect.com/science/article/pii/S0960982212012687">smelly compound called trimethylamine</a>, which allows mice to verify the species of a potential mate. <a href="https://www.sciencedirect.com/science/article/abs/pii/S0093691X21003083">Pigs</a> and <a href="https://www.nature.com/articles/4381097a">elephants</a> have sex pheromones too. </p>
<p>It is possible that humans also produce VOCs for attracting the perfect mate. Scientists have yet to fully decode skin – or other VOCs that are released from our bodies. But evidence for human love pheromones so far is <a href="https://www.science.org/content/article/do-human-pheromones-actually-exist">controversial at best</a>. <a href="https://www.newscientist.com/article/dn3835-colour-vision-ended-human-pheromone-use/">One theory suggests</a> that they were lost about 23 million years ago when primates developed full colour vision and started relying on their enhanced vision to choose a mate.</p>
<p>However, we believe that whether human pheromones exist or not, skin VOCs can reveal who and how we are, in terms of things like ageing, nutrition and fitness, fertility and even stress levels. This signature probably contains markers we can use to monitor our health and diagnose disease.</p><img src="https://counter.theconversation.com/content/215311/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aoife Morrin receives funding from Science Foundation Ireland.</span></em></p>The science of smell is an exciting area of research.Aoife Morrin, Associate Professor of Analytical Chemistry, Dublin City UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2140532023-12-15T13:22:43Z2023-12-15T13:22:43ZRacism produces subtle brain changes that lead to increased disease risk in Black populations<figure><img src="https://images.theconversation.com/files/565115/original/file-20231212-21-79wl3z.jpg?ixlib=rb-1.1.0&rect=50%2C30%2C6659%2C4436&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Coping with everyday affronts comes at a cost and requires a certain level of emotional suppression. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/composite-of-portraits-with-varying-shades-of-skin-royalty-free-image/1249641728?phrase=discrimination&searchscope=image%2Cfilm&adppopup=true">RyanJLane/E+ via Getty Images</a></span></figcaption></figure><p>The U.S. is in the midst of a racial reckoning. The COVID-19 pandemic, which took a particularly <a href="https://covidtracking.com/race">heavy toll on Black communities</a>, turned a harsh spotlight on long-standing health disparities that the public could no longer overlook.</p>
<p>Although the health disparities for Black communities have been well known to researchers for decades, the pandemic put real names and faces to these numbers. Compared with white people, Black people are at much greater risk for developing a range of health problems, including <a href="https://minorityhealth.hhs.gov/heart-disease-and-african-americans">heart disease</a>, <a href="https://minorityhealth.hhs.gov/diabetes-and-african-americans">diabetes</a> and <a href="https://doi.org/10.1016/j.jalz.2018.09.009">dementia</a>. For example, Black people are twice as likely as white people to <a href="https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf">develop Alzheimer’s disease</a>.</p>
<p>A vast and growing body of research shows that <a href="https://doi.org/10.1146/annurev-publhealth-040218-043750">racism contributes to systems that promote health inequities</a>. Most recently, our team has also learned that racism directly contributes to these inequities on a neurobiological level.</p>
<p>We are <a href="https://www.negarfani.com/">clinical</a> <a href="https://www.mcleanhospital.org/profile/nathaniel-harnett">neuroscientists</a> who study the multifaceted ways in which racism affects how our brains develop and function. We use brain imaging to study how trauma such as sexual assault or racial discrimination can cause stress that leads to mental health disorders like depression and post-traumatic stress disorder, or PTSD. </p>
<p>We have studied trauma in the context of a study known as the <a href="https://www.gradytraumaproject.com/">Grady Trauma Project</a>, which has been running for nearly 20 years. This study is largely focused on the trauma and stress of Black people in the metropolitan Atlanta, Georgia, community.</p>
<h2>How discrimination alters the brain</h2>
<p>Racial discrimination is commonly experienced through subtle indignities: a woman clutching her purse as a Black man walks by on the sidewalk, a shopkeeper keeping close watch on a Black woman shopping in a clothing store, a comment about a Black employee being a “diversity hire.” These slights are often referred to as <a href="https://www.med.unc.edu/inclusion/justice-equity-diversity-and-inclusion-j-e-d-i-toolkit/microaggressions-microaffirmations/#">microaggressions</a>.</p>
<p>Decades of research has shown that the everyday burden of these race-related threats, slights and exclusions in day-to-day life translates into a <a href="https://doi.org/10.1146/annurev-publhealth-040218-043750">real increase in disease risk</a>. But researchers are only beginning to understand how these forms of discrimination affect a person’s biology and overall health.</p>
<p>Our team’s research shows that the <a href="https://doi.org/10.1016/j.bpsc.2022.05.004">everyday burden of racism</a> <a href="https://doi.org/10.1001/jamapsychiatry.2021.1480">affects the function</a> and <a href="https://doi.org/10.1016/j.biopsych.2021.08.011">structure</a> <a href="https://doi.org/10.1038/s41386-022-01445-8">of the brain</a>. In turn, these changes play a major role in risk for health problems.</p>
<p>For instance, our studies show that racial discrimination <a href="https://doi.org/10.1001/jamapsychiatry.2021.1480">increases the activity of brain regions</a>, <a href="https://doi.org/10.1038/s41386-023-01737-7">such as the prefrontal cortex</a>, that are involved in regulating emotions. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/565418/original/file-20231213-25-bah2a6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Scientist and technologist view brain images." src="https://images.theconversation.com/files/565418/original/file-20231213-25-bah2a6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565418/original/file-20231213-25-bah2a6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=480&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565418/original/file-20231213-25-bah2a6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=480&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565418/original/file-20231213-25-bah2a6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=480&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565418/original/file-20231213-25-bah2a6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=603&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565418/original/file-20231213-25-bah2a6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=603&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565418/original/file-20231213-25-bah2a6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=603&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Negar Fani and a team member view brain images.</span>
<span class="attribution"><span class="source">Patrick Heagney</span></span>
</figcaption>
</figure>
<p>This increased activity in prefrontal brain regions occurs because responding to these types of affronts requires high-effort coping strategies, such as suppressing emotions. People who have experienced more racial discrimination also show more activation in brain regions that enable them to <a href="https://doi.org/10.1016/j.dr.2021.100967">inhibit and suppress anger, shock or sadness</a> so that they can curate a socially acceptable response. </p>
<h2>A cost for overcompensating</h2>
<p>Despite the fact that high-energy coping allows people to manage a constant barrage of threats, this comes at a cost.</p>
<p>The more brain energy you use to suppress, control or manage your feelings, the more energy you take away from the rest of the body. Over time, and without prolonged periods of rest, relief and restoration, this can contribute to other problems, a process that public health researcher <a href="https://psc.isr.umich.edu/news/a-monumental-new-book-weathering-arline-geronimuss-lifes-work/">Arline Geronimus termed “weathering</a>.” Having these brain regions in continual overdrive is <a href="https://doi.org/10.1016/j.socscimed.2020.113169">linked with</a> <a href="https://doi.org/10.1007%2Fs12110-010-9078-0">accelerated biological aging</a>, which can <a href="https://doi.org/10.1016%2Fj.ssmph.2018.11.003">create vulnerability for health problems</a> and early death. </p>
<p>In our research, we have found that this <a href="https://doi.org/10.1038/s41386-022-01445-8">weathering process is evident</a> in the <a href="https://doi.org/10.1016/j.biopsych.2021.08.011">gradual degradation</a> <a href="https://doi.org/10.1016/j.bpsc.2022.05.004">of brain structure</a>, particularly in the heavily myelinated axons of the brain, known as “<a href="https://medlineplus.gov/ency/article/002344.htm#">white matter</a>,” which serve as the brain’s information highways. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/565504/original/file-20231213-21-yeiyph.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Computer-generated image of white matter tracts in the brain." src="https://images.theconversation.com/files/565504/original/file-20231213-21-yeiyph.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565504/original/file-20231213-21-yeiyph.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=293&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565504/original/file-20231213-21-yeiyph.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=293&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565504/original/file-20231213-21-yeiyph.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=293&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565504/original/file-20231213-21-yeiyph.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=368&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565504/original/file-20231213-21-yeiyph.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=368&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565504/original/file-20231213-21-yeiyph.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=368&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Rendering of white matter fibers − shown in color − throughout the brain.</span>
<span class="attribution"><span class="source">Negar Fani</span></span>
</figcaption>
</figure>
<p><a href="https://medlineplus.gov/ency/article/002261.htm">Myelin</a> is a protective sheath around nerve fibers that allows for improved communication between brain cells. Similar to highways for vehicles, without sufficient maintenance of the myelin, degradation will occur. </p>
<p>Erosion in these brain pathways can affect self-regulation, making a person more vulnerable to developing unhealthy coping strategies for stress, such as <a href="https://doi.org/10.1176/appi.ajp.2015.15060710">emotional eating or substance use</a>. These behaviors, in turn, can increase one’s risk for a wide variety of health problems. </p>
<p>These racism-related changes in the brain, and their direct effects on coping, may help to explain why Black people are twice as likely to develop brain health problems such as <a href="https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf">Alzheimer’s disease</a> compared with white people.</p>
<h2>Recognizing racial gaslighting</h2>
<p>In our view, what makes racism particularly insidious and pernicious to the health of Black people is the societal invalidation that accompanies it. This makes racial trauma effectively invisible. Racism, whether it <a href="https://doi.org/10.1177/1745691616659391">originates from people</a> or from institutional systems, is often rationalized, <a href="https://doi.org/10.1016/j.beth.2020.09.001">excused or dismissed</a>. </p>
<p>Such invalidation leads those who experience racism to second-guess themselves: “Am I just being too sensitive?” People who have the temerity to report racist events are often ridiculed or met with skepticism. This <a href="https://doi.org/10.1038/s41578-021-00361-5">extends to</a> <a href="https://doi.org/10.1177/2372732220984183">academic spheres</a> <a href="https://doi.org/10.1016/j.cell.2020.06.009">as well</a>.</p>
<p>This continual questioning and doubting of the circumstances around racist experiences, or <a href="https://doi.org/10.1080/21565503.2017.1403934">racial gaslighting</a>, may be part of what depletes the brain of its resources, causing the weathering that ultimately increases vulnerability to brain health problems.</p>
<p>Interrupting this cycle requires that people learn to identify their biases toward people of color and people in marginalized groups more generally, and to understand how those biases may lead to discriminatory words and behavior. We believe that by finding their blind spots, people can see ways in which their actions and behaviors could be viewed as hurtful, exclusionary or offensive. Through recognition of these experiences as racist, people can become allies rather than skeptics. </p>
<p><a href="https://www.institutionalcourage.org/">Institutions can help</a> to create a culture of <a href="https://doi.org/10.1176/appi.focus.20220045">healing, validation and support</a> for people of color. A validating, supportive institutional culture may help people of color normalize their reactions to these stressors, in addition to the connection – and restoration – they may find within their communities.</p><img src="https://counter.theconversation.com/content/214053/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Negar Fani receives funding from the National Institutes of Health and Emory University School of Medicine. </span></em></p><p class="fine-print"><em><span>Nathaniel Harnett receives funding from the National Institutes of Health, the Brain and Behavior Research Foundation, and the Presidents and Fellows of Harvard College. </span></em></p>Racial threats and slights take a toll on health, but the continual invalidation and questioning of whether those so-called microaggressions exist has an even more insidious effect, research shows.Negar Fani, Associate Professor of Psychiatry and Neuroscience, Emory UniversityNathaniel Harnett, Assistant Professor of Psychiatry, Harvard Medical School Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2170592023-12-13T13:35:34Z2023-12-13T13:35:34ZHealth misinformation is rampant on social media – here’s what it does, why it spreads and what people can do about it<figure><img src="https://images.theconversation.com/files/564379/original/file-20231207-23-75o0yn.jpg?ixlib=rb-1.1.0&rect=62%2C26%2C5904%2C4070&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Media literacy is more essential than ever. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/myth-fake-news-and-facts-vector-illustration-royalty-free-illustration/1358189151?phrase=social+media+misinformation&searchscope=image%2Cfilm&adppopup=true">Wanlee Prachyapanaprai/iStock via Getty Images Plus</a></span></figcaption></figure><p>The global anti-vaccine movement and vaccine hesitancy that <a href="https://doi.org/10.1093/cid/ciaa433">accelerated during the COVID-19 pandemic</a> show no signs of abating.</p>
<p>According to a survey of U.S. adults, Americans in October 2023 were <a href="https://www.annenbergpublicpolicycenter.org/vaccine-confidence-falls-as-belief-in-health-misinformation-grows/">less likely to view approved vaccines as safe</a> than they were in April 2021. As vaccine confidence falls, health misinformation continues to spread like wildfire on social media and in real life.</p>
<p>I am a <a href="https://www.bu.edu/sph/profile/monica-wang/">public health</a> <a href="https://scholar.google.com/citations?user=5g6xyEMAAAAJ&hl=en">expert</a> in <a href="https://doi.org/10.1093/abm/kaaa088">health misinformation</a>, <a href="https://doi.org/10.1093/tbm/ibac096">science communication</a> and <a href="https://doi.org/10.1891/9780826180148">health behavior change</a>.</p>
<p>In my view, we cannot underestimate the <a href="https://doi.org/10.2105/AJPH.2020.305905">dangers of health misinformation</a> and the need to understand why it spreads and what we can do about it. Health misinformation is defined as any health-related claim that is false based on current scientific consensus. </p>
<h2>False claims about vaccines</h2>
<p>Vaccines are the No. 1 topic of misleading health claims. Some <a href="https://doi.org/10.3389%2Ffmicb.2020.00372">common myths about vaccines</a> include: </p>
<ul>
<li><p><strong>Their supposed link with human diagnoses of autism</strong>. Multiple studies have <a href="https://doi.org/10.1016/j.vaccine.2014.04.085">discredited this claim</a>, and it has been firmly refuted by the <a href="https://www.who.int/groups/global-advisory-committee-on-vaccine-safety/topics/mmr-vaccines-and-autism">World Health Organization</a>, the <a href="https://www.nationalacademies.org/based-on-science/vaccines-do-not-cause-autism">National Academies of Sciences, Engineering and Medicine</a>, the <a href="https://publications.aap.org/patiented/article-abstract/doi/10.1542/peo_document599/82016/Vaccines-Autism-Toolkit">American Academy of Pediatrics</a> and the <a href="https://www.cdc.gov/vaccinesafety/concerns/autism.html">Centers for Disease Control and Prevention</a>.</p></li>
<li><p><strong>Concerns with the COVID-19 vaccine leading to infertility</strong>. This connection has been debunked through a <a href="https://doi.org/10.1016%2Fj.vaccine.2022.09.019">systematic review and meta-analysis</a>, one of the most robust forms of synthesizing scientific evidence.</p></li>
<li><p><strong>Safety concerns about vaccine ingredients, such as thimerosal, aluminum and formaldehyde</strong>. Extensive studies have shown these ingredients are safe when used in <a href="https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/vaccine-myth-fact">the minimal amounts contained in vaccines</a>.</p></li>
<li><p><strong>Vaccines as medically unnecessary to protect from disease</strong>. The development and dissemination of vaccines for life-threatening diseases such as smallpox, polio, measles, mumps, rubella and the flu has saved <a href="https://doi.org/10.1073%2Fpnas.1704507114">millions of lives</a>. It also played a critical role in historic <a href="https://doi.org/10.1073/pnas.1413559111">increases in average life expectancy</a> – from 47 years in 1900 in the U.S. to 76 years in 2023. </p></li>
</ul>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CX9WyO4s4kA","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<h2>The costs of health misinformation</h2>
<p>Beliefs in such myths have come at the highest cost. </p>
<p>An estimated 319,000 COVID-19 deaths that occurred between January 2021 and April 2022 in the U.S. <a href="https://globalepidemics.org/vaccinations/">could have been prevented</a> if those individuals had been vaccinated, according to a data dashboard from the Brown University School of Public Health. Misinformation and disinformation about COVID-19 vaccines alone have cost the U.S. economy an estimated <a href="https://doi.org/10.1093/tbm/ibac096">US$50 million to $300 million per day</a> in direct costs from hospitalizations, long-term illness, lives lost and economic losses from missed work.</p>
<p>Though vaccine myths and misunderstandings tend to dominate conversations about health, there is an <a href="https://doi.org/10.2196%2F17187">abundance of misinformation</a> on social media surrounding diets and eating disorders, smoking or substance use, chronic diseases and medical treatments. </p>
<p>My team’s research and that of others show that social <a href="https://doi.org/10.2196/43961">media platforms have become go-to sources</a> <a href="https://doi.org/10.2196%2F17917">for health information</a>, especially among adolescents and young adults.
However, many people are not equipped to maneuver the maze of health misinformation.</p>
<p>For example, an analysis of Instagram and TikTok posts from 2022 to 2023 by The Washington Post and the nonprofit news site The Examination found that the food, beverage and dietary supplement industries paid dozens of registered dietitian influencers to <a href="https://www.washingtonpost.com/wellness/2023/09/13/dietitian-instagram-tiktok-paid-food-industry/">post content promoting diet soda, sugar and supplements</a>, reaching millions of viewers. The dietitians’ relationships with the food industry were not always made clear to viewers. </p>
<p>Studies show that health misinformation spread on social media results in <a href="https://doi.org/10.1016%2Fj.vaccine.2022.09.046">fewer people getting vaccinated</a> and can also increase the risk of other health dangers such as <a href="https://www.scientificamerican.com/article/how-a-weight-loss-trend-on-tiktok-might-encourage-eating-disorders/">disordered eating</a> and <a href="https://doi.org/10.18297/tce/vol1/iss1/16">unsafe sex practices and sexually transmitted infections</a>. Health misinformation has even bled over into animal health, with a 2023 study finding that 53% of dog owners surveyed in a nationally representative sample report being <a href="https://doi.org/10.1016/j.vaccine.2023.08.059">skeptical of pet vaccines</a>.</p>
<h2>Health misinformation is on the rise</h2>
<p>One major reason behind the spread of health misinformation is <a href="https://www.pewresearch.org/science/2023/11/14/americans-trust-in-scientists-positive-views-of-science-continue-to-decline/">declining trust in science</a> and <a href="https://www.pewresearch.org/politics/2023/09/19/public-trust-in-government-1958-2023/">government</a>. Rising political polarization, coupled with <a href="https://doi.org/10.1080%2F08964289.2019.1619511">historical medical mistrust</a> among communities that have experienced and continue to experience <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194634/">unequal health care treatment</a>, exacerbates preexisting divides.</p>
<p>The lack of trust is both fueled and reinforced by the way misinformation can spread today. Social media platforms allow people to <a href="https://doi.org/10.2105%2FAJPH.2020.305905">form information silos</a> with ease; you can curate your networks and your feed by unfollowing or muting contradictory views from your own and liking and sharing content that aligns with your existing beliefs and value systems. </p>
<p>By tailoring content based on past interactions, social media algorithms can unintentionally <a href="https://doi.org/10.1016/j.tics.2023.06.008">limit your exposure</a> to diverse perspectives and generate a fragmented and incomplete understanding of information. Even more concerning, a study of misinformation spread on Twitter analyzing data from 2006 to 2017 found that <a href="https://doi.org/10.1126/science.aap9559">falsehoods were 70% more likely to be shared</a> than the truth and spread “further, faster, deeper and more broadly than the truth” across all categories of information.</p>
<figure>
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<figcaption><span class="caption">The average kindergarten student sees about 70 media messages every day. By the time they’re in high school, teens spend more than a third of their day using media.</span></figcaption>
</figure>
<h2>How to combat misinformation</h2>
<p>The lack of robust and standardized regulation of misinformation content on social media places the difficult task of discerning what is true or false information on individual users. We scientists and research entities can also do better in communicating our science and rebuilding trust, as my colleague and I have <a href="https://www.bu.edu/articles/2023/rebuilding-public-trust-in-science/">previously written</a>. I also provide <a href="https://doi.org/10.1001/jamapediatrics.2023.5282">peer-reviewed recommendations</a> for the important roles that parents/caregivers, policymakers and social media companies can play. </p>
<p>Below are some steps that consumers can take to identify and prevent health misinformation spread: </p>
<ul>
<li><p><strong>Check the source.</strong> Determine the credibility of the health information by checking if the source is a reputable organization or agency such as the <a href="https://www.who.int">World Health Organization</a>, the <a href="https://www.nih.gov">National Institutes of Health</a> or the <a href="https://www.cdc.gov">Centers for Disease Control and Prevention</a>. Other credible sources include an established medical or scientific institution or a peer-reviewed study in an academic journal. Be cautious of information that comes from unknown or biased sources.</p></li>
<li><p><strong>Examine author credentials.</strong> Look for qualifications, expertise and relevant professional affiliations for the author or authors presenting the information. Be wary if author information is missing or difficult to verify.</p></li>
<li><p><strong>Pay attention to the date.</strong> Scientific knowledge by design is meant to evolve as new evidence emerges. Outdated information may not be the most accurate. Look for recent data and updates that contextualize findings within the broader field. </p></li>
<li><p><strong>Cross-reference to determine scientific consensus.</strong> Cross-reference information across multiple reliable sources. Strong consensus across experts and multiple scientific studies supports the validity of health information. If a health claim on social media contradicts widely accepted scientific consensus and stems from unknown or unreputable sources, it is likely unreliable. </p></li>
<li><p><strong>Question sensational claims.</strong> Misleading health information often uses sensational language designed to provoke strong emotions to grab attention. Phrases like “miracle cure,” “secret remedy” or “guaranteed results” may signal exaggeration. Be alert for potential conflicts of interest and sponsored content.</p></li>
<li><p><strong>Weigh scientific evidence over individual anecdotes.</strong> Prioritize information grounded in scientific studies that have undergone rigorous research methods, such as randomized controlled trials, peer review and validation. When done well with representative samples, the scientific process provides a reliable foundation for health recommendations compared to individual anecdotes. Though personal stories can be compelling, they should not be the sole basis for health decisions. </p></li>
<li><p><strong>Talk with a health care professional.</strong> If health information is confusing or contradictory, seek guidance from trusted health care providers who can offer personalized advice based on their expertise and individual health needs. </p></li>
<li><p><strong>When in doubt, don’t share.</strong> Sharing health claims without validity or verification contributes to misinformation spread and preventable harm.</p></li>
</ul>
<p>All of us can play a part in responsibly consuming and sharing information so that the spread of the truth outpaces the false.</p><img src="https://counter.theconversation.com/content/217059/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Monica Wang receives funding from the National Institutes of Health. </span></em></p>Studies show that health misinformation on social media has led to fewer people getting vaccinated and more lives lost to COVID-19 and other life-threatening diseases.Monica Wang, Associate Professor of Public Health, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2168462023-12-04T17:26:43Z2023-12-04T17:26:43ZRats are more human than you think – and they certainly like being around us<figure><img src="https://images.theconversation.com/files/561844/original/file-20231127-29-v6hvrg.jpg?ixlib=rb-1.1.0&rect=7%2C14%2C2488%2C1646&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/two-cute-curious-brown-rats-looking-295110965">Gallinago_media/Shutterstock</a></span></figcaption></figure><p>Rats have a somewhat unfortunate tendency to enjoy living where people live. That’s how a biologist tried to explain people’s hatred for the rodents in a television <a href="https://www.svt.se/nyheter/lokalt/skane/tre-fragor-om-darfor-gnager-rattorna-sonder-din-bil">news feature about rats</a> gnawing electrical cables in parked cars in the southern Swedish town of Malmö. </p>
<p>The brown rat, <em>Rattus norvegicus</em>, is one of the species best adapted to modern society. These rats have followed humans around the world to become one of the most abundant mammals, spreading from their native distribution in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8214441/">northern China</a> and Mongolia and reaching Europe <a href="https://royalsocietypublishing.org/doi/10.1098/rspb.2016.1762">in the 1500s</a>, possibly even earlier. Black rats, however, arrived in Europe as early as the <a href="https://www.york.ac.uk/news-and-events/news/2022/research/black-rat-europe/">1st century AD</a>. </p>
<p>Today almost all wild brown rats are <a href="https://davidrousefaicp.com/synanthropic-species-why-are-they-important-to-our-future/">synanthropic</a>, meaning they live in close association with humans, eating our leftovers and using human structures for shelter. The relationship between rats and humans is one of commensalism, a word derived from the Latin term “commensal”, meaning “<a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/commensalism#:%7E:text=Literally%2C%20the%20term%20means%20%E2%80%9Ceating,two%20partners%20can%20survive%20independently.">eating at the same table</a>”. </p>
<p>Throughout the centuries, rats have been cast as humanity’s dark shadow. Rats have had an enormous impact on human civilisation, not least through the spread of diseases. They have long been associated with <a href="https://archive.org/details/dictionary-of-mythology-folklore-and-symbols-vols-1-3-gertrude-jobes-1962">dirt, death and destruction</a>. In medieval Europe people loathed rats for their so-called brutishness, <a href="https://press.uchicago.edu/ucp/books/book/distributed/R/bo3616680.html">seemingly limitless sexual appetite</a> and fecundity. But their huge numbers and adaptability mirrors humans’ evolutionary success. </p>
<p>They have <a href="https://www.sciencedirect.com/science/article/abs/pii/S0160932705000785">spread with wars</a> and European imperialism to colonised territories in the Americas as well as Africa and Australia. Rats <a href="http://0-blogs.biomedcentral.com.brum.beds.ac.uk/bugbitten/2014/11/10/parasites-and-diseases-in-the-trenches-of-world-war-i/">thrive in the trenches</a> of <a href="https://www.businessinsider.com/rats-in-russian-trenches-front-line-add-to-disgusting-conditions-2023-10?r=US&IR=T">modern warfare</a> even today. </p>
<h2>A social and empathetic animal</h2>
<p>Real rats are far from the despicable creatures they often are made out to be. Several studies have shown that rats have powerful empathy. </p>
<figure>
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</figure>
<p>These animals can share the emotional state of others, which in psychology is called emotional contagion. <a href="https://www.sciencedirect.com/science/article/pii/S1364661322001115">Research has shown</a> that when a rat sees another rat in distress, the neural structures activated in that rat’s brain closely resembles those activated in humans brains when feeling empathy for pain of others. </p>
<p><a href="https://www.washingtonpost.com/national/health-science/a-new-model-of-empathy-the-rat/2011/12/08/gIQAAx0jfO_story.html">One experiment showed</a> that rats will release a fellow rat from an unpleasant cage even if they are not rewarded for it. And if given chocolate treats afterwards, the free rat would usually save at least one treat for the former captive. </p>
<p>This selfless behaviour comes from rats’ socially complex lives in family groups of multiple generations. They form lifelong bonds with other rats and share socially learned skills, such as foraging techniques, across generations. This means rats have a <a href="https://elifesciences.org/articles/54020">form of culture</a>. </p>
<p><a href="https://www.theguardian.com/science/2023/nov/02/rats-may-have-power-imagination-research">A study from 2023</a> even showed that rats can imagine places and things that aren’t in front of them at the time. In experiments rats were shown to <a href="https://www.science.org/doi/10.1126/science.adh5206">navigate a space</a> in their thoughts, that they have previously explored. As in the studies of empathy, researchers demonstrated this by comparing the regions in the rat’s brains that were activated to those that are activated when humans think about navigating their way through places they have visited.</p>
<figure>
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</figure>
<p>This ability to imagine also suggests that rats have a sense of past and future. </p>
<h2>Living and dying with rats</h2>
<p>With this in mind, human ways of dealing with rats seem cruel. The most common chemical method for rat control <a href="https://www.pestprooflondon.co.uk/rat-poison/">is anticoagulants</a>, which cause fatal internal bleeding one to two weeks after a rat eats the poison. Since rats are both socially intelligent and cautious, they prefer to sample unfamiliar food and then wait to see if it makes them or other rats sick. </p>
<p>It’s called <a href="https://www.sciencedirect.com/science/article/abs/pii/0168159189900373">poison shyness</a>. With anticoagulants however, the time between consumption of the bait and the rat dying is so long that they don’t usually associate it with their feeding habits. </p>
<p>The human motivation for learning about rats has often been the desire to kill them. The foremost experts in wild rat behaviour are their exterminators. And yet, current methods for controlling wild rat populations are not very effective.</p>
<p>Some rats have <a href="https://www.pestcontrol.basf.co.uk/Documents/Training/Anticolagulant-Resistance-in-the-UK.pdf?1647246881707">developed resistance to the poisons</a> and are able to eat it and survive. Trapping them is notoriously difficult, and they often recolonise the territory from which they have been removed.</p>
<p><a href="https://www.icup.org.uk/media/ntwhyvrt/icup466.pdf">Global urbanisation</a> is probably only going to bring humans into <a href="https://www.pnas.org/doi/10.1073/pnas.2112341119#:%7E:text=As%20urbanization%20has%20intensified%20globally,spaces%20(3%E2%80%935).">closer contact with rats</a>, and killing rats the way it is done today isn’t ethical. </p>
<figure class="align-center ">
<img alt="Rat poking its head up from a black iron hatch/" src="https://images.theconversation.com/files/562400/original/file-20231129-21-x68ffx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/562400/original/file-20231129-21-x68ffx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/562400/original/file-20231129-21-x68ffx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/562400/original/file-20231129-21-x68ffx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/562400/original/file-20231129-21-x68ffx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/562400/original/file-20231129-21-x68ffx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/562400/original/file-20231129-21-x68ffx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It’s time to consider if there are less violent ways of living alongside rats.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cute-gray-rat-looking-out-hole-1148729435">TashaBubo/Shutterstock</a></span>
</figcaption>
</figure>
<p>Instead, we should consider other strategies, like the ones explored by the <a href="https://www.helsinki.fi/en/projects/urban-rats">Urban Rat Project</a> at the University of Helsinki. Here researchers from different disciplines are trying to get a deeper understanding of conflicts between rats and humans. They are studying both species and their interactions, in hope of a future with less bloody human-rat relations.
The project has spotted that places in urban areas where people feed birds tend to attract rats as well – which people then try to eradicate using poison or traps.</p>
<p>Research has also suggested <a href="https://helda.helsinki.fi/items/36d81d1e-9d71-41e2-b694-6ae88a8b4be5">that with increased knowledge</a> about rats and their behaviour people tend to develop a more positive attitude towards them. So more knowledge of wild rats’ social behaviour is needed. And humans need to manage their own behaviour to avoid conflict with rats. </p>
<p>A good place to start would be reducing food waste and stop leaving leftovers out unsecured. Less rats around human food sources, for example, and more knowledge about their behaviour would mean a lower risk of diseases spreading from rats to humans, as well as from humans to rats. </p>
<p>Humanity’s future is with the rat, a social and empathetic animal. So it’s time we understood our shadows.</p><img src="https://counter.theconversation.com/content/216846/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tobias Linné does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Rats are well known to cause problems for humans. But we need a new approach to our relationship with them.Tobias Linné, Assistant Professor in Media and Communication Studies, Lund UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2175162023-11-21T13:23:42Z2023-11-21T13:23:42ZGaza’s next tragedy: Disease risk spreads amid overcrowded shelters, dirty water and breakdown of basic sanitation<p>After more than a month of <a href="https://www.washingtonpost.com/world/interactive/2023/gaza-rising-death-toll-civilians/">being subjected to sustained bombing</a>, the besieged people of the Gaza Strip are now confronted with another threat to life: disease.</p>
<p><a href="https://www.lemonde.fr/en/international/article/2023/11/12/displaced-gazans-lack-everything-in-overcrowded-unrwa-shelters_6249054_4.html">Overcrowding at shelters</a>, a <a href="https://www.reuters.com/world/middle-east/gaza-people-resort-drinking-salty-water-garbage-piles-up-2023-10-16/">breakdown of basic sanitation</a>, the <a href="https://reliefweb.int/report/occupied-palestinian-territory/dead-bodies-remain-scattered-streets-and-under-rubble-new-health-disaster-looms-over-gaza-enar">rising number of unburied dead</a> and a <a href="https://www.nbcnews.com/health/health-news/disease-runs-rampant-gaza-clean-water-runs-rcna125091">scarcity of clean drinking water</a> have left the enclave “on the precipice of major disease outbreaks,” <a href="https://news.sky.com/story/gaza-on-verge-of-major-disease-outbreak-world-health-organisation-warns-13011923">according to the World Health Organization</a>.</p>
<p>As an <a href="https://ccie.ucf.edu/person/yara-asi/">expert in Palestinian public health systems</a> who wrote about the many relationships between war and health for my forthcoming book “<a href="https://www.press.jhu.edu/books/title/12483/how-war-kills">How War Kills: The Overlooked Threats to Our Health</a>,” I believe that the looming crisis cannot be underestimated. The easy spread of infectious disease in wartime conditions can be just as devastating as airstrikes to health and mortality – if not more so. Health care services in Gaza – <a href="https://theconversation.com/decades-of-underfunding-blockade-have-weakened-gazas-health-system-the-siege-has-pushed-it-into-abject-crisis-215679">already vulnerable prior to the Israeli bombing campaign</a> – have essentially no capacity to cope with a major outbreak.</p>
<h2>Disease already rampant</h2>
<p>History <a href="https://doi.org/10.1093/clind/16.4.580">has proved time</a> <a href="https://doi.org/10.2217/fmb-2018-0323">and again</a> that war zones can be a breeding ground for disease. Anywhere impoverished and underresourced people crowd for shelter or access to resources – often in facilities with inadequate living conditions, sanitation services or access to clean water – is prone to the spread of disease. This can be through airborne or droplet transmission, contaminated food or water, living vectors like fleas, mosquitoes or lice, or improperly cleaned and managed wounds.</p>
<p>In any situation of armed conflict or mass displacement, the threat of infectious disease is <a href="https://doi.org/10.1016/S0140-6736(02)11807-1">among the primary concerns</a> of public health professionals. And from the outset of the Israeli bombing campaign, experts have <a href="https://www.msf.org/hospitals-are-overwhelmed-catastrophic-situation-gaza">predicted dire health consequences</a> for Gaza.</p>
<p>After all, the Gaza Strip had fragile health and water, sanitation and hygiene sectors long before the <a href="https://apnews.com/article/israel-palestinians-gaza-hamas-rockets-airstrikes-tel-aviv-11fb98655c256d54ecb5329284fc37d2">Oct. 7, 2023, Hamas attack</a> that killed 1,200 Israelis and prompted the retaliatory airstrikes. The health system of Gaza, one of the most densely populated places in the world, has long been plagued by <a href="https://theconversation.com/decades-of-underfunding-blockade-have-weakened-gazas-health-system-the-siege-has-pushed-it-into-abject-crisis-215679">underfunding and the effects of the blockade</a> imposed by Israel in 2007.</p>
<p>Waterborne illness was <a href="https://www.haaretz.com/middle-east-news/palestinians/2018-10-16/ty-article-magazine/.premium/polluted-water-a-leading-cause-of-gazan-child-mortality-says-rand-corp-study/0000017f-e847-dc7e-adff-f8ef68c50000?lts=1700169133776">already a major cause of child mortality</a> – the result of the contamination of most of Gaza’s water. In early 2023, an estimated <a href="https://www.anera.org/blog/gazas-water-crisis-puts-thousands-at-risk-of-preventable-death/">97% of water</a> in the enclave was unfit to drink, and more than 12% of child mortality cases were caused by <a href="https://www.ochaopt.org/content/study-warns-water-sanitation-crisis-gaza-may-cause-disease-outbreak-and-possible-epidemic">waterborne ailments</a>, like typhoid fever, cholera and hepatitis A, that are very rare in areas with functional and adequate water systems.</p>
<figure class="align-center ">
<img alt="A woman in a dress and headscarf accompanies a patient on a gurney." src="https://images.theconversation.com/files/560562/original/file-20231120-16-p42dv2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/560562/original/file-20231120-16-p42dv2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/560562/original/file-20231120-16-p42dv2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/560562/original/file-20231120-16-p42dv2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/560562/original/file-20231120-16-p42dv2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/560562/original/file-20231120-16-p42dv2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/560562/original/file-20231120-16-p42dv2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Palestinians flee Gaza City carrying their sick sister on Nov. 18, 2023.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/palestinians-flee-gaza-city-carrying-their-sick-sister-news-photo/1790171061?adppopup=true">Loay Ayyoub/For The Washington Post via Getty Images</a></span>
</figcaption>
</figure>
<p>Other forms of infectious disease spread have also been reported in recent years. Gaza had experienced <a href="https://www.longdom.org/open-access/epidemiology-of-different-types-of-meningitis-cases-in-gaza-governoratesoccupied-palestinian-territory-december-2013-january-2014-jaa-1000132.pdf">several previous outbreaks of meningitis</a> – an inflammation of the tissues surrounding the brain and spinal cord typically caused by infection – notably in 1997, 2004 and 2013.</p>
<p>In late 2019, a <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2020-DON232">small outbreak of measles</a> – a highly contagious, airborne virus – was reported in Gaza, with almost half of reported cases in unvaccinated people. Despite a relatively high vaccination rate in Gaza generally, these gaps in vaccination and the inability to respond quickly to outbreaks <a href="https://doi.org/10.1016/S1473-3099(20)30075-X">were attributed by the WHO</a> to “the continuous socio-economic decline since 2009, conflict, and closure.”</p>
<p>And the <a href="https://mezan.org/uploads/files/1665041769435.pdf">COVID-19 pandemic</a> hit the Gaza Strip hard, exacerbated by the Israeli blockade that prevented or delayed the import of vital <a href="https://www.aljazeera.com/news/2020/11/23/gaza-declares-covid-19-disaster-with-health-system-near-collapse">personal protective equipment</a>, <a href="https://www.aljazeera.com/news/2020/12/7/coronavirus-test-kits-run-out-in-gaza-as-collapse-fears-grow">testing kits</a> <a href="https://theconversation.com/israel-faces-legal-and-practical-obligations-for-including-palestinians-in-vaccine-success-153711">and vaccines</a>.</p>
<h2>A system overwhelmed</h2>
<p>The vulnerability of Gaza’s health care meant that from the outset of the latest conflict, organizations such as the <a href="https://www.reuters.com/world/middle-east/un-agencies-call-ceasefire-humanitarian-access-throughout-gaza-2023-10-21/">WHO voiced concern</a> that the violence and deprivation could quickly overwhelm the system.</p>
<p>There are several ways war in general, and the conflict in Gaza in particular, accelerates and promotes infectious disease risk.</p>
<p>Almost concurrently with the start of the bombing campaign, Israel <a href="https://www.theguardian.com/world/2023/oct/09/israel-declares-siege-on-gaza-as-hamas-claims-israeli-strikes-killed-captives">imposed siege conditions</a> on Gaza. This prevented the import of fuel needed to run generators for vital infrastructure. Generators are needed because Israel <a href="https://www.middleeasteye.net/news/gaza-hospitals-struggle-cope-israel-cuts-electricity">shut off electricity</a> to Gaza.</p>
<p>As fuel has essentially run out in recent days, this has meant <a href="https://www.cnn.com/2023/10/18/middleeast/gaza-water-access-supply-mapped-dg/index.html">no power for desalination plants</a> or for solid waste collection. As a consequence, many people have been <a href="https://www.theguardian.com/global-development/2023/nov/04/lack-of-clean-drinking-water-for-95-of-people-in-gaza-threatens-health-crisis">forced to consume contaminated water</a> or live in conditions where living carriers of disease, like rodents and insects, thrive. </p>
<p>Even basic cleaning supplies are scarce, and equipment used to sterilize everything from medical equipment to baby bottles is inoperable. </p>
<p>These unhygienic conditions come as hundreds of thousands of Palestinians in Gaza attempt to flee the bombing to the few remaining places left to shelter. This has <a href="https://www.reuters.com/world/middle-east/who-voices-concern-over-spread-disease-gaza-2023-11-17/">caused massive overcrowding</a>, which increases the risk of an infectious disease outbreak. </p>
<h2>Children especially vulnerable</h2>
<p>Already, the WHO <a href="https://www.emro.who.int/media/news/risk-of-disease-spread-soars-in-gaza-as-health-facilities-water-and-sanitation-systems-disrupted.html">has reported worrying trends</a> since mid-October 2023, including more than 44,000 cases of diarrhea in Gaza. </p>
<p>Diarrhea is a particular risk for young children who are prone to profound dehydration. It represents the <a href="https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease">second-leading cause of death worldwide</a> in children younger than 5 years of age. Half of the diarrhea cases reported in Gaza since the Israeli bombing campaign began <a href="https://www.nbcnews.com/health/health-news/disease-runs-rampant-gaza-clean-water-runs-rcna125091">have been in children under 5</a>.</p>
<p>Meanwhile, <a href="https://www.emro.who.int/media/news/risk-of-disease-spread-soars-in-gaza-as-health-facilities-water-and-sanitation-systems-disrupted.html">nearly 9,000 cases of scabies</a> – a skin rash caused by mites – have been reported, as have more than 1,000 cases of chickenpox.</p>
<p>More <a href="https://www.reuters.com/world/middle-east/who-voices-concern-over-spread-disease-gaza-2023-11-17/">than 70,000 cases of upper respiratory infections</a> have been documented, far higher than what would be expected otherwise. These are just cases that were reported; undoubtedly, more people who were unable to get to a health facility for diagnosis are also sick.</p>
<p>Reports of the spread of chickenpox and upper respiratory infections like influenza and COVID-19 are particularly dangerous considering children’s vaccination schedules are being highly disrupted by conflict. With health services overstretched and the mass movement of families, young children and newborns are likely going without vital, lifesaving inoculations just as winter – the peak season for respiratory infections – arrives. </p>
<p>Upper respiratory infections are also exacerbated by the amount of <a href="https://www.pbs.org/newshour/show/a-look-inside-the-gaza-hospital-raided-by-israeli-defense-forces">dust and other pollutants</a> in the air due to the destruction of buildings during bombing.</p>
<p>Then there is the direct impact of the bombing campaign. A <a href="https://www.cnn.com/2023/11/02/middleeast/gaza-hospitals-overwhelmed-as-power-run-out-intl/index.html">lack of antibiotics</a> – due to both the siege and the <a href="https://abcnews.go.com/International/wireStory/live-updates-shell-hits-gaza-hospital-killing-12-105027214">destruction of health facilities</a> – means physicians are unable to adequately treat thousands of patients with open wounds or in need of medical operations, including amputations.</p>
<h2>More death and suffering</h2>
<p>Increasingly, doctors are even running out of wound dressings to protect injuries from exposure. Poor infection prevention controls, high casualty rates and high concentrations of toxic heavy metals, among other factors, are leading to <a href="https://doi.org/10.1016/S0140-6736(23)02508-4">reports of antimicrobial resistance</a>, which occurs when bacteria and viruses evolve over time to no longer respond to antibiotics and other antimicrobial medications. This has the potential to lead to health issues long after the bombing stops. Similar trends were also seen in Iraq, where <a href="https://doi.org/10.1136/bmjgh-2022-010863">antimicrobial resistance rates remain high</a> despite the peak of bombing campaigns ending many years ago.</p>
<p>And with <a href="https://www.timesofisrael.com/thousands-of-bodies-lie-buried-in-rubble-gazans-dig-to-retrieve-them-often-by-hand/#:%7E:text=%E2%80%9CWe%20just%20want%20to%20find,families%2C%20who%20are%20overwhelmingly%20Muslim.">many bodies laying under rubble</a>, unable to be retrieved, and the necessity of <a href="https://www.nbcnews.com/news/world/gaza-burials-dead-israel-hamas-war-rcna124238">digging multiple mass graves</a> near sites where people are sheltering, there is also increased risk of disease arising from an inability to adequately dispose of the dead.</p>
<p>While the images and photos from Gaza of areas and people that have been bombed are devastating and have caused a <a href="https://www.ochaopt.org/content/hostilities-gaza-strip-and-israel-flash-update-42">massive death toll – at least 12,000</a> by mid-November, according to Gaza health authorities – the rapid spread of infectious disease has the ability to cause even greater mortality and suffering to a population reeling from weeks of sustained bombing.</p><img src="https://counter.theconversation.com/content/217516/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yara M. Asi does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>High levels of diarrhea, scabies and respiratory infections have been reported as bombing campaign progresses – and children are the most vulnerable.Yara M. Asi, Assistant Professor of Global Health Management and Informatics, University of Central FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2164832023-10-27T14:09:00Z2023-10-27T14:09:00ZChad’s first dengue fever outbreak: what you should know<p><em>Chad has <a href="https://www.cidrap.umn.edu/dengue/chad-reports-its-first-dengue-outbreak">reported</a> its first dengue outbreak, according to the World Health Organization (WHO). The country’s health ministry declared an outbreak on 15 August and so far 1,342 suspected cases have been reported, 41 of them confirmed in the laboratory. One death was reported among the patients with lab-confirmed cases. The outbreak started in Ouaddaï province in eastern Chad, currently the outbreak epicentre. Illnesses have also been reported in three other provinces. Godfred Akoto Boafo spoke to medical entomologist Eunice Anyango Owino about the disease.</em></p>
<h2>What causes dengue fever and how does it affect people?</h2>
<p><a href="https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue">Dengue fever</a> is a mosquito-borne viral disease caused by one of the four dengue virus serotypes. It is primarily transmitted by the <em>Aedes aegypti</em> mosquito and to a lesser extent the <em>Aedes albopictus</em> mosquito, mainly in the tropical and sub-tropical areas of the world. </p>
<p>Infection with one serotype provides long-term immunity to that particular serotype, but not the others. That means that, after recovery, a person can still be infected by the other three serotypes. Serotypes are groups within a single species of microorganisms, such as bacteria or viruses, which share distinctive surface structures.</p>
<p>Most infections produce only mild flu-like illness; 80% of cases are asymptomatic. But getting infected with different serotypes one after the other puts a person at a greater risk of severe dengue, also known as dengue hemorrhagic fever. It is characterised by serious internal bleeding and organ damage, and a sudden drop in blood pressure that causes shock which can be fatal. </p>
<h2>How widespread is it in the Sahel? Why is this first outbreak in Chad significant?</h2>
<p>Dengue fever has been <a href="https://pubmed.ncbi.nlm.nih.gov/37473544/">endemic in Sudan</a>, with outbreaks documented in 2010, 2013, 2017 and 2019. Unfortunately, due to years of political and civil conflicts, the control and response capacity of the public health sector in Sudan has been limited. </p>
<p>The risk of spread in the Sahel region, which includes Niger, Mali and Chad, has always been high. This is because these countries all host the suitable mosquito vectors (<em>Aedes</em>). They also share the same tropical climate with seasonal heavy rains and floods. </p>
<p>To add to the problem, countries like Chad are grappling with a massive influx of refugees and returnees from Sudan who might be carrying the disease. The epicentre of the current outbreak, the <a href="https://www.unocha.org/publications/report/chad/chad-humanitarian-update-june-2023#:%7E:text=Following%20the%20escalation%20of%20conflict%20in%20El%20Geneina,Sudanese%20border%20in%20the%20Ouadda%C3%AF%20province%20of%20Chad">province of Ouaddaï</a> at the eastern border with Sudan, hosts more than 400,000 refugees. </p>
<p>The cities at the border with Sudan are densely populated and have poor sanitation. This provides a favourable environment for the vectors to breed. </p>
<p>In addition, Chad lacks effective disease control programmes. This is its first dengue outbreak. It doesn’t have the necessary public health preparedness and response capacities. So the risk posed by this outbreak is high. </p>
<p>The movement of the <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2019-DON207">returning refugees</a> has the potential to spread the outbreak in Chad and even across the border to other countries in the Sahel, the rest of Africa, and the world at large. </p>
<h2>What treatment is available?</h2>
<p>There’s currently no available treatment for dengue in the world. Timely detection and case management, especially treatment of dehydration and plasma leakage by oral or intravenous rehydration, are key in preventing severe illness and death. </p>
<p>There is an approved dengue vaccine (Dengvaxia) for use in people aged 9-45 years. But for it to be effective they must have had one infection of dengue by any of the four serotype viruses, which must be confirmed by a laboratory test. </p>
<p>The vaccine is given in three doses within 12 months and protects against all the four dengue virus serotypes with an efficacy of 80%. However, its availability in developing countries in Africa isn’t assured, although it has been licensed by several national regulatory authorities. </p>
<p>Apart from the vaccine, the only other guard against dengue fever is prevention of mosquito bites and vector control.</p>
<h2>What is the way forward in controlling the disease?</h2>
<p>More investment should be put on expanding clinical and laboratory capabilities to deal with the disease. Given that this is Chad’s first outbreak, it needs to:</p>
<ul>
<li><p>put in place standard operating procedures for clinical management of suspected and confirmed dengue cases </p></li>
<li><p>expand the capacity for early detection of cases – this could be done by procurement of rapid diagnostic tests and by alerting communities </p></li>
<li><p>strengthen disease surveillance and coordinate the response by actively finding cases. Cases within the community are likely to be underreported as dengue is unknown to the public. Also, clinicians might not be familiar with the disease presentation. It could be confused with other common fevers. </p></li>
<li><p>put in place effective vector control measures, like draining stagnant water around residential areas, cleaning and replenishing water storage containers on a weekly basis, distributing insecticide-treated nets, spraying indoors and using window and door screens.</p></li>
<li><p>strengthen surveillance to assess the vector breeding potential in containers and to monitor insecticide resistance. This is critical for selecting the most effective insecticides. </p></li>
<li><p>make communities aware of the risks of infection and how to protect themselves. Engaged communities can take ownership of the vector control strategy and adopt healthy behaviours. </p></li>
<li><p>strengthen cross-border collaboration. The current outbreak most likely spread from Sudan. The focus should be on prevention and vector control measures in border areas.</p></li>
<li><p>mobilise resources for a national contingency plan for dengue preparedness and response. And seek help from experienced organisations like the WHO.</p></li>
</ul><img src="https://counter.theconversation.com/content/216483/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eunice Anyango Owino receives funding from National Research Fund, Kenya. </span></em></p>The Sahel region is grappling with an outbreak of the deadly mosquito-borne disease.Eunice Anyango Owino, Medical Entomologist at the School of Biological Sciences, University of NairobiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2091552023-10-18T14:18:15Z2023-10-18T14:18:15ZTapeworm is spreading in Kenya – demand for meat brings parasite to new areas<p><em>Echinococcus granulosus</em>, a type of tapeworm, is a harmful parasite that affects <a href="https://www.who.int/news-room/fact-sheets/detail/echinococcosis">1 million people</a> worldwide. </p>
<p>The parasite can grow slowly in people for years to form thick-walled cysts in vital organs, such as the liver and lungs. Known as cystic echinococcosis, or hydatid disease, it can cause abdominal pain, nausea and vomiting. And if not treated, it can be fatal.</p>
<p>It’s a zoonotic disease, meaning it spreads from animals to people, with a <a href="https://www.cdc.gov/dpdx/echinococcosis/index.html">life cycle</a> involving humans, dogs and ruminant livestock. It’s also considered a <a href="https://www.who.int/news-room/facts-in-pictures/detail/neglected-zoonotic-tropical-diseases">neglected disease</a> by the World Health Organization (WHO). It needs greater attention because of how dangerous it can be and because treatment can be invasive and expensive. It costs <a href="https://www.who.int/news-room/fact-sheets/detail/echinococcosis">US$3 billion a year</a> globally to treat cases and compensate for losses to the livestock industry. </p>
<p>In Kenya, the disease has <a href="https://doi.org/10.1080/00034983.1982.11687565">long been endemic</a> – meaning present over a long period of time at a relatively low level – in pastoralist communities who live and work closely with livestock, in north-western Kenya and Maasailand. </p>
<p>Traditional pastoralist livestock farming in Kenya’s north, for example in Turkana, has <a href="https://doi.org/10.1080/00034983.1985.11811888">concentrated</a> the risk of disease in communities there. But populations in other parts of Kenya <a href="https://www.nature.com/articles/s41598-021-98495-7">are increasing</a>, and thus so is the demand for meat. As a result, more animals are being driven south for slaughter, bringing tapeworm infections with them.</p>
<p>We’re part of a collaboration between the <a href="https://www.ilri.org">International Livestock Research Institute</a>, <a href="https://www.jkuat.ac.ke/">Jomo Kenyatta University of Science and Technology</a>, the <a href="https://www.liverpool.ac.uk/">University of Liverpool</a> and the <a href="http://www.kemri.go.ke">Kenya Medical Research Institute</a>. We’ve tracked the spread of <em>Echinococcus</em> tapeworm into populations in a non-endemic area for the first time. This work is important so that steps can be taken to prevent the spread of such diseases, particularly from animals to humans.</p>
<p>We conducted four pieces of research which covered how prevalent <em>Echinococcus</em> tapeworm was in livestock being brought for slaughter, how it spread to people and how great the human disease burden was. </p>
<p>We’ve found that the parasite is highly prevalent in livestock moving into these non-endemic areas and is now spreading, via dogs, into human populations.</p>
<p>Our findings highlight how important it is to carry out disease surveillance, particularly as populations grow and dynamics change. </p>
<h2>Mapping the spread</h2>
<p>Our studies focused on Busia and Bungoma counties, which border one another and which previously didn’t have the tapeworm disease, cystic echinococcosis, among humans and livestock. </p>
<p>For our <a href="https://www.nature.com/articles/s41598-021-98495-7">first study</a> we assessed how prevalent tapeworm was in livestock being brought for slaughter. Over two years, we collected over 16,000 reports in both counties and <a href="https://www.nature.com/articles/s41598-021-98495-7">found</a> a very high infection rate in the samples we collected – 32% of the livers of cattle and goats, 74% of lungs in cattle and 58% of lungs in goats.</p>
<p>Our <a href="https://onlinelibrary.wiley.com/doi/10.1002/ece3.7317">second</a> and <a href="https://www.sciencedirect.com/science/article/pii/S2405939022001459?via%3Dihub">third</a> studies sought to understand how <em>Echinococcus</em> tapeworm might spread to humans in the counties. We hypothesised that local dogs could be acting as the vector. </p>
<p>Dogs congregate at slaughter facilities and consume whatever is discarded. For instance, we saw that often lungs from slaughtered animals were being discarded because of hydatid cysts. Dogs could get tapeworms from eating meat like this.</p>
<p>We tracked the movements of 73 dogs using GPS collars over five days each and saw that they regularly visited slaughterhouses. Through examining their faecal samples, we saw that the parasite was present, and 16% were positive for <em>Echinococcus</em> antigens in faeces. This meant they could bring the disease to households and people. </p>
<p>The parasite matures in the dogs’ intestines, and the dog sheds eggs in faeces, contaminating the environment. People get infected when inadvertently parasite eggs from the environment are eaten, usually due to poor household hygiene.</p>
<p>Our <a href="https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0000235">final study</a> was to examine how great the human disease burden was in Bungoma county. Using ultrasound technology, we found cystic lesions which may indicate <em>Echinococcus</em> infection among a small number (around 1%) of the community members.</p>
<p>While we did not find the population extensively suffered from this disease, we detected early signs of the establishment of a local transmission cycle. This means that the parasite has been introduced and is spreading slowly in groups of people and dogs which have not been exposed before. This slow-moving outbreak could soon represent a much more significant public health problem if left unchecked.</p>
<p>Unfortunately, very few people in the area can access the tools necessary to diagnose and treat the condition. Ultrasound imaging is the most effective way to screen for and monitor infections, allowing healthcare providers to offer people the necessary treatment. By the time human infections are advanced, expensive operative procedures to remove hydatid cysts are the only treatment available.</p>
<p>Routine ultrasound imaging over time also helps monitor treatment and surgical outcome. However, many health facilities lack ultrasound services. </p>
<h2>A public health risk</h2>
<p>The intersection of infected livestock from endemic tapeworm regions and dogs scavenging for disposed animal by-products creates conditions under which it is more likely that humans become infected. </p>
<p>As Africa’s agricultural systems face increasing demands from population growth and demographic changes, rapid unplanned growth can have devastating unintended consequences. </p>
<p>To protect populations, systems of surveillance must keep up with the changing world. Tracking the spread of disease, as we have done with <em>Echinococcus granulosus</em> in a non-endemic region, is an essential step to prevent future outbreaks of public health concern.</p>
<p><em>Madison Spinelli, Princeton in Africa Fellow at the International Livestock Research Institute, contributed to the writing of this article.</em></p><img src="https://counter.theconversation.com/content/209155/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eric Fèvre receives funding from UKRI, the Wellcome Trust, US DTRA and the CGIAR.</span></em></p><p class="fine-print"><em><span>Laura Falzon and Titus Mutwiri do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The intersection of infected livestock from endemic tapeworm regions and dogs scavenging for disposed animal by-products creates the perfect storm to infect vulnerable human populations.Titus Mutwiri, Lecturer, Kenya Methodist UniversityEric Fèvre, Professor of Veterinary Infectious Diseases, University of Liverpool and International Livestock Research Institute, Kenya, University of LiverpoolLaura Falzon, Post-doctoral research associate, University of LiverpoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2134462023-09-20T21:28:41Z2023-09-20T21:28:41ZObesity is a dangerous disease that shares key features with cancer<figure><img src="https://images.theconversation.com/files/549385/original/file-20230920-19-5q8kcd.jpg?ixlib=rb-1.1.0&rect=3851%2C14%2C5663%2C4180&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Obesity is itself a disease, in addition to contributing to the onset and progression of other conditions such as diabetes, heart attack and stroke.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/obesity-is-a-dangerous-disease-that-shares-key-features-with-cancer" width="100%" height="400"></iframe>
<p>Although obesity has been <a href="https://doi.org/10.1038/ijo.2008.247">recognized as a disease by the World Health Organization (WHO)</a> since 1948, its identity as a disease may not be widely perceived the same way as other health conditions. </p>
<p>People living with obesity are less <a href="https://doi.org/10.1007/s13679-021-00444-y">likely to receive dedicated care for that condition</a>, in contrast to patients with other diseases, such as cancer. However, obesity and cancer have several similarities. This is of <a href="https://www.worldobesityday.org/">global crucial importance</a>, given the dramatic increase in numbers of affected adults and children, <a href="https://data.worldobesity.org/country/canada-36/">including in Canada</a>.</p>
<h2>Obesity is a disease</h2>
<p>Like cancer, or other medically recognized diseases, obesity should be seriously considered as such by public opinion. Not only is obesity itself a disease, but it can also contribute to the onset and progression of <a href="https://doi.org/10.1177/2042018820934955">cancer and other diseases</a>, such as <a href="https://doi.org/10.1155/2018/3407306">diabetes, atherosclerosis, heart attack and stroke</a>.</p>
<p>The disease of obesity affects people in several ways:</p>
<p><strong>Mechanically:</strong> Obesity imposes an excessive <a href="https://www.health.harvard.edu/pain/why-weight-matters-when-it-comes-to-joint-pain">pressure on the bones and the joints</a>, as well as internal organs. It can also <a href="https://www.sleepfoundation.org/sleep-apnea/weight-loss-and-sleep-apnea">potentially cause airway obstruction</a> that can lead to obstructive sleep apnea.</p>
<p><strong>Biologically:</strong> <a href="https://doi.org/10.3389/fimmu.2022.907750">Obesity can lead to osteoarthritis</a>, for example, and it presents with <a href="https://doi.org/10.1172/JCI92035">inflammation</a> and <a href="https://doi.org/10.3390/ijms21103570">dysregulated secretions</a> by dysfunctional fat tissue cells. </p>
<p>Obesity can also result in <a href="https://doi.org/10.1172/JCI81507%22%22">abnormal fat deposits on vital organs</a>, which seriously alters the whole organism’s <a href="https://www.britannica.com/science/homeostasis">homeostasis</a>, or biological stability.</p>
<p><strong>Psychologically:</strong> <a href="https://doi.org/10.1111/scs.12756">Patients with obesity may face difficulties in accomplishing daily activities</a>; even simple things such as tying their shoelaces may be a challenge. This is further worsened by <a href="https://doi.org/10.1016/j.eclinm.2022.101464">social media’s deep influence</a> and promotion of a presumed “ideal” unrealistic body shape image, which stigmatizes patients with obesity. </p>
<p>There is also evidence that obesity is accompanied by <a href="https://doi.org/10.1007/s12272-019-01138-9">brain inflammation</a> and increased risk of mental health conditions such as major <a href="https://doi.org/10.1038/s41380-018-0017-5">depressive disorder</a> and <a href="https://doi.org/10.1007/s40211-019-0302-9">anxiety</a>.</p>
<h2>Common characteristics of obesity and cancer</h2>
<figure class="align-center ">
<img alt="Illustration with two human figures representing cancer and obesity flanking a list of common factors: Metastatic, Recurrent, Progressive and Multifactorial" src="https://images.theconversation.com/files/548475/original/file-20230915-23-edvy8n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/548475/original/file-20230915-23-edvy8n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=503&fit=crop&dpr=1 600w, https://images.theconversation.com/files/548475/original/file-20230915-23-edvy8n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=503&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/548475/original/file-20230915-23-edvy8n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=503&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/548475/original/file-20230915-23-edvy8n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=633&fit=crop&dpr=1 754w, https://images.theconversation.com/files/548475/original/file-20230915-23-edvy8n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=633&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/548475/original/file-20230915-23-edvy8n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=633&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">As a disease, obesity shares many common features with cancer.</span>
<span class="attribution"><span class="source">(Besma Boubertakh, using Biorender.com and Mindthegraph.com)</span></span>
</figcaption>
</figure>
<p>Obesity shares several major features with cancer:</p>
<p><strong>Multifactorial grounds:</strong> Both diseases present no single known cause, which can make prevention and treatment challenging. </p>
<p>Obesity is not simply due to individual lifestyles of high-calorie consumption or low levels of physical exercise, since the balance between energy intake and expenditure can be tipped in either direction by <a href="https://doi.org/10.1007/s00261-012-9862-x">genetics, the environment as well as other factors that are not completely understood</a>.</p>
<p><strong>Metastasis:</strong> <a href="https://doi.org/10.3390/cells11121872">Like cancer, obesity can involve metastases</a>, meaning that the disease can spread to other parts of the body. </p>
<p>In the case of obesity, this takes the form of ectopic fat deposits, which occur when adipose (fat) tissue cannot store all of the excess <a href="https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/triglycerides/art-20048186">triglycerides</a>, a type of lipid, or fat. Triglycerides then accumulate beyond their normal locations, including around organs. In obesity, fat can be deposited on the heart, the liver, in blood vessels and <a href="https://doi.org/10.1113/jphysiol.2012.239491">even the brain</a>. These deposits can alter vital organ function and have devastating effects on an individual’s health.</p>
<p><strong>Progressive development and stages:</strong> <a href="https://doi.org/10.1155/2015/619734">Obesity</a>, like <a href="https://doi.org/10.1038/s41568-020-00300-6">cancer,</a> can develop progressively to reach advanced harmful stages. One of the reasons why people may consider obesity as a less serious illness than cancer is that they may pay more attention to the stages of cancer. </p>
<p>In fact, both obesity and cancer might advance progressively in the absence of proper diagnosis and intervention. However, deaths that originate in obesity are most often attributed to potential consequent diseases (such as cardiovascular ischemic events or even cancer) and neglect the pivotal impact of obesity.</p>
<figure class="align-center ">
<img alt="A red yo-yo with a measuring tape instead of a string" src="https://images.theconversation.com/files/549432/original/file-20230920-29-30f3tt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/549432/original/file-20230920-29-30f3tt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/549432/original/file-20230920-29-30f3tt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/549432/original/file-20230920-29-30f3tt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/549432/original/file-20230920-29-30f3tt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/549432/original/file-20230920-29-30f3tt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/549432/original/file-20230920-29-30f3tt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many people with obesity struggle to control weight regain following weight loss, a phenomenon often called ‘yo-yo’ effect. However, recurrence is a better term that should replace yo-yo, since it more seriously emphasizes that obesity is far from a game.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p><strong>Recurrence:</strong> Those who recover from obesity can experience recurrence of the disease. A good example is seen in <em>The Biggest Loser</em> TV series. <a href="https://www.health.harvard.edu/diet-and-weight-loss/lessons-from-the-biggest-loser">Contestants who lost weight</a> on the show <a href="https://doi.org/10.1002/oby.21538">later regained it</a>.</p>
<p>Obesity recurrence is often referred to as “yo-yo” effect. However, “recurrence” is a better term that should replace yo-yo, since it more seriously emphasizes that obesity is far from a game. In fact, certain patients struggle deeply to curb uncontrollable weight regain.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-obesity-epidemic-is-fuelled-by-biology-not-lack-of-willpower-209121">The obesity epidemic is fuelled by biology, not lack of willpower</a>
</strong>
</em>
</p>
<hr>
<p>As illustrated by the tale of the Emperor’s New Clothes, people’s perceptions can be erroneous. Often, perceptions of obesity do not reflect its serious threats to health. Obesity is scientifically proven to be a disease, and internationally recognized as one. The mirroring of its features with cancer reveals its inherent morbid potential.</p>
<figure class="align-center ">
<img alt="Illustration of a tailor, and a king in his underwear looking in a mirror" src="https://images.theconversation.com/files/549437/original/file-20230920-25-zab88z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/549437/original/file-20230920-25-zab88z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/549437/original/file-20230920-25-zab88z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/549437/original/file-20230920-25-zab88z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/549437/original/file-20230920-25-zab88z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/549437/original/file-20230920-25-zab88z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/549437/original/file-20230920-25-zab88z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">We need to heed the lesson from the tale of the Emperor’s New Clothes, and recognize the reality of things: obesity is not simply a discomfort but a real disease.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Obesity is a disease because it can cause deterioration of several aspects of health. <a href="https://www.who.int/about/governance/constitution">WHO defines health</a> as “a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity.” </p>
<p>Even though obesity shares numerous morbidity characteristics with cancer, it does not get the same society-wide recognition as a disease, and people with obesity may be less likely to get the help and treatment they need. There is an urgent need to reshape the way obesity is viewed.</p><img src="https://counter.theconversation.com/content/213446/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors receive funding from the Canada Excellence Research Chair on the Microbiome-Endocannabinoidome Axis in Metabolic Health (CERC-MEND; Chairholder Prof. Vincenzo Di Marzo).</span></em></p><p class="fine-print"><em><span>Cristoforo Silvestri receives funding from the Canada First Research Excellence Fund through Sentinelle Nord of Université Laval.</span></em></p>Obesity is a disease that shares several characteristics with cancer, but does not get the same society-wide recognition of its disease status, so people with obesity are less likely to get treatment.Besma Boubertakh, Doctoral student, molecular medicine, Université LavalCristoforo Silvestri, Assistant Professor, Faculty of Medicine, Université LavalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2086582023-09-03T20:02:28Z2023-09-03T20:02:28ZSimon Schama’s history of 18th and 19th century disease outbreaks speaks powerfully to the present<figure><img src="https://images.theconversation.com/files/543587/original/file-20230821-93007-4ympol.png?ixlib=rb-1.1.0&rect=0%2C5%2C3946%2C2970&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cholera, Le Petite Journal (1912).</span> <span class="attribution"><span class="source">Bibliothèque nationale de France/Wikimedia Commons</span></span></figcaption></figure><p>Pandemics. Quarantine. Vaccines. These concepts have been at the forefront of our minds for over three years now. Having lived through the height of the COVID pandemic, it would be easy for us to imagine we have just experienced something unique in human history. </p>
<p>In <a href="https://www.simonandschuster.com.au/books/Foreign-Bodies/Simon-Schama/9781471169892">Foreign Bodies: Pandemics, Vaccines and the Health of Nations</a>, Simon Schama illustrates that this is about as far from the truth as possible. He examines the reactions to outbreaks of smallpox, cholera and plague in the 18th and 19th centuries, focusing on some key individuals – people who are often left out of the grand narrative of scientific progress.</p>
<hr>
<p><em>Review: Foreign Bodies: Pandemics, Vaccines and the Health of Nations – Simon Schama (Simon & Schuster)</em></p>
<hr>
<p>Schama specialises in Jewish and French history, and some have suggested he is not necessarily the right person to write a history of public health responses to diseases of pandemic proportions. But as a historian of medicine and public health, I find it quite revolutionary to see a historian of Schama’s ilk examining the field. </p>
<p>I was ten years old when I watched his BBC series <a href="https://www.imdb.com/title/tt0273359/">A History of Britain</a>. It was the first time in my life I genuinely understood that history was something that can never truly be “known”, but was something to be studied and interrogated for its nuances and hidden stories. To read Schama writing about an area of history I am personally invested in is genuinely exciting.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/542912/original/file-20230816-21-lgegoq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/542912/original/file-20230816-21-lgegoq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542912/original/file-20230816-21-lgegoq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=925&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542912/original/file-20230816-21-lgegoq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=925&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542912/original/file-20230816-21-lgegoq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=925&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542912/original/file-20230816-21-lgegoq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1162&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542912/original/file-20230816-21-lgegoq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1162&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542912/original/file-20230816-21-lgegoq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1162&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<p>In Foreign Bodies, Schama demonstrates that the histories of medicine and public health are deeply entwined with broader understandings of social history. He shows that, far from being a separate field of study, some of the “big picture” histories readers associate with him have indeed been heavily influenced by disease outbreaks and the reactions to them. </p>
<p>By leading the reader through broad sweeps of history, featuring relatively well-known figures and events, Schama places the histories of vaccinology and other advances in medicine and public health in their broader content. This is what Schama does best: he uses the macro history to highlight the intricacies of the micro histories.</p>
<h2>The ‘other’</h2>
<p>One of the striking themes in Foreign Bodies is Schama’s acknowledgement of the parallels between our ancestors’ responses to outbreaks of new and terrifying diseases and the ways we have sought to place the blame for COVID. We have a natural tendency to look for an “other” to blame – people from other cultures that we do not truly understand. </p>
<p>This is exemplified by <a href="https://www.bbc.com/news/world-asia-india-55050012">Waldemar Haffkine</a>, the central figure in much of Schama’s narrative. Of Jewish origin, Haffkine was the “other”: a person whose ancestors have often borne the blame for pandemics throughout European history. In the 14th century, for example, at the time of the Black Plague, it was believed that Jewish people were poisoning wells. There were trials and executions as the suffering populations sought desperately to find a reason for the cruel fate that had befallen them.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/543580/original/file-20230820-146262-it2dl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/543580/original/file-20230820-146262-it2dl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/543580/original/file-20230820-146262-it2dl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=884&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543580/original/file-20230820-146262-it2dl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=884&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543580/original/file-20230820-146262-it2dl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=884&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543580/original/file-20230820-146262-it2dl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1111&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543580/original/file-20230820-146262-it2dl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1111&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543580/original/file-20230820-146262-it2dl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1111&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Waldemar Haffkine (1860-1930).</span>
<span class="attribution"><span class="source">Wellcome Images/Wikimedia Commons</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Schama turns this narrative on its head. He highlights the substantial role of individuals like Haffkine in advancing revolutionary science. Haffkine is the hero of the story: a talented and dedicated scientist, who revolutionised the fields of immunology and vaccinology through his work to vaccinate the population of India against cholera and plague. Through Haffkine, Schama demonstrates that some of the greatest advances in medical science come not from the core of the medical establishment, but rather from those on the periphery. </p>
<p>As Schama indicates, however, Haffkine still had to earn the patronage of more well-known members of the medical establishment. This came in the form of Sir Joseph Lister, the <a href="https://www.sciencemuseum.org.uk/objects-and-stories/medicine/listers-antisepsis-system">famed pioneer</a> of antiseptics in surgery. That it was necessary for Haffkine to gain the support of such an influential figure to establish his worth as a scientist highlights the intersection of medical science and politics.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/diseases-gave-us-the-rise-of-christianity-the-end-of-the-aztecs-and-public-sanitation-how-might-future-plagues-change-human-history-201569">Diseases gave us the rise of Christianity, the end of the Aztecs and public sanitation. How might future plagues change human history?</a>
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</em>
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<h2>Inoculation</h2>
<p>Another key example in Foreign Bodies is the pioneering work of <a href="https://www.britannica.com/biography/Lady-Mary-Wortley-Montagu">Lady Mary Wortley Montagu</a>, an English aristocrat whose husband was appointed ambassador to the Ottoman Empire in the 18th century. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/543579/original/file-20230820-177767-ejqrek.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/543579/original/file-20230820-177767-ejqrek.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/543579/original/file-20230820-177767-ejqrek.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=978&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543579/original/file-20230820-177767-ejqrek.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=978&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543579/original/file-20230820-177767-ejqrek.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=978&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543579/original/file-20230820-177767-ejqrek.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1228&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543579/original/file-20230820-177767-ejqrek.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1228&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543579/original/file-20230820-177767-ejqrek.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1228&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Lady Mary Wortley Montagu with her son Edward – Jean Baptiste Vanmour (c.1717).</span>
<span class="attribution"><span class="source">Public domain</span></span>
</figcaption>
</figure>
<p>During her time in Turkey, Lady Montagu was exposed to the traditional practice that would come to be known in European medical circles as inoculation (or variolation). This was the practice of deliberately infecting children with smallpox in order to induce a mild case of the disease, preventing them from contracting the virus naturally and suffering its disfiguring and potentially fatal effects.</p>
<p>Lady Montagu had been disfigured by an attack of smallpox herself. She sought to protect her own children from suffering the same fate. In doing so, she introduced English high society to the concept of inoculation. </p>
<p>This is yet another case of the “other” – a woman – revolutionising the way in which medicine was practised. And in this case, the “othering” is even more evident. Inoculation was seen as counterproductive to many in the English medical establishment and viewed with suspicion in broader society. Many resisted the notion of deliberately infecting children with a potentially deadly disease. The suspicion was compounded by the fact that Lady Montagu had brought the practice back to Europe from Turkey.</p>
<p>Schama highlights that the form of inoculation Lady Montagu introduced to English society was not, in fact, an entirely new concept within the British Isles. He touches on the fact that versions of inoculation were already practised in Wales and the Scotish Highlands. According to Schama, this helped the wider medical establishment to accept the practice – once they had noted that inoculation was not truly “foreign”, but in fact “home-grown” to some extent. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/to-prepare-for-future-pandemics-we-can-learn-from-the-oecds-top-two-performers-new-zealand-and-iceland-198973">To prepare for future pandemics, we can learn from the OECD's top two performers: New Zealand and Iceland</a>
</strong>
</em>
</p>
<hr>
<h2>Medicine and politics</h2>
<p>Schama’s examination of smallpox prophylaxis in Europe ends before <a href="https://www.britannica.com/biography/Edward-Jenner">Edward Jenner</a>’s discovery of vaccination in 1796, which substituted the less-dangerous cowpox virus for smallpox in the inoculation procedure. That is a different story, however, to the one Schama is telling. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/543581/original/file-20230821-239355-6ttzir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/543581/original/file-20230821-239355-6ttzir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/543581/original/file-20230821-239355-6ttzir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=750&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543581/original/file-20230821-239355-6ttzir.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=750&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543581/original/file-20230821-239355-6ttzir.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=750&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543581/original/file-20230821-239355-6ttzir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=943&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543581/original/file-20230821-239355-6ttzir.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=943&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543581/original/file-20230821-239355-6ttzir.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=943&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Edward Jenner (1749-1823) – James Northcote.</span>
<span class="attribution"><span class="source">Public domain</span></span>
</figcaption>
</figure>
<p>Foreign Bodies is heavily invested in the history of the intersection of medicine and politics. Schama examines the role of the great European powers of the 18th and 19th centuries in the management of pandemics and the proliferation of life-saving medical procedures, such as vaccination. Central to this narrative is the acknowledgement that, while our medical knowledge and the acumen of our public health regimes have improved drastically since the times of Haffkine and Lady Montagu, the political issues have hardly changed.</p>
<p>The parallels between the ways in which previous generations sought to blame the “other” and the ongoing suspicion that COVID may have artificial origins are obvious throughout. Schama’s reflections on the ways people reacted to outbreaks of cholera, plague and smallpox show that we have never truly lost our suspicion of the “other”, nor have we grasped the notion that humanity generally brings these pandemics upon itself. </p>
<p>There is a link between continuous <a href="https://www.frontiersin.org/articles/10.3389/fmicb.2020.631736/full">economic expansion and the rise of epidemic diseases</a>, sometimes to pandemic proportions, and it is fascinating to read Schama reflecting on this theme throughout Foreign Bodies. </p>
<p>Perhaps the most striking example is the British unwillingness to heed public health warnings during the opening of the Suez Canal, when they refused to implement basic quarantine principles in the wake of a cholera outbreak. Of course, the rules of quarantine did apply to non-European travellers, as Schama demonstrates, indicating once again where the blame was being squarely placed. </p>
<p>There is an extensive list of disease outbreaks that Schama could have chosen to explore this concept. One of the most obvious examples would be the Spanish Flu pandemic that followed World War I. The “Spanish Flu”, as it came to be called – despite the fact <a href="https://www.britannica.com/event/influenza-pandemic-of-1918-1919">its place of origin is uncertain</a> – carries many of the same “othering” tropes and perhaps most closely resembles COVID in this regard.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/543582/original/file-20230821-177767-vwidum.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/543582/original/file-20230821-177767-vwidum.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/543582/original/file-20230821-177767-vwidum.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543582/original/file-20230821-177767-vwidum.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543582/original/file-20230821-177767-vwidum.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543582/original/file-20230821-177767-vwidum.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543582/original/file-20230821-177767-vwidum.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543582/original/file-20230821-177767-vwidum.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Simon Schama.</span>
<span class="attribution"><span class="source">Financial Times/Wikimedia Commons</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>It would be impossible for Schama to incorporate every pandemic into this one volume. His choice of three of the most feared epidemic diseases in history – smallpox, cholera and plague – is enough to demonstrate his point. The choice covers viral (smallpox) and bacterial (cholera and plague) diseases at critical points in their history, when globalisation was spreading new strains between previously disparate populations.</p>
<p>At the core of Foreign Bodies is Schama’s understanding that “all history is natural history”. No matter how much we believe our knowledge and our technological capabilities have evolved, we are still at the mercy of the natural world.</p>
<p>COVID has only further demonstrated this point, as Schama notes in his reflections on the pandemic. Quarantined, away from the bustle of regular life, he reflects in his prologue on the way nature quickly reclaimed territories that we have moulded and shaped for our own needs – the cities, the suburbs, even the carefully curated and manicured green spaces that surround us. </p>
<p>Schama shows that pandemics are an ongoing feature of our existence on this planet. He also provides a devastating insight into our likely future responses to disease outbreaks. If you want to believe scientific knowledge will eventually prevail, he observes, “it is probably best not to ask a historian”. </p>
<p>Foreign Bodies provides a perhaps bleak, but truthful, view of our world today, as we continue to struggle with COVID and anticipate the looming threat of whichever disease will become the next great pandemic.</p><img src="https://counter.theconversation.com/content/208658/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ella Stewart-Peters does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>No matter how much we believe our knowledge and our technological capabilities have evolved, pandemics prove we are still at the mercy of the natural world.Ella Stewart-Peters, Affiliate, College of Medicine and Public Health, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2099252023-08-21T13:01:08Z2023-08-21T13:01:08ZThe order in which you acquire diseases could affect your life expectancy – new research<figure><img src="https://images.theconversation.com/files/542634/original/file-20230814-15-6ly3wb.jpg?ixlib=rb-1.1.0&rect=47%2C0%2C5310%2C3497&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Almost two-thirds of UK adults aged 65 and over possess two or more long-term health conditions.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/elderly-couple-tourists-sea-resort-1596444508">EvgL/Shutterstock</a></span></figcaption></figure><p><a href="https://doi.org/10.1016/S0140-6736(12)60240-2">More than 25%</a> of adults in the UK have two or more long-term health conditions. This increases to 65% for people older than 65 years, and to almost 82% for those aged 85 or older. </p>
<p><a href="https://doi.org/10.1016/S2468-2667(23)00098-1">Our study</a> assessed how a number of multiple long-term health conditions (<a href="https://www.nhs.uk/mental-health/conditions/psychosis/overview/">psychosis</a>, diabetes and congestive heart failure) develop over time, and what effect this can have on life expectancy. We chose these conditions because, together, they can lead to substantial reductions in how long someone lives.</p>
<p>We analysed the development of these conditions over a 20-year period for more than 1.6 million adults aged 25 and over. We used data held within the <a href="https://saildatabank.com/">SAIL databank</a>, which provides secure access to routinely collected anonymous health and administrative records for the population of Wales.</p>
<p>We also worked with patients and the public from across the UK to understand their experience of living with multiple long-term conditions. </p>
<p>Using statistical models, we examined the order and timing of developing psychosis, diabetes and congestive heart failure in patients of the same age, sex and area-level deprivation – and the related impact on their life expectancy. </p>
<h2>The impact of disease order</h2>
<p>We found that the order in which people developed these diseases had an important impact on their life expectancy. People who developed diabetes, psychosis and congestive heart failure, in that order, had the largest loss in life expectancy (approximately 13 years, on average).</p>
<p>People who developed the same conditions in a different order were less affected. So, for example, a 50-year-old man in an area of average deprivation could experience a difference in his life expectancy of more than 10 years, depending on the order in which he developed the three diseases. </p>
<p>Our research also identified that people who first developed diabetes, then psychosis and finally congestive heart failure carried a higher risk of developing the next long-term health condition, or dying within five years of their last diagnosis. </p>
<p>However, the development of further conditions is not always life-limiting. For example, people diagnosed with psychosis and diabetes – in any order – had a higher life expectancy than those diagnosed with psychosis alone. While this was a surprising finding, we expect people with diabetes to have more regular contact with health professionals through diabetic clinics, for example, which may improve their overall health. </p>
<p>Our study also found that congestive heart failure on its own, and in combination with psychosis (in any order), had a similar effect on life expectancy to the “worst case” combination of diabetes, psychosis and congestive heart failure (in that order). </p>
<figure class="align-center ">
<img alt="An empty bed in a hospital surrounded with medical equipment" src="https://images.theconversation.com/files/542796/original/file-20230815-25-8wyoa2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/542796/original/file-20230815-25-8wyoa2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542796/original/file-20230815-25-8wyoa2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542796/original/file-20230815-25-8wyoa2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542796/original/file-20230815-25-8wyoa2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542796/original/file-20230815-25-8wyoa2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542796/original/file-20230815-25-8wyoa2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The application of this research could lead to improved outcomes for the NHS.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/national-health-service-uk-19th-march-608498993">Imran Khan's Photography/Shutterstock</a></span>
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<p>This is the first study to examine how the order of developing multiple long-term conditions affects a person’s life expectancy. This research could be used to inform patients, healthcare providers and decision-makers on the appropriate identification of diseases and management of patient care. In turn, this could lead to improved outcomes for patients and the NHS. </p>
<p>Our research also helps to support healthcare delivery by looking at the factors that may increase a person’s risk of developing disease, as well as identifying potential opportunities for disease screening and earlier intervention.</p>
<h2>Applying our research</h2>
<p>Future research could evaluate the impact of screening programmes and interventions in delaying the development of further long-term conditions and extending life.</p>
<p>However, it is important to note that our research used information from routinely collected health records, which are not always accurate – some diagnoses may be missing or delayed. Also, diagnoses are not always accurately described. These are all important factors in being able to accurately estimate the impact of multiple long-term conditions on life expectancy. </p>
<p><a href="https://phenotypes.healthdatagateway.org/">Further research funded by Health Data Research UK</a>, the national institute for health data science, aims to harmonise how this data is collected and reported. Over time, this will improve the quality of information obtained from routinely collected health records for research. </p>
<p>While our study examined the development of one group of multiple long-term conditions, this approach could be replicated for any other combination of conditions – including the development of long-term health conditions following COVID-19 infection (known as long COVID), and the impact this has on quality of life.</p>
<p>Those living with multiple long-term conditions often experience increased use of healthcare services and medications, as well as greater difficulty with day-to-day tasks. This leads to a reduced quality of life as well as reduced life expectancy. </p>
<p>Our research has shown that the combination of long-term conditions and order in which you develop them may both have a substantial impact on your life expectancy. However, this relationship can be complex, and the development of further disease does not always reduce life expectancy.</p><img src="https://counter.theconversation.com/content/209925/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rhiannon Owen receives funding from the Academy of Medical Sciences (AMS), Health and Care Research Wales (HCRW), Heath Data Research UK (HDRUK), Medical Research Council (MRC), and the National Institute for Health and Care Research (NIHR). She is affiliated with the National Institute for Health and Care Excellence (NICE). </span></em></p>People who developed diabetes, psychosis and congestive heart failure, in that order, experienced the largest reduction in life expectancyRhiannon Owen, Professor of Statistics, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2092242023-07-30T20:08:36Z2023-07-30T20:08:36ZRenaming obesity won’t fix weight stigma overnight. Here’s what we really need to do<figure><img src="https://images.theconversation.com/files/536241/original/file-20230707-27-wk8k6h.jpg?ixlib=rb-1.1.0&rect=4%2C0%2C994%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-curvy-woman-smiling-on-camera-1923802535">Shutterstock</a></span></figcaption></figure><p>The stigma that surrounds people living in larger bodies is pervasive and deeply affects the people it’s directed at. It’s been described as one of the last acceptable <a href="https://theconversation.com/how-australias-discrimination-laws-and-public-health-campaigns-perpetuate-fat-stigma-80471">forms of</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592337">discrimination</a>.</p>
<p>Some researchers think the term “obesity” itself is part of the problem, and are calling for a <a href="https://pubmed.ncbi.nlm.nih.gov/27967229/">name change</a> to reduce stigma. They’re <a href="https://onlinelibrary.wiley.com/doi/10.1111/obr.13590">proposing</a> “adipose-based chronic disease” instead.</p>
<p>We study the stigma that surrounds obesity – around the time of <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/obr.13147">pregnancy</a>, among <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/oby.23266">health professionals</a> and health <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00071-8/fulltext">students</a>, and in <a href="https://www.phrp.com.au/issues/october-2022-volume-32-issue-3/weight-stigma-in-australia/">public health</a> more widely. Here’s what’s really needed to reduce weight stigma.</p>
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Read more:
<a href="https://theconversation.com/lizzo-proudly-calls-herself-a-fat-woman-are-we-allowed-to-as-well-209682">Lizzo proudly calls herself a 'fat' woman. Are we allowed to as well?</a>
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<h2>Weight stigma is common</h2>
<p>Up to <a href="https://pubmed.ncbi.nlm.nih.gov/26596238/">42% of adults</a> living in larger bodies experience weight stigma. This is when others have negative beliefs, attitudes, assumptions and judgements towards them, unfairly viewing them as lazy, and lacking in willpower or self-discipline. </p>
<p>People in larger bodies experience <a href="https://onlinelibrary.wiley.com/doi/full/10.1038/oby.2008.636">discrimination</a> in many areas, including in the workplace, intimate and family relationships, education, health care and the media.</p>
<p>Weight stigma is associated with <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1116-5">harms</a> including increased cortisol levels (the main stress hormone in the body), negative body image, increased weight gain, and poor mental health. It leads to decreased uptake of, and quality of, health care.</p>
<p>Weight stigma may even pose a <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1116-5">greater threat</a> to someone’s health than increasing body size.</p>
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Read more:
<a href="https://theconversation.com/should-gps-bring-up-a-patients-weight-in-consultations-about-other-matters-we-asked-5-experts-209681">Should GPs bring up a patient’s weight in consultations about other matters? We asked 5 experts</a>
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<h2>Should we rename obesity?</h2>
<p>Calls to remove or rename health conditions or identifications to reduce stigma are not new. For example, in the 1950s homosexuality was classed as a “<a href="https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp-rj.2022.180103">sociopathic personality disturbance</a>”. Following many years of protests and activism, the term and condition <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695779/">were removed</a> from the globally recognised classification of mental health disorders.</p>
<p>In recent weeks, European researchers have renamed non-alcoholic fatty liver disease “metabolic dysfunction-associated steatotic liver disease”. This occurred after <a href="https://www.bmj.com/content/382/bmj.p1587">up to 66%</a> of health-care professionals surveyed felt the terms “non-alcoholic” and “fatty” to be stigmatising.</p>
<p>Perhaps it is finally time to follow suit and rename obesity. But is “adiposity-based chronic disease” the answer?</p>
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<strong>
Read more:
<a href="https://theconversation.com/changing-the-terminology-to-people-with-obesity-wont-reduce-stigma-against-fat-people-124266">Changing the terminology to 'people with obesity' won't reduce stigma against fat people</a>
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<h2>A new name needs to go beyond BMI</h2>
<p>There are two common ways people view obesity. </p>
<p>First, most people use the term for people with a body-mass index (BMI) of 30kg/m² or above. Most, if not all, public health organisations also use BMI to categorise obesity and <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00138-9/fulltext">make assumptions</a> about health. </p>
<p>However, BMI alone is not enough to accurately summarise someone’s health. It does not account for muscle mass and <a href="https://www.cdc.gov/obesity/downloads/bmiforpactitioners.pdf">does not provide</a> information about the distribution of body weight or adipose tissue (body fat). A high BMI can occur <a href="https://theconversation.com/using-bmi-to-measure-your-health-is-nonsense-heres-why-180412">without</a> biological indicators of poor health.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1532156365363417088"}"></div></p>
<p>Second, obesity is sometimes used to describe the condition of excess weight when mainly <a href="https://onlinelibrary.wiley.com/doi/10.1111/obr.13590">accompanied by</a> metabolic abnormalities.</p>
<p>To simplify, this reflects how the body has adapted to the environment in a way that makes it more susceptible to health risks, with excess weight a by-product of this.</p>
<p>Renaming obesity “adiposity-based chronic disease” acknowledges the chronic metabolic dysfunction associated with what we currently term obesity. It also avoids labelling people purely on body size.</p>
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<strong>
Read more:
<a href="https://theconversation.com/using-bmi-to-measure-your-health-is-nonsense-heres-why-180412">Using BMI to measure your health is nonsense. Here's why</a>
</strong>
</em>
</p>
<hr>
<h2>Is obesity a disease anyway?</h2>
<p>“Adiposity-based chronic disease” is an acknowledgement of a disease state. Yet there is still no universal consensus on whether obesity is a disease. Nor is there clear agreement on the definition of “disease”. </p>
<p>People who take a biological-dysfunction approach to disease <a href="https://pubmed.ncbi.nlm.nih.gov/25336733/">argue</a> dysfunction occurs when physiological or psychological systems don’t do what they’re supposed to.</p>
<p>By this definition, obesity may <a href="https://pubmed.ncbi.nlm.nih.gov/37279872/">not be classified as a disease</a> until after harm from the additional weight occurs. That’s because the excess weight itself may not initially be harmful.</p>
<p>Even if we do categorise obesity as a disease, there may still be value in renaming it.</p>
<p>Renaming obesity may improve public understanding that while obesity is often associated with an increase in BMI, the increased BMI <em>itself</em> is not the disease. This change could move the focus from obesity and body size, to a more nuanced understanding and discussion of the biological, environmental, and lifestyle factors <a href="https://onlinelibrary.wiley.com/doi/10.1111/obr.13590">associated</a> with it.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/when-youre-sick-the-support-youll-get-may-depend-on-the-worth-of-your-disease-93955">When you're sick, the support you'll get may depend on the 'worth' of your disease</a>
</strong>
</em>
</p>
<hr>
<h2>Workshopping alternatives</h2>
<p>Before deciding to rename obesity, we need discussions between obesity and stigma experts, health-care professionals, members of the public, and crucially, <a href="https://www.phrp.com.au/issues/october-2022-volume-32-issue-3/weight-stigma-in-australia/">people living with obesity</a>.</p>
<p>Such discussions can ensure robust evidence informs any future decisions, and proposed new terms are not also stigmatising. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/539447/original/file-20230726-15-ii0clw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Friends sitting around table drinking beer and smiling" src="https://images.theconversation.com/files/539447/original/file-20230726-15-ii0clw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/539447/original/file-20230726-15-ii0clw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/539447/original/file-20230726-15-ii0clw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/539447/original/file-20230726-15-ii0clw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/539447/original/file-20230726-15-ii0clw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/539447/original/file-20230726-15-ii0clw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/539447/original/file-20230726-15-ii0clw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People living with obesity need to have a say in any future terms for it.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/aCEg6DQEiDo">AllGo - An App For Plus Size People/Unsplash</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/todays-disease-names-are-less-catchy-but-also-less-likely-to-cause-stigma-131465">Today's disease names are less catchy, but also less likely to cause stigma</a>
</strong>
</em>
</p>
<hr>
<h2>What else can we do?</h2>
<p>Even then, renaming obesity may not be enough to reduce the stigma.</p>
<p>Our constant exposure to the socially-defined and acceptable idealisation of smaller bodies (the “thin ideal”) and the pervasiveness of weight stigma means this stigma is deeply ingrained at a societal level.</p>
<p>Perhaps true reductions in obesity stigma may only come from a societal shift – away from the focus of the “thin ideal” to one that acknowledges health and wellbeing can occur at a range of body sizes.</p><img src="https://counter.theconversation.com/content/209224/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Blake Lawrence is a member of The Obesity Society and The Obesity Collective. </span></em></p><p class="fine-print"><em><span>Briony Hill receives funding from the Australian Research Council and The Australian Prevention Partnership Centre. She is affiliated with The Obesity Collective. </span></em></p><p class="fine-print"><em><span>Ravisha Jayawickrama does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Obesity is out and ‘adipose-based chronic disease’ is in, according to a recent paper. But a name change alone won’t fix entrenched stigma.Ravisha Jayawickrama, PhD candidate, School of Population Health, Curtin UniversityBlake Lawrence, Lecturer, Curtin School of Population Health, Curtin UniversityBriony Hill, Deputy Head, Health and Social Care Unit and Senior Research Fellow, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2060592023-07-14T12:49:48Z2023-07-14T12:49:48ZCuring America’s loneliness epidemic would make us healthier, fitter and less likely to abuse drugs<figure><img src="https://images.theconversation.com/files/536880/original/file-20230711-23-gus5qs.jpg?ixlib=rb-1.1.0&rect=8%2C16%2C5599%2C3707&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Loneliness increases the risk of chronic disease and mental health challenges.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/person-touching-window-royalty-free-image/979116946?phrase=loneliness&adppopup=true">An Kirillova/500px Prime via Getty Images</a></span></figcaption></figure><p>A <a href="https://www.hhs.gov/about/news/2023/05/03/new-surgeon-general-advisory-raises-alarm-about-devastating-impact-epidemic-loneliness-isolation-united-states.html">national health</a> <a href="https://www.hhs.gov/about/news/2023/05/03/new-surgeon-general-advisory-raises-alarm-about-devastating-impact-epidemic-loneliness-isolation-united-states.html">advisory</a> issued by U.S. Surgeon General Vivek Murthy on May 3, 2023, sheds light on the urgent public health issues of loneliness and isolation. </p>
<p>The report reflects Dr. Murthy’s personal and professional experience with the damaging health impacts of loneliness. As surprising as it sounds, social isolation and loneliness have the same effect on human health as smoking 15 cigarettes a day, which is to say, it can <a href="https://blogs.scientificamerican.com/observations/loneliness-is-harmful-to-our-nations-health">shorten life span by up to 15 years</a>. </p>
<p>I’m <a href="https://scholar.google.com/citations?user=Xih6zgoAAAAJ&hl=en&oi=ao">a leader in academic and clinical medicine</a> and I served as the <a href="https://www.hsc.wvu.edu/news/story?headline=gov-justice-names-wvu-s-clay-marsh-to-lead-covid-19-efforts-for-west-virginia">COVID-19 czar for the state of West Virginia</a>, so I have experience in thinking about public health emergencies and how to fix them. </p>
<p>Let’s first look at the problem and then examine some solutions and what the nation would gain by implementing them.</p>
<h2>Defining the issue</h2>
<p>Loneliness and social isolation are widespread. A 2021 <a href="https://newsroom.thecignagroup.com/loneliness-epidemic-persists-post-pandemic-look">survey by Cigna</a> shows nearly 1 in 6 <a href="https://newsroom.thecignagroup.com/loneliness-epidemic-persists-post-pandemic-look">Americans reported feeling lonely or isolated</a>. That means <a href="https://doi.org/10.1371/journal.pone.0280308">these conditions</a> likely affect either you or someone you know.</p>
<p>In the same survey, young adults were <a href="https://newsroom.thecignagroup.com/loneliness-epidemic-persists-post-pandemic-look">nearly twice as likely</a> as those over age 65 to report feeling lonely or isolated. In addition, 75% of Hispanics and 68% of Black or African American people reported these conditions, as did a majority of lower-income respondents and single parents.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/536883/original/file-20230711-25-cnlgjk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Four people in a living room, laughing and talking." src="https://images.theconversation.com/files/536883/original/file-20230711-25-cnlgjk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/536883/original/file-20230711-25-cnlgjk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=383&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536883/original/file-20230711-25-cnlgjk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=383&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536883/original/file-20230711-25-cnlgjk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=383&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536883/original/file-20230711-25-cnlgjk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=481&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536883/original/file-20230711-25-cnlgjk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=481&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536883/original/file-20230711-25-cnlgjk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=481&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Healthy relationships help people feel wanted and contribute to human longevity.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/new-jersey-friends-hanging-out-in-living-room-royalty-free-image/545865797?phrase=happy+people+socializing&adppopup=true">Tetra Images via Getty Images</a></span>
</figcaption>
</figure>
<p>While there are no definitive explanations for these high numbers, experts have suggested <a href="https://www.cigna.com/static/www-cigna-com/docs/about-us/newsroom/studies-and-reports/combatting-loneliness/cigna-2020-loneliness-factsheet.pdf">several possible determinants</a>: the mobility of the population, the shift from in-person to remote work and learning since the beginning of the pandemic, and the deep divides in society caused by <a href="https://doi.org/10.1111/nana.12685">social
media</a> and <a href="https://www.theguardian.com/media/2013/apr/12/news-is-bad-rolf-dobelli">irresponsible news sites</a>. To grab the attention of viewers, some advertisers and media leaders understand that human beings are biased toward messages that <a href="https://thehill.com/opinion/technology/556160-media-spread-fear-americans-listen/">activate fear and loss</a>. In fact, the scientific term “<a href="https://doi.org/10.1007/BF00122574">aversion bias</a>” demonstrates people are twice as fearful of loss as happy for gain.</p>
<p>When we feel socially isolated and lonely, our <a href="https://www.psychologytoday.com/us/blog/the-power-prime/202204/do-you-perceive-life-threat-or-challenge">vigilance for threat</a> activates our core survival instincts, which are rooted in evolutionary times. For early humans, being accepted and belonging to a group or community were <a href="https://www.cogneurosociety.org/lonely_cacioppo_sep15/">key factors in survival</a>. Being separated or ousted from one’s tribe meant <a href="https://doi.org/10.1080%2F02699931.2013.837379">almost certain death</a>. </p>
<p>Thriving relationships became critical to human feelings of safety and well-being. In fact, <a href="https://www.6seconds.org/2021/04/19/harvard-grant-study/">longevity studies</a> consistently find that the strength of one’s lifelong relationships is the most important driver of a long and healthy life.</p>
<h2>Stress and loneliness are connected</h2>
<p>The human nervous system is balanced into two modes: the “<a href="https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response">fight or flight</a>” of the sympathetic system and the “rest and digest” of the parasympathetic system.</p>
<p>Loneliness and isolation <a href="https://doi.org/10.7812/TPP/19.099">drive unbalanced activation of the sympathetic nervous system</a>, leading to hypervigilance, or scanning the environment for threats. Once this threat response is activated, people see their environment as unsafe, leading to release of hormones that interfere with our trust and pleasure responses. As this stress-response heightens, people experience surges in hormones that elevate their heart rate and blood pressure.</p>
<p>Over time, release of these hormones damages our blood vessels, heart, <a href="https://www.livescience.com/65446-sympathetic-nervous-system.html">brain</a>, blood and <a href="https://doi.org/10.3390/ijms22084241">liver</a> and our <a href="https://doi.org/10.1093/ajh/hpaa074">metabolic</a> and musculoskeletal systems. Much like a car engine that is continually over-revved, our body’s systems begin to break down and our perceived <a href="http://doi.org/10.1177/2049463718802868">experience of pain</a> is heightened.</p>
<p>Feelings of worthlessness and fear increase the risk of substance use, mental health challenges, a variety of chronic diseases and obesity – all of which can contribute to <a href="https://www.hhs.gov/about/news/2023/05/03/new-surgeon-general-advisory-raises-alarm-about-devastating-impact-epidemic-loneliness-isolation-united-states.html">a reduced life span</a>.</p>
<p>In other words, loneliness and isolation <a href="https://www.brookings.edu/wp-content/uploads/2017/08/casetextsp17bpea.pdf">drive disease and shorten life spans</a> through unbalanced activation of the sympathetic nervous system induced by the perception of threat and chronic stress. </p>
<p>Of course, <a href="http://doi.org/10.1136/gpsych-2020-100461">stress can also lead people to isolate themselves</a>, so the effects do go both ways.</p>
<h2>Finding relief</h2>
<p>A primary solution to loneliness and social isolation is meaningful social connection. </p>
<p>Societal <a href="https://www.who.int/teams/social-determinants-of-health/demographic-change-and-healthy-ageing/social-isolation-and-loneliness">connections boost our perceptions</a> of psychological and physical safety, worth and value and enhance feelings of belonging and contributing. </p>
<p>These critical relationships branch out from our families to our friends to form networks of trust and community. These <a href="https://www.ted.com/talks/robert_waldinger_what_makes_a_good_life_lessons_from_the_longest_study_on_happiness/c">networks of relationships are termed “social capital</a>.” </p>
<p>Princeton University economists <a href="https://www.brookings.edu/bpea-articles/mortality-and-morbidity-in-the-21st-century/">Anne Case and Angus Deaton</a> hypothesize that <a href="https://www.brookings.edu/wp-content/uploads/2020/07/Sawhill_Social-Capital_Final_07.16.2020.pdf">the reduction of social capital</a> and hope stemming from the loss of jobs in Appalachia and the Ohio River Valley from 1999 to 2013 was a key driver of deaths from overdose, suicide and liver disease in these areas.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/nSVR5AoWUcU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Among the signs of loneliness: feeling exhausted and being unable to control your emotions.</span></figcaption>
</figure>
<p>So what can be done to address the loneliness epidemic?</p>
<p>In his <a href="https://www.hhs.gov/surgeongeneral/priorities/connection/resources/index.html">Framework for a National Strategy to Advance Social Connection</a>, Murthy provides a practical <a href="https://www.hhs.gov/surgeongeneral/priorities/connection/index.html#action">call for action</a> to address the public health problem of social disconnection and to strengthen social connection and community. These strategies include being open to new relationships, reconnecting with friends and distant family members and serving others by volunteering. The framework includes <a href="https://www.hhs.gov/surgeongeneral/priorities/connection/resources/index.html">shareable tools and resources</a> for individuals and organizations to invest in community-based social relationships and improve their community’s mental health. </p>
<p>One reason I am answering this call is that my home state of West Virginia is the only one located entirely in Appalachia. </p>
<p>Appalachia is <a href="https://www.arc.gov/wp-content/uploads/2023/01/Appalachian-Diseases-of-Despair-Update-November-2022.pdf">the central location of “deaths of despair</a>,” meaning people living here are disproportionately affected by the loss of jobs, social capital, purpose and relationships that result in the experience of loneliness and social isolation. </p>
<p>This may explain why West Virginians have the <a href="https://www.aarp.org/health/conditions-treatments/info-2022/life-expectancy.html">second-lowest life expectancy in the country</a> and some of the poorest health metrics. </p>
<p>But I would argue West Virginia also has resilient people who care about one another. There is a real goodness and kindness in our people. To serve our state better, the staff at the flagship university academic medical center is building <a href="https://www.wvnews.com/wvu-medicine-continues-growth-through-new-acquisitions-launch-of-transformational-insurance-services-subsidiary/article_1490b6d4-a56e-11ec-8703-0b80626d5f5d.html">more sophisticated and better health care access</a>. My colleagues in business and government are focusing on reversing loneliness and social isolation through jobs that provide income, social capital and caring relationships. </p>
<p>Like the COVID-19 pandemic, the isolation and loneliness pandemic requires us to work together in community to make a positive difference.</p><img src="https://counter.theconversation.com/content/206059/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clay Marsh has received funding from NIH, American Thoracic Society, Ohio State University, West Virginia University. He is affiliated as a member of the Scientific Advisory Board with Caris Life Sciences. </span></em></p>At least half of surveyed US adults experienced loneliness and social isolation.Clay Marsh, Chancellor and Executive Dean for Health Sciences, West Virginia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2086392023-07-04T15:11:39Z2023-07-04T15:11:39ZBiting flies are attracted to blue traps – we used AI to work out why<p>Flies which feast on blood – such as tsetse and horse flies – inflict painful bites and spread debilitating diseases among people and animals alike. So a lot of work has gone into designing the most efficient traps to control the populations of these flies.</p>
<p>Biting fly traps tend to be blue, because decades of field research has shown that such flies find this colour especially attractive. But it’s never been clear why these flies find blue to be so irresistible – especially since blue objects are not a common sight in the natural environment.</p>
<p>Scientists have speculated that blue surfaces might look like <a href="https://royalsocietypublishing.org/doi/10.1098/rsbl.2003.0121">shaded places</a> to flies since shadows have a blueish tinge. Tsetse flies in particular seek out such shaded spots to rest in, which might explain their attraction to blue traps. </p>
<p>Another possibility is that blue surfaces might <a href="https://resjournals.onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2915.1999.00163.x">lure hungry flies</a> by providing them with the telltale signs they use to distinguish animals against a background of foliage. According to this theory, a fly might mistake a blue trap for an animal it wishes to bite and feed upon. </p>
<figure class="align-left ">
<img alt="A blue canvas, diamond shaped container is suspended from a tree." src="https://images.theconversation.com/files/535007/original/file-20230630-24873-ovj9iw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/535007/original/file-20230630-24873-ovj9iw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/535007/original/file-20230630-24873-ovj9iw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/535007/original/file-20230630-24873-ovj9iw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/535007/original/file-20230630-24873-ovj9iw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/535007/original/file-20230630-24873-ovj9iw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/535007/original/file-20230630-24873-ovj9iw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A bright blue trap for tsetse flies is suspended from a tree.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bright-blue-trap-dangerous-tsetse-fly-724357057">Fabian Plock/Shutterstock</a></span>
</figcaption>
</figure>
<p>But assessing these possibilities is especially tricky because flies perceive colour differently to people. Humans perceive colour using the responses of three kinds of light-detecting photoreceptor in the retina which are broadly sensitive to blue, green and red wavelengths of light.</p>
<p>But most “higher flies” – such as tsetse and horseflies – have five kinds of photoreceptor sensitive to UV, blue and green wavelengths. So, a blue trap won’t look the same to a fly as it does to the human who designed it.</p>
<h2>From flies to AI…</h2>
<p>In <a href="https://royalsocietypublishing.org/doi/10.1098/rspb.2023.0463#d1e1574">our study</a>, we tackled the problem by using artificial intelligence (AI). We used artificial neural networks which are a form of machine learning inspired by the structure of real nervous systems. Artificial neural networks learn by modifying the strengths of connections between a network of artificial neurons.</p>
<p>We fed these networks with the photoreceptor signals that a fly would experience when looking at animals or foliage backgrounds, both in light and in shade. We then trained the networks to distinguish animals from leaves, and shaded from unshaded objects, using only that visual information.</p>
<p>The trained networks would find the most efficient way of processing the visual signals, which we expected to share properties with the mechanisms that have evolved in real flies’ nervous systems. We then investigated whether the artificial neural networks classified blue traps as animals or as shaded surfaces.</p>
<h2>Blueness or brightness?</h2>
<p>After training, our neural networks could easily distinguish animals from leaf backgrounds, and shaded from unshaded stimuli, using the sensory information available to a fly. However, what surprised us was that they solved these problems in completely different ways.</p>
<p>The networks identified shade using brightness and not colour – quite simply, the darker a stimulus appeared, the more likely it was to be classified as shaded. Meanwhile, animals were identified using the relative strength of blue and green photoreceptor signals. Relatively greater blue compared to green signals indicated that a stimulus was probably an animal rather than a leaf, and vice versa.</p>
<p>The implications of this became clear when we fed these networks the visual signals caused by blue traps. The blue traps were never mistaken for shaded surfaces, but they were commonly misclassified as animals.</p>
<figure class="align-center ">
<img alt="A close up of an insect with huge blue/green eyes" src="https://images.theconversation.com/files/535038/original/file-20230630-13700-zuvny9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/535038/original/file-20230630-13700-zuvny9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/535038/original/file-20230630-13700-zuvny9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/535038/original/file-20230630-13700-zuvny9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/535038/original/file-20230630-13700-zuvny9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/535038/original/file-20230630-13700-zuvny9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/535038/original/file-20230630-13700-zuvny9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The horse fly (<em>Hybomitra epistates</em>) can inflict painful bites upon people and livestock.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/horse-fly-hybomitra-epistates-portrait-1773555527">Mircea Costina/Shutterstock</a></span>
</figcaption>
</figure>
<p>Of course, artificial neural networks are not real flies, nor exact models of a fly’s nervous system. But they do show us the most efficient way of processing a fly’s visual signals to identify natural stimuli. And we expect evolution to have taken advantage of similar principles in real fly nervous systems.</p>
<p>The best way to identify shade using the visual information a fly has is through brightness and not blueness. Meanwhile, the best way of identifying animals was, somewhat counterintuitively, using blueness. Such a mechanism is very strongly stimulated by blue traps, explaining why they prove such a powerful lure for hungry flies. Further evidence for this idea comes from field studies which show that tsetse landing on coloured traps are <a href="https://resjournals.onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-3032.1990.tb00519.x">relatively starved</a>.</p>
<p>If we can understand the sensory signals and behaviour that cause flies to be caught in traps, we can engineer traps to more efficiently exploit those mechanisms and more effectively control the flies. We’ve already had <a href="https://journals.plos.org/plosntds/article?id=10.1371%2Fjournal.pntd.0007905#:%7E:text=Tsetse%20can%20be%20controlled%20using%20insecticide-treated%20fabric%20targets%2C,these%20fabrics%20to%20be%20more%20attractive%20to%20tsetse.">some success</a> in doing this for tsetse flies.</p>
<p>More effective traps will help minimise the impacts of those flies on health and welfare of people and animals. They could help prevent the damaging effects of biting flies on livestock, help in the fight against dangerous fly-borne diseases such as <a href="https://www.who.int/news-room/fact-sheets/detail/trypanosomiasis-human-african-(sleeping-sickness)">sleeping sickness</a>, and protect us and animals from fly attacks in general.</p><img src="https://counter.theconversation.com/content/208639/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Roger Santer has received funding from the Knowledge Economy Skills Scholarships program, and from the Centre for International Development Research at Aberystwyth (CIDRA). </span></em></p>New research on what attracts blood-feasting flies to blue objects could help minimise the impacts of those insects on people and animals.Roger Santer, Lecturer in Zoology, Aberystwyth UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2066212023-05-30T11:49:49Z2023-05-30T11:49:49ZTobacco use is costly, but so is quitting. Surveys of 8 African countries show who needs help<figure><img src="https://images.theconversation.com/files/528876/original/file-20230529-17-hxj4e5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Media Lens King/Getty Images</span></span></figcaption></figure><p>Tobacco use imposes a large health and economic burden worldwide. Research <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8223261/#bib10">estimates</a> that, in 2019, about 8 million deaths were attributable to tobacco smoking. Tobacco also reduces <a href="https://www.who.int/data/gho/indicator-metadata-registry/imr-details/158">years of healthy living</a>: about 200 million <a href="https://www.who.int/data/gho/indicator-metadata-registry/imr-details/158#:%7E:text=Definition%3A-,One%20DALY%20represents%20the%20loss%20of%20the%20equivalent%20of%20one,health%20condition%20in%20a%20population.">disability-adjusted life years</a> in 2019. </p>
<p>This health burden comes with high economic costs, directly through medical treatment for tobacco-related diseases, and indirectly through productivity losses. Globally, the total economic cost of smoking amounted to around <a href="https://tobaccocontrol.bmj.com/content/27/1/58">1.8%</a> of the world’s annual GDP in 2012. Global studies are rare because they are so data intensive. </p>
<p>Though overall tobacco use has been <a href="https://www.annualreviews.org/doi/10.1146/annurev-publhealth-032315-021850?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed">declining</a> in most high-income countries since the 1970s, it has been stable or rising in most low- and middle-income countries. Today, more than <a href="https://www.who.int/news-room/fact-sheets/detail/tobacco#:%7E:text=Over%2080%25%20of%20the%20world's,(WHO%20FCTC)%20in%202003.">80%</a> of the world’s smokers live in low- and middle-income countries, resulting in a skewed burden of disease. </p>
<p>This skewed burden of tobacco-related disease exists within countries too. In <a href="https://cancercontrol.cancer.gov/sites/default/files/2020-06/m21_2.pdf">most countries</a>, tobacco use is disproportionately prevalent among the poor - the very people who can least afford to finance the healthcare and financial costs associated with it.</p>
<p>Tobacco use is not only about who smokes but about who quits. In high-income <a href="https://doi.org/10.1136/jech-2014-205171">countries</a>, it’s mostly wealthier users who attempt to quit – and who succeed. But research on cessation in lower income countries has been scarce.</p>
<p>A <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0277702#sec018">study</a> I co-authored with <a href="https://www.iash.ed.ac.uk/profile/dr-laura-rossouw">Dr Laura Rossouw</a> set out to fill some gaps. We decided to measure inequalities in tobacco cessation in eight sub-Saharan African countries. Using the most recent <a href="https://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/global-adult-tobacco-survey">Global Adult Tobacco Surveys</a> in Botswana, Cameroon, Ethiopia, Kenya, Nigeria, Senegal, Tanzania and Uganda, we found that the people most likely to try and succeed at quitting were wealthier and better-educated individuals. Inequalities in ability to stop using tobacco were associated with socio-economic status, urban or rural residence, and not knowing or believing that tobacco consumption leads to serious illness.</p>
<p>We suggest that governments in these countries can do more to support socio-economically disadvantaged smokers in their efforts to stop using tobacco. Their strategies should be aligned with the guidelines outlined in the <a href="https://fctc.who.int/who-fctc/overview">World Health Organization’s (WHO) Framework Convention on Tobacco Control</a>.</p>
<p>Providing subsidised medical support to smokers trying to quit could make these services more accessible to the poor. This would ease the <a href="https://cancercontrol.cancer.gov/sites/default/files/2020-06/m21_2.pdf">disproportionate</a> health and financial burden of the tobacco-related illnesses that they suffer.</p>
<h2>Who uses tobacco</h2>
<p>Our analysis used nationally representative surveys of individuals aged 15 and older from each of the eight countries included in our sample. The Global Adult Tobacco Survey captures information about who is using tobacco and in what form, as well as demographic and socio-economic variables. It’s a standard survey design which allows comparison of countries. </p>
<p>We chose the eight sub-Saharan countries based on availability of data. The earliest survey was conducted in 2012 in Nigeria; the most recent, in Tanzania in 2018. Each survey recorded information on thousands of individuals – tobacco users and non-users. It also showed who had attempted to quit.</p>
<p>Across the countries, tobacco users were more likely to be in the lowest income group. In Uganda, Tanzania, Kenya, and Botswana, more than 40% of current and past tobacco users were in the lowest fifth of the income spectrum. And in Cameroon, Ethiopia, Kenya, Senegal and Uganda, more than 50% of current and past tobacco users had not completed any formal education.</p>
<p>Smokers who had tried to stop in the past year made up as many as 53% of current smokers (in Botswana), and at least 29% (Cameroon).</p>
<p>Our analysis showed that differences in wealth status contributed to inequalities between former and current tobacco users. Education widened the wealth-related gap. Living in an urban area (versus rural) did so too in some of the countries but not in Ethiopia, Senegal and Uganda. Tobacco health knowledge also played a part in creating inequality between richer and poorer smokers. Being misinformed about tobacco’s health consequences was concentrated among individuals with lower levels of education.</p>
<p>Our results showed that attempts to stop using tobacco – and successful attempts – were concentrated among wealthier individuals and those with higher levels of education.</p>
<h2>What helps smokers quit?</h2>
<p>The WHO’s guidelines, ratified by <a href="https://fctc.who.int/who-fctc/overview/parties">182 countries</a>, show which policies work best to reduce tobacco use. The WHO also <a>monitors</a> which countries are using the policies. </p>
<p>Among the <a href="https://www.who.int/initiatives/mpower">key policies</a> are warning about the dangers of tobacco use, banning advertising, offering help to quit, and taxing tobacco products.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-ghana-is-using-graphic-pictures-to-cut-tobacco-use-116845">How Ghana is using graphic pictures to cut tobacco use</a>
</strong>
</em>
</p>
<hr>
<p>The most recent WHO <a href="https://www.who.int/publications/i/item/9789240032095">Report on the Global Tobacco Epidemic</a> (2021) covers all 195 of the world’s countries. It shows there has been progress in following policies to reduce tobacco demand. </p>
<p>But of all the recommended measures to reduce the demand for tobacco, the least progress has been made with:</p>
<ul>
<li><p>offering tobacco users help to quit </p></li>
<li><p>raising tobacco taxes.</p></li>
</ul>
<p>A large body of <a href="https://cancercontrol.cancer.gov/sites/default/files/2020-06/m21_complete.pdf">evidence</a> conclusively shows that tobacco taxation is the most effective and efficient way to reduce tobacco consumption. But right now, out of all the policies, best-practice tobacco tax <a href="https://fctc.who.int/docs/librariesprovider12/technical-documents/who-fctc-article-6-guidelines.pdf?sfvrsn=3bee36c8_50&download=true">policies</a> protect the least number of people in the world. </p>
<p>As for offering <a href="https://theconversation.com/tobacco-control-south-africa-must-do-more-to-help-people-quit-smoking-161628">services</a> to tobacco users trying to quit: 55% of all low-income countries offer no support at all. No low-income countries offer the best-practice services. </p>
<p>Counselling and medication can <a href="https://www.cdc.gov/tobacco/data_statistics/sgr/2020-smoking-cessation/fact-sheets/healthcare-professionals-health-systems/index.html">more than</a> double a tobacco user’s chance of successfully quitting. But paying for it is a <a href="https://linkinghub.elsevier.com/retrieve/pii/S0091743519301057">challenge</a>. </p>
<p>There’s an opportunity to use tobacco taxation not only to reduce the demand for tobacco, but also to <a href="https://www.who.int/publications/i/item/9789240019188">generate revenue</a> for efforts to help users quit. </p>
<h2>Action is required</h2>
<p>Governments have an opportunity to reap health benefits for their citizens, and financial benefits for their country, through implementation of evidence-based tobacco-control policies.</p>
<p><a href="https://link.springer.com/article/10.1007/s00181-022-02226-4">Research</a> shows that a healthy population is a more productive and prosperous one.</p><img src="https://counter.theconversation.com/content/206621/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sam Filby works for the Research Unit on the Economics of Excisable Products based at the University of Cape Town. Her research is funded by the African Capacity Building Foundation through the Bill & Melinda Gates Foundation, Tax Justice Network Africa (also through the Bill & Melinda Gates Foundation), the CDC Foundation, and Cancer Research UK. Sam is also CIO of byegwaai, an app-based smoking cessation program.</span></em></p>In low-income countries, tobacco use is often associated with lower income and less education. These users can’t afford to pay for counselling and medication.Sam Filby, Research Officer, Research Unit on the Economics of Excisable Products, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1997012023-04-05T15:25:42Z2023-04-05T15:25:42ZGrey seals are returning to UK waters – but their situation remains precarious<figure><img src="https://images.theconversation.com/files/519523/original/file-20230405-24-g8121a.jpg?ixlib=rb-1.1.0&rect=0%2C13%2C4346%2C2355&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">One-third of the world's grey seals now live the UK's waters.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/group-grey-seals-peeking-out-water-1834319254">F-Focus by Mati Kose/Shutterstock</a></span></figcaption></figure><p>Seals, sea lions and walruses – a group of animals called <a href="https://www.marinemammalcenter.org/animal-care/learn-about-marine-mammals/pinnipeds#:%7E:text=The%20word%20%22pinniped%22%20means%20fin,of%20pinnipeds%20lived%20on%20land.">pinnipeds</a> – have been heavily exploited throughout much of human history. Many of these species have at some point even been threatened with extinction. </p>
<p>But, in the UK, their decline has largely been reversed. Since the <a href="https://www.legislation.gov.uk/ukpga/1970/30/contents">Conservation of Seals Act 1970</a> prohibited the killing or injuring of grey and harbour seals around the UK, the <a href="http://www.smru.st-andrews.ac.uk/files/2022/08/SCOS-2021.pdf">number of grey seals</a> in the country has doubled to 157,000 – although there seems to be <a href="http://www.smru.st-andrews.ac.uk/files/2022/08/SCOS-2021.pdf">significant regional variation</a>. More than one-third of the world’s grey seals now populate the UK’s waters. </p>
<p>This is excellent news for seal conservation. But it can be problematic for the fishing industry, which now faces an <a href="https://www.sciencedirect.com/science/article/pii/S235198942030754X">increase in damage to catch and gear</a> inflicted by seals. Understanding how seal populations are changing will help manage their interactions with fisheries and other marine industries.</p>
<p>Grey seals and other pinnipeds are intelligent and highly adaptable creatures, able to switch their prey and foraging habits to suit their environment. But the threats these species face are changing fast. Slow to reproduce and vulnerable to climate change and disease, these now common animals could become threatened in the future should conditions continue to change.</p>
<figure class="align-center ">
<img alt="A crowd of people looking at a group of young seals." src="https://images.theconversation.com/files/519522/original/file-20230405-20-wu78vt.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4913%2C3684&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519522/original/file-20230405-20-wu78vt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519522/original/file-20230405-20-wu78vt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519522/original/file-20230405-20-wu78vt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519522/original/file-20230405-20-wu78vt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519522/original/file-20230405-20-wu78vt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519522/original/file-20230405-20-wu78vt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Donna Nook grey seal colony in Lincolnshire, UK.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doona-nook-uk-november-23-2018-1245989839">Stephan Morris/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Opportunistic foragers</h2>
<p>The population expansion of UK grey seals is probably the result of several factors. </p>
<p>In the decade that followed the Conservation of Seals Act, rising populations may have been the result of a lack of hunting or managed culls. Culls were carried out at some grey seal sites in the 1970s, but not as blanket attempts to control the overall population. </p>
<p>But since then, population increases may instead be due to changes in food availability. In the absence of other sources of mortality, food availability often drives population expansion. And grey seals are opportunistic foragers that feed on whichever prey is easiest to catch. </p>
<p><a href="https://www.cambridge.org/core/journals/journal-of-the-marine-biological-association-of-the-united-kingdom/article/review-of-spatial-and-temporal-variation-in-grey-and-common-seal-diet-in-the-united-kingdom-and-ireland/297F79B7D47371E49B5C493029CCB5A8">Several studies</a> have looked at how grey seal diets have changed over the past few decades. By examining the hard parts that remain in seal faeces such as bones and shells, it is possible to reconstruct their prey. This technique underreports some food groups such as <a href="https://en.wikipedia.org/wiki/Salmonidae">salmonids</a>, but is currently the only method that allows scientists to quantify a seal’s diet. </p>
<p>In three separate years (1985, 2002 and 2010), seal faeces were collected in coastal areas of Scotland and eastern England. Seal diets consisted of 66 different species, showcasing their ability to exploit <a href="https://www.ices.dk/advice/Pages/Latest-Advice.aspx">whatever prey becomes available</a>. </p>
<p>When large fish are absent, they hunt smaller prey such as <a href="https://www.britannica.com/animal/sand-lance">sandeels</a>. But, as populations of larger prey species such as <a href="https://www.britannica.com/animal/herring">herring</a>, <a href="https://www.britannica.com/animal/cod-fish-Gadus-species">cod</a> and <a href="https://www.britannica.com/animal/whiting-fish-Gadus-genus">whiting</a> increase, they exploit this too. </p>
<h2>No time for complacency</h2>
<p>Grey seals, and other pinnipeds, inhabit a dynamic environment and the threats they face are changing rapidly. <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1748-7692.2011.00479.x">Climate change</a>, for example, is affecting local food composition and abundance. </p>
<p>One of the main ways this occurs is through a process called “tropicalisation”, where rising sea temperatures cause warm water species to replace species that live in cooler waters. On average, marine species are shifting polewards at a <a href="https://www.nature.com/articles/nclimate1958">rate of 72km per decade</a>. </p>
<p>Seals are also vulnerable to population shocks. Pinnipeds have a long lifespan and tend to have small numbers of offspring – <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0077908">usually only one pup per year</a>. Any environmental change that is short-lived can be buffered by seals’ longevity. If they don’t successfully pup one year, then they are likely to do so the next. </p>
<p>But any increase in adult mortality can quickly affect a population. Seal populations are therefore particularly vulnerable to <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1748-7692.2011.00479.x">diseases</a> and other sources of adult mortality. </p>
<p>Respiratory diseases have a particularly acute impact on the foraging ability of diving animals such as seals. What could be a relatively minor threat to an animal that lives on land, could be life-threatening to one that dives. For example, more than 3,000 <a href="https://www.britannica.com/animal/sea-lion">sea lions</a> were found dead or dying on Peru’s coast following an <a href="https://www.nhm.ac.uk/discover/news/2023/march/bird-flu-kills-thousands-south-american-sea-lions-outbreak-continues.html#:%7E:text=An%20outbreak%20of%20highly%20pathogenic,American%20sea%20lions%20in%20Peru.">outbreak of influenza</a> in January 2023. Over 1,000 sea lions died on just one island, Isla San Gallan.</p>
<p>Climate change is likely to increase the risk of disease in the future. <a href="https://www.science.org/doi/10.1126/science.1063699">Research</a> finds that warmer conditions favour pathogen development, survival and spread. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1637206797504135168"}"></div></p>
<h2>Green energy infrastructure</h2>
<p>The way that humans use the sea is also changing. Offshore wind, for example, is <a href="https://www.thecrownestate.co.uk/en-gb/what-we-do/on-the-seabed/offshore-wind-evidence-and-change-programme/">projected to supply</a> around one-third of the UK’s electricity generation by 2030. But, the construction, operation and maintenance of offshore wind farms causes noise disturbance and may change the behaviour of marine animals. </p>
<p><a href="https://besjournals.onlinelibrary.wiley.com/doi/10.1111/1365-2664.12678">Research</a> on harbour seals found that they tend to avoid areas where piling activity (the process of driving foundations into the seabed) is ongoing. Where piling is occurring, seals use of the area was found to decrease by 83%. </p>
<p>But offshore wind infrastructure can also lead to the development of artificial reefs. These reefs may result in an <a href="https://www.sciencedirect.com/science/article/pii/S0960982214007490">increased density of prey</a> in the surrounding area and could improve foraging opportunities. Whether ocean infrastructure such as this will benefit seals depends on if it supports an increase in prey populations across a region – or simply concentrates existing populations in a smaller area.</p>
<figure class="align-center ">
<img alt="A wind farm off the coast of the UK in the North sea." src="https://images.theconversation.com/files/519529/original/file-20230405-28-cy2rn7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519529/original/file-20230405-28-cy2rn7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519529/original/file-20230405-28-cy2rn7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519529/original/file-20230405-28-cy2rn7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519529/original/file-20230405-28-cy2rn7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519529/original/file-20230405-28-cy2rn7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519529/original/file-20230405-28-cy2rn7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A wind farm off the coast of the UK in the North sea.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/wind-farm-north-sea-on-coast-1091969441">Riekelt Hakvoort/Shutterstock</a></span>
</figcaption>
</figure>
<p>Grey seals are the top marine predator in UK waters and seem to have become more common since the 1980s. But their situation remains precarious and they have little buffer should conditions change. This vulnerability highlights the importance of understanding the impact of future threats including climate change, more renewable energy infrastructure and disease outbreak.</p><img src="https://counter.theconversation.com/content/199701/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katrina Davis receives funding from the John Fell Oxford University Press Research Fund. </span></em></p><p class="fine-print"><em><span>Richard Bevan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Grey seals are now common in the UK – but their status remains fragile.Katrina Davis, Associate Professor of Conservation Biology, University of OxfordRichard Bevan, Senior Lecturer in Biology, Newcastle UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1978502023-02-06T12:20:00Z2023-02-06T12:20:00ZThree surprising reasons human actions threaten endangered primates<figure><img src="https://images.theconversation.com/files/506834/original/file-20230127-25-sl362z.jpg?ixlib=rb-1.1.0&rect=9%2C18%2C2994%2C1976&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A baby chimpanzee enjoys his food. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-gourmet-adorable-baby-chimpanzee-enjoying-1986791387">Michaela Pilch/Shutterstock</a></span></figcaption></figure><p>Monkeys, apes and lemurs are cute, familiar and lovable. But an estimated 60% of all primate species are listed as <a href="https://www.science.org/doi/10.1126/sciadv.1600946">vulnerable, threatened or endangered</a>, according to the International Union for Conservation of Nature, a network of environmental organisations. </p>
<p>You’ve probably heard about the main problems, like <a href="https://theconversation.com/deforestation-on-indonesian-island-of-sulawesi-destroys-habitat-of-endemic-primates-147189">deforestation</a> and the loss of habitat. But primates are a diverse group of animals with a wide geographical range, so there are many more subtle ways our actions as humans put these wonderful animals at risk.</p>
<h2>1. Dogs</h2>
<p>Everywhere we go, our best friends are likely to go with us. <a href="https://link.springer.com/book/10.1007/978-3-031-11736-7">Our review</a> shows that dogs are present in many primate habitats. These predators sometimes kill and injure primates, but they also may simply chase and harass them, disrupting their socialising or foraging. </p>
<p>Being on the lookout for harassing dogs is stressful and causes primates to use more energy. Reducing these potentially lethal encounters depends on conservationists communicating with dog owners, <a href="https://link.springer.com/chapter/10.1007/978-3-031-11736-7_5">who often don’t recognise</a> the danger their dogs pose to such wildlife.</p>
<figure class="align-center ">
<img alt="A black and white dog stands over a monkey in the street. The monkey has its mouth open." src="https://images.theconversation.com/files/506836/original/file-20230127-7614-6vw6f7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/506836/original/file-20230127-7614-6vw6f7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=373&fit=crop&dpr=1 600w, https://images.theconversation.com/files/506836/original/file-20230127-7614-6vw6f7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=373&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/506836/original/file-20230127-7614-6vw6f7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=373&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/506836/original/file-20230127-7614-6vw6f7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=469&fit=crop&dpr=1 754w, https://images.theconversation.com/files/506836/original/file-20230127-7614-6vw6f7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=469&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/506836/original/file-20230127-7614-6vw6f7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=469&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">Ma. Czarita A. Aguja/Shutterstock</span></span>
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<p>When diseases jump between animal species, they can cause serious harm to a species that does not have the necessary resistance. Dog diseases such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9179186/">canine heartworm </a>and <a href="https://royalsocietypublishing.org/doi/full/10.1098/rspb.2018.2772">parvovirus</a> can be passed from dogs to primates, and could potentially be fatal. There’s also the possibility that pathogens – viruses, bacteria or parasites – could evolve to spread more easily or become more deadly. </p>
<h2>2. Depictions</h2>
<p>If you live outside a country where primates live, you may never see a live primate outside of a zoo. Nevertheless, your media choices can still affect their conservation. </p>
<p><a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0118487">Researchers have discovered</a> that our choices of what we watch on YouTube, Instagram or TikTok can end up fuelling the use of primates as pets or in entertainment. Primates are cute, and we love to watch videos of them. However, many of these pictures and videos show them in artificial contexts, such as primates wearing clothes or interacting with office equipment.</p>
<p>When people view such content, <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0022050">they often say</a> they want a primate as a pet and are less likely to believe that these animals are endangered. </p>
<p>We can help to protect primates by not viewing or sharing videos that show animals in unnatural situations. The <a href="https://human-primate-interactions.org/resources/">responsibility</a> for interacting with primates respectfully is even higher for those who live near primates or those who embark on <a href="https://theconversation.com/five-ways-to-be-a-responsible-wildlife-tourist-118869">wildlife tourism</a>.</p>
<p>People’s activities can affect where primates live, what food they eat, and how they live their lives. Many tourist destinations in these types of locations cater to people’s desire to interact and take pictures with primates by keeping them as pets or encouraging feeding or similar interactions. </p>
<p><a href="https://link.springer.com/book/10.1007/978-3-031-11736-7">Our research found</a> that these practices harm the animals, increase the poaching or the trade of primates, and can lead to dangerous situations for both the primates and people. Photographs that show monkeys posing with humans alarm primatologists because we understand the risks of being bitten or of passing on diseases. But the wider public may be unaware of these dangers.</p>
<h2>3. Disease</h2>
<p>The potential for disease transmission between humans and primates is high, partly because of our closely related biology. When diseases move from animals to humans they are known as “zoonoses”. And when they are transferred from animals to human beings, they are known as “anthroponoses”.</p>
<p>The African apes – chimpanzees, bonobos and gorillas – seem to be particularly <a href="https://www.science.org/content/article/primatologists-work-keep-great-apes-safe-coronavirus">vulnerable to human respiratory infections</a>. Protecting these endangered animals from infectious disease is an important conservation goal.</p>
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<img alt="A silverback gorilla sits within thick, green vegetation" src="https://images.theconversation.com/files/506845/original/file-20230127-26-x0cl2i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/506845/original/file-20230127-26-x0cl2i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/506845/original/file-20230127-26-x0cl2i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/506845/original/file-20230127-26-x0cl2i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/506845/original/file-20230127-26-x0cl2i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/506845/original/file-20230127-26-x0cl2i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/506845/original/file-20230127-26-x0cl2i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">An endangered silverback mountain gorilla.</span>
<span class="attribution"><span class="source">Denys Kutsevalov/Shutterstock</span></span>
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<p>The risk of disease transmission between humans and nonhuman primates is worsened by close contact. Some primate species have always lived near people. But as human need for space grows and primate habitats become more fragmented, these encounters become more common. </p>
<p>Primate tourism also brings humans closer to wildlife, with people sometimes even holding the animals or sharing food with them. The <a href="https://theconversation.com/putting-primates-on-screen-is-fuelling-the-illegal-pet-trade-91995">pet trade</a> goes further and brings wild primates into our homes, where animals can contract illness from their owners and vice versa. </p>
<p><a href="https://humanprimateinteractions.files.wordpress.com/2022/10/primate-as-pets.pdf">Preventing the primate pet trade</a> and encouraging safe and respectful interactions with wildlife are vital for both human and nonhuman primate health.</p>
<p>These are only a few examples of the ways humans impact wild primates. And animal biologists are increasingly interested in such human-generated issues for wildlife conservation.</p><img src="https://counter.theconversation.com/content/197850/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tracie McKinney is affiliated with the IUCN SSC Primate Specialist Group's Section for Human-Primate Interactions (SHPI).</span></em></p><p class="fine-print"><em><span>Michelle Rodrigues is affiliated with the IUCN SSC Primate Specialist Group's Section for Human-Primate Interactions (SHPI).</span></em></p><p class="fine-print"><em><span>Sian Waters is affiliated with the IUCN SSC Primate Specialist Group's Section for Human-Primate Interactions (SHPI)</span></em></p>Most of us have heard of the dangers of deforestation but there are other more subtle ways that human beings can endanger monkeys, apes and lemurs.Tracie McKinney, Senior Lecturer in Biological Anthropology, University of South WalesMichelle Rodrigues, Assistant Professor, Marquette UniversitySian Waters, Honorary Research Fellow, Durham UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1977992023-01-14T09:53:17Z2023-01-14T09:53:17ZWhy cholera continues to threaten many African countries<figure><img src="https://images.theconversation.com/files/504431/original/file-20230113-17-bb62ey.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Key to preventing cholera is a good supply of water.</span> <span class="attribution"><span class="source">Getty images</span></span></figcaption></figure><p><em>Many African countries are periodically affected by outbreaks of cholera. For instance, Malawi’s current outbreak, the <a href="https://www.bloomberg.com/news/articles/2023-01-12/worst-cholera-outbreak-in-decades-kills-750-people-in-malawi">worst</a> in two decades, has claimed <a href="https://www.theeastafrican.co.ke/tea/rest-of-africa/cholera-outbreak-kills-620-in-malawi-4073880#:%7E:text=Malawi%20has%20recorded%2018%2C222%20cholera,Health%20Minister%20Khumbize%20Chiponda%20announced">hundreds</a> of lives and forced the closure of schools and many businesses. Cholera deaths have now been <a href="https://www.bloomberg.com/news/articles/2023-05-22/south-african-capital-hit-by-cholera-outbreak-with-10-dead">reported</a> in South Africa too.</em></p>
<p><em>Microbiologist Sam Kariuki, the director of Kenya’s Medical Research Institute, explains what cholera is and why it’s so hard to control in Africa.</em></p>
<h2>Why is cholera still such a big issue for African countries?</h2>
<p>Cholera is a disease <a href="https://www.gtfcc.org/research/cholera-prevention-preparedness-and-control-in-kenya-through-hotspot-mapping-genotyping-exposure-assessment-and-wash-oral-cholera-vaccine-interventions/">caused and spread by</a> bacteria – specifically <em>Vibrio cholerae</em> – which you can get by eating or drinking contaminated food or water. </p>
<p>It’s an <a href="https://books.google.co.ke/books?id=qpjshPr7HVcC&pg=PA197&lpg=PA197&dq=cholera+and+bangal&source=bl&ots=4htxUE4c61&sig=S52TKJb0YKHttBcyNZt2jJRtLcY&hl=en&sa=X&redir_esc=y#v=onepage&q=cholera%20and%20bangal&f=false">old disease</a> which has mostly <a href="https://www.ncbi.nlm.nih.gov/pubmed/2857326">affected</a> developing countries, many of which are in Africa. Between 2014 and 2021 Africa <a href="https://reliefweb.int/report/world/who-and-partners-revamp-war-against-cholera-africa">accounted for</a> 21% of cholera cases and 80% of deaths reported globally.</p>
<iframe id="noa-web-audio-player" style="border: none" src="https://embed-player.newsoveraudio.com/v4?key=x84olp&id=https://theconversation.com/why-cholera-continues-to-threaten-many-african-countries-197799&bgColor=F5F5F5&color=D8352A&playColor=D8352A" width="100%" height="110px"></iframe>
<p>In several African countries, cholera is the leading cause of severe diarrhoea. In 2021, the World Health Organization <a href="https://reliefweb.int/report/world/who-and-partners-revamp-war-against-cholera-africa">reported</a> that Africa experienced its highest ever reported numbers – more than 137,000 cases and 4,062 deaths in 19 countries.</p>
<p>It has persisted in Africa partly because of <a href="https://www.washingtonpost.com/politics/2022/01/28/is-africa-losing-ground-battle-water-sanitation/">worsening</a> sanitation, poor and unreliable water supplies and worsening socioeconomic conditions. For instance, when people’s incomes can’t keep up with inflation they’ll move to more affordable housing – often this is in congested, unsanitary settings where water and other hygiene services are already stretched to the limit.</p>
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Read more:
<a href="https://theconversation.com/kenyas-urban-poor-are-being-exploited-by-informal-water-markets-144582">Kenya's urban poor are being exploited by informal water markets</a>
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<p>In addition, in the last decade, many African countries have witnessed an <a href="https://www.afdb.org/en/documents/africas-urbanisation-dynamics-2022-economic-power-africas-cities">upsurge in population migration</a> to urban areas in search of livelihoods. Many of these people end up in poor urban slums where water and sanitation infrastructure remains a challenge. </p>
<p>Displaced populations – a major concern in several African countries – are also very vulnerable to water and food contamination. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/504400/original/file-20230113-17-rju7ae.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/504400/original/file-20230113-17-rju7ae.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/504400/original/file-20230113-17-rju7ae.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/504400/original/file-20230113-17-rju7ae.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/504400/original/file-20230113-17-rju7ae.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/504400/original/file-20230113-17-rju7ae.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/504400/original/file-20230113-17-rju7ae.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Sadiki Sabimana, an internally displaced person, holds water he believes is contaminated with cholera, in the DRC’s Masisi area.</span>
<span class="attribution"><span class="source">Alexis Huguet/AFP</span></span>
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<p>It’s important to control cholera because it can cause severe illness and death. In mild cases cholera can be managed through oral rehydration salts to replace lost fluids and electrolytes. Severe cases may require antibiotic treatment. It’s vital to diagnose and treat cases quickly – cholera can <a href="http://www.who.int/mediacentre/factsheets/fs107/en/">kill within hours</a> if untreated. </p>
<p>In 2015, it was <a href="https://bmjopen.bmj.com/content/11/3/e044615">estimated that</a> over one million cases in 44 African countries resulted in an economic burden of US$130 million from cholera-related illness and its treatment. </p>
<h2>What’s missing in the response?</h2>
<p>African governments must acknowledge that the burden of cholera is huge. In my opinion, governments in endemic areas don’t recognise cholera as a major issue until there’s a big outbreak, when it’s out of control. They treat it as a once off. </p>
<p>The burden of cholera could get worse unless governments put measures in place to control and prevent outbreaks. They need to address water and hygiene infrastructure. </p>
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<strong>
Read more:
<a href="https://theconversation.com/cholera-how-african-countries-are-failing-to-do-even-the-basics-74445">Cholera: how African countries are failing to do even the basics</a>
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<p>There must also be community engagement. For instance, widespread messaging that encourages hand washing, boiling water and other preventive measures. Community health <a href="https://www.cdc.gov/mmwr/volumes/65/wr/mm6503a7.htm">extension workers</a> are key in getting these messages across and distributing supplies during an outbreak.</p>
<p>For the most vulnerable populations we must apply oral cholera vaccines. Data on cholera hotspots from surveillance studies will be vital to ensure critical populations are targeted first. </p>
<p>There are various brands and variation of the oral cholera vaccine, and they are all easy to administer because they are taken orally. They have an effectiveness rate of <a href="https://www.cdc.gov/cholera/vaccines.html#:%7E:text=The%20vaccine%20manufacturer%20reports%20Vaxchora,3%E2%80%936%20months%20after%20vaccination.">between</a> 60% to 80% but require a yearly booster. There’s not been a concerted vaccination campaign in many countries, however, because governments are not taking the prevention and control of the disease seriously. </p>
<p>Finally, the issue of drug resistance needs to be addressed. Drug resistance has made it possible for these cholera strains to stay longer in the environment. </p>
<p>I was part of a team that conducted a <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0074829">study</a> in Kenya which found that bacteria that causes cholera has become resistant to some antibiotics. Some types of drug resistance are caused by a natural interaction of the <em>Vibrio cholerae</em> bacteria with other drug resistant bacteria in the environment. </p>
<p>The overuse of antibiotics also contributes to drug resistance. Government agencies should develop ways to monitor the use of antibiotics and restrict their prescription. Regulation of antibiotic use in animals should also be improved. Healthcare workers also need to be trained in the proper use of antibiotics.</p>
<h2>Have there been any recent advances?</h2>
<p>One important one has been the development of rapid diagnostic tests that can be used by health workers in the field. These kits are available at costs far lower than lab culture costs. Using them makes it possible to confirm outbreaks promptly so treatment can be initiated. </p>
<p>In addition, more countries are now adopting the oral cholera vaccine for prevention and control. </p>
<p>What is lacking is a concerted effort for all endemic countries – which I consider to be all countries in sub-Saharan Africa – to have joint measures to tackle cross-border transmission and persistence of cholera outbreaks. </p>
<p>Some countries are still in denial about outbreaks. This is partly due to fears about repercussions on trade and tourism. But in an interconnected world this attitude isn’t helpful. </p>
<p>I am optimistic that we can control cholera in African settings. In the short term this could be done through raising awareness among vulnerable populations and interventions like the oral cholera vaccine.</p>
<p>In the long term African countries need improved water hygiene infrastructure, housing and enhanced socioeconomic conditions. But there must be a strong will by relevant government ministries to work together to realise these goals.</p><img src="https://counter.theconversation.com/content/197799/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Samuel Kariuki does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Cholera has persisted longer in Africa largely due to worsening hygiene and sanitation situations in urban areas.Samuel Kariuki, Chief Research Scientist and Director, Centre for Microbiology Research, Kenya Medical Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1892882022-12-22T16:56:00Z2022-12-22T16:56:00ZChronic pain: An invisible disease whose sufferers are unfairly stigmatized<figure><img src="https://images.theconversation.com/files/481359/original/file-20220826-2852-t3iovl.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Even though chronic pain is recognized by scientists as a disease in its own right, it remains largely under-recognized, under-diagnosed and, above all, subject to many prejudices. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Imagine living with pain every day for months, or even years — pain that is so intrusive, it disrupts every day of your life.</p>
<p>Unfortunately, this is the daily reality of millions of people living with chronic pain. And all too often, they find their condition being stigmatized or even denied outright.</p>
<p>As a doctoral student in the epidemiology of chronic pain, I have the opportunity to work with patient partners. Given the high prevalence and multiple impacts of this disease, it is high time we started working to change attitudes and confront the prejudices that surround it.</p>
<h2>Essential pain and acute pain</h2>
<p>Before discussing chronic pain, let’s start at the beginning. Is pain always a negative thing? Of course not. Pain is essential to our proper functioning. It acts as an <a href="https://www.canada.ca/content/dam/hc-sc/documents/corporate/about-health-canada/public-engagement/external-advisory-bodies/canadian-pain-task-force/report-2019/canadian-pain-task-force-June-2019-report-en.pdf">alarm system</a> to warn us of danger.</p>
<p>For example, if we were to accidentally put our hand on a hot stove top, a pain message would be sent to our brain. Before we even had time to think about it, we would remove our hand from the hot surface, avoiding an intense burn in the process. This pain provides us with the reflexes we need in order to avoid the worst situations.</p>
<p>Pain can also last a little longer. This is the case, for example, after an injury, an operation or an infection. <a href="https://www.canada.ca/content/dam/hc-sc/documents/corporate/about-health-canada/public-engagement/external-advisory-bodies/canadian-pain-task-force/report-2019/canadian-pain-task-force-June-2019-report-en.pdf">This pain will often resolve itself after a normal healing cycle</a> or disappear with the help of treatment. This is called acute pain. Short-term pain like this is perceived more as a symptom.</p>
<h2>Chronic pain, a disease with multiple impacts</h2>
<p>When pain persists beyond the normal healing time, it is no longer considered simply a symptom, but a <a href="https://doi.org/10.1097/j.pain.0000000000000160">disease in its own right</a>. This is called chronic pain. Chronic pain is defined as <a href="https://doi.org/10.1097/j.pain.0000000000001384">pain that persists for a minimum of three months</a>. Yet, for the vast majority of people living with this disease, the pain persists for several years.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/472372/original/file-20220704-12-5r8qlt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/472372/original/file-20220704-12-5r8qlt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/472372/original/file-20220704-12-5r8qlt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/472372/original/file-20220704-12-5r8qlt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/472372/original/file-20220704-12-5r8qlt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/472372/original/file-20220704-12-5r8qlt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/472372/original/file-20220704-12-5r8qlt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">‘Displacement,’ by Chloe Fleisher, 13, who lives with chronic pain. Submitted as part of the art contest titled ‘Pain and mental health,’ this artwork won an award from the Canadian Pain Society in 2022.</span>
<span class="attribution"><span class="source">(Marimée Godbout-Parent)</span></span>
</figcaption>
</figure>
<p>In these people, the pain message is somehow missing. It is no longer present to warn us of dangers, but becomes a burden on its own. Chronic pain can occur as a result of cancer, an accident, or after surgery. Unfortunately, sometimes we are unable to find the cause. This makes it difficult to treat.</p>
<p>Although this disease is not widely recognized, it is estimated to affect about <a href="https://doi.org/10.24095/hpcdp.31.4.04">20 per cent of the Canadian population</a>. Considering that our population in 2022 is estimated to be close to 39 million, this would mean that approximately 7.5 million people are living with chronic pain. For the purpose of comparison, 7.5 million Canadians is equivalent to <a href="https://worldpopulationreview.com/canadian-provinces/quebec-population">the entire population of Québec</a>. It’s an impressive and worrisome number.</p>
<p>In addition to affecting a large portion of the population, chronic pain <a href="https://www.canada.ca/content/dam/hc-sc/documents/corporate/about-health-canada/public-engagement/external-advisory-bodies/canadian-pain-task-force/report-2019/canadian-pain-task-force-June-2019-report-en.pdf">causes more than just physical pain</a>. The disease affects the daily functioning, psychological well-being, quality of life, social life and work of the people afflicted by it.</p>
<p>Imagine having so much pain that it reduces your ability to work, play with your children, see your friends or concentrate and even affects your ability to carry out everyday tasks. Despite the person’s desire to stay active, the body just can’t keep up. So it’s not surprising that consequences such as fatigue, frustration, sadness, anxiety and depression follow. The constant overlap between physical, psychological and social difficulties creates deep distress in this population.</p>
<h2>A stigmatized disease</h2>
<p>Despite the significant impacts associated with it, <a href="https://doi.org/10.1111/j.1526-4637.2011.01264.x">chronic pain remains largely stigmatized</a>. Indeed, negative attitudes and beliefs that people living with chronic pain <a href="https://doi.org/10.1080/24740527.2017.1369849">have become dependent on their medications, that they are exaggerating the severity of their condition, are just lazy</a> or do not want to help themselves are widespread.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/IcdsYdUls44?wmode=transparent&start=48" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Chronic pain is a very real disease.</span></figcaption>
</figure>
<p>So, knowing the multiple consequences and prevalence of chronic pain, why is there still so much prejudice and stigma towards those who suffer from it?</p>
<p>The question remains unanswered. For some, what we cannot see simply does not exist. Because pain is an experience that varies from person to person, because we don’t have a specific tool for detecting it or because we can’t necessarily see it, pain can seem invisible. We have a harder time feeling <a href="https://doi.org/10.1016/j.jpain.2013.11.002">sympathy or understanding for things that cannot be explained medically</a> with medical tests or X-rays.</p>
<h2>How to become an ally</h2>
<p>So, despite the many explanations offered by patients, they often have to deal with prejudices from health professionals, their entourage or the general population. Many people living with chronic pain feel that their pain is not understood by their friends, family, employers or even their health-care professionals, which adds to their feelings of helplessness, sadness and anger. In addition to dealing with the difficulties that chronic pain brings, these comments place an inestimable burden on sufferers. </p>
<p>Francine, who has been living with chronic pain for 15 years, regularly receives these types of comments from her family and friends:</p>
<blockquote>
<p>Well, you’ve only been walking for 10 minutes, you can do more. Just try harder.</p>
</blockquote>
<p>Sylvie, who has lived with chronic pain for 17 years, has to deal with her doctor’s comments:</p>
<blockquote>
<p>“You are the only patient I have not been able to relieve with cortisone shots in 40 years, so perhaps you should consult a psychologist instead.</p>
</blockquote>
<p>These phrases, which can sound harmless to some, are often loaded with meaning for those who hear them on a daily basis. Accepting chronic pain as a disease is an important and difficult step. It should not be coupled with such pejorative comments.</p>
<p>Without being experts in the field, we can all play a role, in one way or another, in the lives of these people. Offering an active and understanding ear, not making quick judgments and acknowledging their condition is already a huge step in the right direction.</p>
<p>Support and communication with those around you are elements that should not be neglected and can certainly make a positive difference.</p>
<p><em>This article was written in collaboration with Sylvie Beaudoin and Christian Bertrand, patient partners.</em></p><img src="https://counter.theconversation.com/content/189288/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marimée Godbout-Parent has received funding from the Canadian Institutes of Health Research (CIHR).</span></em></p>Although chronic pain is recognized by scientists as a disease in its own right, it remains largely under-recognized, under-diagnosed and, above all, associated with numerous prejudices.Marimée Godbout-Parent, Étudiante au doctorat recherche en sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1932402022-11-03T13:46:52Z2022-11-03T13:46:52ZClimate change: the effects of extreme heat on health in Africa – 4 essential reads<figure><img src="https://images.theconversation.com/files/492993/original/file-20221102-22-59h8xy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">shutterstock</span> </figcaption></figure><p>Scientists are sounding the <a href="https://www.unicef.org/reports/coldest-year-rest-of-their-lives-children-heatwaves">alarm</a> about the extreme increases in the Earth’s temperature. A new report by UNICEF <a href="https://www.unicef.org/media/129506/file/UNICEF-coldest-year-heatwaves-and-children-EN.pdf">warns</a> that 2022 could be the “coldest year of the rest of our lives”. Heatwaves are becoming stronger and lasting longer. These increases are threatening the limits of human survival. </p>
<p>The African continent is particularly at risk – it’s heating up <a href="https://unfccc.int/news/climate-change-is-an-increasing-threat-to-africa">more</a>, and faster, than any other region in the world. By 2030, up to <a href="https://www.uneca.org/stories/state-of-climate-in-africa-report-2020">118 million extremely poor people</a> in Africa will be subject to the devastating impacts of drought and intense heat. This has huge implications for human health, from the spread of disease to heat stress. </p>
<p>Experts writing for The Conversation Africa have explored these issues in a number of articles. We’ve collected four of these important reads here.</p>
<h2>1. Surviving extreme heat</h2>
<p>The general limit of heat we should live in is 35°C wet-bulb temperature, which is a measure of both air temperature and humidity. Beyond this, the body struggles to cool itself. </p>
<p>Extreme heat is a serious health hazard. Many of the temperatures being recorded in Africa now, and those projected for the next decade, are already close to the limits of human survival, or “liveability”.</p>
<p>Health experts Abdu Mohiddin, Christopher Jack, Evans Kituyi, Kristie Ebi, Matthew Chersich and Stanley Luchters provide insights into who’s most at risk from extreme heat, and what must be done to mitigate it.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/extreme-heat-hurts-human-health-its-effects-must-be-mitigated-urgently-171327">Extreme heat hurts human health. Its effects must be mitigated -- urgently</a>
</strong>
</em>
</p>
<hr>
<h2>2. Vulnerable living spaces</h2>
<p>Cities are recognised as areas particularly vulnerable to the effects of heat on health. This is because urbanised areas experience higher temperatures than less-urbanised or rural areas. </p>
<p>Within cities, people living in informal settlements are particularly at risk of increased temperatures. Lorena Pasquini, a climate change adaptation researcher, <a href="https://theconversation.com/heat-and-health-dar-es-salaams-informal-settlements-need-help-181816">reveals</a> why. She carried out research in informal settlements in Tanzania’s capital, Dar es Salaam, and explains that the structures people live in have features that either increase temperatures or lack features that would cool them down. </p>
<p>In addition, inadequate or absent planning means that housing is too densely packed so that air can’t circulate.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heat-and-health-dar-es-salaams-informal-settlements-need-help-181816">Heat and health: Dar es Salaam's informal settlements need help</a>
</strong>
</em>
</p>
<hr>
<h2>3. Children at risk</h2>
<p>Children, especially newborn babies, are at particular risk of heat stress. This is because they’re less able to control their body temperature. They can easily become dangerously hot or cold.</p>
<p>Climate experts Cathryn Birch, John Marsham and Sarah Chapman <a href="https://theconversation.com/climate-change-will-cause-more-african-children-to-die-from-hot-weather-188609">estimate</a> that between 2011 and 2020, there were between 12,000 and 19,000 heat-related child deaths per year in Africa. </p>
<p>Climate change accounts for about half of these deaths. The additional deaths due to climate change cancel out the recent reduction in heat-related deaths that was achieved through developmental improvements.</p>
<p>This <a href="https://theconversation.com/climate-change-will-cause-more-african-children-to-die-from-hot-weather-188609">research</a> underscores the urgent need to reduce emissions and the impact of heat on babies and children.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/climate-change-will-cause-more-african-children-to-die-from-hot-weather-188609">Climate change will cause more African children to die from hot weather</a>
</strong>
</em>
</p>
<hr>
<h2>4. Growing risk of mosquito-borne diseases</h2>
<p>Extreme heat can have a <a href="https://www.who.int/news-room/fact-sheets/detail/climate-change-heat-and-health">direct impact</a> on people’s health, for example by causing heat exhaustion or heat strokes. High temperatures also have an indirect impact on health – for example through disease transmission. Researchers have <a href="https://wellcome.org/news/how-climate-change-affects-vector-borne-diseases">warned</a> that climate change will lead to an increase in the number of people exposed to new mosquito-borne diseases. </p>
<p>Mosquitoes are among the deadliest animals in the world. Beyond being annoying, these insects transmit diseases such as malaria, zika virus and yellow fever. </p>
<p>Shüné Oliver, a biochemist, and her colleagues at South Africa’s National Institute for Communicable Diseases have been tracking <em>Anopheles arabiensis</em>, one of the mosquito species that transmits malaria. </p>
<p>Their research shows that insecticide-resistant mosquitoes can withstand extreme heat. This will complicate malaria control.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-higher-temperatures-and-pollution-are-affecting-mosquitoes-114768">How higher temperatures and pollution are affecting mosquitoes</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/193240/count.gif" alt="The Conversation" width="1" height="1" />
Marginalised or minority groups seem to suffer the most from heat-related deaths and disease.Moina Spooner, Assistant EditorIna Skosana, Health + Medicine Editor (Africa edition)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1907712022-10-10T14:51:36Z2022-10-10T14:51:36Z‘Forever chemicals’ are everywhere – here’s what you need to know about them<figure><img src="https://images.theconversation.com/files/488987/original/file-20221010-14-gno6qd.jpg?ixlib=rb-1.1.0&rect=10%2C0%2C3527%2C2354&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some non-stick pans may contain PFAS.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fried-egg-on-frying-pan-48274687">Parpalea Catalin/ Shutterstock</a></span></figcaption></figure><p>Whether you’ve heard of them before or not, “forever chemicals” are all around us. Stain-resistant carpets, non-stick pans, mascara and even some food packaging all contain these chemicals. But while these products can be very useful to us, the chemicals they contain have a darker side. Research has shown that they’re linked to <a href="https://www.epa.gov/pfas/our-current-understanding-human-health-and-environmental-risks-pfas">health problems</a>, including cancer. And one recent study even suggested that <a href="https://www.theguardian.com/society/2022/oct/05/pfas-sperm-count-mobility-testicle-development">in utero exposure</a> to forever chemicals can affect a man’s sperm count and quality later in life.</p>
<p>Here’s what you should know about them.</p>
<h2>What are forever chemicals?</h2>
<p>Forever chemicals are a class of chemicals collectively known as per- and polyfluorinated alkyl substances (PFAS), which were first introduced in the 1940s.</p>
<p>Their high thermal and chemical stability, coupled with their ability to repel grease and water, make these chemicals uniquely suited for a variety of engineering and commercial uses. As such, they can be found in many consumer products, such as makeup, fire extinguishers, fast food wrapping, textiles, stain repellents and electronics. The actual number of PFAS in circulation worldwide has yet to be defined – though according to some resources, this number is <a href="https://ehp.niehs.nih.gov/doi/10.1289/EHP4158">well over 4,700</a> chemicals. </p>
<p>The reason PFAS are called forever chemicals is because they <a href="https://www.hbm4eu.eu/wp-content/uploads/2021/11/Factsheet_PFAS.pdf">persist in the environment</a> for decades. For example, it would take approximately 400 years to break down just 500 mg (roughly the equivalent of a paracetamol tablet) of a type of forever chemical called perfluorooctane sulphonic acid (PFOS). This chemical was once used as a spray-on stain repellent for textiles. The same amount of another forever chemical known as perfluorooctanoic acid (PFOA) would take 800 years to break down. This chemical was used in the manufacture of non-stick pans. </p>
<p>Given that PFAS are used in so many everyday items, it also means they can find their way into the sewage system during washing, or into landfill after disposal – which may allow them to eventually end up in rivers. They’re also known to accumulate in plants and animals as they move through the food chain, so they may end up in the foods we eat including <a href="https://www.buzzfeednews.com/article/nidhisubbaraman/pfas-food-farms-milk-produce">milk</a> and <a href="https://www.sciencedirect.com/science/article/pii/S004565352202776X#:%7E:text=Eight%20PFAS%20were%20detected%20in,of%20free%2Dranging%20laying%20hens.&text=PFOS%20was%20the%20dominant%20compound%20and%20concentrations%20decreased%20from%20the%20fluorochemical%20plant.&text=Diet%20and%20age%20of%20laying,PFOS%20and%20PFOA%20egg%20concentrations.&text=Homegrown%20eggs%20can%20be%20an%20important%20exposure%20pathway%20of%20PFAS%20to%20humans.">eggs</a>. </p>
<p>For instance, <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1012230/Poly-_and_perfluoroalkyl_substances_-sources_pathways_and_environmental_data_-_report.pdf">research from 2014 and 2019</a> showed traces of PFOA and PFOS – which have not been commercially produced in Europe for over a decade – were still present in most rivers, lakes and ground water in the UK. In 2021, PFOS was also <a href="https://www.theguardian.com/environment/2022/feb/08/high-levels-of-toxic-chemicals-found-in-cambridgeshire-drinking-water">detected in drinking water</a> in Cambridgeshire. The source of the contamination was not clear, but may have been from historic use of firefighting foam from an airfield nearby.</p>
<figure class="align-center ">
<img alt="A woman holding a glass of water." src="https://images.theconversation.com/files/488992/original/file-20221010-11-d5cf4v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488992/original/file-20221010-11-d5cf4v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488992/original/file-20221010-11-d5cf4v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488992/original/file-20221010-11-d5cf4v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488992/original/file-20221010-11-d5cf4v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488992/original/file-20221010-11-d5cf4v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488992/original/file-20221010-11-d5cf4v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Forever chemicals have even been found in drinking water.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-drinking-water-570636958">sebra/ Shutterstock</a></span>
</figcaption>
</figure>
<p>These pollutants have even been found in <a href="https://pubs.acs.org/doi/10.1021/acs.est.2c02592">formerly pristine parts of the world</a>, far from where they were manufactured or used. This has created an immense environmental challenge which does not respect national boundaries. And due to their extreme persistence, these pollutants are likely to adversely affect future generations.</p>
<h2>Health problems</h2>
<p>Just as PFAS take a long time to break down in the environment, forever chemicals can also stay within our bodies for a long time – <a href="https://www.bbc.com/future/article/20220512-the-chemicals-that-linger-for-decades-in-your-blood">possibly even decades</a>. They may also accumulate in our body the more we come into contact with them.</p>
<p>Research shows that PFAS are implicated in many different diseases, with studies linking them to testicular and kidney cancer, thyroid problems, obesity, reproductive disorders and developmental issues in the foetus. They may also raise cholesterol levels, act as immunosuppressants and lower the effectiveness of vaccines. Research has also shown that PFAS has been detected in <a href="https://www.theguardian.com/environment/2022/sep/23/forever-chemicals-found-umbilical-cord-blood-samples-studies">umbilical cords</a>.</p>
<p>Only two PFAS have been banned in Europe so far. But six more are <a href="http://chm.pops.int/theconvention/thepops/chemicalsproposedforlisting/tabid/2510/default.aspx">currently under review</a> – including chemicals used in insecticides and paints – because of their health risks. </p>
<p>However, even if we could collect all the PFAS pollution in the world, there’s no way to safely dispose of them. These pollutants are not biodegradable and thermally very stable. Even at the high temperatures of incineration they break down to toxic and corrosive substances or fluorocarbons which are potent greenhouse gases and their disposal would need to be carefully monitored. This makes regulation of these chemicals even more important than it already is.</p>
<p>As consumers, we can reduce the amount of forever chemicals reaching the environment (and our bodies) by trying to purchase products which are free from forever chemicals. Before purchasing waterproof or stain resistant textiles, read the label to make sure they haven’t been treated with PFAS. Better yet, look for products labelled as free from PFC, PFOS, and PFOA. Also take care to examine items such as fast food wrapping, cosmetics and dental floss for these ingredients. If you still aren’t sure what to look out for, you can also check online using <a href="https://www.pfasfree.org.uk/current-initiatives/pfas-free-product">this resource</a> which can tell you which everyday products are free from forever chemicals.</p><img src="https://counter.theconversation.com/content/190771/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joanne Roberts receives funding from
British Mass Spectrometry Society. </span></em></p>So-called ‘forever chemicals’ are in many of the everyday products we use.Joanne Roberts, Research Fellow, Environmental Chemistry, Glasgow Caledonian UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1834732022-08-09T15:40:53Z2022-08-09T15:40:53ZPersonalised medicine made in hospitals can revolutionise the way diseases are treated – the challenge now will be implementing it<figure><img src="https://images.theconversation.com/files/477860/original/file-20220805-18-i87fkb.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C5104%2C2874&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Manufacturing a treatment this way would mean patients could get their treatment faster.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hospital-ward-friendly-male-nurse-talks-1940771059">Gorodenkoff/ Shutterstock</a></span></figcaption></figure><p>Imagine a patient with a rare genetic disorder that makes their arms and legs have imprecise and slow movements. For years, the patient has faced serious restrictions in day-to-day life. They tried several treatments, but all have failed to ease the symptoms.</p>
<p>Now imagine a university team discovering a therapy that could tackle this condition, with a solution that lies in the patient’s own body. The patient’s blood would be collected, some key cells would be separated in a laboratory, gene-editing techniques would be applied, and personalised medicine, produced with specialised equipment, would be injected back into the patient’s body. </p>
<p>A biological process would then be triggered in which all faulty genes would be corrected, reducing the disease’s severity, perhaps correcting it all together. The modification would be restricted to the patient and would not be passed on to their children, since it would not affect reproductive cells.</p>
<p>Our story has a catch, though: the blood cells needed for the personalised medicine are very fragile and do not live very long outside the human body. This means there’s little time to take the blood to the specialised laboratory, transport the cells to the production facility, and take the medicine back to the hospital where the patient is. </p>
<p>But what if all these production steps were quickly performed in the same place – that is, in the hospital?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-human-body-has-37-trillion-cells-if-we-can-work-out-what-they-all-do-the-results-could-revolutionise-healthcare-185654">The human body has 37 trillion cells. If we can work out what they all do, the results could revolutionise healthcare</a>
</strong>
</em>
</p>
<hr>
<p>Our story is ceasing to be just imagination because this way of producing medicines in the hospital is actually emerging. It’s what specialists call <a href="https://discovery.ucl.ac.uk/id/eprint/10135577/">point-of-care manufacture</a>. And there are several notable examples of it already in use.</p>
<p>For instance, a medicine for <a href="https://www.clinicbarcelona.org/en/news/hospital-clinic-idibaps-has-developed-a-car-t-cell-therapy-for-multiple-myeloma-that-shows-an-effectiveness-of-over-70-after-one-year-follow-up">multiple myeloma</a> (a type of bone marrow cancer) is being produced in the Hospital Clinic in Barcelona, Spain. Products for <a href="https://www.lausanneuniversityhospital.com/healing-severe-burn-victims">severe burns</a> are being manufactured in Lausanne University Hospital in Switzerland. </p>
<p>At the University of Colorado in the US, researchers are developing a therapy for <a href="https://www.healio.com/news/hematology-oncology/20220408/pointofcare-cart-shows-promising-efficacy-safety-for-bcell-nonhodgkin-lymphoma">hard-to-treat lymphoma</a>, a type of blood cancer. In the UK, an NHS Blood and Transplant laboratory is investigating the manufacture of red blood cells – which, if successful, could be carried out in hospitals and other clinical settings for the <a href="https://onlinelibrary.wiley.com/doi/10.1111/trf.15426">treatment of cardiac diseases</a>.</p>
<p>These illnesses might not have been treated if the medicines had needed to be frozen and transported over long distances, instead of being made in the hospital.</p>
<h2>Are we ready for it?</h2>
<p>Given that these therapies have such a short shelf life and will need to be produced at the patient’s bedside, there are many things we need to consider before we can deploy them on a wider scale. For example, what measures should hospitals, companies, and regulators take to adopt this model and make it work? This is what our <a href="https://www.ucl.ac.uk/biochemical-engineering/research/research-and-training-centres/future-targeted-healthcare-manufacturing-hub">research team has been investigating</a>. </p>
<p>It’s vital that the same safe and high-quality production methods are used in different hospitals so that all patients receive the best possible care. This is why <a href="https://www.gov.uk/government/consultations/point-of-care-consultation/consultation-on-point-of-care-manufacturing">regulatory agencies in the UK</a> are already proposing new ways of managing this model. </p>
<p>For example, it has been suggested that to begin with, manufacturers could oversee the medicine’s production in several different hospitals from a central site. They could also be responsible for providing training and quality control in the hospitals that have rolled out point-of-care manufacture to ensure that the products are safe and high-quality.</p>
<p>But just because a new policy has been made, doesn’t mean it will be successfully implemented. This will mean hospitals and companies will need to change how they operate for these new technologies to be implemented safely and efficiently.</p>
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<img alt="A group of five doctors and nurses have a discussion while seated at a conference table." src="https://images.theconversation.com/files/477861/original/file-20220805-25340-n21evt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/477861/original/file-20220805-25340-n21evt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/477861/original/file-20220805-25340-n21evt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/477861/original/file-20220805-25340-n21evt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/477861/original/file-20220805-25340-n21evt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/477861/original/file-20220805-25340-n21evt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/477861/original/file-20220805-25340-n21evt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Making point-of-care manufacture possible will require cooperation at all levels.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/high-angle-view-young-africanamerican-doctor-1674031528">SeventyFour/ Shutterstock</a></span>
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<p>Our research, in collaboration with the <a href="https://www.ucl.ac.uk/steapp/sites/steapp/files/fthmh_poc_workshop_report_-_june_2021.pdf">Medicines and Healthcare Products Regulatory Agency</a> (MHRA) and several public and private sector organisations has also looked at what benefits and challenges there may be in implementing this innovative approach to the production of medicines.</p>
<p>In <a href="https://www.ucl.ac.uk/steapp/sites/steapp/files/point-of-care_manufacture_of_advanced_therapies_fthm_policy_brief_jul_2022.pdf">a recent publication</a>, we put forward several steps that need to be taken by regulators, hospital staff, and companies to make the production of personalised therapies in hospitals a reality. First, trusts, clinical centres and hospital staff will need to investigate how best to make therapy production happen in medical wards. They will also need to identify any issues – such as staff training and data management – which may stop this from happening.</p>
<p>Companies already developing these advanced treatments can also supply hospitals with manufacturing equipment and production system know-how, making it easier to start developing personalised therapies in hospitals with as little disruption to day-to-day operations as possible. Regulators may need to provide guidance for different therapies to ensure quality control and patient safety.</p>
<p>Now, let us return to our patient’s story. After receiving the therapy produced in the hospital, the patient goes on to live a healthy life and have a child that is diagnosed with the same genetic condition. But now, the way to receive treatment is much clearer. </p>
<p>The child will be treated in a specialised hospital where certified equipment and trained staff are available for producing and delivering an enhanced version of the personalised therapy. With more experience and better infrastructure in place, the child will receive a treatment that yields faster outcomes with fewer side effects. </p>
<p>But this will only be possible if everyone – including hospital staff, manufacturers, scientists and policymakers – work together to ensure point-of-care manufacture is successfully rolled out.</p><img src="https://counter.theconversation.com/content/183473/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Irina Brass receives funding from the UK's Engineering and Physical Sciences Research Council (EPSRC). </span></em></p><p class="fine-print"><em><span>Edison Bicudo and Penny Carmichael do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>‘Point-of-care manufacture’ of advanced therapies is already being used in hospitals in the UK, Spain, Switzerland and the US.Irina Brass, Associate Professor in Regulation, Innovation and Public Policy, UCLEdison Bicudo, Research Fellow Biopharmaceutical Regulation, UCLPenny Carmichael, Policy Adviser, Faculty of Engineering Science, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1866082022-07-11T12:29:46Z2022-07-11T12:29:46Z1 in 8 U.S. deaths from 2020 to 2021 came from COVID-19 – leaving millions of relatives reeling from distinctly difficult grief<figure><img src="https://images.theconversation.com/files/473229/original/file-20220708-21-ud78px.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5950%2C4060&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When a person loses a loved one to COVID-19, the mental health effects can be severe.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/midsection-of-woman-holding-hands-royalty-free-image/1324340507">Ol'ga Efimova / EyeEm via Getty Images</a></span></figcaption></figure><figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/473098/original/file-20220707-9634-elgdz5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/473098/original/file-20220707-9634-elgdz5.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=255&fit=crop&dpr=1 600w, https://images.theconversation.com/files/473098/original/file-20220707-9634-elgdz5.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=255&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/473098/original/file-20220707-9634-elgdz5.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=255&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/473098/original/file-20220707-9634-elgdz5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=321&fit=crop&dpr=1 754w, https://images.theconversation.com/files/473098/original/file-20220707-9634-elgdz5.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=321&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/473098/original/file-20220707-9634-elgdz5.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=321&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p>COVID-19 was the third-most-common cause of death between March 2020 and October 2021 in the U.S., behind only heart disease and cancer, according to a <a href="https://doi.org/10.1001/jamainternmed.2022.2476">recent study</a>.</p>
<p>Older adults face the greatest risk of <a href="https://doi.org/10.1001/jamanetworkopen.2022.12686">dying from COVID-19</a>, but infection with the coronavirus remains a serious risk for younger people, too. In 2021, COVID-19 was the <a href="https://doi.org/10.1001/jamainternmed.2022.2476">leading cause of death</a> in adults aged 45 to 54, the second leading cause for adults aged 35 to 44 and the fourth leading cause for those aged 15 to 34.</p>
<p>As sociologists who study population health, we have been assessing how losing a loved one to COVID-19 has affected people’s well-being. Our research shows that more than <a href="https://doi.org/10.1073/pnas.2007476117">9 million people have lost a close relative</a> to COVID-19 in the U.S. This dramatic rise in bereavement is troubling because our research finds that COVID-19 bereavement not only <a href="https://doi.org/10.1093/geronb/gbab132">increases people’s risk of depression</a>, but can make them uniquely vulnerable to mental distress. </p>
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<h2>The distinctness of grieving COVID-19 deaths</h2>
<p>Researchers have a sense of what constitutes <a href="https://doi.org/10.1016/j.jpainsymman.2019.07.033">“good” and “bad” deaths</a>. Bad deaths are those that involve pain or discomfort and happen in isolation. Their unexpectedness also makes these deaths more distressing. People whose loved ones die “bad deaths” tend to report <a href="https://doi.org/10.2307/1519809">greater mental distress</a> than those whose loved ones died in more favorable circumstances. </p>
<p>COVID-19 deaths often <a href="https://doi.org/10.1080/08959420.2020.1764320">bear many hallmarks</a> of “bad” deaths. They are preceded by physical pain and distress, often occur in isolated hospital settings and happen suddenly – leaving family members unprepared. The ongoing nature of the pandemic has inflicted an added layer of agony, as individuals are grieving during a time of protracted social isolation, economic precarity and general uncertainty.</p>
<p>In another <a href="https://doi.org/10.1093/geronb/gbac085">recent study</a>, our team used national survey data from 27 countries to test whether the mental health impacts of COVID-19 deaths are more severe than death from other causes. We focused on the case of spousal death and compared two groups of people: those whose spouses died of COVID-19 in the pandemic’s first wave and those whose spouses died of other causes just before the pandemic began. We found that COVID-19 widows and widowers <a href="https://doi.org/10.1093/geronb/gbac085">face higher rates of depression and loneliness</a> than expected based on widow and widower mental health outcomes pre-pandemic.</p>
<h2>The secondary population health consequences of COVID-19 deaths</h2>
<p>The outsized effects of COVID-19 deaths on grieving spouses’ mental health is troubling because we estimate that nearly 500,000 people have already <a href="https://doi.org/10.1073/pnas.2007476117">lost a spouse</a> to COVID-19 in the U.S. alone.
The mental health problems that people face after losing a loved one can also lead to <a href="https://doi.org/10.1093/geronb/gbaa044">declines in physical health and even increase a person’s risk of death</a>.</p>
<p>Our research suggests that COVID-19 not only increased rates of family bereavement, but that people who lost loved ones to the coronavirus were particularly distressed afterward. But we studied only widowhood; future research needs to identify the potentially unique health, social and economic consequences of COVID-19 losses for other bereaved relatives. </p>
<p>With COVID-19 representing 1 in every 8 deaths between March 2020 and October 2021, there are millions of people who could benefit greatly from financial, social and mental health support. It is also critical to continue taking steps to prevent future COVID-19 deaths. Each death averted not only saves a life but also saves numerous loved ones from the harm that follows these tragedies.</p><img src="https://counter.theconversation.com/content/186608/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Smith-Greenaway receives funding from the National Science Foundation and the National Institute of Child Health and Human Development. </span></em></p><p class="fine-print"><em><span>Ashton Verdery receives funding from The National Institute on Aging (1R01AG060949).</span></em></p><p class="fine-print"><em><span>Shawn Bauldry receives funding from the National Institute on Aging. </span></em></p><p class="fine-print"><em><span>Haowei Wang does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>COVID-19 deaths tend to be more unexpected and traumatic than other types of deaths. A sociologist explains the mental health burdens facing the millions who’ve lost a relative to the coronavirus.Emily Smith-Greenaway, Associate Professor of Sociology, USC Dornsife College of Letters, Arts and SciencesAshton Verdery, Professor of Sociology, Demography and Social Data Analytics, Penn StateHaowei Wang, Postdoctoral Research Associate in Sociology, Penn StateShawn Bauldry, Associate Professor of Sociology, Purdue UniversityLicensed as Creative Commons – attribution, no derivatives.