Tag: development

  • Massive proportion of world’s population are living with herpes infection

    Massive proportion of world’s population are living with herpes infection

    Virus causing genital herpes may put millions of people at greater risk of infection with HIV

    About half a billion people worldwide are living with genital herpes, and several billion have an oral herpes infection, new estimates show.

    Authored by staff at the University of Bristol, World Health Organization (WHO), and Weill Cornell Medical College-Qatar, and published in the Bulletin of the World Health Organization,
    the new study estimates the global infection prevalence and incidence of herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) in 2016. 

    “Herpes infection affects millions of people across the globe and can have far-reaching health effects. We need more investment and commitment to develop better treatment and prevention tools for this infection.” says Dr Sami Gottlieb, Medical
    Officer at WHO and an author of the study.

    Prevalence and incidence

    An estimated 491.5 million people were living with HSV-2 infection in 2016, equivalent to 13.2% of the world’s population aged 15 to 49 years. HSV-2 is almost exclusively sexually transmitted, causing infection in the genital or anal area (genital
    herpes).

    An estimated 3.7 billion people had HSV-1 infection during the same year – around 66.6% of the world’s population aged 0 to 49. HSV-1 is mainly transmitted by oral to oral contact to cause infection in or around the mouth (oral herpes). However,
    HSV-1 can also be transmitted to the genital area through oral-genital contact – during oral sex – to cause genital herpes. Most HSV-1 infections were oral; however, between 122 million to 192 million people were estimated to have genital
    HSV-1 infection, depending on the assumptions used in the estimation model.

    Because herpes is a lifelong infection, estimated prevalence increased with age; HSV-2 prevalence was also higher among women and in the WHO African Region.

    Health and social impacts

    Most people living with herpes, caused by either HSV-1 or 2, are unaware they have the infection.

    When symptoms do occur however, oral herpes infection can lead to painful sores around the mouth (“cold sores”). Genital herpes infection can cause recurring, often painful, genital sores, often referred to as genital ulcer disease. 

    WHO and partners published a study in March 2020 estimating that around 5% of the world’s population (187 million people) suffered from at least one episode of herpes-related genital ulcer disease in 2016 (1). Most of these episodes were due to
    HSV-2, which can recur frequently over many years.

    Recurrent symptoms of genital herpes can lead to stigma and psychological distress, and can have an important impact on quality of life and sexual relationships. However, in time, most people with herpes adjust to living with the infection.

    “Genital herpes is a substantial health concern worldwide – beyond the potential pain and discomfort suffered by people living with the infection, the associated social consequences can have a profound effect on sexual and reproductive health”
    says Dr Ian Askew, Director of the Department of Sexual and Reproductive Health and Research at WHO. 

    Herpes and HIV

    A strong association exists between HSV-2 infection and HIV infection. In 2019, WHO commissioned a modeling study to estimate how much HSV-2 infection might contribute to HIV incidence. The study estimated that almost 30% of new sexually acquired HIV
    infections in 2016 worldwide were likely attributable to HSV-2 infection (2). 

    Evidence shows that people with HSV-2 infection are at least three times more likely to become infected with HIV, if exposed. HSV-2 leads to inflammation and small breaks in the genital and anal skin that can make it easier for HIV to cause infection.
    In addition, people with both HIV and HSV-2 infection are more likely to spread HIV to others.

    Women have higher biologic susceptibility to both HSV-2 and HIV. Women living in the WHO Africa Region have the highest HSV-2 prevalence and exposure to HIV – putting them at greatest risk of HIV infection, with negative implications for their health
    and well-being. 

    For people living with HIV (or who are living with other conditions that compromise their immune systems) as well as HSV-2, the symptoms of herpes can be more severe and more frequent. 

    Neonatal herpes

    Neonatal herpes can occur when an infant is exposed to HSV in the genital tract during delivery. This is a rare condition, occurring in an estimated 10 out of every 100,000 births globally, but can lead to lasting neurologic disability or death. The risk
    for neonatal herpes is greatest when a mother acquires HSV infection for the first time in late pregnancy. Women who have genital herpes before they become pregnant are at very low risk of transmitting HSV to their infants.

    No cure – better treatment and prevention needed

    There is no cure for herpes. At present, antiviral medications, such as acyclovir, famciclovir, and valacyclovir, can help to reduce the severity and frequency of symptoms but cannot cure the infection.

    As well as increasing awareness about HSV infection and its symptoms, improved access to antiviral medications and heightened HIV prevention efforts for those with genital HSV symptoms are needed globally. 

    In addition, development of better treatment and prevention interventions is needed, particularly HSV vaccines. WHO and partners are working to accelerate research to develop new strategies for prevention and control of HSV infections. Such research includes
    the development of HSV vaccines and topical microbicides. Several candidate vaccines and microbicides are currently being studied.

    “A vaccine against HSV infection would not only help to promote and protect the health and well-being of millions of people, particularly women, worldwide – it could also potentially have an impact on slowing the spread of HIV, if developed
    and provided alongside other HIV prevention strategies” says Dr Meg Doherty, Director of the WHO Department of Global HIV, Hepatitis, and STI Programmes.

    Related publications

    WHO guidelines for the treatment of Genital Herpes Simplex Virus

    WHO preferred product characteristics for herpes simplex virus vaccines

     

    ———————-

    (1) Looker KJ, Johnston C, Welton NJ, et al. The global and regional burden of genital ulcer disease due to herpes simplex virus: a natural history modelling study. BMJ Glob Health. 2020;5(3):e001875. doi: 10.1136/bmjgh-2019- 001875.

    (2) Looker KJ, Welton NJ, Sabin KM, et al.Global and regional estimates of the contribution of herpes simplex virus type 2 infection to HIV incidence: a population attributable fraction analysis using published epidemiological data. Lancet Infect Dis.2020;20(2):240-249. doi: 10.1016/S1473-3099(19)30470-0.

    Massive proportion of world’s population are living with herpes infection
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  • New FAQs address healthcare workers questions on breastfeeding and COVID-19

    New FAQs address healthcare workers questions on breastfeeding and COVID-19

    Mothers and healthcare workers who support them have many questions and concerns about whether it is safe for mothers with confirmed or suspected COVID-19 to be close to and breastfeed their babies during the pandemic.

    To address their questions, WHO has released a list of Frequently asked questions: Breastfeeding and COVID-19. The FAQ complements the WHO interim guidance: Clinical management of severe acute respiratory infection when COVID-19 is suspected and draws upon other WHO recommendations on infant and young child feeding.

    The FAQs aim to provide information to healthcare workers supporting mothers and families in maternity services and community settings, and communicate how the interim guidance should be implemented. Additionally, the FAQs provide information about the protective effects of breastfeeding and skin-to-skin contact, and the harmful effects of inappropriate use of infant formula milk.

    Accompanying the FAQs is a decision tree which provides step-by-step guidance to health workers on how to support mothers with confirmed or suspected COVID-19 to breastfeed. It provides advice on what to do if mothers are not well enough to breastfeed, as well as appropriate hygiene measures for mothers, including wearing a medical mask if available, to reduce the possibility of the COVID-19 virus being spread to her infant.

    Benefits of breastfeeding outweigh potential risks

    The COVID-19 virus has not been detected in the breastmilk of any mother with confirmed and suspected COVID-19 and there is no evidence so far that the virus is transmitted through breastfeeding. Researchers continue to test breastmilk from mothers with the infection.

    WHO recommends that all mothers with confirmed or suspected COVID-19 continue to have skin-to-skin contact and to breastfeed. In all socio-economic settings, breastfeeding improves survival and provides lifelong health and development advantages to newborns and infants. Breastfeeding also reduces the risk of breast and ovarian cancer for the mother. Skin-to-skin contact, including kangaroo mother care, reduces neonatal mortality, especially for low birth weight newborns.

    While infants and children can contract COVID-19, they are at low risk of infection. The few confirmed cases of COVID-19 in young children to date have experienced only mild or asymptomatic illness.

    WHO’s recommendations on the care and feeding of infants whose mothers have confirmed or suspected COVID-19 aim to improve the immediate and lifelong survival, health and development of their newborns and infants. These recommendations consider the likelihood and potential risks of COVID-19 in infants and also the risks of serious illness and death when infants are not breastfed or when infant formula milk are used inappropriately.

    WHO’s Q&A on breastfeeding and COVID-19 also provides additional infection prevention advice to mothers with confirmed or suspected COVID-19.

    New FAQs address healthcare workers questions on breastfeeding and COVID-19
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  • Global leaders unite to ensure everyone everywhere can access new vaccines, tests and treatments for COVID-19

    Global leaders unite to ensure everyone everywhere can access new vaccines, tests and treatments for COVID-19

    Heads of state and global health leaders today made an unprecedented commitment to work together to accelerate the development and production of new vaccines, tests and treatments for COVID-19 and assure equitable access worldwide.

    The COVID-19 pandemic has already affected more than 2.4 million people, killing over 160,000. It is taking a huge toll on families, societies, health systems and economies around the world, and for as long as this virus threatens any country, the entire world is at risk. 

    There is an urgent need, therefore, while following existing measures to keep people physically distanced and to test and track all contacts of people who test positive, for innovative COVID-19 vaccines, diagnostics and treatments.

    “We will only halt COVID-19 through solidarity,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Countries, health partners, manufacturers, and the private sector must act together and ensure that the fruits of science and research can benefit everybody.”

    Work has already started. Since January, WHO has been working with researchers from hundreds of institutions to develop and test vaccines, standardize assays and standardize regulatory approaches on innovative trial designs and define criteria to prioritize vaccine candidates.  The Organization has prequalified diagnostics that are being used all over the world, and more are in the pipeline. And it is coordinating a global trial to assess the safety and efficacy of four therapeutics against COVID-19.

    The challenge is to speed up and harmonize processes to ensure that once products are deemed safe and effective, they can be brought to the billions of people in the world who need them. Past experience, in the early days of HIV treatment, for example, and in the deployment of vaccines against the H1N1 outbreak in 2009, shows that even when tools are available, they have not been equally available to all.

    So today leaders came together at a virtual event, co-hosted by the World Health Organization, the President of France, the President of the European Commission, and the Bill & Melinda Gates Foundation. The event was joined by the UN Secretary General, the AU Commission Chairperson, the G20 President, heads of state of France, South Africa, Germany, Vietnam, Costa Rica, Italy, Rwanda, Norway, Spain, Malaysia and the UK (represented by the First Secretary of State).

    Health leaders from the Coalition for Epidemic Preparedness Innovations (CEPI), GAVI-the Vaccine Alliance, the Global Fund, UNITAID, the Wellcome Trust, the International Red Cross and Red Crescent Movement (IFRC), the International Federation of Pharmaceutical Manufacturers (IFPMA), the Developing Countries Vaccine Manufacturers’ Network (DCVMN), and the International Generic and Biosimilar Medicines Association (IGBA) committed to come together, guided by a common vision of a planet protected from human suffering and the devastating social and economic consequences of COVID-19, to launch this groundbreaking collaboration. They are joined by two Special Envoys:  Ngozi Okonjo-Iweala, Gavi Board Chair and Sir Andrew Witty, former CEO of GlaxoSmithKline.

    They pledged to work towards equitable global access based on an unprecedented level of partnership. They agreed to create a strong unified voice, to build on past experience and to be accountable to the world, to communities and to one another.

    “Our shared commitment is to ensure all people have access to all the tools to prevent, detect, treat and defeat COVID-19,” said Dr Tedros. “No country and no organization can do this alone. The Access to COVID-19 Tools Accelerator brings together the combined power of several organizations to work with speed and scale.”

    Health leaders called on the global community and political leaders to support this landmark collaboration and for donors to provide the necessary resources to accelerate achievement of its objectives, capitalizing on the opportunity provided by a forthcoming pledging initiative that starts on 4 May 2020. This initiative, spearheaded by the European Union, aims to mobilize the significant resources needed to accelerate the work towards protecting the world from COVID-19.

     

    Global leaders unite to ensure everyone everywhere can access new vaccines, tests and treatments for COVID-19
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  • Commitment and call to action: Global collaboration to accelerate new COVID-19 health technologies

    Commitment and call to action: Global collaboration to accelerate new COVID-19 health technologies

    Our Vision and Mission

    Grounded in a vision of a planet protected from human suffering
    and the devastating social and economic consequences of
    COVID-19, we, an initial group of global health actors (BMGF,
    CEPI, Gavi, Global Fund, UNITAID, Wellcome Trust, WHO) and
    private sector partners and other stakeholders, are launching
    a landmark, global and time-limited collaboration to accelerate the
    development, production and equitable global access to new COVID-19 essential health technologies.

    We know that as long as anyone is at risk from this virus, the entire
    world is at risk – every single person on the planet needs to be
    protected from this disease.

    We agree that alongside evidence-based public health measures,
    innovative COVID-19 diagnostics, therapeutics and vaccines are
    needed – in record time and at record scale and access – to save
    millions of lives and countless trillions of dollars, and to return
    the world to a sense of ‘normalcy’.

    We recognize the significant amount of critical work, investment
    and initiatives already ongoing around the world to expedite
    the development and deployment of innovative COVID-19 related
    products and interventions.

    We appreciate that while development and deployment of
    innovative products is essential, it will not be enough. We must
    simultaneously and urgently accelerate the strengthening of
    sustainable health systems and capacities to enable delivery of
    the new COVID-19 tools to those who need them and to mitigate
    the knock-on impact on other diseases.

    We remember lessons from the past, which have shown that even
    when effective tools are available to the world, too often some
    are protected, while others are not. This inequity is unacceptable –
    all tools to address COVID-19 must be available to all. In the fight
    against COVID-19, no one should be left behind.

    We understand we cannot do this alone, and that we need to
    work together in unprecedented and inclusive partnership with all
    stakeholders – political leaders, public and private sector partners,
    civil society, academia, and all other stakeholders across society
    – jointly leveraging our comparative strengths and respective
    voices to drive towards collective solutions, an accelerated path,
    and access for all. We are stronger, faster and more effective
    working together.

    Our Mission is not only accelerated development and availability
    of new COVID-19 tools – it is to accelerate equitable global access
    to safe, quality, effective, and affordable COVID-19 diagnostics,
    therapeutics and vaccines, and thus to ensure that in the fight
    against COVID-19, no one is left behind.

    Our Commitment

    1. We commit to the shared aim of equitable global
      access to innovative tools for COVID-19 for all.
    2. We commit to an unprecedented level of partnership
      – proactively engaging stakeholders, aligning and
      coordinating efforts, building on existing collaborations, collectively devising solutions, and grounding
      our partnership in transparency, and science.
    3. We commit to create a strong unified voice to
      maximize impact, recognizing this is not about
      singular decision-making authority, but rather
      collective problem-solving, interconnectedness and
      inclusivity, where all stakeholders can connect and
      benefit from the expertise, knowledge and activities
      of this shared action-oriented platform.
    4. We commit to build on past experiences towards
      achieving this objective, including ensuring that
      every activity we undertake is executed through the
      lens of equitable global access, and that the voices
      of the communities most affected are heard.
    5. We commit to be accountable to the world, to
      communities, and to one another. We are coming
      together in the spirit of solidarity, and in the service
      of humanity, to achieve our mission and vision.

    Our Call

    We ask the global community and political leaders to
    support this landmark collaboration, and for donors to
    provide the necessary resources to accelerate achievement
    of the objectives of this global collaboration, capitalizing
    on the opportunity provided by the rolling pledging
    campaign that will start on 4 May 2020.

    Commitment and call to action: Global collaboration to accelerate new COVID-19 health technologies
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  • INFOSAN Quarterly Summary, 2020 #1

    Food safety incidents

    During the first quarter of 2020, the INFOSAN Secretariat was involved in 38 food safety incidents involving 109 WHO Member States and 9 territories of WHO Member States. There were 25 incidents involving a biological hazard (Salmonella spp. [8], Listeria monocytogenes [5], Norovirus [3] Shiga-toxin producing Escherichia coli [2], Clostridium botulinum [2] Bacillus cereus [2], Cronobacter spp. [1], Shigella sonnei [1], unspecified biological hazard [1]), 6 involving an undeclared allergen (milk [3], peanut (1), egg [1], gluten [1]), 5 involving a physical hazard (undetermined foreign matter [2], glass [1], metal [1], plastic [1]), one involving a chemical/toxin hazard (histamine), and one linked to an unspecified hazard.

    The food categories that were most commonly involved in the 38 incidents during the first quarter of 2020 involved fish and other seafood (8), herbs and spices (4), legumes and pulses (4), milk and dairy products (3), nuts and oilseeds (3), snacks, desserts and other foods (3), cereals and cereal-based products (2), composite food (2), fruit and fruit products (2), meat and meat products (2), vegetables and vegetable products (2), products of special nutritional use (1), and food for infants and small children (1). One incident involved an unknown food source.

    During such international food safety incidents, the INFOSAN Secretariat relies on the swift action of national INFOSAN Emergency Contact Points to respond to requests for information. Rapid sharing of information through INFOSAN enables members to implement appropriate risk management measures to prevent illness in their respective countries.

    Geographic scope

    The outlined incidents involved Member States from all WHO regions: Europe (39), followed by the Americas (24), Africa (24), the Western Pacific (18), the Eastern Mediterranean (8) and South-East Asia (6).

    Recall in several countries of frozen spring roll sheets from Singapore due to the presence of an undeclared allergen

    In February 2020, the INFOSAN Secretariat was notified by the European Rapid Alert System for Food and Feed (RASFF) and INFOSAN colleagues in Australia of a recall in Australia and several European countries of frozen spring roll sheets due to the detection of an undeclared allergen (milk), imported from Singapore. In collaboration with RASFF, the INFOSAN Secretariat was informed that the implicated frozen spring roll sheets were distributed internationally to 46 Member States from four WHO regions and 4 territories in Europe and the Western Pacific. Moreover, through engagement with the INFOSAN Emergency Contact Point (ECP) in Singapore, the INFOSAN Secretariat also received details of further distribution of implicated products to additional WHO Member States from all WHO regions, taking the total number of Member States involved to 65. It was also reported that the products involved had been redistributed by some countries to Europe, the Americas and Africa. Consequently, several countries recalled the implicated products to relabel them and investigated the issue to identify illnesses related to the consumption of the implicated frozen spring roll sheets. No illnesses were reported to the INFOSAN Secretariat.

    This incident has highlighted undeclared allergens as an important category of hazards that can result in a largescale international response to implement risk management measures and prevent illness. In addition, it exemplified efficient communication among INFOSAN members and the Secretariat.

    Outbreak of Listeriosis in the United States of America linked to enoki mushrooms imported from the Republic of Korea

    In March 2020, the INFOSAN Secretariat was made aware by the United States (US) Centers for Disease Control and Prevention (CDC) of an outbreak of Listeriosis in the US linked to the consumption of enoki mushrooms, imported from the Republic of Korea. In total, 36 cases including 4 deaths have been reported in the US. Following investigations in Canada, carried out in collaboration with the US, the INFOSAN Secretariat was informed of 6 cases of Listeriosis between 2017 and 2019 in Canada potentially related by whole genome sequencing (WGS) to the ongoing outbreak in the USA. In addition, food isolates (from enoki mushrooms from the Republic of Korea) genetically associated with the cluster of cases have been collected in 2019 by authorities in Canada. The WGS information pertaining to the cases and food isolates were shared on the INFOSAN Community Website to assist the identification of cases in other countries.

    The INFOSAN Secretariat engaged the INFOSAN Emergency Contact Point (ECP) in the Republic of Korea to seek details on any further international distribution of the implicated enoki mushrooms. Investigations are ongoing. 

    News & activities

    Food Sector and the COVID-19 outbreak

    On 31 December 2019, WHO was alerted to several cases of pneumonia of unknown origin in the city of Wuhan, Hubei Province, China. The virus, a previously unknown coronavirus has been named SARS-CoV-2 and is the cause of the COVID-19 disease.

    The WHO Epidemic Information Network (EPI-WIN) aims to share information tailored to specific sectors, including food and agriculture. The INFOSAN Secretariat has recently developed a guidance document for food businesses with regards to COVID-19 and food safety which is now available online. The guidance has also been disseminated through EPI-WIN and presented during two webinars.

    Call for applicants: INFOSAN Train-the-Trainer Workshop

    In February, the INFOSAN Secretariat issued a call for applications for the INFOSAN Train-the-Trainer workshop. With the constant growth of the network, and the increased need for training that this entails, the INFOSAN Secretariat, in collaboration with the Canadian Food Inspection Agency (CFIA), has announced this workshop which aims to increase the human resources available to train INFOSAN members on a range of INFOSAN-related topics, online or in-person. As a result, it is expected that the understanding of the roles and responsibilities of INFOSAN members will be improved, resulting in greater participation that will enhance speed and efficiency during the response to food safety emergencies at the global level. The INFOSAN Secretariat, together with CFIA, look forward to hosting this important workshop later this year.

    Developing the new INFOSAN Community Website

    The INFOSAN Community Website (ICW) continues to be an effective tool for the network to disseminate information during food safety emergencies. Over the past year, through the INFOSAN member survey, the Secretariat has gained a better understanding of how members use the ICW and how it can be improved to enhance information sharing. The information collected, together with the experience of members of the Secretariat, has provided numerous innovative ideas to guide the development of the new ICW. The Secretariat is pleased to announce that the competitive process to select the vendor that will develop the new INFOSAN Community Website has concluded and the work on the creation of the new ICW has begun. 

    Voice of an active network member

    voice-5-2020

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  • Hard fought gains in immunization coverage at risk without critical health services, warns WHO

    Hard fought gains in immunization coverage at risk without critical health services, warns WHO

    Shutting down immunization services in the COVID-19 pandemic risks triggering a resurgence of diseases that can be prevented with safe and effective vaccines, warns WHO in the lead-up to World Immunization Week (24-30 April). 

    When immunization services are disrupted, even for brief periods during emergencies, the risk of vaccine-preventable disease outbreaks, such as measles and polio, increase. Last year’s deadly measles outbreak in the Democratic Republic of the
    Congo, which took more than 6000 lives in a country already facing its largest Ebola outbreak, highlights the importance of maintaining essential health services, such as immunization in times of emergency. Further disease outbreaks will also overwhelm
    health systems already battling the impacts of COVID-19.

    “Disease outbreaks must not remain a threat when we have safe and effective vaccines to protect us,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “While the world strives to develop a new vaccine for COVID-19 at record speed,
    we must not risk losing the fight to protect everyone, everywhere against vaccine-preventable diseases. These diseases will come roaring back if we do not vaccinate.”

    WHO is working with partners all over the world to accelerate research and development of a safe and effective vaccine and ensure equitable access for the billions of people who will need it.

    But even with an expedited process, development of a vaccine for COVID-19 will take time. Precautionary measures are essential now to help keep us safe from disease, including diseases for which vaccines already protect children and adults.

    Too many people are still excluded from the benefits of vaccines

    Prior to the COVID-19 pandemic, the world had made immense progress in ensuring that children are vaccinated. In 2018, 86 percent of children under the age of five globally were vaccinated with three doses of diphtheria, tetanus and pertussis (DTP3) and
    one dose of the measles vaccine, up from 72 percent in 2000 and 20 percent in 1980. The number of children paralyzed by polio has been reduced by 99.9 percent worldwide. 

    Yet, global vaccination coverage is still far from the 95 per cent coverage needed to fully protect communities against outbreaks of this vaccine-preventable disease. 

    In 2018 nearly 20 million children worldwide – more than 1 in 10 – missed out on lifesaving vaccines, such as measles, diphtheria and tetanus. Roughly, 13 million of the children have never received any vaccines, putting them and their communities
    at risk of disease and death. The majority of these children live in countries with already fragile health systems, further limiting their access to essential health services when they fall sick.

    Measles continues to remain an ever-present threat, especially if vaccination rates drops. Current projections indicate that the number of reported measles cases for 2019 will be at least 800 000. In 2020 there are increasing concerns about another
    resurgence, especially if vaccination rates fall due to delay or suspension of scheduled immunization activities as a result of COVID-19. 

    Outbreaks of polio, diphtheria and yellow fever are also of high concern, especially in the countries least able to respond quickly and decisively to address an emerging outbreak, as seen in previous emergencies such as the polio outbreak in Syria in
    2013. 

    Maintaining immunization services during COVID-19

    As the response to COVID-19 continues, countries must act now protect immunization services, in order to further minimize disease outbreaks and loss of life. This includes, facilitating urgent catch up programmes in places where
    services have been disrupted, ensuring strong supply chains, disease surveillance and trained health workers. Caregivers should also make sure they continue to vaccinate their children in line with national policies.

    New WHO guidelines on immunization and COVID-19 recommend that governments temporarily pause preventive immunization
    campaigns where there is no active outbreak of a vaccine-preventable disease. But it urges countries prioritize the continuation of routine immunization of children in essential service delivery, as well as adult vaccinations such as influenza
    for groups most at risk. If immunization services must be suspended, urgent catch-up vaccinations should be rescheduled as soon as possible, prioritizing those most at risk.

    Hard fought gains in immunization coverage at risk without critical health services, warns WHO
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  • What matters to women in the postnatal period?

    What matters to women in the postnatal period?

    The right to a positive maternity healthcare experience at every stage 

    Each pregnancy is unique and clinical needs can change across the pregnancy, childbirth and postnatal periods. One thing that never changes is the right to a positive experience at every stage. 

    Achieving the best possible physical, emotional, and psychological outcomes for every individual and newborn requires health systems to take a human rights-based approach: not only preventing maternal death and morbidity, but prioritising person-centred
    care and well-being.

    WHO is developing new guidelines for a positive experience of postnatal care, due to be published next year. To inform these guidelines and ensure that postnatal services can better meet the needs of women and their babies, WHO undertook a qualitative
    systematic review on what matters to women in the postnatal period.

    Joys and challenges in the postnatal period

    There is limited research about values and preferences in the postnatal period, defined by WHO as the first six weeks after childbirth. Studies have often focused on the results of specific postnatal interventions, rather than on the individuals who use
    them. 

    ‘What matters to women in the postnatal period: A meta-synthesis of qualitative studies,’ published in PLOS ONE, gives long-overdue respect to the authority of women’s own experiences. The authors review first-hand data from 15 countries
    and 36 studies published after the year 2000 relating to women’s beliefs, expectations and values at this significant time of life.  

    These studies affirm that a positive postnatal experience can result in joy, self-confidence and enhanced capacity to thrive as both a person and a parent.

    They are also vocal about the potential challenges of adjusting to a ‘new normal’ following childbirth, including changes in self-identity, relationships, and sexual behaviour.

    What is a positive postnatal experience? 

    A positive postnatal experience for a woman will be one that responds to her specific context and preferences. 

    It will provide the confidence, knowledge and skills women need in the weeks following childbirth, supporting them to adjust to any changes in their intimate relationships and build new family ones. Women will be better equipped to navigate physical and
    emotional challenges and to experience the dynamic achievement of personal growth. 

    This should be a shared responsibility, not a solitary one. Community has a critical role in enabling a positive postnatal experience, including partners, family and elders.

    It is crucial that healthcare providers meet each woman’s needs, as well as those of their babies. 

    Supporting choices and rights to improve postnatal health outcomes

    There are an estimated 303 000 maternal deaths annually, according to recent WHO figures. Most of these deaths occur postnatally. 

    The postnatal period is therefore a vital opportunity to improve both maternal and neonatal health and wellbeing: supporting healthy behaviors, providing life-skills education, facilitating breastfeeding, counselling women about family planning options,
    supporting good mental health, preventing and treating childbirth-related complications. 

    Health care systems that empower individuals by supporting their values, preferences and rights are fundamental to improving maternal and newborn health outcomes. 

    WHO’s guidance for positive maternity care

    WHO has recently released recommendations on antenatal care for a positive pregnancy experience, and on intrapartum care for a positive childbirth experience.

    These publications made important clinical updates, including an increase from four to eight recommended antenatal contacts, and a revision to the decision-making process for interventions to accelerate labour. 

    They also uphold every woman’s right to a positive maternity care experience: one where her pregnancy does not erase her competency, autonomy and right to participate in decision-making for her own care and the care of her newborn. 

    Women’s choices and rights to sexual and reproductive health care, including maternity care, should be respected at every stage of the continuum of maternal and newborn care. This is true across all income settings, as well as in humanitarian settings
    and during public health emergencies.

    When WHO’s postnatal guidelines are released next year, they will complete the maternity care series built around what matters to women.

    Rather than dividing care into three periods of antenatal, intrapartum and postnatal, these publications can be used to establish a model in which health systems support women, their baby and wider network physically, psychologically, socially and emotionally
    through this significant life event. 

    Other resources

     

    What matters to women in the postnatal period?
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  • PRE-NATAL INFLUENCES

    PRE-NATAL INFLUENCES

    The term “Pre-Natal” of course means “before birth,” and Pre-Natal Influences are those influences exerted upon the child before its birth into the world. The students of Eugenics are vitally interested in the subject of Pre-Natal Influences, as they recognize that therein is to be found the secret of much which will work along the line of “better offspring,” and general race-betterment.

    Pre-Natal Influences (as the term is used in the present consideration of the subject) may be considered as manifesting in three phases, as follows:

    (1) The influence of the physical, mental, and moral “family characteristics” of the parents, transmitted to the child along the lines of heredity.

    (2) The influence of the acquired personal characteristics of the parents (particularly the acquired characteristics which are especially active at and just previous to the time of actual conception), transmitted to the child along the lines of heredity.

    (3) The influence of “maternal impressions” (after conception, and during the period of gestation or pregnancy) transmitted to the child physiologically and psychologically.

    I shall now ask you to proceed with me to a consideration of the various phases of Pre-Natal Influences coming under the above name three general classes, and the principal factors involved therein.

    Heredity in General.

    By “heredity” is meant “the tendency which there is in each animal or plant, in all essential characters, to resemble its parents”; or “the hereditary transmission of physical or psychical characteristics of parents to their offspring.”

    There is a great disagreement among the authorities as to how far the principle of heredity really extends, and the real causes of heredity are in dispute. In the present consideration we shall, of course, pass over the technical phases of the subject, and shall touch only upon the general features and principles involved.

    Shute, in his work entitled “Organic Evolution,” says: “That an offspring always inherits from its parents many of their characteristics is well known; that it always varies, more or less, from them, is also equally well known. Heredity and variation are twin forces that play upon every creature, holding it rigidly true to the parental type or compelling more or less divergence therefrom, according to the strength of the one or other power; so that every creature is the resultant of the activities of these two great parallel forces. Variation is co-extensive with heredity, and every living creature gives evidence of the existence of variations.

    “Mental heredity can be illustrated by studying the genealogies of such persons as Aristotle, Goethe, Darwin, Coleridge, Milton, etc. Probably the Bach family, of Germany, supply one of the best illustrations of the inheritance of intellectual character that we know of. The record of this family begins in 1550, lasting through eight generations to 1800. For about two centuries it gave to the world musicians and singers of high rank. The founder was Weit Bach, a baker of Presburg, who sought recreation from his routine work in song and music. For nearly two hundred years his descendants, who were very numerous in Franconia, Thuringia, and Saxony, retained a musical talent, being all church singers and organists. When the members of the family had become very numerous and widely separated from one another, they decided to meet at a stated place once a year. Often more than a hundred persons—men, women, and children—bearing the name of Bach were thus brought together. This family reunion continued until nearly the middle of the eighteenth century. In this family of musicians, twenty-nine became eminent.

    “Inheritance of moral character is well known. Heredity, in its relation to crime and pauperism, has been thoroughly investigated by Mr. Dugdale in his most instructive little work entitled “The Jukes.” In this work the descendants of one vicious and neglected girl are traced through a large number of generations. It reveals that a large proportion of the descendants of this woman became licentious, for, in the course of six generations, fifty-two percent of the children were illegitimate. It shows also that there were seven times more paupers among the women than among the average women of the state, and nine times more paupers among the male descendants than among the average men of the state. The inheritance of physical peculiarities is so obvious as to need no illustration. Among the ancients the Romans stereotyped its truth by the use of such expressions as ‘the labiones’ or thick-lipped; ‘the nasones,’ or big-nosed; ‘the capitones,’ or big-headed, and ‘the buccones,’ or swollen-cheeked, etc. In more recent times we read of the Austrian lip and the Bourbon nose.”

    But in all considerations of the subject of heredity, one must always remember that the inheritance of physical, mental, and moral characteristics is not alone from the immediate parents, but rather from many ancestors further removed in order and time. Back of each person there is a long line of paternal and maternal ancestors, extending back to the beginning of the race. And in that line there are influences for good and evil, awaiting favorable environment for awakening into new life unless restrained by the will of the individual.

    As Shute says: “There will come a time when the fertilized ovum will have a highly complex nucleus composed of many different ancestral groups of hereditary units. One often hears the expression that a child is a chip of the old block; but this is only a very partial truth, for the child is pre-eminently a composite chip of many old blocks.” And Luther Burbank has well said: “Heredity means much; but what is heredity? Not some hideous ancestral spectre, forever crossing the path of a human being. Heredity is simply the sum of all the environments of all past generations on the responsive ever-moving life-forces.”

    Transmission of Acquired Characteristics.

    One of the great disputes of biology is that concerning the question of whether or not parents may transmit to their offspring their personal “acquired characteristics” as well as those inherited from their line of ancestors. One side of the controversy points to the observed cases of children and grandchildren resembling each other, physically, mentally, and morally, in acquired characteristics; but the other side explains these facts as due to environment rather than to heredity.

    The best authorities seem to favor a middle-view, holding that acquired characteristics may be and are transmitted as “tendencies” in the offspring. Thus as each succeeding generation manifests the acquired tendency, it adds a cumulative force to the family heredity. At the same time they hold that “environment” is needed to “draw out” the inherited “tendency.” For instance, a child born with evil tendencies, and placed in an evil environment, will most likely manifest evil conduct. The same child, if placed in a good environment, will not have the evil tendencies “drawn out” by the environment, and will probably not manifest evil conduct. The same rule applies to the child drawn with good “tendencies.” In short, it is held that heredity and environment tend to balance each other—the “something within” is called out (or not called out) by the “something without.” The life of the individual is held to be a continuous action and reaction between heredity and environment, and both of these elements must be taken into consideration when we think of the subject.

    Shute says: “As influencing a man’s life and character, which is the strongest factor, heredity or environment?” In our opinion, as the result of long study and reading, where we have an average man of a sound mind in a sound body, there environment will be the strongest factor whether for good or evil—that is, in men in general, who have no organic defect, such as insanity or idiocy, and allied affections, the stronger force is environment; but in those having such defect, heredity is the controlling power, and we may add, the destroying power.

    The Eugenic Rule Regarding Heredity.

    It is one of the cardinal principles of Eugenics that those with a bad family history should not become parents. By this it is not meant that the manifestation of undesirable tendencies, physical, mental, and moral, on the part of certain individuals of a family necessarily constitutes a “bad family history.” On the contrary, many of the best families have, from time to time, individuals who manifest undesirable tendencies, and who are in general out of harmony with the general family standard. It is an old axiom that “there is a black sheep in every flock”; and the flock must be measured by its general standard, and not by its exceptional black sheep.

    A “bad family history” is one in which the family has clearly manifested certain undesirable physical, mental, and moral traits in a marked degree, and in a sufficientnumber of instances to establish a standard. Some families have a “bad family history” for inebriety; others for epilepsy; others for licentiousness; others for dishonesty—the history extending over several generations, and including a marked number of individuals in each generation. Individuals of such a family should refrain from bearing children; and if children be born to such the greatest care should be exercised by the parents in the matter of surrounding the child with the environment least calculated to “draw out” the undesirable characteristic. The child has a right to be well born, and to be protected from being brought into the world subjected to the handicap of a “bad family history.” If individuals cannot endow their children with a good family history, they should refrain from bearing children—such is the Eugenic advice on the subject.

    The same rule applies to the question of “acquired characteristics” of the parents—especially those acquired characteristics which are especially active at or just before the time of the contemplated conception. Though the family history of both husband and wife be ever so good, it is held that if one or both of the parents have acquired undesirable and transmissible characteristics, physical, mental, or moral, then the question of bringing children into the world should be carefully considered, and conscientiously decided, after competent authorities have been consulted concerning the case. The prospective child should always be given the benefit of the doubt in such cases. To bring children into the world merely to gratify personal pleasure or pride, regardless of the welfare of the child, is something utterly unworthy of an intelligent and moral human being.

    Fitness for Parenthood.

    In determining the “fitness” for parenthood, on the part of husband and wife, the mental, physical, and moral qualities should all be taken into consideration. Weak or abnormal mentality; chronic immorality or perverted moral sense; or diseased or abnormal physical conditions—these should always be regarded as bars to parenthood. To violate this principle is to deliberately violate the fundamental laws of Nature, as well as those principles which are accepted as representing the best thought and customs of the race. A mental, moral, or physical “pervert” or “defective” is manifestly an “unfit,” considered as a prospective parent. Parenthood on the part of such individuals is not only a crime against society, but always a base injustice perpetrated upon the offspring.

    A very interesting phase of the general subject now before us for consideration is that which touches upon the effect of those particular acquired characteristics which are especially active at the time, or just before the time of conception. The best authorities hold that the influences manifest and active in the prospective father and mother during the period immediately preceding conception will have a marked effect upon the character of the child. The following quotations from authorities on the subject will serve to illustrate this idea.

    Riddell says: “The transient physical, mental and moral conditions of the parents, prior to the initial of life, at the time of inception, do affect offspring.” Dr. Cowan says: “Through the rightly directed wills of the mother and father, preceding and during ante-natal life, the child’s form of body, character of mind, and purity of soul are formed and established. That in its plastic shape, during ante-natal life, like clay in the hand of the potter, it can be molded into absolutely any form of body and soul the parents may knowingly desire.” Newton says: “Numerous facts indicate that offspring may be affected and their tendencies shaped by a great variety of influences, among which moods and influences more or less permanent may be included.”

    Riddell says: “The influence of environmental conditions and pre-natal training are ever evident. Colts from dams that have been under regular training are faster than those from the same mother foaled before she had been trained. The puppies of the trained shepherd dog learn much more rapidly than do those from the untrained animal. No sportsman would think of paying a high price for a puppy, the mother of which was stupid and untrained. The same law applies, only with greater effect, to the human family.” Greer says: “No married couple will desire, design and love a babe into existence without the first requisite—good physical health.” Grant Allen says: “To prepare ourselves for the duties of maternity and paternity by making ourselves as vigorous and healthful as we can be, is a duty we owe to children unborn.” Holbrook says: “It is essential, therefore, that if children are to be well-born, the parents should be careful that at the moment of procreation they are fitted for the performance of so serious an act.” Another authority says: “Generation should be preceded by regeneration.”

    Cowan says: “In the conception of a new life, the mass of mankind observes no law unless it be the law of chance. Out of the licentious or incontinent actions of a husband’s nature, conception after a time is discovered to take place. No preparation of body, mind, or soul is made by either parent. Not more than one child in perhaps ten thousand is brought into the world with the consent and loving desire of its parents. The other nine thousand, nine hundred, and ninety nine children are endowed with the accumulated sins of the parents. Is it any wonder that there is so much sin, sickness, drunkenness, suffering, licentiousness, murder, suicide, and prematuredeath, and so little of purity, chastity, success, goodness, happiness and long life in the world?”

    Preparation for Parenthood.

    The ancient Greeks attached great importance to the mental, moral and physical condition of the parents at the moment of conception, and for a period preceding the same. The Investigations of modern scientists have tended to corroborate the facts upon which the ancient theories were based. Modern science teaches that the life-cells of each parent are impressed with the condition of the respective parents, and retain this impression until they meet and finally coalesce and combine, the combined cell then receiving the result of the original impressions.

    The best authorities on the subject claim that a reasonable time of self-restraint and continence should be observed by the prospective parents before the conception of the child. This contention is borne out by the experience of the breeders of fine horses and cattle, who have discovered that the best offspring are produced when the animals have been restrained from sexual intercourse for a reasonable time; this precaution being particularly observed in the case of the male parent animal. Writers on the subject cite a number of instances to prove that this law maintains in human as well is in animal life. It is claimed that Sir Isaac Newton was conceived after a period of over a year of total sexual abstinence on the part of his parents. Many other celebrated men are said to have been conceived after an absence from home on the part of the father, or a temporary absence from home on the part of the mother. Many physicians are able to cite many similar cases observed in the course of their own experience.

    The prospective parents should endeavor to bring themselves up to a high degree of physical health and well-being. The blood of the mother should be enriched byproper nutrition, and the organs of the body should be brought to a state of normal functioning along the lines of digestion, assimilation, and elimination.

    The minds of both parents should be exercised by reading the right kind of books, and by paying attention to natural objects of interest. A little change of scene will tend to awaken the powers of observation and attention. Riddell says: “If the prospective parents will habitually exercise the reasoning faculties and inventive powers, usually the offspring will have a fair degree of inventive talent and originality, even where these qualities are originally deficient in the parents. When there is a considerable natural talent or where there are latent inventive powers, constant training on the part of the parents will usually give the offspring exceptional powers in this direction.”

    The prospective parents should also develop and exercise their moral faculties in the period preceding conception. This course will tend to reproduce the same quality in the child. The reverse of this, alas, is also true. A case is cited of a man who procreated a child while plotting a nefarious crime; and the child in after life manifested a tendency toward theft, roguery and rascality, even at a very early age. The lack of moral fibre so often noticed in the sons of rich men who have attained their success through questionable methods is perhaps as much attributable to these pre-conceptual influences as to the “spoiling” environment of the child after birth.

    In the period of physical, mental, and moral preparation for parenthood the leading thought of both parents should be: “Do we wish our child to be like this?” This thought, if carried as an ideal, will act both in the direction of self-restraint and self-development.

    The actual time of the conception of the new life should be carefully chosen, so that it may occur under the best circumstances and conditions. The suggestions embodied in the preceding paragraphs should have been carefully observed; and the time chosen should be one in which a peaceful and happy state of mind is possessed by both parents. The ovum of the woman is believed to have its greatest vitality about the time of the close of each menstrual period, and many good authorities hold that this is not only the natural period for sexual intercourse, but is also the exact period in which the life-forces in the ovum are strongest; and that, consequently, the child conceived at this period is likely to be stronger and more vigorous than the one conceived at a later time between the menstrual periods.

    Dr. Stall says: “Medical authorities attach great importance to the mental condition at the moment of conjunction and conception. It is quite universally believed that this is a moment of unparalleled importance to the welfare of the future being. It is an awful crime to beget life carelessly, and when in improper and unworthy mental states. Some people seem to think that the matter of begetting a child, like the matter of selecting a wife, should be left wholly to blind chance. Neither of these two important events can be too much safeguarded by wise and thoughtful consideration. If conception is permitted to take place when either one or both of the parents are in bad health; if the wife is an unwilling mother, and the embryo is developed by her while her whole nature rebels against the admission into the family of a child who is not wanted, the children begotten and born under such circumstances can never be other than sickly, nervous and fretful during their entire childhood, and cross and uncompanionable throughout their whole lives.

    “Much of the differences which exist between children of the same parents may be easily attributed to the different bodily and mental conditions of the parents at theperiod of conjunction, the changed physical, intellectual and emotional states of the parents at the different periods of conception producing the corresponding differences in their offspring. The results of purposed and prepared parenthood are so great and so desirable that a husband and wife should consider these matters carefully, making preparations, and approach the period when they would beget offspring and bring immortal beings into the world with the greatest thoughtfulness, consideration, and also with prayer.”

    Dr. Hufeland says: “In my opinion, it is of the utmost importance that the moment of conception should be confined to a period when the sensation of collected powers, ardent passion, and a mind cheerful and free from care, invite to it on both sides.” Riddell says: “The law of initial impressions is well established. It has been understood and applied by stock-raisers for centuries. Experiments prove that the qualities most highly excited in animals prior to their union are most fully transmitted. The speed of horses and the acquired characters of the dog have been improved by the applications of the law. History and classic literature contain many references that recognize its importance, like Shakespeare’s ‘Come on, ye cowards; ye were got in fear.’ Ancient laws forbade union while parents were intoxicated, because such unions resulted in the production of drunkards and monstrosities. The asylums for the feeble-minded contain hundreds of unfortunate ones that are the product of such unions. The law of initial impressions, like the other laws of heredity, is traced most easily where morbid conditions are transmitted; but fortunately it is quite as potential in the production of desirable qualities. Unusual excitement to the social, intellectual or religious powers on the parents just prior to the inception of the new life frequently produce in the child corresponding tendencies.”

    Dr. Stockham says: “Many a drunkard owes his lifelong appetite for alcohol to the fact that the inception of his life could be traced to a night of dissipation on the part of his father.” Fleming says: “Not only do drunkards transmit to their descendants tendency toward insanity and crime, but even habitually sober parents who at the moment of conception are in a temporary state of drunkenness beget children who are epileptic or paralytic, idiotic or insane, very often microcephalic, or with remarkable weakness of mind, which is transformed at the first favorable occasion into insanity.”

    The time of conception should undoubtedly be chosen to correspond to a time in which the sex-powers of both parents are at their maximum. This is arrived at by a reasonable period of previous continence and abstinence from sexual relations between the married couple, and by an observance of the natural law which renders the woman most strong sexually at the close of the menstrual period. The husband, as well as the wife, is most strong sexually at this period, as under normal conditions his sex-power is most actively called forth by that of the woman at this period. At this period the wave of sex-power is at its height, and this is the best time for the beginning of the new life. As Riddell says: “Strong, vigorous, chaste sexuality at the time of conception is of supreme importance; it is indispensable to good results. No number of other conditions or factors can be so favorable as to justify the creation of a new life when the vitality of either parent is low. Parents transmit their physical constitution, intellect and morals only to the extent of the sex-power at the time of inception.”

    It is needless to say that there should exist between the prospective parents a strong bond of affection and attraction. By an irony of civilized life, the term “love child” is applied only to the offspring of unmarried lovers—men and women whose affection or passion have run away with their judgment, and who have “loved not wisely, but too well.” Some of the world’s greatest men and women have been “love children” of this kind; and in such cases it is probably true that their physical and mental strength has been the result of the ardent feeling animating the parents at the moment of conception. Such children seldom result from the “tired bed” or worn-out passion, love killed by sexual excesses, indifference on the part of one of the participants of the union, “duty” intercourse without affection or passion, or forced sexual relations. Every child should be a “love child” in the true sense of the term. The term should be one of respect, not of reproach. There should be no children but “love children.” The fruit of the perfect mating and marriage should be the perfect “love child”—and it would always be so if husbands and wives would but observe the laws of the normal, natural, sex-life.

    And, last of all—and perhaps more important than all—is the fact that at the moment of conception the minds and hearts of both of the prospective parents should be united in a strong love and desire for the hoped-for child. At that moment their best natures should blend into each other, and their love for each other fuse into a new love—the love of the child of the union. Under such circumstances, in such act the Cosmic Forces flow unhindered through the beings of the parents, and the new life is begun under the approving smile of Nature.

    Maternal Impressions.

    One of the oldest and most firmly-rooted beliefs of the race is that which holds that the pregnant mother may, and often does, consciously or unconsciously, impress upon her unborn child certain mental, moral, or physical traits. The majority of persons accept this idea as self-evident, and are able to cite cases within their own personal experience which go to prove the correctness of the popular belief. But certain modern authorities have sought to tear down this belief, and to discredit the general idea. Let us briefly consider both sides of this question.

    On the side of the generally accepted belief, Riddell says: “The more I study the influence of maternal impressions upon the life, mentality and character of men, the more I am led to believe that the education and moral training that a child receives before it sees the light of day are the most influential, and, therefore, the most important part of its education.” Newton says: “A mother may, during the period of gestation, exercise some influence, by her own voluntary mental and physical action, either unwittingly or purposely, in determining the traits and tendencies of her offspring. This is now a common belief among intelligent people. Every observant teacher could doubtless bear witness to the same general facts, and it would be easy to fill a volume with testimonials from various sources illustrative and confirmatory of the law under discussion. Such facts establish beyond question the conviction that the mother has it largely in her power to confer on her child such a tendency of mind and conformation of brain as shall not only facilitate the acquisition of knowledge in any specific direction, but make it certain that such knowledge will be sought and acquired.”

    Dr. Fordyce Baker says: “The weight of authority must be conceded to be in favor of the idea that maternal impressions may effect the growth, form and character of a forming child.” Dr. Rokitansky says: “The question whether mental emotions do influence the development of the child must be answered ‘Yes!’” Dr. Brittain says: “The singular effects produced on the unborn child by the sudden mental emotions of the mother are remarkable examples of a kind of electrotyping on the sensitive surface of living forms. It is doubtless true that the mind’s action in such cases may increase or diminish the molecular deposits in the several portions of the system. The precise place which each separate particle assumes may be determined by the influence of thought or feeling. If, for example, there exists in the mother any unusual tendency of the vital forces to the brain at the critical period, there will be a similar cerebral development and activity in the offspring.”

    Newton says: “The human embryo is formed and developed in all its parts, even to the minutest detail, by and through the action of the vital, mental, and spiritual forces of the mother, which forces act in and through the corresponding portions of her own organism. And while this process may go on unconsciously, or without the mother’s voluntary participation or direction, yet she may consciously and purposely so direct her activities as, with a good degree of certainty, to accomplish specifically desired ends in determining the traits and qualities of her offspring.” Professor Bayer says: “The influence of the mind of a prospective mother upon her child, before its birth, is of tremendous importance to its active existence as a member of society, from the fact that it lies in the mother’s power to shape its mentality, that it may be a power for good or for evil.”

    The views of that school of thought which is opposed to this old and generally accepted idea of material impressions, are ably presented by Dr. Saleeby, as follows: “Consider the case. The baby is at this time already a baby, though rather small and uncanny, floating in a fluid of its own manufacture. Its sole connection with the mother is by means of its umbilical cord—that is to say, blood-vessels, arterial and venous. There is no nervous connection whatever; absolutely nothing but the blood-stream, carried along a system of tubes. This blood is the child’s blood, which it sends forth from itself along the umbillical cord to a special organ, the placenta or afterbirth, half made by itself and half made by the mother, in which the child’s blood travels in thin vessels so close to the mother’s blood that their contents can be interchanged. Yet the two streams never mix. The child’s blood, having disposed of its carbonic acid and waste products to the mother’s blood, and having received therefrom oxygen and food, returns so laden to the child. Pray how is the mother’s reading of history to make the child a historian? We see now how the learning of geometry on the part of the mother before its birth will not set her baby upon that royal road to geometry of which Euclid rightly denied the existence—any more than after its birth. Such a thing does not happen—unless we are to call in Telepathy.”

    All this argument may seem quite convincing—at first. But when we begin to consider the matter carefully, we begin to perceive the weak places in the argument as above presented. In the first place, it is known that emotions powerfully affect the condition, quality, and “life” of the blood. We know that cheerful emotions impart certain uplifting qualities to the blood, while depressing emotions correspondingly react upon it. Fear, worry, fright, jealousy, etc., are actual poisons to the blood, and have brought on diseased conditions to the persons manifesting these emotions. Moreover, it is known that impaired quality of the blood reacts upon the brain. Is it so unreasonable, then, to hold that emotional states in the mother may react upon the mental and physical condition of the unborn child, through the blood? Does not something similar occur in the case of the babe, after its birth, when it is affected by the conditions of its mother’s milk brought on by her depressing emotions, fright, etc.? This would seem to explain at least the matter of emotional reactions between mother and unborn babe.

    But the case is not closed with the presentation of the evidence of physiology, important though that may be. There is an entirely different field of science to be drawn upon before the case is closed. The orthodox physiologist makes the mistake of supposing that all mental impulses and transmission of psychic energy require the service of nerves as channels of transmission. While such channels are usually required, we have good reasons for believing that there are exceptions to the rule. There have been found tiny creatures, possessing life and energy, performing the functions of nourishment, elimination, and even of reproduction—and yet without a nervous system. In one well-known instance, that of the moneron, we find not only an absence of a nervous system but also the lack of organs of any kind—and yet the creature lives, acts, moves, eats, thinks, and reproduces itself.

    Then, again, consider the moving cells of the blood, unconnected with the brain, unattached to the nervous system, and yet rushing to the work of repairing a wound, or of repelling an intruding germ, in obedience to a mental command from the controlling subconscious mental regions of the living creature. How does the mental impulse reach these cells and others of similar nature in the system? If we were not so sure of the facts, might we not feel inclined to say with Dr. Saleeby, in the above quoted sentence: “Such a thing does not happen—unless we are to call in telepathy.”

    Moreover, examining Dr. Saleeby’s statement, we see mention made of the placenta at being “half made by the embryo, and half made by the mother.” How does this co-operation and co-ordination of effort and subconscious will arise? How does the subconscious mentality of the embryo know that the subconscious mentality of the mother is making its half of the placenta, or vice versa? Again, how is the subconscious mentality of the mother affected by the presence and development of the child—how do her mammary glands respond to the growth and development of the child? In short, how is the manifest co-operation and co-ordination between the “nature” of the mother and the “nature” of the child possible, unless there exists some psychical, as well as some physical, relation between the two beings.

    The person conscientiously considering this subject must include in his thought the discoveries of modern psychology concerning what is known as the “subconscious mind,” which controls the unconscious and instinctive functions of the physical body, and also receives impressions and suggestions from the surface consciousness of its owner. This factor being admitted to our thought on the subject, we may find it possible to accept the idea of material impressions from mother to child operating from the subconscious mind of the mother to that of the child. In other words, that there is a subconscious mental connection, as well as the physical connection, between the mother and her unborn child.

    Many careful thinkers (and observers) find it just as easy to accept the fact of this strange “sympathetic co-ordination” between a mother and her unborn child as it is to accept the very frequent “sympathetic sickness” of the husband during the pregnancy of his wife—or of the “sympathetic labor pains” so often experienced by the husband during the confinement of his wife. Both of the latter two cases occur too often to permit the phenomenon to be denied off hand by those who would set aside all facts not agreeing with their particular personal theories. There is no nervous system connecting husband and wife, and of such cases the critic like Dr. Saleeby might say: “Such a thing does not happen—unless we call in telepathy!” The fact remains that many things actually happen which according to the orthodox physiological theories “cannot happen.” But they DO happen, nevertheless, whether we call it “telepathy” or merely label it “certain facts, the exact causes of which Science in the present state of its knowledge (or ignorance) cannot definitely determine.” One irrefutable fact outweighs a ton of mere general denials of possibility.

    It is recorded that the mother of Charles Kingsley believed in maternal impressions, and during her period of pregnancy exercised her imagination and emotions in the direction of wishing, and imagining, that the coming child should have the same love of Devonshire scenery that so delighted her. The result proved her theory, for though Kingsley never saw Devonshire until he was a man of thirty years of age, every Devonshire scene had a mysterious charm for him throughout his entire life. It is said that Robert Burns was so strongly impressed parentally by the old Scotch songs and ballads that his mother sung during her pregnancy, that his whole nature longed to express itself in like measure and substance. He always believed that his poetic spirit was kindled by this tendency on the part of his mother during the period preceding his birth.

    The mother of Napoleon Bonaparte during several months of her pregnancy, accompanied her husband during his military campaigns in Corsica, and during the entire term she lived in an atmosphere of battles, military strategy, and troops. When the boy was very young he manifested an unusual interest in war and conquest, and his whole mind had the military bent, although his brothers were in no wise remarkable in this direction. The artist, Flaxman, stated that his mother had related to him how for several months prior to his birth she had spent many hours each day studying drawings and engravings, and endeavoring to visualize by memory the beautiful figures of the human body drawn by the masters. The result was that from early childhood Flaxman manifested an intense delight in drawing; and in after life his drawings were regarded as masterpieces. He, and his mother, always attributed his talent to the parental impressions above mentioned.

    “Buffalo Bill” was believed to owe his characteristics to the mental states of his mother, the family living in Missouri during the days of frontier fights and disturbances, the mother being called upon several times to exercise resourceful courage and fortitude. A well-known worker along the lines of liberal Christianity is said to have attributed his tendencies in that direction to the prayers of his mother, during her pregnancy, that the child might be true to the teachings of the Christ, and should be a laborer in the cause of human brotherhood. This man, relating the fact, said: “I may have been converted before I was born.” A well-known writer along the lines of moral philosophy is believed by friends to owe his talent to the earnest thoughts and hopes of his mother during pregnancy—she is said to have pictured the child as a son destined to become a great moral philosopher, her mind being so firmly fixed on this fact that she felt it was already an assured fact.

    The Greeks were wont to surround the pregnant women with beautiful statuary, and it is recorded that in many cases the children afterward born closely resembled these works of art and beauty. It is claimed that many Italian women closely resemble the face shown in Raphael’s “Madonna,” copies of this celebrated picture being quite common in Italian households. Frances Willard, the temperance worker, is said to have very closely resembled a young woman of whom her mother was very fond. Many family resemblances are believed to have arisen in this way, rather than by heredity. Zerah Colburn, the mathematical prodigy whose feats astounded the scientific world in the early part of the last century, is said to have derived his wonderful faculty from maternal impressions of this kind; his mother is said to have occupied much of her time during her pregnancy in studying arithmetic and working problems, the study being quite new to her and proving very interesting.

    Cases similar to those above quoted might be duplicated almost indefinitely. The story is practically the same in each and every case. The principle involved is always that the pregnant mother took a decided interest in certain subjects, studies, and work, and that the child when born manifested at an early age similar tastes and inclinations. But far more important to the average prospective parent is the fact that many authorities positively claim that any pregnant mother may consciously and deliberately influence and shape the character, physical, mental, and moral of her unborn child.

    Newton well says, on this subject: “In the cases usually given to the public bearing on this topic, the moulding power appears to have been exercised merely by accident or chance; that is, without any intelligent purpose on the part of mothers to produce the results. Can there be any doubt that similar means, if purposely and wisely adopted, and applied with the greater care and precision which enlightened intention secure, would produce under the same law even more perfect results. Is it not altogether probable that an intentional direction of the vital or mental forces to any particular portion of the brain will cause a development and activity in the corresponding portion of the brain of the offspring? There seems to be no reasonable ground on which these propositions can be denied. The brain is made up of a congeries of organs which are the organs of distinct faculties of the mind or soul. It follows, then, that if the mother during gestation maintains a special activity of any one brain organ, or group of organs, in her brain, she thereby causes more development of the corresponding organ or group in the brain of the fetus. She thus determines a tendency in the child to special activity of the faculties, of which such organs are the instruments. It is plain, furthermore, that if any one organ or faculty may thus be cultivated before birth, and its activity enhanced for life, so may any other—and so may all. It would seem, then, clearly within the bounds of possibility that a mother, by pursuing a systematic and comprehensive method, may give a well-rounded and harmoniously developed organism to her child—notwithstanding her own defects, which, under the unguided operation of hereditary law, are likely to be repeated in her offspring. Or it is within her power to impart a leading tendency in any specific direction that she may deem desirable, for a life of the highest usefulness. In this way ancestral defects and undesirable hereditary traits, of whatever nature or however strong, may be overcome, or in a good degree counterbalanced by giving greater activity to counteracting tendencies; and, in this way, too, it would appear the coveted gifts of genius may be conferred. In other words, it would seem to be within the mother’s power, by the voluntary and intelligent direction of her own forces, in orderly and systematic methods, both to mold the physical form to lines of beauty, and shape the mental, moral, and spiritual features of her child to an extent to which no limit can be assigned.”

    I think that in the pages of this particular part of the book the prospective parent may find hints and general directions toward a clearly defined ideal, which is carefully studied, and as carefully put into practice will produce results far beyond the dreams of the average man and woman. The hope is a magnificent one, and the best testimony is in favor of the possibility of its actual realization.

    PRIVATE Sex Advice to Women By R. B. Armitage, M. D.

    For Young Wives and those who Expect to be Married.

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  • Strengthening accountability to end TB

    WHO today released a Checklist to enable Member States and their partners to assess the status of work at the national level to strengthen accountability to End TB, principally: national commitments made, actions taken on those commitments, monitoring & reporting approaches, and the nature of any high-level review mechanisms. The Checklist has been developed in response to requests from Member States, regions, civil society and partners as a tool to support the adaptation and implementation of the WHO Multisectoral Accountability Framework (MAF-TB) released in 2019. It responds also to the UN General Assembly request to WHO to ensure implementation of the Framework.

    There are four components of the MAF-TB that form a cycle for strengthening accountability: Commitments, Actions, Monitoring and Reporting, and Review, that were released during the World Health Assembly in May, 2019. In the political declaration of the first UN high-level meeting on TB, world leaders called for WHO to finalize the framework and ensure its implementation in 2019.

    After its publication in May, 2019, WHO began work with pathfinding country counterparts who were seeking to move ahead on key elements including, among others: formal adoption of country-specific targets for 2022 for increased TB case detection and treatment in line with the global targets in the political declaration; updating or development of new national TB strategic plans based on 2022 and 2030 targets and other new commitments; coordination platforms across sectors and stakeholders; formalizing engagement with civil society across End TB efforts;  producing robust performance reports; and, using those reports to inform high-level review bodies that will assess and drive faster progress.  Based on the MAF-TB document, relevant country experiences, and specific requests from countries and partners, WHO developed the MAF-TB Checklist. The Checklist is especially relevant for high TB burden countries, but has content relevant to all countries.  The appropriateness of different approaches may vary, according to national constitutional, legal and/or regulatory frameworks or other relevant factors.

    The MAF-TB Checklist has three annexes on:

    1. engagement across government ministries and bodies;
    2. engagement of civil society and affected communities; and,
    3. adoption  and implementation of WHO TB guidance.

    In releasing this MAF-TB Checklist today, Dr Tereza Kasaeva, Director of the WHO Global TB Programme noted,  “At this enormously difficult time, all countries and partners are focused on the COVID-19 pandemic.  Lessons learnt from ongoing TB programmes are helping the response. Likewise, TB efforts will benefit from learning underway on collaboration, innovation and accountability in confronting the virus.”

    WHO will be helping Ministries of Health and partners to use the Checklist, hold related consultations and move forward with more effective collaboration and review mechanisms.  The WHO Civil Society Task Force on TB also will support countries and civil society partners, using the Checklist. Progress in strengthening accountability will be assessed in the 2020 Report of the UN Secretary-General on progress since the 2018 TB UN high-level meeting, as well as in the WHO Global TB Report 2020.

    The WHO TB Civil Society Task Force, National TB  Programme Managers and other country officials, WHO staff at all levels, consultants working with WHO and The Global Fund, and staff of partner agencies, contributed content to, and/or provided feedback on, the MAF-TB Checklist during its development.   Access the Checklist and 3 annexes.  

    An online form of the checklist will be available shortly here, along with additional information.  

    Translations of the Checklist and annexes, as soon as available in Arabic, Chinese, French, Russian and Spanish, will be posted at the above link as well.   Kindly contact gtbprogramme@who.int if you have questions regarding the MAF-TB Checklist or to request versions in MS Word format if needed.

     

    Read More
    https://www.who.int/news-room/detail/08-04-2020-strengthening-accountability-to-end-tb

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  • Glossary of Youth: Its Education, Regimen, and Hygiene, by G. Stanley Hall

    Glossary of Youth: Its Education, Regimen, and Hygiene, by G. Stanley Hall

    GLOSSARY

    AGAMIC. Unmarried; unmarriageable, sometimes non-sexed.

    AGENIC. Lacking in reproductive power; sterile.

    AMPHIMIXIS. That form of reproduction which involves the mingling of substance from two individuals so as to effect a mixture of hereditary characteristics. It includes the phenomena of conjugation and fertilization among both unicellular and multicellular organisms.

    ANABOLISM. See METABOLISM.

    ANAMNESIC. Pertaining to or aiding recollection.

    ANEMIC. Deficient in blood; bloodless.

    ANTHROPOMORPHISM. The attributing of human characteristics to natural, supernatural, or divine beings.

    ANTHROPOMETRY. Science of measurement of the human body.

    ARTIFACT. Any artificial product.

    APHASIA. Impairment or lose of the ability to understand or use speech.

    ASSOCIATIONISM. The psychological theory which regards the laws of association as the fundamental laws of mental action and development.

    ATAVISTIC. Pertaining to reversion through the influence of heredity to remote ancestral characteristics.

    ATAXIC. Pertaining to inability to coördinate voluntary movements; irregular.

    CALAMO-PAPYRUS. Reed papyrus or pen-paper.

    CATABOLISM. See METABOLISM.

    CATHARSIS. Purgation or cleansing. Aristotle’s esthetic theory that little renders immune for much.

    CEREBRATION. Brain action, conscious or unconscious.

    CHOREA. St. Vitus’s dance; a nervous disease marked by irregular and involuntary movements of the limbs and face.

    CHRESTOMATHY. A collection of extracts and choice pieces.

    CHRISTENTHUM. The Christian belief; the spirit of Christianity.

    COMMANDO EXERCISES. Gymnastic exercises whose order is dependent upon the spoken command of the director.

    CORTEX. The gray matter of the brain, mostly on its surface.

    CORTICAL. Pertaining to the cortex.

    CRANIOMETRY. The measurement of skulls.

    CRYPTOGAMOUS. Having an obscure mode of fertilization; or, of plants that do not blossom.

    CULTUS. A system of religious belief and worship.

    DEUTSCHENTHUM. The spirit of the German people.

    DIATHESIS. A constitutional predisposition.

    EPHEBIC. Pertaining to the Greek system of instruction given to young men to fit them for citizenship; adolescent.

    EPIGONI. Successors; followers who only follow.

    EPISTEMOLOGY. The theory of knowledge; that branch of logic which undertakes to explain how knowledge is possible and to define its limitations, meaning, and worth.

    EUPEPTIC. Having good digestion.

    EUPHORIA. The sense of well-being; of fullness of life.

    EVIRATION. Emasculation; loss of manly characteristics.

    FERAL. Wild by nature; untamed; undomesticated.

    FORMICARY. An artificial ants’ nest.

    GEMÜTH. Disposition; the entire affective soul and its habitual state.

    HEBETUDE. Dullness; stupidity.

    HEDONISTIC. Relating to hedonism, that form of Greek philosophy which taught that pleasure is the chief end of existence.

    HETAERA. A Greek courtesan. This class was often highly trained in music and social art, and represented the highest grade of culture among Greek women.

    HETEROGENY. (1) The spontaneous generation of animals and vegetables, low in the scale of organization, from inorganic elements. (2) That kind of generation in which the parent, whether plant or animal, produces offspring differing in structure or habit from itself, but in which after one or more generations the original form reappears.

    HETERONOMOUS. Having a different name.

    HOROLOGY. The science of measuring time and of constructing instruments for that purpose.

    HYGEIA. The Greek goddess of health; health.

    HYPERMETHODIC. Methodic to excess; overmethodic.

    HYPERTROPHY. Excessive growth.

    INDISCERPTIBLE. Incapable of being destroyed by separation of parts.

    INHIBITION. Interference with the normal result of a nervous excitement by an opposing force.

    IRRADIATION. The diffusion of nervous stimuli out of the path of normal discharge which, as a result of the excitation of a peripheral end organ may excite other central organs than those directly connected with it.

    KINESOLOGICAL. Pertaining to the science of tests and measurements of bodily strength.

    KINESOMETER. An instrument for measuring muscular strength.

    MEDULLATION. The investment of nerve fibers with a protective covering or medullary sheath, consisting of white, fat-like matter.

    MERISTIC. Pertaining to the levels or spinal and cerebral segments of the body.

    METABOLISM. The act or process by which, on the one hand, dead food is built up into living matter—anabolism, and by which, on the other, the living matter is broken down into simpler products within a cell or organism—catabolism.

    METAMORPHOSIS. Change of form or structure; transformation.

    METEMPSYCHOSIS. The doctrine of the transmigration of the soul from one body to another.

    MONOPHRASTIC. Pertaining to or consisting of a single phrase.

    MONOTECHNIC. Pertaining to a single art or craft.

    MORPHOLOGY. The science of form and structure of plants and animals without regard to function.

    MYOLOGY. The scientific knowledge of the muscular system.

    MYTHOPOEIC. Producing or having a tendency to produce myths.

    NOETIC. Of, pertaining to, or conceived by, mind.

    NUANCE. Slight shade; difference; distinction; degree.

    ORTHOGENIC. Pertaining to right beginning and development.

    ORTHOPEDIC. Relating to the art of curing deformities.

    OSSUARY. A depository of dry bones.

    PALEOPSYCHIC. Pertaining to the antiquity of the soul.

    PANTHEISTIC. Relating to that doctrine which holds that the entire phenomenal universe, including man and nature, is the ever-changing manifestation of God, who rises to self-consciousness and personality only in man.

    PATRISTICS. That department of study occupied with the doctrines and writings of the fathers of the Christian Church.

    PHOBIA. Excessive or morbid fear of anything.

    PHYLETICALLY. In accordance with the phylum or race; racially.

    PHYLETIC. Pertaining to a race or clan.

    PHYLOGENY. The history of the evolution of a species or group; tribal history; ancestral development as opposed to ontogeny or the development of the individual.

    PHYLUM. A term introduced by Haeckel to designate the great branches of the animal and vegetable kingdoms. Each phylum may include several classes.

    PICKELHAUBE. The spiked helmet of the German army.

    PLANKTON. Sea animals and plants collectively; distinguished from coast or bottom forms and floating in a great mass.

    POLYGAMIC (LOVE). Pertaining to the habit of having more than one mate of the opposite sex.

    POLYPHRASTIC. Having many phrases; pertaining to rambling, incoherent speech.

    POST-SIMIAN. Pertaining to an age later than that in which simian or monkey-like forms prevailed.

    PRENUBILE. Pertaining to the age before sexual maturity or marriageability is reached.

    PRIE DIEU. A praying desk.

    PROPEDEUTIC. Preliminary; introductory.

    PROPHYLACTIC. Any medicine or measure efficacious in preventing disease.

    PSEUDOPHOBIAC. Pertaining to a morbid condition in which the subject is continually in fear of having said something not strictly true.

    PSYCHOGENESIS. The origin and development of soul.

    PSYCHONOMIC. Pertaining to the laws of mind.

    PSYCHOSIS. Mental constitution or condition; any change in consciousness, especially if abnormal.

    PUBERTY. The age of sexual maturity.

    PUBESCENT. Relating to the dawning of puberty.

    PYGMOID. Of pygmy size and form.

    RABULIST. A chronic wrangler; one who argues about everything.

    SCHEMA. A synopsis; a summary. In the Kantian sense, a general type.

    SCHEMATISM. An outline of any systematic arrangement; an outline.

    SUPERFOETATION. A second conception some time after a prior one, by which two foetuses of different age exist together in the same female. Often used figuratively.

    TEMIBILITY. (From Italian temibile, to be feared.) The principle of adjustment of penalty to crime in just that degree necessary to prevent a repetition of the criminal act.

    TIC. A nervous affection of the muscles; a twitching.

    TRANSCENDENTAL. In the Kantian system having an a priori character, transcending experience, presupposed in and necessary to experience.

    TRAUMATA. Wounds.

    TRAUMATISM. A wound; any morbid condition produced by wounds or other external violence.

    VERBIGERATION. The continual utterance of certain words or phrases at short intervals, without reference to their meaning, as seen in insane Gedankenflucht or rapid flight of thought.

    Extract from Youth: Its Education, Regimen, and Hygiene, by G. Stanley Hall

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