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At Balukhali refugee camp in Bangladesh, unclean water, cramped living quarters and squalid conditions create a prime environment for outbreaks of preventable diseases among the estimated 650,000 Rohingya Muslims who have fled strife in neighboring Myanmar.

While 900,000 doses of oral cholera vaccine already have been delivered by more than 200 mobile vaccination teams, another contagious bacterial infection, diphtheria, has emerged.

“Diphtheria is a vaccine preventable disease. It’s an illustration of how the Rohingya population that are living in the makeshift settlements here had very little access to health care in their place of origin in Myanmar,” said Kate Nolan, emergency coordinator with international aid group Medecins Sans Frontieres, or Doctors Without Borders.

Diphtheria often causes the buildup of a sticky grey-white membrane in the throat or nose. The infection causes airway obstruction and damage to the heart and nervous system. The fatality rate increases without the diphtheria antitoxin.

“This is an extremely vulnerable population with low vaccination coverage, living in conditions that could be a breeding ground for infectious diseases like cholera, measles, rubella and diphtheria,” said Dr. Navaratnasamy Paranietharan, the World Health Organization representative to Bangladesh.

Myanmar’s health sector is rated among the worst in the world, particularly in the ethnic regions where conflict and poverty have delayed medical development.

The Rohingya refugees fled Myanmar’s northern Rakhine state after insurgents attacked security forces in late August, prompting a military crackdown that has since been described as ethnic cleansing.

‘Appalling’ health care

Myanmar’s government denies it has engaged in ethnic cleansing, and it insists that a majority of the violence and burning of Rohingya villages was done by the Rohingya militants who attacked the Myanmar security forces.

“The health care facilities for the Rohingya in Rakhine state are appalling and just a small amount of the needs were being met, even before the attacks in August,” said Rohingya expert Chris Lewa of the Arakan Project, a human rights organization that monitors and documents the situation.

According to Lewa, the impoverished Rohingya population in northern Rakhine say they are treated with discrimination by Myanmar medical staff at government hospitals and face severe movement restrictions when traveling to health care facilities.

Lewa points to Myanmar’s Maungdaw District, where the army conducted so-called “clearance operations” following deadly insurgent attacks last year.

“Health facilities set up by INGOs [international nongovernmental organizations] in Maungdaw have been burned to the ground, which will make it even more difficult for them if and when they are allowed to return,” Lewa added.

Currently, INGOs are not allowed in the areas outside Maungdaw.

Doctors Without Borders has responded to the rapid spread of diphtheria in neighboring Bangladesh by converting one of its mother and child inpatient facilities at the Balukhali makeshift settlement, and at another inpatient site, into treatment centers.

“The emergence of this disease is a concern because it contributes to an existing precarious public health situation that we have in the makeshift settlements,” Nolan said.

Tracking down carriers

Now, potential carriers must get antitoxins and antibiotics to prevent the further spread of the bacterium and kill it.

“We need to find all the suspected cases in the camps and get them all here to start the antibiotic treatment and keep them isolated for 48 hours,” said on-duty doctor Thomas Hansen.

Because the disease spreads easily through water droplets from sneezing and coughing, medical teams are tasked with following up on initial quarantine with visits to a patient’s family to trace and treat people who might have come in contact with the disease in the community.

Doctors Without Borders and health partners like the International Federation of Red Cross and Red Crescent Societies are working together to isolate suspected cases.

One of the biggest challenges for health workers, however, is getting to remote locations where potential outbreaks can occur.

With the sudden influx of the 650,000 refugees, new land clearance has led to huts being constructed well beyond the main roadways.

“They live in areas that are difficult to reach. You cannot reach them by cars or Tom Toms [three-wheeled taxis] because of no roads, so they will have to carry their patients to where they can get treatment,” said Dagne Hordvei, team leader with the Norwegian Red Cross.

“We have an agreement with [Doctors Without Borders] that we take the measles patients from them, and they take the diphtheria patients, with lots of activity going out to the communities to try to reduce the speed of the spreading of diphtheria.”

Vaccination campaign

As Bangladesh’s Ministry of Health and Family Welfare — working with the World Health Organization, UNICEF and other health partners — implements a vaccination campaign to prevent future outbreaks of diphtheria, it appears that at least some of the next generation of Rohingya will have protection from preventable diseases.

“We are working with partners to ensure that clinical guidance is available to health workers, and that there are enough beds and medicines for those who get sick. But the only way to control this outbreak is to protect people, particularly children, through vaccination,” said the WHO’s Paranietharan.

As of December 21, Doctors Without Borders has seen more than 2,000 suspected diphtheria cases in its health facilities, and the number is rising daily. Most of the patients are between the ages of 5 and 14 years old.

More than 20 Rohingya in Bangladesh have died from the disease.
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Eleven years since the end of the civil war in Uganda, which pitted Lord’s Resistance Army rebels against the government, tens of thousands of people still struggle with post-traumatic stress disorder.

Mental health practitioners estimate that seven in 10 people in Northern Uganda were traumatically affected by the war.

At the age of 12, Francis Okello Oloya was blinded by a bomb blast as he dug in the family garden. In a boarding school for the blind, Okello found it difficult to ask people for help, especially in getting to the toilet at night. Now a 29-year-old community psychologist, that childhood experience led to the birth of a project involving what he calls comfort dogs.

“I had to navigate my way from the sleeping quarter to latrine and that was not easy,” he said. “And these dogs came to know that I needed help. And they began the practice of helping me from the sleeping quarters to the latrine. Being a person of visual impairment, you normally feel that you are going to burden people a lot.”

Dogs are mainly used for hunting in Uganda, with a few people warming up to the idea of owning dogs at home, mostly for security. But Okello began collecting street dogs, which were handed over to guardians with training in dog handling.

In 2015, Okello started The Comfort Dog Project to help people in Gulu town, especially those who were suffering from post-traumatic stress disorder, depression and anxiety.

Philda Akum, 35, is one of the 29 beneficiaries of the project. In 1997, she and her four brothers were abducted by the LRA and taken to Sudan.

One of her brothers tried to escape.

That brother was captured and killed, Akum says. Another brother was selected to go to the battlefront; he was shot dead. Two days later, her youngest brother contracted cholera and died. The horrors have left her traumatized, she says. She returned home and joined group therapy, which is how she got her dog, Lok Oroma.

Lucy Adok, 39, spent five years fighting in the bush.

“I was in combat and saw many people being killed,” she said. “I was destroyed. When I returned home, I experienced flashbacks and any loud sound sounded like a bullet. When I learned that I could get a dog as a friend, I took on Sadiq.

“I now spend a lot of time with Sadiq. I have dreams of our games during the day and slowly Sadiq has replaced the bad memories from the war.”

The dogs find a home, and the guardians find life companions.
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A first-of-its kind genetic treatment for blindness will cost $850,000, less than the $1 million price tag that had been expected, but it’s still among the most expensive genetic therapies in the world.

Spark Therapeutics says it decided on the lower price tag for Luxturna (Lux-turn-a) after hearing from health insurers about their ability to cover the injectable treatment.

Consternation over skyrocketing drug prices, especially in the U.S., has led to intense scrutiny from patients, Congress, insurers and hospitals.

Luxturna, approved last month, is the nation’s first gene therapy for an inherited disease. It can improve the vision of those with a rare form of blindness that affects just a few thousand people in the U.S.
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Malawi is battling a cholera outbreak that began at the start of the rainy season in November. The disease has killed four people, and more than 150 others are hospitalized.

The disease — an acute diarrheal infection caused by consuming contaminated food or water — affects children and adults, and can kill within hours if left untreated.

The hardest-hit districts are Nkhatabay and Karonga, on the shores of Lake Malawi.

“As of today, we have 137 cases which we have registered from Karonga only,” said Joshua Malango, spokesperson for the Ministry of Health. “And unlike Karonga, in Nkhatabay we have 16 cases as of today, with no deaths. While in Karonga we had three deaths.” 

The Kasungu and Dowa districts have registered one case each, while on Tuesday, medical workers confirmed two cases in the capital, Lilongwe.

The outbreak is believed to have been triggered by poor hygiene among residents, especially in Karonga.

According to Karonga-based journalist Special Absalom, more than 70 percent of people there use untreated water. 

“People who are along the lakeshore area use water directly from the lake, while others who are close to the rivers, they are using water from the rivers and some are even using wells,” Absalom said.

In neighboring Zambia, the disease has killed about 40 people in the capital, Lusaka, and affected more than 1,500 others since September.

However, Malawians bordering Zambia should not panic over the Lusaka outbreak, Malango says.

“We are not that close with Lusaka. But we are not taking it lightly. We are putting measures to ensure that people traveling in and out of the country, they must have proper surveillance, we have checked them to ensure that Malawians are safe,” he said. 

Meanwhile, Malawi’s government has embarked on a nationwide campaign to remind people to wash their hands with soap, especially after using the toilet and before eating any food.

More importantly, Malango says, the government is distributing chlorine and other chemicals to treat drinking water.

Malawi suffered its worst cholera outbreak in 2009, when 82 people died and more than 3,000 people were infected across the country.
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Gun violence is a reality of American life and across the country, more than a dozen people were shot to death on the first day of 2018. The shootings happen everywhere – in homes, shopping centers, on the street, and in schools. There were nine school shootings in the United States in 2017, leaving 15 people dead 18 others wounded. Now, a new simulation program is designed to help keep teachers and students safe from a shooter. VOA’s Kevin Enochs reports.
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After more than a decade of steady increases in the rate of children diagnosed with autism in the United States, the rate has plateaued in the past three years, researchers said Tuesday.

The findings were based on a nationwide study in which more than 30,000 parents reported whether their children had been diagnosed with autism spectrum disorder (ASD).

“The estimated ASD prevalence was 2.41 percent among US children and adolescents in 2014-2016, with no statistically significant increase over the three years,” said the research letter by experts at the University of Iowa, published in the Journal of the American Medical Association (JAMA).

The first observation of a plateau was made by a separate group in 2012, when the rate flattened out to 1.46 percent, according to the Autism and Developmental Disabilities Monitoring (ADDM) Network.

Federal health authorities say that means about one in 68 children in the United States have the neurodevelopmental disability, whose causes remain poorly understood.

The ADDM had documented a “continuous increase from 0.67 percent in 2000 to 1.47 percent in 2010.”

The 2.4 percent rate described in the JAMA report translates to one in 47 children, but researchers cautioned that the discrepancy may be explained by “differences in study design and participant characteristics.”

The JAMA report, based on the annual National Health Interview Survey, did not delve into “underlying causes for the findings and cannot make conclusions about their medical significance.”

The U.S. Centers for Disease Control and Prevention also noted a plateau in the autism rate in 2016, but said it was “too soon to know whether ASD prevalence in the United States might be starting to stabilize.”
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The record-shattering cold gripping most of the United States has been blamed for at least nine deaths in recent weeks and forecasters say the worst is yet to come. 

The National Weather Service issued wind chill advisories and freeze warnings Tuesday for 40 U.S. states.

“Arctic air mass will bring a prolonged period of much-below-normal temperatures and dangerously cold wind chills to the central and eastern U.S. over the next week,” NWS tweeted.

Hard freeze warnings remain in effect through Wednesday in typically balmy states, including Texas, Louisiana, Mississippi and Alabama. Temperatures fell to -13 Celsius (8.6 Fahrenheit) near Cullman, Alabama, and -7 Celsius (19.4 Fahrenheit) in Mobile, Alabama.

City officials opened warming shelters across the South as cold temperatures brought rare snow flurries as far south as Austin, Texas. In Savannah, Georgia, where the average high temperature in January is 16 Celsius (61 Fahrenheit),  the temperature hovered at -1 Celsius (30.2 Fahrenheit) at noon Tuesday.

Hospitals across the U.S. are seeing a surge in emergency room visits for hypothermia and other ailments as temperatures plunge well below freezing.

The central U.S. has borne the brunt of the frigid temperatures since the snap began around Christmas. Omaha, Nebraska, broke a record dating back more than 130 years as teeth chattered in temperatures of -29C (-20 Fahrenheit). While Aberdeen, South Dakota, saw the mercury fall to -36C (32.8 Fahrenheit), breaking a record set in 1919.

Arctic temperatures also caused problems on waterways, for both waterfowl and boats. Firefighters in Richmond, Virginia, freed a swan that was stuck for hours Monday in the middle of a frozen pond.

In New York, transportation officials suspended the Newburgh-Beacon commuter ferry service on Tuesday because of icy conditions on the Hudson River. In Florida, several water parks in Orlando are closed because of the extreme temperatures, CNN reported. 

Tourists visiting the Horseshoe Falls at Niagara Falls snapped photos of flowing water that had turned to icicles.  

The Atlantic White Shark Conservancy reported frozen sharks were washing on beaches south of Boston

Meanwhile, forecasters are tracking a storm that could bring snow and ice to the East Coast later this week. The private AccuWeather forecaster said the cold snap could combine with a storm brewing off the Bahamas to bring snow and high winds to much of the Eastern Seaboard as it heads north on Wednesday and Thursday.
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Every day after work, Ariana Hawk drives to a water distribution center in Flint, Michigan, where the city provides free bottled water to its residents.

Hawk’s 4-year-old son, Sincere Smith, became the poster child for Flint’s water crisis when his face, pocked by lead-poisoning scars, appeared on the cover of Time Magazine in 2016.

His mother says she still only uses bottled water when she bathes her five children and prepares food. She continues this practice even though the state of Michigan has declared the water is safe to drink, but only if filtered because not all of the lead-affected pipes have been replaced.

“Governor Snyder say that we need to use that filter because our water is safe,” Hawk says. “Our water is not safe.”

Two years after a state of emergency was declared because of lead-poisoned water, many in Flint, like Hawk, still don’t believe the water is safe.

“Some people do not trust regardless of what scientific data shows,” says Sheryl Thompson of the Flint Department of Health and Human Services.

“I even had my pipes redone,” says Flint resident Clades Beal, “but the water is still looking the same.”

Pregnant women and people younger than 21 who drank Flint water are now eligible for special health care coverage paid for by the government. So far, there is no way to reverse the effects of lead poisoning.

“In children, we are worried about decreased IQ points, Attention Deficit Hyperactivity Disorder as well as other cognitive impairment,” says Nathaniel DeNicola, MD of George Washington University. “For children, there is not really a way to reverse those effects, but with proper diet, nutrition, counseling, decrease of the exposures, you can help to not make that adverse effects as impactful.”

And while Flint residents continue to receive help, including bags of food, the government works on replacing lead pipes, which was made possible by a settlement from a $97 million lawsuit brought the Natural Resources Defense Council.

“Right now we are in the implementation of the settlement, of the agreement,” says Dimple Chaudhary of the Natural Resources Defense Council. “We were able to get this great agreement. Again recognizing that there is still so much to do in Flint but this piece of it is a good step forward.”

“The state who in my opinion is liable and really should step up so we can get this mass construction,” says Eric Mays, a Flint City councilman. “It should be a national infrastructure project.”

Meanwhile, Flint residents continue their daily battle for clean water.

“That is not fair to the citizens,” Hawk says. “That is not fair to these kids.”
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For people who are in the workforce already, the added burden of unpaid caregiving for a family member or loved one may lead to insomnia and other sleep issues, according to a large study from Sweden.

Researchers found that the likelihood of sleep problems rose with the number of hours spent in unpaid caregiving, and when caregiving stopped, sleep disturbances were reduced.

“Informal caregiving is common, and the need for carers is expected to grow due to population aging and cuts to social care services in various countries,” said lead study author Lawrence Sacco of the Institute of Gerontology at King’s College London in the UK.

Caregivers often face conflicting schedules and feel a sense of obligation, leaving some with little or no choice about when and how to help loved ones, he noted.

“Sleeping problems are common and deserve attention because people with insomnia are more likely to suffer from other physical illnesses,” Sacco told Reuters Health by email. “Sleep disturbance and tiredness are also symptoms of depression and other mood disorders.”

Sacco and his colleagues at the Stress Research Institute at Stockholm University analyzed responses from 12,200 participants in the Swedish Longitudinal Occupational Survey of Health, a questionnaire mailed every two years to employed residents of Sweden aged 16 to 64. The researchers focused on surveys in 2010 through 2016.

They defined informal caregivers as those who, without pay, help or care for an elderly, ill or disabled relative other than a child or grandchild. Participants were asked how many hours they typically spend on this caregiving each week.

They were also asked how often in the prior three months they had difficulties falling asleep, repeated awakenings, premature awakenings or restless sleep.

About 85 percent of the survey participants were not caregivers, while 12 percent spent 1 to 5 hours providing care each week and 2 percent spent anywhere from 6 to 15 hours caregiving.

After adjusting for social and economic factors, as well as the caregiver’s own health status, the researchers found that sleep problems were more common among caregivers overall, and most common among those who provided more than five hours a week.

When caregiving ceased from one survey year to the following one, researchers saw a drop in reported sleep troubles.

Caregivers were more likely to be female and older, to have less education, to work less than 20 paid hours per week and to report physical pain, chronic illness, poor health and depression.

“This means that increases in informal caregiving that are expected in the years ahead as a result of population aging may hit those who are already struggling the hardest,” Sacco said.

The study team saw no difference in sleep problems between men who provided no care versus those who provided up to five hours of caregiving, but women reported sleep problems at all levels of caregiving. That could be related to the different tasks that men and women perform as caregivers, the authors write in the journal Sleep.

Future studies should look at working people in various countries, Sacco added, since Sweden uses a welfare model aimed at minimizing conflict between paid work and caregiving commitments.

“This is a wake-up call to governments and employers that they should be supporting informal caregivers better,” he said.

In addition, future research should examine what types and aspects of caregiving affect sleep the most, said Dr. Barry Oken of Oregon Health and Science University in Portland, who wasn’t involved in the study.

“Caregiving at home for someone with dementia or chronic pain may cause more problems with the care recipient’s sleep and perhaps then the caregiver’s sleep,” he told Reuters Health by email.

Oken said he is interested in finding ways to help caregivers improve their sleep. In recent studies, he and colleagues have found that mind-body practices, such as mindfulness meditation, can improve mental health in caregivers and stressed older adults.

“Be aware that sleeping may be impacted by caregiving and explore with health providers what you can do to minimize it,” he said. “What society can do to help minimize this is alluded to here but is a bigger question.”

 
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People who drink hot tea daily may be less likely than others to develop glaucoma symptoms, U.S. researchers say.

Compared to coffee, soft drink and iced tea drinkers, study participants who consumed a cup or more of hot caffeinated tea daily had 74 percent lower odds of having glaucoma, the study authors report in the British Journal of Ophthalmology.

“Glaucoma can lead to blindness, and it would be great if it could be prevented because there is no cure,” said lead author Dr. Anne Coleman of the University of California, Los Angeles.

“The best way to prevent it is to get your eyes checked,” Coleman told Reuters Health in a telephone interview. “But we are also interested in lifestyle habits and what we can do to make a difference.”

Glaucoma is the second leading cause of blindness worldwide, according to the World Health Organization, affecting an estimated 58 million people. That includes more than three million Americans, only half of whom are aware they have the disease, according to the Glaucoma Research Foundation.

Coffee, or caffeine in general have previously been linked to increased glaucoma risk, although recent studies don’t agree, Coleman and her colleagues write.

To evaluate the relationship between specific caffeinated drinks and glaucoma, Coleman and colleagues analyzed data on a sample of more than 10,000 people in the U.S. who were representative of the entire population.

Participants in the National Health and Nutrition Examination Survey during 2005-2006 answered questions about their diets and lifestyles, had medical exams and blood tests and also underwent eye examinations.

About 1,700 participants were over age 40, had no other known eye diseases and had full eye examination results from the survey. In this group, Coleman’s team found that just over 5 percent, 82 people, had glaucoma.

Almost half of participants reported drinking coffee often, but less than 10 percent drank hot tea daily. The research team found no associations between coffee, iced tea, decaffeinated tea or soft drink consumption and the likelihood of having glaucoma.

“Tea drinkers should keep drinking and don’t need to stop because of a fear of glaucoma,” Coleman said. “This makes sense, but we’ll see if it holds up in future studies.”

Future studies should look at the habits, activities and nutrition that affect lifestyle and glaucoma risks, said Idan Hecht of Tel-Aviv University in Israel, who wasn’t involved in the research.

“In the past few years, there has been a tremendous increase in interest, and subsequently research, into the ways lifestyle changes can influence diseases,” Hecht told Reuters Health by email.

Recent research indicates that vitamins C, E and zinc can help vision. Other studies indicate that antioxidants in tea could have similar effects, he noted.

“Patients can and should be involved and take an active role in the management of their ailments,” Hecht said. “Exercising, eating healthy and trying novel ways to improve your health is something you should definitely explore and bring up with your physician.”

Environmental factors could play a role in glaucoma risk as well, said Dr. Ahmad Aref at the University of Illinois at Chicago.

“As our population grows older, we need to think about the other factors that could help, particularly when it comes to the health benefits of physical activity,” he told Reuters Health by phone.

Overall, both medical and non-medical approaches are key to treating the disease in the future, Aref added.

“It’s a tough disease because we don’t have a way to bring vision back once it’s lost,” he said. “All we can do is prevent it from getting worse, and we want to help patients do that.”
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Israeli archaeologists unveiled on Monday a 2,700-year-old clay seal impression which they said belonged to a biblical governor of Jerusalem.

The artifact, inscribed in an ancient Hebrew script as “belonging to the governor of the city”, was likely attached to a shipment or sent as a souvenir on behalf of the governor, the most prominent local position held in Jerusalem at the time, the Israel Antiquities Authority said.

The impression, the size of a small coin, depicts two standing men, facing each other in a mirror-like manner and wearing striped garments reaching down to their knees. It was unearthed near the plaza of Judaism’s Western Wall in the Old City of Jerusalem.

“It supports the Biblical rendering of the existence of a governor of the city in Jerusalem 2,700 years ago,” an Antiquities Authority statement quoted excavator Shlomit Weksler-Bdolah as saying.

Governors of Jerusalem, appointed by the king, are mentioned twice in the Bible, in 2 Kings, which refers to Joshua holding the position, and in 2 Chronicles, which mentions Masseiah in the post during the reign of Josiah.

The Antiquities Authority’s announcement came several weeks after U.S. President Donald Trump recognized Jerusalem as Israel’s capital, a decision that overturned a decades-old policy on the status of the city and stirred Palestinian protests and international concern.
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