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Older Women Count: Special UN Panel Focuses on Violence Against Older Women

csw59The year 2015 marks a significant milestone – the 20th anniversary of the Fourth World Conference on Women and adoption of the 1995 Beijing Declaration and Platform for Action. This was the focus of the 59th session of the Commission on the Status of Women (CSW59). The annual two-week gathering at the United Nations Headquarters in New York wraps up today.

Despite some progress over the last two decades, the areas of concern identified in the Beijing Declaration are still relevant and urgent today. Violence against women, and in particular, violence against older women, remains an issue that stymies even the most ardent supporters of women’s rights. At Older Women Count, Bringing Visibility to Violence against Older Women 20 years after Beijing, a standing-room only audience learned more about the need to include older women in discussions on gender-based violence and how countries are addressing the challenges.

Approximately 850 million people, or about one in 10, were over the age of 60 in 2012, according to Susan Markham, Senior Coordinator for Gender Equality and Women’s Empowerment, USAID. By 2030, that number will grow to 1.375 billion people age 60-plus; about 16 percent of the world’s population. Older women make up the majority of those over 60, and most live in developing countries.

“Women often outlive men in old age but starting from birth they often have less status, less education, less choice in childbearing, less access to formal employment and are less likely to inherit property,” Bunting said. Yet,“they are more likely to be widowed and to be harmed by traditional practices. Older women are also more likely to experience poverty, as well as social exclusion and many forms of violence.” Age, gender, caste and class are just a few of the many factors working against older women.

Correcting the gender imbalance includes helping women gain better access to education, healthcare, and giving them more of a voice within their communities, Markham said. “We must take older women into account as we work to end poverty and build strong, emergent democracies. It can’t happen without them.”

Kate Bunting, CEO of HelpAge International, a non-profit focusing on the rights of older adults worldwide, and sponsor of the panel said, “despite increasing evidence on how discrimination affects women in older age and the challenges they face, older women are almost entirely absent from the picture.”

credit: Staffan Scherz

credit: Staffan Scherz

She said most measurements of gender-violence — including domestic, sexual and emotional violence — only include women aged 15 to 49. Gaps in research and policy on violence in later life are representative of a host of broader issues surrounding lack of inclusion of age into gender concerns, according to HelpAge. Often, older women and protections for their rights fall through the cracks.

Her Excellency Maria Cristina Perceval, Permanent Representative of Argentina to the UN and forceful advocate for human rights, noted that over a billion women worldwide have been victims of violence in the past 20 years. “This is the real dimension of inequality.”

She reminded the audience that 33 years have elapsed since the UN convention went into force against all forms of discrimination against women, 20 years since the adoption of the Beijing Platform, and 13 years since the adoption of the Madrid international Action Plan on Aging. “These instruments contain concrete commitments to eradicate violence against women; in some cases specifying older women as one of the most vulnerable groups and to protect them from abuse, neglect and violence.”

Governments have an obligation to protect the rights of women, including older women, from any form of abuse and to investigate and prosecute those who commit these acts, including those which result from traditional practices and beliefs,” she added.


Violence against older adults primarily affects women, not just because women outlive men, but also because there is more violence directed against women, according to Kathy Greenlee, Assistant Secretary for Aging, US Department of Health and Human Services.

She recounted the story of one woman who fled an abusive husband, only to be swindled out of her life savings and isolated from family and community by the very caregivers she had hired to help her. “She talked about the loss of pride and trust in others, the impact of emotional abuse. And it was devastating.”

This woman, said Greenlee, was a U.S. veteran, who asked, “don’t I deserve better?”

Greenlee uses this story as a way to grapple with the significance of the work, in terms of both numbers and impact. “I believe that the abuse of older people – women and men – is simply an outrage against humanity,” she commented. “It is so disrespectful to all of us, as humans, to face this in old age.”

It’s easy to just see older women as a category, but they’re not, she added. “Older women are us.” It’s the women you see in the mirror, whether she’s with you today or arrives in 20 years. It’s us. It’s a phase of life that presents opportunity as well as vulnerability. In this regard, I consider it an outrage that it happens.”

Greenlee reiterated the need for older women to be part of the conversation about gender violence.


There’s a need for more data, and more innovative approaches to create resilience among survivors, she said. That requires the global community to talk about this seriously and come together to find common solutions. Those on the panel, and those in attendance are committed to making that happen before another 20 years passes.

The entire panel discussion is available on UN-TV (runs 1 hour, 15 minutes)

 

The Upside of ADHD

Lara Cheslow photoThis guest post is written by Lara Cheslow, a cell biology and neuroscience university graduate. Lara has researched in a neuroscience lab and currently teaches math and science. She aspires to become a science writer to keep learning and reporting on exciting new research developments.

Attention deficit hyperactivity disorder is the most commonly diagnosed psychiatric illness in US school children. According to the most recent CDC report, 11% of kids between the ages of 4 and 17 have been diagnosed with ADHD at some point in their lives. Research suggests that ADHD and ADDers may have lower-than-average levels of dopamine, the neurotransmitter that helps us zero-in on important things around us. ADHD is usually treated using stimulants, like amphetamines, that are classified as Schedule II drugs alongside methamphetamines and morphine. These medications, like Adderall, Concerta, and Focalin, spike their users’ dopamine levels, which allows them to tune out buzzing peripheral details that otherwise vie for attention.

ADHD is characterized by inattention, hyperactivity, and impulsivity. According to Yale associate professor of public health, Dr. Jason Fletcher, adults with persisting childhood ADHD are “much less likely to be employed at age thirty, and those who [have] jobs [earn] over thirty percent less each year than individuals who [are] not diagnosed with ADHD.”

Outside structured settings, however, the apparent curse can actually be a blessing. Thomas Edison is the historical poster boy for retrospectively-diagnosed ADHD. An inquisitive but unfocused student, he was branded “addled” and dull by his grade school teacher. Edison lasted three months in grade school before his mother insisted on homeschooling him. Free to pursue his insatiably varied interests at home, Edison read voraciously while honing his mechanical and chemical skills.

David Neeleman, the founder and head of JetBlue Airways, is a proud ADDer. Though he barely scraped by in college, the CEO now uses his disorder as an asset. “If someone told me you could be normal or you could continue to have your ADD, I would take ADD,” says Neeleman. “My ADD brain naturally searches for better ways of doing things.”

So if the three pillars of ADHD (inattention, hyperactivity, and impulsivity) equal creativity, energy, and curiosity in less rigid settings, why do we characterize these traits as a disorder? A new neurological study conducted by Washington University’s Dr. Dan T.A. Eisenberg suggests a biological justification for the retention of these traits in our collective gene pool, despite their clash with structured lifestyles. Dr. Eisenberg examined genetic differences among nomadic and settled factions of Ariaal tribesmen in northern Kenya. Specifically, the research correlated nourishment and the presence of the DRD4/7R allele, which is linked to ADHD and codes for a less sensitive dopamine receptor. Among roaming nomads with a dynamic lifestyle, those with the less responsive receptor were better nourished. Settled and organized farmers, on the other hand, were better nourished if they lacked the insensitive receptor gene.

For individuals who flit smoothly between changing landscapes, ADHD can be an evolutionary advantage. Like the agrarian Ariaal lifestyle, our lives are generally structured, so it’s no surprise that the disorder is at odds with many of our activities. In school especially, ADHD symptoms can be disruptive and derailing to teachers organizing a regimented curriculum for their classes. But when a round peg doesn’t fit a square hole, which one needs to change?

written by Lara Cheslow

Healthstyles on January8, 2015: One Nurse’s Ebola Story

WBAIOne of the major stories in 2014 was the Ebola crisis. Actually, the story’s beginnings in West Africa received relatively little media attention, despite the rapid increase in new cases in Liberia, Sierra Leone, and Guinea throughout the spring and summer, with initial death rates ranging from 50% to 90%.

Then a nurse and a physician who had become sick with Ebola in West Africa were flown to the U.S. for treatment. They survived, but Donald Trump got media attention with his call to ban other American health care workers with Ebola from returning to the U.S. for treatment.

On September 30th, the CDC reported that the first case of Ebola had been diagnosed in the U.S. Thomas Eric Duncan was a Liberian man who arrived by plane in Dallas, Texas, at the end of September to visit his finance. Prior to leaving Liberia, he had been with people who had Ebola. Duncan became ill, and was initially sent home after being seen at Dallas Presbyterian Hospital. But he got sicker and subsequently tested positive for Ebola. He was hospitalized at Dallas Presbyterian and died on October 8th. He was the first person to die of Ebola in the US.

The media frenzy began.

The diagnosis of two people coming into the U.S. with Ebola and two nurses becoming ill after exposure in a U.S. hospital led to an escalation of media coverage of Ebola that bordered on fear-mongering. It led to calls for banning flights from West Africa and quarantining all Americans who have contact with people with Ebola. But the initial media coverage brought hope to those who knew that bringing public attention to the health, humanitarian, and economic impact of Ebola in West Africa was essential to get the West’s attention and resources to bear on the crisis. Unfortunately, American media’s attention was on Ebola in America, with only limited attention to what was going on in West Africa.

The media is fickle. One minute media coverage of one issue is unrelenting and terribly redundant. The next minute, there’s no attention to the issue. It’s been six weeks since Craig Spencer was discharged from New York’s Bellevue Hospital and over two months since a case of Ebola was diagnosed in this country. What media coverage of what is happening in Liberia, Sierra Leone and Guinea have you seen?

The silence is deafening, as we approach 20,000 cases of Ebola in West Africa, almost 8000 of whom have died, compared with 4 cases in the U.S. and one death of a man who was diagnosed late in the illness.

On Thursday, January 8, 2015, at 1:00 PM, Healthstyles once again focuses on the story of Ebola. Host Diana Mason, RN, PhD, interviews nurse Deborah Wilson, RN, a nurse who spent six weeks in Foya, Liberia, caring for patients at an Ebola Treatment Center run by Doctors Without Borders. Her return to the U.S. coincided with the two Dallas nurses being diagnosed with Ebola, so she experienced the paranoia of friends, family, and colleagues whose fear of becoming infected was out of proportion to the realities of the disease. Mason and Wilson reflect on what happened in 2014 and what the implications are for 2015.

So tune into Healthstyles on January 8th, from 1:00 to 1:55 PM on WBAI, 99.5 FM, New York City, or at http://www.wbai.org. To listen to the interview any time, click here:

Public Health and Vaccinations

This guest post is by Steven M. Gorelick, PhD, Distinguished Lecturer in the Department of Film and Media Studies at Hunter College, City University of New York.

Epidemiologists have long known that international airports are especially problematic spaces when it comes to transmission of infectious diseases. What we often forget, though, in the midst of CNN’s seemingly scheduled weekly public panic, is that in the case of the most common communicable diseases, vaccinated people virtually never contract any of the viruses for which effective vaccines have long been available, regardless of whether they are exposed in airports, stadiums, classrooms, or public restrooms.

But what about the social and public health impact of those who choose not to be vaccinated?

That is the question that leads me to strongly recommend this short, riveting account of what happened in March, 2014 — at an unnamed US international airport — when four unvaccinated men were exposed to what turned out to be the B3 measles strain, the predominant strain circulating in the Philippines and in the United States in early 2014. The article appears in the December 19, 2013, edition of Mortality and Morbidity, a weekly compendium of the best work in applied epidemiology published by the Center for Disease Control, and is included in the journal’s short section “Field Notes.”

At first glance, the short article presents as an elegant and informed piece of detective work by epidemiologists and infectious disease specialists, a few paragraphs that took months of work. Read it and see how much inspired thought and investigation went into figuring out how four men who found themselves in the same airport earlier this year ended up contracting a specific variety of a disease that is rarely seen these days in the United States.

But there is something more ominous in this case study. It also reads as a powerful cautionary tale of the perils that very well might be revived in a world in which we allow decades of work by immunologists and other scientists — work that rendered many diseases such as mumps, measles, rubella, whooping cough, polio and others virtually invisible — to be swept aside by the wave of anti-vaccination and anti-evidence lunacy peddled by respected scientific and medical luminaries like  Jenny McCarthy and Michele Bachmann.

It is important to note that vaccination rates are — for reasons including poverty and inadequate public health infrastructure– lower in developing countries. The extraordinary leaps here in the United States must not be allowed to obscure the very different and disturbing story in other parts of the world. Much effort is being made to remedy this inexcusable discrepancy. More, though,  needs to be done. We may be polio free, but many parts of the world are not.

But guess what? The epicenter of the new vaccine denial isn’t in the developing world. It’s right here in the United States. And I don’t think it’s simply  a coincidence that many in this new generation of denialists — relatively young, evidence-hostile,  self-anointed, “immunologists in their own mind” — weren’t around to watch  the legs of a kid across the street start to wither overnight from the scourge that was polio;  never knew that mumps, on rare occasions, could cause hearing loss and, on less rare occasions, cause miscarriages in pregnant women; weren’t watching in the 1950s when an annual average of greater than 500,000 cases and nearly 500 deaths from measles (mostly young children) were reported in the United States.

You will hear some hyperventilating vaccine denialists claim that mainstream science simply dismisses all their concerns, but this straw man grievance doesn’t hold. Any serious immunologist will be the first to tell you that each vaccine does indeed have some very serious possible side effects. But they will quickly add something the denialists seem not to hear, that the incidence of such side effects is negligible and substantially  outweighed by the debilitating and infinitely more widespread effects of the illness itself.

And while the problem of vaccine manufacturing quality control — another denialist trope — has been successfully and aggressively dealt with, an early and all-too-real 1950s nightmare known as “The Cutter-Incident”,  resulting from one lab’s fatally botched manufacture of a shipment of  Salk’s inactivated poliovirus vaccine, continues to haunt the world view of many opponents of vaccine. Denialists seem unaware or uninterested in the even more rigorous and highly regulated manufacturing process that is closely monitored on a batch by batch basis.

Didn’t the denialists notice that the serious scientific community did not completely and categorically dismiss each and every concern they  raised in  the early days of the controversy. Points raised about the effects of thimerosal, a mercury-containing preservative that was at one time used in vaccine production, were examined in several large-scale  studies that ultimately could not confirm harmful effects.  Yet  even with this finding, public concern led the CDC and the American Academy of Pediatrics to request that thiomersal no longer be used in manufacture. No serious scientist advocating vaccination will ever say that research has somehow removed all the risk from  the process of manufacturing antigen-based vaccines.

People who think that scientists based primarily in research institutes and universities are instinctively dismissive of controversial claims have not watched scientists work. Those doing gold standard research will drive you crazy with all their non-stop talk about the galling complexity, nuance, and uncertainty of multi-variate research questions and how, while they might be viscerally skeptical about a given claim,  they are loathe to completely dismiss any possibility until they can do so with very solid statistical confidence.

Many people would, I think, be surprised at the extent to which the formal scientific research system of journals and peer review  constantly — and yes, sometimes to the annoyance and frustration of the scientists — initially rejects numerous papers submitted to prestige journals because the authors have not convincingly disproven alternate hypotheses for the causal link they are touting. I wish I could get serious airline miles for each letter received by researchers in just this calendar year that included something like the following  hypothetical and fictional language:

“The evidence you cite for a direct causal link between the controlled use  by adolescents between the age of 12 – 17 of sub-cutaneously injected monoredepharbodopitoritol and subsequent substantial reduction in acne symptoms is intriguing, certainly leaning strongly in the direction of a possible causal link that appears unlikely to occur by chance. Here, though, is the problem. A number of other explanations exist in the literature for how and why even severe cases of acne will spontaneously improve between the ages of 17 – 19.

These include the  hypothesized effect of  grape juice consumption, a sudden change in home location that may eliminate  hypothesized environmental and climatological causes of acne such as cold and rainy weather, and changes in niacin consumption that are hypothesized to ameliorate severe acne symptoms in subjects of Mediterranean and Sub-Saharan Africa descent.  We would like you to resubmit the article after you have more persuasively  and confidently rejected these alternate explanations with a reasonable degree of statistical confidence.”

Will somebody please tell me I am slipping into hopeless catastrophic thinking and pull me back. Now.

I need some optimism here.

Tell me I’m wrong and that science and inference and probability are more widely understood than I think. Tell me that the withdrawn and discredited “evidence” reported by Andrew Wakefield, whose medical license was revoked for fraud,  is not still being cited on the talk show circuit as evidence. Tell me that serious, caring parents are not learning the basics of immunology from a second-rate actor on a third-rate talk show.  Tell me that no one, not one single person, who finds themselves struggling with a child’s mental illness has even listened to any of Tom Cruise’s brilliant and erudite lectures on the biological and neurological action of serotonin uptake inhibitors.

And most of all, can someone — anyone — gently assure me that we will not be so fully engaged in the fight against all sorts of global, 21st century geo-political threats that we let a bunch of old legacy diseases, long consigned to the dustbin of public health, sneak back in through a side entrance simply because we ignored the growing influence of anti-vaccine crusaders  who couldn’t explain the difference between a virus and bacteria if it bit them in the keister.

Healthstyles on December 11: Choosing Wisely and Women’s Economic Development

WBAI

There’s an old saying that “women hold up half the sky”. But around the world, women–and thus their families–are living in poverty with little access to the education that can help them to make a decent living and promote the health of their families. A longstanding international development practice has targeted investments in women’s enterprises, particularly in small businesses and agriculture. These investments have involved partnerships among public, private and philanthropic sectors. But one nurse is advocating that its time to invest in the education and work of female nurses and midwives in low income countries–and that doing so would not only be a wise investment in women’s education and economic development, but could also strengthen local health systems and reduce maternal and infant mortality.

This week’s Healthstyles program opens with producer and co-host Diana Mason, PhD, RN, FAAN, talking this nurse about her new approach to women’s economic development in low resource countries. The nurse is Marla Salmon, ScD, RN, FAAN, Professor of Nursing and Global Public health, and Senior Visiting Fellow at the Evans School of Public Affairs at the University of Washington. She is also a member of the Institute of Medicine where she has worked on developing this idea and building multi-sector support for it. You can listen to the interview here:

The second half of Healthstyles focuses on unnecessary care. The United States spent between $158 billion and $226 billion on overtreatment in 2011. This overtreatment includes unnecessary tests and procedures that can be harmful and costly. For example, pregnant women who deliver in a hospital are often put on continuous electronic monitoring of fetal heart rate ostensibly to ensure that the soon-to-be-born baby is not in distress. But the monitoring means that the laboring woman is unable to move around, which can slow down the labor, and misinterpretation of the monitoring can lead to unnecessary inducement of labor or Caesarean sections that can jeopardize the health and outcomes for both the mother and the infant.

So why do we do these unnecessary tests and procedures and how do we know what is unnecessary? Choosing Wisely is designed to help the public identify which tests and procedures should be questioned if recommended by a provider. On the second half of Healthstyles, Diana Mason discusses the problem of unnecessary care and the Choosing Wisely initiative with Daniel Wolfson, MHSA, Executive Vice President of the ABIM Foundation that developed Choosing Wisely; Karen Cox, RN, PhD, FAAN, Chief Operating Officer of Mercy Children’s Hosptial in Kansas City, MO, and the chair of the American Academy of Nursing’s Task Force for selecting nursing’s list of Choosing Wisely recommendations; and Lisa Woodward, Vice President of Nursing Education at Doctors Hospital at Rennaisance in Edinburg, Texas, and Co-leader of the South Region for the Texas Action Coalition that is involved in promoting the use of the Choosing Wisely list throughout the state.

You can listen to the segment on unnecessary care and Choosing Wisely here:

So tune in for Healthstyles on Thursday, December 11, 2014, on WBAI in New York City at 99.5 FM or online at wbai.org.

Healthstyles is sponsored by the Center for Health, Media & Policy at Hunter College, City University of New York.

 

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