Tag Archives: history

When private meets public sector: the history of a tangled relationship

Interaction between the private and public sectors can be a politically charged process in the UK, not least when the contracts that underpin such a partnership go wrong. Here are some recent examples of cooperation between public bodies and private companies that have caused controversy.

Scottish schools

A private finance contract to build a series of Edinburgh schools became a costly embarrassment after the new buildings were found to be faulty and one partly fell down. A report into the deal found that the contractors had used substandard concrete to build the schools, all of which were considered unsafe and in need of substantial repair. But a review by the council found that the financing behind the Edinburgh Schools Partnership (ESP) was not to blame. ESP is a private finance initiative (PFI), a popular form of funding for projects whereby a company pays the upfront construction cost and is then paid back over time by the government, which effectively pays the constructor to lease the property. However, the review did say there were aspects of the way in which the PFI methodology was implemented that “increased the risk of poor quality design and construction”.

Virgin Health

Private firms scooped almost 70% of the 386 contracts to run clinical health services put out to tender in England during 2016-17. They included the seven highest-value contracts, worth £2.43bn between them, and 13 of the 20 most lucrative tenders. Last year, Virgin Care, owned by Richard Branson sued six clinical trusts after it lost an £82m bid. It secured an out-of-court settlement. It also went on to win £1bn worth of contracts.

London Underground PPI

Bob Kiley, tube boss in the early 2000s

Bob Kiley, tube boss in the early 2000s, described the PPP financing model for transport improvements in London as ‘fatally flawed’. Photograph: Channel 4

A series of public-private partnerships (PPPs) were signed by the last Labour government in 2002 and 2003 to upgrade and carry out maintenance on London’s tube network. Described at the time by then tube boss Bob Kiley as “fatally flawed”, by 2010 the process had unravelled. In exchange for carrying out complex work on an ailing network, the businesses behind the contracts would receive a monthly payment that would increase or decrease depending on whether they hit targets for measures such as train cleanliness and reliability of services. The process became mired in endless rows over costs; the biggest contractor, Metronet, eventually went bust and the other, Tube Lines, was bought out.

East coast rail

For the second time in a decade, the secretary of state for transport has been forced to bail out a private rail company running the vital east coast mainline. In 2009, the then Labour government took the line under public control after its private operator, National Express, couldn’t pay out the £1.4bn promised under the contract. The previous holder of the franchise, GNER, had already been stripped of the route after its US parent firm was struck by financial troubles. Last year, the government waived the majority of payments due under Stagecoach’s £3.3bn contract to run the London to Edinburgh route. Whenever the merits of rail privatisation are debated, the east coast line is a key argument for those in favour of nationalisation.

Yemen’s cholera outbreak now the worst in history as millionth case looms

The cholera epidemic in Yemen has become the largest and fastest-spreading outbreak of the disease in modern history, with a million cases expected by the end of the year and at least 600,000 children likely to be affected.

The World Health Organization has reported more than 815,000 suspected cases of the disease in Yemen and 2,156 deaths. About 4,000 suspected cases are being reported daily, more than half of which are among children under five, who account for a quarter of all cases.

The spread of the outbreak, which has quickly surpassed Haiti as the biggest since modern records began in 1949, has been exacerbated by hunger and malnutrition. While there were 815,000 cases of cholera in Haiti between 2010 and 2017, Yemen has exceeded that number in just six months.

Save the Children has warned that, at the current rate of infection, the number of cases will reach seven figures before the turn of the year, 60% of which will be among children. In July, the International Committee of the Red Cross predicted there would be 600,000 suspected cholera cases in the country by the end of the year.

Tamer Kirolos, Save the Children’s country director for Yemen, said an outbreak of this scale and speed is “what you get when a country is brought to its knees by conflict, when a healthcare system is on the brink of collapse, when its children are starving, and when its people are blocked from getting the medical treatment they need”.

Kirolos said: “There’s no doubt this is a man-made crisis. Cholera only rears its head when there’s a complete and total breakdown in sanitation. All parties to the conflict must take responsibility for the health emergency we find ourselves in.”

More than two years of fighting between the Saudi-led coalition and Houthi rebels has crippled the country, causing widespread internal displacement, the collapse of the public health system, and leaving millions on the brink of famine.

When I see a mother lose her baby because of cholera, it makes me so angry

Dr Mariam Aldogani, Save the Children

The crisis was exacerbated when sanitation workers whose salaries had gone unpaid went on strike. This meant garbage was left on the streets, which was then washed into the water supply. It is estimated that 19.3 million Yemenis – more than two-thirds of the population – do not have access to clean water and sanitation.

The government stopped funding the public health department in 2016, meaning many doctors and hospital staff have not received salaries for more than a year. Healthcare has since been provided mainly by international organisations, the efforts of whom have been hampered by the conflict.

The spread of the disease has nonetheless slowed. At the beginning of the most recent outbreak, in May this year, between 5,000 and 6,000 new cases were detected daily. That rate has since dropped to just under 4,000 a day. The mortality rate has also declined, from 1% at the beginning of the outbreak to 0.26% now.

“Whatever decline we’re seeing now is due to the heroic efforts of workers at the scene,” said Sherin Varkey, the officiating representative of Unicef Yemen.

Varkey said the situation would not be solved until there was peace in the country.

“There are no signals that give us any reason for optimism. We know that both parties to the conflict are continuing with their blatant disregard of the rights of children,” he said. “We’re at a cliff and we’re staring down and it is bottomless. There seems to be no hope.”

A worker is pictured in a government hospital’s drug store in Sana’a, Yemen

A worker is seen at a government hospital’s drug store in Sana’a, Yemen. Photograph: Khaled Abdullah/Reuters

Cholera should be easily treatable with oral rehydration salts and access to clean water. But Mariam Aldogani, Save the Children’s health adviser for the city of Hodeidah, said conditions in the country had made this very difficult.

Aldogani said: “All the NGOs are trying to increase the knowledge of how to prevent the disease, because it’s preventable, you have to boil the water. But if you don’t have money to buy gas, and you have to walk a long way to get the wood, how can you boil the water?”

Aldogani, who has been a doctor since 2010, said witnessing the suffering of her patients was deeply painful. “I saw one young man, he had cholera and severe dehydration. He was in a coma and he died in front of his mother. We tried our best, but he came too late and she was crying, and I cried. It makes me angry. When I see a mother lose her baby, especially a stillbirth, she waits for this baby for a long time and then she loses it because of cholera, it makes me so angry.

“The war is a big problem for us, it’s a wound. But with the cholera, you have the wound and you put salt in the wound. It hurts. I hope this war can be stopped. We need peace for the children of Yemen. Our situation before the war was not good, but it was not like this.”

The History of Cat Food: Why You’re Probably Feeding Your Cat Wrong

Let’s take a trip through time.

We’ll visit prehistoric African landscapes, ancient Egyptian cities, Victorian streets featuring the sound of cat’s meat men hawking their wares, the unique economic situation of World War II, and the business boom of post-war America.

The unifying thread woven through all of these curious scenes is, as you guessed, cats – and the food they eat.

Their natural dietary needs haven’t changed, either. Nevertheless, humans always have to do things the hard way. Ideas about feline nutrition have transformed quite a bit over the years.

We’ll begin our journey over 12,000 years ago. These are the days of felis silvestris lybica or the African wildcat. This small cat living in Africa, the Near East, and around the Arabian peninsula, is the ancestor of the domesticated cat. This hardy hunter lives primarily off of small rodents, supplementing their diet with small mammals, bugs, birds, reptiles, and amphibians. As obligate carnivores, their diet is comprised of meat – although they’re known to occasionally eat jackalberries.

While dogs were domesticated much earlier (think as much as well over 20,000 years earlier) by hunter-gatherers, the domestication and keeping of cats is always the sign of advanced civilization. Yep, you read that right. You may use this fact in your next argument with a dog person.

Wildcats wandering by a settlement would have noticed the abundance of rodents feasting on the grain stores, twitched their whiskers, and dove in. Thanks to their fantastic value as rodent management tools, these cats quickly earned their place in society. People not advanced enough to harvest and store surplus grain were of little interest to wildcats. Similarly, without grain stores in need of protection, these hunter-gatherers wouldn’t have recognized their practical value.

As is the case with so many things, the story of feline domestication is closely linked to food and diet. Humans need grains and cats need meat. Our different and mutually beneficial dietary needs were the basis for the entire relationship between cats and people.

Continuing onward through the ages of cat-worshipping ancient Egypt and the reverent Romans, cats continued to live on a similar diet – they hunted snakes, rats, mice, and other pests. People may have given them treats to encourage the cats to stick around, but for the most part, these early cats fended for themselves.

This continued for thousands of years. Throughout most of history, cats have been full-time employees in an agrarian society. Although they were valuable companion animals as well, cats were hunters and pest controllers.

The Medieval era was a very turbulent time for cats. Among Muslims, cats were beloved pets. But in Christian Europe, they were seen as devilish creatures – still, of course, profoundly linked to their proclivity to hunt rodents. Medieval printing pioneer William Caxton is credited with this statement that in a sense likens the cat to the devil while addressing its predatory nature:

“The devyl playeth ofte with the synnar, lyke as the catte doth with the mous.”

By the 1700’s, however, European cats were no longer persecuted and again rose to high esteem for their ability to get rid of hated brown rats, which hit Europe in the 18th century.

Through the middle of the 19th century, cats were viewed as independent animals capable of essentially feeding themselves. However, it was around this time that you’ll see evidence that there was a new idea going around.

In 1837, French writer Mauny de Mornay declared that:

“It is… thought wrongly that the cat, ill-fed, hunts better and takes more mice; this too is a grave error. The cat who is not given food is feeble and sickly; as soon as he has bitten into a mouse, he lies down to rest and sleep; while well fed, he is wide awake and satisfies his natural taste in chasing all that belongs to the rat family.”

But what would that well-fed cat eat? Probably a lot of horse meat – cheap meat often sold for pets by street vendors. At the time, “complete and balanced” commercial food didn’t exist even for dogs. The first food made just for dogs hit the market in 1860. James Spratt introduced Patent Meal Fibrine Dog Cakes that year. They were a hit in England and their popularity quickly caught on in America, kicking off the spread of the pet food industry.

It was in the same year that Scottish doctor Gordon Stables stated that:

“…cat ought to be fed at least twice a day. Let her have a dish to herself, put down to her, and removed when the meal is finished. Experience is the best teacher as regards the quantity of a cat’s food, and in quality let it be varied. Oatmeal porridge and milk, or white bread steeped in warm milk, to which a little sugar has been added, are both excellent breakfasts for puss; and for dinner she must have an allowance of flesh. Boiled lights are better for her than horse-meat, and occasionally let her have fish.”

So we see what the cultured Victorian cat might eat: oatmeal and bread with milk and sugar for breakfast, followed by organs, horse meat, and fish for dinner. And perhaps some Spratt’s Patent Cat Food. Note, though, that at this time commercial pet food was still viewed as a luxury item. It didn’t become really common until around the 20’s and 30’s.

It was around that time when the first canned cat food hit the market. Most canned cat foods were fish-based and more popular in coastal areas that produced plenty of seafood byproducts.

Well, dry cat food didn’t exist at all until World War II shook up the world economy and forced major changes in production. For one, pet food was classified as a non-essential good. Secondly, metal rationing took a toll on the can production industry, forcing pet food manufacturers to do something different. Production shifted towards an emphasis on dry food and kibble for cats and dogs. 

After the war, dry food established itself as an essential part of pet care. Commercial pet food, in general, was an essential. Human food manufacturers saw the popularity of pet food as a great opportunity to make use of byproducts. Pet food manufacturers utilized clever marketing to convince consumers that table scraps, raw food, and prey were not enough to keep their pets healthy

Today, dry food is the number one most popular type of cat food in the United States.

We’ve gone from the carnivorous diet of felis silvestris lybica, through the rodent-fueled early days of feline domestication and the thousands of years of meat-eating pest control that followed, onward into times of milk, sugar, and horsemeat, and finally concluding with today’s period: one marked by the prevalence of a grain-based diet for cats.

Grain has always been a critical part of the cat’s relationship with people. Humans use grain as a primary food source, harvesting and storing it for future use. Rodents threaten the stores of that grain, attracting cats, who need the flesh of those rodents to survive. Cats keep the pests in check and, so doing, have earned their place in human society.

Dry cat food has been a staple for only about the last seventy years. That’s just about .5% of the history of domesticated cats. Does it really make sense to believe that this new diet – necessitated by wartime restrictions and popularized by the opportunity to make money off of human food byproducts – is truly appropriate for our cats?

The flaws of dry cat food are numerous and manifest in some of the most common health issues affecting cats today: poor dental health, diabetes, and feline urinary tract disease.

Check out Everything You Need to Know About Dry Cat Food and learn more about why you should probably throw out your cat’s dry food today.

Through Wildernesscat, you can learn even more about your cat’s nutritional and lifestyle needs. Armed with that information, you may begin to make choices to effect positive change in your cat’s world. Visit our site to change your cat’s life through dietary changes, nutritional supplements, and other natural care products – all available through Wildernesscat.

Worried your partner might have a bisexual history? Why? | Phoebe Jane Boyd

“Use a condom, the pill, or get an IUD – avoid pregnancy” was the drill from sexual health practitioners who came to speak at my comprehensive school in Kent. There wasn’t much detail or thought beyond, “Some of these boys are going to get some of these girls pregnant before they hit 16 – let’s try to get that down to a lower number than we had last year.”

Thankfully, when it comes to the subject of sexual identity, there’s now more guidance than ever trickling down into the societal subconscious in the west – hopefully in schools, but certainly during publicity rounds for films starring Kelly Rowland and Cat Deeley. While talking about Love By the 10th Date to the New York Post last week, Rowland espoused the importance of knowledge when embarking on a sexual relationship with another: “I can’t tell someone how to feel about dating someone who is bisexual or had a past gay experience, but it’s proper to ask [if they have] in today’s times.”

Women who have sex with women are less likely to get a smear test, because many of us don’t realise we need to

It is “proper” to ask? Maybe it’s unfortunate phrasing, or maybe not being able to hear the tone of voice in which the opinion was offered gives it negative impact, but the sentence rings faintly of suspicion and mild disapproval: “Please submit your history of sex with people of the same gender, and it will then be decided whether or not you are too risky to be intimate with.” That’s how it comes across to this particular someone who is “bisexual or [has] had a past gay experience”, anyway.

Bisexuality just continues to have a bad rep, even though it’s on the rise (according to CNN) … or then again, maybe it’s not on the rise (according to the Verge). Statistics on the spread of sexually transmitted diseases, and which groups of people are spreading them, are easily found (and quickly wielded by those mistrustful of anything beyond heteronormativity), but they can obscure a simple and universal truth that applies to all groups, whether those groups are on the rise or not. And that is: whatever genitalia you and your partner(s) have, you should protect yourselves (condom/dental dam/wash your hands and accoutrement between uses, thank you). Ignoring that fact in favour of “it’s the bisexuals, mostly” is the source of so much harm.

You don’t have to openly identify as bisexual to get the bad side of bisexuality, because it goes beyond the myths of promiscuity, greed and dishonesty still held by some – biphobia also has an impact on physical health. Here in the UK, if you’re a man who’s had sex with another man in the last 12 months, you can’t donate blood (though that stance is currently being reviewed). Women who have sex with women are less likely to get a smear test, because many of us don’t realise we need to – we’re forgotten by the healthcare system, or our needs are misunderstood.

“Gay and bisexual women are at lower risk for HPV,” we confidently tell each other, “we don’t need a smear test.” A lot of us have heard that from our doctors, as well. It was only after seeing a leaflet about the issue from lgbthealth.org.uk during this month’s Cervical Cancer Prevention Week that I realised this was just ignorance.

In 2008, Stonewall released findings that one in 50 lesbian and bisexual women had been refused a smear test, even when they requested one. The 2015 survey on training gaps in healthcare, Unhealthy Attitudes, found that three in four patient-facing staff had not received any training on the health needs of LGBTQ people. Many women get variations of the “use a condom, the pill, or get an IUD – avoid pregnancy” mantra from our doctors to this day, if we don’t declare our gayness or bisexuality as we walk through the surgery door. Sometimes even a declaration is ignored by an uncomfortable practitioner. Straightness is still automatically assumed, unless you’re lucky enough to have a doctor who doesn’t see heterosexuality as the default for everyone they treat.

According to that 2015 Stonewall study, a third of healthcare professionals felt that the NHS and social care services should be doing more to meet the needs of LGBTQ patients, which is encouraging. Knowledge is wanted – needed – to undo the harmful myths that block help and prevent education. And that is what is “proper” (to quote the star of Freddy vs Jason and Love By the 10th Date) – fighting ignorance and biphobia, rather than continuing to be suspicious of sexual histories that might have featured people of the same gender. Whatever and whoever is in our sexual pasts, we must protect each other, and stay informed. That’s healthy.

2016 was the worst year in NHS history – we must fight for its survival

The last 12 months have been the worst in the history of the NHS. Our health system is under pressure like never before. The moment of crisis many warned of has arrived, and it is not clear that the NHS can be retrieved from this state of affairs.

We used to say that flailing A&Es represented an early warning sign that the health service was under pressure. And so that has proven to be. England’s major A&Es are under record strain with black alerts being regularly sounded, and in some instances wards turning patients away. Last year the A&E crisis spread to other sectors.

Ambulance response times have reached critically low levels, with one third of ambulances failing to meet their targets for life threatening callouts. The acute care sector is bulging with unnecessary admissions particularly from over-75s who are presenting themselves at A&Es when they should be cared for by the social care sector that has suffered £5bn of cuts.

In the community, general practice is on life support; as more is demanded of it, the proportion of the NHS budget that goes to primary care has effectively shrunk. Primary care provides 90% of the consultations in the NHS yet only gets 8% of the budget. GPs are leaving, and new entrants are declining to enter general practice.

We once bickered with the Treasury for clawing back millions in Department of Health underspend under Labour. Under the Tories, that is a distant memory as NHS trusts recorded a deficit in excess of £2bn last year.

A government elected to fix near-bankrupted banks has replaced that by bankrupting our hospitals. Idiotic spending decisions in the NHS have been rife.

The most worrying aspect of the government delivering the lowest additional funding increase to the NHS in its history has been the knock-on effect on patients, in terms of treatment and facilities available. More than 13,000 beds have been closed, cutting the capacity of the NHS by 5 million a year.

So bad was 2016, that nine former health secretaries condemned the government for failing to live up to its promises on mental health.

Commissioners and providers alike have had to resort to rationing care to try to balance their books. Unfortunately, this is not always to the benefit of customers or patients.

As the health service’s budget faces greater pressure than before, it is difficult to ignore the toll the intrusion of the free market has taken. Last year, £13bn of healthcare was purchased from non NHS providers (pdf), a 76% increase since 2010. Given that the private sector has a stated goal to make 8%-14% profits from the NHS, can taxpayers really afford this choice?

While the NHS has increased the cash it takes from the private sector by 30% to £558m last year (pdf), waiting lists have soared to an eight-year high. Now, 4 million patients are on waiting lists. This in effect means NHS patients are being delayed in their treatment to make way for wealthy private patients who can afford to skip the queue.

The pressure on our staff has also reached unprecedented levels. Nurses have seen real-term pay cuts since 2010 of over £2,000. Moreover, aspiring nurses will also be denied a bursary to train and this at a time when unfilled nursing vacancies have climbed 600% since 2010. It will not surprise you to learn that applicants for trainee nursing courses have fallen 20% this year.

Likewise, the pressure on junior doctors remains intense. They too have seen real-term pay cuts, as well as an enforced contract.

It remains impossible to meet the demands of the ill-described seven-day NHS until serious funding issues have been resolved, otherwise we are asking our doctors to shoulder the blame for unsafe care.

The continuing media war Jeremy Hunt has waged against doctors has so depleted workforce morale that there are more doctors wanting to leave the NHS than are in training.

It will take a political will only witnessed twice in the last 70 years, 1948 and 1997, to alter the current trajectory on which the NHS is set. The £22bn of efficiencies (a euphemism for cuts), dressed up as sustainability and transformation plans smacks of what was tried with the Nicholson challenge. The National Audit Office has warned that these efficiencies are not possible without causing lasting damage to the NHS’s ability to provide safe care.

We are at a cliff edge. Do we carry on into the unknown with broken funding promises and more cuts or do we cry foul now, and demand a rethink before it is too late?

Let’s pledge in 2017 to fight for its survival. The NHS belongs to us, not the politicians and not the privateers. We cannot trust the government to be its safe custodian. It’s up to each and every one of us to fight for the NHS, otherwise it won’t be there to look after us, never mind the next generation.

Join the Healthcare Professionals Network to read more about issues like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

The mental benefits of art history: why we must keep the A level | Daniel Glaser

Just when we thought we were going to lose art history A level, the government recently announced a reprieve. As Anish Kapoor said: ‘Art and art history are the study of what inspires and guides the poetic in us.’

Studying art can have a dramatic effect on our brain activity, too. What we know changes how we look at things and this is easy to prove in the art world. Scientists have tracked the movements of an art historian’s eyes: the results show how they scan, fixate and linger on particular points of the canvas reveals their skill and is entirely different to someone with an untrained eye.

We know that every area of expertise changes our view of the world, so why concentrate on art historians? Simply because they are the easiest to study, as they’re often focusing on one static image at a time – unlike film critics, racing drivers or neurosurgeons. This may reassure parents worried about the gravitas of the subject. Now they know that if their children immerse themselves in art history, they will develop such a specialist skill it will produce a  change in their brains. Maybe more government ministers should study it, too.

Dr Daniel Glaser is director of Science Gallery at King’s College London

UK already celebrates LGBT History Month | Brief letters

“Asked … whether he thought there should be a gay history month along the lines of black history month, Corbyn said: ‘There could be that…’ ” (Report, theguardian.com, 27 October). Lesbian, Gay, Bisexual, Trans History Month has existed in the UK since 2005 and has a major impact on schools throughout the country. We still celebrate it every February. I should know because I am the CEO of the charity that runs it.
Tony Fenwick
CEO, Schools Out UK/LGBT History Month

I am grateful to Mr Fox for explaining that the EU is putting politics over prosperity (Fox warns on tariffs, 27 October) as I was assuming that they were putting principles over profit.
Steve Shearsmith
Cottingham, East Yorkshire

Surely, with the active use of stents and microchip implants, the medical profession can invent some non-invasive valve procedure that can switch on and off the effect of a vasectomy (Letters, 27 October)? I freely offer this idea to the world as long as it is for ever known as a stop-cock.
Stephen Andrews
(Happily had the snip 30 years ago)
Charlbury, Oxfordshire

With Bake Off the nation’s favourite programme, and 10 million watching the final episode (Royal picnic wins Bake Off crown for teacher, 27 October), is it just a coincidence that, in the same week, Public Health England issue dire warnings about a major increase in Type 2 diabetes?
Peter Davis
Dovercourt, Essex

Bob Dylan did not “change rock from teenage to adult music” (Notes & queries, 27 October). His fans simply got older.
Michael Short
St Leonards-on-Sea, East Sussex

You picture Christ’s tomb (Jesus Christ’s tomb uncovered, Eyewitness, 28 October). No mention of any bones. That would be an atheist’s dream, surely!
Jerry Stuart

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

‘We are writing the history of Zika’: one year into the crisis in Brazil

Two weeks shy of his first birthday, doctors began feeding José Wesley Campos through a nose tube because swallowing problems had left him dangerously underweight.

Learning how to eat is the baby’s latest struggle as medical problems mount for him and many other infants born with small heads to mothers infected with the Zika virus in Brazil.

“It hurts me to see him like this. I didn’t want this for him,” said José’s mother, Solange Ferreira, breaking into tears as she cradled her son.

A year after a spike in the number of newborns with the defect known as microcephaly, doctors and researchers have seen many of the babies develop swallowing difficulties, epileptic seizures and vision and hearing problems.

While more study is needed, Zika-caused microcephaly appears to be causing more severe problems in these infants than in patients born with small heads because of the other infections known to cause microcephaly, such as German measles and herpes. The problems are so particular that doctors are now calling the condition congenital Zika syndrome.

“We are seeing a lot of seizures. And now they are having many problems eating, so a lot of these children start using feeding tubes,” said Dr Vanessa Van der Linden, a pediatric neurologist in Recife who was one of the first doctors to suspect that Zika caused microcephaly.

Zika, mainly transmitted by mosquito, was not known to cause birth defects until a large outbreak swept through north-eastern states in Latin America’s largest nation, setting off alarm worldwide. Numerous studies confirmed the link.

Seven percent of the babies with microcephaly that Van der Linden and her team have treated were also born with arm and leg deformities that had not previously been linked to other causes of microcephaly, she said.

To complicate matters, there are babies whose heads were normal at birth but stopped growing proportionally months later. Other infants infected with the virus in the womb did not have microcephaly but developed different problems, such as a patient of Van der Linden’s who started having difficulties moving his left hand.

“We may not even know about the ones with slight problems out there,” Van der Linden said. “We are writing the history of this disease.”

On a recent day, José lay on a blue mat wearing just brown moccasins and a diaper, his bony chest pressed by a respiratory therapist helping him clear congested airways.

Jose, who has been visited by the Associated Press three times in the last year, is like a newborn. He is slow to follow objects with his crossed eyes. His head is unsteady when he tries to hold it up, and he weighs less than 13 pounds, far below the 22 pounds that is average for a baby his age.

Breathing problems make his cries sound like gargling, and his legs stiffen when he is picked up. To see, he must wear tiny blue-rimmed glasses, which makes him fussy.

Arthur Conceicao, who recently turned one, has seizures every day despite taking medication for epilepsy. He also started taking high-calorie formula through a tube after he appeared to choke during meals.

“It’s every mom’s dream to see their child open his mouth and eat well,” said his mother, Rozilene Ferreira, adding that each day seemed to bring new problems.

Studies are under way to determine if the timing of the infection during pregnancy affected the severity of the abnormalities, said Ricardo Ximenes, a researcher at the Fiocruz Institute in Recife.

Also, three groups of babies whose mothers were infected with Zika are being followed for a study funded by the US National Institutes of Health. The groups include infants born with microcephaly, some born with normal-sized heads found to have brain damage or other physical problems and babies who have not had any symptoms or developmental delays.

At birth, Bernardo Oliveira’s head measured more than 13 inches, well within the average range. His mother, Barbara Ferreira, thought her child was spared from the virus that had infected her during pregnancy and stricken many newborns in maternity wards in her hometown of Caruaru, a small city 80 miles west of Recife.

But Bernardo cried non-stop. The pediatrician told Ferreira that her baby was likely colicky and would get better by the third month. Instead, the crying got worse, so Ferreira took him to a government-funded event where neurologists were seeing patients with suspected brain damage.

“At the end of the second month, beginning of the third, his head stopped growing,” Ferreira said. “Bernardo was afflicted by the Zika virus after all. I was in despair.”

In Brazil, the government has reported 2,001 cases of microcephaly or other brain malformations in the last year. So far, only 343 have been confirmed by tests to have been caused by Zika, but the health ministry argues that the rest are most likely caused by the virus.

The health minister, Ricardo Barros, said there was a drop of 85% in microcephaly cases in August and September compared to those months last year, when the first births started worrying pediatricians. He credited growing awareness of the virus and government attempts to combat mosquitoes through spraying campaigns.

Despite all the problems, some infants with the syndrome are showing signs of progress.

On a recent evening, 11-month-old Joao Miguel Silva Nunes pulled himself up in his playpen and played peek-a-boo with his mother, Rosileide da Silva.

“He is my source of pride,” Silva said. “He makes me feel that things are working out.”

Jeremy Hunt says five-day doctors’ strike will be ‘worst in NHS history’

Jeremy Hunt has accused junior doctors of inflicting “the worst doctors’ strike in NHS history” by announcing a five-day walkout later this month.

In a series of broadcast interviews on Thursday, the health secretary also tried to exploit divisions in the BMA, the doctors’ union, after members rejected a deal over new contracts recommended by the body’s leaders.

Speaking to Sky News, Hunt said: “Patients will be asking why it is that the BMA, who only in May said ‘this deal is a good deal for doctors, a good deal for patients, it’s good for the NHS, it’s good for equality’, are now saying it is such a bad deal that they want to inflict the worst doctors’ strike in NHS history.”

Dr Mark Porter, chair of the BMA council, said the decision to announce five consecutive days of strike from 12 September was made after “long and difficult debates”.

Hunt claimed he was ready to continue negotiations.

Hunt claimed he was ready to continue negotiations. Photograph: Neil Hall/PA

Repeatedly challenged on BBC Radio 4’s Today programme about the level of support for the strike, Porter did not dispute a claim that the council backed five-day strike action by only 16 votes to 14. But he denied that there had been block voting by consultants and GPs to reject the strike.

The latest planned strike action is the first since BMA members rejected the government’s final offer on the contract in a 58% to 42% vote in July, despite a recommendation to accept by the BMA’s leadership.

At the heart of the contract dispute is Hunt’s proposal to change what constitutes “unsocial” hours for which junior doctors can claim extra pay, turning 7am to 5pm on Saturday into a normal working day as part of a Tory manifesto pledge to create a “seven-day NHS”.

There have been five previous walkouts in the dispute, all this year. The longest lasted two consecutive days, and the first all-out strike – including junior doctors working in emergency departments – was held in April. More than 100,000 operations and outpatient appointments have been cancelled so far as a result of industrial action.

Porter said Hunt had left junior doctors with no alternative but to strike again.

He said: “The reason the strikes have been announced is the continued reluctance of the secretary of state for health to do anything other than impose a new contract on junior doctors, a contract in which junior doctors have demonstrated repeatedly that they do not have confidence.”

He also dismissed a claim by Chris Hopson, chief executive of NHS Providers, that the government and employers side had made 73 concessions in the negotiations.

Porter said: “Anyone could count up the number of commas changed and words inserted into a negotiated document containing tens of thousands of words and come up with a number like 73. That number is completely meaningless.”

He added: “It is time to give up the incremental approach of changing a word here or there. That is not going to work as the doctors have comprehensively shown in the latest referendum.”

“The only alternative that junior doctors have been left with is protracted strike action. The reason this dispute has become protracted … is the insistence of the government on moving ahead without agreement.”

Hunt claimed he was ready to continue negotiations.

“The way to solve the honest disagreement is to sit round the table and talk,” he said. “It is cooperation and dialogue and not confrontation and strikes, which is going to cause absolute misery to hundreds of thousands of families up and down this country.”

Hunt claimed there were only two outstanding issues to resolve. “In July they wrote to us and said there were just four outstanding issues of concerns – we have solved two of those four issues to their satisfaction.

“The main sticking point are two issues around pay: Saturday pay and automatic pay rises for part-time workers. Weekend pay rates for doctors are higher than for nurses, police officers, and fire officers. In the 24/7 society that we live in it is very fair and reasonable deal.”

Syphilis is on the rise when it should be confined to history

As the old saying goes, “Laughter is the best medicine. Unless you have syphilis in which case penicillin is the best choice”. The disease, caused by the bacterium Treponema Pallidum and passed on through unprotected oral, vaginal and anal sex, has affected the famous through the ages (Al Capone and, reportedly, Hitler, to name just two).

But syphilis is in no way confined to big names, nor is it a sexually transmitted infection (STI) of the past. The 2016 Public Health England (PHE) syphilis report has shown that infection rates are on the up, with disproportionate rates in London. In 2015, the capital accounted for 56% of all cases in England, with a 22% increase in diagnoses in the year 2014-15. Since 2010 the number of cases of syphilis in Londoners has increased by 163%, with a 22% increase in the year from 2014 to 2015. The borough of Lambeth has the highest rates, closely followed by the City of London and Southwark.

Men who have sex with men (MSM) represented 90% of all syphilis cases in 2015, with a 232% increase in diagnosis over the last five years, said the report. More than half of the MSM diagnosed with syphilis in 2015 were also infected with HIV, and over half additionally tested positive for a separate STI. Rates in heterosexuals remain stable but are higher than ideal.

It’s 2016. Safe sex campaigns and targeted prevention efforts are in place. Sexual health care is free and accessible to both high and low risk groups. So what is going on?

The basic science can’t be sugar coated. More condomless sex leads to higher rates of syphilis, (and gonorrhoea, chlamydia, HIV … the list goes on). Untreated syphilis means the disease continues to be passed on and leads to potentially horrifying long-term medical complications. Action is needed now to address the reasons behind these patterns, particularly in MSM, the group most affected.

In MSM, higher numbers of partners is a key reason behind the heavily inflated rates, compounded by the use of apps such as Grindr, venue based and group sex. The reported increased use of Chemsex (recreational drugs used during sex) is also of concern, lowering sexual inhibitions and making the likelihood of using a condom less likely.

Another worrying phenomenon is “sero-sorting” – when men choose partners who have the same HIV status, in theory negating the need to use a condom. However, this puts both partners at high risk of contracting a plethora of STIs.

So what to do? A wag of the finger and a warning to wear condoms is insufficient. While individuals do need to take responsibility for their personal health, adequate support and infrastructure is essential to achieve better sexual health in the UK and turn around these rising figures.

Progress begins with knowledge, which in turn begins with education. Sex education in schools remains an optional curriculum, with countless young people, particularly teen MSMs, missing out on vital advice needed to keep them healthy.

Sexual health clinics manage the majority of syphilis testing and treatment and so attention must be paid to the massive budget cuts being faced by sexual health and MSM support services. MSM are advised to have regular STI checks (which includes a syphilis test), use condoms and seek support if they are struggling to maintain their personal health. Only robust, accessible and adequately funded services will be able to maintain this level of care. Responsibility is now on the government to ensure the needs of some of its most vulnerable populations are being met.

Further study is needed to look at the complex background to increasing rates of STIs in high risk groups. But while syphilis has been a feature of centuries past, there’s no doubt that its story now should be confined to the history books.

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