Debating medicalization of Female Genital Mutilation/Cutting (FGM/C) : learning from (policy) experiences across countries

Background: Although Female Genital Mutilation/Cutting (FGM/C) is internationally considered a harmful practice, it is increasingly being medicalized allegedly to reduce its negative health effects, and is thus suggested as a harm reduction strategy in response to these perceived health risks. In many countries where FGM/C is traditionally practiced, the prevalence rates of medicalization are increasing, and in countries of migration, such as the United Kingdom, the United States of America or Sweden, court cases or the repeated issuing of statements in favor of presumed minimal forms of FGM/C to replace more invasive forms, has raised the debate between the medical harm reduction arguments and the human rights approach. Main body: The purpose of this paper is to discuss the arguments associated with the medicalization of FGM/C, a trend that could undermine the achievement of Sustainable Development Goal 5.3. The paper uses four country case studies, Egypt, Indonesia, Kenya and UK, to discuss the reasons for engaging in medicalized forms of FGM/C, or not, and explores the ongoing public discourse in those countries concerning harm reduction versus human rights, and the contradiction between medical ethics, national criminal justice systems and international conventions. The discussion is structured around four key hotly contested ethical dilemmas. Firstly, that the WHO definition of medicalized FGM/C is too narrow allowing medicalized FGM to be justified by many healthcare professionals as a form of harm reduction which contradicts the medical oath of do no harm. Secondly, that medicalized FGM/C is a human rights abuse with lifelong consequences, no matter who performs it. Thirdly, that health care professionals who perform medicalized FGM/C are sustaining cultural norms that they themselves support and are also gaining financially. Fourthly, the contradiction between protecting traditional cultural rights in legal constitutions versus human rights legislation, which criminalizes FGM/C. Conclusion: More research needs to be done in order to understand the complexities that are facilitating the medicalization of FGM/C as well as how policy strategies can be strengthened to have a greater de-medicalization impact. Tackling medicalization of FGM/C will accelerate the achievement of the Sustainable Development Goal of ending FGM by 2030

Bringing the OpenMI to LIFE Progress Report No. 4 - 31st March 2008 – 30th September 2008

The Water Framework Directive demands an integrated approach to water management. This requires the ability to predict how catchment processes will behave and interact in response to the activities of water managers and others. In most contexts, it is not feasible to build a single predictive model that adequately represents all the processes; therefore a means of linking models of individual processes is required. This is met by the FP5 HarmonIT project’s Open Modelling Interface and Environment (the OpenMI). The purpose of this project is to transform the OpenMI from a research output to a sustainable operational Standard. It will build the capacity to use the OpenMI and will demonstrate it under operational conditions. It will also develop, test and demonstrate the future support organisation for the OpenMI. Finally, information about the OpenMI will be disseminated to users

Hydrogen-powered road vehicles : the health benfits and drawbacks of a new fuel

Because of the political, social and environmental problems associated with dependency on fossil fuels, there is considerable interest in alternative energy sources. Hydrogen is regarded as a promising option, particularly as a fuel for road vehicles. The Dutch Energy Research Centre (ECN) recently published a vision of the future, in which it suggested that by 2050 more than half of all cars in the Netherlands could be running on hydrogen. A switch to using hydrogen as the primary energy source for road vehicles would have far-reaching social consequences. As with all technological developments, opportunities would be created, but drawbacks would inevitably be encountered as well. Some of the disadvantages associated with hydrogen are already known, and are to some degree manageable. It is likely, however, that other drawbacks would come to light only once hydrogen-powered cars were actually in use. With that thought in mind, and in view of the social significance of a possible transition to hydrogen, it was decided that the Health Council should assess the positive and negative effects that hydrogen use could have on public health. It is particularly important to make such an assessment at the present early stage in the development of hydrogen technologies, so that gaps in existing scientific knowledge may be identified and appropriate strategies may be developed for addressing such gaps. This report has been produced by the Health and Environment Surveillance Committee, which has special responsibility for the identification of important correlations between environmental factors and public health

Application of social media in the environment and health professional community

The purpose of the EU FP6 funded coordination action HENVINET was to create a permanent network of environment and health professionals. The main outcome is a networking portal (http://www.henvinet.eu), based on the concepts of social media to support communication between professional stakeholders in the environment and health fields. Its aim is to enable sharing of relevant information in an innovative and interactive manner to eventually support policy making. A social networking tool is not necessarily a typical platform for communication in the professional context, or between scientists and decision-makers. The aim of this paper is to look upon the use of social media in relevant professional communities in the light of the HENVINET experience, and to reflect on the acceptance and usefulness of such a new approach

Drug therapy: dose-response relationship of oral mesalazine in inflammatory bowel disease.

Mesalazine is widely used in the treatment of inflammatory bowel disease. Little is known about the dose-response relationship and about possible dose related side effects. In ulcerative colitis higher dosages of mesalazine (3 g) are more effective in maintaining a remission than lower dosages (1.5 g). In mild to moderately active ulcerative colitis, studies also indicate that higher dosages might be more effective in inducing remission. Dose-comparing studies in Crohn's disease are even more sparse, but the available results indicate higher efficacy at higher dose levels. None of the known side effects of mesalazine are clearly dose-related. A pH-dependent release system, however, can cause a sudden release of high doses of mesalazine. Consequent peak levels in serum have been implicated in mesalazine induced nephrotoxicity. In conclusion, despite the current practice of using increasing dosages of mesalazine in inflammatory bowel disease, both efficacy and safety have been established tentatively

Mapping EORTC-QLQ-C30 to EQ-5D-3L in patients with colorectal cancer

AIMS: The primary aim of this study was to perform a mapping of the EORTC-QLQ-C30 scores to EQ-5D-3L for the SIRFLOX study; a large dataset of patients with previously untreated liver-only or liver-dominant metastatic colorectal cancer (mCRC). A secondary aim was to compare the predictive validity of existing mappings from EORTC-QLQ-C30 to EQ-5D-3L conducted in other cancers. METHODS AND MATERIALS: Questionnaires (completed within 529 patients) were used in a linear mixed regression to model EQ-5D-3L utility values (scored using the UK tariff) as a function of the five function scores, nine symptom scores and the global score from the EORTC-QLQ-C30 questionnaire. A Tobit regression was also performed. The mean EQ-5D-3L values for the SIRFLOX trial were calculated and compared with predicted EQ-5D-3L values derived using published. RESULTS: The linear mixed regression model provided a satisfactory mapping between the EORTC-QLQ-C30 and the EQ-5D-3L, whilst the Tobit model did not perform as well. When utilities from the SIRFLOX data were calculated with previously published mapping studies, three out of five studies performed well (<10% mean difference). LIMITATIONS: The main limitation of the study was the lack of meaningful observations post-progression (67 paired observations). For this reason, we were unable to test whether the mapping holds by disease stage. Additionally, although the study adds to the literature of mappings to the EQ-5D-3L, it is not known how results would differ using the EQ-5D-5L. CONCLUSION: This study is the first of its kind in liver-only or liver-dominant mCRC, and mCRC in general. The mapping constructed showed a good fit to the data and provides practitioners with an additional mapping between EORTC-QLQ-C30 to EQ-5D-3L using a large dataset (529 patients, 707 paired observations). The study also confirmed the generalisability of mappings published by Proskorovsky, Kontodimopoulos and Longworth to liver-only or liver-dominant mCRC

A critical study of the translations of Gottfried's Tristan by Hermann Kurz, Karl Simrock and Wilhelm Hertz

There have been many surveys of the general reception of the Tristan story in the nineteenth century and the countless versions which it inspired including Richard Wagner's music-drama. The present study examines the nineteenth-century literal translations which made the Middle High German form of the story available again. Gottfried von Strassburg's text underwent a stylistic transformation during each transition into modern German. Modern and medieval modes of poetic expression were different enough to force the translators to take up a definite attitude to the problem; compromise was difficult. The early translators, Hermann Kurz and Karl Simrock, were faithful to the letter of the original, but perhaps too much spellbound by its external form to convey to the modern reader its essential grace. In the later versions, a second one by Hermann Kurz and one by Wilhelm Hertz, both the original diction and the original structure were altered to meet modern aesthetic requirements. In all cases the narrative survived, but not the tone of Gottfried's composition. A detailed examination of the language of each version shows the elements which brought about the change in tone. A study of the features rejected and the features retained reveals which qualities of the original were valued by the modern translators. As indicators of the modern opinion of Tristan and as the means by which Gottfried von Strassburg reached the public of the mid-nineteenth century, the versions form an important part of the history of the Tristan story in modern times. The versions examined include the unpublished, fragmentary second attempt by Hermann Kurz, from manuscripts in the Reutlingen Heimatmuseum.<p

Short-wavelength sensitive opsin (SWS1) as a new marker for vertebrate phylogenetics

BACKGROUND: Vertebrate SWS1 visual pigments mediate visual transduction in response to light at short wavelengths. Due to their importance in vision, SWS1 genes have been isolated from a surprisingly wide range of vertebrates, including lampreys, teleosts, amphibians, reptiles, birds, and mammals. The SWS1 genes exhibit many of the characteristics of genes typically targeted for phylogenetic analyses. This study investigates both the utility of SWS1 as a marker for inferring vertebrate phylogenetic relationships, and the characteristics of the gene that contribute to its phylogenetic utility. RESULTS: Phylogenetic analyses of vertebrate SWS1 genes produced topologies that were remarkably congruent with generally accepted hypotheses of vertebrate evolution at both higher and lower taxonomic levels. The few exceptions were generally associated with areas of poor taxonomic sampling, or relationships that have been difficult to resolve using other molecular markers. The SWS1 data set was characterized by a substantial amount of among-site rate variation, and a relatively unskewed substitution rate matrix, even when the data were partitioned into different codon sites and individual taxonomic groups. Although there were nucleotide biases in some groups at third positions, these biases were not convergent across different taxonomic groups. CONCLUSION: Our results suggest that SWS1 may be a good marker for vertebrate phylogenetics due to the variable yet consistent patterns of sequence evolution exhibited across fairly wide taxonomic groups. This may result from constraints imposed by the functional role of SWS1 pigments in visual transduction