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Immediate skin-to-skin contact advised for premature newborns by WHO

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The World Health Organization has changed its stance on “kangaroo care” for premature or small newborns who are clinically unstable, now recommending they have this skin-to-skin contact before incubation



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23 November 2022

A baby in a neonatal intensive care unit is held by its mother

Jill Lehmann/Getty Images

Premature or low-birth-weight babies who are clinically unstable should have skin-to-skin contact, known as kangaroo care, before incubation, according to updated guidance from the World Health Organization (WHO).

“The guidelines apply to all babies except those that need mechanical ventilation,” says Harish Chellani at the Vardhman Mahavir Medical College in India.

Around 15 to 20 per cent of newborns globally are premature – born before 37 weeks – or have a low birth weight, below 2.5 kilograms, which can make them clinically unstable. This is partly defined as needing intravenous fluids or having an unhealthy breathing or heart rate.

Since 2015, the WHO had recommended that such babies were incubated until they became clinically stable and only then receive kangaroo care. This was based on research that examined the care of newborns in hospital, with the results suggesting that having kangaroo care post-incubation cuts the risk of death by 40 per cent compared with incubation alone.

The new advice follows a trial with more than 3200 low-birth-weight infants and their mothers who gave birth in hospitals in five African or Asian countries.

Chellani and his colleagues compared babies who received immediate, prolonged kangaroo care before incubation with those who had limited skin-to-skin contact after incubation.

The babies who had immediate kangaroo care that continued for about 17 hours a day until they were discharged were 25 per cent less likely to die within one month than those who were incubated first.

This 25 per cent drop occurred on top of the previously mentioned 40 per cent fall. Outside this 17-hour window, the babies were in an incubator.

Kangaroo care may boost a baby’s immunity and lower stress.

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The Guardian view on NHS strikes: a last resort and a cry of despair | Editorial

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Industrial action can have many causes, but there are two responses available to governments – negotiation or confrontation. Which path ministers take depends on a calculation about public opinion. Sympathy with the strikers will encourage compromise; suspicion that their demands are excessive permits intransigence.

Frontline health workers are generally held in high esteem, and the Covid pandemic reinforced national affection for the NHS. That sentiment will extend to support for striking nurses in England, Wales and Northern Ireland, but compassion will compete with anxiety about patient care. Mindful of that balance, the government has adopted a stance of calibrated intransigence, signalling readiness to talk, but not about the main issue – pay.

The government’s offer, a flat rate increase of £1,400 for most health workers, amounts to a real terms cut, given double-digit inflation. The Royal College of Nursing says that its members have suffered a 20% fall in incomes since 2010. The union is asking for a 5% pay rise on top of inflation.

The Department of Health and Social Care says public sector pay restraint is unavoidable in times of straitened national finances, and that the health service has been treated with relative largesse. Those arguments would carry more authority if constraints on the Treasury weren’t a result of the government’s own colossal mismanagement of the economy, and if the public sector was not still suffering from the effects of the last dose of Conservative austerity.

There is little flex in budgets because Liz Truss’s wild fiscal experiments ruined Britain’s credibility on financial markets. And there is less capacity to make do with less in the NHS because its staff have endured stress and falling living standards for years.

Those grievances were set aside during the pandemic – a commitment recognised in ritual clapping on the nation’s doorsteps. But applause doesn’t pay bills, as the nurses’ banners say. Critics of the strike might try to cast industrial action as an abdication of the duty to care, but the greater threat to safety is corrosion of working conditions and staff stretched too thin. Patients suffer most when nurses are forced out of the profession and none can be recruited.

The same applies to ambulance drivers, who have also voted to strike. These are workers with a vocation. They know better than their critics what is at stake when they withdraw their labour. That they feel compelled do it is a measure of desperation. It expresses fear of penury and also anger at the state of a health service where government reliance on the willingness of underpaid staff to go the extra mile has turned to cynical exploitation.

Whether the public sees it that way is hard to predict, not least because the mood around strikes and the government reaction will be shaped by disputes in other sectors. A winter of discontent will test the patience of people whose services are withdrawn. It will also compound the growing sense of national stagnation under a government that is weak and directionless.

Either way, the prime minister should not imagine that he can ride out the coming storm or deflect blame for disruptions and stoppages. There is room for debate over the methods by which health workers express their grievances, but little question over where the responsibility lies for a crisis that has been building for 12 years of Conservative government.

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Daily horoscope for December 1, 2022 – New York Daily News

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It might feel like one thing after another today! Romantic Venus in Sagittarius is forming a rare opposition to red-blooded Mars in Gemini at 12:28 am EST, creating tension between our wants and needs. Messenger Mercury will then argue with Neptune, making misinterpretation all too easy — luckily, a supportive sextile between Venus and Saturn should help us focus on the things that really matter. The Moon will slip into Aries later on, giving the end of the day an extra flare.

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March 21-April 19

Fabulous opportunities await you out in the great wide world, but more local action might require your attention first and foremost. Venus in your adventurous 9th house is opposing your ruler Mars in your community sector, which could make it seem like you have to deal with rather mundane issues instead of chasing after your heart’s desire. You could be pleasantly surprised when Mars stirs up its own excitement for you after all — don’t hesitate to go out on those adventures.

April 20-May 20

A windfall is appearing on the horizon! It might be easier to make ends meet than you originally anticipated as Venus in your 8th House of Shared Resources finds common ground with Mars in your income sector, which could offer you a few helping hands. Mars could have you spending more than usual, but if you realize you need a bit more cash to get everything you want, Venus wants to bring any necessary assistance your way. Don’t be afraid to ask for help.

May 21-June 20

People probably want the best for you, even if you don’t quite see it at first. Venus in your partnership sector is adding a bountiful touch to your relationships, and you’ll be on the receiving end of her gifts as she opposes heated Mars in your sign. Someone could pinpoint exactly what you need and offer it to you, so be bold about asking for aid if necessary. You’re working extra hard as you host Mars, so it’s okay if others pick up some slack.

June 21-July 22

The cosmos is emphasizing self-care at this time. Venus is in your 6th House of Wellness, doing her best to ease your mind and your body, and this is heightened as she makes a strong opposition to Mars in your subconscious sector. The red planet has been stirring up issues behind the scenes, perhaps resulting in overwhelming insomnia or exhaustion, but Venus is going to do what she can to make sure you’re getting proper rest. You’ve earned yourself a spa day!

July 23-August 22

Pursuing your passions might become something of a group effort. There is a powerful angle between bountiful Venus in your lucky 5th house and energetic Mars in your social 11th house, so while Venus will want to do nothing but indulge, Mars will be bringing other people into the mix. You’ll need to make sure you don’t strong-arm anyone into getting your way. That said, as long as you handle the situation diplomatically, there isn’t any reason you can’t get exactly what you want.

August 23-September 22

Taking it slow right now is easier said than done! Venus in your homey 4th house is giving you the urge to nest and spruce up your living space, but today she is also coming into opposition with Mars, currently in your career sector. A professional matter could demand your sudden attention, forcing you to jump up off the couch and away from your domestic inspiration. Tend to any important issues involving your career or reputation before you get back to lazing around.

September 23-October 22

You don’t have to go far to find happiness today, Libra. Your ruler Venus is dancing through your local 3rd house, bringing exciting experiences right to your front door. That in mind, her rough opposition to Mars in your expansion sector could make it feel like you’re too focused on the old and not enough on the new. Don’t feel bad if you choose to repeat your pleasures rather than seek out new ones. There’s nothing wrong with having established favorites.

October 23-November 21

It’s a good day to count your blessings. Venus in your money sector is doing all she can to indulge you and your wallet, but you might have to deal with a financial issue when she opposes Mars in your intense 8th house. A big bill could arrive, or perhaps someone close needs to borrow some funds, but with Venus involved you’ll probably end up with more than enough to comfortably meet your needs — and those of anyone else. Be reasonable, but generous.

November 22-December 21

Life is presently a matter of give and take. You’re prepared to show off your best side with Venus visiting your sign, but you ought to be careful about who you’re showing that side to. When Venus disagrees with Mars in your partnership sector, you may feel like the playing field isn’t as even as you’d like or that you’re not receiving your fair dues. Be upfront about your needs, but make sure you’re giving as much as you think you are.

December 22-January 19

Your dreams can take you far, but hopefully not at the expense of reality. Venus in your fantastical 12th house is opposing warrior Mars in your responsible 6th house, so even if you feel the urge to tap out, something will most likely call your name in the here and now. Perhaps a co-worker or client creates a problem that only you can solve. Once you take the time to consciously handle the issue, you should be able to get back to daydreaming.

January 20-February 18

Going with the herd might require a bit of extra effort at the moment. In particular, a potent opposition between Venus in your 11th House of Groups and Mars in your 5th House of Personal Passions could create some tension for you. People might request your presence, even as Mars tempts you to focus only on yourself. At least give others a chance — you may realize that they actually have wonderful opportunities to offer you, if only you let them.

February 19-March 20

You can move mountains currently, Pisces — though such feats might have to wait for some domestic duties. It’s easy to show off your talents as Venus tours your professional 10th house, but when she opposes Mars in your home sector, watch out for fires you’ll need to extinguish before you can return to your official duties. If a family member or roommate creates a headache for you, don’t burn yourself out trying to deal with it, but don’t let any issues keep simmering, either.

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‘I lost my retirement, my career, my home’: the HIV laws still criminalising Americans | US news

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Robert Suttle was 30 when he was arrested and imprisoned for the felony of “intentional exposure to the Aids virus”. He had met the man at a gay club on New Year’s Eve 2007 and they had quickly begun a relationship.

Suttle says he disclosed his status as HIV-positive to his partner immediately. However, when the couple separated a few months later, the man pressed charges claiming that Suttle had not disclosed his status. Suttle now views this as “retaliation” over the breakup.

Despite the fact Suttle was on treatment that brought his viral load low enough that he could not transmit HIV to another person, Louisiana police arrested him at his workplace and he was sentenced to six months in prison. The Louisiana law – like many across the US – focused on exposure and not transmission and did not require actual transmission for a conviction to occur.

HIV exposure or transmission is still criminalised in 33 US states under various laws, most of which involve disclosure and exposure. The laws fail to take into account that people like Suttle, on therapeutic medications, can be “undetectable” – meaning the risk of transmitting the virus is almost zero, while the HIV prevention drug PrEP reduces the risk of infection by 99% when taken correctly. Having sex with another person when you are living with HIV can land you with years of prison time even though, thanks to modern science, HIV is no longer a death sentence.

portrait
Robert Suttle. Photograph: Jennifer Doherty

Other HIV laws criminalise acts such as breastfeeding, biting and spitting. Many of these laws were instated in the 1980s, “when people were scared to death of HIV and didn’t know how HIV was transmitted”, explains Catherine Brown, executive director of the Elizabeth Taylor Aids Foundation, which runs the campaign HIV Is Not a Crime. The campaign does not aim to legalize rare cases of malicious contamination but to bring the laws up to date with contemporary science, specifically “U=U” – “undetectable equals untransmittable” – or the fact that HIV cannot be transmitted through saliva. It’s clear that these enduring laws are a result of HIV stigma, adds Brown, because other viruses are not criminalised in the same way.

“If you’re having sex and you know you’re HIV-positive in Louisiana, that is considered intent, it makes you criminally liable,” says Suttle. “We did have sex, so that’s the exposure – but they didn’t look into whether I was on treatment or used a condom. And if people say ‘did you disclose’, it doesn’t matter, because it’s one person’s word against the other’s.”

Although Suttle was incarcerated for six months over a decade ago, he is still paying the price. After leaving prison, he was placed on the sex offender’s register, a fact his neighbors were alerted to via mail notifications listing his “crime” and thus disclosing his HIV-positive status. “Being Black, being gay, being HIV-positive, then being an incarcerated person and a ‘sex offender’ in the conservative south?” he says over Zoom from his home in New York City. “I didn’t know how I was going to move forward.”

The overall number of people arrested under HIV criminalisation laws in the US is not tracked. However, HIV Justice counts at least 2936 cases to date, with the real number probably much higher. According to the Williams Institute, a thinktank at the University of California, Los Angeles, certain groups are disproportionately targeted.

“The data shows that Black transgender women and Black and brown men having sex with men are the two groups these laws disproportionately effect,” says Brown. Before Nevada updated its laws in 2021, for example, 28% of people living with HIV were Black, whereas 46% of convictions for HIV-related laws were against Black people. As of 2022, Black women are 290 times more likely to be on the registry for an HIV conviction than white men. Ten states also have laws specifically targeting sex workers, turning a prostitution charge – often a misdemeanor – into a felony for people living with HIV.

For those prosecuted under these laws, doing prison time or being placed on the sex offenders register can end up affecting their lives more than their diagnosis itself.

“I lost my retirement, my career, my home,” says Ken Pinkela, a former US army lieutenant colonel in his fifties who joined the military when it was illegal to be openly gay. Pinkela was convicted in June 2012 of an alleged aggravated assault for HIV exposure and spent 272 days in the military prison at Fort Leavenworth. Discharged from the military, and with an assault charge on the books (despite a lack of evidence), he struggled to find employment. “Once you’ve been convicted, it never goes away.”

Lashanda Salinas, 41, who was first diagnosed with HIV at 16, was convicted under HIV criminalisation laws in 2007. Her listing on the Tennessee sex offender’s register ranks highly among Google search results for her name.

portrait
Lashanda Salinas. Photograph: Handout

In 2006, Salinas – then on treatment – began a relationship with a man. “I told him I was HIV-positive and asked if he was OK with that and he said he was,” she says. They moved in together and later separated.

“About a month or two after our relationship ended, I’m at my job and a police officer walks in and says: ‘Are you Lashanda?’ I said, ‘Yes, ma’am,’ and she said, ‘You’re under arrest.’ I asked her what I had done and she said: ‘Your boyfriend says you did not tell him that you are HIV-positive and he’s bringing charges against you.’”

In the police car on the way to Nashville, Salinas tried to tell the officer that something wasn’t right; her partner knew she had told him. “But when I got in jail and those doors locked, I realised this is not a prank – this is what he is really doing.”

Salinas ended up doing nearly two months in jail, after accepting a plea bargain of three years’ probation. As in Suttle’s case, the judge did not tell her that upon release, she would be placed on the sex offenders register for 15 years because her crime was a sexual offence. She was required to take sex offender classes, must pay $150 a year to be on the register, and is not allowed around anyone under the age of 18. Her cousin graduates this year and she is unable to attend the ceremony. “I just want a normal life,” says Salinas. “My life is nowhere near normal.”

Since her conviction, Salinas has asked a partner to sign a written document attesting to her disclosure of her HIV status. In future, she says, she would consider videoing a partner as she discloses her status. “That’s the only way I can have some kind of stability so this won’t happen again,” she says.

As Pinkela points out, the laws put pressure on those who are living with HIV to disclose their status before they are ready, or when it might not be safe to do so.

Portrait in uniform
Ken Pinkela. Photograph: Handout

The American Psychological Association also notes the laws can also increase risky behaviour when it comes to HIV and therefore appear to do more harm than good. Brown agrees that these laws are stifling the fight against Aids, citing UNAIDS’s goal of eradicating HIV globally by 2030: “The issue with criminalisation is people are afraid they will be arrested if they test positive. Yet if we have the issue of getting them tested, then we can’t get them into treatment, and that’s a barrier to us ending the epidemic.”

The problem extends far beyond the US. On a global level, HIV Justice Network has recorded 270 arrests across 39 countries over the last three years, although the real number may be closer to 700. Conviction rates were highest in Uzbekistan, Russia and Belarus, followed by the US. Many countries also maintain travel restrictions against people living with HIV, while more than a dozen countries worldwide hold residency bans.

According to Ken Pinkela, who now campaigns against the laws, the work involves educating prosecutors and legislators about contemporary HIV science, as well as the UN’s recommendation for limiting HIV criminalisation to rare cases of intentional transmission, where malicious intent can be proven beyond a reasonable doubt.

S Mandisa Moore-O’Neal, a former civil rights attorney and now executive director at the Center for HIV Law and Policy (CHLP), agrees with this approach. “If we are serious about ending the epidemic, we must update these laws, including repeal if we can ensure that what is created in their place won’t have to be reformed 10 years from now,” she explains. She adds that we should “not fall into the trap” of using one’s undetectable viral load – which can change in a person’s lifetime – as the sole basis for modernizing these laws. “It should be based on a specific intent to transmit and actual transmission.”

In April 2022, a federal court ruled that the Pentagon’s restriction policies regarding service members with HIV were outdated and unconstitutional. Pinkela hopes this indicates the same approach may be applied to more state laws in the near future.

Since the Elizabeth Taylor Aids Foundation launched HIV Is Not A Crime in 2020, six states have updated their laws, with the help of awareness-raising from celebrities such as Andy Cohen and Paris Jackson. However, in November 2022, Pennsylvania’s governor, Tom Wolf, signed a new law charging people with a second-degree felony and up to 10 years in jail if they knew or “should have known” that they had a communicable disease after transmitting it to someone else. Nonetheless, “we’re continuing on campaigning in seven states in 2023”, says Brown.

In the meantime, what is devastating, Pinkela says, is that someone in the US reading this who has recently been diagnosed with HIV may be finding out for the first time that these laws exist. They may be wondering whether they can engage in sexual relationships at all. He reminds them that HIV is not a death sentence and advises them to talk to their doctor and get to know the laws in their area using resources such as HIV Justice and CHLP.

“Those three letters just still seem to invoke such fear,” says Pinkela of enduring HIV discrimination. He hopes that seeing the faces of healthy people living with HIV like himself helps get the message across that it should not be viewed differently from other chronic health conditions.

For Salinas, advocacy work has been a way to reclaim self-esteem and a sense of identity when it has been so difficult to get a job. “I got to the point where my voice needs to be heard, to affect somebody, somewhere, somehow. If not for me, I want these laws changed for the people behind me.”

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