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More to be done to boost maternal well-being: Masagos, Health News & Top Stories

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Couples with low birth weight babies and pregnant women with gestational diabetes need more support, and more can also be done to ensure the mental health and well-being of mothers, said Second Health Minister Masagos Zulkifli yesterday.

This extra support will provide a better environment for the children here to grow up in, as the first few years are crucial for the child to build a strong foundation, he said.

Mr. Masagos, who is also Minister for Social and Family Development, spoke at the third forum of Temasek Shophouse Conversations.

Around 700 registered participants from the public, private and municipal sectors took part in the virtual event, which was organized by the Temasek Foundation in cooperation with the KK Women’s and Children’s Hospital (KKH).

Mr Masagos said Singapore has achieved good international rankings for life expectancy and the lowest child mortality rates.

“We can do more in some areas: go further upstream where we can, focus our resources on specific development paths that deserve more attention,” he said.

He found that one in ten babies in Singapore are born with low birth weights and are therefore at a higher risk of developing physical and mental health problems such as obesity and attention deficit hyperactivity disorder later in life.

Maternal malnutrition and health issues, mother’s age and premature birth are key factors that contribute to low birth weight, he said.

The Growing Up in Singapore Towards Healthy Outcomes (Gusto) study also found that one in five pregnant women is at risk of developing gestational diabetes (GDM).

Gusto is a longitudinal study started here in 2009 to examine how pregnancy and early childhood diseases affect the health and development of women and their children.

Pregnancy diabetes, also known as gestational diabetes, is a condition of abnormal or elevated glucose levels during pregnancy.

Mothers and their children are then at higher risk of metabolic disorders and children are at higher risk of developing obesity.

With this in mind, KKH initiated the Temasek Foundation’s GDM Care Program to better care for mothers with GDM, said Mr Masagos.

“But we shouldn’t just see this as a medical problem. This is an area where society as a whole is stressful,” he added.

The Gusto study found that maternal depression during pregnancy affects the development of the fetus’ brain microstructure, which can lead to anxiety and mood disorders later in the child’s life.

Therefore, according to Mr Masagos, it is important to strengthen social support for mothers and expectant mothers, and everyone can get involved.

For example, during pregnancy and postpartum examinations of pregnant women and mothers, health workers actively monitor symptoms of low mood and depression, while social services and community groups can also keep an eye out for such symptoms.

In the workplace, employees and colleagues who are pregnant or returning to work after maternity leave can be offered more psychological and emotional support, for example through more flexible work arrangements.

“At home and in the community, we can support our spouses, friends, relatives and neighbors who are pregnant and may be suffering from psycho-emotional stress,” Masagos said.

He also provided information about the inter-agency task force that aims to promote maternal health and child welfare. The formation of the task force was announced during the debate on the Ministry of Health’s budget earlier this year.

The task force is developing a five-year strategy for comprehensive care for women and their children, starting before conception and up to the child’s 18th birthday.

Mr. Masagos outlined the Task Force’s plans.

First, the task force will translate evidence-based findings into policies and programs to address upstream risk factors. This includes the review of upstream preventive health measures for women and children or the investigation of how young couples can be better prepared and equipped for parenthood.

Second, the participating governments and agencies are reviewing their service delivery processes and will examine how health authorities can strengthen collaboration with organizations in the social and educational sectors.

Third, the Task Force will use public education to raise awareness and engagement to shape positive behaviors.

Mr. Masagos said: “If we (children) want to have the best start in life, our support must also extend to the mother … It makes sense that our entire society invests in this cause because it benefits everyone. “

Women’s Health

First, do no harm? Medicine’s unbelievable, sometimes horrific treatment of women

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Hippocrates, the founder of modern medicine, believed that women were controlled by their uterus. The father of modern gynecology, James Marion Sims, experimented with enslaved black women without anesthesia in the mid-19th century and believed they felt less pain than white women. (His statue stood in New York’s Central Park for more than a century before it was removed in 2018.) Doctors claimed that women’s suffrage would harm the fragile bodies and diminished minds of women. Such examples cast a hideous shadow on “first, do no harm”.

The history of medicine is as social and cultural as it is scientific, and male dominance is firmly anchored in its foundations. But even the author Elinor Cleghorn, who last year dealt with the history of women’s relationships with medicine, was surprised “how deliberate and insidious it was,” she says. “Biological theories about female bodies have been used to strengthen and perpetuate restrictive societal ideas about women.”

Doctors could tell me what was happening in my body, but they couldn’t tell why I got systemic lupus or why I am more prone to it as a woman

Cleghorn’s new book, Unwell Women, enumerates a litany of ways in which women’s minds and bodies have been misunderstood and misdiagnosed throughout history. From the wandering uterus of ancient Greece (the idea that a displaced uterus caused a lot of women’s diseases) and the witch trials of medieval Europe, to the onset of hysteria to modern myths about menstruation, she lays out the incredible and sometimes terrible treatment of women for millennia in the name of medicine.

A former Oxford researcher with a background in feminist culture and history, Cleghorn meticulously constructs an often terrifying framework to show how and why the patriarchal medical world is so harmful to women, especially underserved women and women of color. And Unwell Women shows how the legacy of disenfranchisement and discrimination continues today, resulting in women being underrepresented in medical studies, women’s pain being psychological or emotional, and an inadequate, sometimes hostile system that women tend to be Offers antidepressants and sedatives as a referral for further diagnosis and more targeted care.

Cleghorn was inspired to write the book after years of being discharged from doctors before she was finally diagnosed with systemic lupus, a difficult-to-diagnose disease that is nine times more common in women than men. (Pop star Selena Gomez has spoken openly about her struggles with the complex, incurable disease.)

“I was trying to understand why none of my doctors could really explain much about it. They could tell me what was happening in my body, but they couldn’t tell why I got it or why I am more prone to it as a woman. I started digging through the history of medicine and finding women who really felt like me in case studies. ”(Cleghorn began writing the book during the lockdown, relying on online medical archives and the extensive ones Wellcome Library digital collections. “Fortunately for me, the men who wrote about women’s bodies love to write a lot about them,” she chuckles.)

There is a quiet radicalism in using women’s knowledge of themselves to transform the culture of medical inequality

These “related women” brought Cleghorn to learn about other chronic, incurable diseases that affect more women than men. One of these diseases is endometriosis, which affects an estimated one in ten women worldwide and whose diagnosis takes an average of seven to nine years. Although it was named in the 1920s, all of its diagnostic secrets remain to this day, notes Cleghorn. “Endometriosis was described by a doctor in the 1920s as the enigma of etiology, and we still don’t know what causes it. Tracking this lack of progress over 100 years has been a real example of how little progress we have made. I wanted to go back and find out why these conditions are still surrounded by so many question marks and where these gaps, injustices and discrimination actually come from. “

Today’s booming wellness industry, which, according to Cleghorn, benefits most from women and whose popularity is related to the prevalence of such confusing diseases, has fallen into the breach. “The industry knows that women with these health problems are being let down by traditional medicine, so it adapts to being caring, listening, and seeing you as an individual. A lot of language in the wellness industry strikes me as frightening the 19th century with its conditions and syndromes. “

Throughout the book, Cleghorn highlights the increasing effects of race, access, and privilege on gender. “In the UK, we have faced our health failures in black, Asian and ethnically diverse women, who have far greater health disparities than white women, especially in reproductive health,” she notes. But she is dismayed by the “very reassuring” response from the British government. “It’s annoying and shocking that there is no more money, strategy, funding, research, and urgent prioritization of issues like the maternal mortality of black women.”

It is probably the first time in history that women’s subjective experiences and voices are used. This is an important start because women are not a monolith

Parallel to this story of frustrations and injustices, there is an empowering alternate story of resistance and beneficial contributions from women. She quotes the pioneering American doctor Mary Putnam Jacobi, who in the 1870s denied the idea that women need rest during menstruation. “At that time, men doctors only used anecdotes and guesses, but Putnam Jacobi used the subjective knowledge of women to conclusively refute them. There is a quiet radicalism in using women’s knowledge of themselves to change the culture of medical inequality. “

Cleghorn relies on this with a final chapter entitled Believe Us. For a long time women were considered to be unreliable narrators of their own bodies. Although modern medicine today enables women to educate themselves about their bodies (a luxury that has been banned for centuries) and offers women the opportunity to enter the medical community, Cleghorn believes that understanding women’s health continues to be a problem remains.

But getting started with a solution is easy, she says. “It’s really important to prioritize women’s voices. I don’t think all of this is a grand patriarchal conspiracy – implicit, unconscious bias is so ingrained, even in the very establishment of doctor-patient interaction. When I have the opportunity to speak freely without feeling rushed or judged, I feel better cared for. “

The UK government’s recent women’s health strategy, in which they seek evidence from women about their treatment by the health system, is groundbreaking, she notes. “It is probably the first time in history that the subjective experiences and voices of women are used. This is an important start because women are not a monolith. “

Cleghorn hopes her book will help anyone who has had a difficult or painful health experience “feel validated and valued because it can be so isolating, so demoralizing, and dehumanizing. But having a disease also makes sense insofar as you are part of that production of very important knowledge. I hope readers can relate to this story, which we hope we can change now. ”- Wächter

Unwell Women, by Elinor Cleghorn, is published by Weidenfeld & Nicolson

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Women’s Health

Plant-based diet appears to offer protection against hypertension and preeclampsia

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A plant-based diet appears to offer significant protection for rats bred to become hypertensive on a high-salt diet, scientists report. If the rats become pregnant, the whole grain diet also protects the mothers and their offspring from fatal preeclampsia.

While we’ve all heard about avoiding the salt shaker, an estimated 30-50% of us have significant increases in blood pressure in response to high salt intake, percentages even higher and more effective in blacks.

The two new studies provide further evidence that the gut microbiota, which contains trillions of microorganisms that help us digest food and play a key role in regulating the response of our immune system, also plays a role in the unhealthy response to salt, so the researchers from The Medical College of Georgia and the Medical College of Wisconsin report in the journals ACTA PHYSIOLOGICA and Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health.

The results provide further evidence of the “potential power” of nutritional interventions in improving gut microbiota and, consequently, our long-term health, says Dr. David L. Mattson, chairman of the MCG Department of Physiology, Georgia Research Alliance Eminent Scholar in Hypertension and senior author of the two studies.

They result from the unexpected observation that the protection works even on a well-established model of salt-sensitive hypertension: the salt-sensitive dahl rat.

As the name suggests, these rodents are bred to develop high blood pressure and progressive kidney disease on a high-salt diet. In 2001, the Medical College of Wisconsin shared its colony of Dahl SS rats fed a milk-based protein diet with Charles Rivers Laboratories. When the rats arrived at Charles River Laboratories, based in Wilmington, Massachusetts, they were switched to a grain-based diet. Both diets are relatively low in sodium, although the protein or casein-based diets actually contain a little less salt.

It was soon discovered that when high salt content was added to their food, the relocated rodents developed significantly less hypertension and associated kidney damage than the rat colonies remaining in Wisconsin.

People ordered them and used them with the idea that they would study hypertension and they developed next to none. “

Dr. David L. Mattson, chairman, MCG Department of Physiology

More than a decade of research has documented these differences, write Mattson and his colleagues at MCG and MCW, and have now shown that developing salt-sensitive hypertension is not just about sodium consumption.

“The animal protein enhanced the effects of the salt,” says Mattson, a long-time hypertension researcher who, along with Dr. Justine M. Abais-Battad, Physiologist and Postdoc Dr. John Henry Dasinger, joined MCG from Wisconsin two summers ago.

“Because the gut microbiota is implicated in chronic diseases such as high blood pressure, we have assumed that dietary changes shift the microbiota to mediate the development of salt-sensitive hypertension and kidney disease,” they write in the journal ACTA PHYSIOLOGICA.

The intestinal microbiome is supposed to metabolize and break down what we eat and transform it into a form that gives us nourishment, says first author Abais-Battad, and conversely, it reflects what we eat.

When they looked at the microbiomes in the rats, “Of course they were different,” she says.

They sequenced the genetic material from both rat colonies and found they were “virtually identical”, but their response to a high-salt diet was far from, Mattson says.

As expected at the time, the Wisconsin rats developed kidney damage and inflammation – both indicators of high blood pressure – but on the same high-salt diet, the Charles River rats experienced significantly less of these unhealthy results. The marked differences they saw in their microbiota reflected the difference in the incidence and severity of the disease.

When given the protected rats some of the signature gut microbiota of Wisconsin rats via a stool transplant, the rats experienced spikes in blood pressure, kidney damage, and the number of immune cells that migrate to the kidneys, organs that play a big role in regulating blood pressure by regulating blood pressure Fluid balance, in part by determining sodium retention. It also changed the makeup of their microbiota.

But when they shared the protected rats’ microbiota with the Wisconsin rats, it didn’t have much of an impact, possibly because the new microorganisms couldn’t thrive in the face of the animal protein diet, the scientists say.

Preeclampsia is a potentially fatal problem during pregnancy in which the mother’s blood pressure, which was previously normally normal, increases and organs such as the kidneys and liver show signs of damage. There is evidence that even on a low-salt diet, Dahl salt-sensitive rats tend to develop preeclampsia.

To study the effects of diet in this scenario, the Dahl SS rats were kept on their respective plant or animal protein diets, which in turn are each relatively low in salt, and both groups had three separate pregnancies and births.

Whole-grain diet rats were protected from preeclampsia, while about half of the rats dieted on animal cheese developed this significant pregnancy complication, says Dasinger, lead author of the preeclampsia study. They experienced a significant increase in the amount of protein secreted in their urine, an indicator of kidney problems that worsened with each pregnancy; increased inflammation, a driver of high blood pressure; increased pressure in the renal artery; and showed significant signs of kidney destruction when organs were examined at follow-up. They died from problems like stroke, kidney disease, and other cardiovascular problems.

“This means that it is helpful during pregnancy, but also for their long-term health and can protect their children, if mom is careful what she eats during pregnancy,” says Dasinger. The scientists note that this reinforces the message that doctors and scientists have been sending expectant mothers for decades.

They plan to study more directly the effects of diet on the offspring and see if the protection is passed on to the babies through breast milk, Dasinger says. Since they know that the function of immune cells is influenced by diet, they also want to take a closer look at the function of the emerging immune cells and already have some evidence that T cells, drivers of the immune response, are a factor in the development of preeclampsia.

The work that Abais-Battad, Dasinger, and Mattson have already done shows that a major difference between the various diets is that the protein-based diet leads to the production of more pro-inflammatory molecules, while the plant-based diet actually appears to suppress these factors .

They also study the impact of diet on the renin-angiotensin system, which helps regulate blood pressure. You also want to better dissect the blood pressure increasing bacteria and the factors they produce.

High blood pressure is the largest modifiable risk factor for developing cardiovascular disease and according to the latest guidelines from groups like the American Heart Association that say a systolic or peak of 120+ is elevated and peaks of 130-139 high blood pressure in the first Stage, almost half of us are hypertensive. Diet – including a high-salt diet – is one of the most important modifiable risk factors for high blood pressure and cardiovascular disease, according to scientists. It has been found that people and animals with hypertension alike have an imbalanced, less diverse gut microbiota than people with normal blood pressure.

Source:

Medical College of Georgia at Augusta University

Journal references:

  • Dasinger, JH et al. (2021) The dietary protein source contributes to the risk of developing maternal syndrome in the salt-sensitive Dahl rat. Pregnancy hypertension. doi.org/10.1016/j.preghy.2021.04.002.
  • Abais-Battad, JM, et al. (2021) Dietary influences on the gut microbiota of the Dahl SS rat and its effects on salt-sensitive hypertension and kidney damage. ACTA PHYSIOLOGICS. doi.org/10.1111/apha.13662.
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Women’s Health

Mississipi’s People Should Choose its Abortion Laws

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By
Lynn Fitch

June 14, 2021 6:27 p.m. ET

A clinic escort at a women’s clinic in Jackson, Miss., May 20.


Photo:

Rogelio V. Solis / Associated Press

Jackson, miss.

When the Supreme Court hears from the parties in the Dobbs v Jackson Women’s Health Organization case in its next term, the arguments will concern the constitutionality of an abortion law in Mississippi that protects life after 15 weeks of gestation. At stake is the right of the people to speak up through their elected leaders on the protection of the endangered life and health of women.

The Supreme Court recognized a right to an abortion in 1973 and the court made it clear that this right is not absolute. But that’s not the end of the story. The people act for legitimate interests through their elected lawmakers who pass laws and their elected governors who sign them. The elected officials protect women’s health by making sure women have the information to make informed decisions and receive adequate medical care. They protect the sanctity of life by, for example, banning abortion simply because of the disability of a baby.

States also enact laws to protect the environment and consumers; support religious expression, free speech and the right to bear arms; promote access to education and health care; to define criminal offenses and set criminal penalties and much more. In any case, the legislature must carefully weigh the competing and legitimate interests of the people it represents. The elected executive, which is also accountable to the people, ensures that the interests of the people are enforced and controls the law by either signing the law or exercising its veto.

According to the wisdom of the Founding Fathers, the Supreme Court was given the task of providing guideposts to the legislative bodies to help them safeguard legitimate interests without violating fundamental constitutional rights.

When it comes to regulating abortion, the nearly 50-year history of the jurisdiction since Roe does not provide a clear guide. Rules based on the viability of the unborn child are fluid. It has long been considered impossible to have a baby outside the uterus before 28. Now we read more and more about babies born at 21 weeks of age who survive and go home to celebrate their first Christmas with their families.

The rapid progress in medical technology has made the measure of economic efficiency increasingly unstable. If we know anything about the advancement of science, medicine will not retreat; it will continue to move forward. All the more important is the question before the Supreme Court in Dobbs: Can the people through their state legislation impose restrictions on abortion – restrictions that protect the legitimate interests of the state – against this uncertain and crumbling line called viability?

As the Mississippi attorney general, it is my duty to defend the laws of my state, and I enjoy doing that here. We are simply asking the court to reaffirm citizens’ right to the protection of their legitimate interests and to clarify how they can do so.

Ms. Fitch is the Mississippi Attorney General.

Copyright © 2020 Dow Jones & Company, Inc. All rights reserved. 87990cbe856818d5eddac44c7b1cdeb8

Appeared in the print edition of June 15, 2021 as “Abortion and the People”.

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