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Bird flu could be on the cusp of transmitting between humans − but there are ways to slow down viral evolution

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Workers who are in frequent contact with potentially sick animals are at high risk of bird flu infection. Costfoto/NurPhoto via Getty Images
Ron Barrett, Macalester College Disease forecasts are like weather forecasts: We cannot predict the finer details of a particular outbreak or a particular storm, but we can often identify when these threats are emerging and prepare accordingly. The viruses that cause avian influenza are potential threats to global health. Recent animal outbreaks from a subtype called H5N1 have been especially troubling to scientists. Although human infections from H5N1 have been relatively rare, there have been a little more than 900 known cases globally since 2003 – nearly 50% of these cases have been fatal – a mortality rate about 20 times higher than that of the 1918 flu pandemic. If the worst of these rare infections ever became common among people, the results could be devastating. Approaching potential disease threats from an anthropological perspective, my colleagues and I recently published a book called “Emerging Infections: Three Epidemiological Transitions from Prehistory to the Present” to examine the ways human behaviors have shaped the evolution of infectious diseases, beginning with their first major emergence in the Neolithic period and continuing for 10,000 years to the present day. Viewed from this deep time perspective, it becomes evident that H5N1 is displaying a common pattern of stepwise invasion from animal to human populations. Like many emerging viruses, H5N1 is making incremental evolutionary changes that could allow it to transmit between people. The periods between these evolutionary steps present opportunities to slow this process and possibly avert a global disaster.

Spillover and viral chatter

When a disease-causing pathogen such as a flu virus is already adapted to infect a particular animal species, it may eventually evolve the ability to infect a new species, such as humans, through a process called spillover. Spillover is a tricky enterprise. To be successful, the pathogen must have the right set of molecular “keys” compatible with the host’s molecular “locks” so it can break in and out of host cells and hijack their replication machinery. Because these locks often vary between species, the pathogen may have to try many different keys before it can infect an entirely new host species. For instance, the keys a virus successfully uses to infect chickens and ducks may not work on cattle and humans. And because new keys can be made only through random mutation, the odds of obtaining all the right ones are very slim. Given these evolutionary challenges, it is not surprising that pathogens often get stuck partway into the spillover process. A new variant of the pathogen might be transmissible from an animal only to a person who is either more susceptible due to preexisting illness or more likely to be infected because of extended exposure to the pathogen. Even then, the pathogen might not be able to break out of its human host and transmit to another person. This is the current situation with H5N1. For the past year, there have been many animal outbreaks in a variety of wild and domestic animals, especially among birds and cattle. But there have also been a small number of human cases, most of which have occurred among poultry and dairy workers who worked closely with large numbers of infected animals.
Diagram depicting three stages, the first of bird to bird, the second bird to human and duck, and the third duck to duck and human to human
Pathogen transmission can be modeled in three stages. In Stage 1, the pathogen can be transmitted only between nonhuman animals. In stage 2, the pathogen can also be transmitted to humans, but it is not yet adapted for human-to-human transmission. In Stage 3, the pathogen is fully capable of human-to-human transmission. Ron Barrett, CC BY-SA
Epidemiologists call this situation viral chatter: when human infections occur only in small, sporadic outbreaks that appear like the chattering signals of coded radio communications – tiny bursts of unclear information that may add up to a very ominous message. In the case of viral chatter, the message would be a human pandemic. Sporadic, individual cases of H5N1 among people suggest that human-to-human transmission may likely occur at some point. But even so, no one knows how long or how many steps it would take for this to happen. Influenza viruses evolve rapidly. This is partly because two or more flu varieties can infect the same host simultaneously, allowing them to reshuffle their genetic material with one another to produce entirely new varieties.
Diagram showing a virus with genetic strands derived from two other viruses
Genetic reshuffling – aka antigenic shift – between a highly pathogenic strain of avian influenza and a strain of human influenza could create a new strain that’s even more infectious among people. Eunsun Yoo/Biomolecules & Therapeutics, CC BY-NC
These reshuffling events are more likely to occur when there is a diverse range of host species. So it is particularly concerning that H5N1 is known to have infected at least 450 different animal species. It may not be long before the viral chatter gives way to larger human epidemics.

Reshaping the trajectory

The good news is that people can take basic measures to slow down the evolution of H5N1 and potentially reduce the lethality of avian influenza should it ever become a common human infection. But governments and businesses will need to act. People can start by taking better care of food animals. The total weight of the world’s poultry is greater than all wild bird species combined. So it is not surprising that the geography of most H5N1 outbreaks track more closely with large-scale housing and international transfers of live poultry than with the nesting and migration patterns of wild aquatic birds. Reducing these agricultural practices could help curb the evolution and spread of H5N1.
Back of truck filled with chickens in stacked cages
Large-scale commercial transport of domesticated animals is associated with the evolution and spread of new influenza varieties. ben/Flickr, CC BY-SA
People can also take better care of themselves. At the individual level, most people can vaccinate against the common, seasonal influenza viruses that circulate every year. At first glance this practice may not seem connected to the emergence of avian influenza. But in addition to preventing seasonal illness, vaccination against common human varieties of the virus will reduce the odds of it mixing with avian varieties and giving them the traits they need for human-to-human transmission. At the population level, societies can work together to improve nutrition and sanitation in the world’s poorest populations. History has shown that better nutrition increases overall resistance to new infections, and better sanitation reduces how much and how often people are exposed to new pathogens. And in today’s interconnected world, the disease problems of any society will eventually spread to every society. For more than 10,000 years, human behaviors have shaped the evolutionary trajectories of infectious diseases. Knowing this, people can reshape these trajectories for the better.The Conversation Ron Barrett, Professor of Anthropology, Macalester College This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Get Proactive with Your Eye Health

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Eye Health

Eye Health

(Family Features) Glaucoma, one of the leading causes of permanent blindness, often does its damage silently – with no noticeable symptoms – as vision is lost. Glaucoma affects an estimated 3 million Americans, but most people don’t know they have the condition until it’s revealed in an eye exam. Once vision is lost, it cannot be recovered. If left untreated, glaucoma can cause blindness. That’s why when it comes to detecting and treating glaucoma, the earlier, the better. What is Glaucoma? Glaucoma is an eye disease caused by increased pressure in the eye, which can damage the optic nerve and reduce vision, sometimes making objects look blurry or dark. Early on, most people don’t notice what’s happening, but as glaucoma progresses, you may notice some loss of peripheral vision. By this point, the disease has progressed significantly toward blindness, and treatment options may be limited. Diagnosing Glaucoma Regular eye exams, including specific glaucoma tests, are important for the early detection and diagnosis of glaucoma. If diagnosed early, an eye doctor can recommend treatment to manage glaucoma and help prevent vision loss. “Many patients are surprised to learn glaucoma often presents with no initial symptoms,” said Oluwatosin U. Smith, MD, glaucoma specialist and ophthalmologist at Glaucoma Associates of Texas. “That’s why routine, comprehensive eye exams are so vital. These screenings allow us to detect glaucoma in its earliest stages, often before any vision loss occurs. Early diagnosis and treatment are the cornerstone of effective glaucoma management and it empowers us to take proactive steps to protect your vision.” To check for glaucoma, your eye doctor tests your eye pressure, peripheral vision and overall eye health. The painless screening is the only way to accurately diagnose the condition and determine appropriate treatment. Traditional Glaucoma Treatment For decades, prescription eye drops have been the most common treatment to help lower eye pressure and slow the progression of the disease. Although prescription eye drops are commonly prescribed and generally effective at lowering eye pressure, they can cause challenges and unwanted side effects, including redness, irritation, burning, stinging or difficulty putting them in the eye. In addition, patients may find it difficult to remember to take their eye drops every day, and missing doses – even by accident – can put vision at risk by allowing eye pressure to rise unchecked. When prescription eye drops are unsuccessful at controlling eye pressure or managing glaucoma, an eye doctor may change treatment by prescribing additional prescription eye drops, which can make the challenges and inconveniences associated with prescription eye drops worse. 17370 detail image embed1 Modern Glaucoma Management Takes a Proactive Approach Modern glaucoma management is evolving with a shift from reactive – that is, take prescription eye drops and “watch and wait” until glaucoma progresses before exploring alternative treatment – to proactive management. Taking a proactive approach to glaucoma treatment means choosing a minimally invasive procedure earlier in the treatment journey to help slow the progression of glaucoma and minimize vision loss while reducing the challenges of daily prescription eye drops. “The shift toward a more proactive approach represents a significant advancement in how we manage glaucoma,” Smith said. “Traditionally, we waited for vision loss before a procedural intervention. However, with modern minimally invasive procedures, we can now proactively lower eye pressure and protect the optic nerve much earlier. This approach helps us preserve our patients’ vision and quality of life for longer. I encourage anyone with a glaucoma diagnosis, or those with risk factors, to discuss proactive options with their ophthalmologist.”
  • Procedural pharmaceuticals, or drug delivery systems, may include tiny, FDA-approved implants that deliver medication continuously to help lower eye pressure and protect vision.
  • Micro-invasive, or minimally invasive, glaucoma surgery involves less-invasive procedures, devices (such as stents) and techniques with faster recovery times than traditional surgeries.
  • Laser treatment commonly involves a laser being aimed through a special lens onto the drainage system of the eye, triggering a natural change that helps fluid drain from the eye to lower pressure.
These treatments may be used in combination with prescription eye drops or on their own. If you or a loved one has been diagnosed with glaucoma, visit livingwithglaucoma.com to learn more and help manage the condition.   Photos courtesy of Shutterstock   collect?v=1&tid=UA 482330 7&cid=1955551e 1975 5e52 0cdb 8516071094cd&sc=start&t=pageview&dl=http%3A%2F%2Ftrack.familyfeatures SOURCE: Glaukos

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As views on spanking shift worldwide, most US adults support it, and 19 states allow physical punishment in schools

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Spanking in the U.S. generally ends around age 12, when children become big enough to resist or fight back. Sandro Di Carlo Darsa/Brand X Pictures via Getty Images
Christina Erickson, University of North Dakota Nearly a half-century after the Supreme Court ruled that school spankings are permissible and not “cruel and unusual punishment,” many U.S. states allow physical punishment for students who have misbehaved. Today, over a third of the states allow teachers to paddle or spank students. More than 100,000 students are paddled in U.S. schools each year. Christina Erickson, an associate dean and professor of social work at the University of North Dakota, wrote a book on the subject: “Spanked: How Hitting Our Children is Harming Ourselves.” She discussed the scope of the practice and its effects with The Conversation.

What spanking legislation exists worldwide?

Around the world, 68 countries have banned the hitting of children in any form, including spanking. This movement began in 1979 with Sweden’s ban on all forms of physical punishment, including spanking in any setting, and including in the family home. The pace of change quickened in the early 2000s when more countries adopted similar laws. For example, the legal language of countries like Nepal rests on an emerging definition of children as rights holders similar to adults and as humans worth protecting from harm.
Back view of students sitting at desks inside a classroom.
Spanking in schools is legal in 19 states. Maskot/Getty Images

What are US policies toward spanking?

Each state in the U.S. has its own child abuse laws, and all states, tribes and territories aim to protect children from abuse. But all state laws also allow parents to hit their children if it does not leave an injury or a mark. A typical example is Oklahoma’s definition of child abuse and neglect. It includes an exception that permits parents to use ordinary force as a means of discipline, including spanking, using an implement like a switch or a paddle. However, leaving evidence of hitting, such as welts, bruises, swelling or lacerations, is illegal and considered child abuse in all states. Parental spanking of children is considered unique from other physical violence because of the relational context and the purpose. Laws entitle parents to hit their children for the purpose of teaching a lesson or punishing them to improve behavior. Children are the only individuals in society who can be hit by another person and the law does not regard it as assault. Spanking’s impact on a child is unfortunately similar to abusive hitting. Spanking has been labeled as an “Adverse Childhood Experience,” or ACE. These are events that cause poor health outcomes over the span of one’s life. The practice of spanking also affects parents. Acceptance of the physical discipline of spanking puts parents at risk for the escalation of physical punishment that leads to abuse. Parents who spank their child have the potential to abuse them and be caught in a legal and child protection system that aims to protect children from harm. It is unclear what triggers a parent to cross over from discipline into abuse. Research shows that spanking at a young age, such as a 1-year-old, increases the chance of involvement by Child Protective Services by 33%. Some school districts require permission from parents to allow disciplinary paddling in school, while others do not require any communication. State law does not assure agreement between parents and school districts on what offenses warrant a paddling. Parents may feel they have no alternative but to keep their child in school, or fear reprisal from school administrators. Some students are old enough to denounce the punishment themselves.
In this school district, physical punishment is used only when parents give written permission.

Is spanking considered the same as hitting?

The term spank conceals the concept of hitting and is so commonplace it goes unquestioned, despite the fact that it is a grown adult hitting a person much smaller than them. The concept is further concealed because hitting a child’s bottom hides any injuries that may occur. Types of hitting that are categorized as spanking have narrowed over the years but still persist. Some parents still use implements such as tree switches, wooden spoons, shoes or paddles to “spank” children, raising the chances for abuse. Most spanking ends by the age of 12, partly because children this age are able to fight back. When a child turns 18, parental hitting becomes the same as hitting any other adult, a form of domestic violence or assault throughout the U.S. There is a lack of a consistent understanding of what constitutes a spanking. The definition of spanking is unique to each family. The number of hits, clothed or not, or using an implement, all reflect geographical or familial differences in understanding what a spanking is.

How do US adults view spanking?

People in the United States generally accept spanking as part of raising children: 56% of U.S. adults strongly agree or agree that “… it is sometimes necessary to discipline a child with a good, hard spanking.” This view has been slowly changing since 1986, when 83% of adults agreed with that statement. The laws worldwide that protect children from being hit usually begin by disallowing nonparental adults to hit children. This is happening in the U.S. too, where 31 states have banned paddling in schools. At a national level, efforts have been made to end physical punishment in schools. However, 19 states still allow spanking of children in public schools, which was upheld by a 1977 Supreme Court case. With the slow but steady drop of parents who believe that sometimes children need a good hard spanking, as well as the ban of paddling in schools in 31 states, one could argue that the U.S. is moving toward a reduction in spanking.

What does research say about spanking?

Spanking’s negative influence on children’s behavior has been documented for decades. Spanking seems to work in the moment when it comes to changing or stopping the immediate behavior, but the negative effects are hidden in the short term and occur later in the child’s life. Yet because the spanking seemed to work at the time, the parent doesn’t connect the continued bad behavior of the child to the spanking. An abundance of research shows that spanking causes increased negative behaviors in childhood. Spanking lowers executive functioning for children, increases dating violence as teenagers and even increases struggles with mental health and substance abuse in adulthood. Spanking does not teach new or healthy behaviors, and is a stress-inducing event for the child and the adult hitting them. No studies have shown positive long-term benefits from spanking. Because of the long-standing and expansive research findings showing a range of harm from spanking and the increased association with child abuse, the American Psychological Association recommends that parents should never spank their children.

What are some resources for parents?

Consider these questions when choosing a discipline method for your child:
  • Is the expectation of your child developmentally accurate? One of the most common reasons parents spank is because they are expecting a behavior the child is not developmentally able to execute.
  • Can the discipline you choose grow with your child? Nearly all spanking ends by age 12, when kids are big enough to fight back. Choose discipline methods you can use over the long term, such as additional chores, apologies, difficult conversations and others that can grow with your child.
  • Might there be another explanation for your child’s behavior? Difficulty of understanding, fear or miscommunication? Think of your child as a learner and use a growth mindset to help your child learn from their life experiences.
Parents are the leaders of their families. Good leaders show strength in nonthreatening ways, listen to others and explain their decisions. Don’t spoil your kids. But being firm does not have to include hitting.

Is spanking children good for parents?

Doubtful. Parents who hit their kids may be unaware that it influences their frustration in other relationships. Expressing aggression recharges an angry and short-tempered internal battery that transfers into other parts of the adults’ lives. Practicing calm when with your children will help you be calmer at work and in your other relationships. Listening to and speaking with a child about challenges, even from a very early age, is the best way to make it part of your relationship for the rest of your life. Choose a method that allows you to grow. Parents matter too.The Conversation Christina Erickson, Associate Dean in the College of Nursing and Professional Disciplines, University of North Dakota This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Understanding Hypertrophic Cardiomyopathy

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Hypertrophic Cardiomyopathy (Family Features) Hypertrophic cardiomyopathy, also called HCM, is the leading cause of sudden cardiac death in young athletes, sometimes with no warning signs. It is characterized by the thickening and stiffening of the heart walls, which can impede the heart’s ability to pump blood efficiently since the chambers cannot fill up. In addition, HCM is the most common inherited heart disease, affecting 1 in 500 people in the U.S., according to the American Heart Association. Because HCM runs in families, first-degree relatives – including parents, siblings and children – should be screened if a family member has been diagnosed. Consider this information to get a better understanding of this life-altering genetic condition’s symptoms and diagnosis, which can make a crucial difference in managing the disease effectively. Recognizing the Signs and Symptoms The symptoms and severity of HCM can vary widely among individuals. While some people may experience no symptoms at all, common symptoms include fatigue, fainting, shortness of breath, dizziness, chest pain and irregular heartbeats, especially during physical activity. Research shows Black male athletes in high-intensity sports like football and basketball may be at higher risk. The Importance of Family History in Diagnosis Because HCM is a genetic condition, family history is a critical component in its diagnosis. If someone in your family has been diagnosed with HCM, heart failure or cardiac arrest, children, siblings and parents should be screened for HCM. Genetic testing and echocardiograms are commonly used to catch HCM early. These tests assess the thickness of the heart muscle and observe blood flow, which can indicate the presence of the disease. There are two main types of HCM – obstructive and nonobstructive – and treatment options vary depending on the type and severity of symptoms. If HCM runs in your family, don’t wait. Talk to your doctor about screening options and encourage your loved ones to do the same. Early detection can be lifesaving. To learn more about HCM, visit heart.org/HCMStudentAthlete.   Photo courtesy of Shutterstock   collect?v=1&tid=UA 482330 7&cid=1955551e 1975 5e52 0cdb 8516071094cd&sc=start&t=pageview&dl=http%3A%2F%2Ftrack.familyfeatures SOURCE: American Heart Association

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