The waiting room on the third floor of a bustling Manila shopping mall feels like a cozy lounge. Young men and women sit on a plush, light blue sofa next to a table where condoms — plain and chocolate flavor — and lubricants are lined up next to tiny pamphlets with tips to keep hookups fun and safe. 

Dr. Jeremy Jordan Castro, medical officer of the Klinika Eastwood HIV and sexually transmitted infection (STI) testing center, told DW that the focus on wellbeing rather than illness is deliberate.

"We want to normalize HIV and STI testing as part of regular health care. With advancements in medication and technology, HIV is now manageable like other chronic conditions such as hypertension or diabetes."

Most of the clinic services, which include STI screening as well as medications to prevent HIV before or after potential exposure, are free and are explained by a gender-diverse team trained to provide confidential counseling.

Klinika Eastwood is part of the government's broader efforts to destigmatize sexual health care, encourage HIV testing and treatment and reverse the Philippines' continuous rise in HIV infections, especially among young people.

According to the UNAIDS global report released earlier this month, the country has seen a staggering 543% increase in new infections between 2010 and 2023. While still a low-incidence country with a total number of people living with HIV (PLHIV) recorded at 189,900 last year, the Department of Health (DOH) warned that if the current trend continues, the number of PLHIV could reach 448,000 by 2030.

Young people most affected by HIV

Against a general global trend of managing and reducing HIV infections, the Philippines stands as an outlier, grappling instead with an estimated 50 new infections diagnosed a day. Nearly half of new infections in 2024 were among individuals aged 15-24 years, with MSM (men who have sex with men) accounting for 89% of these cases.

"We're seeing infection rates reminiscent of New York or San Francisco during the height of the AIDS crisis in the 1980s," Benedict Bernabe, head of the HIV advocacy and awareness group The Red Whistle, told DW.

Bernabe noted that since 2005, new infections have shifted primarily to men who have sex with men and emphasized the need for government health resources to adapt, focusing on increased testing and targeted interventions for this demographic.

Gibby Gorres of the Southeast Asia Against Stigma collective acknowledged that the rise in recorded HIV cases among the youth partly reflects the government's decision to lower the HIV testing age without parental consent to 15. However, he warned against moral panic in the predominantly Catholic country.

"We cannot afford to ignore that young people are sexually active, some perhaps with one or multiple partners. We need to equip them with correct sexual health information and allow them safe access to testing and treatment," said Gorres.

Missed opportunities for early intervention

One in three people living with HIV in the Philippines is diagnosed at a late stage, often after the diagnosis of underlying infections like tuberculosis or pneumonia. In 2023, delayed diagnoses contributed to 1,700 AIDS-related deaths, despite global advancements in treatment such as pre- and post-exposure prophylaxis, which are available for free in state-run clinics.

However, government data shows that only 13% of key populations are aware of pre-exposure prophylaxis, and just 60% know that HIV testing is free.

"The high rate of late diagnoses underscores the urgent need for accessible and timely HIV testing," Lui Ocampo, executive director of UNAIDS Philippines told DW. Currently, it's estimated that nearly 40% of people living with HIV (PLHIV) in the Philippines are undiagnosed, with misconceptions about HIV and low levels of awareness persisting. Among parts of the population, like transgender women (TGW) and female sex workers (FSW), knowledge about HIV remains alarmingly low, hovering at roughly 30%.

Still a long way to go

Elena Felix has been living with HIV for 30 years. The 66-year-old grandmother recalls her diagnosis in the 1990s, when doctors gave her just 10 years to live.

Today, Felix is a staunch advocate for HIV rights and leads the Association of Positive Women Advocates Inc. (APWAI), a support and advocacy group for women living with HIV. She was one of the complainants in a high-profile case against lawyer Larry Gadon who insinuated that former President Benigno Aquino III died of AIDS. Aquino died from kidney disease in 2021.

Gadon went as far as heckling and threatening PLHIV individuals planning to file a complaint, warning they would be subjected to public humiliation. Earlier this year, the Supreme Court ruled for the disbarment of Gadon. Felix hopes the victory sends a powerful message: HIV status should never be used to shame or discredit anyone.

"If some people think that they can use HIV misinformation to shame and humiliate a former president, it can be very damaging and discouraging especially for young people. We need to change this mindset of victim-blaming that says that if you get HIV, it's a death sentence of your own doing," Felix told DW.

Edited by: Srinivas Mazumdaru

Loneliness is becoming an increasingly serious problem in Germany, according to a new survey carried out by one of the country's leading public health insurers.

Around 60% of Germans suffer from loneliness either often, sometimes or rarely, according to the survey, which was presented in Berlin on Wednesday by the Techniker Krankenkasse (TK) health insurance company.

The study is based on a representative telephone survey of 1,403 people carried out in May by the research institute, Forsa.

It found that loneliness appears to particularly affect younger people — of those in the 18 to 39 age group, 68% said they often, sometimes or rarely felt lonely. The issue also seems to trouble younger people more: 36% of 18 to 39-year-olds said the feeling of loneliness weighs on them very heavily or quite heavily, while among the age groups between 40 and 59 and the 60-plus generation, the figure was only 19% and 21% respectively.

Speaking at a press conference presenting the report in Berlin on Wednesday, Janosch Schobin, a sociologist who works for the government-supported Loneliness Network, said this loneliness is often triggered by the changing life circumstances more likely to happen in younger years: leaving home, moving to new towns, shifting between jobs.

Single people are three times more likely to feel lonely than those with partners, and though there is no difference between men and women in the intensity of the feeling of loneliness, a partnership does play a role: 33% of singles feel very or quite strongly burdened by loneliness. Among people who have a steady partner, this figure is only 22%.

Loneliness remains taboo for men

The study found that education level, work or whether people lived in large or small towns were not significant factors in whether or not people were lonely. Nor was there a significant difference between the number of lonely men and women.

The main contributing factors to loneliness were the state of a person's partnerships and social networks. However, poverty increases the chances of being lonely, and older single people are at a higher risk of loneliness than younger singles.

Changing life circumstances are also a significant factor: Losing a job and a partner through separation or death often leads to a collapse of social networks and loneliness.

But the report found that admitting to loneliness continues to be difficult for people, especially men. Only 22% of men who experienced loneliness said they talked about it with other people — compared with 40% of female respondents to the survey.

The main reason given was that "didn't want to burden others" with the issue. Some 29% said it was uncomfortable for them to talk about loneliness, while 9% said they had no one with whom they could talk about their loneliness.

Loneliness is a health issue

Physical and mental ailments are also associated with an increased sense of loneliness. Some 23% of people who experienced loneliness said they consider their health poor — compared with 13% of those who do not feel lonely.

Poor health can especially lead to loneliness if individual limitations, such as those caused by disabilities, hearing loss or phases of depression, make communication with others more difficult.

Loneliness appears to be a psychological stressor: Symptoms such as stress and exhaustion, tiredness, feeling low, sleep disorders and anxiety occur much more frequently in lonely people.

"Loneliness can lead to physical ailments, too. That isn't a theory anymore. It has been proven," Jens Baas, board chairman at the TK health insurance company, said Wednesday, mentioning links to dementia.

Lonely people also appear to experience general physical ailments more frequently, including back pain and stomachaches, breathing difficulties and asthma.

Exactly why there should be a connection between loneliness and health remains something of a scientific mystery.

"It would be nice if we could explain the connection, but it's not that easy," said Baas. "In science, we can see that there is a clear connection between the soul and the body — we see it in many illnesses, but how it works physiologically, we don't know."

Edited by: Rina Goldenberg

While you're here: Every Tuesday, DW editors round up what is happening in German politics and society. You can sign up here for the weekly email newsletter Berlin Briefing.

Initial lab analyses suggest the mysterious disease spreading in the Democratic Republic of Congo could be malaria, though authorities still believe more than one infection may be involved in the outbreak. 

World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus on Tuesday confirmed results of the first lab tests of the disease showed the presence of the mosquito-transmitted infection.

"Of the 12 initial samples collected, 10 tested positive for malaria, although it’s possible that more than one disease is involved," he said during a media briefing.

So far, Congo has recorded 416 cases of the undiagnosed disease. Severe cases have been reported among severely malnourished people, including 31 deaths, mostly children. 

The spread of the disease is currently concentrated in the Panzi district in Kwango province, located about 700 kilometers (435 miles) from the capital, Kinshasa. Panzi district is remote, with difficult-to-access roads and nearly non-existent health infrastructure.

Health officials say the disease is most likely to be an already-known illness rather than a brand-new one.

"Reports of outbreaks with fatalities crop up somewhere in the world several times a year. Almost all turn out to be an already well-known infection with limited global consequences," said Paul Hunter, an epidemiologist at the University of East Anglia, UK, in a press statement.

What is the likeliest cause of the disease outbreak?

Jake Dunning, an infectious disease specialist at the University of Oxford, UK, said calling the incident a Disease X outbreak could be misleading and counterproductive.

"Disease X should only really be used when there is an infectious disease with epidemic or pandemic potential and a novel pathogen has been identified or is strongly suspected. It would be more appropriate to say that, currently, this is an undiagnosed morbidity and mortality event," Dunning told DW via email.

The disease causes flu-like symptoms of fever, headache, cough and anemia. 

That's why the WHO also believes the unidentified disease will most likely be traced back to already known causes. 

Based on the symptoms, acute pneumonia, influenza, COVID-19, measles and malaria are being considered as possible causes.

These symptoms are associated with malaria, but other infections that may be causing the illness include measles and mosquito-borne diseases like dengue and chikungunya.

Africa CDC investigating causes with local authorities, WHO

The Africa Centres for Disease Control and Prevention (Africa CDC) has deployed a multidisciplinary team of science and health experts to support the WHO and DRC's Ministry of Health's ongoing investigation. 

Meanwhile, they are running diagnostic tests and implementing disease control measures on the basis that more than one disease is responsible for the infections.

However, they are likely to face difficulties detecting the cause because of the affected area's remoteness and logistical barriers. 

Limited mobile phone and internet coverage across the region have hampered deployment of response teams. It's a two-day drive from the nearest major healthcare hub in Kinshasa due to the rainy season affecting roads.

Why is this disease such a mystery?

Health experts believe the causes of the outbreak are unknown because of limited testing capabilities in the region. 

Clinical laboratories in the Panzi district can only test for common pathogens. The detection of rarer pathogens often requires samples to be sent to specialist laboratories. Scientists there use techniques that aren't available in remote areas, such as gene sequencing, to find which pathogens are causing a disease to spread.

For DRC, this might mean samples will be sent abroad for testing, increasing delays. 

"The DRC has some great clinicians, scientists, and laboratories, all well versed in outbreaks and emerging infections, but the DRC is a huge country and arguably remains resource-limited and a complex environment," Dunning told DW.

The lack of information about the disease makes it harder for local health authorities to accurately assess the threat they face.

International healthcare teams are investigating so-called transmission dynamics, and actively searching for additional cases, both within health facilities and at the community level.  

"It is vital that these cases are investigated promptly so that appropriate treatment and control measures can be implemented," said Hunter.

Deputy governor of Kwango Remy Saki told DW on December 8 that the province had implemented measures to prevent the epidemic from spreading. 

The measures include limiting the movement of people and registering the entry and exit of people from surrounding villages, as well as wearing face masks.

Edited by: Zulfikar Abbany

This article was updated on December 11 to add information about the WHO’s laboratory testing results. 

Health authorities in the Democratic Republic of Congo (DRC) are investigating the outbreak of a disease that has killed dozens of people.

"We don't know if we are dealing with a viral disease or a bacterial disease," Dieudonne Mwamba, director general of the National Public Health Institute, said during an online press briefing by the AU's health watchdog, Africa CDC.

So far, authorities have confirmed nearly 80 deaths out of 376 reported cases, with the first infections recorded at the end of October.

Children at high risk of infection

The unknown disease is currently concentrated in the Panzi district in the Kwango province, located about 435 miles (700 kilometers) from the capital, Kinshasa. Panzi district is remote, with difficult-to-access roads and nearly non-existent health infrastructure.

Authorities have dispatched a medical research team, including epidemiologists, to the site to assess the situation and take samples to Kikwit for analysis.

According to the Health Minister Samuel-Roger Kamba, people present symptoms of fever, cough, runny nose, headache and body aches.

"This is a syndrome that resembles a flu syndrome with respiratory distress for some children and for some people who have died," the minister said.

He said 40% of cases had occurred in children younger than 5, most of whom were "already fragile due to malnutrition."

There is also an abnormal drop in hemoglobin levels in the blood, according to provincial Health Minister Apollinaire Yumba.

He advised the population to abstain from all contact with corpses to avoid contamination and, at the same time, appealed to national and international authorities to send medical supplies.

According to an anonymous source within the World Health Organization, the WHO has also sent a team.

Measures to contain the illness

Kamba said the seasonal flu period ran from October to March, peaking in December, which is something to consider when dealing with the mysterious disease.

"Is it a severe seasonal flu with people on the table who are fragile because of malnutrition, because of anemia, because of other diseases? Or is it another germ? We will know with the results," he said.

Vice Governor Remy Saki told DW that the province has implemented measures to prevent the epidemic from spreading.

"Among these measures, for example, immigration officials have been asked to limit the movement of people and to register the entry and exit of people from surrounding villages, as well as to apply the barrier measures previously used during the coronavirus period. Wearing a mask is also required," he said.

Mpox is still a threat

DR Congo is already plagued by the Mpox epidemic, with more than 47,000 suspected cases and over 1,000 suspected deaths from the disease in the Central African country, according to the World Health Organization.

Dieudonne Mwamba, director general of the National Public Health Institute, said officials were on "maximum alert" and would need to confirm whether the unknown disease is a respiratory infection.

"We must note also that, in the Panzi health zone, there was a large typhoid epidemic two years ago and that the malnutrition rates in this health zone are at around 40%. These are vulnerability factors," he added.

This article was initially published in French.

Edited by: Chrispin Mwakideu 

 

Promilla Butani, a leading New Delhi pediatrician, suffers from asthma and dreads the clouds of pollution that blanket India's capital city on a regular basis.

Bhutani has been hospitalized twice this year due to poor air quality and was put on an extra dose of oral steroidal asthma medication to stay functional.

"I had to go to Mumbai last week for an important function and stepped out with an N95 mask that is highly effective at filtering out airborne particles. But before I could reach the airport, I felt sick and had to cancel the trip," Bhutani told DW.

At the other end of the city, Manish Paswan, a tuk-tuk driver, struggles with a violent cough outside the new clinic for pollution-related illnesses at the Ram Manohar Lohia Hospital.

"It has been a horrible time, and I have been facing breathing issues for the last two weeks, especially after [the light festival] Diwali. For a few days, I even had panic attacks and came to see the doctor for help," Paswan told DW.

Air pollution goes beyond New Delhi

The recently opened clinic has already become a lifeline for those grappling with pollution-induced diseases, including bronchitis and breathing difficulties.

Doctors in this and other hospitals report cases of breathlessness, asthma, and chronic obstructive pulmonary disease (COPD). They say there are more patients than last year.

"The elderly and those with heart conditions are particularly susceptible, experiencing heightened symptoms and requiring hospitalization," pulmonologist Kailash Gupta told DW.

New Delhi has been dealing with air pollution for a long time, earning it the label of the world's most polluted city.

However, experts and doctors warn that air pollution also threatens huge swaths of India outside the capital.

The primary problem is airborne particulate matter, especially fine particles that are 2.5 microns or less in diameter, designated as "PM 2.5," which are small enough to enter air sacs in the lungs. 

The issue transcends jurisdictions and individual sectors of industry — agriculture, industry, power plants, households, and transport all contribute significantly to air pollution in India.

Pollution affects children

A study published in 2021 found that 1.67 million people died due to air pollution in 2019.

Researchers from the Global Observatory on Pollution and Health (GOPH) at Boston College, the Indian Council of Medical Research, and the Public Health Foundation of India described it as the largest pollution-related death toll in any country in the world, adding the costs amounted to $36.8 billion (€35.12) in economic losses.

"It is also having a profound effect on the next generation of Indians," GOPH director Philip Landrigan told DW.

"It increases future risk for heart disease, diabetes, and respiratory disease for today's children when they become adults. It is reducing children's IQ and it will be very difficult for India to move forward socially or economically if they don't do something about the problem," said Landrigan, who is a pediatrician. 

A more recent study linked air pollution to some 2.1 million deaths per year in the world's most populous country. The "State of Global Air Report 2024" says 12,000 deaths every year can be specifically linked to air pollution in New Delhi.

"464 children under 5 die daily in India due to air pollution, surpassing tobacco, and diabetes as the leading cause of death," the report says.

Other studies, however,  report lower overall casualty figures.

'Nobody can escape'

Surgeon Arvind Kumar described air pollution as a silent pandemic.

"We have serious and unacceptable levels of air pollution that not only affect people's lives and unborn children in the country, but will destroy ecosystems. Nobody can escape the ill effects of bad air as its affects every organ of the body," Kumar told DW.

After seeing the growing impact of air pollution first-hand in his patients, Kumar decided to set up a medical non-profit called Lung Care Foundation in India

"There is unambiguous data, but nothing is being done to hit at the sources of pollution," he added.

What is the way forward?

A report published by the World Bank in 2023 called for a so-called "airshed" approach to air pollution problems.

An airshed is defined as a region that shares a common flow of air, which may become uniformly polluted and stagnant.

The global organization says India needs airshed-wide coordination in regions where a significant portion of PM 2.5 pollution originates from sources outside the cities.

"India, therefore, needs to look beyond its cities and take action at the sub-national level for effective air pollution control strategies and apply new set of tools for airshed-based management," the World Bank said in a June statement "Catalyzing Clean Air in India."

Grassroots-level for major benefits

Doctors for Clean Air (DFCA), a network of doctors who advocate for clean air and raise awareness about the health effects of air pollution, has been expanding its grassroots engagement with communities in the hardest-hit regions.

"Finally, one realizes that a citizen-led initiative and people's movement to be most beneficial. It takes time but has provided results," Surgeon P S Bakshi told DW.

He pointed to the example of farmers in the Bajra village of Jalandhar district in Punjab.

The villagers, like so many others in northern India, used to burn stubble and straw after harvesting crops of rice and wheat.

The practice is a quick and cheap way to clear their fields for the next crop cycle, but it also contributes to air pollution.

Bakshi said farmers in Bajra agreed to banish the practice after the surgeon explained the negative health impact.

"The number of farm fires in Punjab has fallen sharply but more needs to be done to change the narrative on health and air quality," said Bakshi.

Edited by: Darko Janjevic

"Measles have come back to Germany," according to the country's top disease control center, the Robert-Koch Institute (RKI). 2024 has seen a staggering rise in the number of cases of the illness, which is especially common in small children and can be fatal. Some 614 cases have been recorded so far, up from 8 just three years earlier.

Measles is an airborne disease that commonly causes rash and high fevers that are extremely dangerous for small children and claimed some 107,000 lives globally in 2023. Since 2019, parents in Germany are legally required to get their children the two jabs necessary for full immunity. If not, they must pay a fine of €2,500 ($2,630).

Other vaccine-preventable illnesses, such as Hepatitis B and whooping cough are also on the rise. The reasons behind the jump are multifaceted and complex, experts have said, ranging from immigration to COVID-19 to increasing vaccine skepticism and anti-vaccine activism online.

Lingering effects of the COVID-19 pandemic

"Nearly all infectious diseases rates declined during the pandemic," said Bonn-based pediatrician Dr. Axel Gerschlauer, due to COVID-19 measures such as social distancing and mask-wearing. The aftereffects can also be seen in a "hesitancy to go to the doctor except in the most necessary cases, for fear of the risk of infection" inside a practice.

Imported cases are also an issue. Dr. Karella Easwaran of Cologne told public broadcaster ARD that "today, there are a lot of people traveling. A lot of people immigrating here. Many children from war zones," where vaccinations are not available, she said, and whose parents may not be aware when they reach Germany about the necessity of the vaccine.

Vaccine skepticism on the rise

Then there is the issue of vaccine hesitancy and the anti-vaccine movement. Dr. Gerschlauer cautioned that the two must be viewed as separate phenomena. "With skeptical parents, concerns and fears can often be allayed with explanations and statistics. Often, a simple information leaflet or a brief conversation is enough," he said. However, "with ˈhardcore vaccine opponents, our hands are tied. They live in their own bubble, which we can no longer penetrate from the outside."

According to a study published earlier in November by research firm Statista, vaccine skepticism has been steadily rising in Germany, from 22% of adults in 2022 to 25% in 2024.

As for the "hardcore" anti-vaccine movement, it has a long history in Germany going all the way back to the 1800s, promoted by people with various agendas – antisemitic precursors to the Nazis, who viewed medical advancements coming from Jewish doctors with skepticism, to groups of doctors worried about the safety of how early vaccines were administered.

According to the Federal Center for Health Education (BzgA), the number of people identifying as completely anti-vaccine has risen only slightly in the past decades, from 4% in 2004 to 6% in 2020. Their numbers can seem larger, however, through their prevalence on social media and the number of anti-vaccine mandate demonstrations that occurred in Germany in response to the COVID-19 pandemic.

In that vein, some doctors see vaccine mandates as counterproductive, adding fuel to the anti-vaccine fire by appearing to curtail personal freedoms.

Esoteric thinking, far-right sympathy prevalent in the anti-vaccine movement

Studies have shown other significant indicators of anti-vaccine sentiment. A recent report by doctors at the University of Freiburg in southern Germany showed a connection between what they called "esoteric thinking" and vaccine hesitancy and refusal. For example, people who may believe in homeopathy or have gone through alternative forms of education like Waldorf Schools, are more likely to view vaccines critically. Another study carried out by the state government of Saxony in 2021 found a correlation between supporters of the far-right Alternative for Germany (AfD) party and vaccine skepticism.

For Dr. Gerschlauer, politicians and doctorsˈ groups could help solve the problem through sustained information campaigns.

"When you see how much effort was put into advertising the vaccination against meningococcus B in recent years, even though this shot was not even recommended by [Germany's vaccine commission] STIKO at the time, and how many people were reached by this advertising campaign, then you would wish that the same effort was made for the measles vaccination!"

Edited by Rina Goldenberg

While you're here: Every Tuesday, DW editors round up what is happening in German politics and society. You can sign up here for the weekly email newsletter Berlin Briefing.

I was 17 years old the first (and only) time I used laughing gas — nitrous oxide — for fun. I was with some friends who showed me. It was sold at the grocery store.

As an anxious teenager, I was wary, but the fact it was available for legal purchase at the supermarket helped assuage my concerns. If it was really that harmful, I thought, surely it wouldn't be available for anyone to buy.

Health experts say this is a common introduction to the party drug. Kids are told, often by peers, that laughing gas won't harm them. They may believe it because there are no warnings plastered across whipped cream canisters in stores. You don't have to find a dealer, or even be 21, to get hold of the substance.

Many teenagers don't realize laughing gas is dangerous 

In 2018, a report published in the journal Frontiers in Psychiatry reported that 92% of teenagers in the UK who had heard of laughing gas "were not aware of any side effects" associated with its use.

Now, governments are moving to regulate the substance. The UK passed a law in 2023 banning nitrous oxide. It is classified as a drug in the Netherlands. And as recently as May 2024, Louisiana became the first US state to sign a law prohibiting laughing gas from being sold in retail stores. German regulators are also considering a ban.

But why? What makes nitrous oxide dangerous? Here's what you should know about laughing gas and how it can affect your health.

What is laughing gas and why is it widely available?

Laughing gas is the colloquial term for nitrous oxide, a clear gas.

It is used in medicine to relax patients when they are having wisdom teeth removed, for instance, or during childbirth.

Nitrous oxide can cause a euphoric feeling that users describe as a "head rush." You may feel light-headed, dizzy or disoriented.

When used recreationally, the effect of the gas is short-lived, lasting 30 seconds to a minute. Users may inhale it multiple times in a single session.

Along with its use in medical settings, nitrous oxide is used to make whipped cream, hence its availability at your local grocery store.

The canisters are reportedly also sold at kiosks and corner shops across Europe and in vape shops in the US.

Health experts say they have seen a boom in the number of vendors selling nitrous oxide since 2017. That's according to Devan Mair of a student campaign at Queen Mary University of London called N2O: Know the Risks. 

N₂O is the chemical formula for nitrous oxide — a compound of two nitrogen atoms and one oxygen atom. 

Can nitrous oxide be addictive?

Although health experts have said most laughing gas users take the substance infrequently, some research has indicated a subset of individuals who appear to get hooked. But the evidence is thin.

Researchers set out to determine whether nitrous oxide could be addictive in an evaluation of the evidence, a so-called meta study published in the journal Addiction in October 2023.

They found that, although the research is sparse, what has been published indicates "consistent evidence for the presence of at least four substance abuse disorder criteria in heavy N2O [nitrous oxide] users."

The authors concluded that nitrous oxide "could well be addictive." They advised that it should be handled as a "potentially addictive substance" until more assessments are conducted.

How common is laughing gas usage?

Recreational use of nitrous oxide varies from country to country.

The UK, for example, has reported some of the highest levels of its illicit use. A British government report in 2020 warned that nitrous oxide was second on the list of the most commonly used recreational drugs among people aged 16 to 24.

In other European countries and in the US, people also use the substance to get high, with numbers of these users reportedly growing.

A 2018 study of nitrous oxide use in China indicated that teens picked up the habit from peers who studied abroad. Nitrous oxide is banned for recreational sale in Australia and Japan.

Research on the drug's ubiquity in places like India, the Middle East and sub-Saharan Africa is largely non-existent.

What are the negative side effects of laughing gas?

Apart from the initial short-term effects described above, regular use of laughing gas has been associated with neurological complications. 

In heavy users, nitrous oxide can inactivate vitamin B12, which aids in the formulation of myelin, Mair told DW.

Myelin, or the myelin sheath, is a protective layer on nerves — including those in the brain and spinal cord. When myelin fails to form, a person's nerves can become damaged, resulting in numbness, the feeling of pins and needles in the hands and feet, loss of balance and general weakness. 

Mair said such cases were common in the UK. "At the Royal London Hospital in East London, in Feb 2023, there was a case of nitrous oxide-related nerve damage every nine days," he said.

Experts say if a heavy recreational user of nitrous oxide starts to notice serious symptoms of a B12 deficiency, they should seek emergency care immediately.

According to a 2023 report on nitrous oxide published by the British government, these warning symptoms include: tingling and numbness in the hands or feet, skin crawling, and later, "staggering uncoordinated walk, lower limb weakness, muscles stiffening or tightening, overactive or overresponsive bodily reflexes such as twitching, bladder/bowel complaints of incontinence or retention and sexual dysfunction."

The adverse effects of nitrous oxide can be reversed, but only if they are addressed quickly. Seek medical advice if you feel unsure and require more information.

Edited by: Zulfikar Abbany

Sources:

Up: The rise of nitrous oxide abuse. An international survey of contemporary nitrous oxide use. Journal: Journal of Psychopharmacology. https://pubmed.ncbi.nlm.nih.gov/26912510/

Laughing gas inhalation in Chinese youth: a public health issue. Journal: The Lancet. https://www.thelancet.com/journals/lanpub/article/PIIS2468-26671830134-8/fulltext

No Laughing Matter: Presence, consumption trends, drug awareness, and perceptions of "Hippy Crack" (Nitrous Oxide) among young adults in England. Journal: Frontiers in Psychiatry https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5786547/

Does nitrous oxide addiction exist? An evaluation of the evidence for the presence and prevalence of substance use disorder symptoms in recreational nitrous oxide users. Journal: Addiction Opinion and Debate https://onlinelibrary.wiley.com/doi/10.1111/add.16380

Nitrous oxide: updated harms assessment, UK government report, 2023 https://www.gov.uk/government/publications/nitrous-oxide-updated-harms-assessment/nitrous-oxide-updated-harms-assessment-accessible#uk-prevalence-and-patterns-of-use

Germany's upper house of parliament has passed the law on the restructuring of the hospital sector, paving the way for its gradual implementation starting January 2025 and ending in 2029. The chamber representing Germany's 16 federal states passed the law following a heated debate, with the center-right Christian Democrats demanding more leeway for the implementation.

The hospital reform is the brainchild of Health Minister Karl Lauterbach, who described the reform as "nothing short of a revolution." Speaking at an annual doctors' conference in early May, the German health minister said the reform plans they had been working on for two years marked a "Zeitenwende" (turning of the times) in German health care — an allusion to the military overhaul Chancellor Olaf Scholz announced after Russia's full-scale invasion of Ukraine in February 2022.

A new way to pay hospitals

The two-pronged hospital reform will change the way German hospitals are financed and impose new care standards.

Germany has the highest number of hospital beds per capita in the European Union, at 7.9 beds per 1,000 inhabitants, compared to the EU average of 5.3. But maintaining these is expensive. According to Lauterbach, this has left many hospitals on the brink of bankruptcy. The result is that patients are being kept in hospital unnecessarily so hospitals can charge health insurers extra money — which in turn drives up the whole country's health costs and insurance contributions.

The reform means that hospitals will no longer be paid per treatment — instead, they will get a guaranteed income for making certain services available. This, it is hoped, will alleviate the financial pressure on hospitals to pack in as many operations and treatments as they can, even if they are poorly qualified to carry them out.

This measure is supposed to ensure that patients needing complex treatments are referred to specialists earlier. This, according to the Health Ministry, will reduce health costs in the long run, as patients stand a better chance of being cured and are less likely to fall victim to mistakes, as hospital staff will be less rushed and overworked. Lauterbach has claimed this reform will save tens of thousands of lives a year.

Too many hospitals

"The hospital reform is right and important," Dirk Heinrich, an ear-nose-throat specialist and chairman of the doctors' association Virchowbund, told DW. "We do have too much in-patient care, but what is happening now is way too little. Reforming the hospitals without a comprehensive outpatient treatment reform, and without emergency care reform, won't make a difference."

Eugen Brysch, chairman of patients' protection organization Deutsche Stiftung Patientenschutz was also skeptical. "In the field of outpatient medical care, elderly, chronically ill and care-dependent people will find it almost impossible to find a new doctor," he said.

Germany also struggles with a lack of doctors' offices in rural areas, as fewer doctors want to live there. The Health Ministry wants to tackle this issue by offering extra money for clinics in rural areas. Here again, Brysch was cautious. 

"The fact that better earning opportunities are now being created will not in itself lead to more doctors in rural areas. After all, other location factors also play a role," he said.

One issue has been resolved in the new reforms: a cap on payments for general practitioners. Doctors have long complained about this budget limit — and occasionally gone on strike over it — because they say it often forces them to treat patients for free. Scrapping the cap, Lauterbach hopes, will provide doctors with incentives to take on more patients.

Heinrich welcomed this move, but again, said it failed to go far enough. "It stops halfway because the budgets remain in place for specialist doctors," he said. "It's no use for a patient if they get an appointment quicker at their family doctor but then have to wait months for a specialist."

Hospital reform — the steps ahead

"A few hundred hospitals will close," Lauterbach told the tabloid Bild am Sonntag after the reform passed the Bundestag, the lower house of parliament, in October. There isn't enough medical demand for these hospitals, he added, explaining that one-third of all hospital beds are empty and still there aren't enough nurses.

"We have such an inefficient system, in no other country in Western Europe is life expectancy lower than in Germany," Lauterbach said, arguing that "centralization will improve the quality of care."

Health insurance contributions are set to increase next year also due to the reform. However, Lauterbach told Bild am Sonntag that he does not expect any further increases in the following year, if his health reform proposals are implemented.

Edited by: Rina Goldenberg

This article has been updated to reflect the passing of the law on November 22, 2024.

While you're here: Every Tuesday, DW editors round up what is happening in German politics and society. You can sign up here for the weekly email newsletter Berlin Briefing.

Millions of people die as a direct result of bacterial infections — especially when the bacteria have developed a resistance to the antibiotics we use to treat them. It's this drug resistance that makes them particularly deadly. 

And the latest data is not encouraging. The emergence of several drug-resistant bacteria species is proving a serious problem for health systems around the world, especially for low-and-middle income countries.

It's estimated that bacterial antimicrobial resistance was directly responsible for 1.27 million global deaths in 2019, and could be associated with as many as 4.95 million deaths, according to the the World Health Organization (WHO).

Priority drug-resistant bacteria which can cause serious illness include mycobacterium tuberculosis, the bacteria that causes tuberculosis, and high-burden resistant pathogens such as Salmonella, Shigella, Pseudomonas aeruginosa, and Staphylococcus aureus.

Difference between antibiotic resistance and antimicrobial resistance

In this article, we'll focus on antibiotic resistance. But more broadly, you may have heard the term antimicrobial resistance (AMR).

AMR refers to all kinds of microbes — tiny living things, or organisms — including bacteria but also parasites, viruses and fungi, which have adapted to resist common medical treatments.

Put simply: the drugs don't work as well as they used to, and we're struggling to find new ones to treat illnesses. Even common ones like urinary tract infections (UTIs) can turn fatal when left untreated.

How the World Health Organization ranks bacteria as dangerous

The WHO monitors and ranks bacteria according to various data:

• Mortality rates
• Incidence (number of infections)
• Non-fatal health burden
• Trend of resistance
• Transmissibility
• Preventability
• Treatability
• Pipeline (new drugs in development) 

The bacteria get a score for each metric and then get ranked. The 2024 list features two dozen priority pathogens. Here are the top eight.

Top 8 bacterial pathogens

1. Klebsiella pneumoniae

Klebsiella is a type of bacteria found in the intestines and human feces. Klebsiella pneumoniae can cause pneumonia, bloodstream infections, wound or surgical site infections and meningitis if it gets into the nervous system. 

Klebsiella pneumoniae can become a so-called "superbug" in hospitals, spreading fast and becoming resistant to most available drug treatments.

It is specifically resistant to carbapenem, an "antibiotic of last resort" — it's used when all other treatments for multidrug-resistant pathogens have failed. Klebsiella pneumoniae is also resistant to a third-generation antibiotic called cephalosporin.

2. Escherichia coli (E. coli)

As with klebsiella bacteria, Escherichia coli (E. coli) bacteria are usually found in the intestines of human and non-human animals. They are also found in the environment, food and water.

Most kinds of E. coli are harmless, but some can cause illnesses, including diarrhea, urinary tract infections, pneumonia and sepsis. E.Coli concentrations in Paris' Seine River came under scrutiny during the 2024 Summer Olympics in France. 

E. coli is resistant to third-generation cephalosporin — a commonly prescribed antibiotic, which is also used to treat sexually transmitted infections, such as gonorrhea. E. coli is also resistant to carbapenem.

3. Acinetobacter baumannii

Back in 2012, researchers described Acinetobacter baumannii as an "emerging opportunistic bacterial pathogen" associated with hospital-acquired infections (HAIs).

Long-term hospital patients with a compromised immune system, or those in hospital for more than 90 days, were identified as having a high risk of contracting an infection. Acinetobacter baumannii is carbapenem-resistant.

4. Mycobacterium tuberculosis

Mycobacterium tuberculosis (TB) causes tuberculosis, a potentially fatal, bacterial infection of the lungs.

TB killed 1.25 million people, including 161,000 people with HIV, in 2023.

The WHO said "TB has probably returned to being the world's leading cause of death from a single infectious agent, following three years in which it was replaced by coronavirus disease (COVID-19)."

Mycobacterium tuberculosis is resistant to rifampicin — an antibiotic used to treat mycobacterial infections, like TB and leprosy, or M. leprae.

5. Salmonella Typhi

Salmonella Typhi causes typhoid fever, a life-threatening illness. It mostly affects people living in regions with poor sanitation and unsafe water and food sources — such as parts of Asia, Africa and Latin America.

The US Centers for Disease Control and Prevention estimates there are about 9 million cases of typhoid worldwide every year. Salmonella Typhi is resistant to flouroquinolone — a broad-spectrum antibiotic, with a range of side effects, which have led the European Medicines Agency to restrict its use.

6. Shigella species

There are four species of Shigella: Shigella sonnei, Shigella flexneri, Shigella boydii, Shigella dysenteriae. Shigella bacteria cause diarrhea, stomach pain and fever.

They spread via contaminated food and water, but also during sexual activity with a sick person. They are fluoroquinolone-resistant.

Shigella species that are resistant to almost all antimicrobial classes are increasing in prevalence and becoming globally dominant. The greatest burden of disease is in low- and middle-income countries with poor sanitation.

7. Enterococcus faecium

Enterococcus faecium lives in the gut flora, also known as microbiome. It can lead to serious illness for people with diabetes or a chronic kidney condition.

Enterococcus, can cause infections such as UTIs and infections of the nervous system, if it enters parts of the body outside the gut.

Enterococcus are resistant to vancomycin — an antibiotic, which is also used to treat infections caused by staphylococci bacteria, which is also drug-resistant.

8. Pseudomonas aeruginosa

Pseudomonas aeruginosa leads to infections in the blood, lungs, urinary tract and other parts of the body, often after surgery in hospitals. Pseudomonas aeruginosa bacteria are multidrug-resistant (MDR), including the common antibiotic, carbapenems.

Pseudomonas aeruginosa infections carry specific risks in immunocompromised patients. Despite being moved from "critical" to "high" priority, it remains a significant concern due to its drug resistance profile.

Edited by: Fred Schwaller

Select sources:

2024 WHO Bacterial Priority Pathogens List (WHO BPPL), World Health Organization https://www.who.int/publications/i/item/9789240093461

Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050. Lancet, 2024. DOI: 10.1016/S0140-6736(24)01867-1

Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050, Lancet, 2024. DOI: German Center for Infection Research, glossary https://www.dzif.de/en/glossar

National (US) Human Genome Research Institute, glossary https://www.genome.gov/genetics-glossary

Allulose is a rarer form of sugar first identified in wheat leaves in the 1940s. However, it remained seldom used and under-researched.

That was until the 1990s, when Ken Izumori, a professor in the Faculty of Agriculture at Kagawa University, Japan, came along. Izumori discovered a microorganism in soil near the university that converted fructose into allulose, with the help of an enzyme.

It's taken another 20-30 years of research, but allulose is now slowly gaining popularity as a sweetener, or alternative to sugar, in the US and South Korea, where it has been approved for commercial use.

Allulose (also known as D-allulose and D-psicose) is still described as rare because it is found in only small quantities in figs, raisins, kiwis, wheat, maple syrup and molasses.

It's said to be about 70% as sweet as conventional sugar (sucrose) but has only 10% of the calories. In fact, you might see it advertised as calorie-free, good for weight management, or beneficial for people with type 2 diabetes.

Are the claims supported by scientific evidence? We take a look.

Is allulose a zero-calorie sweetener?

The US regulatory body Food and Drug Administration (FDA) has approved the use of allulose in foods as "generally recognized as safe."

But the European Union, Canada and other countries consider allulose as a novel food that has yet to be sufficiently assessed for its safety.

That's why scientists are still assessing the effects of allulose on our bodies.

Recent studies show that the body does absorb allulose, but it does not metabolize it, meaning it could well be glucose- and calorie-free.

In other words, the body does not recognize that allulose contains energy in the form of calories and is, therefore, "tricked" into excreting the majority of the calories.

This may make allulose useful for people who want to lose weight but who still want to enjoy an occasional sweet treat. It's the same reason why allulose could also be useful for those on a ketogenic diet too — a diet with as little carbohydrate as possible (sugar is a carbohydrate).

There is also evidence that allulose does not cause tooth decay, like sugar does.

Glycemic index: How does allulose compare to sugar?

There are also claims that allulose does not raise blood sugar levels.

The glycemic index (GI) ranks foods based on how quickly they are digested and increase blood glucose levels.

Pure sugar raises blood glucose levels by 65 on a scale from 0 to 100.

White bread has a GI of 100 — it takes a long time to digest white bread, and it raises blood glucose levels greatly.

However, evidence shows that allulose does not raise blood glucose levels at all.

 

Is allulose good for people at risk of type 2 diabetes?

Because allulose seems to have little or no impact on blood glucose, it could be an ideal sugar alternative for people with, or at risk of, type 2 diabetes.

Studies have found that even high doses of allulose did not cause glucose levels to fluctuate in people with diabetes or healthy people.

Some studies have found that eating allulose reduces glucose and insulin levels in people after meals, as well as decreasing the amount of glucose and insulin fluctuation in the blood.

This may be good news for people with diabetes, who have less effective insulin systems and can't regulate blood sugar levels effectively.

However, more evidence from larger clinical trial-type studies are needed back up the claim that allulose is beneficial for people with diabetes.

Does natural always mean healthy?

Allulose does not have a strong aftertaste, meaning it's a useful sweetener for commercial foods like chocolate.

"We lowered the calories [in our chocolate] by up to 40% by replacing sugar with something that is almost calorie-free," said Michelle Oten, founder of GOALZ, a company that only uses allulose to sweeten their products.

Oten said they wanted "something that's found in nature, not created in a lab by playing with molecules." But allulose's label of it being natural and healthy may be deceptive.

For example, there are indications that consuming large amounts of allulose may cause stomachache, diarrhea, bloating, or gas.

Table sugar is natural, just like allulose. It comes from sugar beet or sugar cane plants. In fact, it's possible to make allulose from fructose (fruit sugar) by changing its chemical form with enzymes.

The list of health concerns from eating sugar are long. To name just a few: Diabetes, heart disease, depression, tooth decay, bad skin, cancer. Natural isn't always healthy, then.

What about allulose as an alternative to sugar? Many regulators say it's not harmful to eat, especially compared to sugar. But more studies are needed to know whether allulose has a beneficial impact on health.

This article was written by Lilia Breytenbach during an internship in the DW science department, with support from Zulfikar Abbany and Fred Schwaller.

Sources:

Effects of D-allulose on glucose tolerance and insulin response to a standard oral sucrose load: Results of a prospective, randomized, crossover study, published by Franchi, F., et al. in the journal BMJ Open Diabetes Research & Care (2021) https://doi.org/10.1136/bmjdrc-2020-001939

Allulose in human diet: the knowns and the unknowns, published by Daniel H., Hauner H., Hornef M., Clavel T. in the British Journal of Nutrition (2022). doi: 10.1017/S0007114521003172. 

H5N1 bird flu cases have US authorities — and other nations monitoring its outbreak — on high alert.

More than 60 human H5N1 infections have been confirmed in the US, mostly among agricultural workers close to infected cattle and birds. At time of writing, more than 123 million poultry have been infected across all US states, in addition to 865 dairy herds.

On Wednesday, the US Centers for Disease Control and Prevention (CDC) confirmed the first "severe" case of H5N1 had hospitalized a person in Louisiana.

California governor Gavin Newsom also declared a state of emergency to address the spread of the virus.

Almost all cases of H5N1 in people are due to exposure to live or dead animals and no human-to-human transmission has been recorded.

To ensure readiness for potential transmission between people, scientists are testing new vaccine technologies to protect against emerging diseases.

New research may have found a breakthrough new method for creating more effective vaccines against influenza viruses.

The study, published December 19 in the journal Science, demonstrated a new way to improve the effectiveness of the annual flu shot.

Our immune systems are "biased" towards certain flu viruses

The new study aimed to understand why seasonal flu vaccine effectiveness is only between roughly 40-66%.

There are many strains of influenza circulating at any time and health authorities constantly monitor their spread to create targeted seasonal vaccines.

The final jab in the arm usually contains four selected flu strains, but the body rarely develops a good response to each. 

Part of the problem is that people’s immune systems often produce antibodies tailored to a specific influenza subtype — not necessarily the specific ones put into the vaccine.

"For a long time, people thought that individual flu strain preference [subtype bias] was something you couldn’t do anything about," Mark Davis, an immunologist at Stanford University, US, who led the study.

But Davis’ team found the real reason for these immune biases — we inherit them our parents via our genes.

In an initial analysis of twins and newborns, around three-quarters of people with no previous exposure to influenza were found to have biased immune responses to specific flu strains.

Boosting seasonal flu shot effectiveness 

Davis’ team then sought to "unbias" the immune system so it could respond better to different types of influenza strains. 

Their new vaccine technology combines key molecules from different flu strains into a single compound.

The immune system recognizes its preferred molecule, then recruits other "helper" immune cells to build defenses to all strains in the combination.

Although only tested in lab dishes so far, Davis said their vaccine platform could push the effectiveness of flu vaccines from its around 66% "into the nineties."

The current flu vaccines don't give equal protection to all the influenza viruses it contains, so "you’ve got to make a vaccine that has all the major variables in it," Davis said.

New methods could improve flu vaccines

Isabelle Bekeredjian-Ding, director of the University of Marburg’s Institute for Medical Microbiology and Hospital Hygiene in Germany, said the research sheds light on "something that, at least in vaccinology, has not been fully understood."

“The real highlight of the paper is that it can describe the [immune] cell properties that are needed to produce specific types of immune responses," said Bekeredjian-Ding, who was not involved in the research.

A drawback of Davis’ study was that it was lab-based, meaning the vaccine has not yet been trialed in humans.

Davis said their next task is to convince manufacturers that adopting their method is the way for forward in vaccine development.

After that, the new vaccines will need to go through rigorous testing in clinical trials to ensure they are safe and effective. Only then can they become available for widespread use.

Testing COVID technologies to target H5N1

Meanwhile the CDC has completed a study of an H5N1 vaccine using the mRNA technology used to create COVID-19 vaccines.

The study, published in Science Translational Medicine, tested a prototype H5N1 mRNA vaccine in ferrets. 

Vaccinated ferrets, even those with severe symptoms, overcame H5N1 infection, but unvaccinated ferrets did not.

The measure is a milestone in pre-pandemic preparation, said Bin Zhou at Centers for Disease Control and Prevention in Atlanta, USA, who led the study.

The vaccine is yet to be tested in humans, but Zhou thinks similar results could be expected in human trials. 

“We can say that the mRNA is a promising platform… If there is a pandemic then we’re prepared for that part, unlike COVID-19 at the beginning where we didn’t have anything prepared for the vaccine,” Zhou said.

Edited by: Fred Schwaller

Sources

Coupling antigens from multiple subtypes of influenza can broaden antibody and T cell responses. Published by Vamsee Mallajosyula, Saborni Chakraborty et al. in Science. http://dx.doi.org/10.1126/science.adi2396

An influenza mRNA vaccine protects ferrets from lethal infection with highly  pathogenic avian influenza A(H5N1) virus. Published by Masato Hatta, Yasuko Hatta et al in Science Translational Medicine. http://dx.doi.org/10.1126/scitranslmed.ads1273

 

The onions are caramelized in your pan, you flip them over with your black spatula, but in doing so you've probably laced your dish with hidden chemicals.

That's what a recent study published in the journal Chemosphere concludes — household black plastic items have been silently releasing harmful chemicals.

Researchers tested various household objects made from black plastic to see if they had traces of toxic substances usually found in recycled materials.

The study's lead author Megan Liu, a science and policy manager for US-based environmental advocacy organization Toxic-Free-Future, said 85% of the products tested contained chemicals used as flame retardants.

"We purchased 203 black plastic food serviceware items, hair accessories, kitchen utensils, and toys, and screened them for bromine, a chemical element that indicates presence of (the harmful) brominated flame retardants," Liu told DW.

"They then selected the 20 products with the highest levels of bromine, and found flame retardants in 17 of those products."

Why are black plastics harmful?

Plastics used in electronic and electrical products contain flame retardants to prevent them catching fire. 

Decabromodiphenyl Ether (DecaBDE) was one of the most commonly used flame retardants until the European Union banned its use in electronics in 2006. Since then, similar chemicals have replaced it.

However obsolete additives like DecaBDE can slip through the cracks. When electronic plastics are recycled, these chemicals can make their way into household objects.

Recycled parts from old electronics like TV casings are often used to make black household plastics, but these recycled products are not strictly checked for the presence of harmful fire-retarding chemicals.

That's why Liu's team only tested black plastics for flame retardants and not other colored variants.

"We did not test other colors of plastic besides black plastic. Toxic flame retardants are intentionally added to the black plastic enclosures around electronics," Liu said.

Liu also found higher levels of toxic flame retardants in styrene-based plastics often used in electronics, including acrylonitrile butadiene styrene and high impact polystyrene (HIPS), "further supporting our hypothesis that flame retardants are ending up in everyday products we don’t expect".

What health risks do black plastics have?

Flame retardant plastics, particularly DecaBDE, have been linked to cancer, hormonal imbalance, nerve and reproductive damage. Potentially, it's a package of hidden health risks.

Similarly, another chemical compound called 2,4,6-Tribromophenol in black plastic is, "associated with thyroid disruption in humans and mice and has been detected in serum, breast milk, and placenta,” the study states.

These flame retarding plastics have been known to leach from household electronics like televisions into the environment, according to 2015 research published in the journal Science of The Total Environment. 

The consequences are greater when these contaminants travel from cooking utensils into food and from toys to saliva.

It's not just black plastic, though. In 2024, the Research Council of Norway identified a quarter of all plastic chemicals — not just those found in black recycled plastics — are hazardous to human health and the environment. 

Is it time to throw your black plastic cooking utensils away?

In Liu's study, the highest leakage of harmful chemicals was observed in a sushi tray — a simple black takeaway box.

The study further observed high risk in kitchen utensils like peelers, spatulas and spoons.

Notable contamination was also found in children's toys, including plastic cars, a traveler's checker set and a pirate coin medallion.

Liu's team also expressed concern these fire retarding plastics were more often found in consumer products sold at small retailers catering to immigrant communities or specific ethnic groups.

But tracking contamination is difficult, particularly where recycled materials are involved. 

Bethanie Carney Almroth, an ecotoxicology researcher at the University of Gothenburg in Sweden, said recycling programs like those used to recycle plastic drink bottles often mix waste products indiscriminately. 

"We know very little about which chemicals are present in recycled materials," Carney Almroth told DW.

Households could address exposure to these chemicals by avoiding toys with black plastic components and replacing utensils made from these materials with wooden ones.

Other simple measures to reduce exposure include not reheating food in black plastic containers, and throwing away chipped or dented plastic utensils.

But Carney Almroth says such measures alone won't cut it.

"Given the pervasive presence of plastics in products, and the lack of information available to the public, people should also support systemic changes necessary around plastics governance, including bans and restrictions on chemicals, changes in product design and shifts to reuse or refill systems," said Carney Almroth.

Edited by: Matthew Ward Agius

Primary Source:

• From e-waste to living space: Flame retardants contaminating household items add to concern about plastic recycling

Additional reading:

• Mass transfer of PBDEs from plastic TV casing to indoor dust via three migration pathways — A test chamber investigation

• State of the science on plastic chemicals - Identifying and addressing chemicals and polymers of concern

Warning: This text contains descriptions of sexual violence:

No one can deny that being raped is one of the most distressing, horrendous and demeaning experiences anyone could have. It almost always leaves the victim with feelings of self-loathing, self-blame and rage, and can cause post-traumatic stress disorder (PTSD).

But have you ever wondered about rapists, like Dominique Pelicot who in December 2024 received a 20 year jail sentence for mass rape? 

Why do men rape? This is a complicated question with multiple answers, as several factors play roles in producing a rapist.

A sexual assaulter can be any kind of person. This statement isn't meant to make everyone scared of everyone else; rather, it just means that there isn't one specific type who commits such kinds of crimes.

That is what Dr. Samuel D. Smithyman, a US clinical psychologist, learned when he anonymously interviewed 50 men back in the 1970s who had confessed to having raped someone. These men had diverse backgrounds, social statuses and, of course, different personalities and mentalities. What surprised him was how unconcerned they sounded when talking about such a criminal offense.

Motives behind rape vary and are difficult to quantify. However, studies show that rapists have some common characteristics:

- a lack of empathy

- narcissism

- feelings of hostility towards women

Toxic masculinity

Sherry Hamby,  a research professor of psychology at the University of the South in the US state of Tennessee, told DW that "sexual assault is not about sexual gratification or sexual interest, but more about dominating people."

Hamby, who is also founding editor of the American Psychological Association's journal Psychology of Violence, explained how toxic masculinity promotes rape culture. "A lot of offenders of rape and other sexual assaults are young men," she said. "The only way to have social status among male peers in many cases is to be highly sexually experienced, and not being sexually active is often stigmatized."

She believes that these kinds of peer pressure set men up to become sex offenders because "many are just in absolute panic they're going to be discovered as not sexually experienced by their peers."

In other words, there are elements at work in some cultures, and often even in media, that suggest to these men that they should assert dominance over women as a form of fake masculinity and that stigmatize those who don't have a lot of sexual encounters.

Is rape a sexual desire or an act of violence?

It is necessary to first establish that rape is not a behavioral or mental disorder, but a criminal offense. Although some rapists may have a psychological disorder, there is no such disorder that compels people to rape.

Evolutionary biologist Randy Thornhill and evolutionary anthropologist Craig Palmer  believe, in contrast to Hamby, that the primary motive behind rape is indeed sex. They argue  that rape is an adaptation  — a result of Darwinian selection and are of the opinion that it evolved to increase the reproductive success of men. They point out that most victims are women of childbearing age, saying this supports their hypothesis that rape derives from a desire to reproduce.

However, their book, "A Natural History of Rape: Biological Bases of Sexual Coercion," was sharply criticized in the science journal Nature.  It said that the pieces of evidence cited by the authors were misleading, biased or "equally support alternative explanations."

In fact, most social scientists, psychologists and feminist activists are of the opinion that rape nearly exclusively has to do with issues of power and violence. They say that rape is not about lust but motivated by the urge to control and dominate, and that it could also be driven by hatred and hostility towards women.

Hostility toward women 

Rapists often see women as sex objects who are there to fulfill men's sexual needs. They tend to hold false beliefs, often described as rape myths.  For instance, a rapist can believe that if a woman says no, she really means yes, and that she is just playing around or challenging him.

Antonia Abbey,  a social psychologist at Wayne State University in the US city of Detroit, wrote that one repeat assaulter believed the woman  "was just being hard to get." Another believed that "most women say 'no' at first most times. A man has to persist to determine if she really means it." 

 Abbey quoted yet another repeat offender as saying: "I felt as if I had gotten something that I was entitled to, and I felt I was repaying her for sexually arousing me." This man described both of his rape experiences as "powerful," "titillating," and "very exciting."

Sherry Hamby told DW that in some cultures, patriarchy and dominance are expressed through a kind of "dehumanization" in which women are seen as inferior beings to men. This makes it much easier for women to become the targets of aggression.

According to Hamby,  for men in such cultures, "part of their cultural training is for them to lose touch with their emotions." They do not know how to deal with their own feelings and even worse, they are not aware of the feelings of others or simply do not care.

The link between narcissism and rape seems to be especially strong when repeat offenders are concerned. One of the key characteristics shared by rapists and narcissists is a tendency to dehumanize others.

Types of rapist

There are several types of rapists.  There is the opportunistic rapist, who seizes any chance for sexual gratification, such as the loss of self-control on the part of their victim under the influence of alcohol.

Another type is sadistic rapist, whose motivation is to humiliate and degrade victims.

The vindictive rapist has anger and aggression focused directly toward women. Such a rapist believes he is permitted to sexually attack women because he feels he has been hurt, rejected or wronged by women in the past.

Rapists often deny having raped their victims and freqently try to justify their actions. Men who admit rape often try to find excuses for what they have done.

Sexual assault is an inexcusable act of violence and a criminal offense. Unfortunately, a lot of the victims remain silent to avoid stigmatization and being blamed by society, while their rapists are free to look for another victim.

This article deals with men raping adult women, not children, and not with any other form of sexual abuse. It was updated on December 19 2024 to include news about the Gisele Pelicot court case.

 

The spread of H5N1 avian influenza in North America has countries beyond the United States on alert.

Some governments are buying up vaccine stocks and ramping up precautionary measures in response to the circulating virus.

The bird flu variant has infected about 700 dairy herds — mainly in California on the US West Coast — between March and early December 2024. More than 1,200 commercial and backyard poultry facilities and hobbyist bird flocks have also been infected.

H5N1 has also been detected in a pig in the northwestern state of Oregon and in raw cow's milk in California.

Nearly 60 people — mainly agricultural workers working near infected cattle and poultry — have been infected.

At least two adults in Midwestern state of Missouri, one child in California and another in British Columbia in Canada, have been infected by an unidentified source.

Though no cases of human-to-human transmission have been recorded, there are concerns the H5N1 variant could be one mutation away from becoming a major public health concern.

A study published in the journal Science on December 5 found that a single genetic change to the circulating H5N1 had enabled it to jump more easily from other mammals to humans.

"We're particularly worried about pigs because we know from many other outbreaks that pigs are a mixing vessel for influenza viruses," Meghan Davis, an environmental health researcher at Johns Hopkins Bloomberg School of Public Health, told DW's Science Unscripted podcast.

Davis said influenza's ability to exchange genetic information inside mammals meant a much different, potentially dangerous pathogen could develop. Genetic shifts in the virus may make it easier to spread to humans.

Is a new pandemic brewing? 

Prior to the outbreak of SARS-CoV-2 — the virus that causes COVID-19 — health scientists warned that there was a risk of an emerging pandemic.

Ultimately it was a novel coronavirus and not an influenza strain that triggered the pandemic. But the chance of a global influenza-driven event was — and is — cause for concern.

"With H5N1, there's a big unknown," Peter Jay Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine in the US state of Texas told Science Unscripted.

"We know there's a likelihood that there could be a significant bird flu pandemic, maybe resembling the 1918 flu pandemic," Hotez said, "but we can't say when that will be."

Other nations are increasing surveillance and precautionary measures. The UK government this week ordered five million doses of an H5 influenza vaccine. In November, one case of H5N1 was confirmed at a poultry farm in Cornwall, in the south-west of England.

"I agree with what the UK did because it's not like you can press a button and suddenly have millions of doses of [H5 vaccine] appear," Hotez said. "Making flu vaccine by the traditional way is a slow process."

Hotez describes the rate of pandemic threats as having a "regular cadence," pointing to SARS in 2002 and MERS in 2012, which were dangerous but did not balloon to a global scale.

A pandemic was declared due to H1N1 influenza in 2009, though its impact didn't match that of COVID-19.

"We have to get ready for H5N1. We've also got this rise in Ebola and other filovirus [severe hemorrhagic] infections that we're seeing — we have to be ready for that," Hotez said. "And we're starting to see [a rise in] mosquito transmitted virus infections like dengue and chikungunya and then Zika virus infections both in southern Europe and the southern United States."

'They're contrarians, they're activists'

Scientists and health experts in the United States have expressed concern about several nominations and appointments that President-elect Donald Trump has made for his incoming administration.

Among Trump's picks are Robert F. Kennedy Jr. to lead the Department of Health and Human Services and Dave Weldon for the top job of the Centers for Disease Control and Prevention.

Kennedy and Weldon are known for their opposition to vaccination.

Although Trump was president at the outset of the coronavirus pandemic and led massive investment in vaccine supply security through programs such as Operation Warp Speed, Hotez said the absence of people with established experience in health issues in Trump's new administration is concerning.

"[In Trump's first administration] they were pretty mainstream public health physicians and public health scientists, but this new round is something that's quite different — they're contrarians, they're activists, they've openly campaigned against vaccines and interventions," Hotez said.

Health experts in other nations are closely watching how H5N1 is handled in North America.

"The current incidence of infection in the US demands we closely study samples of viruses from humans and other animals," said Martin Schwemmle, a virologist at Freiburg University Medical Center.

The European Centre for Disease Prevention and Control said in a November 2024 report that it was continuing to monitor the US and Canadian situations "together with partner organizations in Europe and will continue to update its assessment of the risk for humans ... as new information becomes available."

It also recommended increased surveillance and monitoring of people exposed to avian influenza, and that doctors and nurses ask patients whether they have had any contact with animals.

Edited by: Zulfikar Abbany

 

Sources:

USDA Reported H5N1 Bird Flu Detections in US Backyard and Commercial Poultry. US Centers for Disease Control and Prevention 

H5 Bird Flu: Current Situation. US Centers for Disease Control and Prevention 

Global Avian Influenza Viruses with Zoonotic Potential situation update. Food and Agricultural Organization of the United. Nations 

 

Syphilis and Christopher Columbus have more in common than you might think. Both touched down on new continents and colonized local inhabitants at the end of the 15th century: Columbus the indigenous Americans, syphilis the Europeans. Both also sought a route to Asia.

Syphilis first erupted in Europe in 1494 in a French army camp, a year after Columbus returned from a voyage to America . The disfiguring disease spread between soldiers and their sexual partners, causing sores on their genitals, rectums or mouths. 

Within just five years, syphilis had spread through all of Europe. Soon after, it spread to India, China, and Japan. Sex, although not the only route of transmission, is an effective disease spreader.  

This so-called "Columbian hypothesis" argues that syphilis was brought over to Europe by sailors returning from their colonization of indigenous Americans. The idea is that new diseases were exchanged between Europeans and Americans as new goods were: Gunpowder for tomatoes; smallpox for syphilis.

A new study published December 18, 2024, in the journal Nature gives credence to this hypothesis. 

Kirsten Bos, an anthropologist at the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany, ran a genetic analysis of five skeletons found in South America. The analyses led Bos and her colleagues to believe a precursor to syphilis-causing bacteria had circulated in the Americas 8,000 years ago. 

"Four of the five skeletons [we analyzed] are dated before 1492, meaning that this pathogen diversity was already present in the Americas at the time of [Chrisopher] Columbian contact," said study author Bos.

Syphilis originated in America 8,000 years ago

To test the Columbian hypothesis, Bos and her colleagues performed a genetic analysis on bacteria in bone lesions in the five skeletons, which came from Chile, Argentina, Peru, and Mexico.

Their bacterial samples included three subspecies of the treponemal bacterial family, which are responsible for different treponemal diseases. One subspecies, T. pallidum, causes modern syphilis.

Bos compared the genetic differences of older treponemal subspecies with modern syphilis samples. That data allowed the team to extrapolate the time it took for the bacteria to evolve, and estimate when the pathogen emerged. 

Their analysis seemed to confirm that the syphilis-causing bacteria T. pallidum emerged from the 8,000-year-old precursor around the time of Columbus.

"Our model suggests syphilis first appeared on the scene around 500 or 600 years ago, either in the Americas, or in Europe (or elsewhere) from a [bacterial] strain introduced from the Americas," said Bos.

How did syphilis spread around the world?

The study provides compelling evidence that T. pallidum was widely circulating in the Americas before the arrival of Columbus from Renaissance Europe. Yet, it doesn't conclusively prove that syphilis was brought to Europe from the Americas. 

"[It shows that] that the Americas acted as a reservoir where [syphilis-causing bacteria] were widely circulating. It could still have come to Europe from elsewhere or have already been there," said Mathew Beale, a genomics expert at the Wellcome Sanger Institute in Cambridge, UK. Beale was not involved in the study.

Studies show that treponemal diseases may have been endemic in Northern Europe around the same time as Columbus's voyages or possibly even earlier.

The exact origins of syphilis are difficult to trace, said Kerttu Majander, an archeogeneticist at the University of Basel in Switzerland.

One hypothesis is that treponemal diseases have always been around, piggybacking onto humans as they migrated from Asia to the Americas, some 12,000 years ago.

"Another theory is that they're zoonotic, meaning [precursors of syphilis] jumped from animals to humans in America. But we haven't found evidence of animals with treponemal diseases yet," said Majander.

It's also unclear what caused modern syphilis to emerge as a highly transmissible sexually transmitted infection 500-600 years ago. 

"It could be that something caused treponemal bacterial species to recombine and cause more aggressive forms of syphilis, but we don't know," said Majander.

What makes it even more complicated is that syphilis and gonorrhea were often confused in historical records, and only formally recognized as separate diseases around 200 years ago.

"There is still historical debate about whether the ‘syphilis' outbreak described in the 15th Century was really caused by T. pallidum," Beale said.

Antibiotic-resistant strains of syphilis are a problem today 

Untreated, syphilis once disfigured people's bodies and caused paralysis, blindness, attacks of pain and even death.

The development of the antibiotic penicillin in 1943 eradicated the dangerous symptoms of syphilis, if not the disease itself.

But syphilis lives on. Sexual transmission causes over 8 million new cases each year, while congenital syphilis causes around 200,000 stillbirths. Cases are rising in young adults, too, and research suggests this could be linked to a rise in unprotected sex.

Antibiotic-resistant strains exist for T. pallidum, too, meaning deadlier syphilis infections are re-emerging. 

That's why studies like this are relevant, said Majander, especially if we want to eradicate syphilis: "[The study shows] that syphilis has the capability of adapting to any environment. It raises the question whether other treponemal diseases existed before, and whether new, more aggressive diseases could emerge in the future."

Edited by: Zulfikar Abbany

Sources:

Barquera, R., et al. Ancient genomes reveal a deep history of Treponema pallidum in the Americas. Nature (2024). https://doi.org/10.1038/s41586-024-08515-5

Majander, K., et al. Redefining the treponemal history through pre-Columbian genomes from Brazil. Nature 627, 182–188 (2024). https://doi.org/10.1038/s41586-023-06965-x