Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Monday, November 30, 2015

Coping With War's Consequences: Syria

"Most of them left either after their house was destroyed, or they had at least one or two close relatives or friends who died."
"We have people who have quite a lot of signs of stress, depression and so on."
Paul Yon, head, Medecins Sans Frontieres Lebanon mission

"In many ways, a migration like this is unprecedented ... the numbers could be staggering. [But] there are a lot of health-care workers who really want to contribute."
Dr. Meb Rashid, medical director, Crossroads Clinic, Toronto

"I saw a lot of Syrian refugees who came to Turkey and they did not receive what they expected in support ... They decided by themselves to go back to Syria, to areas in the middle of the conflict, putting themselves in 100 percent risk of death."
"They decided to do this rather than stay in a country that provided them with a safe environment, but no other type of understanding or support."
Mohamed Elshazly, International Medical Corps., California
Syrian refugees at a tent settlement in Al Ain, Lebanon. Photo by Nick Rice
The United Nations Refugee Agency has had its hands full attempting to cope with the myriad human needs of the greatest migration since the end of the Second World War, of people escaping conflict in Syria, seeking refuge in neighbouring countries like Turkey, Lebanon and Jordan primarily. Living there in their millions, in unfamiliar surroundings, familiarizing themselves with living with the bare necessities of life, mourning the loss of their comfort, their homes, their possessions, their security.

Some of these refugees will eventually return to their country of origin when the conflict which has entered its fifth year of a tyrannical government turning its military loose on its own civilian population in a brutal sectarian war that has pitted an Alawite Shiite autocracy against the majority Sunni population of the country, eventually, somehow comes to a conclusion. The Sunni Syrians did not take up arms against their ruling elite, what they did was to mount protests against their unequal treatment as citizens of the state.

Those protests engendered a response that no one could have anticipated in its raging brutality where every and all Sunni Syrians are considered by the ruling Shiite minority to be 'terrorists' whom the regime is justified in wiping from the face of the Earth. Various countries of the world have resolved to do what they can to absorb tens of thousands of the resulting refugees comprised of Sunni Syrians, Syrian Christians, and minorities such as Kurds and Yazidis, along with gays, targeted by all.

Huffington Post

This, apart from the Syrians who have left the country with no intention of settling anywhere but the wealthier of the European countries of their choice, enabling themselves with the use of human smugglers to find haven in particular areas, because they have the pecuniary means to buy that avenue of escape from Syrian bloodshed. The greater numbers of Syrian refugees living in sprawling camps in neighbouring countries haven't the means to buy their way into another country through migration.

Those countries like Canada that have stated a firm number of refugees they are committed to welcoming as new landed residents are anticipating both the burden and the responsibility of catering to the needs of people fleeing terror, leaving their homes behind. In Canada, medical providers know that they will be challenged by the needs the refugees will present. Refugees with war injuries, with chronic diseases under-treated for years, and those suffering from psychological stress.

Physicians and health clinics throughout the country have signed up as volunteers to lend their services to those in need. Although the medical system can hazard informed opinions relating to the kinds of medical services that will be required, until the reality presents itself when the refugees appear on Canadian soil and their needs begin the process of care, it is guesswork. It is evidently not infectious diseases that may present as a problem.

Refugees whose medical conditions have gone untreated while they have lived in countries like Lebanon, Iraq and Jordan likely will present with diabetes, hypertension and other chronic diseases having worsened during that period. Adults and children alike who suffered from the effects of both torture and bombs afflicting their bodies, who have never had adequate care, will also be expected to present with dire medical needs to be met.

Dr. Anna Banerji
Dr. Anna Banerji examines Noor-Zehra El-Maliki, who recently arrived from an Iraqi refugee camp in Turkey. (CBC)

But it is the psychologically afflicted that ae expected to represent the most significant area requiring immediate attention. Four in ten Syrians appear to be suffering some manner of transitory mental health symptoms, readily treatable. Insomnia, loss of appetite, depression, represent the loss that people have suffered and the horrors they have been submitted to. The state of helplessness and desperation, dependence on the goodwill of others for rescue from dreadful situations makes further victims of people.

"They are in desperate need of serious psychological help and support to overcome the trauma and the horror they have been through", stated a study releasing the findings of academics in Jordan who had interviewed Syrian migrants in that country. In particular, the child refugees suffering mental health problems will be a realized challenge. Of refugees treated by the International Medical Corps. 54 percent were afflicted with a severe emotional disorder like anxiety or depression.

Another 27 percent were treated for epilepsy, while 17 percent had a psychotic condition like schizophrenia. The high numbers were attributed to the belief that these figures are an over-representation, given that people in distress sought out treatment. In Canada, on the other hand, there is a belief that roughly five percent of the 25,000 Syrian refugees expected to arrive will require professional mental health treatment.

The best-case scenario anticipation is that existential stability, decent housing, community support and eventual integration assistance into Canadian society will diminish mental health issues that most people in such situations struggle with.

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Sunday, November 29, 2015

Sacrificing Children As Sex Possessions

"My parents are poor, they cannot afford to look after me. I helped my family when I got married; they no longer need to support me."
16-year-old Mozambican girl

"I was in the ninth grade. Now I get up at 6 a.m. I clean the house, then I clean my mother-in-law's house and I also work on the farm."
16-year-old in Inhambane province, Mozambique

"Mostly it's a situation where the mother herself was given away as a little girl, so they think it's normal."
"It becomes something generational."
Pascoa Claudino Sumbana Ferrao, government director, Inhambane City

"The problem is that girls and women are not allowed to speak. If a man stands up in church and says God showed him in a dream that he should marry a certain girl, then that is God's commandment which must be obeyed."
Zimbabwean church elder
Child bride in Niger -- The Economist

In Nigeria, 23 million girls and women were married in childhood, making that country home to the largest number of child brides in Africa. Elsewhere in Africa, Chad and Central African Republic are among the countries with the highest rates of child marriage today. The world gasped in horror as the Islamist terrorist group operating out of Nigeria, Boko Haram, kidnapped almost 300 schoolgirls in Chibok, where they attended a private school for girls. The wholesale abduction of hundreds of girls was viewed as an atrocity, and it was.

But the custom of male relatives of young girls selling those girls into marriages with mature and often much-older men prevails throughout Africa and south Asia. Those girls are sold, although the custom is to consider their selling price a 'bride price', much as cattle are sold at auction for whatever the going price might be, to add to an enterprising man's holdings. In this case, a young girl is considered the property of whoever offers the best bride price to an often rural, often penurious family.

It's hard to see how this practise is condoned and the abduction of hundreds is condemned. How different are they? In either instance, slavery results and a lifetime of misery.

The fate of one girl was outlined, a fourteen-year-old schoolgirl whose school uniform was discarded when she was handed a traditional wedding robe and informed her seventh-grade studies in South Africa were over because her male relatives had taken a $570 bride price from a man she had no idea even existed, who happened to be twice her age. After the marriage where she had been beaten and raped, she made a successful escape and reported her experience at a police station.

Officially, child-bride arranged marriages are forbidden by law in many of the countries where they occur. A law that is ignored in favour of what has become a tradition; selling young girls into lifetime servitude under the name of marriage. In the instance of the young girl who related her experience to police in South Africa, a criminal prosecution of child marriage resulted.

A recently released UNICEF report has highlighted the "lost childhoods and shattered futures", of these young girls with the demands that these governments enact more aggressive responses to put an end to the practise in Africa altogether. Where, across the continent girls are being used as possessions to be sold, the price bargained for to be used for family debts. Sometimes girls are sold into marriage in the belief that this will ensure they aren't able to engage in mischief.
What lies in store for these girls is anything but a placid future life of comfort and care as a valued companion for a man. Their lives are comprised of violent incidents, of poverty and risk of HIV, according to UNICEF. In the criminal case that took place in South Africa the husband was found guilty of rape, assault and human trafficking, sentenced to 22 years in prison for what he kept insisting was a traditional practise.

That tradition is called "ukuthwala". At one time young men would reach an agreement with a girl, and both would make an effort to convince her family to agree to their marrying. At the present time, some older men have taken to abducting girls, raping them, and forcing them into a 'marriage' that has more in common with slavery than marriage, according to the Commission for Gender Equality in South Africa.

In Ethiopia as well abductions and forced marriages of girls represented custom, but were outlawed in 2004. That this is against the law is no guarantee whatever that the practise will not continue, for it does. In Mozambique no laws exist to prevent child marriages. If a village community decides a girl should be married in a traditional ceremony her consent is not required and authorities are powerless to intervene. Nearly half of women between 20 and 24 married before the age of 18.

In Zimbabwean society early marriage is recognized as an avoidance of sin and child marriage is encouraged among the followers of churches combining evangelical Christianity and traditional African beliefs. Church leaders go so far as to enforce virginity testing rituals on girls as young as twelve.
Number of African child brides to soar by 2050 as population grows-U.N
  • Pregnancy is consistently among the leading causes of death for girls ages 15 to 19 worldwide.
  • Child brides often face a higher risk of contracting HIV because they often marry an older man with more sexual experience. Girls ages 15 – 19 are 2 to 6 times more likely to contract HIV than boys of the same age in sub-Saharan Africa.
  • Girls who marry before 18 are more likely to experience domestic violence than their peers who marry later. A study conducted by ICRW in two states in India found that girls who were married before 18 were twice as likely to report being beaten, slapped or threatened by their husbands than girls who married later.
  • Child brides often show signs symptomatic of sexual abuse and post-traumatic stress such as feelings of hopelessness, helplessness and severe depression. 
  • While countries with the highest prevalence of child marriage are concentrated in Western and Sub-Saharan Africa, due to population size, the largest number of child brides reside in South Asia.   
  • Girls living in poor households are almost twice as likely to marry before 18 than girls in higher income households.
  • More than half of the girls in Bangladesh, Mali, Mozambique and Niger are married before age 18. In these same countries, more than 75 percent of people live on less than $2 a day.   International Centre for Research on Women
Child Marriage Around the World
Percentage of girls marrying before the age of 18                      1 Niger 76.6
2 Chad 71.5
3 Bangladesh 68.7
4 Mali 65.4
5 Guinea 64.5
6 Central African Republic 57.0
7 Nepal 56.1
8 Mozambique 55.9
9 Uganda 54.1
10 Burkina Faso 51.9
11 India 50.0
12 Ethiopia 49.1
13 Liberia 48.4
13 Yemen 48.4
15 Cameroon 47.2
16 Eritrea 47.0
17 Malawi 46.9
18 Nicaragua 43.3
18 Nigeria 43.3
20 Zambia 42.1 Source: ICRW 2007

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Saturday, November 28, 2015

Casey Family Agony Lives On

"In light of the trial judge’s strong findings of bias against the Crown’s main accident reconstruction witness it was unreasonable for him to conclude that he could nonetheless accept the aspects of the evidence bearing on the key question in dispute."
Natsis notice of appeal
The family of Bryan Casey, seen here at left with his wife and three children, is suing the woman accused in the fatal crash that killed Casey. (Submitted photo)
A man returning home from a day of work to his family has the dismal misfortune to be on the highway with his pick-up truck at the very time when an intoxicated woman driving her own vehicle passes the centre line and rams his vehicle, causing morbidly massive injuries leading directly to his death. And when 50-year-old Bryan Casey died in that head-on crash on Highway 17 near Arnprior on Mach 31, 2011, his wife was left bereft, his three children fatherless.

The woman who drove recklessly inebriated was a Pembroke dentist. Her dangerous driving was directly observed by many people who were witnesses at a trial that found her guilty of causing this man's untimely death. They spoke of seeing a heavily intoxicated woman, unsteady on her feet, enter her Ford Expedition van as she exited the Crazy Horse bar in Kanata, backing her vehicle into a parked car, accelerating at high speed onto the nearby highway, swerving and speeding at estimated speeds of 130 km/hr.

Witnesses testified that this dangerous driver almost collided with a concrete wall during the 24-minute drive that ensued before she slammed head-on into the Dodge pickup that Mr. Casey was driving. She was seen to exit her vehicle at the accident site, having difficulty walking, slurring her speech, her face and eyes reflecting her drunken state. She was querulous and self-absorbed in her verbal exchanges with investigating authorities, demanding to be taken to hospital, never once enquiring about the condition of the man she hit.

Her entitled, arrogant behaviour throughout the episode gave ample clue to the type of woman she is, negligent of others' safety, insistent on her own right to special consideration, as though she were the victim, not the perpetrator. Expert testimony given at trial by investigating RCMP officers was challenged by her high-priced lawyers who picked apart the evidence and insisted it be ignored in light of claims that errors had occurred and the officers were biased against this woman.

The sitting justice agreed to set aside her blood-alcohol reading of two and a half times the legal limit, but while acceding to some of the defence charges, did take note of evidence signalling that Mr. Casey who also had a lower but elevated blood-alcohol reading, was driving capably and attempted to evade the vehicle heading directly for him, while Ms. Natsis never attempted to swerve away or brake. The 'black box' recovered from her vehicle also testified to the speed she maintained.

Two weeks earlier Ms. Natsis was sentenced to five years in prison. She has decided to appeal her conviction on the grounds that the judge erred in considering evidence that her lawyers insisted should be discarded as unreliable. Those same lawyers made every effort to de-legitimize testimony given by every witness for the prosecution. Ultimately trial judge Neil Kozloff found the woman guilty as charged and she was convicted.

She has now hired a new set of criminal lawyers known for their expertise in the courtroom, at huge expense. Her trial took 55 sitting days, over a four-year period, unheard of, but for the efforts extended on behalf of a woman able to afford to turn justice on its head. Now she has the expertise of several Toronto lawyers, one of whom is representing the hugely-popular former CBC radio host, Jian Ghomeshi in his sexual assault trial.

This is a woman whose addiction to alcohol coupled with a monumental ego poses an ongoing threat to society. Her previous bail conditions throughout the trial period mandated that she no longer consume alcohol and not go anywhere near a liquor outlet, but a violation of her bail conditions took place when she purchased two bottles of vodka at a downtown Ottawa Liquor Control Board outlet. A violation for which she was sentenced to 40 days in prison.

Now this woman who has put the family of the man she killed in a vehicular homicide through hell for years, is determined that she does not belong in prison, since she has pleaded innocent throughout their ordeal and hers. She and her lawyers have centered their appeal on alleged errors committed by the trial judge. They are asking an appeals court to set aside her impaired and dangerous driving convictions, to find her not guilty, or to order a new trial.

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Friday, November 27, 2015

Therapeutic Recreation

"Gone is the day where a patient says, 'I smoke cannabis recreationally and I continue to do this for my pain' — and I have to shy away from that. I can say, medically, I have a prescription pad and I can actually bring [cannabis] to the table as part of their pain regimen."
"Right now we’re not really using it [marijuana] as a medication. We’re giving people permission to experiment with it."
Dr. Hance Clarke, Toronto General Hospital

"We’re kind of conditioned in society to look down on marijuana, because of all the propaganda we’ve been fed all our lives. [But] it’s basically given me my life back."
Bob Deslauriers, 58, hepatitis C sufferer

Bob Deslauriers' medial marijuana joints contain high-potency pot which has lessened his dependence on a type of morphine for pain control.
Chris Roussakis for National Post   Bob Deslauriers' medial marijuana joints contain high-potency pot which has lessened his dependence on a type of morphine for pain control.
"We have a statewide epidemic of opioid deaths. As soon as we can get people off opioids to a nonaddicting substance — and medicinal marijuana is nonaddicting — I think it would dramatically impact the amount of opioid deaths."
Dr. Gary Witman of Canna Care Docs, Fall River Canna Care clinic
In Canada, a multi-hospital research project is underway for the purpose of testing the wisdom of substituting a non-addictive drug for a hugely addictive one. The idea is to overcome a social problem that is both debilitating and deathly. When physicians prescribe opioids for their patients for short-term use in controlling pain, the end result is often addiction. And opioids, though they fulfill the objective of dulling pain, create an additional, worse problem; addiction leading to death.

And even while this research is being pursued, surveys suggest that medical-cannabis users are taking the initiative of their own accord and substituting pot for prescription pharmaceuticals. Canada is recognized to be second only to the United States in the use of opioids through prescription. The result has been hundreds of Canadians dying annually, from overdoses. And it's not because they are overdosing themselves necessarily, but merely using what their doctors have prescribed.

Of course huge numbers of people caught in the addiction cycle are there because they have spiralled from its legitimate, prescribed use to over-consumption because they have become heavily addicted, adding to the death toll. A case study was recently made public by Dr. Hance Clarke out of Toronto General Hospital, who co-authored it as part of his association with Ontario's Transitional Pain Service, provincially funded to aid post-operative patients who become dependent on medication.

One patient in particular was the subject of the study, and the outcome appears to point the way through to making opioids redundant with the simple substitution of a far less harmful drug which can achieve the positive effects that opioids are known for, without burdening users with their negatively harmful consequences. That patient was a man from Eastern Ontario whose back operation in 1987 left him with a hepatitis C infection transmitted by tainted blood in a transfusion.

Eventually his liver was destroyed and a transplant required. As a result of his health condition and the surgeries this engineer and former corporate CEO was dependent on so much painkiller he was unable to function. And then marijuana was provided for his use and that made it possible for him to be gradually weaned away from most of the opioids he had been dependent on; the exception being a small dose of morphine.

The result was the return of his intellectual capacity and his ability to function again as he normally would. His dependence on the legal but debilitating drug was alleviated by the introduction of a once-illicit drug and a medical-prescriptive war was won. Or potentially gained, since Dr. Hance points out with all due caution that one problem solved simply is one problem solved.

The results could be reflected in other patients with similar problems, but until numerous patients are studied under a rigorous, randomized controlled trial, celebration is somewhat premature. But this kind of experimental exchange of prescribed drugs is happening elsewhere, too.

A number of clinics and physicians in Boston, Massachusetts have launched a program of drug substitution, finding the new protocol far more beneficial to their patients. Canna Care Docs operates in seven States of the Union as a network of facilities whose doctors issue medicinal marijuana cards, including to their patients in the nine clinics they operate in Massachusetts. 

On the other hand, for every enthusiast about enlisting the aid of marijuana and rejecting harder drugs, there is an opposing view that holds that any time additional drugs are added to the situation, problems ensue and it is drugs themselves and their addiction potential and how that affects people's lives that is the problem. These are people who view marijuana as a 'gateway' drug leading users to harder drug use, and the downward spiral that results.

For Bob Deslauriers that substitution saved his life, transforming him from someone who merely existed with no quality of life left to him under the pain-killing for life-numbing effect of opioids, to being able to resume his former work schedule with the use of a marijuana strain high in the compound cannabidiol (CBC) to treat his pain, and another with plenty of tetrahydrocannabinol (THC) to control chronic nausea.

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Thursday, November 26, 2015

Sometimes the Law Really is an Ass

"Is there not a possibility that a very unhappy thing happened here? Two young people made love, and somebody came afterwards and poisoned the girl’s mind?"
"[If the alleged victim] knew she was drunk … was not an onus on her to be more careful?"
"She certainly had the ability, perhaps learned from her experience on the streets, to tell [him] to fuck off."
"Why didn’t you just sink your bottom down into the [bathroom] basin so he couldn’t penetrate you?"
"Certainly the complainant and the accused are amoral people ... the complainant and the accused’s morality, their sense of values, leaves a lot to be desired."
"The accused hasn’t explained why she allowed the sex to happen if she didn’t want it."
Alberta Justice Robin Camp
"I have come to recognize that things that I said and attitudes I displayed during the trial of this matter, and in my decision, caused deep and significant pain to many people," wrote Federal Court Justice Robin Camp.
Federal Court Justice Robin Camp -- Alberta Justice/Calgary Herald
"[Although it is] the right of everyone in the Canadian legal community to insist on high standards in the administration of justice [one can only be] troubled by the public campaign for Justice Camp's removal. He cannot defend himself or rebut these attacks in the media."
"This is why professional conduct rules across Canada place 'special responsibility' on lawyers criticizing judges."
Frank Addario, lawyer for Justice Camp
The complaint against him, filed by four law professors from the University of Calgary and Dalhousie University states: "at numerous points during the proceeding, Justice Camp was dismissive of, if not contemptuous toward, the substantive law of sexual assault and the rules of evidence. [He was] frequently sarcastic and disrespectful to Crown counsel when she attempted to explain to him how these rules work, [and his] articulated disrespect for these legal rules was, in some instances, combined with a refusal to apply them."

Such wisdom handed down by an Alberta provincial judge hearing a case of a 250-lb. belligerent man sexually assaulting a 19-year-old woman in the bathroom of his apartment where a casual get-together was taking place. Why didn't she resist, why didn't she scream for help, why didn't she fight off her attacker? All questions that the esteemed justice put to the complainant, busy demolishing whatever self-esteem the young woman had left to her. Obviously, women are willing accomplices to violent rape. Well, that happened in 2014.

Since then this man's judicial wisdom and folksy recommendations (in his finding of not guilty, Justice Camp informed the rapist that men must be more gentle and careful with women, something he should tell his friends to enable them to "protect themselves" not "get into trouble".) have been awarded the kind of recognition that someone in his profession salivates over; an appointment to the Federal Court. And then, someone got upset and spilled the beans that Justice Robin Camp had strewn all over his reputation, and the details hit the news and women were very, very agitated. Some of those women are law professors, and they were troubled enough to lodge an official complaint.

And now, belatedly, but perhaps never too late, the Canadian Judicial Council has placed Justice Camp's professional conduct of that trial under investigation. While remonstrating with the young woman who brought her complaint of rape against her attacker that she must surely have invited the rape and she would do better to behave in a more seemly fashion in future, he admonished the man, and giving him the credit of the doubt, acquitted him of sexually assaulting the complainant.

Thankfully, that verdict was overturned on appeal and another trial will ensue, to ensure that the young woman who must surely have the courage of her conviction that she should have something to say about whether or not she is interested in having carnal relations with some brutish lout, will undergo another reprise of the horror, fear and disgust she felt when she was attacked. For his even-handed pains in acquitting the rapist and blaming the victim, Justice Camp has been removed from cases.

It seems that the more sober-minded within the august legal community to which this man had been elevated in June after his distinguished career as a provincial court judge in Calgary, thought better of the qualifications of a man who would address a woman on the witness stand by asking: "When your ankles were held together by your jeans, your skinny jeans, why couldn't you just keep your knees together?" Needless to say, once all of this disgraceful behaviour was brought to light, Justice Camp apologized.

And he is slated to attend sensitivity training sessions. Will they really help a man who has grown to maturity in the legal profession no less, and still retains such antediluvian theories? "There is a significant public interest in raising awareness about judicial attitudes and perspectives that are wildly out of sync with modern thinking and dramatically inconsistent with the values reflected in laws addressing problems such as sexual violence" reads in part the letter that Alice Woolley, one of the four law professors complaining to the CJC wrote to the Canadian Judicial Council.

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Wednesday, November 25, 2015

The Rowan's Law Act

"Would knowledge of concussions have prevented her death? I think there's a good chance it would have, if she had been more clued in. In fact, she did try to clue herself in. One of her texts indicated she had Googled 'concussion'. But she didn't read enough, or it didn't sink in enough, to prevent her from playing in that final game that took her life."
"We found out in the Rowan Stringer inquest that some [amateur football] leagues had done nothing about concussions -- zero." 
"We do think the adolescent brain is the most sensitive brain to the effects of concussion. We used to think the infant brain was the most sensitive to trauma, but it appears now, because of the huge number of connections that are being made during adolescence, there's a reason to worry more about adolescents getting concussed. They certainly take longer than adults to recover."
Dr.Charles Tator, neurosurgeon, Krembil Neuroscience Centre, Toronto Western Hospital

"I'm totally shocked, because typically in Canada we're more progressive as far as health care goes and safety."
"In the States, they realized this is serious, this is dangerous, and this is worth having legislation."
Kathleen Stringer, Ottawa
Concussion death inspires push for 'Rowan’s Law'
17-year-old Rowan Stringer died in hospital after suffering injuries in a high school rugby game in May 2013.
"When I see the kids, they're often pretty down. They're pretty fed up. They've had persistent headaches, often for months. They find it more difficult to do their schoolwork, because they find it difficult to concentrate and attend."
"They haven't been allowed to go back to play sports, so they're feeling socially isolated from their friends. When we see these kids, it's often quite sad."
Dr. Karen Barlow, pediatric neurologist, Alberta Children's Hospital
Facebook    Rowan Stringer, right, carries the ball in a picture on her Facebook page 
"If I had a dollar for every time I heard, 'Suck it up and play through it' during my career, I wouldn't be on a student budget. All of us seem to feel the team can't win without us, and that's a great feeling to have, because you feel like you're imoportant and contributing. But there's no win that will ever be more important than your ability to function."
"I knew I was doing the wrong thing [playing through a concussion], but it didn't matter at that point. I was still too young to realize that your brain isn't something you can put in a cast and hope it will get better."
Molly Tissenbaum, Ontarian, hockey goalie, Harvard University

"She was Jekyll and Hyde. As brilliant as she had been, she couldn't come up with any answers at school. She was so frustrated by it [post-concussion syndrome]. She was like the Tasmanian Devil. Not the real one, the one we all know from the Warner Bros. cartoon. Things were all over the house. She couldn't remember where anything had been put, so she would just whirl around looking for what it was that she thought she put down, and it was always right beside her. She was not on her game at all."
Lisa Tissenbaum, Molly's mother

"Nothing can stop me! Unless I'm dead", Rowan Stringer wrote in a text message she sent to her best friend the night before she was to play her last rugby game for her school team. She played after two concussions in the space of a week, while exercising her talent for sports. She had been an exuberant volunteer at Children's Hospital of Eastern Ontario, preparing to attend University of Ottawa's nursing program in the fall of 2013. But CHEO was where she died on May 12, 2013, from the results of exacerbating the concussions she had suffered.

A coroner's inquest that followed pointed out starkly the laissez-faire attitude of authorities, sport officials and the public in a massive failure to understand just how serious the effects of repeated blows on the cranium can be, both in the short term and long-range into the future. This 17-year-old girl who loved playing rugby and had a zest for life and anticipated a fulfilling future surrendered her life to a lack of understanding of what her headaches presaged.

While Canada and the provinces have no laws respecting youth concussions, all 50 States in the U.S. do have such laws. Ontario has just now passed the first of such laws in Canada, and it has been called 'Rowan's Law', meant to bring awareness to the problem of youth concussions and to prevent situations such as Rowan's from re-occurring, robbing a young life of a future. Among professional athletes concussions have taken the headlines in recent years.

The National Football League was accused of masking risks of repeated head injuries and is now facing a $1-billion settlement with thousands of former players. The National Hockey League and the National Football League have, over the last few years, both adopted protocols to address concussions. Players are required to leave the bench and report to a quiet room for assessment by a doctor after a hit to the head, with the NHL. The NFL has addressed the critical issue through requiring a player with a suspected concussion to have a team doctor clearance plus an independent neurologist go-ahead, before being permitted to return to the game.

For youth sports in Canada, however, few such rules exist despite that in 2012 the Canadian Paediatric Society pointed out that a statute requiring all regional sporting associations and school boards was required for the development of a written concussion recognition and management policy. The Paediatric Society pointed out that concussions account for nine to 12 percent of all high school sports injuries.

Six years ago Washington was the first state to bring forward a concussion law, named after a 13-year-old football player who had suffered a life-threatening brain injury after a return to the game following a hard strike earlier in the game. Three years earlier at the Alberta Children's Hospital traumatic brain injury program 100 to 150 children were treated annually with persistent concussion symptoms. That number has risen and will hit 400 this year.

A 2014 Ontario study discovered the total number of pediatric concussion visits to emergency departments and physician offices rose to 14,886 in 2010 from 8,736 in 2003. The rate per 100,000 population increased to 754 from 467 for boys and to 441 from 209 for girls, during that period. In a 2013 study out of North Carolina it was found that up to 40 percent of concussions that occurred to American high school athletes failed to be reported to coaches or to medical officials.

Molly Tissenbaum, remembering her own experiences when she was a younger athlete feels relief that Ontario has finally passed a concussion-protection law. "I think this law is going to be a very important first step in recognizing that say, 'I'm injured, I cannot play', is not a sign of weakness. It's mind-blowing the number of kids who are in organized sports, and they're vulnerable to these things, because there's nothing protecting them except their own ability to say, 'I'm hurt', or 'I'm not'. Having been an athlete, I know that might be the single most difficult thing to say."

Management of the adolescent concussion victim. Abstract

Increasing awareness and understanding of the implications of concussion have shaped a more proactive management approach to this problem. Although the incidence of brain injuries in adolescent athletes is probably in the range of 1.6 to 3.8 million per year (Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Facts for physicians about mild traumatic brain injury. Available at:, difficulties in recognizing and diagnosing this condition mean that as many as 80% go unrecognized and have led to its being known as "the silent epidemic." Attempts to improve the evaluation on the sidelines, in the outpatient clinic, and in the home are helping to improve management. Better understanding of the prognosis and clinical course of concussion, as well as the importance of physical and mental rest, have also helped healthcare providers to make better decisions about allowing athletes to return to play.  Congeni J1. Adolesc Med State Art Rev. 2009 Apr;20(1):41-56, viii. Review. U.S. Library of Medicine, National Institutes of Health

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Tuesday, November 24, 2015

Questioning Medical Ethics in "Saving" Lives

"This is about invasive, aggressive, expensive life-sustaining treatments, used against people's wishes."
"Most people's concept of the dying moment is a tender moment, a warm moment, the family around you, holding your hand, preserving dignity. The reality for people undergoing resuscitation is the opposite of that."
"There's a real failure on our part to engage these older patients ... to honestly elicit their wishes."
Dr. Daren Heyland, critical-care physician/Queen's University professor

"Then when you sit down and have an open and direct conversation about it, you find out that's not what they want at all."
Dr. Stephen Workman, critical care specialist, QEII Health Sciences Centre, Halifax

"The big, long tradition of not really working with families is still very, very deep."
Sholom Glouberman, founder, Patients Canada (advocacy group)
Issues over end-of-life care — from euthanasia to deciding when to stop life-preserving treatment — have been drawing attention recently like never before.
Getty Creative   Issues over end-of-life care — from euthanasia to deciding when to stop life-preserving treatment — have been drawing attention recently like never before

A new study published in the journal BMJ Quality and Safety points out among other disturbing facts, that over a third of elderly and gravely sick patients who are hospitalized have been selected routinely to receive cardiopulmonary resuscitation whether or not they have indicated that they want the application of this generally-agreed futile measure, given their health condition. Logic might have it that something of this vital nature would be discussed between the attending physician and the patient on admission to hospital or at some time before the perceived need to take such action arises.

The authors of the report consider these orders that appear longevity-unwarranted -- to impose on gravely ill elderly patients a procedure that is both painful and futile -- represent a 'medical error' resulting from lack of communication. According to Dr. Heyland, who headed the research project that informed the paper, attempts to restart an arrested heart only on rare occasions save someone's life. What these attempts do in more real terms is impose on the helpless unneeded violence at a time when they really need a tranquil passage from life to death.

Over 800 patients were interviewed by the researchers, along with 600 members of their families at sixteen hospitals across Canada. Among other questions, the critical one of whether the patient would wish CPR to be performed on them (chest compressions meant to restart the heart and keep the patient alive in the wake of a cardiac arrest)was posed. With the response noted, the researchers looked at the patients' bedside charts to determine whether they were compatible with the stated wishes of the patients themselves.

For the large majority of patients -- most of whom were in their 80s with four in ten having congestive heart failure, advanced cancer or end-stage dementia -- who expressed a wish not to have CPR, 35 percent of the charts expressly indicated "full code" or made no mention of CPR, both of which amounted to the same outcome; to use all methods to restart the heart. On the other hand, the study found evidence that eight percent who said they would wish CPR had the opposite written on their charts.

Some doctors hide behind euphemisms because they’re afraid of upsetting families or simply unsure of the prognosis, one physician says.
Fotolia Some doctors hide behind euphemisms because they’re afraid of upsetting families or simply unsure of the prognosis, one physician says

Up to two percent of patients undergoing cardiopulmonary resuscitation in hospital live to see another day at home. Half of that number come out of the experience with serious neurological damage ensuing as a result of the application of CPR. Most of those interviewed stated they had not informed medical staff of their preference and for the simple reason that they were not asked. The truth is, people on both sides of the equation, health service providers and the public alike, prefer to skirt the issue of unpleasant end-of-life issues. And this is to the detriment of both.

Dr. Workman in Halifax felt the default position used throughout health care practise places any patient in full code unless their chart states otherwise. He feels this is a fall-back negating the need of medical practitioners to broach an uncomfortable subject; both for themselves and the public. But unless the chart reflects the patient's specific position the obligation of health professionals to act in a manner consonant with a patient's wishes cannot result.

Increasing numbers of people are now looking after their sick and elderly family members. They are themselves quite reluctant to speak of such matters when they feel they are reflecting their loved one's best interests and wishes for themselves about when life-sustaining treatment should stop, advises Mr. Glouberman of the Patients Canada advocacy group. This is, of course, a matter affecting people everywhere, not just in Canada; an issue long overdue for a system of best-practise to be adopted.

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Monday, November 23, 2015

Marital Incompatibility on Steroids

"If, despite all the evidence I have, the accused are allowed to escape then no other women will ever try to prosecute for this type of crime."
"Ultrasounds in India always happen behind closed doors because every doctor knows it's a crime and will never give the results in writing."
"They didn't say anything to me, but afterwards it was clear that my husband and my in-laws knew that I was carrying girls. After that, they began badgering me to have at least one of them killed. They told me we could not bring up two girls, we would not be able to afford to get them married."
"He threw me out of the house because he wants to remarry someone who can give him a son.""Even as an educated woman I am pushed around. But my daughters are now my biggest source of happiness, and I am proud that I have saved them."
Mitu Khurana, 39, pediatrician, Jaipur, Rajasthan
Mitu Khurana (right), from Jaipur, claims her husband Kamal (left) secretly asked doctors to take an ultra-sound of her babies while she was in hospital with a stomach complaint in 2004
Mitu Khurana (right), from Jaipur, claims her husband Kamal (left) secretly asked doctors to take an ultra-sound of her babies while she was in hospital with a stomach complaint in 2004

China and India, each representing huge countries geographically and each having over a billion people (1.3-billion and 1.2-billion respectively) undertook to persuade their citizens to have fewer children; China with a one-child-only per family law, India with forced sterilization. In both countries boy babies were considered to be more desirable than girl babies and the result has been the abortion of female foetuses with a resulting gender imbalance causing social havoc in both countries. 
China has relented on its one-child coercion, and India has made ultrasounds illegal.

Social and cultural biases cannot be changed so readily to meet a new climate of enlightenment, however, and ultrasounds are still taking place, illegally. Dr. Mitu Khurana has fought a long legal battle over an ultrasound that was done at her husband's behest without her knowledge when she was pregnant with twin girls. She had experienced an allergic reaction and was taken to hospital, given sedatives and a kidney scan taken. Her husband took advantage of the opportunity to convince colleagues to take an ultrasound.
The 39-year-old paediatrician (pictured) refused to abort the twins and is now beginning a 'landmark' legal fight at India's high court
The 39-year-old paediatrician refused to abort the twins and is involved in a 'landmark' legal fight at India's high court

Dr. Kamal Khurana, her husband, has denied his wife's allegations. This is, in fact, the first time that such charges have ever been brought to an Indian court. But it is an important struggle for very basic human rights. It has been estimated that 12 million female foetuses were aborted in India through a period of 30 years. An investigation of 89 hospitals n Delhi alone discovered birthrate discrepancies of great proportions. In one instance, 285 girls were delivered for every 1,000 boys.
The United Nations made note of the situation and concluded that the number of violent sex crimes so common in India may very well be partially related to the dwindling number of Indian girls in the population, a shortage that has reached "emergency proportions". The lawsuit that Dr. Khurana brought both against her husband and the Jaipur Golden Hospital was thrown out recently by a lower court, citing a lack of evidence.
Dr. Khurana described the untenable situation she faced after the 2004 ultrasound had been taken without her permission, and against the law, in a collusion between her husband and other doctors at the hospital. Her husband afterward began insisting she have an abortion and was often violent in his behaviour; once, she stated, pushing her down a set of stairs. When she asked for medical help, her husband responded by confining her with "the intention to induce abortion".
It was her parents who brought her to hospital the next morning. Her twin girls, Guddi and Pari, were born some time later, prematurely at 31 weeks' gestation. They are now ten years of age. Dr. Khurana says that when one of her little girls was only four months old her mother-in-law had attempted to push the child down a staircase. Her husband denied the girls could have been his; he had been informed by a priest that he would have a son. He insisted that a DNA test be undertaken.

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Sunday, November 22, 2015

Making Elemental Day-1 Nutrition Choices

"Women are often deeply and profoundly destroyed by the realization that they're not succeeding at this fundamental criteria of being an even halfway decent parent."
"Women are given the impression that feeding babies formula is playing fast and loose with their health. The question of choice, which is central to so many women's issues, most notably abortion, is almost totally absent from discussions about infant-feeding practices."
"The most draconian criteria of the Baby-Friendly Hospital Initiative is the one where a baby can't be given anything other than human milk except where medically indicated. I don't know how hospitals determine what counts as 'medically indicated', but it could be open to interpretation and a baby failing to latch, that for sure doesn't count."
University of Toronto professor Courtney Jung

"It's essentially saying it's OK to formula-feed -- and the message I want to get across is not that it's not OK to formula feed -- but the truth is if you're a baby-friendly hospital, the message you want to send is that breastfeeding is the best thing you can do for your child. By supplying formula at market price, the incentive to push breast milk is a lot higher."
"There's a lot of evidence that breastfeeding improves infant health. Some studies show it decreases the rate of infection-related hospitalization by up to 30 percent for every additional month of breastfeeding. When you're in a publicly funded hospital system, that's huge."
Dr. Catherine Pound, clinical investigator, Children's Hospital of Eastern Ontario, Ottawa

"There are some women who have more difficulty and we don't really understand why. It's not a slam-dunk for all women and there are some who just don't want to, either because it's uncomfortable or they have to go back to work right away. There are all kinds of reasons."
"While there's no evidence of any health benefits of formula, there are certain proven benefits to breastfeeding, and probably things for which breastfeeding has a protective effect that haven't been discovered yet."
Dr. Michael Kramer, professor of pediatrics and epidemiology and biostatistics, McGill University, Montreal
Woman Breastfeeding
Thayer Allyson Gowdy

Breastfeeding newborns has become sacred. At one time in human history there were no alternatives; a woman gave birth to a baby and the natural corollary to that was to feed the baby just as all warm-blooded animals that nature has created do, to sustain life. It is natural, a part of the life-process. My mother and I, though worlds apart; she a European, I a North American, both gave birth at age 24, and both of us breast-fed.

My mother did so for reasons that likely reflected the fact that it was done in her cultural background and she had witnessed it innumerable times through that culture's exposure. I did so, because I entertained no thoughts to do otherwise; it was the same kind of natural function as bearing a baby and delivering it represented, a continuum of new life and sustenance; one incomplete without the other. I was completely disinterested in hearing from anyone how awful childbirth was, and just as disinterested in hearing anything about caring for my baby.

I knew I would adapt, and I did. At the time I gave birth to the first of my three children no one gave me advice about breast-feeding, not even my mother, and nor was there any public or special-group programs meant to guide new mothers toward breast-feeding. In fact, breast-feeding had become an anomaly, with bottle-feeding having assumed wild popularity, taking the place of the natural version entirely. The introduction of formula feeding, giving babies bottles instead of the breast had become institutionalized.

When I asked nurses at the hospital about it, they were bemused and unable to give me any information. They actually had little idea on how to proceed with breastfeeding.  On the other hand, I took it for granted that since it was a natural process I would experience no problems relating to breast feeding, and I never did. My daughter who 35 years later had her own child, and at a time when breast-feeding was making a spectacular come-back, did experience problems and that completely took me by surprise; 'latching' was the culprit and her self-confidence plummeted.

Now, the social atmosphere in North America is to shun bottle-feeding in the concern that a newborn is entitled to a healthy start in life, and mother's milk provides that healthy head-start. Women now are proud of their choice to breast-feed and proclaim it from the rooftops -- celebrating that from their pulpits on social media, and women's magazines as a personal triumph. In the process subtly demonizing those who choose not to breast-feed.

A study undertaken in 2014 and published in the Journal of Maternal and Child Health, resulting from researchers following 14,000 women in England discovering that those women who planned to breastfeed but as matters transpired their plans went awry and they bottle-fed instead -- were 2-1/2 times more likely to develop postpartum depression than those who hadn't intended to breastfeed in the beginning. They may perhaps have suffered disappointment in their lack of resolve, and guilt ensued.

The World Health Organization and UNICEF launched an initiative in 1991 (the Baby-Friendly Hospital Initiative) to support breastfeeding. In all likelihood this was spurred by the fact that women in poor countries had succumbed to the belief that formula was superior to breast milk, because this is the way that formula-makers advertised their product. Because formula is expensive and breast milk is not, women living in poverty tended to water down the formula, with predictable results.

Research has suggested that breast-feeding reduces risk of food allergies, asthma, obesity and other chronic diseases; Type 2 diabetes, as an example. "Given the mixed -- and mostly negative -- evidence, it does more harm than good", stated Dr. Kramer. "While there's no evidence of any health benefits of formula, there are certain proven benefits to breastfeeding, and probably things for which breastfeeding has a protective effect that haven't been discovered yet."

Breast-feeding an infant is not, of course, all there is to raising children and nurturing them and providing first-rate care for their development. There is a myriad of other vitally important components in being a good mother to a vulnerably dependent little human. Breast-feeding is merely among the first. But there doesn't appear to be any compelling reason why the alternative, formula-feeding won't work to start a baby off in its first six months of life.
The American Academy of Pediatrics (AAP) recommends breast milk as the best nutrition for infants. Babies should be breastfed exclusively for the first six months, according to the AAP. After other foods have been introduced, the AAP encourages mothers to continue to breastfeed until baby is at least a year old, and as long after that as both mother and child are willing.
Breast milk is good for your baby in many ways:
Breastfeeding is good for moms, too. Women who breastfeed have a reduced risk of breast cancer, diabetes, heart disease, osteoporosis, and ovarian cancer.

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Saturday, November 21, 2015

Top Mind Prevails

"I spent many, many days in the dunce's corner. I think the teachers thought I was a challenge sent by the devil ... They were not themselves particularly educated about learning disabilities."
"....I have no understanding of grammar and I can only spell words I can visualize."
"Systematic reviews are part of the DNA of providing best practice guidelines, and that impacts the care we give to patients. That's why it's so important that they're done right and reported correctly."
Dr. David Moher, senior scientist, The Ottawa Hospital
Research relevance: About 40,000 clinical trials are ongoing at any one time, globally. They represent the most valid medical research, but also the most costly. The potential bias inherent in reported RCTs can severely overstate the effect of any intervention, such as a new treatment for malaria. Programs built on a foundation of faulty data cause suffering and waste money.
Systematic reviews are key means of accessing evidence in the ever-changing environment of healthcare. They provide a synthesis of available evidence and support strong decision-making. Those that are reported with low quality are likely to induce varying degrees of bias, thus distorting the estimates of the effectiveness (and harms) of interventions. Accurate and complete reporting of systematic reviews provides readers with a transparent record of the processes involved in a review's conduct, clarifies possible sources of bias, and allows the reader to make an informed judgment of the value and relevance of the evidence University Research Chair in Systematic Reviews
Dr. David Moher, of the Ottawa Hospital, is one of the most influential medical scientists in the world. Bruno Schlumberger file photo / Ottawa Citizen
Dr. Moher is a hugely unusual individual. He has had to struggle throughout his life with a kind of mental roadblock which has made it extremely difficult for him, as a man with a scientific mind to perform the most basic of communication pursuits; deciphering language patterns; in other words to do what most of us take for granted: reading. Some people with dyslexia tend to attempt reading and writing from right to left, so what could be more frustrating than having to cope with a mind that reacts in its own inimitable way?

Yet this is a man who has excelled in the world of medical science as an expert in the systematic review of medical studies, and one of the world's most influential scientific minds. So influential that as a clinical epidemiologist, one who has written and published over 500 research papers, many of those papers and their findings have been referenced over 25,000 times by other scientists. That is a rate indicating the trust placed in this man's unusual and precise mind to make sense of what others cannot.

He is placed among the top one percent of the world's most highly cited researchers. And yet dyslexia remains a challenge for Dr. Moher. Imagine, from childhood forward facing the never-ending roadblock of a mind that perceives and reacts differently than the norm. When we communicate it is in a certain manner, readily accessible to everyone. Almost everyone; anyone who cannot readily access communication is at a tremendous disadvantage. A small boy's trust in himself, an older student's morale, and an adult's determination to succeed despite clear adversity.

In Dr. Moher's case, his disadvantages were overcome by the sheer quality of his mind insisting that he persevere and find ways to go forward and to rise about his disability. As far as he is concerned it was for him a combination of inquisitiveness (the first mark of a scientific mind), perseverance and good fortune. The luck was represented by the encouragement he received working as a research assistant for an epidemiologist who saw his potential, urging him to apply for graduate school, poor marks be damned.

As a clinical epidemiologist whose scientific papers are of vital importance to the world of medical science and practise, he is also a University of Ottawa research chair and Director of Clinical Research, CHEO (Children's Hospital of Eastern Ontario) Research Institute. He is set to be awarded with a career achievement award in recognition of his contributions to medical science. "Instead of reading ten articles about the effectiveness of a drug or a device, why not read one study that aggregates those ten studies?", he asks, and this is precisely what he does.

Over 70 systematic reviews covering a broad range of subjects from cancer to diabetes, stroke to HIV and Ebola, along with a widely heralded systematic review of systematic reviews concluding that the quality of studies varies dramatically have led to advances in health care. These systematic reviews give physicians a summary of current evidence relating to the diagnosis and treatment of specific diseases with the reviews identifying the clinical studies on a given topic, analyzing the data contained in them, then synthesizing their findings.

Dr. Moyer developed reporting guidelines and a 25-point checklist in use by clinical trials researchers around the world, which came out of his analyzing thousands of clinical trials and identifying common shortcomings. His guidelines ensure that those research results are relevant and of use in a manner advancing medical science's efficiency and effectiveness. This is a man who struggled to become a health-sciences pioneer.

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Friday, November 20, 2015

Epidemic of Male Suicide

"Suicide in men has been described as a "silent epidemic": epidemic because of its high incidence and substantial contribution to men’s mortality, and silent be­cause of a lack of public awareness, a paucity of explanatory research, and the reluctance of men to seek help for suicide-related concerns. A statistical overview demonstrates a shockingly high rate of death by suicide for men compared with women, and a need to focus attention on prevention, screening, treatment, and service delivery. Promising lines of research include identification of clinical indicators specifically predictive of male suicide and exploration of precipitating and predisposing factors that distinguish male suicide and account for the substantial gender disparity. Only by breaking the silence—building public awareness, refining explanatory frameworks, implementing preventive strategies, and undertaking research—will we overcome this epidemic."
Dan Bilsker, PhD, Jennifer White, EdD  BCMJ, Vol. 53, No. 10

"The Centers for Disease Control and Prevention (CDC) collects data about mortality in the U.S., including deaths by suicide. In 2013 (the most recent year for which full data are available), 41,149 suicides were reported, making suicide the 10th leading cause of death for Americans. In that year, someone in the country died by suicide every 12.8 minutes."
"In 2013, the highest suicide rate (19.1) was among people 45 to 64 years old. The second highest rate (18.6) occurred in those 85 years and older. Younger groups have had consistently lower suicide rates than middle-aged and older adults. In 2013, adolescents and young adults aged 15 to 24 had a suicide rate of 10.9."
"For many years, the suicide rate has been about 4 times higher among men than among women. In 2013, men had a suicide rate of 20.2, and women had a rate of 5.5. Of those who died by suicide in 2013, 77.9% were male and 22.1% were female."
American Foundation for Suicide Prevention 

In Canada, fifty men every week die by suicide. Most of these occurrences relate to men between the ages of forty to sixty years of age. And most often mental disequilibrium is the cause. Although women too of course will commit suicide, of those that take place in Canada -- and there is ample evidence that this formula is true for other places of the world -- 75 percent of suicides are committed by men.

Sharp rise in suicides among middle aged men as recession takes toll
Male suicide rates have hit their highest since 2001 Photo: Alamy

Professor Dan Bilsker of Simon Fraser University calls it a "silent epidemic of male suicide". In fact, in Great Britain it has been noted that male suicides are on the rise, according to the Office for National Statistics there.
"Of the total number of suicides in the UK, 78 per cent were male and 22 per cent were female, the ONS said. Some 4,858 male suicides were recorded in 2013, compared to 1,375 female suicides.
The highest UK suicide rate was among men aged 45 to 59, with 25.1 deaths per 100,000 - the highest for that age group since 1981 and the first time that age group has recorded the highest rate."
The Telegraph
The factors in play relating to middle-aged men in modern society appear to be manifold; one of the reasons could be occupational stress which reflect men working in dangerous, dirty occupations that include mining, fishing, forestry, oil/gas, construction, law enforcement and the military, according to Robert Whitley, principal investigator of the Social Psychiatry Research and Interest Group at McGill University's Department of Psychiatry.

Mr. Whitley points out the links between cyclical, seasonal and economic nature of these occupations, shuttling between intense work periods interspersed by periods of unemployment, and with both, come stresses. In addition the jobs themselves by their very nature mean that workers are subjected to social isolation, separation from family, physical risk, injury and violence; in turn leading to higher disability rates, substance abuse and post-traumatic stress disorders; predictors of suicide.

Very intimate life events are also associated with depression and suicide, affecting middle-aged men. Divorce is one such event when men stand to lose the focal points of their emotional investment in life. All that they worked for, acquiring a home for their family, close contact with their children, descend toward becoming an object of public discussion in a deleterious conclusion while losing a major portion of their earnings and their pension.

The experiences that court proceedings through the family justice system that men go through has them despairing of the institutional sexist atmosphere that prevails, with rulings that disfavour their interests, leaving men desperate, distraught and disempowered. Fathers' rights to remain in close contact with their children are rarely supported by the court, while the concern centres on extracting as much as possible of acquired material resources to further an assured future for any children resulting from a failed marriage.

Men are traditionally expected to be stoic, to gird themselves to face all adversity and to make an heroic effort to hide their pain from the outside world. They rarely discuss their emotional turmoil, far less than women tend to, in airing their unhappiness and finding solace in the compassion and aid that others proffer. Women are likelier to seek the help of medical professionals than men and this proclivity aids women to counteract emotional stress, while men tend to bypass those options.

The 'masculine' personality is one that is self-sufficient, capable of fending for himself, and finding his own solutions to his overwhelming problems. Only, all too often that is an idealized version of reality, with men opting to suffer in silence without emotional or practical support that could conceivably help them bridge the wide gap between normalcy and a descent into emotional despair.

Silhouette of a man Suicides accounted for 19 males deaths per 100,000 people in the UK in 2013, compared with 5.1 female deaths. Photograph: Alamy

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