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Redefining life-long benefits of sexual health

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From adolescence to old age, sexual health constantly needs to be revaluated in the light of every individual’s changing circumstances, the UN health agency said on Friday.

According to the World Health Organization (WHO), sexual health is determined by the quality and safety of people’s relationships: with oneself and other individuals, with family and friends, and the society in which we live, including the gender norms that shape our experiences.

“Sexual health is not a fixed state of being, and every person’s needs will change across the life course,” said Ian Askew, former Director of WHO Sexual and Reproductive Health and Research, and co-author of a new publication exploring the role of sexual pleasure in sexual and reproductive health and rights programming. 

More than physical

Sexual relationships are themselves dependent on whether everyone’s human rights related to their sexuality are realized and protected, according to WHO.

The UN health agency’s working definition of sexual health emphasizes a positive and respectful approach to sexuality and sexual relationships that is much more than just physical.

“This is why it is crucial to undertake a range of activities across this continuum: from support of sexual well-being, to prevention and management of disease,” said Mr. Askew.

Integrating pleasure

Ahead of Valentine’s Day, on Monday, a new analysis was published in the open-access journal PLOS ONE on the importance of including sexual pleasure and not only disease risks, when designing sexual health programmes. 

“Sexual health education and services have traditionally promoted safer sex practices by focusing on risk reduction and preventing disease, without acknowledging how safer sex can also promote intimacy, pleasure, consent, and wellbeing,” said Lianne Gonsalves, WHO paper co-author. 

Sexual health linked to sexual well-being

  • It is a state of physical, emotional, mental and social well-being, related to sexuality.
  • Sexual health is not merely the absence of disease, dysfunction or infirmity.
  • It requires a positive and respectful approach to sexuality and sexual relationships.
  • Good sexual health offers pleasurable and safe sexual experiences, free of coercion, discrimination and violence.
  • It respects, protects and fulfills the sexual rights of all persons.

“This review provides a simple message: programmes which better reflect the reasons people have sex – including for pleasure – see better health outcomes”.

The hope is that these results will galvanize the sexual and reproductive health and rights community, to promote services that educate and equip people to engage in sex that is safe, consensual, and pleasurable.

Emerging interventions

Interventions specifically intended to improve sexual well-being are gradually emerging.

This year’s new edition of the International Classification of Diseases, for the first time, has a chapter devoted to sexual health.

By providing the latest evidence-based definitions, WHO is facilitating the diagnosis and appropriate management for a wide variety of conditions related to sexual health.

Unhealthy reality

Unfortunately, many women, girls and gender-diverse persons, go through the ordeal of experiencing non-consensual and violent sex.

WHO is supporting national efforts globally to prevent and manage the consequences of all forms of sexual violence.

And to eliminate diseases that affect sexual health, the UN health agency is developing new global strategies to address sexually transmitted diseases, while taking into account the current pandemic-induced health system disruptions.

Being human

WHO maintains that good sexual health is “fundamental to the overall health and well-being of individuals, couples and families, and to the social and economic development of communities and countries”.

As such, it is committed to identifying and promoting sexual health itself, so that everyone, everywhere is able to fulfil their human rights related to their sexuality and sexual well-being.

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Health & Wellness

Tackling rising anxiety, burnout and depression in the workplace

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European researchers are developing online tools to help small and medium-sized enterprises improve the mental health of employees.

By Andrew Dunne

Ask a person working in a small business how things are going and the question might prompt a mix of responses. On the one hand, work in a small organisation can be enjoyable, exciting and creative. On the other, it’s often lonely, hectic and stressful.

For Ella Arensman, something about the nature of small and medium-sized enterprises (SMEs) – whatever the sector – makes their employees vulnerable when it comes to psychological and emotional well-being. Unlike bigger companies, SMEs often lack dedicated support in this area.

Small firms, big tests 

Arensman is professor of public mental health at University College Cork in Ireland and coordinator of the EU-funded MENTUPP project, which began in 2020 and runs through this year. With partners from across Europe, the initiative is trailblazing a new approach to helping SMEs tackle worker mental-health troubles including depression.

‘We hope MENTUPP can support people with their mental health,’ Arensman said. ‘Then maybe the progression of depression can be reversed.’

The EU is home to around 23 million SMEs, defined as business that have fewer than 250 employees and annual turnover of no more than €50 million. Ranging from construction companies and hauliers to cafes and hairdressers, they make up more than 90% of EU businesses.

For four decades, Arensman has led international work into self-harm, suicide, depression, anxiety, substance misuse and the stigma surrounding mental health at work.

She has observed a rising trend in such challenges faced by workers, with serious consequences for the individuals themselves and for wider society.

Depression and anxiety are now the most prevalent psychological and emotional troubles faced in the workplace. One in five workers reports poor mental health.

The problem has only been exacerbated by the COVID-19 pandemic that broke out in 2020. Add to this the current cost-of-living crisis caused by high inflation and the result is a perfect storm for mental health.

The knock-on cost to the economy through lost productivity and absenteeism is eyewatering. According to World Health Organization global estimates, $1 trillion (around €940 billion) in work-place productivity are lost each year as a result of depression and anxiety.

Against this stark backdrop, attention at the EU level is now focused on intervention, which is where MENTUPP has a role to play.

Three vulnerable sectors

The project provides a free, online resource for SME employees. The goal is to plug a gap in well-being support in three sectors where workers are deemed particularly vulnerable: construction, health and information technology.

In 2019, Arensman published a study on work-related risk factors associated with suicide. Since then, she has been on a mission to improve support.

‘I just realised we needed to do much more work upstream before people get into these suicidal crises,’ Arensman said.

The MENTUPP team is drawing inspiration from a suicide-prevention programme first developed in Australia to help construction workers open up about anxiety, depression and suicidal thoughts.

For the past decade ‘‘Mates in Construction’’ (MIC) has been challenging stigmas surrounding mental health and raising awareness of techniques to boost well-being in a traditionally male-dominated sector where such conversations can be hard to foster.

Arensman calls its work as ‘‘exceptional’’ in breaking down barriers and increasing the number of workers accessing support.

A 2020 report by MIC and Melbourne University found that, since the ‘‘Mates’’ programme was introduced, suicide rates among construction workers across Australia had declined by almost 8%, bringing the level closer to the male average for many Australian states.

Arensman is now testing MENTUPP’s own online support system. This offers hundreds of evidence-based materials, ranging from suggestions for destigmatising conversations about mental health in the workplace to increasing well-being for SME employees.

Tailor-made tips

In Barcelona, Spain, Dr Beatriz Olaya has diagnosed similar mental-health challenges faced by SME workers.

‘When we went into these small businesses, we realised there was just a huge need,’ said Olaya, a clinical psychologist. ‘People need psychological support and they very often don’t know how to access it.’

She coordinates an EU-funded project called EMPOWER that tackles similar issues as MENTUPP and also began in 2020. Running until mid-2024, EMPOWER is an eHealth platform featuring a website, an app, an online video and text resources.

After registering with the site or app, a person completes a series of questionnaires that help the project team to elicit details about current stress levels, depression, anxiety, sleep and psychosocial risk factors.

From there, the EMPOWER system creates a series of tailor-made tips to help people feel better. There is also support for those on sick leave as a result of mental-health problems.

When logging in each day, the user is prompted to indicate how he or she feels before being guided through psychological techniques to help lift spirits or keep the person on track. These include breathing and relaxation exercises plus popular daily goal-setting tasks to increase motivation.

‘If you decide to run twice a week, by setting this new habit to improve your mood, the app reminds you and rewards you,’ Olaya said.

Some of the tips are based on cognitive behavioural therapy, which teaches skills for coping with difficulties by focusing on how thoughts, beliefs and attitudes affect feelings and actions.

Olaya and the team have developed EMPOWER with businesses in Finland, Poland, Spain and the UK. Multi-language versions of the app are now being tested with more than 600 people in the four countries.

‘We want to show that it’s both low-cost and effective,’ Olaya said.

Hopeful signs

As for MENTUPP, its support system also includes an app and the whole package is still being tested. Results are due later this year.

Arensman then expects further improvements and refinements to be made before the system can be deployed much more widely. In a positive preliminary sign, she recalled how a small Irish construction company that has used the package was better able to support the mental well-being of one of its workers.

‘They told us that, if they hadn’t had these resources, they would not have identified the warning signs,’ Arensman said. ‘With these resources, they could better identify what was going on and intervene.’

Feedback from other users in MENTUPP’s partner countries has been similarly encouraging. Arensman is hopeful that the project will ultimately prove as effective as ‘‘Mates’’ in Australia in reducing self-harm and suicide and increasing job satisfaction and productivity.

‘We’re not there yet, but we will be very soon we hope,’ she said.

The article was originally published in Horizon, the EU Research and Innovation Magazine. 

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Health & Wellness

As bird flu surges in Europe, race is on to stop the spread

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With tens of millions of poultry culled every year to contain avian influenza, scientists are rushing to find new ways to protect flocks from infection and avert a human pandemic.


Researchers are learning important lessons about how bird flu spreads and the characteristics of the virus in Europe.

Bird flu is on the rise throughout the world and the consequences for both migratory birds and domestic poultry are devastating.

In Europe, over 2 467 outbreaks were reported in poultry in 2021-2022, resulting in the slaughter of 48 million domestic birds in 37 countries. It was the largest bird flu epidemic so far observed on the continent. In Germany alone, 2.3 million birds were destroyed in 2021.

Farmer fears

‘When it affects your flock, the consequences for the farmer are devastating,’ said Wolfgang Schleicher, managing director of ZDG, the central association of the German poultry industry. ‘Not only does it hurt emotionally when a positive infection is detected and you are forced to kill all your birds, but it hurts financially too.’

Until this decade, bird flu was a sporadic visitor to Europe. But now farmers face the constant threat of business disruption. In Germany, one of the EU’s biggest poultry producers, a farmer receives partial compensation for the losses and costs resulting from the culling of birds. But as losses rise, so do insurance premiums. 

In addition, the high costs of cleaning and disinfecting barns after an outbreak must be borne primarily by the farmer. And after a cull, farms are prohibited from keeping animals for about 30 days. In short, the price a farm must pay for a bird flu infection is high and pushes the operation to its limits. ‘The fight against avian influenza is at the top of our priorities,’ European Health Commissioner Stella Kyriakides said last month when announcing new EU rules on the vaccination of animals to curb the spread of the disease. ‘These outbreaks are causing enormous damage to this agricultural sector and hamper trade.’ So far, just one vaccine is authorised in the EU against bird flu. The new EU rules, which will enter into force on 12 March, will allow the movement of animals and goods from businesses and zones where vaccination has taken place. It’s not just farmers who are feeling the pinch. Consumers are noticing increases in the prices of chicken meat and eggs, and sometimes shortages on supermarket shelves.

Then there’s the worry of infection spilling over into the human population. Given the opportunity, the virus could mutate and become more infectious to humans, perhaps even triggering a pandemic.

All of which makes EU scientists intent on finding ways to bring bird flu to heel. 

Transmission of the virus happens in two ways – directly with airborne particles of it moving from bird to bird and indirectly through contaminated material such as farm equipment. But until recently, the exact mechanisms of transmission have remained poorly understood.

New knowledge

Professor Thomas Mettenleiter coordinated the EU-funded DELTA-FLU project, which set out to fill in the knowledge gaps. The five-year initiative, which ended in late 2022, brought together experts from Belgium, Germany, Italy, the Netherlands, Sweden, the UK, the US and Hong Kong. 

‘Highly pathogenic avian influenza has been a major animal disease for quite some time, but this has been particularly true over the past five years,’ said Mettenleiter, a German virologist. 

Previously, migratory birds from Asia spread the virus to domestic birds in a seasonal pattern, with periods of low risk in summer. Infection has now changed from rare, sporadic outbreaks to a situation of continuous risk.

Often, this leads to domestic poultry being culled. If the virus is found in a flock, every bird must be destroyed. And when bird flu is detected in an area, either in wild birds or on commercial premises, birds that would otherwise roam free are routinely ordered to quarantine in barns.

‘But our study has shown that it’s frequently human activity and not direct infection from wild birds that causes new incursions of the virus,’ said Mettenleiter, who is president of the FLI Federal Research Institute for Animal Health in Germany.

People carry the virus into premises on contaminated shoes, clothes, machines, animal feed and bedding, he says.

More care must be taken when handling poultry and biosecurity measures need to be stepped up, according to Mettenleiter. To this end, he and his team have drafted guidelines for higher hygiene standards for personnel working with flocks in lockdown. The hope is that these guidelines will be adopted Europe-wide. 

Current wave

While strains of bird flu have probably existed for millennia, the variant that kickstarted the current wave of outbreaks – A(H5N1) – emerged in 1996 in China as a result of the rapid expansion of the commercial duck and poultry sectors. It then spilled over to wild birds and – only rarely – to humans. 

This highly contagious variant has now branched off into many sub-variants that occur primarily in commercial poultry and wild water birds.

The virus is classified as either high or low pathogenic (HPAI or LPAI) depending on its genetic characteristics and ability to cause disease and mortality in chickens. Poultry infected with LPAI viruses may show mild signs of the disease or none at all, while HPAI infections can cause severe disease and death. 

To complicate matters, LPAI viruses can mutate into other highly pathogenic strains, making it vital for outbreaks to be managed promptly. Both HPAI and LPAI can spread quickly through flocks.

DELTA-FLU unpacked the genetic makeup of the bird flu strains currently prevailing on the continent. Using whole-genome sequencing techniques, the researchers made the surprise discovery that bird flu in Europe is a ‘‘swarm incursion” – in other words, there are many variants circulating (more than 15 in Europe). 

From this, the researchers demonstrated that variants are blending their genetic material to create new sub-variants. Worryingly, since 2016, some of these mutated viruses have spilled over into other animals, including foxes, minks and seals. Globally, there have been at least 200 recorded cases in mammals.

Encouragingly though, bird flu remains poorly adapted to humans. Infections in humans do occur from time to time, but they are rare and usually happen only after close, prolonged and unprotected (no gloves or other protective wear) contact with infected birds. 

Pig link

A bird flu pandemic is unlikely to arise unless the virus first becomes established in an intermediary mammal – most likely a pig. Pig cells have qualities that make it possible for viruses from both birds and humans to take hold and replicate.

‘The worry is that one day a pig will act as a mixing vessel, co-hosting flu viruses from both birds and humans,’ said Mettenleiter. ‘This could result in a novel reassortment – a hybrid virus with genetic material from both viruses.’ Scientific work on more bird flu vaccines for poultry is taking place in parallel with persistent deliberations by governments in Europe about the merits of vaccination to counter the disease. Vaccinating animals against disease can lead to trade barriers in export markets. That’s because of concerns in some importing countries that vaccinated animals can still contract a disease and spread it.   

In this context, surveillance remains extremely important, according to Mettenleiter.

Research in this article was funded by the EU. The article was originally published in Horizon, the EU Research and Innovation Magazine. 

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Breeders of new fish hope to tickle taste buds of salmon, cod and tuna lovers

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Fish farming can make food supplies more stable while itself becoming more sustainable, according to researchers in Hungary and Norway.

By Pieter Devuyst

Attention seafood lovers! Gabor Hetyey strongly recommends a new dish: fried catfish.

Hetyey is no restaurant chef in his native Hungary. Rather, he belongs to a Budapest-based organisation that helped breed a new variety of catfish after a decade of research.

Best breed

His non-profit entity coordinated an EU-funded project to show the promises of fish farming, also known as aquaculture. The new type of catfish developed as a result of the initiative can adapt quickly to different breeding environments, grows faster and is more resistant to diseases.

‘One of the main outputs of the project was the newly created German-Hungarian hybrid catfish, bred from two of the most excellent yet unrelated lines,’ said Hetyey, managing director of Kseris.

Fish farming will be crucial to ensuring enough food for a growing global population now at 8 billion people because oceans and seas are already at the limit of overfishing. Furthermore, fish form part of a healthy diet because they contain such nutrients as omega-3, vitamins and minerals.

‘We are removing fish at a much greater rate than they can reproduce,’ said Hetyey. ‘At the same time, demand for fish is steadily increasing.’

The project, called SilGen, created a mass-production system for premium-quality freshwater catfish. The initiative ran for 24 months until last year, building on research begun in 2012 by five leading fish-breeding and research companies.

The researchers started by breeding the best possible domesticated version of the European catfish. They mapped out the genes of the fish and marked beneficial traits to improve the offspring until coming up with the new breed, which has taken the name of the project.

Besides adapting better, growing faster and being more resilient, the SilGen catfish offers environmental gains because breeding it involves fewer chemicals and antibiotics, according to Hetyey.

‘SilGen catfish can be produced and distributed in a more sustainable way,’ he said. ‘The system is unique in giving a complete solution to the breeder – not just for production but also for marketing and distribution.’

Tasty and easy

Apart from making fish breeding more efficient, the project focused on consumers by making it easier for them to eat catfish at home. It devised a method to offer ready-to-cook catfish fillets, with plans to make this product available in Germany, Hungary and Slovenia.

‘The modern European consumer does not have time or energy to purchase unprocessed fish, preferring to buy ready-to-cook, boneless fillet instead,’ Hetyey said.

The researchers hope this convenience supermarket item can increase the consumption of catfish across Europe and meet rising demand for local, sustainably produced food.

While catfish is relatively unknown to consumers, its white meat and firm texture could make it an appealing alternative to the likes of cod, salmon and tuna. Hetyey says it needs to be prepared the right way to have a chance of winning over fish eaters.

‘Catfish, blackened or fried, is one of the best-tasting fish worldwide – but only when it’s seasoned and cooked properly,’ he said.

The SilGen developers are working with farmers and restaurants to make the fish more widely available. There are promising negotiations with fish producers interested in using the SilGen technology, according to Hetyey.

Gene expressions

While finding the best possible breed of fish for farming is still usually based on genetics, genes can only partially explain the physical differences in fish.

Epigenetics, which includes the study of how the environment can change the way genes work, could become a powerful ally in improving the breeding of fish for food.

Unlike genetic changes, most epigenetic ones are reversible and don’t alter a DNA sequence. However, they can activate or deactivate certain genes and, as a result, help animals survive in different environments.

‘They’re almost like on and off switches of genes,’ said Professor Jorge Fernandes, a molecular-biology specialist at Nord University in Norway.

Fernandes had been working on epigenetics for years when he started reading about fish domestication. He became fascinated by how quickly the appearance of creatures like goldfish can change – for example their colours, the number of tails they have or the extent to which their eyes “pop out”.

‘It just stayed on my mind, even at night,’ Fernandes said. ‘And, at some point, I was thinking: this cannot be just genetics.’

This marked the start of the EPIFISH project, which ran for six years until 2022. Funded by the European Research Council, the project studied the role of epigenetics in fish domestication and selection to provide more knowledge to breeders and producers.

Nile native

The initiative focused on Nile tilapia, which are native to northern Africa and are one of the most-sold farmed fish species in the world.

‘It is quite tolerant to new environmental conditions and can eat almost anything, which makes it a very successful species for aquaculture,’ Fernandes said.

Nile tilapia become much bigger on farms than in their native habitats. Fernandes wanted to understand the epigenetic changes that allowed the fish to adapt quickly and grow better in captivity compared to the wild.

Looking at epigenetic markers, the researchers discovered that the fat-metabolism genes of the farmed fish are more active than in the wild because they consume more fat through their feed. If they consume too much fat, this can in the worst case cause a condition called “fatty liver”.

This knowledge could help producers understand how best to grow tilapia in a farming environment and make output of them more sustainable in the long run.

Next order

The EPIFISH findings could eventually be applied to other fish species.

‘With a bit of extra research, it could also be used for the selective breeding of salmon, sea bass, carp and other important farmed species and be expanded to other traits than growth like resistance to disease,’ Fernandes said.

Meanwhile, back in landlocked Hungary, Hetyey expressed confidence in the future consumer appeal of the SilGen catfish – as long as it becomes a more common offering in supermarkets and restaurants.

‘We believe that the only obstacle to consuming SilGen catfish is that consumers have not tasted it yet,’ he said.

Research in this article was funded via the EU’s European Research Council (ERC). The article was originally published in Horizon, the EU Research and Innovation Magazine. 

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