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Suga’s pledge to boost fertility treatment won’t reverse declining birth rate, say experts

mymedicplus — Mon, 12 Oct 2020 05:16:55 +0000

Source – https://japantoday.com/

TOKYO

Prime Minister Yoshihide Suga’s pledge to boost fertility treatment support has offered rays of hope to couples longing for babies, but experts say the policy will not be a panacea for reversing the nation’s declining birth rate.

As Japan, with the world’s oldest population, struggles with dwindling numbers of newborns, Suga has vowed to make often costly fertility treatment eligible for coverage by national health insurance, with government officials eyeing the change as early as 2022. In the run-up, subsidies for couples undergoing such treatment will be sharply increased.

Many couples who have undergone years of fertility treatment at the cost of millions of yen were encouraged by the move, but some experts say it may not be enough to boost the birth rate at a time when it is under fresh strain as the coronavirus pandemic darkens the economic prospects of working-age people.

Japan’s total fertility rate — the average number of children born per woman during their reproductive years — stood at 1.36 in 2019 with a record-low 865,234 babies born that year. The government aims to raise the rate to 1.8.

A 37-year-old Tokyo woman, who gave birth to a child after spending 2 million yen on four years of fertility treatment since she was 30, said she was “heartened” by Suga’s push for expanded support.

The woman, who changed clinics twice in the pursuit of better treatment, expressed hope that the public insurance coverage “will help improve the quality of medical care” provided at fertility clinics because their technology and equipment differ.

She also said she had not been correctly informed about rates of successful treatment at fertility clinics. Currently, as they operate outside insurance coverage, there are no standards covering their disclosure of clinical outcomes.

Another woman, a 35-year-old resident in an area north of Tokyo, also welcomed the new premier’s initiative after spending 8.5 million yen on six years of fertility treatment. But she expressed concern that “women could be regarded as ‘child-bearing machines’ if the policy is only targeted at reversing the declining birth rate.”

At present, most of the fertility treatment in Japan, except for the initial phase, such as tests to look into infertility and provision of ovulation-inducing drugs for timed intercourse, is not covered by the public health insurance, under which patients shoulder 30 percent of costs.

More advanced methods such as in vitro fertilization, where eggs are collected from ovaries and fertilized by sperm in a lab, and microinjection, which resembles regular IVF but in which a single sperm is injected into an egg, can cost several hundred thousand yen per cycle.

Even though public subsidies totaling 1.05 million yen are available for couples for up to six IVF cycles, there is an age limit for women, currently set at 43. There is also a cap on a couple’s combined annual income, set at 7.3 million yen in most municipalities.

“It’s easy for couples comprising two full-time workers to exceed the annual income threshold,” said Ran Kawai, a journalist specialized in childbirth issues. Furthermore, many recipients of the subsidies cannot cover the total costs despite the assistance, she added.

Under Suga’s initiative, the health ministry is considering scrapping the annual income cap as well as relaxing restrictions on the number of IVF cycles and boosting the amount of subsidies from next April, ministry officials said.

In countries such as France, Germany, Belgium and Israel, fertility treatment is covered by public health insurance to some degree, mostly with limits on the number of cycles and women’s age, according to their authorities and data compiled by the NLI Research Institute.

But Japan has not opted for insurance coverage, with infertility not defined as a disease, despite a record 56,979 babies born in 2018 via 454,893 IVF cycles, or one in 16 newborns that year for the highest rate ever. In 2015, 18.2 percent, or one in every 5.5 couples, underwent infertility tests or fertility treatment.

The number of IVF cycles conducted in Japan is the largest among major countries, according to the International Committee for Monitoring Assisted Reproductive Technologies.

Akiko Matsumoto, head of nonprofit group Fine that supports those suffering from infertility, said momentum for seeking expanded assistance for them grew among Japanese political circles with then-Chief Cabinet Secretary Suga receiving a petition from ruling party members on the matter in June.

“When we organized a study session in parliament on fertility treatment in January, about 100 participants came, which was much larger than expected, and some of them enthusiastically discussed the matter,” she said.

“It was encouraging to see the issue has gained public awareness, with some talking about their own fertility treatment experiences or someone close to them,” Matsumoto said.

Among the lawmakers of the ruling Liberal Democratic Party pushing for insurance coverage of fertility treatment and other support is Seiko Noda, currently the party’s executive acting secretary general, who gave birth to a boy at the age 50 in 2011 through IVF using a donated egg in the United States.

The major opposition Constitutional Democratic Party of Japan similarly submitted a petition to the health ministry in February, calling for insurance coverage and other patient support. CDPJ leader Yukio Edano’s twin sons were born in 2006 after four years of fertility treatment.

The CDPJ also stressed that expanded public support for fertility treatment should not lead to increased pressure on couples to bear a child.

Both Kawai and Matsumoto said they hope lowering the economic burden through insurance coverage leads more young couples to start advanced fertility treatment early, as their success rate is higher compared with that for older couples, possibly shortening the treatment period.

According to 2018 data from the Japan Society of Obstetrics and Gynecology, the rate of childbirth per total IVF cycles stood at 21.6 percent for women aged 30, but fell to 9.5 percent for those aged 40.

“About two-thirds of advanced fertility treatment patients in Japan are aged 35 or older. If the government can boost financial assistance to people through the universal insurance coverage, they can feel free to start receiving it any time,” Kawai said.

The journalist also argued it is unreasonable that IVF treatment for those with such problems as tubal obstruction and lack of sperm in semen has not been covered by health insurance.

A Fine online survey conducted for four months through January 2019, which drew responses from some 1,500 people who have undergone fertility treatment, found the largest group of 24 percent shouldered costs of from 1 million yen to less than 2 million yen.

More than half of the respondents said they have become hesitant about, postponed or given up receiving advanced treatment due to economic burdens, with percentages high among those under 35.

The health ministry is set to conduct by next March a survey on some 600 IVF clinics and the general public in Japan on fertility treatment costs. Since the amount of the current subsidies is based on the ministry’s fiscal 1998 survey, Matsumoto said such research is “long overdue.”

Kawai said boosting support for fertility treatment should be seen as only one of several measures needed to help reverse the declining birth rate as Japanese women’s lifestyles diversify, with many marrying later in life.

She suggested that another factor stemming from the coronavirus pandemic that may affect the birth rate besides the expected drag from the economic impact is that many young people may be missing opportunities to go out and find partners.

“The number of newborns is expected to sharply drop this year,” she said.

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More Than Half the Brazilian Population is Overweight; Obesity Climbing Rapidly

mymedicplus — Sat, 27 Jul 2019 13:04:24 +0000

Source: riotimesonline.com

RIO DE JANEIRO, BRAZIL – The number of obese individuals in Brazil grew 67.8 percent between 2006 and 2018, according to data from the VIGITEL (Surveillance of Risk Factors and Protection for Chronic Diseases by Telephone Survey), which was released on Thursday, July 25th, by the Ministry of Health.

The survey, carried out last year, showed that the index increased from 11.8 percent (2006) to 19.8 percent (2018) and that people between 25 and 34 years of age (84.2 percent) and between 35 and 44 years of age (81.1 percent) recorded the steepest increase in obesity. Among the genders, women showed the highest rate of obesity, with 20.7 percent, while men exhibited 18.7 percent.

The obesity rate had remained stable at 18.9 percent since 2015. The overweight rate also increased in Brazil. More than half of the population (55.7 percent) is overweight, and the rate is 30.8 percent higher than in 2006 when it was 42.6 percent. In this specific case, the population aged between eighteen and 24 years shows a higher incidence.

The data on obesity and overweight took the Body Mass Index (BMI) into account. The survey interviewed 52,395 people from 26 capitals and the Federal District. The interviews, conducted with people over 18 years of age, were performed between February and December 2018.

Increased healthy habits

In spite of the growth in obesity and overweight rates, the Brazilian population is becoming more and more engaged in healthy habits. Between 2008 and 2018, there was a 15.5 percent increase in regular fruit and vegetable intake, which is more prevalent among women (27.2 percent) than among men (18.4 percent).

The practice of physical activities grew by 25.7 percent compared to 2009. “The data indicate that the practice of some physical activity during free time is greater among men (45.4 percent) than among women (31.8 percent),” reports the ministry. “By age group, the rise is more significant in the population between 35 and 44 years old, with an increase of 40.6 percent over the past ten years”.

The adult population is also reducing the intake of soft drinks and sugary beverages. The drop was 53.4 percent in the period from 2007 to 2018. In November, the ministry set targets to reduce the amount of sugar in industrialized products. The goal is to reduce 144,000 tons of sugar in products by 2022.

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Yucatan young rural population, the most overweight

mymedicplus — Fri, 12 Jul 2019 11:11:55 +0000

Source: .theyucatantimes.com

According to data from the National Survey of Health and Nutrition 2012 (Ensanut) cited by the UADY researcher, the number of teenagers living in urban areas of the state that suffer from overweight and obesity, went from 42.5 percent in 2006 to 42 percent in 2012. However, in rural inhabitants this figure represents 52 percent, higher than the national average.

The nutritionist has worked, together with students of the UADY’s School of Nutrition, with several rural communities in nutrition and food education. She currently has a project funded by the Kellogs Foundation with young adolescents between 12 and 19 years of age in the Yucatecan community of Chacsinkin to improve their food health.

According to the expert, this town is a reflection of what has been detected in the all the rural communities across the state, where young people are overweight and obese. Only in this population, around 35 percent of this sector suffers from this disease and others already present cardiovascular risks at a very young age.

Food transition

The specialist has detected that young people have bad eating habits because they stop eating traditional foods, rich in nutrients, to incorporate the “modern stuff”, such as soft drinks, which is what most young people consume, coupled with fried foods, cookies and “Frito Lays”, which are not expensive and can be accessed more easily.

Although, a large part of the families of these populations continue to grow their own food, they young do not do eat those products frequently, and in any case most teenagers prefer “junk” food, however, the grandparents still have an established “food culture”.

In addition, young people have the perception that eating a certain type of food is poor, for example, in the talks they are offered, they are given the option of combining food, such as egg with chaya or beans, but they say: “We always eat chaya, the chaya is for the poor”. However, they think that buying bottled sodas of a certain brand gives them a higher status.

“The food policy in the country must change”, stressed the nutritionist, “the focus should be on education. For its part, companies that sell junk food and candy should pay higher taxes to make it more difficult for people to access these products. they must also modify the labeling of these products, with messages where the consequences of their consumption are made evident (as in the case of cigarette packs).

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Developed, urbanised districts have high HIV prevalence: Study

mymedicplus — Fri, 21 Jun 2019 06:18:43 +0000

Source: thehindubusinessline.com

With over two million HIV infected individuals, India is home to one-third of the world’s HIV population. Although the national level data shows a downward trend, the decline is not uniform across states and districts. A new study has found that underlying factors for the epidemic also vary from region to region, and region-specific strategies may be necessary for HIV control.

There is high prevalence of HIV in 63 districts in South and North-east regions of the country, the study has found. Of them, “better developed, urbanised districts with large population size, better socio-economic status of population are more likely to have consistently high HIV prevalence levels.” While planning HIV control strategies, the focus should be on districts which are showing signs of rapid urbanisation and socio-economic development, the study has suggested.

The factors responsible for the epidemic are complex and can be contrasting for different regions, restricting the use of a single approach for HIV control nationally. Therefore, continuous monitoring for prevalence and causes of disease at the district level is necessary for making control programs more effective.

Researchers used data from 2011 Census, HIV Sentinel Surveillance programme and District Level Household Survey-III and analysed trends from 2007 to 2012 in 640 districts. They correlated HIV prevalence with fourteen factors broadly belonging to categories – population profile; socio-economic factors; HIV and sexually transmitted infections, awareness and condom usage.

The analysis revealed that districts with high literacy, better socio-economic status, and higher proportion of population in reproductive age group and late marriages had consistently high HIV prevalence in all the regions except in southern states.

Elaborating on this trend, researchers explained that often young educated individuals move to urban areas for better opportunities and are separated from family. With better income, they are ready to explore and often have sexual encounters with multiple partners before they get married. This increases chances of HIV. Researchers believe that since south India was first to face HIV upsurge, the HIV epidemic has evolved over time in these states, therefore not affected by factors like better socio-economic indicators like in other states.

“Our study has highlighted inter-regional variations in factors responsible for HIV prevalence. While implementing common strategies for prevention and control of HIV/ AIDS at the national level, additional regional approaches may also be necessary,” explained Dr Rajneesh Joshi, who conducted the study at Pune-based ICMR-National AIDS Research Institute while on a study leave from the Indian army where he is working as a public health specialist.

The study also found that higher knowledge levels about the role of condom use for HIV prevention as well as the use of condoms correlates with reduced HIV cases in districts. However, high literacy and awareness about HIV/AIDS alone does not mean better low HIV prevalence, supplementing this knowledge with HIV prevention methods can only reduce the cases of HIV.

“Results of this study have been communicated to the National AIDS Control Organisation (NACO). We will continue our analysis to track the scenario following the introduction of test and treat policy by the program,” informed Dr Joshi while speaking to India Science Wire.

The study, among other things, has highlighted that the districts which are rapidly progressing towards urbanization and socio-economic development may see an increase in the number of HIV cases. The study further advocates the need to raise awareness of HIV prevention and use of condoms along with HIV in general.

The research team included Dr Sanjay M. Mehendale of Indian Council of Medical Research, New Delhi apart from Dr Rajneesh. The research published in the journal Plos One.

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