Imprisonments in hospitals in at least 30 other countries, including Nigeria and the Democratic Republic of the Congo, China & Thailand, Lithuania & Bulgaria, & others in Latin America & the Middle East

AP Investigation: Hospital patients held hostage for cash. MARIA CHENG. AP, October 25, 2018. https://apnews.com/daf47512c8f74e869b722782299b4a0e

NAIROBI, Kenya (AP) — The Kenyatta National Hospital is east Africa’s biggest medical institution, home to more than a dozen donor-funded projects with international partners — a “Center of Excellence,” says the U.S. Centers for Disease Control and Prevention.

The hospital’s website proudly proclaims its motto — “We Listen ... We Care” — along with photos of smiling doctors, a vaccination campaign and staffers holding aloft a gold trophy at an awards ceremony.

But there are no pictures of Robert Wanyonyi, shot and paralyzed in a robbery more than a year ago. Kenyatta will not allow him to leave the hospital because he cannot pay his bill of nearly 4 million Kenyan shillings ($39,570). He is trapped in his fourth-floor bed, unable to go to India, where he believes doctors might help him.

At Kenyatta National Hospital and at an astonishing number of other hospitals around the world, if you don’t pay up, you don’t go home.

The hospitals often illegally detain patients long after they should be medically discharged, using armed guards, locked doors and even chains to hold those who have not settled their accounts. Mothers and babies are sometimes separated. Even death does not guarantee release: Kenyan hospitals and morgues are holding hundreds of bodies until families can pay their loved ones’ bills, government officials say.

Dozens of doctors, nurses, health experts, patients and administrators told The Associated Press of imprisonments in hospitals in at least 30 other countries, including Nigeria and the Democratic Republic of the Congo, China and Thailand, Lithuania and Bulgaria, and others in Latin America and the Middle East.

The AP investigation built on a report last year by the British think-tank Chatham House; its experts found more than 60 press reports of patient detention in 14 countries in Asia and sub-Saharan Africa.

“What’s striking about this issue is that the more we look for this, the more we find it,” said Dr. Ashish Jha, director of the Harvard Global Health Institute, who was not involved in the British research. “It’s probably hundreds of thousands if not millions of people that this affects worldwide. It is not something that is only happening in a small number of countries, but the problem is that nobody is looking at this and it is way off the public health radar.”

Some examples:

—In the Philippines, Annalyn Manalo was held at Mount Carmel Diocesan General Hospital in Lucena City for 1½ months starting last December following treatment for heart problems. Administrators refused initially to allow her family to pay in installments — and the cost of each extra day in detention was added to the bill.

“We were treated like criminals,” said Manalo’s husband, Sigfredo. “The security guards would come and check on us all the time.”

—In Congo’s second city of Lubumbashi, the AP visited more than 20 hospitals and clinics and found that all but one routinely detained patients who failed to pay, even though the practice is illegal there.

—In Bangalore, India, Emmanuel Malagi was detained in a private hospital for three months after he was treated for a spinal tumor, according to his brother, Christanand. Prevented from seeing him, his family scrambled unsuccessfully to pay his nearly 1.4 lakh rupees ($19,281) bill — and when he died, the hospital demanded another 10 lakh ($13,771) to release the body.

—In Malaysia, a medical student from the Netherlands on a diving trip got the bends. He couldn’t afford his decompression treatment; the hospital locked him in a room for four days, with no food or drink, until he was able to get the money, according to Saskia Mostert, a Dutch academic who has researched hospital detentions.

—In Bolivia, a government ombudsman reported that 49 patients were detained in hospitals or clinics in the last two years because they couldn’t pay, despite a law that prohibits the practice.

During several August visits to Kenyatta National Hospital, The Associated Press witnessed armed guards in military fatigues standing watch over patients, and saw where detainees slept on bedsheets on the floor in cordoned-off rooms. Guards prevented one worried father from seeing his detained toddler. All despite a court ruling years ago that found the detentions were illegal.

Health experts decry hospital imprisonment as a human rights violation. Yet the United Nations, U.S. and international health agencies, donors and charities all have remained silent while pumping billions of dollars into these countries to support splintered health systems or to fight outbreaks of diseases including AIDS and malaria.

“It’s the dirty underbelly of global health that nobody wants to talk about,” said Sophie Harman, a health academic at Queen Mary University of London.

“People know patients are being held prisoner, but they probably think they have bigger battles in public health to fight, so they just have to let this go.”

[...]

Where patients are imprisoned, hospitals acknowledge it is not necessarily profitable. But many say it often leads at least to partial payment and serves as a deterrent.

Unlike many hospitals in developed countries, African hospitals don’t always provide food, clothing or bedding for patients, so holding onto them does not necessarily incur a significant cost. Detained patients typically rely on relatives to bring them food while those without obliging family members resort to begging for help from staff or other patients.

Dr. Festus Njuguna, a pediatric oncologist at the Moi Teaching and Referral Hospital in Eldoret, about 300 kilometers northwest of Nairobi, said the institution regularly holds children with cancer who have finished their treatment, but whose parents cannot pay. The children are typically left on the wards for weeks and months at a time, long after their treatment has ended.

“It’s not a very good feeling for the doctors and nurses who have treated these patients, to see them kept like this,” Njuguna said.

Still, some officials openly defend the practice.

“We can’t just let people leave if they don’t pay,” said Leedy Nyembo-Mugalu administrator of Congo’s Katuba Reference Hospital. He said holding patients wasn’t an issue of human rights, but simply a way to conduct business: “No one ever comes back to pay their bill a month or two later.”

At many Kenyan hospitals, including Kenyatta, officials armed with rifles patrol the hallways and guard the hospital’s gates. Patients must show hospital guards a discharge form to prove they’re allowed to leave and even visitors must sometimes surrender their identification cards before seeing patients.

[...]

“This is something that hospital authorities have been trying to keep under wraps,” said George Morara, vice chairperson of the country’s national commission on human rights. He said the number of Kenyans imprisoned in hospitals is “disturbingly high” and that the practice is “ubiquitous in public and private hospitals.”

He said patients have been held at Kenyatta for up to two years, and it was reasonable to suspect that hundreds of patients could be detained there at any time.

Kenya’s ministry of health and Kenyatta canceled several scheduled interviews with the AP and declined to respond to repeated requests for comment.

[...]

Although the court instructed the government to produce guidelines on how hospitals should waive fees for patients unable to pay, Opondo said the proposed fixes have not gone far enough. A program that provides free maternity care is only available at a select number of private hospitals and does not include post-delivery care.

Earlier this month, Kenya’s High Court ruled again that imprisoning patients “is not one of the acceptable avenues (for hospitals) to recover debt.” The case involved a man detained at Nairobi Women’s Hospital since June 25; the judge ordered his immediate release despite the outstanding bill. Kenyan politicians also will soon debate a proposed amendment to the country’s health law that will explicitly make patient detentions illegal.

The latest amendment was submitted by MP Jared Okelo, a member of Parliament who described the imprisonment of mothers as “rampant.”

Omuya is still scarred by her detention at Pumwani. She says she developed chronic pneumonia after being held in the damp, cold conditions there and has not been able to work full-time since.

Neither Omuya nor Oliele have been paid the damages awarded to them by the court: Omuya was to receive 1,500,000 shillings ($14,842) from the hospital while Oliele was to receive 500,000 shillings ($4,948).

[...]

___
Desmond Tiro in Nairobi and Paola Flores in La Paz, Bolivia contributed to this report.

Paraventricular thalamic neurons represent multiple salient features of sensory stimuli, like reward, aversiveness, novelty, & surprise; the nucleus thus provides context-dependent salience encoding

Dynamic salience processing in paraventricular thalamus gates associative learning. Yingjie Zhu, Gregory Nachtrab, Piper C. Keyes, William E. Allen, Liqun Luo, Xiaoke Chen. Science , Vol. 362, Issue 6413, pp. 423-429. DOI: 10.1126/science.aat0481

Abstract: The salience of behaviorally relevant stimuli is dynamic and influenced by internal state and external environment. Monitoring such changes is critical for effective learning and flexible behavior, but the neuronal substrate for tracking the dynamics of stimulus salience is obscure. We found that neurons in the paraventricular thalamus (PVT) are robustly activated by a variety of behaviorally relevant events, including novel (“unfamiliar”) stimuli, reinforcing stimuli and their predicting cues, as well as omission of the expected reward. PVT responses are scaled with stimulus intensity and modulated by changes in homeostatic state or behavioral context. Inhibition of the PVT responses suppresses appetitive or aversive associative learning and reward extinction. Our findings demonstrate that the PVT gates associative learning by providing a dynamic representation of stimulus salience.

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A close view of the paraventricular thalamus

The paraventricular thalamus is a relay station connecting brainstem and hypothalamic signals that represent internal states with the limbic forebrain that performs associative functions in emotional contexts. Zhu et al. found that paraventricular thalamic neurons represent multiple salient features of sensory stimuli, including reward, aversiveness, novelty, and surprise. The nucleus thus provides context-dependent salience encoding. The thalamus gates sensory information and contributes to the sleep-wake cycle through its interactions with the cerebral cortex. Ren et al. recorded from neurons in the paraventricular thalamus and observed that both population and single-neuron activity were tightly coupled with wakefulness.

Stereotypes about wealthy people’s personality are accurate albeit somewhat exaggerated; wealthy people can be characterized as stable, flexible, & agentic individuals who are focused more on themselves than on others

Leckelt, Marius, David Richter, Carsten Schröder, Albrecht C. P. Küfner, Markus M. Grabka, and Mitja Back. 2018. “The Rich Are Different: Unraveling the Perceived and Self-reported Personality Profiles of High Net-worth Individuals.” PsyArXiv. October 28. doi:10.1111/bjop.12360

Abstract: Beyond money and possessions, how are the rich different from the general population? Drawing on a unique sample of high net-worth individuals from Germany (≥1 million Euro in financial assets; N = 130), nationally representative data (N = 22,981), and an additional online panel (N = 690), we provide the first direct investigation of the stereotypically-perceived and self-reported personality profiles of high net-worth individuals. Investigating the broad personality traits of the Big Five and the more specific traits of narcissism and locus of control, we find that stereotypes about wealthy people’s personality are accurate albeit somewhat exaggerated and that wealthy people can be characterized as stable, flexible, and agentic individuals who are focused more on themselves than on others.

Researchers at Brown U found that alcohol hijacks a conserved memory pathway in the brain and changes which versions of genes are made, forming the cravings that fuel addiction

Alcohol Activates Scabrous-Notch to Influence Associated Memories. Emily Petruccelli et al. Neuron, October 25, 2018. https://doi.org/10.1016/j.neuron.2018.10.005

Highlights
    •  Alcohol cue preference requires Scabrous-Notch interaction in mushroom body neurons
    •  Alcohol activates Notch and Su(H) target gene expression in the adult brain
    •  Dopamine 2 receptor splicing and targeting by Su(H) are altered by alcohol exposure
    •  Alcohol cue preference affects mushroom body gene expression and splicing

Summary: Drugs of abuse, like alcohol, modulate gene expression in reward circuits and consequently alter behavior. However, the in vivo cellular mechanisms through which alcohol induces lasting transcriptional changes are unclear. We show that Drosophila Notch/Su(H) signaling and the secreted fibrinogen-related protein Scabrous in mushroom body (MB) memory circuitry are important for the enduring preference of cues associated with alcohol’s rewarding properties. Alcohol exposure affects Notch responsivity in the adult MB and alters Su(H) targeting at the dopamine-2-like receptor ( Dop2R). Alcohol cue training also caused lasting changes to the MB nuclear transcriptome, including changes in the alternative splicing of Dop2R and newly implicated transcripts like Stat92E. Together, our data suggest that alcohol-induced activation of the highly conserved Notch pathway and accompanying transcriptional responses in memory circuitry contribute to addiction. Ultimately, this provides mechanistic insight into the etiology and pathophysiology of alcohol use disorder.

Press release: http://news.brown.edu/articles/2018/10/alcohol

Literature said property crimes have more instrumental motives, require planning, & hence are particularly sensitive to permanent changes in cost & benefits, but violent crime declines in U.S. cities on days in which the local pollen count is unusually high

Chalfin, Aaron and Danagoulian, Shooshan and Deza, Monica, More Sneezing, Less Crime? Seasonal Allergies, Transitory Costs and the Market for Offenses (August 18, 2018). http://dx.doi.org/10.2139/ssrn.3234415

Abstract: The neoclassical economic model of crime envisions crime as a gamble undertaken by a rational individual who is weighing the costs and benefits of offending at the margin. A large literature estimates the sensitivity of crime to policy inputs that shift the cost of offending such as police and prisons. In this paper, we point out that participants in the market for offenses also respond to transitory changes in situational factors and that these are in constant flux. We consider the responsiveness of crime to a pervasive and common health shock which we argue shifts costs and benefits for offenders and victims: seasonal allergies. Leveraging daily variation in city-specific pollen counts, we present novel evidence that violent crime declines in U.S. cities on days in which the local pollen count is unusually high and that these effects are driven by residential violence. While past literature suggests that property crimes have more instrumental motives, require planning, and hence are particularly sensitive to permanent changes in the cost and benefits of crime, we find evidence that violence may be especially sensitive to situational factors.