Maternal inflammation, growth retardation, and preterm birth: insights into adult cardiovascular disease

The "fetal origin of adult disease Hypothesis" originally described by Barker et al. identified the relationship between impaired in utero growth and adult cardiovascular disease risk and death. Since then, numerous clinical and experimental studies have confirmed that early developmental influences can lead to cardiovascular, pulmonary, metabolic, and psychological diseases during adulthood with and without alterations in birth weight. This so called "fetal programming" includes developmental disruption, immediate adaptation, or predictive adaptation and can lead to epigenetic changes affecting a specific organ or overall health. The intrauterine environment is dramatically impacted by the overall maternal health. Both premature birth or low birth weight can result from a variety of maternal conditions including undernutrition or dysnutrition, metabolic diseases, chronic maternal stresses induced by infections and inflammation, as well as hypercholesterolemia and smoking. Numerous animal studies have supported the importance of both maternal health and maternal environment on the long term outcomes of the offspring. With increasing rates of obesity and diabetes and survival of preterm infants born at early gestational ages, the need to elucidate mechanisms responsible for programming of adult cardiovascular disease is essential for the treatment of upcoming generations.     

Physical, occupational, respiratory, speech, equine and pet therapies for mitochondrial disease

Treatments for mitochondrial disease, while developing, remain limited. Therapies complementary to traditional medical and surgical approaches may benefit the patient with mitochondrial disease. The goals of the 'allied health professions' of physical, occupational, speech and respiratory therapies are to maintain and if possible, improve patients' existing strength, functioning and mobility. These therapists also play an important role in helping patients to compensate for disabilities and adapt to progressive symptoms. Novel forms of physical and occupational therapies, equine or "hippotherapy" and pet therapy, use the human to animal relationship to improve physical and emotional health. To enhance quality of life, an integrated team of experts, under the guidance and supervision of the physician, should be available to the patient with mitochondrial disease.     

The monkey puzzle: a systematic review of studies of stress, social hierarchies, and heart disease in monkeys

Background

It is often suggested that psychosocial factors, such as stress, or one''s social position, may play an important role in producing social gradients in human disease. Evidence in favour of this model of health inequalities has relied, in part, on studies of the health effects of the natural social hierarchies found among non-human primates. This study aimed to assess the strength of this evidence.

Methodology/Principal Findings

A systematic review was carried out to identify all studies of psychosocial factors and coronary artery disease (CAD) in non-human primates. We searched databases (MEDLINE, PsycInfo, EMBASE, and Primatelit from inception to November 2010) to identify experimental and observational studies of the impact of social reorganisation, social instability, and disruption of dominance hierarchies on primate CAD outcomes. We also handsearched bibliographies and examined the citations to those studies in public health articles. Fourteen studies were found which presented evidence on CAD and social status and/or psychosocial stress. These suggested that the association between social status and disease may be sex-specific: in female monkeys dominant status may be protective, with subordinate females having a greater extent of atherosclerosis. In male monkeys the reverse may be the case.

Conclusions/Significance

Overall, non-human primate studies present only limited evidence for an association between social status and CAD, Despite this, there is selective citation of individual non-human primate studies in reviews and commentaries relating to human disease aetiology. Such generalisation of data from monkey studies to human societies does not appear warranted.     

Determinants of Health Service Responsiveness in Community-Based Vector Surveillance for Chagas Disease in Guatemala,El Salvador,and Honduras

Background

Central American countries face a major challenge in the control of Triatoma dimidiata, a widespread vector of Chagas disease that cannot be eliminated. The key to maintaining the risk of transmission of Trypanosoma cruzi at lowest levels is to sustain surveillance throughout endemic areas. Guatemala, El Salvador, and Honduras integrated community-based vector surveillance into local health systems. Community participation was effective in detection of the vector, but some health services had difficulty sustaining their response to reports of vectors from the population. To date, no research has investigated how best to maintain and reinforce health service responsiveness, especially in resource-limited settings.

Methodology/Principal Findings

We reviewed surveillance and response records of 12 health centers in Guatemala, El Salvador, and Honduras from 2008 to 2012 and analyzed the data in relation to the volume of reports of vector infestation, local geography, demography, human resources, managerial approach, and results of interviews with health workers. Health service responsiveness was defined as the percentage of households that reported vector infestation for which the local health service provided indoor residual spraying of insecticide or educational advice. Eight potential determinants of responsiveness were evaluated by linear and mixed-effects multi-linear regression. Health service responsiveness (overall 77.4%) was significantly associated with quarterly monitoring by departmental health offices. Other potential determinants of responsiveness were not found to be significant, partly because of short- and long-term strategies, such as temporary adjustments in manpower and redistribution of tasks among local participants in the effort.

Conclusions/Significance

Consistent monitoring within the local health system contributes to sustainability of health service responsiveness in community-based vector surveillance of Chagas disease. Even with limited resources, countries can improve health service responsiveness with thoughtful strategies and management practices in the local health systems.     

"Post-residency disease" and the medical self: identity, work, and health care among doctors who become patients

Doctors who become patients due to serious illnesses face many challenges related to issues of identity, work, and professionalism. In-depth interviews with such doctors reveal the complex ways in which illness threatens identity in these professionals. In comparison with "medical student's disease," these doctors now exhibit "post-residency disease"-minimizing physical symptoms that are in fact present, leading to decreases in care sought. Doctors often feel they are somehow invulnerable to disease and have to remain strong, not burdening others. Many describe themselves as "workaholics," which can prove to be a double-edged sword, posing problems as well as providing benefits. This professional commitment could interfere with preventive health behaviors and with "practicing what they preach." Some view their illness with their "medical self" - as if they were a physician observing another patient rather than themselves. These doctors often support their approach by choosing a colleague as a doctor who will not challenge them, thereby establishing a "denial system" as opposed to a support system. These doctor-patients confront difficult issues of how much their physicianhood is an identity or an activity, illustrating the intricate relationships and tensions between work, identity, professionalism, and health in contemporary medicine.     

The conceptualisation of health and disease in veterinary medicine

Background  

The concept of health, as well as the concept of disease, is central in veterinary medicine. However, the definitions "health" and "disease" are not generally acknowledged by veterinarians. The aim of this study was to examine how the concepts "health" and "disease" are defined in veterinary textbooks.     

Welch, Sedgwick, and the Hopkins model of hygiene

William H. Welch and William T. Sedgwick, two of the founding fathers of American public health, were both early generation "Hopkins Men." Sedgwick was part of the first group of graduate students to attend Johns Hopkins University, and Welch was part of the initial faculty at the University's medical school. While they never worked together as colleagues at Hopkins, both became interested in the exciting new discoveries of the microbial nature of human disease and developed similar public health programs based on this information. Sedgwick expanded upon these investigations in the new sanitary science program at MIT, where academic public health first emerged in the United States following Sedgwick's appointment in 1883. Welch, who had been exposed to European research in microbiology, promoted microbial research in pathology in Baltimore in 1884. His laboratory-based investigations expanded until they led to the formation of the country's first school of public health in 1916. Thus, a "Hopkins Model" for hygiene and public health emerged from the efforts of both Welch and Sedgwick.     

Between health and illness

This essay explores the connections between health and illness, and the processes of salutogenesis, pathogenesis, and homeostasis. Written from an understanding of human embodiment and the consequences this has for our experiences of health and disease, this essay moves towards a positive definition of health, as an on-going outcome from the processes of a life lived well. "Well" here is measured in terms of wealth, relationships, coherence, fitness, and adaptability. Mencken's criticism that "Hygiene is the corruption of medicine by morality" is answered; the search for health is, in part, a moral as well as a biological enterprise. Both generative processes and remedial measures contribute to health. The patients in my consulting room usually need remedial medicine, but they would also like to flourish as human beings. Doctors should be able to provide a balance of measures towards this end.     

Dog Demography,Animal Bite Management and Rabies Knowledge-Attitude and Practices in the Awash Basin,Eastern Ethiopia

Background

Rabies is a viral zoonosis that has been described in limited numbers of studies in Ethiopia at large and among pastoralists in particular. This study assessed dog demography, bite wound prevalence and management, potential risk factors of disease transmission and knowledge attitude practice towards rabies among urban dwellers, pastoralists and health workers in Awash, Eastern Ethiopia.

Methodology

Information was collected by means of structured questionnaires and interviews and through medical and official records from the Agricultural and Health bureaus.

Principal Findings

Respondents totaled 539 (471 urban, 49 pastoralists, 19 medical). Dog(s) were owned in 33% urban and 75.5% pastoralist households respectively. Mean dog number per dog owning household was 1.50 (95%CI: 1.40–1.60) in urban and 2.05 (95%CI: 1.51–2.60) in pastoralists sites. Human Dog Ratio in Metahara was 4.7:1. No bite wounds records were kept in medical facilities, where staff recalled around 100 bites per year, 2/3 being in adults. Over 90% of the respondents claimed knowing rabies but up to 79.2% pastoralist did not know how dogs acquire the disease; 37.3% urban and 23% pastoralist did not know the symptoms of rabies in dogs; 36% urban and 44% pastoralists did not know rabies symptoms in people. Eighty percent of pastoralists did not know that the disease was fatal in people if untreated. Over half (58.7%) of pastoralist respondents go to traditional healers if bitten, despite a health extension worker program in place in the study area. Knowledge gaps were also shown amidst medical staff.

Conclusions

The study highlighted overall poor disease knowledge, severe under-reporting of human rabies cases, lack of record keeping and poor collaboration between the public and animal health sectors and communities in rabies control.     

Behavioural Risk Factors in Mid-Life Associated with Successful Ageing,Disability, Dementia and Frailty in Later Life: A Rapid Systematic Review

Background

Smoking, alcohol consumption, poor diet and low levels of physical activity significantly contribute to the burden of illness in developed countries. Whilst the links between specific and multiple risk behaviours and individual chronic conditions are well documented, the impact of these behaviours in mid-life across a range of later life outcomes has yet to be comprehensively assessed. This review aimed to provide an overview of behavioural risk factors in mid-life that are associated with successful ageing and the primary prevention or delay of disability, dementia, frailty and non-communicable chronic conditions.

Methods

A literature search was conducted to identify cohort studies published in English since 2000 up to Dec 2014. Multivariate analyses and a minimum follow-up of five years were required for inclusion. Two reviewers screened titles, abstracts and papers independently. Studies were assessed for quality. Evidence was synthesised by mid-life behavioural risk for a range of late life outcomes.

Findings

This search located 10,338 individual references, of which 164 are included in this review. Follow-up data ranged from five years to 36 years. Outcomes include dementia, frailty, disability and cardiovascular disease. There is consistent evidence of beneficial associations between mid-life physical activity, healthy ageing and disease outcomes. Across all populations studied there is consistent evidence that mid-life smoking has a detrimental effect on health. Evidence specific to alcohol consumption was mixed. Limited, but supportive, evidence was available relating specifically to mid-life diet, leisure and social activities or health inequalities.

Conclusions

There is consistent evidence of associations between mid-life behaviours and a range of late life outcomes. The promotion of physical activity, healthy diet and smoking cessation in all mid-life populations should be encouraged for successful ageing and the prevention of disability and chronic disease.     

Web-based consumer health information: public access, digital division, and remainders

Public access Internet portals and decreasing costs of personal computers have created a growing consensus that unequal access to information, or a "digital divide," has largely disappeared for US consumers. A series of technology initiatives in the late 1990s were believed to have largely eliminated the divide. For healthcare patients, access to information is an essential part of the consumer-centric framework outlined in the recently proposed national health information initiative. Data from a recent study of health information-seeking behaviors on the Internet suggest that a "digitally underserved group" persists, effectively limiting the planned national health information infrastructure to wealthier Americans.     

The politics of pathology: how obesity became an epidemic disease

Americans' recent weight gains have been widely described as an "obesity epidemic." Such a characterization, however, has many problems: the average American weight gain has been relatively low (eight to 12 pounds over the last 20 years), and the causal linkages between adiposity, morbidity, and mortality are unclear. Nevertheless, the media and numerous health officials continue to sound dire warnings that obesity has become an epidemic disease. In this article, I examine how and why America's growing weight became an "obesity epidemic." I find the disease characterization has less to do with the health consequences of excess weight and more with the various financial and political incentives of the weight loss industry, medical profession, and public health bureaucracy. This epidemic image was also assisted by the method of displaying information about weight gain with maps in PowerPoint slides. Such characterizations, I argue, are problematic. Given the inconclusive scientific evidence and the absence of a safe and effective weight loss regimen, calling America's growing weight an epidemic disease is likely to cause more harm than good.     

Disease Prevention: Saving Lives or Reducing Health Care Costs?

Background

Disease prevention has been claimed to reduce health care costs. However, preventing lethal diseases increases life expectancy and, thereby, indirectly increases the demand for health care. Previous studies have argued that on balance preventing diseases that reduce longevity increases health care costs while preventing non-fatal diseases could lead to health care savings. The objective of this research is to investigate if disease prevention could result in both increased longevity and lower lifetime health care costs.

Methods

Mortality rates for Netherlands in 2009 were used to construct cause-deleted life tables. Data originating from the Dutch Costs of Illness study was incorporated in order to estimate lifetime health care costs in the absence of selected disease categories. We took into account that for most diseases health care expenditures are concentrated in the last year of life.

Results

Elimination of diseases that reduce life expectancy considerably increase lifetime health care costs. Exemplary are neoplasms that, when eliminated would increase both life expectancy and lifetime health care spending with roughly 5% for men and women. Costs savings are incurred when prevention has only a small effect on longevity such as in the case of mental and behavioural disorders. Diseases of the circulatory system stand out as their elimination would increase life expectancy while reducing health care spending.

Conclusion

The stronger the negative impact of a disease on longevity, the higher health care costs would be after elimination. Successful treatment of fatal diseases leaves less room for longevity gains due to effective prevention but more room for health care savings.     

A Cross-Sectional Survey of Knowledge,Attitude and Practices Related to Cutaneous Leishmaniasis and Sand Flies in Punjab,Pakistan

Background

Recent outbreaks of cutaneous leishmaniasis make the disease a public health concern in Punjab, Pakistan. The knowledge of how the population perceives the disease and its vector is essential in order to design an effective management strategy, but such studies are rare in Pakistan.

Methodology/Principal Findings

The present study was based on a cross-sectional self-administered survey comprising 250 household samples collected from five localities including Bhawalpur, Multan, Jhang, Faisalabad and Lahore. The results revealed that the respondents had a poor knowledge of the vector and disease. Few of the respondents were aware about the identification of sand flies, their breeding place, biting time, transmission of leishmaniasis and control measures. Skin infection and sandflies as the main disease symptom and vector of the disease, respectively, were known to some of the respondents. Some believed that summer was the main peak incidence of the disease and it could be transmitted from man to man via contact. However, most of the respondents believed that the disease could be cured. Admission to hospitals, cleanliness and use of bed nets were the treatment measures for the disease in suspected patients, whereas some thought that the use of bed nets could be helpful in preventing leishmaniasis infection.

Conclusions/Significance

Poor knowledge of the disease and its vector in the study population emphasize the need to initiate health education and awareness campaigns to minimize the risks of cutaneous leishmaniasis outbreaks in the future.     

Modelling the Contributions of Malaria,HIV, Malnutrition and Rainfall to the Decline in Paediatric Invasive Non-typhoidal Salmonella Disease in Malawi

Introduction

Nontyphoidal Salmonellae (NTS) are responsible for a huge burden of bloodstream infection in Sub-Saharan African children. Recent reports of a decline in invasive NTS (iNTS) disease from Kenya and The Gambia have emphasised an association with malaria control. Following a similar decline in iNTS disease in Malawi, we have used 9 years of continuous longitudinal data to model the interrelationships between iNTS disease, malaria, HIV and malnutrition.

Methods

Trends in monthly numbers of childhood iNTS disease presenting at Queen’s Hospital, Blantyre, Malawi from 2002 to 2010 were reviewed in the context of longitudinal monthly data describing malaria slide-positivity among paediatric febrile admissions, paediatric HIV prevalence, nutritional rehabilitation unit admissions and monthly rainfall over the same 9 years, using structural equation models (SEM).

Results

Analysis of 3,105 iNTS episodes identified from 49,093 blood cultures, showed an 11.8% annual decline in iNTS (p < 0.001). SEM analysis produced a stable model with good fit, revealing direct and statistically significant seasonal effects of malaria and malnutrition on the prevalence of iNTS disease. When these data were smoothed to eliminate seasonal cyclic changes, these associations remained strong and there were additional significant effects of HIV prevalence.

Conclusions

These data suggest that the overall decline in iNTS disease observed in Malawi is attributable to multiple public health interventions leading to reductions in malaria, HIV and acute malnutrition. Understanding the impacts of public health programmes on iNTS disease is essential to plan and evaluate interventions.     

Vaccinating behaviour, information, and the dynamics of SIR vaccine preventable diseases

The increasing level of disease control by vaccination jointly with the growing standard of living and health of modern societies could favour the spread of exemption as a "rational" behaviour towards vaccination. Rational exemption implies that families will tend to relate the decision to vaccinate their children to the available information on the state of the disease. Using an SIR model with information dependent vaccination we show that rational exemption might make elimination of the disease an unfeasible task even if coverages as high as 100% are actually reached during epochs of high social alarm. Moreover, we show that rational exemption may also become responsible for the onset of sustained oscillations when the decision to vaccinate also depends on the past history of the disease.     

Misunderstanding as therapy: Doctors,patients and medicines in a rural clinic in Sri Lanka

In this paper I want to draw attention to the integration of Western medicine into therapeutic choices among patients in rural Sri Lanka. These patients' interpretation and use of Western pharmaceuticals is discussed in relation to the Ayurvedic theory of balance. The influence of this theory on people's ideas of health and illness is highlighted in encounters where laymen and professionals alike use Western medicines according to context and their respective perspectives. Such therapeutic encounters are used to describe how the meaning of therapy is negotiated and communicated. The modes of perception used by doctors and patients seem to be mutually exclusive but each has its own logic. Western medicines are used as a symbolic means which help the patients and the practitioners of Western clinical medicine in a rural health unit to communicate through — rather than despite — misunderstandings based on their differing cultural assumptions about the body, about disease and about therapy. This argument is raised in relation to recent theoretical discussions among medical anthropologists concerning doctor-patient relationships, asymmetric medical relations and the analysis of meaning systems