Navigating Diagnoses: Understanding Mind–Body Relations, Mental Health, and Stigma in Nepal

Anthropologists and psychiatrists traditionally have used the salience of a mind–body dichotomy to distinguish Western from non-Western ethnopsychologies. However, despite claims of mind–body holism in non-Western cultures, mind–body divisions are prominent in non-Western groups. In this article, we discuss three issues: the ethnopsychology of mind–body dichotomies in Nepal, the relationship between mind–body dichotomies and the hierarchy of resort in a medical pluralistic context, and, finally, the role of mind–body dichotomies in public health interventions (biomedical and psychosocial) aimed toward decreasing the stigmatization of mental illness. We assert that, by understanding mind–body relations in non-Western settings, their implications, and ways in which to reconstitute these relations in a less stigmatizing manner, medical anthropologists and mental health workers can contribute to the reduction of stigma in global mental health care.

Understanding the role of domain–domain linkers in the spatial orientation of domains in multi-domain proteins

Inter-domain linkers (IDLs)’ bridge flanking domains and support inter-domain communication in multi-domain proteins. Their sequence and conformational preferences enable them to carry out varied functions. They also provide sufficient flexibility to facilitate domain motions and, in conjunction with the interacting interfaces, they also regulate the inter-domain geometry (IDG). In spite of the basic intuitive understanding of the inter-domain orientations with respect to linker conformations and interfaces, we still do not entirely understand the precise relationship among the three. We show that IDG is evolutionarily well conserved and is constrained by the domain–domain interface interactions. The IDLs modulate the interactions by varying their lengths, conformations and local structure, thereby affecting the overall IDG. Results of our analysis provide guidelines in modelling of multi-domain proteins from the tertiary structures of constituent domain components.     

Epidemiology of Pediatric Ocular Trauma in the Chaoshan Region,China, 2001–2010

Background

Ocular trauma is the leading cause of monocular visual disability and noncongenital unilateral blindness in children. This study describes the epidemiology and medical care associated with nonfatal pediatric (≤17 years of age) eye injury-related hospitalization in the largest industrial base for plastic toy production in China.

Methods

A population-based retrospective study of patients hospitalized for ocular and orbital trauma in the ophthalmology departments of 3 major tertiary hospitals from 1st January 2001 to 31st December 2010 was performed.

Results

The study included 1035 injured eyes from 1018 patients over a 10-year period: 560 (54.1%) eyes exhibited open globe injuries, 402 (38.8%) eyes suffered closed globe injuries, 10 (1.0%) eyes suffered chemical injuries and 8 (0.8%) eyes exhibited thermal injuries, representing an average annual hospitalization rate of 0.37 per 10,000 (95% confidence interval [CI], 0.36–0.38) due to pediatric eye injury in the Chaoshan region. The mean patient age was 9.2±4.4 years with a male-to-female ratio of 3.3∶1 (P = 0.007). Children aged 6 to 11 years accounted for the highest percentage (40.8%, 416/1018) of hospitalization, 56.7% (236/416) of whom were hospitalized for open globe wounds. Injury occurred most frequently at home (73.1%). Open globe wounds cost the single most expensive financial burden (60.8%) of total charges with $998±702 mean charges per hospitalization.

Conclusions

Open globe wounds occurred at home are earmarked for the priorities to prevention strategies. Higher public awareness of protecting primary schoolchildren from home-related eye injuries should be strengthened urgently by legislation or regulation since the traditional industrial mode seems to remain the pattern for the foreseeable future. Further research that provide detailed information on the specific inciting agents of pediatric eye injuries are recommended for facilitating the development and targeting of appropriate injury prevention initiatives.     

Changes in the status of tortoise populations in Greece 1984–2001

Three species of tortoise (Testudinidae) occur in Greece (Testudo hermanni, T. graeca and the endemic T. marginata), all of which have been listed as rare or vulnerable. This paper describes the current situation of 75 populations that were last observed in the 1970s and 1980s and described in 1989. Twenty-nine populations had declined in density and/or status (significantly more than had improved), 10 of which were functionally extinct. A particularly notable loss was a dense population of T. marginata at Gytheion in the Peloponnese due to a widespread fire. Declining populations were significantly associated with identified high threat in 1989 and with close proximity to human settlement. There were no significant effects of tortoise species, area of site, characteristics of surrounding areas or original density on these changes. Declines were less associated with agriculture than predicted in 1989, reflecting changing economic conditions in Greece in the 1990s. Continuing threats to tortoise habitats make their long-term future appear bleak outside of protected areas. The risk of extinction from stochastic variation in small populations was also assessed, using the VORTEX program. This risk was much lower than that from habitat loss; 60–96% of populations of 100 tortoises would survive for 1000 years, depending on adult body size, compared to only 0–0.02% of habitats. The high survival potential of small populations would facilitate conservation of the high intraspecific diversity of tortoises in Greece.     

Time Series Analysis of Trends in Malaria Cases and Deaths at Hospitals and the Effect of Antimalarial Interventions, 2001–2011, Ethiopia

Background

The Government of Ethiopia and its partners have deployed artemisinin-based combination therapies (ACT) since 2004 and long-lasting insecticidal nets (LLINs) since 2005. Malaria interventions and trends in malaria cases and deaths were assessed at hospitals in malaria transmission areas during 2001–2011.

Methods

Regional LLINs distribution records were used to estimate the proportion of the population-at-risk protected by LLINs. Hospital records were reviewed to estimate ACT availability. Time-series analysis was applied to data from 41 hospitals in malaria risk areas to assess trends of malaria cases and deaths during pre-intervention (2001–2005) and post-interventions (2006–2011) periods.

Findings

The proportion of the population-at-risk potentially protected by LLINs increased to 51% in 2011. The proportion of facilities with ACTs in stock exceeded 87% during 2006–2011. Among all ages, confirmed malaria cases in 2011 declined by 66% (95% confidence interval [CI], 44–79%) and SPR by 37% (CI, 20%–51%) compared to the level predicted by pre-intervention trends. In children under 5 years of age, malaria admissions and deaths fell by 81% (CI, 47%–94%) and 73% (CI, 48%–86%) respectively. Optimal breakpoint of the trendlines occurred between January and June 2006, consistent with the timing of malaria interventions. Over the same period, non-malaria cases and deaths either increased or remained unchanged, the number of malaria diagnostic tests performed reflected the decline in malaria cases, and rainfall remained at levels supportive of malaria transmission.

Conclusions

Malaria cases and deaths in Ethiopian hospitals decreased substantially during 2006–2011 in conjunction with scale-up of malaria interventions. The decrease could not be accounted for by changes in hospital visits, malaria diagnostic testing or rainfall. However, given the history of variable malaria transmission in Ethiopia, more data would be required to exclude the possibility that the decrease is due to other factors.     

Understanding Inequalities in Child Health in Ethiopia: Health Achievements Are Improving in the Period 2000–2011

Objective

In Ethiopia, coverage of key health services is low, and community based services have been implemented to improve access to key services. This study aims to describe and assess the level and the distribution of health outcomes and coverage for key services in Ethiopia, and their association with socioeconomic and geographic determinants.

Methods

Data were obtained from the 2000, 2005 and 2011 Ethiopian Demographic and Health Surveys. As indicators of access to health care, the following variables were included: Under-five and neonatal deaths, skilled birth attendance, coverage of vaccinations, oral rehydration therapy for diarrhoea, and antibiotics for suspected pneumonia. For each of the indicators in 2011, inequality was described by estimating their concentration index and a geographic Gini index. For further assessment of the inequalities, the concentration indices were decomposed. An index of health achievement, integrating mean coverage and the distribution of coverage, was estimated. Changes from 2000 to 2011 in coverage, inequality and health achievement were assessed.

Results

Significant pro-rich inequalities were found for all indicators except treatment for suspected pneumonia in 2011. The geographic Gini index showed significant regional inequality for most indicators. The decomposition of the 2011 concentration indices revealed that the factor contributing the most to the observed inequalities was different levels of wealth. The mean of all indicators improved from 2000 to 2011, and the health achievement index improved for most indicators. The socioeconomic inequalities seem to increase from 2000 to 2011 for under-five and neonatal deaths, whereas they are stable or decreasing for the other indicators.

Conclusion

There is an unequal socioeconomic and geographic distribution of health and access to key services in Ethiopia. Although the health achievement indices improved for most indicators from 2000 to 2011, socioeconomic determinants need to be addressed in order to achieve better and more fairly distributed health.     

Profile and Treatment Outcomes of Tuberculosis in the Elderly in Southeastern Nigeria, 2011–2012

Background

The demographic transition and increasing life expectancy in Africa has lead to a rising elderly population. In Nigeria, little is known about the profile of and treatment outcomes of tuberculosis (TB) in the elderly.

Methods

Retrospective cohort study of adult TB patients treated between January 2011 and December 2012 in two large health facilities in Nigeria. The demographic, clinical and treatment outcomes of patients aged 60 and older were compared with those aged 15 to 59 years.

Results

Elderly (≥60 years) TB patients accounted for 12.7% of all (1668) adult TB enrolled. Elderly patients had a higher proportion of men compared to non-elderly (64.2% vs 56.8%; p = 0.043); but a lower proportion of smear-positive TB at baseline (40.7% vs 65.8%; p<0.001). A higher proportion of elderly patients failed to smear convert after the intensive phase of treatment (23.7% vs 19.8%; p = 0.06), and overall elderly patients had lower treatment success rates (68.9% vs 77.1%; p = 0.009). Unsuccessful outcomes were mainly due to higher default and deaths in the elderly. The risk factors for unsuccessful outcomes in the elderly were: extrapulmonary TB case (adjusted odds ratio (aOR) 10.9; 95% confidence interval (CI) 1.1–108), and HIV co-infection (aOR 3.6; CI 1.1–11.7).

Conclusions

Treatment outcomes of elderly TB patients were inferior to non-elderly adults with higher death and default rates being implicated. With the rising elderly population, specific strategies are needed to quickly address TB management in the elderly in resource-limited settings.     

Formation and Rapid Export of the Monochlorobimane–Glutathione Conjugate in Cultured Rat Astrocytes

Monochlorobimane (MCB) is often used to visualize glutathione (GSH) levels in cultured cells, since it is quickly converted to a fluorescent GSH conjugate (GS–MCB). To test for consequences of MCB application on the GSH metabolism of astrocytes, we have studied rat astrocyte-rich primary cultures as model system. MCB caused a concentration dependent rapid decrease in the cellular GSH content. Simultaneously, a transient accumulation of GS–MCB in the cells was observed with a maximal content 5 min after MCB application. The cellular accumulation was followed by a rapid release of GS–MCB into the medium with a maximal initial export rate of 27.9 ± 6.5 nmol h⁻¹ mg protein⁻¹. Transporters of the family of multidrug resistance proteins (Mrps) are likely to be involved in this export, since the Mrp inhibitor MK571 lowered the export rate by 60%. These data demonstrate that, due to its rapid export from astrocytes, GS–MCB is only under well-defined conditions a reliable indicator of the cellular GSH concentration and that MK571 can be used to maintain maximal GS–MCB levels in astrocytes.     

Monitoring records of plant species in the Hakone region of Fuji-Hakone-Izu National Park, Japan, 2001–2010

The monitoring of species occurrences is a crucial aspect of biodiversity conservation, and regional volunteerism can serve as a powerful tool in such endeavors. The Fuji-Hakone-Izu National Park in the Hakone region of Kanagawa Prefecture, Japan, boasts a volunteer association of approximately 100 members. These volunteers have monitored plant species occurrences from 2001 to the present along several hiking trails in the region. In this paper, I present the annual observation records of plant occurrences in Hakone from 2001 to 2010. This data set includes 1,071 species of plants from 151 families. Scientific names follow the Y List, and this data set includes several threatened plant species. Data files are formatted based on the Darwin Core and Darwin Core Archives, which are defined by the Biodiversity Information Standards (BIS) or Biodiversity Information Standards Taxonomic Databases Working Group (TDWG). Data files filled on required and some additional item on Darwin Core. The data set can download from the author’s personal Web site as of July 2012. These data will soon be published for the Global Biodiversity Information Facility (GBIF) through GBIF Japan. All users can then access the data from the GBIF portal site.     

Comparison of Toxoplasma gondii Seroprevalence in Shelter Cats and Dogs during 1999–2001 and 2009–2011 in Tokyo,Japan

Toxoplasma gondii is an important human health concern with respect to abortion, congenital hydrocephalus, and encephalitis in immunocompromised people. Cats and dogs both are potential sources of T. gondii because they have close contact with humans. However, no epidemiological surveys have been conducted in Tokyo over the past decade. Therefore, the present study investigated and compared the seroprevalence of T. gondii infection in shelter cats and dogs during 1999–2001 and 2009–2011 in Tokyo, Japan. Serum samples were collected from 337 shelter cats and 325 shelter dogs in urban and suburban areas of Tokyo, during 1999–2001 (233 cats and 219 dogs) and 2009–2011 (104 cats and 106 dogs). T. gondii antibodies were measured in the serum samples using a commercial latex agglutination test. Data were compared using the Fisher’s exact test, and significance was indicated at P < 0.05. The overall seroprevalence of T. gondii infection in cats was 5.6% (13 of 233) in 1999–2001 and 6.7% (7 of 104) in 2009–2011, and that in dogs was 1.8% (4 of 219) and 1.9% (2 of 106), respectively. Significantly higher seroprevalence was observed in cats from suburban areas compared with cats in urban areas during both periods (P < 0.05). These results reveal that there has been little change in the feline and canine seroprevalence over the past decade, indicating that the risk of T. gondii exposure for cats and dogs in Tokyo is considerably low as the seroprevalence has reached a steady state.     

Understanding the Role of the ‘Self’ in the Social Priming of Mimicry

People have a tendency to unconsciously mimic other''s actions. This mimicry has been regarded as a prosocial response which increases social affiliation. Previous research on social priming of mimicry demonstrated an assimilative relationship between mimicry and prosociality of the primed construct: prosocial primes elicit stronger mimicry whereas antisocial primes decrease mimicry. The present research extends these findings by showing that assimilative and contrasting prime-to-behavior effect can both happen on mimicry. Specifically, experiment 1 showed a robust contrast priming effect where priming antisocial behaviors induces stronger mimicry than priming prosocial behaviors. In experiment 2, we manipulated the self-relatedness of the pro/antisocial primes and further revealed that prosocial primes increase mimicry only when the social primes are self-related whereas antisocial primes increase mimicry only when the social primes are self-unrelated. In experiment 3, we used a novel cartoon movie paradigm to prime pro/antisocial behaviors and manipulated the perspective-taking when participants were watching these movies. Again, we found that prosocial primes increase mimicry only when participants took a first-person point of view whereas antisocial primes increase mimicry only when participants took a third-person point of view, which replicated the findings in experiment 2. We suggest that these three studies can be best explained by the active-self theory, which claims that the direction of prime-to-behavior effects depends on how primes are processed in relation to the ‘self’.     

Seasonal and annual variability in the phytoplankton community of the Raunefjord,west coast of Norway from 2001–2006

Changes in phytoplankton community composition potentially affect the entire marine food web. Because of seasonal cycles and inter-annual variations in species composition, long-term monitoring, covering many sequential years, is required to establish a baseline study and to reveal long-term trends. The current study describes the phytoplankton biomass variations and species composition in relation to hydrographic and meteorological conditions in the Raunefjord, western Norway, over a 6-year period from 2001 to 2006. The extent of inflow or upwelling in the fjord varied from year to year and resulted in pronounced differences in water column stability. The annual phytoplankton community succession showed some repeated seasonal patterns, but also high variability between years. Two to four diatom blooms were observed per year, and the spring blooms occurring before water column stratification in March were dominated by Skeletonema marinoi and Chaetoceros socialis, and other Chaetoceros and Thalassiosira spp. Blooms of the haptophytes Phaeocystis pouchetii and Emiliania huxleyi were irregular and in some years totally absent. Although E. huxleyi was present all year round it appeared in bloom concentrations only in 2003, when the summer was warm and the water column characterized by high surface temperatures and pronounced stratification. The annual average abundance of both diatoms and flagellates increased during the six years. Despite the high variation from year to year, our investigation provides valuable knowledge about annual phytoplankton community patterns in the region, and can be used as a reference to detect possible future changes.     

Rapid immobilization of applied nitrogen in saline–alkaline soils

The dynamics of inorganic N are important in soil, and this applies particularly to the saline–alkaline soils of the former lake Texcoco in Mexico with high pH and salinity where a forestation program was started in the 1970s. In soils of lake Texcoco, in Mexico, more than 50% of applied N could not be accounted for one day after application of 200 mg kg^–1 soil along with glucose amendment. It was not clear whether this was due to abiotic or biotic processes, the form of inorganic N applied or the result of applying an easily decomposable substrate. We investigated this by adding glucose and 200 mg kg^–1 soil as (NH₄)₂SO₄-N or KNO₃-N to sterilized and unsterilized soil. The changes in inorganic and ninhydrin N, microbial biomass C and production of CO₂ were then monitored. Between the time of applying N and extraction with 0.5 M K₂SO₄, i.e., after ca 2 h, approximately 110 mg NH₄ ⁺-N kg^–1 dry soil could not be accounted for in the unsterilized and sterilized soil and that remained so for the entire incubation in the sterilized soil. After 1 day this increased to 140 mg NH₄ ⁺-N kg^–1 dry soil in the unsterilized control and 170 mg NH₄ ⁺-N kg^–1 dry soil in C amended soil. Volatilization of NH₃ accounted for 56 mg NH₄ ⁺-N kg^–1 so the rest appeared to be adsorbed on the soil matrix. The NH₃ volatilization and NH₄ ⁺ fixed in the soil matrix remained constant over time and no oxidation to NO₂ ^– or NO₃ ^– had occurred, so unaccounted N in unsterilized soil was probably incorporated into the microbial biomass in excess of what was required for metabolic activity. The unaccounted N was ca 70 mg NO₃ ^––N in nitrate amended soil after 3 days and 138 NO₃ ^––N when glucose was additionally added. Losses through abiotic processes were absent as inferred from changes in sterilized soil and the aerobic incubation inhibited possible losses through denitrification. It was inferred that NO₃ ^– that could not be accounted for was taken up by micro-organisms in excess of what was required for metabolic activity.     

Synoptic analysis of heat-related mortality in Sydney,Australia, 1993–2001

Exposure to extremely hot weather has been associated with increased mortality. Temporal Synoptic Index is an effective method used to analyze the relationship between mortality and combined weather factors. The aim of this study is to examine the short-term effect of ambient heat on mortality in Sydney during the warmest 6-month period (October-March) for the years 1993-2001. Eleven synoptic categories were related to daily mortality rates in Sydney. Two distinctive warm categories were associated with significantly higher mortality rates. Hot, dry and relatively rare Synoptic Category 7 (SC7) days showed the highest daily mortality rates, followed by warm and humid SC3 days, which occurred more frequently. Increased mortality was more pronounced among the elderly population, and gender-stratified analysis showed women to be more vulnerable. Mortality on the day of the weather event was higher than 1 or 2 days after the adverse synoptic situation. Ozone and particulate matter smaller than 10 microm were found at high concentrations in SC3 and SC7, respectively, but their impact on mortality was not clear. The population of Sydney was found to be vulnerable to high temperatures, with a lower susceptibility than those of some cities in the USA and Europe.     

Proceedings of the XVIII Congress of the International Primatological Society Adelaide,Australia, January 7–12, 2001

International Journal of Primatology -     

Determination of Pneumococcal Serotypes in Meningitis Cases in Niger, 2003–2011

Background

The epidemiology of pneumococcal meningitis in the African ‘meningitis belt’ is poorly studied. In order to ensure an effective vaccination strategy and post-vaccination surveillance, we examined the serotype distribution patterns of pneumococcal meningitis in Niger over the period 2003–2011.

Methods

Cerebrospinal fluid (CSF) samples were collected from different health facilities throughout Niger in the frame of the national microbiological surveillance of meningitis. Determination of the serotype of CSF positive for pneumococci was performed using a sequential multiplex PCR method (SM-PCR) adapted with a national algorithm in which 32 different serotypes were covered and grouped into eight consecutive PCR.

Results

The SM-PCR assay could predict the Sp serotype for 779 CSF (88.7%), 98 CSF (11.3%) were not-typeable in our national-adapted algorithm. In total, 26 different serotypes were identified. Serotype 1 (n = 393) was the most prevalent and accounted for 45.3% of infections, followed by serogroups/serotypes 12F/(12A)/(44)/(46) (7.3%), 6/(6A/6B/6C/6D) (5.4%), 14 (5.2%), 5 (4.6%), 23F (4.2%), 45 (3.6%), 2 (3.1%), 18/(18A/18B/18C/18F) (2.9%) and 17 others serotypes with a prevalence of less than 2%. The proportion of serotype 1 in infants(<2 years old) represented only 4.3% of the cases affected by this serotype. In contrast, serotypes 5, 6, 14, 19A and 23F were only detected in very young children.

Conclusions

The proportion of serotype 1 in the pneumococcal meningitis cases and the theoretical vaccine coverage across all age groups advocates for the introduction of a conjugate vaccine (PCV10 or 13) into the Expanded Programme on Immunization (EPI) in Niger. Post-vaccine introduction surveillance supported by molecular approaches will be essential to provide a comprehensive picture of the impact of the vaccine on the burden reduction of pneumococcal meningitis and on pneumococcal serotype distribution.