The circulatory system: blood procurement, AIDS, and the social body in China

The market for blood thrived in China for more than a decade, preying on rural villagers desperate for cash. Profit motives and unhygienic collection created an AIDS epidemic, where now up to 80 percent of adults in some villages are HIV infected. Today, illegal blood banks continue to operate in some areas. Moreover, better screening and blood testing do little to address the underlying cultural reluctance to give blood. This article examines what is at stake for blood donors in the circulation of blood through both the physical and the social bodies in China today. I argue that public health and social policy solutions require consideration of the symbolic meanings of blood and the body, kin relations, and gift exchange. China's HIV-contaminated blood procurement crisis demands a critical reexamination of the hidden processes embedded in a "circulatory system" that has inseparably bound the "gift of life" and a "commodity of death".     

The baladi curative system of Cairo,Egypt

The article explores the symbolic structure of the baladi (traditional) cultural system as revealed in everyday narratives, with a focus on baladi curative action. The everyday illness narrative provides a cultural window to the principles of fluidity and restorative balance of baladi curative practices.The body is seen as a dynamic organism through which both foreign objects and physiological entities can move. The body should be in balance, as with any humorally-influenced system, and so baladi cures aim to restore normal balance and functioning of the body.The article examines in detail a narrative on treatment of a sick child, and another on treatment of fertility problems. It traces such cultural oppositions as insider : outsider; authentic: inauthentic; home remedy: cosmopolitan medicine. In the social as well as the medical arena these themes organize social/medical judgements about correct action and explanations of events.     

Through a glass, darkly: data and uncertainty in the AIDS debate

The HIV/AIDS epidemic is the greatest threat to development in much of Africa. It is already the main cause of death in many countries, especially those in Southern Africa. However there is an absence of solid data on the scale and scope of the disease and how it is evolving. In this article we discuss the data on the epidemic – where it comes from and how it is presented. We note the limitations of the use of antenatal clinic surveys – which provide the bulk of our information.
We then turn to the evidence of impact. The paper shows that the long incubation period between infection and illness means that it takes time for HIV infections to turn into AIDS cases, and AIDS cases to translate into deaths with all the consequences of orphaning, poverty and changing population structures. Furthermore it means that once the HIV prevalence has peaked, AIDS impact will take years to work through – this epidemic is a 'long-wave' event.
The paper is premised on the view that HIV causes AIDS and AIDS causes death. It notes that insufficient and/or unreliable data have allowed leaderships to deny the scope and scale of the problem and that this is unacceptable. However it is incumbent on all to accept the moral responsibility for and the moral consequences of their work, and this includes those who gather, interpret and use the data.     

Heart position in snakes: response to "phylogeny, ecology, and heart position in snakes"

Here we comment on a recent article (Gartner et al. 2010 ) that addresses previous adaptive interpretations of heart position in the context of gravity effects on blood circulation of snakes. The authors used phylogenetically based statistical methods and concluded that both habitat and phylogeny influence heart position, which they contend is relatively more posterior in arboreal compared to terrestrial species. Their result is based on measurements of heart position relative to snout-vent length, rather than total body length as in previous studies. However, gravity acts on the total length of the arterial-venous vasculature, and caudal segments of continuous blood columns cannot be ignored. Arboreal snakes have relatively long tails; therefore anterior hearts appear to be more "posterior" when the position is described relative to a shorter trunk. There is no physiologically valid explanation for the alleged posterior heart position in arboreal snakes, and multiple lines of published evidence to the contrary are ignored. The authors secondarily evaluated their data set with estimates for total body length based on measurements from other taxa. They found no statistical difference between heart position in arboreal versus terrestrial species, yet their article implied otherwise. Gartner et al. ( 2010 ) contrasted "aquatic" and terrestrial species throughout their paper, and they claimed there is no correlation between heart position and habitat among "aquatic and terrestrial species." But they did not include any aquatic species in their data set. Therefore, the article confuses rather than promotes understanding of cardiovascular adaptation to gravity.     

Urban Low-Income African American Men, HIV/AIDS, and Gender Identity

In a 1993 Human Organization article, Jerome Wright called for more research on African American male sexual behavior and the risk for HIV infection. The present article is a response to that call. Wright pointed out a well-known fact of HIV/AIDS prevention programs: such programs have not been very successful in reaching low-income African American males. The present article suggests that perhaps the key to better understanding sex-related health-risk behavior is to conduct more systematic research on gender identity, and the historical and sociocultural origins of such identities. I argue that if we are truly interested in developing effective HIV/AIDS programs targeting low-income African American males, then the sociocultural "meanings" that this population attaches to AIDS-related phenomena must be understood in the broader contexts of American constructs of masculinity, and in the real and perceived experiences of black men in America. Data from several ethnographic and qualitative research projects carried out among low-income African American male and female residents of Baltimore, other parts of Maryland, and Washington, D.C. are used in support of my primary arguments. [HIV/AIDS, African American Males, Gender Constructs, Sociocultural Meaning, Plantation America]     

Fast fuelling but light flight in Broad-billed Sandpipers Limicola falcinellus: stopover ecology at a final take-off site in spring (Sivash, Ukraine)

We studied phenology, staging time and refuelling in Broad-billed Sandpipers Limicola falcinellus stopping over during spring migration in the Sivash (Black Sea, Ukraine) in May 1991–94. In the study area, peak staging numbers of 2000–2500 individuals occurred in the third week of May. In May 1993, 460 birds were marked with a yellow dye and 126 of these were colour-ringed. Before 28 May no departure of birds dyed yellow could be detected; by 3 June all birds had departed. Colour-ringed adults in mid May 1993 staged for a minimum of 8.2 days. After the observed departure of large flocks (24 May and later) the staging time of colour-ringed birds decreased significantly with body mass at the time of capture. Of birds mist-netted in 1991–94, 99.3% were in full summer plumage and 89% were adults. In second-year birds, fuel deposition rate (measured between individuals) was 0.44 g/day. In adults caught from early May to 24 May, overall fuel deposition rate was 1.04 g/day (3.4% of lean body mass). Mean adult body mass in early May was 34.8 g, increasing to 45.5 g after 24 May. Estimated body mass at departure was 51 g. Departure body mass and flight range estimates suggest that although birds refuelled quickly, fuel loads are only just sufficient for an unbroken flight to Scandinavia and the Kola Peninsula. We suggest that Broad-billed Sandpipers use the Sivash as a crucial final take-off stopover site, and that they follow a 'jumping' migration strategy, performed under narrow time constraints.     

Giving birth to gonolia: "culture" and sexually transmitted disease among the Huli of Papua New Guinea

The "culture concept" has been challenged on a number of fronts, both by medical anthropologists researching AIDS and in the discipline of cultural anthropology more generally. Medical anthropologists have argued against the "etiologization" of culture, and cultural anthropologists have taken issue with the tendency to treat beliefs and practices as static and seamlessly shared. Using the narrative of one Huli woman's shifting explanation of a diagnosis of syphilis, this article argues that, rather than avoid the notion of culture, we should strive for representations that demonstrate how individuals use discourses in expedient, ad hoc, and yet deeply felt ways. This article also argues for the importance of a sociology of knowledge approach to understanding local notions of etiology. The woman's understanding of her situation was strongly influenced by her entry into a new "community" of women who had similarly been diagnosed with a sexually transmitted disease.     

"The Divine Impatience": Ritual, Narrative, and Symbolization in the Practice of Martyrdom in Palestine

Violence is obscured by habits of thought, which predispose us to reject that which falls outside of our notion of "normal' human behavior. By dismissing as incomprehensible, or "pathologic" embodied practices that do not correspond to a "rationally ordered' everyday life, some anthropologists concerned with issues of violence forsake a fundamental responsibility to foster an understanding of phenomena that affronts, offends, or questions our own cultural norms and assumptions. Situations of violence, whether due to contextual or individual instability, by definition defy pregiven notions of "rationality" and "normal behavior." This article is about Palestinian martyrs, youths killed in confrontations with the Israeli military. It seeks to identify the cultural and psychological processes that make Palestinian martyrdom possible within the specific context of Israeli military occupation. It elaborates the ritual, narrative, and symbolic dimensions of a practice that exists within a Palestinian discourse of sacrifice and of national liberation. [Palestinian, martyrdom, embodiment, psychoanalysis, violence]     

AIDS and the small city: the cost at Kingston General Hospital.

Although AIDS is often thought of as a "big-city" disease, it is also becoming a serious health care issue for doctors and other health care workers in "small-city" Canada. Kingston, Ont., is one of those small cities, and of the facilities trying to come to grips with a disease about which much remains to be learned. In this article, Drs. Peter Ford and David Robertson outline their hospital''s estimate of the cost, in manpower and money, of dealing with the AIDS crisis. The final estimate: roughly $700,000. Although most of the cost will involve one-time capital spending, they point out that there will likely be ongoing labour-related costs because of the special programs and increased manpower needed to deal with AIDS patients. Clearly, AIDS is no longer a big-city disease.     

Temporal fluctuation in abundance of Brown-headed Cowbirds and their hosts in riparian habitat in the Okanagan Valley, British Columbia, Canada

ABSTRACT.   We tested the hypothesis that the abundance of Brown-headed Cowbirds ( Molothrus ater ) and their hosts, as well as parasitism rates, changed between 1992–1993 and 2001–2003 in riparian habitats in the Okanagan Valley, British Columbia, Canada, where riparian habitat has been reduced in area by more than 85% over the past 60 years. Cowbird abundance declined from a mean of 2.1 and 1.9 individuals per census plot in 1992 and 1993, respectively, to 0.66 individuals per plot in 2001–2002. The mean number of potential host individuals per census plot was also lower in 2001–2002 (5.5) than in 1992 (7.0) and 1993 (7.8). Although the percentage of Yellow Warbler ( Dendroica petechia ) nests parasitized declined (77% in 1992–1993 to 50% in 2002–2003), Yellow Warblers and Song Sparrows ( Melospiza melodia ) in the Okanagan Valley continue to be parasitized at high rates and have low nesting success. Host species and the distance of nests from the edge of nest patches were the strongest predictors of both nest success and parasitism, indicating the importance of large continuous patches of shrubs that allow nests to be located further from edges.     

Universal Aspects of Symbolic Healing: A Theoretical Synthesis

In this article I propose that symbolic healing has a universal structure in which the healer helps the patient particularize a general cultural mythic world and manipulate healing symbols in it. Problems currently existing in the explanation of symbolic healing are examined. The relationship between Western psychotherapy and magical healing is explained, the Junction qfshamanic ecstasy is discussed, and symbolic healing is explained in terms of a theory of living systems.     

Impact of food abundance, diet and food quality on the breeding of the fruit pigeon, Parea Hemiphaga novaeseelandiae chathamensis, on Chatham Island, New Zealand

Breeding and diet of Parea Hemiphaga novaeseelandiae chathamensis were studied in relation to food abundance and quality on Chatham Island from 1991 to 1994. Although pairs were found breeding in all months, they nested predominantly during winter and spring (June-November). The timing of the nesting season, the proportion of pairs that bred and the number of chicks reared per pair varied between nesting seasons. During the 1992–1993 and 1994–1995 nesting seasons, all pairs nested, and many pairs reared two chicks, often involving clutch overlap (58% of 12 cases in 1992–1993, 37% of eight cases in 1994–1995). In 1993–1994, when fruit was scarce, nesting began 2 months later, only 44% of pairs nested and no pairs attempted to rear a second chick. Prior to and during the productive nesting seasons (1992–1993, 1994–1995), the diet of Parea consisted mainly of fruit, particularly that of Matipo Myrsine chathamica in autumn (March-May) and Hoho Pseudopanax chathamicus in winter and spring. Nutrient analyses of the main Parea foods showed that the pulp of these fruit were rich in lipids and available carbohydrates compared with those in foliage foods. Heavy fruiting of Matipo and Hoho promoted early nesting and prolonged nesting for 6 months, including nesting during winter.     

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     

Cost-effectiveness of pharmacotherapy to reduce obesity

Aims

Obesity causes a high disease burden in Australia and across the world. We aimed to analyse the cost-effectiveness of weight reduction with pharmacotherapy in Australia, and to assess its potential to reduce the disease burden due to excess body weight.

Methods

We constructed a multi-state life-table based Markov model in Excel in which body weight influences the incidence of stroke, ischemic heart disease, hypertensive heart disease, diabetes mellitus, osteoarthritis, post-menopausal breast cancer, colon cancer, endometrial cancer and kidney cancer. We use data on effectiveness identified from PubMed searches, on mortality from Australian Bureau of Statistics, on disease costs from the Australian Institute of Health and Welfare, and on drug costs from the Department of Health and Ageing. We evaluate 1-year pharmacological interventions with sibutramine and orlistat targeting obese Australian adults free of obesity-related disease. We use a lifetime horizon for costs and health outcomes and a health sector perspective for costs. Incremental Cost-Effectiveness Ratios (ICERs) below A$50 000 per Disability Adjusted Life Year (DALY) averted are considered good value for money.

Results

The ICERs are A$130 000/DALY (95% uncertainty interval [UI] 93 000–180 000) for sibutramine and A$230 000/DALY (170 000–340 000) for orlistat. The interventions reduce the body weight-related disease burden at the population level by 0.2% and 0.1%, respectively. Modest weight loss during the interventions, rapid post-intervention weight regain and low adherence limit the health benefits.

Conclusions

Treatment with sibutramine or orlistat is not cost-effective from an Australian health sector perspective and has a negligible impact on the total body weight-related disease burden.     

Work as cultural production: labour and self–identity among southwest French wine–growers

I criticize insufficiencies in the Marxist conceptualization of labour as instrumental action as a departure–point to evaluate the relation between work and self–identity among southwest French wine–growers who are members of co–operatives. The symbolic distinction between two wine–growing regions, and the tension between wine–growing as an artisanal practice and wine–growing as science, are used historically and ethnographically to argue for a cultural view of work and self–identity that is differentiated and thus acknowledges the potentials and constraints of power. The article also makes use of French ethnographic materials to address broader issues of the anthropology of work, the critique of science, and the cultural means through which subaltern subjects challenge hegemonic culture and the political economy of exploitation.     

Learning Courage: Child Labour as Moral Practice in Northeast Brazil

This article explores the moral dimensions of child labour as cultural practice in Northeast Brazil. It reveals a link between children's participation in labour and local constructions of childhood as a period of ontological uncertainty and impending transition. Through detailed ethnographic exegesis, the article reveals the symbolic dimensions surrounding children's engagement in productive endeavours, and shows how the local opposition between ‘work’ and ‘play’ arises out of an encompassing moral process. The article critiques the tendency within protectionist influenced anthropological literature to acknowledge the important contribution that children make towards material survival, while denying that contribution any deeper cultural significance.     

The Obesity Epidemic and Its Impact on Urologic Care

Although heart disease and cancer are the number one and two causes of death in the United States, respectively, obesity is gaining speed as a contributing cause to both of those conditions, along with diabetes, arthritis, dyslipidemia, coronary heart disease, gallbladder disease, and certain malignancies. Nearly one-third of the adults in the United States is overweight with a body mass index (BMI) greater than 25 kg/m², and another third of the adult population is obese, with a BMI greater than 30 kg/m². This article reviews the root causes of obesity, the societal implications, and the implications of obesity on various urologic diseases.Key words: Obesity, Morbid obesity, Body mass index, Exercise, Weight loss, Diet, EpidemicMore than 20% of adults in the United States are clinically obese, defined by a body mass index (BMI) of 30 kg/m² or higher, and an additional 30% are overweight, with a BMI between 25 and 30 kg/m².¹ An environment that promotes excessive food intake and discourages physical activity lies at the root of the current obesity epidemic. Although humans have excellent physiologic mechanisms to defend against body weight loss, they have only weak physiologic mechanisms to defend against body weight gain when food is abundant. So much has been discussed about the obesity epidemic that it’s easy to think the issue is being blown out of proportion. After all, people putting on a few pounds may not seem to warrant the proclamation of a national emergency. Although obesity may not attract the degree of attention that heart disease and cancer do, it is a serious public health issue. Experts agree that, as more and more obese children become obese adults, the diseases associated with obesity, such as heart disease, cancer, and particularly diabetes, will surge.The obesity epidemic in the United States is an unintended consequence of the economic, social, and technologic advances realized during the past several decades. The food supply is abundant and low in cost, and palatable foods with high caloric density are readily available in prepackaged forms and at fast-food restaurants. Laborsaving technologies have greatly reduced the amount of physical activity that used to be part of everyday life, and the widespread availability of electronic devices in the home, school, and office has promoted a sedentary lifestyle, particularly among children.A recent study estimated that medical expenditures attributed to overweight and obesity accounted for 9.1% of total US medical expenditures in 1998, and might have reached $78.5 billion dollars.² Today, the healthcare costs attributed to obesity are estimated to be $190 billion—nearly 21% of total US healthcare costs.³ Expenditures will continue to rise, particularly due to increases in the prevalence of obesity and the cost of related healthcare.Total healthcare costs attributable to this obesity epidemic are expected to double every decade, reaching $860.7 to $956.9 billion by 2030, accounting for 16% to 18% of total US healthcare costs, or 1 in every 6 dollars spent on healthcare. ⁴ In addition, obesity is likely to result in a decreased life expectancy for our population. Current US generations may have a shorter life expectancy than their parents if this obesity epidemic cannot be controlled.⁵ Based on nationally representative data and the assumptions of a future of increased obesity rates, along with increased healthcare costs, this paints an alarming picture of the future obesity epidemic. Projections show that if the trends continue, in 15 years, 80% of all American adults will be overweight or obese.⁶     

Ambiguation, Disjuncture, Commitment: A Social Analysis of Caribbean Cultural Creativity

Sociological reassessments of the Caribbean during the last decade provide the basis for this analysis of cultural creativity in Kingston, Jamaica. The intersection of different social networks and formations – for example, lateral transmigrant patterns and vertical state institutions – creates the groundwork for a simultaneous co–working of three characteristic modes of Creole cultural expression – commitment, ambiguation, disjuncture. These modes are not necessarily dialectically integrated because the social formations to which they are allied typically have not been effectively synthesized in teleological or functional terms. I focus especially on a street rhetoric of ambiguation and displacement which I see as falling within the interplay/intermixture mode lying between disjuncture and commitment.