Non-medical treatments and their outcomes

This article is the second of a two-part discussion of non-medical treatment outcomes based upon follow-ups of patients at a Spiritualist temple situated in a rural region of Mexico. The first part of the analysis focussed on two of three categories of patients seeking treatment there (i.e., habitual temple users and first comers). Unlike these two categories of patients who are not believers in Spiritualism, the present concern is with the category of patients (i.e., regulars) who identify Spiritualism as their religion and believe in Spiritualist ideology. These patients require separate consideration because, unlike the others, they are exposed to several Spiritualist therapeutic modalities which influence treatment outcomes. Follow-ups of these patients reveal the dialectical relationship and the gradual nature of the healing process. Spiritualist treatment outcomes are assessed by an interplay of physiological, psychological, sociological, and cultural paradigms. The hypothesis is advanced that while Spiritualist healers frequently fail to eliminate patients' subjectively perceived symptoms, the therapies to which these patients are subject alter cognition by facilitating pain tolerance and promote response to cultural symbols employed by temple healers. Examination of treatment outcomes of these patients also calls attention to syndromes which fail to respond to Spiritualist therapy including psychotic episodes. A brief comparison is made between Spiritualist treatment outcome and psychotherapy which leads to the conclusion that Spiritualists succeed no less than the latter in eliminating the sick role, restoring the individual's behavioral capacities, and eliminating the feeling of being sick.     

Symptomatic differences between the sexes in rural Mexico

This paper addresses the problem of the differential presentation of illness by women and men in two Spiritualist temples and a physician's office situated in rural Mexico. Women's morbidity raises the broader anthropological questions of the interplay between symptomatic expression and women's unequal status in the social structure, their cognitive evaluation of specific life experiences, cultural etiological explanations and Western models of dysphoria. Symptoms presented by patients in different health care delivery sites are compared and case vignettes of patients' illnesses and attributions are presented to demonstrate the ways in which culturally constructed illness attributions and illness expressions comprise a somatic grammar for the articulation of experiential distress. The sick population is compared with a control group of healthy women to highlight the socio-cultural and psychosocial variables that promote illness in women from the same sociocultural strata of rural Mexico. Collective understandings of the role of life events and emotional expression in illness attributions legitimize somatization as a coping style under adverse existential conditions.     

Cogealing divinity: time, worship and kinship in South Indian Hinduism

Daily worship in Hindu temples is characterized by regular repetition. This article juxtaposes iconography and mythology; field data on worship in a Murukan temple in Kalugumalai, South India; and analytic concepts from western and Indian metaphysics, to examine what Gell termed the 'ritual manipulation of time'. In Hindu cosmology, the materialization of divinity – a prerequisite for worship – is inseparably linked not only to the emergence of time but also to the devolution of divinity into gendered forms. Because gender differences play a central role in iconography, mythology and worship, Hinduism provides a rich cultural resource for debating the morality and practice of human kinship, sexuality and procreation. Not only are there significant homologies between human and divine kinship behaviour, but human marriage patterns in South India display the same blend of repetitive yet changing oscillation as do daily and annual temple liturgies.     

Marginalizing Experience: A Critical Analysis of Public Discourse Surrounding Stem Cell Research in Australia (2005�C6)

Over the past decade, stem cell science has generated considerable public and political debate. These debates tend to focus on issues concerning the protection of nascent human life and the need to generate medical and therapeutic treatments for the sick and vulnerable. The framing of the public debate around these issues not only dichotomises and oversimplifies the issues at stake, but tends to marginalise certain types of voices, such as the women who donate their eggs and/or embryos to stem cell research and the patients who might benefit from its potential clinical outcomes. This paper draws on empirical research conducted on a recent stem cell policy episode in Australia. From the qualitative examination of 109 newspaper opinion editorials and twenty-three in-depth interviews, it is argued that these voices are marginalised because they are based on discourses that have less epistemological status in public debate. Our results suggest that the personal experiences of women and patients are marginalised by the alliances that form between more powerful discourse communities that use science as a source of authority and legitimation. It is argued that members of these communities establish legitimacy and assert authority in public debate by discursively deploying science in claims that marginalise other epistemologies. Implications are discussed along with suggestions for a more enriched and inclusive public debate.     

Anthropology and psychiatry

In this paper anthropology and psychiatry are defined as well as their scientific area, their methods and research objectives; the high level of their mutual thematic and methodological complementarity has been emphasized. The sociocultural factors which are inherent in the area of cultural anthropology can affect mental health in a number of ways: by forming a certain personality type that is predisposed for a certain type of disorder, by an education model which increases the frequency of some disorders, by criticism and sanctions of a certain behaviour that is actually desirable from the point of view of mental health preservation, by supporting and rewarding a behaviour model that is harmful for mental health; by its complexity and, in some of the segments, by mutual contradictions they can cause mental disorders; by forming symptoms of mental disorders i.e. by a pathoplastic action through which they become an area of scientific interest of cultural psychiatry. Anthropology directs psychiatry towards creating preventive and therapeutic programs that accept the mutual influence and interconnectedness of socio-cultural conditions and the mental health status.     

Rocky mountain spotted Fever

We compare health maintenance organization enrollees'' evaluations of the care they received from family physicians and chiropractors for low back pain. Patients of chiropractors were three times as likely as patients of family physicians to report that they were very satisfied with the care they received for low back pain (66% versus 22%, respectively). Compared with patients of family physicians, patients of chiropractors were much more likely to have been satisfied with the amount of information they were given, to have perceived that their provider was concerned about them, and to have felt that their provider was comfortable and confident dealing with their problem. Although the more positive evaluations of chiropractors may be related to differences in the patient populations served by the two providers or to benefits of spinal manipulation, it is suggested that a potentially more potent force--the therapeutic effect of the patient and provider interaction itself--may explain the observed differences.     

Role of nuclear receptor corepressor RIP140 in metabolic syndrome

Obesity and its associated complications, which can lead to the development of metabolic syndrome, are a worldwide major public health concern especially in developed countries where they have a very high prevalence. RIP140 is a nuclear coregulator with a pivotal role in controlling lipid and glucose metabolism. Genetically manipulated mice devoid of RIP140 are lean with increased oxygen consumption and are resistant to high-fat diet-induced obesity and hepatic steatosis with improved insulin sensitivity. Moreover, white adipocytes with targeted disruption of RIP140 express genes characteristic of brown fat including CIDEA and UCP1 while skeletal muscles show a shift in fibre type composition enriched in more oxidative fibres. Thus, RIP140 is a potential therapeutic target in metabolic disorders. In this article we will review the role of RIP140 in tissues relevant to the appearance and progression of the metabolic syndrome and discuss how the manipulation of RIP140 levels or activity might represent a therapeutic approach to combat obesity and associated metabolic disorders. This article is part of a Special Issue entitled: Translating nuclear receptors from health to disease.     

T cell lymphoproliferative disorders associated with anti-tumor necrosis factor alpha antibody therapy for ulcerative colitis: literature summary

The enhanced risk of development of lymphoproliferative disorders in patients with inflammatory bowel disease has been attributed to immunosuppressive/immunomodulatory therapies. Infliximab is a chimeric monoclonal immunoglobulin G1 antibody directed against tumor necrosis factor alpha (TNF-α) that was approved by the Food and Drug Administration (FDA) in 1998 as an effective therapeutic agent against inflammatory bowel disease. Malignant lymphomas of both B and T cell lineage have been described in patients undergoing therapy involving TNF-α blockade. To date, eight cases of Epstein–Barr virus (EBV)-negative hepatosplenic T cell lymphoma associated with infliximab have been reported to the FDA’s Adverse Event Reporting System, as well as several other T cell lymphoproliferative disorders with aggressive clinical outcomes. We present the histologic, immunophenotypic, and molecular features of a T cell lymphoproliferative disorder involving the axillary lymph node of a 33-year-old male following infliximab treatment for ulcerative colitis. These EBV-negative lymphomas suggest that lymphoproliferative disorders following infliximab treatment for inflammatory bowel disease may involve EBV-independent immune dysregulation. The spectrum of lymphoproliferative disorders associated with infliximab and the potential mechanisms by which they occur are discussed.     

Quantifying social influence in an online cultural market

We revisit experimental data from an online cultural market in which 14,000 users interact to download songs, and develop a simple model that can explain seemingly complex outcomes. Our results suggest that individual behavior is characterized by a two-step process--the decision to sample and the decision to download a song. Contrary to conventional wisdom, social influence is material to the first step only. The model also identifies the role of placement in mediating social signals, and suggests that in this market with anonymous feedback cues, social influence serves an informational rather than normative role.     

Eph receptors and ephrins

The Eph receptors are the largest known family of receptor tyrosine kinases. The Eph receptors and their membrane-attached ligands, ephrins, show diverse expression patterns during development. Recent studies have demonstrated that Eph receptors and ephrins play important roles in many developmental processes, including neuronal network formation, the patterning of the neural tube and the paraxial mesoderm, the guidance of cell migration, and vascular formation. In the nervous system, Eph receptors and ephrins have been shown to act as positional labels to establish topographic projections. They also play a key role in pathway finding by axons and neural crest cells. The crucial roles of Eph receptors and ephrins during development suggest involvement of these genes in congenital disorders affecting the nervous system and other tissues. It has also been suggested that Eph receptors and ephrins may be involved in carcinogenesis. It is therefore of clinical importance to further analyse the function of these molecules, as manipulation of their function may have therapeutic applications.     

The Functional Role of Balinese Water Temples: A Response to Critics

In earlier publications we have proposed a model to explain the functional role of water temple networks in the agro-ecology of wet rice irrigation on the island of Bali. We argued that the key ecological effects of temple networks are best understood as emergent properties of a complex adaptive system. This argument implies that important aspects of the temple system are largely opaque from the perspective of conventional social science. We proposed that the Green Revolution created a real-world test of our model, by effectively removing the temple networks from their functional role in ecological management. The idea that water temple networks represent a hitherto-unknown kind of institution has been met with appropriate skepticism by other social scientists, who have run a fine-toothed comb through our evidence. Here we evaluate their critiques.     

The Sensorial Production of the Social

In China temple festivals are replete with noises, sights, smells, tastes, and ambient sensory productions. When worshipers converge on a particular temple festival, they produce and experience honghuo (social heat or red-hot sociality). This native concept of honghuo highlights the importance of the social production of a heightened sensory ambience as well as the sensorial production of sociality. In co-producing honghuo the festivalgoers are exhibiting a ‘resonant body-person’ that is in accord with the spirit of mutual responsiveness. I propose a sensory-production model of sensory analysis that foregrounds the active participatory role of social agents in producing a sensorially rich social world. This model extends from, yet also critiques the prevalent cultural phenomenological approach to investigating sensory orders in different cultures. A ‘mindful body’ or an ‘attentive body’ is only the pre-condition for any person's action-full lifeworld.     

Der Arbeitsplatz als Quelle von Angst

Objective Adjustment disorders are often related to the work place. Of special importance in this regard are work related anxieties as every workplace has anxiety provoking features, e.g. failure, bossing by superiors, mobbing by colleagues, angry customers, or accidents. Work can cause anxiety. Similarly, anxiety disorders can cause special work problems. In this study we investigated the quality and quantity of job anxiety in patients with mental and somatic illnesses. Method 90 psychosomatic and 100 orthopaedic inpatients with mental and somatic disorders completed the Job Anxiety Scale. In addition patient characteristics and sick leave were assessed. Results Psychosomatic patients showed significantly higher job anxiety scores than orthopaedic patients. In particular, orthopaedic patients show fears of functional impairment, whereas psychosomatic patients suffer more from anxieties in the dimensions of generalised worrying, panic, fears of existence and global job-anxiety. Job anxieties were significantly correlated with time of sick leave in both groups. Conclusion There are differences in quality and quantity of job anxiety in the different clinical groups. The data suggest that mental disorders cause job anxiety. At the same time, job anxiety is also an important factor in patients with somatic morbidity in order to understand sick leave. This should have consequences for the diagnosis and treatment of these patients     

Role and therapeutic value of dendritic cells in central nervous system autoimmunity

Dendritic cells (DCs) are professional antigen-presenting cells that control the generation of adaptive immunity. Consequently, DCs have a central role in the induction of protective immunity to pathogens and also in the pathogenic immune response responsible for the development and progression of autoimmune disorders. Thus the study of the molecular pathways that control DC development and function is likely to result in new strategies for the therapeutic manipulation of the immune response. In this review, we discuss the role and therapeutic value of DCs in autoimmune diseases, with a special focus on multiple sclerosis.     

Structural and functional roles of ether lipids

Ether lipids, such as plasmalogens, are peroxisomederived glycerophospholipids in which the hydrocarbon chain at the sn-1 position of the glycerol backbone is attached by an ether bond, as opposed to an ester bond in the more common diacyl phospholipids. This seemingly simple biochemical change has profound structural and functional implications. Notably, the tendency of ether lipids to form non-lamellar inverted hexagonal structures in model membranes suggests that they have a role in facilitating membrane fusion processes. Ether lipids are also important for the organization and stability of lipid raft microdomains, cholesterol-rich membrane regions involved in cellular signaling. In addition to their structural roles, a subset of ether lipids are thought to function as endogenous antioxidants, and emerging studies suggest that they are involved in cell differentiation and signaling pathways. Here, we review the biology of ether lipids and their potential significance in human disorders, including neurological diseases, cancer, and metabolic disorders.     

Cultural Modulation of Face and Gaze Scanning in Young Children

Previous research has demonstrated that the way human adults look at others’ faces is modulated by their cultural background, but very little is known about how such a culture-specific pattern of face gaze develops. The current study investigated the role of cultural background on the development of face scanning in young children between the ages of 1 and 7 years, and its modulation by the eye gaze direction of the face. British and Japanese participants’ eye movements were recorded while they observed faces moving their eyes towards or away from the participants. British children fixated more on the mouth whereas Japanese children fixated more on the eyes, replicating the results with adult participants. No cultural differences were observed in the differential responses to direct and averted gaze. The results suggest that different patterns of face scanning exist between different cultures from the first years of life, but differential scanning of direct and averted gaze associated with different cultural norms develop later in life.     

Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level

Physical disorders are, compared to the general population, more prevalent in people with severe mental illness (SMI). Although this excess morbidity and mortality is largely due to modifiable lifestyle risk factors, the screening and assessment of physical health aspects remains poor, even in developed countries. Moreover, specific patient, provider, treatment and system factors act as barriers to the recognition and to the management of physical diseases in people with SMI. Psychiatrists can play a pivotal role in the improvement of the physical health of these patients by expanding their task from clinical psychiatric care to the monitoring and treatment of crucial physical parameters. At a system level, actions are not easy to realize, especially for developing countries. However, at an individual level, even simple and very basic monitoring and treatment actions, undertaken by the treating clinician, can already improve the problem of suboptimal medical care in this population. Adhering to monitoring and treatment guidelines will result in a substantial enhancement of physical health outcomes. Furthermore, psychiatrists can help educate and motivate people with SMI to address their suboptimal lifestyle, including smoking, unhealthy diet and lack of exercise. The adoption of the recommendations presented in this paper across health care systems throughout the world will contribute to a significant improvement in the medical and related psychiatric health outcomes of patients with SMI.     

Recent advances in the manipulation of murine gene expression and its utility for the study of human neurological disease

Transgenic mouse models have vastly contributed to our knowledge of the genetic and molecular pathways underlying the pathogenesis of neurological disorders that affect millions of people worldwide. Not only have they allowed the generation of disease models mimicking the human pathological state but they have also permitted the exploration of the pathological role of specific genes through the generation of knock-out and knock-in models. Classical constitutive transgenic mice have several limitations however, due to behavioral adaptation process occurring and conditional mouse models are time-consuming and often lack extensive spatial or temporal control of gene manipulation. These limitations could be overcome by means of innovative methods that are now available such as RNAi, viral vectors and large cloning DNA vectors. These tools have been extensively used for the generation of mouse models and are characterized by the superior control of transgene expression that has been proven invaluable in the assessment of novel treatments for neurological diseases and to further investigate the molecular processes underlying the etiopathology of neurological disorders. Furthermore, in association with classical transgenic mouse models, they have allowed the validation of innovative therapeutic strategies for the treatment of human neurological disorders. This review describes how these tools have overcome the limitations of classical transgenic mouse models and how they have been of value for the study of human neurological diseases.     

Knowledge, Attitudes, and Practices of Physicians in Tomsk Oblast Tuberculosis Services Regarding Alcohol Use Among Tuberculosis Patients in Tomsk, Russia

In recent years, the Russian Federation has seen a dramatic rise in morbidity and mortality from tuberculosis (TB), attributed in part to an increase in alcohol use disorders (AUDs), which are associated with worse TB treatment outcomes. This study describes the knowledge, attitudes and practices of physicians who treat TB patients in Tomsk, Russia. We conducted semistructured interviews with 16 TB physicians and 1 addiction specialist. Interviews were audiorecorded, transcribed, translated and systematically analyzed. We identified four key domains: definitions of alcohol use and abuse and physicians’ knowledge, attitudes and practices regarding these problems. Physicians described patients as largely precontemplative and reluctant to seek treatment. Physicians recognized their limited knowledge in diagnosing and treating AUDs but expressed interest in acquiring these skills. Few options are currently available for treatment of AUDs in TB patients in Tomsk. These findings suggest that Tomsk physicians are aware of the need to engage AUDs in TB patients but identify a knowledge gap that restricts their ability to do so. Training TB physicians to use simple screening instruments and deliver evidence-based alcohol interventions improves TB outcomes among patients with co-occurring AUDs.