Normal Course Of Life Research Articles

The nonhuman primate hypothalamo-pituitary-adrenal axis is an orchestrator of programming-aging interactions: role of nutrition.

Developmental programming alters life-course multi-organ function and significantly affects life-course health. Recently, interest has developed in how programming may influence the rate of aging. This review describes interactions of nutrition and programming-aging interactions in hypothalamo-pituitary-adrenal (HPA) development and function from fetal development to old age. A full picture of these interactions requires data on levels of HPA activity relating to the hypothalamic, adrenal cortical, circulating blood, and peripheral cortisol metabolism. Data are provided from studies on our baboon, nonhuman primate model both across the normal life course and in offspring of maternal baboons who were moderately undernourished by a global 30% diet reduction during pregnancy and lactation. Sex differences in offspring outcomes in response to similar challenges are described. The data clearly show programming of increased HPA axis activity by moderate maternal undernutrition. Increased postnatal circulating cortisol concentrations are related to accelerated aging of the brain and cardiovascular systems. Future studies should address peripheral cortisol production and the influence of aging advantage in females. These data support the view that the HPA is an orchestrator of interactions of programming-aging mechanisms.

Making Sense of the Unique Pain of Survivors: A Psychoeducational Approach for Suicide Bereavement.

Grief, guilt, abandonment, anger, shame, and rejection are the most common feelings experienced by suicide survivors, who differ from other bereaved individuals for the intensity of these feelings. Moreover, suicide risk and psychiatric disorders associated with suicidality are more frequent in people who have lost a loved person by suicide. Given the complexity and the consequences linked to the suicide of a loved person, it is necessary to act promptly. Among the various strategies, psychoeducation has proved effective for several mental disorders and for suicide bereavement. It is a therapeutic intervention aimed at identifying and understanding the psychological features associated with the mental pain of suicide survivors, to facilitate the management of the illness and the recognition of relationships in the social environment. We developed a psychoeducational group that took place at the Suicide Prevention Center of the Sant’Andrea Hospital in Rome. It was a homogeneous, finite-group composed of 8–12 suicide survivors and conducted by two trained psychologists supervised weekly by the Director of the Suicide Prevention Center. The intervention comprised 21 weekly sessions of 90 min. Each session concerned a determined topic and began with the presentation of the issue, continued with specific exercises, and finished with a group discussion. The main goals of the group were to provide support, normalize the reactions of the survivors, and assist them in reducing their emotional suffering and their thoughts about suicide, investigate the potential presence of suicide risk, implement prevention strategies, and integrate the loss of the loved person. The psychoeducational approach we delivered for suicide survivors allows individuals to interact with other individuals in the same situation in order to help them resume the normal course of life, placing the suicide of a loved person in a broader perspective.

Psychosocial challenges of social reintegration for people with spinal cord injury: a qualitative study.

Qualitative study, using in-depth, and semi-structured interviews. To identify the psychosocial challenges of social reintegration for people with spinal cord injury (SCI) in Iran. People with SCI living in the community in Iran. Eleven individuals with SCI with a median time since injury of 12 years (between 9 and 20 years), two family members, and three specialists (two social workers and one physiotherapist) were selected by purposive sampling with maximum variation. In-depth and semi-structured interviews were conducted and finally the data analyzed through qualitative content methodology. The psychosocial challenges were categorized into four main categories and twelve subcategories: early crises (denial and disbelief; feelings of isolation and depression; dependency crisis; and a sudden change in the normal course of life), disabling society (stigma; discrimination; employment challenges; and educational restriction), environmental barriers to access (lack of barrier-free environments and transportation challenges), and inappropriate services delivery (incomprehensive rules and lack of specialized training). Providing various psychosocial services is essential for the social reintegration of people with SCI. This goal could be achieved by the provision of medical and physical rehabilitation services. The ultimate purpose of rehabilitation is to reintegrate individuals into society after injury or illness; thus, psychosocial issues must also be considered to ensure effective rehabilitation.

Gait Analysis for Early Neurodegenerative Diseases Classification Through the Kinematic Theory of Rapid Human Movements

Neurodegenerative diseases are particular diseases whose decline can partially or completely compromise the normal course of life of a human being. In order to increase the quality of patient's life, a timely diagnosis plays a major role. The analysis of neurodegenerative diseases, and their stage, is also carried out by means of gait analysis. Performing early stage neurodegenerative disease assessment is still an open problem. In this paper, the focus is on modeling the human gait movement pattern by using the kinematic theory of rapid human movements and its sigma-lognormal model. The hypothesis is that the kinematic theory of rapid human movements, originally developed to describe handwriting patterns, and used in conjunction with other spatio-temporal features, can discriminate neurodegenerative diseases patterns, especially in early stages, while analyzing human gait with 2D cameras. The thesis empirically demonstrates its effectiveness in describing neurodegenerative patterns, when used in conjunction with state-of-the-art pose estimation and feature extraction techniques. The solution developed achieved 99.1% of accuracy using velocity-based, angle-based and sigma-lognormal features and left walk orientation.

High-speed gesture modelling through boundary analysis of active signals from wearable data glove

Assistive technology utilises communication by means of gestures with high appreciation in the fields of rehabilitation engineering and security. The necessity for such technique is to extract the communications in terms of intentions from the disabled community. Such systems play a very crucial role during emergency as well as to perform regular communication during normal course of life. To interpret and communicate most distinctive requirements of the person with disability, the caregivers and medical support agents need a well- defined and distinguishable gesture paradigm with its recognition system. Conversion of such communicative gestures is to be made precise and easy. In this proposed work, the feature construction is made with a simple modelling of the gesture signals along the time zone considerations created during the gesture activity. The identification of most active channels for every subject involved in this experiment for different gestures contributes to reduction of complexity in processing and hardware cost.

Probing Ghassan Kanafani’s Committed Fiction: A Study of Two Novellas

Ghassan Kanafani’s commitment to the Palestinian cause is evident in his various works which handle the predicament of an exiled nation. This paper explores the exodus and its influence upon Palestinians in two of his novellas, All That’s Left to You (1966) and Returning to Haifa (1969). These novellas reflect the fragile position and fractured existence of two Palestinian families experiencing the tragic circumstances of the exodus and its consequences. Leaving homeland under life threatening conditions in the hope of finding peace only leads to a life of misery and uncertainty in refugee camps. Being silenced and marginalized, the exiled are further overwhelmed by feelings of shame and guilt. Loss of land, houses, and family members entails loss of happiness, peace and honor. Tormented by such negative feelings, their losses and their poor living conditions, Kanafani’s characters live in an unhealthy family atmosphere endangering their normal course of life, and rendering them emotionally disturbed. They find themselves disoriented, lonely, haunted by traumatic memories, and at a loss for words. In fact, the exodus results in distorted sense of identity, disruptions of their family bonds as well as their normal connections to time, space and culture. Neither time nor the boundless horizon seems to bring hope or change for the better. Siding with the oppressed, dispossessed and displaced and speaking for them reflect Knafani’s love of justice, devotion, and care for the underprivileged.

The impact of sent-down movement on Chinese women's age at first marriage

Background: Chinese women’s age at first marriage increased for more than three years on average during the short period between 1970 and 1979. Demographers attributed it to the 'later, longer, fewer' family planning policy of the 1970s whereas some sociologists suggested that the 'send-down' movement in 1968-1978, which mobilized over 17 million urban youths and sent them to the countryside, may also have played a role. Methods: Using newly available high-quality national representative sample survey data, we estimated the effect of being sent-down on women’s age at first marriage. We then conducted counterfactual simulations to decompose the total increase in women’s age of marriage between 1970 and 1979 into a component attributed to the send-down and a residual component attributed to other factors. Results: Our results suggest that being sent-down delayed Chinese women’s age at first marriage by 1.2 years. For urban women, this accounts for 13.3 percent of the total increase in their age at first marriage between 1970 and 1979. For urban and rural women together, the overall contribution of send-down to the increase in their age of marriage is less than one percent. Conclusions: On one hand, the send-down policy did not play an important role in the demographic transition process in China. On the other hand, for the 17 million sent-down youths, being forced to leave home and settle in a harsh and unfamiliar rural environment at very young ages marked a hard transition to adulthood and inevitably disrupted their normal life course. Delayed marriage, as revealed by this study, may be just tip of the iceberg.

Effect of Chronic Morphine Consumption on Synaptic Plasticity of Rat’s Hippocampus: A Transmission Electron Microscopy Study

It is well known that the synapses undergo some changes in the brain during the course of normal life and under certain pathological or experimental circumstances. One of the main goals of numerous researchers has been to find the reasons for these structural changes. In the present study, we investigated the effects of chronic morphine consumption on synaptic plasticity, postsynaptic density thickness, and synaptic curvatures of hippocampus CA1 area of rats. So for reaching these goals, 24 N-Mary male rats were randomly divided into three groups, morphine (n = 8), placebo (n = 8), and control (n = 8) groups. In the morphine group, complex of morphine (0.1, 0.2, 0.3, and 0.4) mg/mL and in the placebo (sucrose) group complex of sucrose (% 0.3) were used for 21 days. After the end of drug treatment the animals were scarified and perfused intracardinally and finally the CA1 hippocampal samples were taken for ultrastructural studies, and then the obtained data were analyzed by SPSS and one-way analysis of variance. Our data indicated that synaptic numbers per nm3 change significantly in morphine group compared to the other two groups (placebo and control) (P < 0.001) and also statistical analysis revealed a significant difference between groups in terms of thickness of postsynaptic density (P < 0.001) and synaptic curvature (P < 0.007). It seems that morphine dependence in rats plays a main role in the ultrastructural changes of hippocampus.

“Poetry in Yarn”—Making Sense of Life Experiences in the Shadow of Schizophrenia

The poem Personal Particulars by Annika Malmqvist, written in her late 30s, is a distilled narrative about how a life story influenced by a diagnosis of schizophrenia in early youth changes one’s expectations of a normal life course. For a person who suffers from mental illness, the concept of the imagined, perhaps, idealized picture of her/his life plan is disrupted. An important aspect of the poem is the notion of “a whole other life.” The author is telling us what life is not about. Clearly, “the other life” remains silent or not spoken of, a silence reflected in the knowledge field of mental illness. This phenomenon is also described by Foucault1 as the psychiatric monolog of reason. Once a person becomes a psychiatric patient, their identity from then on becomes either that of a mental patient, an ex-patient, or a survivor.2 Their life is interpreted by their interaction with psychiatry, and their mental illness influences all the other life events. Even the popular concept of recovery is a reference to the medical model.2 However, Adame and Knudson2 do stress the existence of an alternative narrative developed within the survivors’ movement. It actually seems to be a challenge to ex-patients to formulate a narrative that does not start with medical language or the discourse of the medical model. Adame and Knudson explain that the survivor movement has developed “an alternative discourse of the good life that exists outside of the dichotomies of illness and health and transcends the counter-narrative and the medical model” (p. 176). Annika Malmqvist (AM), one of the authors of this article, was diagnosed as schizophrenic in her early 20s and considers herself a voice hearer and an ex-mental patient. Now on her own, after being widowed, she lives in an apartment in Stockholm in Sweden, with her 4 cats. This text has a life course perspective in the sense that Annika can be viewed as the story’s vehicle, ie, she formulates a story of “the other life.” The story is about how AM was treated as a child and how she later on, during her adolescence, became mentally ill. The aim is to present a narrative about how she makes sense of her life experiences in relation to her creative embroidery work in the shadow of having been diagnosed as schizophrenic. We do not know enough about people who are diagnosed as schizophrenic in their youth in relation to how they perceive their life course related to creative art work, even though art scientists3,4 and others have focused on the issue.5

The law’s homogeneity

The Atlantic civilisation has over the past centuries been composed of two definitely diverging ethoses and social philosophical inspirations, differing also by their very foundations. The contrasts are perhaps most conspicuous today as to be seen in the difference between approaches to life as a struggle and to law as a game within it. No doubt, on the one hand, there prevails the rest of (1) a European Christian tradition, characterised by communal ethos, with provision of rights as counter-balanced by obligations, in which priority is given to the peace of society and a traditional culture of virtues is promoted to both circumvent excesses and acknowledge human rights, with a focus on prevention of and remedy to actual harms. It is such an environment within which homo ludens as a type of the playful human who is at the same time dutiful and carefree-entirely joyful-constitutes a limiting value. If and insofar as struggle appears at all on the scene, it is mostly recognised as a fight for excellence. As a pathologic version, the loneliness of those staying away from participation may lead to psychical disorders which require subconscious re-compensation, the symbolic sanctioning of which was once accomplished by the psycho-analysis. On the other, there has also evolved (2) an Americanised individualistic atomisation of society, expecting order out of chaos, with absolutisation of rights ascribed to individuals, all closed back in loneliness. As an outcome, obligations are circumvented by entitlements, and unrestrained struggle becomes a part of any normal course of life with the deployment of human rights just to neutralise (if not disintegrate) communitycentred standards. “Life is struggle”-the hero of our brave new world enunciates the words as a commonplace with teeth clenched, convinced that life is barely anything but fight against anybody else (as an improved version, hailed as civilisatory advancement as re-actualising-under the pretext of maximising the chances of-the ominous bellum omnium contra omnes, formulated once in early modern England). Starting from the common deployment of some symbolical “cynical acid” in foundation of modern formal law but developing through differentiated ways of how to search for reason and systemicity in law, the conceptual and methodical effect of this very division is shown in the paper within the perspectives for curing malpractice in law and also in the role of ethics in economy.

‘Sent Down’ in China: Stratification challenged but not denied

Dramatic shocks to social systems can disrupt normal social processes such as life course sequences and socioeconomic attainment. Such shocks provide a rare opportunity for contrasting normal and extraordinary social processes and thus revealing social structures and processes that may otherwise be invisible. The current article focuses on the ‘sent-down’ generation in China of the 1960s and 1970s, many of whom were forcibly relocated to the countryside following middle or high school graduation to “learn from the peasants.” Although most of these young people eventually returned to urban areas, the experience was traumatic for at least some and disrupted normal life course developments and process of socioeconomic attainment for many. This is especially the case for those who stayed in the countryside for an extended period of time. Data from the Chinese General Social Survey indicate that both the formal and informal power of parents was unable to protect children from being sent down. Nevertheless, as the process matured, stratification forces reemerged in the ability of politically well-placed parents to facilitate the early return of their children. Despite some success in attaining college education and Communist Party membership for the sent-down generation, sent-down men report more unhappiness with life than their non-sent-down counterparts and sent-down men and women report much earlier retirement and withdrawal from the labor force than non-sent-down women. These findings collaborate and extend prior research on the sent-down generation and illustrate the lasting effects of both inequality and of attempts to change inequality.

Opportunity and Solidarity

AbstractCurrent restructuring of provision across European welfare states emphasises proactivity, individual responsibility and access to opportunities. Much established social protection rests on a more passive approach and seeks to provide security against the risks encountered during a normal life-course, together with some redistribution towards the poor. A more liberal individualism may suit a more globalised and post-industrial world in which the logic of markets is more powerful and the working class correspondingly weaker. From one perspective, it risks damaging the support for collective provision on which the welfare state rests. This paper uses data from the 2008 European Social Survey to examine whether the shift in responsibility for outcomes more towards individuals may threaten the political legitimacy of welfare states. It shows that a corresponding proactivity of government to secure good access to more equal opportunities for vulnerable groups is required to support individual proactivity in grasping opportunities.

Political Authority: The Two Wheels of the Dharma

Political AuthorityThe Two Wheels of the Dharma Whalen Lai “The twin wheels of the dharma The two wings of the dove” The twin wheels of the dharma, one of power and the other of righteousness, is the classic metaphor in the Buddhist view of the state and the saṅgha. We will first register the distinction of that metaphor by going back to its historical roots, showing how and why it is more meaningful for Buddhists than for Hindus. Then we will map its structural growth sociologically, weigh its overall strengths and weaknesses, and consider other Buddhist options for civil order and interstate relationships. Finally we will examine the price of modernity and the crisis of authority that Buddhist culture faces. Toward a Genealogy of the Twin Wheels The legend of the Buddha is by now well known. Prince Siddhārtha left family and home, and renounced the kingdom and the world. He had seen the inevitability of suffering. He vowed to find its cause to eliminate that result. After his enlightenment, he reflected upon releasing that path to the world. When the Buddha so taught the Four Noble Truths and the Noble Eightfold Path to his old companions at Benares, tradition then remembers that as the Buddha “turning the wheel of dharma.” The wheel (cakra) is a metaphor; it refers to the wheel of a sun chariot and is now on the national flag of India. That cosmic wheel has rolled on since time immemorial; as saṃsāra, it has been endless suffering. That is, until the Buddha so turned the sun wheel anew, marking it possible for the first time end that cycle and point the way to nirvāṇic liberation. History was so changed with that act of the Buddha at Benares. Mankind turned a corner. Christianity sees the event on the cross to be, likewise, a break in time. History as we know it had ended. The end time, the eschatological kingdom with its promise of a new heaven and a new earth, have dawned. The price of Adam’s sin was death. Christ’s resurrection turned that around. In Buddhism, the normal course of life and death (rebirth: saṃsāra) also ended [End Page 171] with the Buddha’s enlightenment under the Bodhi tree. The path to nirvāṇa was open. The city of nirvāṇa is in sight. Or as a Buddhist miracle would tell it, the water of the Ganges flowed backward in response to an act of truth (satyāgraha). The event at Benares when the Buddha turned the wheel of dharma anew may be a major inspiration for the ideology of the twin wheels. In general, Hinduism needs only to presume one wheel; it does not count a second. Although Hinduism knows its share of renunciation and liberation (mokṣa), the Brahmanical system set down by the Vedas is committed to safeguarding the sanctity of the caste system. It can absorb mokṣa under the larger law for its varṇāśramadharma. The renunciation is ideally the last station in life, coming after formal retirement from active household duties, and well approaching old age and a good time for learning how to transcend it. Buddhism challenged the caste system by setting up the saṅgha, a new Buddhist community. Hinduism lacks that call for reconstituting society. It does not know the “saṅgha and state” tension that Buddhists know like Christians would the tension between church and state. In the end, the Vedānta philosophy in Hinduism does not postulate that tension. The ātman-brahman identity of self and universe is inherently monistic. This is not to say Hindus do not face a basic conflict between two contrary worlds. It does but it solves it differently. The tragic dilemma in the Bhagavadgītā is that Arjuna, who came to embrace nonviolence like a Buddhist or a Jain would, was eventually persuaded to fight, namely, to perform his caste duty of being a warrior, ready to kill and be killed. That, in a Greek tragic term, is the dike of some cosmic dharma wheel. Oedipus Rex, in the end, must bow to his fate and lot...

Counting synapses using FIB/SEM microscopy: a true revolution for ultrastructural volume reconstruction

The advent of transmission electron microscopy (TEM) in the 1950s represented a fundamental step in the study of neuronal circuits. The application of this technique soon led to the realization that the number of synapses changes during the course of normal life, as well as under certain pathological or experimental circumstances. Since then, one of the main goals in neurosciences has been to define simple and accurate methods to estimate the magnitude of these changes. Contrary to analysing single sections, TEM reconstructions are extremely time-consuming and difficult. Therefore, most quantitative studies use stereological methods to define the three-dimensional characteristics of synaptic junctions that are studied in two dimensions. Here, to count the exact number of synapses per unit of volume we have applied a new three-dimensional reconstruction method that involves the combination of focused ion beam milling and scanning electron microscopy (FIB/SEM). We show that the images obtained with FIB/SEM are similar to those obtained with TEM, but with the advantage that FIB/SEM permits serial reconstructions of large volumes of tissue to be generated rapidly and automatically. Furthermore, we compared the estimates of the number of synapses obtained with stereological methods with the values obtained by FIB/SEM reconstructions. We concluded that FIB/SEM not only provides the actual number of synapses per volume but it is also much easier and faster to use than other currently available TEM methods. More importantly, it also avoids most of the errors introduced by stereological methods and overcomes the difficulties associated with these techniques.

Young carers in Germany: to live on as normal as possible – a grounded theory study

BackgroundIn contrast to a growing body of research on the situation of adult family care givers, in Germany hardly anything is known about the situation of children and teenagers who are involved in the care of their relatives.MethodsIn this Grounded Theory study 81 semi structured interviews have been carried out with children and their parents in 34 families, in which one member is chronically ill. 41 children and 41 parents participated and the sample is heterogeneous and diverse.ResultsOn the one hand, there is the phenomenon 'keeping the family together", which describes how families themselves cope with the chronic illness and also, which tasks to what extent are being shifted and redistributed within the family in order to manage daily life. Influencing factors, the children's motives as well as the impact on the children also belong to this phenomenon. The second phenomenon 'to live a normal course of life' describes concrete wishes and expectations of support for the family to manage the hindered daily life. These two phenomena linked together constitute the 'model of experience and construction of familial care, in which children take over an active role'.ConclusionIt will be discussed, that the more families are in dire need of support, the more their distress becomes invisible, furthermore, that management of chronic illness is a process, in which the entire family is involved, and thus needs to be considered, and finally, that young carer's relief is not possible without relief of their parents.

Potential Hazards in the Operating Room

The operating room (OR) unit is one of the most sensitive units of a hospital. Unfortunately, only limited efforts have been made so far to optimize the OR towards being an ergonomic work place. Due to a lack of ergonomics, awkward postures and adaptation to sub-optimal conditions, potential hazards for the OR staff as well as for the patients are a normal course of life within operating rooms and OR units. Based on the evaluation of various OR units and surveys among surgeons and OR nurses, various reasons for these hazards can be discovered: medical technical devices were found to be lacking in usability as a result of unclear symbols, hindrances and insufficient ease in handling. In addition, the positioning of devices in the OR demonstrates ergonomic deficiencies which force the employees into awkward and often painful working postures. Cables and tubes often create snares for stumbling, hinder the OR team in their work or cannot be clearly assigned to the correct device. Combining the findings from the ergonomic checklist with the results of the surveys draws a very sharp picture concerning potential hazards within the OR. These hazards can, sometimes easily, be minimized and therewith the safety of the working place OR can be maximized for the OR team as well as for the patient.

Combining Checklists and Staff Surveys - A Powerfull Tool to Evaluate Operating Rooms

Awkward postures, potential hazards and the adaptation to sub-optimal conditions belong to the normal course of life within operating rooms (ORs) and OR units. Ergonomic deficiencies of the OR are mostly the reason therefore. Medical technical devices were found to be lacking in usability due to such as unclear symbols, impracticability, hindrances and insufficient ease in handling. The positioning of devices in the OR shows ergonomic problems that in most cases necessitates an unavoidable awkward working posture for the employees that causes pain. Potential hazards exist for the patient as well as for the OR staff. To detect those conditions a checklist for the OR was developed and evaluated in German hospitals. To confirm the objective results of the checklist, additional surveys were performed among the OR staff to gain subjective personal impressions. Combining the checklist's and the surveys' results is a powerful tool to evaluate the entire OR unit.

Age and Inequality: Diverse Pathways through Later Life

* Cohorts, Inequality, and Social Change * Pathways to Inequality: Intracohort Differentiation over the Life Course * Asynchronous Lives: The Normal Life Course and Its Variations * Pathways to Retirement: The Timing of Retirement * Labor Markets and Occupational Welfare in the United States * U.S. Labor Force Participation in Comparative Perspective * Aging in the Welfare State: Strategic Cross-National Comparisons of Life Course Variability and Aged inequality * Conclusions: The Future of the Age-Structured Life Course

The Impact of Medical and Sexual Politics on Women's Health

Hidden agendas impacting women's health care are explored in the context of the intersecting effects of capitalism as the ideology of medical politics, and patriarchy as the ideology of sexual politics. The mutually enhancing forces of medical and sexual politics collide in scientific reductionism - biological determinism for her'. Women are valued according to their ability and willingness to bear and raise children; illnesses and remedies for those women who are unwilling or unable to conform are invented. Thus, the `raging hormones' of puberty and pregnancy tend to be viewed as good and healthy while those associated with the menstrual cycle and menopause are portrayed as unhealthy and in need of alteration. The medical and psychological professions maintain and enhance their power, prestige and profits and serve the patriarchy by labeling events in the normal life course of women as illnesses, reinforcing social misogyny with medical misogyny, emphasizing reproduction rather than health in prioritizing empirical and clinical research, and attributing women's emotions and behaviors to hormonal fluctuations rather than economic, political and social causes.

Age-dependent characteristics of protection v. susceptibility to Plasmodium falciparum.

Naturally acquired immunity to Plasmodium falciparum may be linked to key features of the immune system that change during normal development and ageing. Evidence of this was seen in non-immune Javanese transmigrants taking up residence in hyperendemic Irian Jaya, Indonesia. After 1-2 years of residence, the adult migrants had less frequent and less intense parasitaemias than their children. Splenomegaly and malaria-like symptoms were also less common in the adults. These age-dependent patterns of relative resistance to P. falciparum mirrored those in lifelong residents. The Javanese adults acquired protective immunity against chronic exposure to infection relatively quickly compared with their children. However, during the initial exposure to infection, the incidence of emergency medical evacuation to hospital with a clinical diagnosis of malaria was 7-fold higher among the adults than in their children. The exaggerated susceptibility of adults to severe morbidity and mortality has been reported in other populations during initial exposure to infection. Thus, whereas adults acquired protection against chronic exposure more rapidly than the children, they were initially more susceptible to severe disease. One possible explanation for these findings is the changes in the immune system that normally occur during ageing. Such changes may establish differences between children and adults that profoundly affect the course of infection by P. falciparum. The ratio of naive to memory T cells gradually diminishes during ageing, as a result of the cumulative effect of exposure to the myriad antigens encountered throughout the normal course of life. Moreover, the gradual involution of the thymus progressively limits the production of naive T cells. The likelihood of stimulating memory T cells with cross-reactive antigens may increase with age and this may bias the immune response to the relative benefits of the host under chronic exposure, or to the detriment of the host under acute exposure. Intrinsic features of the immune system that change with age may determine key characteristics of the immune response to infection by P. falciparum, and whether that response is relatively harmful or beneficial may depend upon the conditions of exposure (i.e. acute or chronic).