Widespread Illness Research Articles

On the Edge of Crisis: Contending Perspectives on Development, Tourism and Community Participation on Rote Island, Indonesia

The eastern Indonesian province of Nusa Tenggara Timur (NTT) is struggling to overcome the burden of widespread poverty, illness, and illiteracy. Within the context of globalisation and Indonesia’s ongoing transitions in governance, people on Rote Island, NTT, are experiencing rapid socio-cultural change. The increasing arrival of tourists and foreign business interests add further complexity to these processes of transition. The direction forward for Rote is a topic of considerable debate amongst community members, development workers, businesses, and other stakeholders. This qualitative pilot study explores key community stakeholders’ perspectives on development, tourism, and community sustainability in Delha, Rote. It has revealed confl icting perspectives about future development and tourism on Rote, with particular concern regarding social, cultural, and environmental impacts, and loss of autonomy and community control. Important ‘dynamics of exclusion’ between stakeholders are identifi ed. More equitable participation in planning and decision-making is needed to ensure that the benefi ts of tourism and development are not concentrated with a privileged few.

On the Edge of Crisis: Contending Perspectives on Development, Tourism and Community Participation on Rote Island, Indonesia

The eastern Indonesian province of Nusa Tenggara Timur (NTT) is struggling to overcome the burden of widespread poverty, illness, and illiteracy. Within the context of globalisation and Indonesia’s ongoing transitions in governance, people on Rote Island, NTT, are experiencing rapid socio-cultural change. The increasing arrival of tourists and foreign business interests add further complexity to these processes of transition. The direction forward for Rote is a topic of considerable debate amongst community members, development workers, businesses, and other stakeholders. This qualitative pilot study explores key community stakeholders’ perspectives on development, tourism, and community sustainability in Delha, Rote. It has revealed confl icting perspectives about future development and tourism on Rote, with particular concern regarding social, cultural, and environmental impacts, and loss of autonomy and community control. Important ‘dynamics of exclusion’ between stakeholders are identifi ed. More equitable participation in planning and decision-making is needed to ensure that the benefi ts of tourism and development are not concentrated with a privileged few.

Cochrane Review: Zinc for the common cold

AbstractBackgroundThe common cold is one of the most widespread illnesses and is a leading cause of visits to the doctor and absenteeism from school and work. Trials conducted since 1984 investigating the role of zinc for the common cold symptoms have had mixed results. Inadequate treatment masking and reduced bioavailability of zinc from some formulations have been cited as influencing results.ObjectivesTo assess the effect of zinc on common cold symptoms.Search methodsWe searched CENTRAL (2010, Issue 2) which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to May week 3, 2010) and EMBASE (1974 to June 2010).Selection criteriaRandomised, double‐blind, placebo‐controlled trials using zinc for at least five consecutive days to treat, or for at least five months to prevent the common cold.Data collection and analysisTwo review authors independently extracted data and assessed trial quality.Main resultsWe included 13 therapeutic trials (966 participants) and two preventive trials (394 participants). Intake of zinc is associated with a significant reduction in the duration (standardised mean difference (SMD) ‐0.97; 95% confidence interval (CI) ‐1.56 to ‐0.38) (P = 0.001), and severity of common cold symptoms (SMD ‐0.39; 95% CI ‐0.77 to ‐0.02) (P = 0.04). There was a significant difference between the zinc and control group for the proportion of participants symptomatic after seven days of treatment (OR 0.45; 95% CI 0.2 to 1.00) (P = 0.05). The incidence rate ratio (IRR) of developing a cold (IRR 0.64; 95% CI 0.47 to 0.88) (P = 0.006), school absence (P = 0.0003) and prescription of antibiotics (P < 0.00001) was lower in the zinc group. Overall adverse events (OR 1.59; 95% CI 0.97 to 2.58) (P = 0.06), bad taste (OR 2.64; 95% CI 1.91 to 3.64) (P < 0.00001) and nausea (OR 2.15; 95% CI 1.44 to 3.23) (P = 0.002) were higher in the zinc group.Authors' conclusionsZinc administered within 24 hours of onset of symptoms reduces the duration and severity of the common cold in healthy people. When supplemented for at least five months, it reduces cold incidence, school absenteeism and prescription of antibiotics in children. There is potential for zinc lozenges to produce side effects. In view of this and the differences in study populations, dosages, formulations and duration of treatment, it is difficult to make firm recommendations about the dose, formulation and duration that should be used.Plain Language SummaryZinc for the common coldThe common cold is often caused by the rhinovirus. It is one of the most widespread illnesses and is a leading cause of visits to the doctor and absenteeism from school and work. Complications of the common cold include otitis media (middle ear infection), sinusitis and exacerbations of reactive airway diseases. There is no proven treatment for the common cold. However, a medication that is even partially effective in the treatment and prevention of the common cold could markedly reduce morbidity and economic losses due to this illness.Zinc inhibits rhinoviral replication and has been tested in trials for treatment of the common cold. This review identified 15 randomized controlled trials, enrolling 1360 participants of all age groups, comparing zinc with placebo (no zinc). We found that zinc (lozenges or syrup) is beneficial in reducing the duration and severity of the common cold in healthy people, when taken within 24 hours of onset of symptoms. People taking zinc are also less likely to have persistence of their cold symptoms beyond seven days of treatment. Zinc supplementation for at least five months reduces incidence, school absenteeism and prescription of antibiotics for children with the common cold. People taking zinc lozenges (not syrup or tablet form) are more likely to experience adverse events, including bad taste and nausea. As there are no studies in participants in whom common cold symptoms might be troublesome (for example, those with underlying chronic illness, immunodeficiency, asthma, etc.), the use of zinc currently cannot be recommended for them. Given the variability in the populations studied (no studies from low‐ or middle‐income countries), dose, formulation and duration of zinc used in the included studies, more research is needed to address these variabilities and determine the optimal duration of treatment as well as the dosage and formulations of zinc that will produce clinical benefits without increasing adverse effects, before making a general recommendation for zinc in treatment of the common cold.

Retinoids for treatment of Alzheimer's disease

Retinoids are Vitamin A derivatives involved in cellular regulatory processes including cell differentiation, neurite outgrowth and defense against oxidative stress. Retinoids may also influence Amyloid beta processing upregulation of alpha secretase via ADAM10. Vitamin A and other retinoids also directly inhibit formation of Amyloid fibrils in vivo. These properties of retinoids are relevant to theories of Alzheimer's disease pathogenesis. Retinoids are already used in treatment of acne vulgaris, psoriasis, neuroblastoma and acute promyelocytic leukemia. Clinical studies involving in cognitively impaired older adults with Alzheimer's disease are beginning with a variety of retinoids. These studies need to address safety issues of retinoids in older populations, and hold hope for demonstrating efficacy in translating these basic mechanisms to treatment of a widespread dementing illness.

Two Birds with One Stone? Possible Dual-Targeting H1N1 Inhibitors from Traditional Chinese Medicine

The H1N1 influenza pandemic of 2009 has claimed over 18,000 lives. During this pandemic, development of drug resistance further complicated efforts to control and treat the widespread illness. This research utilizes traditional Chinese medicine Database@Taiwan (TCM Database@Taiwan) to screen for compounds that simultaneously target H1 and N1 to overcome current difficulties with virus mutations. The top three candidates were de novo derivatives of xylopine and rosmaricine. Bioactivity of the de novo derivatives against N1 were validated by multiple machine learning prediction models. Ability of the de novo compounds to maintain CoMFA/CoMSIA contour and form key interactions implied bioactivity within H1 as well. Addition of a pyridinium fragment was critical to form stable interactions in H1 and N1 as supported by molecular dynamics (MD) simulation. Results from MD, hydrophobic interactions, and torsion angles are consistent and support the findings of docking. Multiple anchors and lack of binding to residues prone to mutation suggest that the TCM de novo derivatives may be resistant to drug resistance and are advantageous over conventional H1N1 treatments such as oseltamivir. These results suggest that the TCM de novo derivatives may be suitable candidates of dual-targeting drugs for influenza.

Transmission of 2009 Pandemic Influenza A (H1N1) Virus among Healthcare Personnel—Southern California, 2009

In April 2009, 2009 pandemic influenza A (H1N1) (hereafter, pH1N1) virus was identified in California, which caused widespread illness throughout the United States. We evaluated pH1N1 transmission among exposed healthcare personnel (HCP) and assessed the use and effectiveness of personal protective equipment (PPE) early in the outbreak. Cohort study. Two hospitals and 1 outpatient clinic in Southern California during March 28-April 24, 2009. Sixty-three HCP exposed to 6 of the first 8 cases of laboratory-confirmed pH1N1 in the United States. Baseline and follow-up questionnaires were used to collect demographic, epidemiologic, and clinical data. Paired serum samples were obtained to test for pH1N1-specific antibodies by microneutralization and hemagglutination-inhibition assays. Serology results were compared with HCP work setting, role, and self-reported PPE use. Possible healthcare-associated pH1N1 transmission was identified in 9 (14%) of 63 exposed HCP; 6 (67%) of 9 seropositive HCP had asymptomatic infection. The highest attack rates occurred among outpatient HCP (6/19 [32%]) and among allied health staff (eg, technicians; 8/33 [24%]). Use of mask or N95 respirator was associated with remaining seronegative (P = .047). Adherence to PPE recommendations for preventing transmission of influenza virus and other respiratory pathogens was inadequate, particularly in outpatient settings. pH1N1 transmission likely occurred in healthcare settings early in the pandemic associated with inadequate PPE use. Organizational support for a comprehensive approach to infectious hazards, including infection prevention training for inpatient- and outpatient-based HCP, is essential to improve HCP and patient safety.

Chemokines: established and novel targets in atherosclerosis

In their role as small chemotactic cytokines, chemokines are crucial mediators and regulators of leukocyte trafficking during immune surveillance and inflammation. Their involvement in the development and progression of inflammatory diseases has been subject of intense investigation. Concordantly, the chemokine system has been explored in search for therapeutic targets to prevent or treat inflammatory disorders, such as atherosclerosis. Targeting the chemokine system offers various entry points for a causative treatment of this widespread and chronic illness. Although this approach has encountered some setbacks, several innovative compounds are currently in an advanced stage of development. In this review, the current standing of this dynamic field is highlighted and the potential advantages and drawbacks of particular strategies are discussed.

Liver Hydatidosis - Surgical Treatment

Hydatid disease is a concealed parasite illness that spreads over all organs and tissues. It is a difficult and widespread invasive illness which occupies a special place in pathology of hepato-billious tract. This study includes analysis of 103 patients operated from liver hydatidosis during a 15 year period. Ratio between female and male patients was 2:1, with a female predominance. The patient's age ranged from 19 to 65 years old, i.e. they were still capable of working, with an average age of 47 years. The patient's were mostly housewives, farmers and cattle breeders (71 or 68.9%). The most frequent method we used was pericystectomy with omentoplastics applied in (51 or 49.5%) cases, then pericystectomy with drainage applied in (31 or 30.1%) cases, followed by extirpation of the cyst applied in (11 or 10.7%) cases, liver resection was performed in only (7 or 6.8%) cases, marsupielisation was performed in (3 or 2.9%) cases, but out of necessity. The most frequently used approaches were the right subcostal ones, medial and Orh's cut - (95 or 92.2%) cases. Postoperative complications occurred in (39 or 37.9%) cases. Lethal result occurred in (2 or 1.9%) cases. Our opinion is that a total cystopericystectomy with omentoplastics, which is a method of choice, decreases hospitalization period and complications.

H1N1 Influenza: Critical Care Aspects

During the Northern Hemisphere spring of 2009, a novel H1N1 influenza A virus emerged in Mexico, causing widespread human infection and acute critical respiratory illness. The 2009 H1N1 virus spread initially to the United States and Canada, with subsequent rapid global dissemination, leading the World Health Organization (WHO) to declare "a public health emergency of international concern" in April 2009, and upgrading the viral threat to pandemic status in June 2009. Despite initial fears, the severity of the 2009 H1N1 pandemic overall did not differ significantly from that of seasonal influenza. However, the demographics of those at risk of severe illness did differ (affecting children and young adults, rather than the very young and the very old). The 2009 H1N1 pandemic led to rapid implementation of health care initiatives, including the provision of critical care services, to limit the effect of the influenza outbreak on the community. This review focuses on the critical care response to the H1N1 pandemic and examines whether the implementation of critical care services as planned a priori matched the reality of the clinical workload and the patient burden that transpired during the 2009 H1N1 influenza pandemic.

The Effects of Caloric Restriction on Health and Longevity

There is increasing evidence that restricting caloric intake may have considerable health benefits in humans. Significant evidence in non-primate animals demonstrates that caloric restriction increases average and maximal life span. However, historically, caloric intake reduction in humans has been involuntary and accompanied by poverty, malnutrition, poor sanitation, and a lack of modern health care. As a result, caloric restriction in people typically has been accompanied by a reduction of both average and maximal life span. Conversely, improvements in standards of living usually are accompanied by an increased food supply and resultant improved health and longevity. The majority of the world is now in a new era where an abundance of caloric intake and its associated obesity are causing widespread chronic illness and premature death. What would happen if one were to institute caloric restriction with high-quality nutrition within an environment of modern sanitation and health care? This review argues that improved health and improved average life span would quite likely result. A lengthening of maximal human life span with this combination is perhaps possible but by no means certain.

Concurrent Influenza and Shigellosis Outbreaks, Papua New Guinea, 2009

Concurrent Influenza and Shigellosis Outbreaks, Papua New Guinea, 2009

An image-based assay for high throughput screening of Giardia lamblia

Giardia lamblia is a protozoan parasite that causes widespread gastrointestinal illness. Drugs to treat giardiasis are limited, but efforts to discover new anti-giardial compounds are constrained by the lack of a facile system for cell culture and inhibitor testing. We achieved robust and reproducible growth of G. lamblia in 384-well tissue culture plates in a modified TYI-S-33 medium. A high throughput assay for the screening of potential anti-giardial compounds was developed utilizing the WB strain of G. lamblia and automated optical detection of parasites after growth with tested inhibitors. We screened a library of 1600 known bioactive molecules and identified 12 compounds that inhibited growth of G. lamblia at low- or sub-micromolar concentrations. Our high throughput assay should facilitate evaluation of available chemical libraries for novel drugs to treat giardiasis.

Deep Brain Stimulation for Treatment-Resistant Depression

Brian did reasonably well for about 3 years, with occasional worsening of depressive symptoms but generally with good functioning, when he developed his current major depressive episode. This was his most severe episode to date, with active suicidal ideation with a plan (but no immediate intent) to shoot himself. Over the next year, he had a number of treatments, among them multiple antidepressant medications, including selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, mirtazapine, tricyclic antidepressants, and tranylcypromine, as well as augmentation with lithium, thyroid hormone, buspirone, atypical antipsychotics, anticonvulsants, stimulants, light therapy, and ongoing psychotherapy. No treatment was able to achieve remission or a persistent clinically signifi cant reduction in symptoms. Given his degree of treatment resistance and continued overall deterioration, including increased suicidal ideation, he was referred for ECT. He achieved a good response (50%‐60% symptom reduction) with eight highdose right unilateral ECT treatments. ECT was delivered concurrently with ongoing medications, and attempts were made to optimize medications during and after ECT. However, Brian relapsed in about 6 weeks, and repeat ECT (including four right unilateral and eight bitemporal treatments delivered concurrently with ongoing medications) was unsuccessful in achieving signifi cant symptom reduction but was associated with notable cognitive impairment.

‘Nature’ is Not Guilty: Foodborne Illness and the Industrial Bagged Salad

AbstractIncreasing incidents of widespread foodborne illness continue to highlight problems with industrialised food production. These problems emerge as a result of complicated interactions between humans and non‐humans in food production networks. This article combines actor‐network theory and political economy to critically examine foodborne illness, focusing on outbreaks related to industrially produced bagged salads from California. The article explores the evolution of the bagged salad, the emergence ofEscherichia coliO157:H7, howE. coliO157:H7 enters the salad production network and the responses of industrial actors. While many continue to blame external nature for foodborne illness, doing so overlooks the fact that outbreaks are co‐produced by humans and non‐humans. Profit‐driven industrial production designs play an important role in the emergence and spread of pathogens. While efforts to address outbreaks focus on controlling non‐humans and adopting new technological fixes, effectively minimising foodborne illness may require a reevaluation of high‐volume and centralised production systems.

Shigellaspp. Antimicrobial Drug Resistance, Papua New Guinea, 2000–2009

<i>Shigella</i>spp. Antimicrobial Drug Resistance, Papua New Guinea, 2000–2009

Presentations to emergency departments for chronic obstructive pulmonary disease in Alberta: a population-based study

Chronic obstructive pulmonary disease (COPD) is a widespread illness with an increasing prevalence in older adults; exacerbations resulting in visits to the emergency department (ED) are common. We sought to determine the epidemiology of COPD presentations to EDs by older adults in Alberta. Administrative databases were used to examine all ED encounters for COPD from April 1999 to March 2005 in Alberta. Data included demographics of patients and timing of ED visits. Data analysis included descriptive summaries and age-sex directly standardized visit rates (DSVRs). There were 85 330 ED visits for acute COPD made by 38 638 patients 55 years of age or older during the study period. More men (53.2%) presented, and the mean age at presentation was 72 years. The age-sex DSVRs remained stable from 2000/01 (24.4/1000) to 2004/05 (25.6/1000). Presentation rates differed among population subgroups. Overall, 67% of visits resulted in discharge from the ED. Chronic obstructive pulmonary disease is a common presentation in Alberta EDs; however, the rates of presentation were stable during the study period, and monthly and hourly trends exhibited similar patterns for each year. Disparities based on age, sex, and socio-economic and cultural statuses were identified. Targeted interventions could be implemented to reduce future ED visits for COPD.

Toxic loopholes: failures and future prospects for environmental law

The EPA was established to enforce the environmental laws Congress enacted during the 1970s. Yet today lethal toxins still permeate our environment, causing widespread illness and even death. Toxic Loopholes investigates these laws, and the agency charged with their enforcement, to explain why they have failed to arrest the nation's rising environmental crime wave and clean up the country's land, air and water. This book illustrates how weak laws, legal loopholes and regulatory negligence harm everyday people struggling to clean up their communities. It demonstrates that our current system of environmental protection pacifies the public with a false sense of security, dampens environmental activism, and erects legal barricades and bureaucratic barriers to shield powerful polluters from the wrath of their victims. After examining the corrosive economic and political forces undermining environmental law making and enforcement, the final chapters assess the potential for real improvement and the possibility of building cooperative international agreements to confront the rising tide of ecological perils threatening the entire planet.

Dietary conjugated linoleic acid and n-3 polyunsaturated fatty acids in inflammatory bowel disease

Inflammatory bowel disease (IBD) is a debilitating and widespread immune-mediated illness of unknown etiology. Current treatments are modestly successful and with significant side-effects. The purpose of this review is to summarize the current understanding of mechanisms of action underlying the anti-inflammatory actions of conjugated linoleic acid (CLA) and n-3 polyunsaturated fatty acids (PUFAs) in IBD. Nutrition-based interventions that target peroxisome proliferator-activated receptors (PPARs) such as dietary CLA and n-3 PUFA have demonstrated anti-inflammatory efficacy in animal models of IBD. Clinical data on n-3 PUFA in IBD remains generally unimpressive, although results of a recent human study demonstrate that IBD remission can be maintained by maintaining the n-3: n-6 ratio more than 0.65 via n-3 PUFA intervention. In mice, CLA prevented inflammation-driven colorectal cancer by activating PPAR gamma and modulating regulatory T cells and macrophages. CLA is the subject of an ongoing clinical study in Crohn's disease patients. Compelling evidence demonstrates that n-3 PUFA and CLA prevent or ameliorate IBD in animal models. However, this basic knowledge has not been translated into novel nutrition-based clinical interventions. For both compounds there is an urgent need for placebo-controlled, large-scale, multicenter clinical trials.

How important are sex differences in cannabinoid action?

In humans as in animals, males and females are dissimilar in their genetic and hormonally driven behaviour; they process information differently, perceive experience and emotions in different ways, display diverse attitudes, language and social skills, and show sex-related differences in the brain anatomy and organization. Drug addiction is a widespread relapsing illness that affects both men and women. Sex-dependent differences have been frequently observed in the biological and behavioural effects of substances of abuse, including cannabis. Beside sex differences observed in the cannabinoid-induced effects related to cannabis abuse and dependence, cannabinoids have been shown to exert sex-dependent effects also in other physiological and behavioural aspects, such as food intake and energy balance (more evident in males), or anxiety and depression (more evident in females). Research has just begun to identify factors which could provide a neurobiological basis for gender-based differences in cannabinoid effects, among which, gonadal hormones seem to play a crucial role. Yet, cannabinoid pharmacodynamic and pharmacokinetic may also be important, as sex differences in cannabinoid effects might be due, at least in part, to differences in muscle mass and fat tissue distribution between males and females. Here, we will review both clinical and laboratory-based research evidence revealing important sex-related differences in cannabinoid effects, and put forward some suggestions for future studies to fill the gap in our knowledge of gender-specific bias in cannabinoid pharmacology.

Serological surveys for 2009 pandemic influenza A H1N1

Since 2009 pandemic influenza A H1N1 was first identified in April, 2009,1 the virus has caused widespread illness worldwide. In The Lancet today, Elizabeth Miller and colleagues2 from the UK Health Protection Agency report a pair of cross-sectional serological surveys in which they address the level of pre-existing immunity to 2009 pandemic H1N1 in the population and, more importantly, estimate the proportion of the population infected during the first pandemic wave in the UK.