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PubMed1999

Fast relief: buying time with medications.

The experience of time famine in contemporary U.S. culture affects household decisions about self-care and the use of pharmaceuticals for self-medication. This article examines the manner in which time demands shape lay interpretations of medicine efficacy and drive increases in medication use for adults as well as children. Medicines, like other time-saving commodities, appear to shift the time-power differential in favor of individuals, placing them in control of how time is spent. When there is "no time to be sick," allopathic medicines become time-saving devices that enable women to fulfill responsibilities at work or home while they attend to sick children or to being ill themselves. Medicines are used to beat the clock by increasing one's own capacity to be productive.

Adult↗
PubMed2004

Free markets and dead mothers: the social ecology of maternal mortality in post-socialist Mongolia.

Beginning in 1990, Mongolia, a former client state of what was then the Soviet Union, undertook liberal economic reforms. These came as a great shock to Mongolia and Mongolians, and resulted in food shortages, reports of famine, widespread unemployment, and a collapse of public health and health care. Although economic conditions have stabilized in recent years, unemployment and poverty are still at disturbingly high levels. One important consequence of the transition has been the transformation of the rural, primarily pastoral, economy. With de-collectivization, herding households have been thrown into a highly insecure subsistence mode of production, and, as a consequence, have become vulnerable to local fluctuations in rainfall and availability and quality of forage, and many now lack access to traded staples and essential commodities. Household food insecurity, malnutrition, and migration of impoverished households to provincial centers and the capital of Ulaanbaatar are one result. Reductions to investments in the health sector have also eroded the quality of services in rural areas, and restricted access to those services still functioning. Evidence suggests that women are particularly vulnerable to these political-ecological changes, and that this vulnerability is manifested in increasing rates of poor reproductive health and maternal mortality. Drawing on case-study ethnographic and epidemiological data, this article explores the links between neoliberal economic reform and maternal mortality in Mongolia.

Adult↗
PubMed2001

Fetal endocrinology and development--manipulation and adaptation to long-term nutritional and environmental challenges.

This article reviews the fetal endocrine system in sheep, a species that has a long gestation and primarily produces a singleton fetus. Attention is focused on information that is applicable to humans. The endocrinology of metabolic homeostasis in sheep fetuses is well adapted to respond to a range of metabolic challenges, including placental restriction and maternal undernutrition. A small placenta results in hypoxaemia, hypoglycaemia, reduced abundance of anabolic hormones, and fetal growth restriction. Fetuses with restricted growth are characterized by tissue-specific reductions in hormone receptor mRNA, for example mRNA for the long form of prolactin receptor is reduced in adipose tissue. In contrast, the adipose tissue of fetuses with accelerated growth, stimulated by increasing maternal nutrition in the second half of gestation, has more protein for the long form of the prolactin receptor and more uncoupling protein 1, by which large amounts of heat are generated at birth. Maternal undernutrition in early gestation, coinciding with the period of rapid placental growth, initially restricts placental growth, but when mothers are fed to requirements, a longer fetus results with a disproportionately large placenta. This nutritional manipulation replicates, in part, epidemiological findings from the Dutch famine of 1944-1945, for which the offspring are at increased risk of adult obesity.

Animal Nutritional Physiological Phenomena↗
PubMed1998

[The development of reference values for the brachial perimeter and body height in comparison with other indicators used for screening of the nutritional status].

Mid-upper-arm circumference (MUAC) based on a single cut-off value for all children under 5 years of age has been used for many years as an alternative nutritional status index for children during famines or refugee crises, and as an additional screening tool in nonemergencies. However, it has recently been questioned whether MUAC is age- and sex-independent. After reviewing the scientific evidence underlying the use and interpretation of MUAC, a WHO Expert Committee recommended a new MUAC-for-age reference for under-5-year-olds. In some settings, however, it is difficult to assess a child's age and in such circumstances MUAC-for height may be a good alternative. The height-based QUAC stick offers a simple means of adjusting MUAC cut-offs according to height, and the MUAC-for-height reference and construction and use of the QUAC stick are described in this article. Also described is the use of the receiver operating characteristic (ROC) curve method to evaluate the performance of MUAC, MUAC-for-age, and MUAC-for-height in screening malnourished children.

Arm↗
PubMed1992

Organisation of veterinary public health in Africa.

Veterinary public health (VPH) is not integrated into the mainstream of public health services in Africa. There are no formal mechanisms within government public health services through which veterinary skills and resources can be effectively harnessed to bear upon community health. There is no conscious, overt or substantial effort by public authorities to incorporate VPH services in the overall approach to public health. VPH activities cover mainly the control of the major animal diseases transmissible to man (zoonoses), meat inspection and, to a limited degree, the quality control of milk, fish and their products. These services are carried out by the Veterinary Services of the Ministry of Agriculture in each country. Concerning education, only 7 of the 28 schools of veterinary medicine in Africa have separate departments where VPH subjects such as epidemiology, food hygiene, zoonoses, biostatistics, community health, public administration, preventive medicine and other related fields are taught by public health-trained and oriented staff. Elsewhere the teaching of VPH subjects is delegated to staff whose foremost interests are in pathology, microbiology and clinical medicine. Postgraduate training in VPH is fast developing in the veterinary schools of Nigeria, Kenya and Uganda. Political instability, war, famine and poverty which deplete human and material resources, lack of intersectorial cooperation in matters of public health and lack of vigour on the part of the veterinary profession as a whole to assert its broader role in the community also contribute to the poor organisation of VPH in Africa. International collaboration in VPH is spearheaded by the Food and Agriculture Organisation (FAO) and the World Health Organisation (WHO). These agencies, along with the Office International des Epizooties (OIE) and other international organisations or groups, are active in promoting the development of VPH programmes by setting guidelines on the organisation and management of VPH, coordinating control programmes for the major zoonoses and providing financial and technical expertise.

Africa↗
PubMed1993

An enzyme-linked immunosorbent assay for the epidemiological survey of Dermatophilus congolensis infection in camels (Camelus dromedarius).

The breeding of camels (Camelus dromedarius) is especially important in arid and semi-arid areas of Africa, where drought and famine frequently occur. A number of diseases which impair camel production have recently been described, including dermatophilosis (caused by Dermatophilus congolensis). However, it is not possible to determine the prevalence of infection from clinical cases alone. An enzyme-linked immunosorbent assay has therefore been developed to determine the epidemiological prevalence of D. congolensis infection in sera of camels. Whole-cell antigen was used on microplates and the test serum was added. Horseradish peroxidase-conjugated sheep antibodies against heavy and light chains of camel immunoglobulin (Ig)G were then added, followed by substrate. The test was used to trace the antibody profile of twelve experimentally-infected camels. Peak antibody levels in serum occurred within twenty-one days following infection. It is planned to use this test to determine the epidemiological prevalence of D. congolensis infection in camels reared in a pastoral area of Kenya.

Actinomycetales↗
PubMed2004

Hurling alone? How social capital failed to save the Irish from cardiovascular disease in the United States.

OBJECTIVES: We performed a historical review of cardiovascular risk profiles of Irish immigrants to the United States, 1850-1970, in regard to lifestyle, socio-economic circumstances, and social capital. METHODS: We analyzed US Census data from 1850-1970, area-based social and epidemiological data from Boston, data from Ireland's National Nutrition Surveillance Centre, and literature on Irish migration. RESULTS: The Irish were consistently at increased risk of cardiovascular diseases, a risk that related initially to material deprivation, across the life course of at least 2 generations. CONCLUSIONS: The principal difference between the Irish and other disadvantaged immigrant groups, such as the Italians, was dietary habits influenced by experiences during the Irish famine. Although there was a psychosocial component to the disadvantage and discrimination they experienced as an ethnic group, the Irish also exhibited strong community networks and support structures that might have been expected to counteract discrimination's negative effects. However, the Irish's high levels of social capital were not protective for cardiovascular disease.

Boston↗
PubMed2002

Increasing incidence of type 2 diabetes in children and adolescents: treatment considerations.

The emerging public health problem of type 2 diabetes in youth reflects increasing rates of childhood obesity. As in adults, type 2 diabetes in children is part of the insulin resistance syndrome that includes hypertension, dyslipidemia and other atherosclerosis risk factors, and hyperandrogenism seen as premature adrenarche and polycystic ovary syndrome. Studies in children document risk factors for type 2 diabetes and associated cardiovascular risk factors, including obesity, family history, diabetic gestation, and underweight or overweight for gestational age. Genetically determined insulin resistance, or limited beta-cell reserve, has been demonstrated in high risk individuals. This genetic background, considered advantageous in a feast and famine existence (the thrifty genotype), is rendered detrimental with abundant food and physical inactivity, a lifestyle demonstrated to be typical of families of children with type 2 diabetes. Case finding in high risk individuals who are asymptomatic may be an appropriate response to the public health challenge of type 2 diabetes in children, because risk factors for cardiovascular disease are already present at the time of diagnosis. Treatment is dictated by the degree of metabolic derangement and symptoms. The only data on the use of oral hypoglycemic agents in children has been with metformin. Prevention efforts will require community and government involvement to reduce obesity and increase physical activity in the child, as well as adult, population.

Adolescent↗
PubMed2003

Central pre-proglucagon derived peptides: opportunities for treatment of obesity.

Modern societies have moved from famine to feast and obesity and its co-morbidities now sweep the world as a global epidemic. Numerous scientific laboratories and pharmaceutical companies have taken the challenge and are now exploiting novel molecular targets for treatment of obesity. The pre-proglucagon system constitutes interesting candidates as potential targets for new anti-obesity drugs. In the periphery, pre-proglucagon derived peptides, Glucagon-Like Peptide-1 (GLP-1), Glucagon-Like Peptide-2 (GLP-2) and oxyntomodulin (OXM) are involved in a wide variety of physiological functions, including glucose homeostasis, gastric emptying, intestinal growth, insulin secretion as well as the regulation of food intake. Peripheral administration of GLP-1 derivatives and analogues to both rodents and man have shown promising effects on food intake and body weight suggesting that such therapies constitute potential anti-obesity treatment. In the central nervous system, pre-proglucagon and hence GLP-1, GLP-2 and OXM are exclusively found in a small population of nerve cells in the nucleus of the solitary tract. These constitute a neural pathway linking the "viscero-sensory" brainstem to hypothalamic nuclei involved in energy homeostasis. Intracerebroventricular administration of all of the three derived peptides robustly decrease food intake. It is evident that central GLP-1 agonism probably in combination with GLP-2 and/or OXM agonism constitute a potential pharmacological tool to reduce food intake and maybe also enhance energy expenditure. This and other aspects of the current state of the role of central pre-proglucagon in energy homeostasis are reviewed.

Animals↗
PubMed2005

Ghrelin and energy balance: focus on current controversies.

Ghrelin is an enteric peptide that is the only known circulating appetite stimulant. This feature of the hormone has garnered widespread attention, as reflected by more than 1000 scientific papers featuring ghrelin that have been published since the first reports of its orexigenic actions, approximately four years ago. In this review, we discuss data that support roles for ghrelin in the short-term regulation of pre-meal hunger and meal initiation, functioning as a unique orexigenic counterpart to short-acting gastrointestinal satiation factors, such as cholecystokinin (CCK). We also highlight evidence indicating that ghrelin satisfies recognized criteria to be viewed as a participant in long-term body-weight regulation--a potential anabolic counterpart to the traditional adiposity hormones, leptin and insulin. We then discuss the following controversial questions in ghrelin research and offer our opinions regarding these debates. (1) Is ghrelin synthesized within the brain? (2) How does ghrelin increase food intake? (3) Does des-acyl ghrelin have a physiologic function? (4) Are there receptors for ghrelin other than GHS-R1a? (5) Does ghrelin regulate insulin secretion? (6) Does ghrelin regulate gastrointestinal motility? (7) Can ghrelin or ghrelin-receptor agonists be used to treat wasting conditions? Finally, we offer a speculative model of ghrelin as a thrifty gene product that evolved to help animals consume and store fat well, thereby increasing their chances of survival during times of famine. We suggest that ghrelin is a "saginary" hormone, from the Latin, saginare, which means, "to fatten".

Animals↗
PubMed2004

Exercise in a pill: feasibility of energy expenditure targets.

The possibility of developing a pill to increase energy expenditure is explored by examining the metabolic processes involved. Such a pill should be targeted at organ systems involved in facultative thermogenesis. In rodents, these are brown adipose tissue (BAT) and skeletal muscle. Since BAT-mediated thermogenesis is not available in adult humans, emphasis here is on skeletal muscle. A hypothesis is presented based on three known facts: (1) plasticity of skeletal muscle, with interconversion of fiber types that differ in their fuel efficiency; (2) presence of thyroxine 5'-deiodinase type 2 (TD2) in human skeletal muscle; (3) gradual increase in thermogenesis that occurs during rehabilitation after starvation, probably in muscle. A low capacity thermogenic system, muscle efficiency thermogenesis (MET), is proposed to occur as adipose stores refill during the transition from famine to feasting to obesity. This system involves increased activity of TD2 and a T3-induced increase in proportion of type II fibers, less efficient at rest and during activity. The protective effect of this system is probably overwhelmed by long-term eating in excess of energy needs. Better understanding of the complex remodeling of differentiated muscle fibers in the conversions proposed and of the regulation of TD2 activity in human skeletal muscle may reveal targets for increasing energy expenditure in humans. In addition, the possibility of exploiting the plasticity of the adipose organ, with conversion of white adipocytes in white adipose tissue to atypical brown adipocytes and increasing thermogenesis in them is considered as another potential target for increasing energy expenditure in humans.

Adaptation, Physiological↗
PubMed2000

Development and quality of life: a critique of Amartya Sen's Development as freedom.

Presented here is a critical analysis of some of the major theses of Amartya Sen, as presented in his seminal work Development As Freedom. The author suggests that Sen's work, while representing a major break with the dominant neoliberal position reproduced in most national and international development agencies, is insufficient to explain the key relationship between freedom and development. The absence of an analysis of the power relations that cause and reproduce underdevelopment through national and international political institutions leaves Sen's work wanting. The author shows how Sen's interpretation of events and the conclusions derived from them, such as an explanation of famine in Bangladesh, are insufficient--when not faulty. The author also critically analyzes the United Nations Development Program reports, which, while documenting the nature and consequences of underdevelopment, barely touch on the political context in which underdevelopment occurs.

Communism↗
PubMed1981

Mode of production and population patterns: policy implications for West African development.

Recent developments in population theory have made possible a re-examination of demographic evidence from West Africa which suggests that population growth and migration are primarily responses to changes in the nature of the production system. Precolonial, colonial, and independence period data provide a series of correlations consistent with the approach and suggest a possible new synthesis of the West African data. The poorest countries of West Africa are those bordering on the Sahara Desert, known as the "Sahel" region. In response to the drought and famine in that region from 1968-1974, numerous proposals have been made for increased attention to reducing population growth. The analysis presented in this paper leads to the conclusion that population policies other than those attempting to lower the birth rate are called for. These would include relocation of populations previously displaced by colonial labor migrations and the re-integration of herding and farming production systems, both of which policies should be considered as population policies. Data are presented from specific projects underway in Senegal, Mauritania, and Mali, to illustrate the argument.

Africa, Western↗
PubMed1975

Assessment of the world food situation-present and future.

The widespread bad harvests of 1972 in various regions of the world, the consequent reduction in grain reserves, the rapid rise in food prices almost everywhere and its impact on inflation, all have served to draw renewed attention to the problem of hunger which affects millions of human beings in the world today. During the 1974 United Nations World Food Conference many important matters relating to this problem were debated: the creation of international grain reserves; problems concerning world trade of foodstuffs; the current difficulties with certain key agricultural production factors, such as fertilizers; the necessity for organizing a worldwide information system on the situation; and prospects of various harvests and threats of famine in underdeveloped countries. It is often the case that discussion of the hunger problem does not correspond to the gravity of the crisis; true causes of the present situation are not examined, and measures are not adopted that will once and for all--for the first time--abolish hunger. In view of the prospect that the real issues are often ignored, the Transnational Institute provides this analysis in an attempt to clarify what must be done to abolish hunger in the belief that this is within the reach of humanity when and if we are determined to end the irrationalities of the present economic system and the relations of domination which some individuals and countries seek to continue.

Agriculture↗
PubMed1988

High prevalence of diabetes in young adult Ethiopian immigrants to Israel.

We performed oral glucose tolerance tests in 158 Ethiopian immigrants to Israel. The subjects were less than 30 yr of age, had lived in Israel less than or equal to 4 yr, and originated from villages in the Gondar and Ambovar regions of Ethiopia. Most had been subjected to famine conditions in Ethiopia and/or extreme hardship in Sudan before or during immigration. All were lean. They revealed a profound change in dietary habits since their arrival in Israel, with consumption of large amounts of refined carbohydrate in place of spicy stews and injura (Ethiopian pita) that had constituted dietary staples in better times in Ethiopia. According to National Diabetes Data Group criteria, 14 (8.9%) of the subjects had diabetes, and another 14 (8.9%) had impaired glucose tolerance. In addition, 13 subjects had a dramatic increase in capillary blood glucose levels (greater than 300 mg/dl) 1 h after ingestion of 75 g glucose, despite fasting and 2-h values well within the normal range, and they complained of associated symptoms during the 1st h of testing. Eleven of 137 men and 3 of 21 women had diabetes; 7 (5.1%) of the men and 7 (33%) of the women had impaired glucose tolerance. These results indicate a high prevalence of diabetes among young adult Ethiopian immigrants of relatively short residency in Israel, for which the factors responsible warrant further investigation.

Adolescent↗
PubMed1996

Mineral values of selected plant foods common to southern Burkina Faso and to Niamey, Niger, west Africa.

Wild and cultivated fruits, leaves, nuts, seeds, spices and vegetables from southern Burkina Faso and Niamey, Niger, were analysed for their copper, iron, magnesium, manganese and zinc concentrations and compared to imported, exotic reference foods found within the study area. The species analysed covered a broad spectrum of local diet; 33 were wild and 16 were cultivated. The edible wild plants were often the highest in mineral concentrations. Five species analysed, exhibited consistently high mineral values, specifically, Adansonia digitata, Boerhavia diffusa, Cerathoteca sesamoides, Sclerocarya birrea and Xylopia sp. The latter was particularly high in zinc, an observation which suggests that there may be a solid rationale for local traditions which recommended its consumption during pregnancy and lactation. Respondents indicated that during times of drought, wild plants were not consumed in the volume they once were, due to changes of infrastructure and in famine relief programmes.

Adult↗
PubMed1999

A review of literature on drug use in Sub-Saharan Africa countries and its economic and social implications.

The drug problem in Africa cannot be seen as an isolated phenomenon but rather as part of the larger narcoscape which partakes of the fluid yet disjunctive qualities of Appadurai's landscapes. In this volatile environment, the transformation of Sub-Saharan Africa (SSA) nations from transit points in an international drug network to consumer countries seems inevitable. At the same time, Africa has undergone rapid economic and social changes that have facilitate this shift. A review of the literature reveals that there is a pressing need to investigate current trends and patterns of drug use in the countries of SSA. These nations, struggling with the consequences of AIDS, famine, refugees, and political unrest, could ill afford to address the consequences of widespread drug use. It is critical, therefore, that they address the drug problem before it reaches crisis proportions. To do so, they need information describing the magnitude of the problem as well as a firm understanding of the relationships between drug use and crime, unemployment, violence, and the breakdown of family life. The more that is known about the nature and complexity of drug use in Africa, the better policymakers can formulate a sound and effective strategy to curtail the drug "epidemic."

Adult↗
PubMed1999

Predicting malaria infection in Gambian children from satellite data and bed net use surveys: the importance of spatial correlation in the interpretation of results.

In line with the renewed World Health Organization Global Malaria Control Strategy, we have advocated the use of satellite imagery by control services to provide environmental information for malaria stratification, monitoring, and early warning. To achieve this operationally, appropriate methodologies must be developed for integrating environmental and epidemiologic data into models that can be used by decision-makers for improved resource allocation. Using methodologies developed for the Famine Early Warning Systems and spatial statistics, we show a significant association between age related malaria infection in Gambian children and the amount of seasonal environmental greenness as measured using the normalized difference vegetation index derived from satellite data. The resulting model is used to predict changes in malaria prevalence rates in children resulting from different bed net control scenarios.

Animals↗