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Autochthonous epidemic typhus associated with Bartonella quintana bacteremia in a homeless person.

Trench fever, a louse-borne disease caused by Bartonella quintana, is reemerging in homeless persons. Epidemic typhus is another life-threatening louse-borne disease caused by Rickettsia prowazekii and known to occur in conditions of war, famine, refugee camps, cold weather, poverty, or lapses in public health. We report the first case of seroconversion to R. prowazekii in a homeless person of Marseilles, France. This was associated with B. quintana bacteremia. Although no outbreaks of typhus have been notified yet in the homeless population, this disease is likely to reemerge in such situation.

Bacteremia↗

[Obesity and thinness in painting].

The obesity, serious frequenty sanitary problem, cause of complications that effects to the expectation of life, with aesthetic repercussion and with an increase in the last decades. Admitted the obesity android, gynoide, central or abdominal, wide aesthetic repercussion and physiopathologic like hyperdislipemias, metabolic alterations (diabetes mellitus, etc...), arterial hypertension, column arthrosis and outlying. Ethiopathologics co-factors, sedentariness, genotypic predisposition, endocrine alterations and of the leptina secretion. Illustrative cases of obesity in the painting of those that characteristic models are exposed, from slight grades to intense affecting to both genders. The thinness counterpoint of the obesity, multicausal process, less frequent than the obesity with aesthetic and psychological repercussion. It is the formed aesthetic thinness to the diverse types physiopathologic, without forgetting the constitutional and family form and the anorexy, the serial ones to disasters, wars, famines, etc..., the mystic thinness of saints and ascetics, and the serial one to consuming processes.

Humans↗

Green-blue water system innovations for upgrading of smallholder farming systems--a policy framework for development.

Rainfed agriculture and other depletion of water by green flows have as yet an untapped potential for improving livelihoods in semi-arid areas through income and food security. A vivid evidence of this is seen in the fact that, although working full time on food production, majority of smallholder farmers are frequently affected by shortage of food or famines. At the same time enough examples exist to show that productivity of labor, water and land under rainfed farming can be doubled or even trebled through proper land management and improved agronomic inputs supported by modest investments to reduce impacts of dry spells. However, these shining examples remain small 'islands of success' across the entire semi-arid areas. Farmers have not adopted these systems due to poor ratio of benefit to costs brought about by inadequate development or complete lack of food trade among the rural areas. This paper argues that there is a need for policy, strategic and programmatic frameworks which facilitate integrated management of land, water and markets. For this kind of strategy to work, a local market for food should be ensured to absorb at competitive prices the surplus produced by farmers in years of good rains. This will promote wealth creation and asset building among the poor in semi-arid areas. A food-exchange "futures" mechanism based on the principle of virtual water trade is proposed as a basis for achieving this objective.

Agriculture↗

Detection of the fetus at risk.

Successful reproduction has ensured the survival of the human race despite disease and famine. However, a good standard of living, combined with a well-balanced diet, is closely related to low maternal, perinatal and infant mortality rates. In the third world, anaemia, rheumatic heart disease, tuberculosis and other infections are still common and the poorly nourished are more susceptible to them. In the Western world food is plentiful but often the individual's diet is poorly balanced. Invariably the fetus takes all the nutrients required from the mother and, if a deficiency occurs, this is reflected in the maternal reserves only. The weight of the baby at birth has a wide biological variation and correlates in the extremes with maternal weight but there are many other factors responsible for fetal growth. In early pregnancy the developing embryo may be susceptible to specific dietary deficiencies and structural malformations may result. A clear link has recently been established between folic acid supplementation and the prevention of recurrence of neural tube defects. Excessive doses of vitamin A should be avoided.

Body Weight↗

Vitamin A deficiency in the Sudan: a call for a surveillance system.

This short review summarizes all the published and unpublished reports on vitamin A deficiency in the Sudan in the last four decades. Different local terms used by people to indicate vitamin A deficiency were enlisted. There is evidence that vitamin A deficiency is a public health problem in eastern Sudan and among communities from western and southern Sudan living around Greater Khartoum, who were displaced from their homelands because of drought, famine conditions and civil unrest. There are reports indicative of vitamin A deficiency problem in the central and the far western provinces. There were no reports from the northern provinces. The need for a surveillance system was discussed.

Child, Preschool↗

Insulin and human obesity.

The prevalence of obesity among modern communities increases dramatically and trends to achieve the characteristics of an epidemic. Obesity is the result of a sedentary life style and increased food intake, which characterises western communities. Obesity is closely related to insulin resistance and hyperinsulinemia and the very frequent combination of obesity and NIDDM is characterised as "Diabesity". The behaviour of man in seeking food and the amount of food consumption is a complicated situation, which is regulated by the CNS and especially in the arcuate nucleus of the hypothalamus. A repertoire of neurohormonal actions, generated in peripheral tissues and integrated in the CNS, encompasses many peptides with orexigenic and anorexigenic actions. Two main hormones, insulin and leptin, accomplish the fine-tuning of these peptides action at the critical level of body weight and energy control. The high prevalence of insulin resistance and hyperinsulinemia in obesity indicates a causative relationship between these two situations. It seems likely that insulin resistance in muscle cells is the prime "defect" which renders individuals vulnerable to obesity. The high prevalence of insulin resistance, about 25%, among otherwise healthy subjects indicates that this genetically determined "defect" may be the result of an evolutionary selection which rendered mankind capable of surviving during long periods of famine, in his long journey from the hunter-gatherer period of his life to the present time of plenty.

Humans↗

[Late morbidity among Holocaust survivors: myth or fact?].

The harsh life in the ghettos and concentration/extermination camps during the Holocaust was characterized by hunger, exposure to extreme cold temperatures, continuous threats, infectious diseases and injuries with acute or permanent disabilities and extreme psychological stress. There is no definite scientific evidence that the Holocaust survivors are exposed to premature aging or premature appearance of various physical diseases. These aspects were thoroughly investigated in other populations: ex-prisoners of war, ex-displaced persons, prisoners and survivors of torture. Famine, disabilities, diseases and stress, particularly at the beginning of or during puberty, were found to increase vulnerability to later morbidity, especially hypertensive and cardiovascular disease and to increased mortality. This article discusses the possibility of premature aging among Holocaust survivors as a late effect of their life conditions during the Holocaust.

Cardiovascular Diseases↗

Neurobiological implications of eating healthy.

Over the last decades, the importance of food in the development of chronic diseases has been examined, as well as the medical value of eating healthy. The contribution of the eating process itself to health and well-being, however, has not been questioned until most recently. Biology has linked eating to appetitive motivational processes with their underlying neurophysiology, including CNS reward circuitries: Eating uses the pleasure-reward physiology to motivate us to eat. Endogenous opiates, such as morphine, insure our survival by helping us to make eating motivational via pleasure induction. After taking in enough food, we become satisfied, i.e., tolerant to food. Our appetite, and so is our appetence, are then low and need a certain time span to reach their former levels for then inducing food-seeking behaviors, food intake, etc. again. When tolerance passes, we once more engage in this pleasurable process related to positive behavioral motivation. Opioid receptor agonists, however, may induce energy intake even beyond an actual need. This interesting potential of opioidergic signaling may have its roots in biological mechanisms that insured the intake and storage of high energy foods, hence preparing for future famines. In our world of today, however, such neurobiological pathways may pose a threat on our health. Thus, feedback mechanisms, such as tolerance, aversion and satiety, have to be finely tuned. Therefore central autoregulation that involves, for example, limbic mu receptor signaling and other endogenous signaling compounds comes into the focus of modern science. The time where research recognizes the importance of neurobiological pathways such as endogenous opiate autoregulation or CNS reward circuitries for examining the physiology of food intake has yet begun. Many questions remain open and have to be answered through future scientific inquiry.

Diet↗

[The microbiological safety of food products, and environmental factors].

The author of the review analyzes the mechanisms of changes of biological properties of microorganisms causing alimentary infections and intoxications. A complex of environmental factors, such as anthropogenic, technogenic, social, ecological, and climatic ones, are considered to be the main cause of these changes. Food contamination by microorganisms and their toxins is facilitated by climatic warming. The exposure of consumers to food toxins grows, and alimentary infections become more frequent. New classes of alimentary infections have appeared; clinical manifestations and complications of food-related infections have become more serious. Besides, the quality and value of food products may be reduced by lactic acid microorganisms and moulds, whose content in food chains increases due to warming, especially in regions with a high anthropogenic load. From the economic perspective, the behavior of microbial food contaminants under the conditions of climatic warming increase direct losses of agricultural products due to their lesion by microscopic fungi, mycotoxins etc., as well as spoilage microflora. This may result in food shortage and famine in distant regions. The article covers control measures and the management of microbiological risks under the condition of climatic warming.

Environmental Exposure↗

[Syphilis in sixteenth-century in Bologna. Health care and social assistance (Part one)].

Syphilis arrived in Bologna in the summer of 1495, after Fornovo's battle on the Taro where Charles VIII's army, following the invasion of Naples, fought against the anti-French league who faced up to the invaders as they withdrew. It was the battle-weary Bolognesi, prisoners, deserters and probably some prostitutes following the French and mercenary army who introduced the infection into the city. At the beginning of the syphilis epidemic, the disease was very aggressive with particularly visible symptoms and many resulting deaths. Subsequently, contemporaries mention an abatement of this aggressivity in time spans that varied, but in no cases exceeded 60 years. In 1507 Bologna lost its political autonomy, becoming dependent on Rome. This was symptomatic of the upheavals throughout Italy in the sixteenth century. In this situation of economic and institutional crisis the Bolognesi were able to react with decision to the epidemic, re-converting the municipal hospital dedicated to S. Maria dei Guarini during the sixteenth century. This hospital, specializing in treating syphilis, was called "Ospedale di San Giobbe". It was closed in 1798, after the entry of the French army into Bologna. In 1560 the Bolognesi, realising that the most important causes of the spread of syphilis were social degradation, prostitution and poverty, founded another institution for the poor and for the prevention of prostitution. This institution was developed by the Opera dei Mendicanti and provided hospitality during the 1590 famine, in a city of 55,000 inhabitants, for as many as 1400 poor and sick. We also present the cure (guaiac and mercury) that they used at the time against syphilis. In such a difficult historical period beset with political and economic problems, the Bolognesi established two important institutions and showed that social solidarity is a value for the whole population.

Catholicism↗

[Syphilis in sixteenth-century in Bologna. Health care and social assistance (part two)].

Syphilis arrived in Bologna in the summer of 1495, after Fornovo's battle on the Taro where Charles VIII's army, following the invasion of Naples, fought against the anti-French league who faced up to the invaders as they withdrew. It was the battle-weary Bolognesi, prisoners, deserters and probably some prostitutes following the French and mercenary army who introduced the infection into the city. At the beginning of the syphilis epidemic, the disease was very aggressive with particularly visible symptoms and many resulting deaths. Subsequently, contemporaries mention an abatement of this aggressivity in time spans that varied, but in no cases exceeded 60 years. In 1507 Bologna lost its political autonomy, becoming dependent on Rome. This was symptomatic of the upheavals throughout Italy in the sixteenth century. In this situation of economic and institutional crisis the Bolognesi were able to react with decision to the epidemic, re-converting the municipal hospital dedicated to S. Maria dei Guarini during the sixteenth century. This hospital, specializing in treating syphilis, was called "Ospedale di San Giobbe". It was closed in 1798, after the entry of the French army into Bologna. In 1560 the Bolognesi, realising that the most important causes of the spread of syphilis were social degradation, prostitution and poverty, founded another institution for the poor and for the prevention of prostitution. This institution was developed by the Opera dei Mendicanti and provided hospitality during the 1590 famine, in a city of 55,000 inhabitants, for as many as 1400 poor and sick. We also present the cure (guaiac and mercury) that they used at the time against syphilis. In such a difficult historical period beset with political and economic problems, the Bolognesi established two important institutions and showed that social solidarity is a value for the whole population.

Combined Modality Therapy↗

[Petechial typhus. History of men, armies and pedicula].

Since the Classical age, humankind has had to cope with petechial typhus, especially during wars and famine. Epidemics chiefly occurred during sieges and followed the paths of armies, when infected soldiers transmitted the infection to populations with whom they came into contact. Winter exacerbated the disease due to the use of unhygienic woollen clothes that allowed the spread of pediculosis. It was only in the early 18th century that petechial typhus outbreaks diminished thanks to the use of Marseille soap and to the new custom of changing clothing at bedtime. In many military campaigns, deaths from typhus were higher than those due to war wounds: recent studies established that the French defeat during the Napoleonic Russian military campaign has to be attributed more to typhus than to the military superiority of the enemy. Indeed, the contagion is estimated to have affected 80% of the 600,000 troops involved. The role of Pediculus as a vehicle of infection established in 1909 by Charles Nicolle, microbiological isolation performed by Howard Ricketts and Stanislaus von Prowazck, and finally the advent of antibiotic therapy, all laid the basis for controlling the disease in the 20th century.

Animals↗

The Solanaceae: foods and poisons.

The plant family Solanaceae contains important foodstuffs such as the potato, tomato and aubergine, together with powerful poisons including mandrake, henbane and deadly nightshade. In the first article in this short series on the family, the history and importance of the potato are described. It was first cultivated by the Inca people in the altiplano of the Andes in prehistoric times. Then it was translocated to Europe by the Spanish invaders. Originally reviled as'peasant food', it was regarded with great suspicion as an evil plant and a potential cause of leprosy. Over several centuries it gradually became established throughout Britain, France and the continent, and in particular in Ireland, where its growth allowed the population to expand very rapidly between 1750 and 1850. In the late 1840s, nemesis arrived in the form of the potato blight and the Irish famine. The 'tatties' went black, a great hunger ensued and thousands died. Later, the causative fungus was isolated and steps were taken to avoid further similar disasters. It is not generally appreciated that potatoes can be poisonous if they are turning green or sprouting (chitting). The tuber is then producing toxic quantities of the alkaloid alpha-solanine. The clinical syndrome of potato poisoning is described briefly.

Europe↗

[Effect of nutritional status during infancy and childhood on the risk of overweight and obesity in adulthood].

OBJECTIVE: To examine the association between fetal nutritional status and overweight and obesity in their adulthood and to provide evidence for formulation of the strategy on preventing low birth weight. METHODS: Using data from 2002 Nationwide Nutrition and Health Survey to set up a case-control method in order to compare body mass index(BMI), prevalence of overweight and obesity as well as to calculate odds ratio of overweight and obesity of case group compared with control group. Three case groups were selected from those who were born in 1959, 1960,1961 respectively, and the controls were those who were born in 1964. RESULTS: The health consequence of being famines on adulthood was evident in women. Means of BMI in women were significantly higher in three case groups than that in control group(P<0.01). After adjustment on geographic regions, the prevalence of overweight in women was significantly higher in three case groups than that in control group(P< 0.01). The prevalence rates of obesity were significantly higher in 1959, 1960 groups than 1964 group(P< 0.05). The odds ratios of overweight of women in three case groups were 28.9% (95% CI:1.063-1.565), 37.2% (95% CI:1. 136-1.658) and 35.2% (95% CI: 1. 103-1.657) respectively, all higher than that in the control group. The odds ratios of obesity of women born in 1959, 1960 groups were 46.5% (95% CI: 1.088-1.972) and 39.6% (95% CI: 1.039- 1.876) respectively, higher than that in the 1964 group. However, such differences were not found in men. CONCLUSION: Higher risks of overweight and obesity in women were caused by malnutrition during their fetal lives. A strategy on preventing low birth weight should be formulated by the government to prevent the chronic disease in adulthood.

Adult↗

[Demographic changes and health management].

Since our Constitution declaration in 1978 and General Law for Health in 1986, to date, the Spanish society has undergorne marked social changes. Socio-economic and health indicators in Spain have also improved as to an increased life expectancy, important reduction in infant mortality, and favourable changes reported in the national Health Survey. Risk factors influence the main causes of death, thus it is said that "man does not die but it kills himself". Healthy health practices are specified, and there is empirical evidence of greater disability-adjusted life years, a better adherence to Mediterranean diet, no smoking, moderate consumption of alcohol, enough time of sleeping, weight control, avoiding obsity and overweight, and increased physical activity, all the above practices achieving a healthier life. At a global scale in the world we live, famine has no frontiers, and fighting against this plague can not await longer. Overall, health and poverty are correlated and it must be overcome for reasons of human dignity, universal rights (even in ius gentium), and ethical dimension as normative of new socio-economic structures. Present must be transformed to recover hope in ou global world, still hungry, and in need of justice, enlightenment and solidarity.

Adolescent↗

Population structure of the Peljesac Peninsula, Yugoslavia.

We gathered serogenetic and parent-offspring migration data from 604 residents of 7 villages on the Peljesac peninsula in southern Yugoslavia. A variety of population genetics and multivariate statistics models and procedures give a concordant picture of the population structure of this region. Extensive migration is the dominant microevolutionary force patterning the variation seen today. Multiple population bottlenecks have also occurred over the past few centuries as a result of disease, famine, war, economic failure, and founder events, making it likely that genetic drift has been an important factor in the history of this population system.

Adult↗

[Inequalities regarding death in the past].

Was mortality differentiated socio-economically in past centuries, as it is nowadays? The issue has been hotly debated. Certain demographers admitted that, periods of famine excepted, the death risk was evenly distributed among the ancient populations, regardless of wealth, instruction or social status. On the other hand, the research project currently carried out at the French National Institute of Demographic Studies is evidencing wide mortality social differentials in the 19th century. In Paris, male life expectancy at the age of 40 reached 29.7 years for the nobility and bourgeoisie, but decreased to 25.6 years among merchants and 23.7 years among workers and day-labourers. Generally speaking, regional differentials were less pronounced than socioeconomic differentials. Mortality decline was found among the elites: life expectancy at 40 of the Knights of the Holy Spirit, for instance, increased to 30.8 years in the 18th century, from 27.8 years in the 16th century. The same life expectancy today (at 40 years of age) reaches 35.7 years among French professionals. The main problem with this kind of research is how to identify and collect relevant information. The researchers make use here of marriage registers from the past century. These registers recorded not only particulars of the married couple but also those of their parents (occupation, age, and date of death, if any). This information allows the calculation of mortality rates (and life expectancy) of ancient birth cohorts in various occupational groups. The primary condition is that the registers have been well kept and soundly stored until now. This is the case in certain city halls: the 4th arrondissement of Paris (1860-1863), Ivry-sur-Seine (1817-1823)... etc...

Female↗

Overseas relief organizations: a guide for health care providers.

Spending time overseas providing health care to people in disaster or famine-related situations can be a very rewarding experience. This article presents lists of various organizations available for health care professionals who wish to spend time in relief work. The lists include qualifications and/or professional needs, locations, lengths of service, and focuses of the organizations. Some of these organizations provide a stipend for the relief worker. In others, the entire cost of the experience must be paid for by the volunteer. Guidelines are given to assist the prospective relief worker in looking for an appropriate agency, such as to obtain a complete job description; know the details of living arrangements; make sure you have compatible philosophies; ask about health concerns; find out if adequate health insurance is provided; and gain knowledge of the culture (e.g., especially about customs, relationships of nationals to relief workers, and religious beliefs). Interested health care providers can write to any of the organizations to obtain further information.

Disasters↗