Applying medical anthropology in the control of infectious disease

This paper focuses on two roles of anthropology in the control of infectious disease. The first is in identifying and describing concerns and understandings of disease, including local knowledge of cause and treatment relevant to disease control. The second is in translating these local concerns into appropriate health interventions, for example, by providing information to be incorporated in education and communication strategies for disease control. Problems arise in control programmes with competing knowledge and value systems. Anthropology's role conventionally has been in the translation of local concepts of illness and treatment, and the adaptation of biomedical knowledge to fit local aetiologies. Medical anthropology plays an important role in examining the local context of disease diagnosis, treatment and prevention, and the structural as well as conceptual barriers to improved health status. National (and international) public health goals which respect local priorities are uncommon, and generic health goals rarely coincide with specific country and community needs. The success of interventions and control programmes is moderated by local priorities and conditions, and sustainable interventions need to acknowledge and address country-specific social, economic and political circumstances.     

Global progress in infectious disease control

There is both good news and bad news concerning infectious disease control globally. The good news is that smallpox has been eradicated, eradication of poliomyelitis and guinea worm disease is on track, and many infectious diseases are under effective control in much of the world. The advances are primarily the result of improved sanitation, effective use of vaccines, and introduction and use of specific therapies (whose impact has primarily been on mortality, rather than incidence). The bad news is that infectious diseases are still the leading cause of death world-wide, new diseases are emerging, old diseases are re-emerging, there are ominous interactions between diseases, and antibiotic resistance is emerging as a major problem. There are many promising developments for the future, including new and improved vaccines, new specific therapies, and new strategies to deal with infectious disease. However, unless eradicated, infectious diseases remain a threat and require continuous efforts to be kept under control. Given the ability of infectious agents to evolve, it is certain that the future will also hold new problems and new diseases.     

Incorporating gender in the anthropology of infectious diseases

The paper focuses on key issues in research and control of infectious diseases and demonstrates the utility of combining a gender perspective with anthropological investigation both for understanding disease and for designing and evaluating interventions for its control. Based on a definition of gender as opposed to sex, it illustrates, with the help of a gender framework for tropical diseases, how this concept is applied. It argues that gender-sensitive research is essential to the understanding of the nature of the disease, its prevalence, distribution, determinants and consequences. Examples are taken from anthropological studies on infectious diseases, including research on urinary schistosomiasis, malaria, leprosy, leishmaniasis and onchocerciasis. How gender-sensitive qualitative research can guide the design and evaluation of appropriate interventions for the prevention and control of infectious diseases is also discussed.     

关于传染病的预防

根据我国<传染病防治法>(1989年发布)的规定,预防、控制和消除传染病的发生与流行是各级医务人员的神圣职责.因此临床医师在搞好临床诊断与治疗工作的同时,也应努力做好传染病的预防工作.传染病预防措施可分为:①疫情未出现时的预防措施;②疫情出现后的防疫措施;③治疗性预防措施.     

Legislation on infectious diseases control

Providing education for intravenous therapy without offering redundant courses is a concern for staff development educators. The consortium approach maximizes resources, provides a standard and consistent level of intravenous training, and provides a cost-effective remedy. Problems, solutions, and benefits to students, educators, and hospitals are described in this article. Emergent issues are also discussed.     

A disease management case study in infectious disease

One of the earliest attempts at risk sharing between a managed-care organization and a pharmaceutical company is the infectious disease management program developed since late 1993 by Intergroup of Arizona and Eli Lilly and Company (Indianapolis, Indiana) in conjunction with the Center for Pharmaceutical Economics at The University of Arizona (Tucson, Arizona) and other entities. In the first phase of the program, protocols were built around eight infectious disease states, and it was recognized that second-line antibiotics were often prescribed when more economical first-line antibiotics would be equally effective. The second phase of the program emphasized developing treatment algorithms focused on patient outcomes, using merged medical and pharmacy claims databases to determine the effects of the antibiotic changes. To implement the program successfully, some significant shifts in corporate, medical, and patient mind-sets had to be addressed. A primary goal was to encourage a movement from a rebate, volume-driven, cost structure to a shared-risk, appropriate-use, reimbursement method in which both managed-care and the pharmaceutical company incentives could mesh as far as possible. Over the long term, it is hoped that this project will lay the groundwork for other disease management programs for high-impact, frequently occurring diseases.     

Applied infectious disease epidemiology in Germany

Applied epidemiology emphasizes the study of the distribution and determinants of disease and health in populations and the application of this study to the control of health problems of immediate public health consequence. Outbreak investigation symbolizes the use and methodology of applied epidemiology for public health. The steps of an outbreak investigation are summarized. Development of a network for applied infectious disease epidemiology involving health departments and other institutions is being built in Germany through epidemiologic training, building communication systems, providing support for outbreak investigation, development of national reference laboratories, and building a comprehensive research program.     

Ehrlichiosis: a new infectious disease

Human ehrlichiosis is transmitted by ticks. For the first time it was described in 1987. The ethiologic agent is Ehrlichia chaffeenisis. The course of the disease may be mild, self-limited or sometimes severe finishing with dead. The main symptoms are: fever, leucopenia, thrombocytopenia, or pancytopenia. Tetracyclines are mostly efficient in the treatment.     

Bradykinin and nitric oxide in infectious disease and cancer

Vascular pathophysiology at the sites of bacterial infection and cancerous tissues share numerous common events similar to inflammatory tissue. Among them enhanced vascular permeability is the universal and hallmark event mediated by bradykinin. All 16 or more bacterial or fungal proteases we have examined activated one or more steps of the kinin generating Hageman-factor-kallikrein cascade. In the meantime, most of the microbial proteases rapidly inactivated various plasma inhibitors such as alpha 1-protease inhibitor and alpha 2-macroglobulin. In addition to the extracellular proteases, bacterial cell wall components (negatively charged LPS) of gram-negative bacteria and teichoic acid moieties of gram-positive bacteria activate the Hageman-factor-kallikrein system and exert hypotensive effects via kinin generation. Endotoxin (LPS) also induces nitric oxide synthase (NOS) which appears to exhibit a rather slow, but significant, effect in relaxing the vascular tone of the infected animal (thus hypotension). Furthermore, bacterial proteases can activate the matrix metalloproteinase (collagenase) resulting in exacerbation of tissue injury in the diseased animal. Many tumor cells or tissues excrete plasminogen activator, and hence activate plasminogen. The plasmin thus generated activates procollagenases, as well as the Hageman-factor-kallikrein system, resulting in pronounced extravasation. Fluid accumulation in pleural and ascitic carcinomatoses is largely due to the activated bradykinin-generating system. We can also demonstrate and control enhanced vascular permeability using kallikrein inhibitors, especially the polymer-conjugated soybean trypsin inhibitor which exhibits a prolonged plasma t1/2, kinin antagonists, NOS inhibitors, NO scavengers, inhibitors of prostaglandins and others. Bacterial proteases induce shock in mice which can be prevented by the soybean trypsin inhibitor by blocking the kallikrein-kinin cascade. Therapeutic use of kinin antagonists and a kallikrein inhibitor has been made for infectious diseases such as septicemia and in tumor pathology.     

Is gastric lymphoma an infectious disease?

In a 10-year-old ovariohysterectomized standard Schnauzer, the finding of dexamethasone-resistant hypersecretion of cortisol, the results of computed tomography, and elevated plasma concentrations of ACTH suggested the presence of both adrenocortical tumour and pituitary-dependent hyperadrenocorticism. The dog made an uneventful recovery after bilateral adrenalectomy and remained in good health for 31/2 years with substitution for the induced hypoadrenocorticism. Then the enlarged pituitary caused neurological signs and eventually euthanasia was performed. The surgically excised right adrenal contained a well-circumscribed tumour of differentiated adrenocortical tissue and in the left adrenal there were two adrenocortical tumours and a pheochromocytoma. The unaffected parts of the adrenal cortices were well developed and without regressive transformation. At necropsy there were no metastatic lesions. The cells of the pituitary tumour were immunopositive for ACTH and had characteristics of malignancy. The present combination of corticotrophic tumour, adrenocortical tumours, and pheochromocytoma may be called 'multiple endocrine neoplasia' (MEN), but does not correspond to the inherited combinations of diseases known in humans as the MEN-1 and the MEN-2 syndromes. It is suggested that the co-existence of hyperadrenocorticism and pheochromocytoma may be related to the vascular supply of the adrenals. Some chromaffin cells of the adrenal medulla are directly exposed to cortical venous blood, and intra-adrenal cortisol is known to stimulate catecholamine synthesis and may promote adrenal medullary hyperplasia or neoplasia.     

Individual differences in utilizing control to cope with job demands: Effects on susceptibility to infectious disease.

This study examined the interactive effects of job demands, control, and individual characteristics on upper respiratory illnesses and immune function. Having high job control appeared to lessen the linkage between job demands and poor health among individuals with high self-efficacy and those who perceived that they were not often responsible for negative job outcomes. Conversely, having high job control exacerbated the association between job demands and poor health among inefficacious individuals. Implications for promoting more healthful work environments and facilitating employee coping are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of time-series analysis in infectious disease surveillance

This study evaluates the impact of rice fields in the city of Bouaké on anopheline fauna and malaria transmission. The Anopheles species represents between 11.4 to 39.2% of mosquitoes in the districts with rice fields and 5.2 to 47.8% in lowland districts with market-gardening. An. gambiae constitutes more than 98% of anopheline population in the city. In the lowland districts with market-gardening, biting rates of An. gambiae varied from 3650 to 6935 bites per man per year. Seasonal variations were correlated with rainfall. The mean annual parturity rate was 72% and the mean sporozoitic index 2%. Malaria transmission started at the beginning of the rainy season and attained its height during the second half of this season. Depending on the district, inhabitants were infected with 78 to 134 bites per year. The mean biting rate of An. gambiae in the districts with rice fields varied from 4745 to 22,630 bites per man per year. Seasonal variations were not correlated with rainfall, but with the growth of rice and the two annual cycles of rice cultivation. The parturity rates of the population of An. gambiae were low (46.2% to 57.2%), especially after rice transplantation. The mean infection rates were between 0.7 and 1.0%. The transmission period covered 7 to 11 months depending on the district with two annual peaks observed at the end of rice cultivation. Inhabitants were infected with 44 to 155 bites per year. Rice fields in Bouaké do not seem notably to have modified malaria transmission in the city.