Poverty and disease are bound together in rural communities of sub-Saharan Africa (SSA) exacerbated by weak social services and conflict. The infectious disease burden in SSA combines the neglected tropical diseases (NTDs) and the 'big three' (malaria, HIV/AIDS and tuberculosis), so-called because they attract more global attention and hence funding. NTDs include human African trypanosomiasis (HAT or sleeping sickness), first noticed by the outside world during the slave trade era and later in the 2-th century by widespread epidemics of disease across the tsetse fly belt. HAT describes two diseases: i) Gambian HAT caused by Trypanosoma brucei gambiense is characteristically chronic with an infectious period lasting up to three years and ii) Rhodesian HAT caused by T.b. rhodesiense is an acute disease, killing its victim within weeks of infection. The two diseases are frequently considered together as both are transmitted by tsetse flies, the parasites are morphologically indistinguishable and the associated diseases are both fatal if left untreated. However, the two diseases are clinical, epidemiologically and geographical distinct, each requiring different control strategies. Under field conditions, where microscopy is the basic diagnostic tool, differentiation is simply by geographical location of the patient; the Great Rift Valley separates the Gambian disease present in West and Central Africa, from East and southern Africa's Rhodesian disease. Control strategies are also distinct; while the Belgian and French colonial strategies to control the disease were patient-centred, the British colonial powers in East Africa were motivated by the effect of tsetse borne diseases on animal health. Towards the end of the colonial ear, both types of disease were heading for elimination but during the immediate post-colonial era in the 1960s, political instability compromised the rigid HAT control programs that had been put in place. For zoonotic Rhodesian sleeping sickness, complex tsetse control programmes proved difficult to maintain and to justify economically; for Gambian sleeping sickness the generalised breakdown of medical services allowed the disease to return, sometimes to devastating levels. The millennium development goals (MDGs) set out in 2000, highlighted specific challenges and opportunities for national and global development. HAT impacts national health goals of national development plans and MDGs and impedes rural development of SSA. NTDs were not addressed directly by MDGs but the World Health Organization (WHO) has reaffirmed its commitment not only to control of HAT but also to eliminate it as a public health problem by 2020. Currently there are 25 countries reporting HAT to WHO, and while the overall prevalence of HAT across Africa continues to fall, epidemics have been recorded, particularly from central Africa, South Sudan and Uganda. Uganda is uniquely, the only country affected by both T.b. gambiense and T.b. rhodesiense and until the present study, there was no evidence to suggest that the two parasite species co-existed in Uganda. The development of a new control paradigm for T.b. rhodesiese in South East Uganda has lowered the incidence of human infections and, more importantly, halted the northerly spread of this parasite. However, recurring epidemics in several established and new disease foci in central Uganda highlight the difficulties involved in eliminating this disease. The present study assesses past and present HAT control strategies centred on Dokolo, Kaberamaido and Soroti Districts located at the centre of Uganda. These districts are highly endemic for T.b. rodesiense, they represent the region of concern for overlap with T.b. gambiense foci in central Uganda, and are the current focus of the Stamp out Sleeping sickness control initiative. The point prevalence of T. brucei s.1 in cattle reservoir from villages with (out) reported human disease located at specific distances to Otuboi, Chagwere and Ochero cattle markets, was evaluated before and six months after trypanocidal treatment, to assess the transferrable impact of zoonotic T.b. rhodesiense to the human population. Overall, the proportion of T. brucei s.1 in cattle dropped significantly from 22% at baseline to 9% six months after trypanocide treatment (P < 0.05, Chi-square + 17.92, 95% C.I. + 1.71 to 4.49). All villages located in sub-counties that received at least 80% treatment coverage had a drop in T. brucei s.1 prevalence from 30.4% (95%, C.I + 22.8 to 38.0) before treatment was done, to 12.9% (95%, C.I. + 7.4 to 18.4) six months after treatment. More specifically, impact on human infective T.b. rhodesiense was also halved. In fact only three cattle were detected with the parasite six months after treatment compared with six from those sampled as baseline. This study also utilises documented cases between 2009 and 2012 to assess the current HAT reporting system for monitoring and evaluating transmission dynamics of the disease. Using a questionnaire, capacity and preparedness of healthcare professionals to respond to disease epidemics was assessed. The point prevalence of sleeping sickness in the three districts in 2009 was determined by screening volunteers. Microscopic examinations detected trypanosomes in four volunteers (4/5311 or 0.075 %) while PCR detected significantly more infections (24, p < 0.001). Multiplex PCR showed that ten of the Trypanozoon infections were T.b. rhodesiense while nested PCR identified four infections as T.b. gamiense, indicating that the distribution of the two forms of sleeping sickness overlaps in Uganda. Second phase investigations followed up the PCR positive cases; these people were screened again, together with members of their homestead and the inhabitants of three neighbouring homes. Besides microscopy and PCR, study subjects were examined clinically for sleeping sickness and completed a questionnaire to assess community recognition of the disease. This extended screen revealed no new cases underlining the importance of stringent early screening that PCR techniques can provide. At local healthcare centres, 54% of reported sleeping sickness cases were diagnosed only at the late stage, indicating a weakness in early diagnosis and hence early reporting. Interviews with local health workers also revealed weaknesses in recognition of clinical signs and a gap in diagnostic capacity. While records at treating hospitals remain a useful indicator for targeting active foci of infection, improvement in capacity to diagnose HAT at an early stage should contribute both to rural health and disease control strategies and also towards WHO's 2020 target of elimination of HAT.

Ao tomar referÃncia à abordagem psicanalÃtica, esta pesquisa se propÃe a uma revisÃo bibliogrÃfica sobre Os Sentidos do Adoecer: refazendo o percurso freudiano, escolhendo como objetivos investigar os sentidos, os mecanismos e as manifestaÃÃes envolvidas no Ãmbito do adoecer psÃquico. A metodologia baseia-se numa pesquisa qualitativa feita atravÃs de uma anÃlise de conteÃdo de um total de 75 resumos selecionados. Buscam-se, em cada resumo, os significados de conteÃdo; escolhem-se dez Ãreas temÃticas articuladas: Adoecer, PulsÃo, Vida/Morte, Dor/Sofrimento, Perdas/Luto, Sintoma, Trauma, Narcisismo, CompulsÃo à repetiÃÃo, Corpo, priorizando-se quatro dessas Ãreas que apresentam uma ligaÃÃo maior com o estudo, quais sejam: Adoecer, PulsÃo, Sintoma e Corpo. A pesquisa aponta a relaÃÃo do adoecer psÃquico com o ârepresamento da libidoâ, refletindo a existÃncia do mecanismo de adoecimento e da formaÃÃo do sintoma. O processo de adoecimento envolve uma dessexualizaÃÃo das funÃÃes egÃicas (as de autopreservaÃÃo e as pulsÃes libidinais), alÃm de ocorrer tambÃm uma vivÃncia desfusional das pulsÃes de vida e de morte, tendo as pulsÃes parciais como conseqÃÃncias dessa fragmentaÃÃo. Os destinos das pulsÃes sugerem uma ligaÃÃo com o adoecimento psÃquico, provocando manifestaÃÃes patolÃgicas como as neuroses traumÃticas, os fenÃmenos da compulsÃo à repetiÃÃo, a forÃa das resistÃncias, a presenÃa dos conteÃdos neurÃticos e seus estados mÃrbidos de sofrimento. / By referring to a psychoanalytic approach,this reaserch proposes a bibliographic rewiew about the signs of sickness: remaking the Freud investigation,choosing as goals to investigate the meanings of psychological diseases, their mecanisms and psychological manifestations involved in the scope of neurotic diseases.The methodology is based on a qualitative reseach done by the analysis of content of a total of 75 selected summaries. In each of these summaries, the meanings of the content are reseached. Ten articulated the areas were chosen:sickness, pulsion, life/death, pain/suffering, loss/mourning, symptom, trauma, narcisism, compulsion to repetition, body, being emphasized the following areas: sickness, pulsion, symptom and body.The reseach points out the relation between the psychological sickness and the opression of the lust,reflecting the existance of the mecanism of sickness and the formation of the symptom.The process of sickness involves a lack of sexual desire, and also a misfunction in the living of the pulsions of life and death, and this fragmentation leads to partial pulsions. The destinies of the pulsions suggest a connection with the psychological sickness,causing pathological manifestations like traumatic neurosis,compulsion to repetition,force of resistences,neurotic contents and their state of morbid suffering.

The purpose of this study was to determine if arterial oxygen saturation (SaO2), as measured by a finger pulse oximeter upon rapid arrival to 4260 m, could be predictive of acute mountain sickness (AMS) or summit success on a climb to 5640 m. In total 73 climbers volunteered to participate in the study. After excluding those taking drugs to counteract the effects of AMS and those with missing data, 48 participants (45 male, 3 female) remained. Climbers were transported from 2650 m to the Piedra Grande hut at 4260 m on Pico de Orizaba within 2 hr. After a median time of 10 ± 13 hr at the hut, they climbed toward the summit (5640 m) and returned with a median trip time of 13.3 ± 4.8 hr. The Lake Louise Self-assessment Questionnaire (LLSA) for AMS, heart rate, and SaO2 from a finger pulse oximeter was collected upon arrival at the hut, repeated immediately before the climbers departed for their summit attempts, and immediately upon their return. The presence of AMS was defined as a LLSA score ≥ 3 with a headache and at least one other symptom. Fifty-nine percent of the participants successfully reached the summit. Average SaO2 for all participants at 4260 m prior to their departure for the summit was 84.2 ± 3.8%. Sixty percent of the participants met the criteria for AMS during their ascent. There was not a significant difference (p = .90) in SaO2 between those who experienced AMS (SaO2 = 84.3 ± 3.3%) and those who did not (SaO2 = 84.2 ± 4.2%) during the ascent. Neither was there a significant difference (p = .18) in SaO2 between those who reached the summit (84.8 ± 3.7%) and those who did not (83.3 ± 4.0%). Arterial oxygen saturation does not appear to be predictive of AMS or summit success.

<p>Tidigare forskning om sjuknärvaro har pekat på både inre personlighetsegenskaper och yttre arbetsrelaterade faktorer som betydelsefulla för fenomenet. Syftet med föreliggande enkätstudie, genomförd på tre arbetsplatser i Mellansverige (N = 76), var att undersöka sjuknärvarons samband med villkorlig självkänsla, baserad på prestationer eller relationer, samt med olika yttre faktorer. Även sjukfrånvaro, som visat sig vara nära knuten till sjuknärvaro, samt självskattad hälsa, beaktades. Resultatet visade att sjuknärvaro inte var relaterad till någon typ av villkorlig självkänsla och av yttre faktorer var det endast upplevelsen av arbetsplatsen som en viktig social funktion som visade ett signifikant samband med sjuknärvaro. Låg självskattad hälsa däremot var relaterad till sjuknärvaro samt prestationsbaserad självkänsla. Framtida forskning bör vidare undersöka den villkorliga självkänslans relation till sjuknärvaro.</p>

The concept of sickness behavior offers a framework to view both the neurovegetative and psychological symptoms that accompany illness as a common entity that results from increased inflammatory activation. Despite the prevalence of sickness behavior in medical populations, to our knowledge this study provides the first attempt to develop a standardized measure to assess sickness behavior using standard self-report questionnaires commonly used with cancer patients. The set of items included in the measure match theoretical conceptualizations of sickness behavior and target symptoms that comprise anhedonia, depressed mood, cognitive dysfunction, social disinterest, fatigue, low libido, poor appetite, somnolence, sensitivity to pain, and malaise. The measure showed high internal consistency, adequate test-retest reliability, and good convergent validity with both psychological and biological correlates. A confirmatory factor analysis also determined that a two-factor, rather than a single-factor measurement model, encompassing a physical and a psychological sickness symptom dimension, accounted for sickness behavior. Future psychometric work is still needed to further validate this new practical assessment tool. Descriptive analyses revealed relatively low levels of sickness behavior symptoms in the sample as a whole with both physical and psychological sickness behavior symptoms exhibiting a significant linear decrease over time. As expected, both physical and psychological sickness behavior symptoms showed associations with two pro-inflammatory cytokine markers, IL6 and TNF-alpha and a neuroendocrine marker, cortisol. Longitudinal associations suggest that higher levels of the pro-inflammatory cytokine TNF-alpha may impact the progressive decline of physical sickness symptoms over time with symptoms taking longer to disappear. Because cortisol was associated with more rather than less physical sickness symptoms, results raise the question of whether the anti-inflammatory neuroendocrine activity may be dysregulated in breast cancer survivors. The mechanistic basis for these associations requires further examination. In this study it was also evaluated whether a cognitive behavioral stress management intervention and relaxation training intervention could reduce sickness symptoms over time. Breast cancer survivors were assessed at baseline and then randomly assigned to a 10-week cognitive behavioral stress management intervention (N = 70) or a 1-day control condition (N = 55). Psychosocial measures, urine, and blood were obtained from participants at 3 months, 6 months, and 12 months post-intervention to assess relevant behavioral, endocrine and immune variables. Relative to the control group, the experimental group showed marginally more prevalence of physical sickness behavior symptoms in the short term (post-intervention, 3-months; p = .08) and a steadier decline of symptoms in the long-term (15-month follow-up period). The adaptive nature of sickness behavior as a motivational strategy that helps restore homeostatic balance in the long run may be one possible interpretation of these results. Whether these intervention effects on sickness behavior were mediated by changes in pro-inflammatory cytokines or cortisol was examined but not supported by these data and needs to be further examined in future studies.

Linfection par le circovirus du pigeon (PiCV) observée régulièrement chez le jeune pigeon voyageur et de chair a été décrite dans le monde entier et est généralement considérée comme un facteur important du déclenchement du syndrome de la maladie des jeunes pigeons (YPDS). En utilisant un test sensible damplification en chaîne par polymérase (PCR), la présence de lacide désoxyibonucléique (ADN) viral du PiCV a été mise en évidence chez 13 embryons sur les 66 examinés. Par contre, aucune mise en évidence de lADN viral na été possible à partir des écouvillons de jabot prélevés chez 64 pigeons adultes nourrissant des jeunes âgés de 1 à 10 jours. LADN circoviral a également été détecté chez un nombre élevé de sujets adultes (30 sur 39 pigeons examinés) et a été le plus souvent détecté dans les organes respiratoires, incluant la trachée, le pharynx et les poumons, puis dans les tissus de la rate, des reins et du foie. Il a également été détecté dans lovaire et/ou les testicules de quelques sujets. Les tests réalisés sur des écouvillons cloacaux et pharyngés et des échantillons de sang récoltés immédiatement avant leuthanasie des pigeons adultes nont pas permis de détecter tous les oiseaux trouvés positifs lors des examens réalisés post mortem. Des tests complémentaires réalisés par PCR sur des écouvillons cloacaux prélevés séquentiellement sur 19 jeunes pigeons ont montré que 4 sujets excrétaient du virus à lâge de 15 jours pour un seul au moment du sevrage, à lâge de 28 jours. Par contre la détection de lADN viral dans les écouvillons cloacaux a atteint 100 % chez les jeunes âgés de 51 jours. Lors de la vaccination de jeunes pigeons naturellement infectés au moyen du Colombovac Paratyphus®, aucun signe clinique ni aucune différence statistique nont pu être mis en évidence entre le nombre de pigeons vaccinés et de témoins non vaccinés quant aux écouvillons et échantillons sanguins prélevés sur les oiseaux vivants et trouvés positifs par PCR, ainsi que sur les tissus examinés lors de lautopsie. Une méthode PCR quantitative basée sur la technologie SYBR Green a été développée et la validation de cette méthode sur divers échantillons tissulaires issus de jeunes pigeons présentant des symptômes du YPDS a révélé des quantités importantes de copies de génome dans certains tissus, jusque 2,88 x 10^8 copies par milligramme de foie, 5,57 x 10^8 par milligramme de rate et jusque 2,07 x 10^9 copies par milligramme de bourse de Fabricius (BF). Pour le foie, la BF et le sérum, la charge virale était significativement plus élevée chez les pigeons malades que chez les oiseaux apparemment en bonne santé. De lADN circoviral a également été mis en évidence en grande quantité dans le sperme (jusque 1,0 x 10^7 copies par éjaculat) et sur les écouvillons cloacaux prélevés chez de jeunes pigeons (jusque 3,6 x 10^10 copies par écouvillon)confirmant par un apport chiffré les observations faites lors des deux premières études sur la transmission verticale et horizontale du virus. Lanalyse de sérums de pigeons prélevés en 1991 en Belgique a montré la présence du virus six ans avant le premier diagnostic histologique. Un test dimmunofluorescence indirecte (IIF) basé sur la détection de la protéine de capside du PiCV obtenue en utilisant le système baculoviruscellules dinsecte et permettant la titration des anticorps dirigés contre la capside du PiCV a été développé. Vingt-sept des 28 sérums examinés et provenant de pigeons naturellement infectés par le PiCV, dont 4 présentaient des symptômes du YPDS, ont été trouvés positifs à des titres exprimés en logarithme de base 2 variant de 4 à 8 unités. Seul un jeune pigeon malade âgé de 4 semaines était dépourvu danticorps mesurés par IIF. Enfin, la mise au point dun vaccin plasmidique codant la protéine de capside du PiCV a été réalisée en clonant le gène ORF C1 du PiCV dans le plasmide pcDNA 3.1/H5-HIS/TOPO. Lexpression de la protéine de capside a été mise en évidence par IIF après transfection de cellules PK15. Deux groupes de 5 souris femelles, âgées de 6 à 8 semaines (BALB/c) ont été immunisées par voie intramusculaire (IM), dont un groupe vacciné avec le plasmide adjuvé par le phosphate daluminium. Après 2 et 4 immunisations les anticorps ont été mesurés par IIF et il a été noté que ladjuvant avait stimulé la réponse immunitaire de manière conséquente. Ces résultats constituent un premier pas encourageant pour lobtention dun vaccin potentiel chez le pigeon. En conclusion, limportance du mode de transmission verticale du circovirus du pigeon essentiellement via loeuf embryonné a été démontrée. Néanmoins, la plupart des jeunes sinfectent dans le colombier pendant la période de postsevrage. Les tests réalisés sur les futurs reproducteurs ne permettent pas lexclusion des pigeons adultes infectés des programmes de reproduction et rendent donc léradication du virus difficile. La vaccination au moyen du Colombovac Paratyphus® ne doit pas être considérée comme un facteur modifiant le déroulement de linfection par le PiCV. La détection de quantités relativement importantes dADN viral pourrait être corrélée au statut clinique du pigeonneau infecté par le PiCV. Le rôle de limmunité humorale spécifique devra être précisé quant à lexpression ou non de linfection. Enfin, les modalités dapplication du vaccin plasmidique, testé sur souris, doivent encore être déterminées expérimentalement chez le pigeon.

Tidigare forskning om sjuknärvaro har pekat på både inre personlighetsegenskaper och yttre arbetsrelaterade faktorer som betydelsefulla för fenomenet. Syftet med föreliggande enkätstudie, genomförd på tre arbetsplatser i Mellansverige (N = 76), var att undersöka sjuknärvarons samband med villkorlig självkänsla, baserad på prestationer eller relationer, samt med olika yttre faktorer. Även sjukfrånvaro, som visat sig vara nära knuten till sjuknärvaro, samt självskattad hälsa, beaktades. Resultatet visade att sjuknärvaro inte var relaterad till någon typ av villkorlig självkänsla och av yttre faktorer var det endast upplevelsen av arbetsplatsen som en viktig social funktion som visade ett signifikant samband med sjuknärvaro. Låg självskattad hälsa däremot var relaterad till sjuknärvaro samt prestationsbaserad självkänsla. Framtida forskning bör vidare undersöka den villkorliga självkänslans relation till sjuknärvaro.

The purpose of the present study is to assess the role of the concepts of health and sickness in Nietzsche&rsquo / s philosophy. While doing this, our basic presupposition will be that these concepts owe their special place to their being the new criteria for Nietzsche&rsquo / s project of revaluation of all existing values. Nietzsche was philosophizing in the face of the crisis of 19th century Europe, that is, nihilism. According to him, Western traditional thought is based on an otherworldly oriented conception of life the values of which are nothing but a negation of life. Although these values had served man&rsquo / s justification of living for a long time, they reached their expiration by the &lsquo / death of god&rsquo / resulting from the materialistic tendency of the flourishing natural sciences of the 19th century. The &lsquo / death of god&rsquo / paved the way for a devaluation of once most valuable values, of which the most notable are &lsquo / good&rsquo / and &lsquo / bad&rsquo / . Thus, Nietzsche&rsquo / s project of revaluation needs new evaluative criteria as well, which is &lsquo / health&rsquo / and &lsquo / sickness&rsquo / . In this study, I will argue that, Nietzsche situates a physiological understanding of these concepts at the very heart of his revaluation and their somehow metaphorical application to culture and modern society is based on a physiological conception of them as well.

Every year an avorage of 40 000 Swedes fall ill with different forms of cancer. Chemotheraphy has an effect on the tumour cells as well as the healthy cells in the body, this causes many side effects which can be very problematic for the patient. The study was carried out in order to indicate the care measures that are taken to deal with the side effects i. e stomatit, loss of hair and sickness/vomiting, that are connected with chemotheraphy so that the outpatients will experience a quality of life. The method used was a qualitative interview with six nurses from the South if Sweden, all of whom are working with chemotheraphy patients. The results showed that the nurses thought that quality of life was individual, in their care work the patients needs and valuations were used as a starting point. Aside form the specific care measures for respective side-effects they put an emphasis on talking and giving information to patients. In addition, they indicated the relationship they had with their patients. Accordi ng to them a good relation to the patient is a prerequisite of good care work.

The following report documents the inspiration, themes, preparation, and challenges faced in writing the feature length screenplay Horse Latitudes. This is the story of a young woman who works as a spam writer for an advertising agency. In hopes of moving up in the company, Cairo begins working undercover for her boss, writing erotica blog entries for his personal website. She begins using the people closest to her for material, thus betraying her own morals. As she descends deeper into debt to her boss, she becomes physically ill until she can no longer survive in the world she has created. This is a story based on the author’s own experiences of working for a spam company and being committed to a hospital. This report also includes supplemental planning documents used in the final draft. / text