Looking through the lens of social science approaches: A scoping review of leishmaniases and Chagas disease research.

Scholars have called for increased attention to sociocultural, economic, historical, and political processes shaping Neglected Tropical Diseases (NTDs) ecology. We conducted a scoping review to identify major research themes and the knowledge gaps in social science literature in leishmaniases or Chagas disease (CD). Following the scoping review protocol, we first determined the focus of the review to be centered on identifying research that approaches leishmaniases and CD from social science perspective and was indexed by large, biomedically focused databases. We then searched PubMed and Web of Science using "Leishmaniasis" and "Chagas disease" with "social science" or "anthropology" as search terms. We analyzed 199 articles (123 on leishmaniases and 76 on CD), categorizing them into three main research themes. Sociocultural dimensions of the diseases (leishmaniases=60.2 %; CD=68.4 %) primarily focused on individuals' knowledge, practices, and behaviors, barriers to accessing healthcare (especially in endemic regions), psychosocial effects, stigma, and traditional treatments. Research focused on socioeconomic dimensions of the diseases (leishmaniases=29.3 %; CD=19.7 %) included topics like household characteristics, social capital, and infrastructure access. A final theme, the historical and political contexts of the diseases (Leishmaniases=10.5 %; CD=11.9 %) was less common than other themes. Here, studies consider civil war and the (re)emergence of leishmaniasis, as well as the significance of CD discovery for scientific and public health in Brazil, which is the most common country for research on both leishmaniases and CD that draws on social science approaches. Future directions for research include focusing on how social institutions and economic factors shape diseases education, control measures, healthcare access, and quality of life of people affected by NTDs. Greater attention to social sciences can help mitigate and undo the ways that structural biases have infiltrated biomedicine.

HIV Stigma Reduction Interventions Among Health Care Providers and Students in Different Countries: A Systematic Review.

BACKGROUND: Health care providers' stigmatizing attitudes are obstacles to patients' well- being and quality of life. Dealing with HIV-related stigma and understanding the impact of feasible interventions on reducing stigmatizing attitudes among health care providers are considered important strategies to improve the quality of HIV care, patient-provider relationships, and provide supportive and safe care services. OBJECTIVE: The aim of this study was to systematically review interventions to reduce HIV-related stigma among health care providers. METHODS: This systematic review was performed using Medline, CINAHL, ERIC, and APA PsycInfo, Health Source: Nursing/Academic Edition to search for quasi-experimental studies and randomized controlled trials (RCTs) designed to reduce HIV stigma among health care providers. The quality of eligible research studies was independently appraised by two reviewers. RESULTS: A total of 774 studies were screened, 100 articles were assessed for eligibility, and 10 studies met the inclusion criteria. All interventions effectively reduced HIV-related stigma. Elements of successful interventions included knowledge modules, peer education, patients' testimonials, Photovoice-informed stigma reduction training, stigma-free space intervention, and popular opinion leaders. Interventions were assessed and compared in terms of contents, delivery modes, HIV stigma measurements, follow-up, and limitations. CONCLUSION: This systematic review supports the effectiveness of in-person educational interventions at reducing HIV-related stigma among health care providers across countries. Comparisons of delivery modes of interventions indicated that educational interventions delivered by patients' testimonials and peer education strategies are more promising than lecture-based teaching methods. Further studies are needed to assess the long-term effects of interventions on clinical behaviors and practices.

Landscape disturbance impacts on Attalea butyracea palm distribution in central Panama.

BACKGROUND: Increased Attalea butyracea palm propagation, notable for its role as key habitat for the primary Chagas disease vector in Panama, has been linked to landscape disturbance in single-palm observations in this region. Close proximity of these palms to human dwellings is proposed to increase risk of Chagas disease transmission from sylvatic transmission cycles to domestic transmission involving human populations. This study examines the relationship between landscape disturbance and mature A. butyracea spatial distribution, density, and proximity to human populations and vector and reservoir species' movement corridors at a regional scale in a 300 km2 heterogeneous tropical landscape in central Panama. METHODS: We remotely identified the locations of over 50,000 mature A. butyracea palms using high-resolution WorldView2 satellite imagery. A local Getis-Ord Gi* spatial analysis identified significant clusters of aggregated palms. Associations between palm and cluster abundance and a landscape disturbance gradient, derived from official Panama land cover data, were tested using Chi-square tests for Homogeneity and Z-test for proportions. Kruskall-Wallis non-parametric analysis of variance tests were run to assess whether palm cluster area varied by disturbance level, or whether disturbance was associated with proximity of palms and palm clusters to susceptible populations or vector movement corridors. RESULTS: Our findings indicate a regional relationship between landscape disturbance and A. butyracea occurrence. We observe a significant increase in both individual and clustered A. butyracea in secondary forest, but a reduction of palms in agricultural settings. We do not detect evidence of any reduction in abundance of palms in residential settings. The majority of residential and commercial buildings in our study area are within vector flight distance of potential vector habitat in palm crowns. CONCLUSIONS: We observe probable anthropogenic elimination of A. butyracea palms in agricultural, but not residential, settings. Even in heavily deforested regions, significant concentrations of mature palms remain in close proximity to human establishments.

Longitudinal Changes in Measures of Body Fat and Diet Among Adult Tsimane' Forager-Horticulturalists of Bolivia, 2002-2010.

OBJECTIVE: This study examined changes in body fat and diet among Tsimane' forager-horticulturalists and assessed how dietary shifts relate to increases in adiposity between 2002 and 2010. METHODS: Longitudinal anthropometric and household-level dietary recall data from 365 men and 339 women aged ≥20 years in the Tsimane' Amazonian Panel Study were used. Multilevel mixed-effects models estimated how BMI, body fat percentage, waist circumference, skinfolds, and fat-free mass relate to household consumption of crops, hunted or fished foods, domesticated animal products, cooking oil, and refined grains and sugar. RESULTS: Women's prevalence of overweight and obesity increased from 22.6% and 2.4% in 2002 to 28.8% and 8.9% in 2010, respectively, and BMI increased by 0.60% ± 0.12% per year (P < 0.001). Increases in fat-free mass accounted for some of this observed weight gain among women. Men's prevalence of overweight and obesity increased from 16.2% and 0.7% to 25.0% and 2.2%, respectively, and BMI increased by 0.22% ± 0.09% per year (P = 0.009). Household use of cooking oil increased and was positively associated with female BMI. Consumption of domesticated animal products did not change significantly but was positively associated with female BMI and male waist circumference. CONCLUSIONS: Even small increases in energy-dense market-based foods can contribute to adiposity gains among a moderately active, subsistence-based population.

Age-related decline in urine concentration may not be universal: Comparative study from the U.S. and two small-scale societies.

OBJECTIVES: Evidence from industrialized populations suggests that urine concentrating ability declines with age. However, lifestyle factors including episodic protein intake and low hypertension may help explain differences between populations. Whether this age-related decline occurs among small-scale populations with active lifestyles and non-Western diets is unknown. We test the universality of age-related urine concentration decline. MATERIALS AND METHODS: We used urine specific gravity (Usg) and urine osmolality (Uosm) data from 15,055 U.S. nonpregnant adults without kidney failure aged 18-80 in 2007-2012 participating in the National Health and Nutrition Examination Survey (NHANES). We tested the relationship of age on urine concentration biomarkers with multiple linear regressions using survey commands. We compared results to longitudinal data on Usg from 116 Tsimane' forager-horticulturalists (266 observations) adults aged 18-83 in 2013-2014 from Lowland Bolivia, and to 38 Hadza hunter-gatherers (156 observations) aged 18-75 in 2010-2015 from Tanzania using random-effects panel linear regressions. RESULTS: Among U.S. adults, age was significantly negatively associated with Usg (Adjusted beta [B] = -0.0009 g/mL/10 years; SE = 0.0001; p < 0.001) and Uosm (B = -28.1 mOsm/kg/10 yr; SE = 2.4; p < 0.001). In contrast, among Tsimane' (B = 0.0003 g/mL/10 yr; SE = 0.0002; p = 0.16) and Hadza (B = -0.0004 g/mL/10 yr; SE = 0.0004; p = 0.29) age was not associated with Usg. Older Tsimane' and Hadza exhibited similar within-individual variability in Usg equivalent to younger adults. DISCUSSION: While U.S. adults exhibited age-related declines in urine concentration, Tsimane' and Hadza adults did not exhibit the same statistical decline in Usg. Mismatches between evolved physiology and modern environments in lifestyle may affect kidney physiology and disease risk.

Birth seasons and heights among girls and boys below 12 years of age: lasting effects and catch-up growth among native Amazonians in Bolivia.

BACKGROUND: Seasons affect many social, economic, and biological outcomes, particularly in low-resource settings, and some studies suggest that birth season affects child growth. AIM: To study a predictor of stunting that has received limited attention: birth season. SUBJECTS AND METHODS: This study uses cross-sectional data collected during 2008 in a low-resource society of horticulturists-foragers in the Bolivian Amazon, Tsimane'. It estimates the associations between birth months and height-for-age Z-scores (HAZ) for 562 girls and 546 boys separately, from birth until age 11 years or pre-puberty, which in this society occurs ∼13-14 years. RESULTS: Children born during the rainy season (February-May) were shorter, while children born during the end of the dry season and the start of the rainy season (August-November) were taller, both compared with their age-sex peers born during the rest of the year. The correlations of birth season with HAZ were stronger for boys than for girls. Controlling for birth season, there is some evidence of eventual partial catch-up growth, with the HAZ of girls or boys worsening until ∼ age 4-5 years, but improving thereafter. By age 6 years, many girls and boys had ceased to be stunted, irrespective of birth season. CONCLUSION: The results suggest that redressing stunting will require attention to conditions in utero, infancy and late childhood.

Percutaneous implant retention of a nasal prosthesis.

This report describes an approach to the simultaneous retention of a nasal prosthesis and an intraoral prosthesis for a patient who had undergone a total rhinectomy with resection of the upper lip and premaxilla. At the time of the nasal resection, 2 dental implants were placed adjacent to the resection margins in the first premolar positions. These were used to anchor an intraoral, milled titanium bar and overdenture to replace the missing anterior teeth and provide support for the upper lip, which had been reconstructed with a vascularized radial forearm free-flap. The titanium bar also incorporated a connection for a tissue-penetrating percutaneous nasal extension, which pierced the radial forearm flap near the junction with the hard palate. Magnetic attachments screwed to the nasal extension retained a nasal prosthesis. The predictable and straightforward implementation of this novel concept with digital design and manufacture of the titanium components and guided placement of the nasal extension was made possible with software planning.

A New Approach to Implant-Based Midface Reconstruction Following Subtotal Maxillectomy.

This case presentation describes the reconstruction of an extensive maxillary-orbital defect following subtotal resection of the maxilla en bloc with orbital exenteration in a young adult following the diagnosis of chondrosarcoma. A new approach to composite midface reconstruction with dental implants is described, in which computer-guided surgery (CGS) was used to obliquely position dental implants interradicularly in the residual maxilla, such that the implant tips lie in close proximity to the root apices of the remaining teeth. The implants were then used to fixate a milled-titanium bar, fabricated using computer-aided design and manufacture (CAD/CAM), and provided with attachments for the stabilization and retention of a maxillary obturator.

Catch-up growth and growth deficits: Nine-year annual panel child growth for native Amazonians in Bolivia.

BACKGROUND: Childhood growth stunting is negatively associated with cognitive and health outcomes, and is claimed to be irreversible after age 2. AIM: To estimate growth rates for children aged 2-7 who were stunted (sex-age standardised z-score [HAZ] <-2), marginally-stunted (-2 ≤ HAZ ≤-1) or not-stunted (HAZ >-1) at baseline and tracked annually until age 11; frequency of movement among height categories; and variation in height predicted by early childhood height. SUBJECTS AND METHODS: This study used a 9-year annual panel (2002-2010) from a native Amazonian society of horticulturalists-foragers (Tsimane'; n = 174 girls; 179 boys at baseline). Descriptive statistics and random-effect regressions were used. RESULTS: This study found some evidence of catch-up growth in HAZ, but persistent height deficits. Children stunted at baseline improved 1 HAZ unit by age 11 and had higher annual growth rates than non-stunted children. Marginally-stunted boys had a 0.1 HAZ units higher annual growth rate than non-stunted boys. Despite some catch up, ∼ 80% of marginally-stunted children at baseline remained marginally-stunted by age 11. The height deficit increased from age 2 to 11. Modest year-to-year movement was found between height categories. CONCLUSIONS: The prevalence of growth faltering among the Tsimane' has declined, but hurdles still substantially lock children into height categories.

The reverse zygomatic implant: a new implant for maxillofacial reconstruction.

This case report describes the rehabilitation of a patient who had been treated with a hemimaxillectomy, reconstruction with a latissimus dorsi vascularized free flap, and radiotherapy for carcinoma of the sinus some years previously. Limited jaw opening, difficult access through the flap to the bony site, and the very small amount of bone available in which to anchor the implant inspired the development and use of a new "reverse zygomatic" implant. For this treatment, site preparation and implant insertion were accomplished using an extraoral approach. The implant was used along with two other conventional zygomatic implants to provide support for a milled titanium bar and overdenture to rehabilitate the maxilla. Two years later, the patient continues to enjoy a healthy reconstruction. The reverse zygomatic implant appears to show promise as a useful addition to the implant armamentarium for the treatment of the patient undergoing maxillectomy.

The Tsimane' Amazonian Panel Study (TAPS): Nine years (2002-2010) of annual data available to the public.

This brief communication contains a description of the 2002-2010 annual panel collected by the Tsimane' Amazonian Panel Study team. The study took place among the Tsimane', a native Amazonian society of forager-horticulturalists. The team tracked a wide range of socio-economic and anthropometric variables from all residents (633 adults ≥16 years; 820 children) in 13 villages along the Maniqui River, Department of Beni. The panel is ideally suited to examine how market exposure and modernization affect the well-being of a highly autarkic population and to examine human growth in a non-Western rural setting.

Water from fruit or the river? Examining hydration strategies and gastrointestinal illness among Tsimane' adults in the Bolivian Amazon.

OBJECTIVE: Water is an essential nutrient overlooked in many cross-cultural studies of human nutrition. The present article describes dietary water intake patterns among forager-horticulturalist adults in lowland Bolivia, compares daily intake with international references and examines if variation in how people acquire water relates to gastrointestinal illness. DESIGN: Cross-sectional observational study used survey, anthropometric and qualitative methods with Tsimane' adults selected by age and sex stratification sampling in one community. SETTING: Research occurred in one Tsimane' village in the Beni department, Bolivia with limited access to clean water. The 24 h diet and health recalls were conducted in July-August 2012 and qualitative interviews/ethnographic observation in September-October 2013. SUBJECTS: Forty-five Tsimane' household heads (49% men) took part in the first data collection and twenty-two Tsimane' (55% men) were included in the follow-up interviews. RESULTS: Men and women reported consuming 4·9 litres and 4·4 litres of water daily from all dietary sources, respectively. On average, water from foods represented 50 % of total water intake. Thirteen per cent of participants reported symptoms of gastrointestinal illness. In a logistic regression model adjusted for age, BMI, sex and raw water consumed, each percentage increase in water obtained from foods was associated with a reduced risk of gastrointestinal illness (OR=0·92; 95% CI 0·85, 0·99). CONCLUSIONS: Both total water intake and percentage of water from foods were higher than averages in industrialized countries. These findings suggest that people without access to clean water may rely on water-rich foods as a dietary adaptation to reduce pathogen exposures.

Possible contributions of skin pigmentation and vitamin D in a polyfactorial model of seasonal affective disorder.

Seasonal affective disorder (SAD) is a polyfactorial and polygenetic disorder that involves biological and psychological sub-mechanisms that differentially involve depression, seasonality, circadian rhythms, retinal sensitivity, iris pigmentation, sleep factors, and the neurotransmitters involved with these systems. Within the framework of the polyfactorial conceptualization of SAD, we review the possible contributions of vitamin D3 with respect to the aforementioned sub-mechanisms. We hypothesize that rather than functioning primarily as a proximal or direct sub-mechanism in the etiology of SAD, vitamin D likely functions in a more foundational and regulative role in potentiating the sub-mechanisms associated with the depressive and seasonality factors. There are several reasons for this position: 1. vitamin D levels fluctuate in the body seasonally, with a lag, in direct relation to seasonally-available sunlight; 2. lower vitamin D levels have been observed in depressed patients (as well as in patients with other psychiatric disorders) compared to controls; 3. vitamin D levels in the central nervous system affect the production of both serotonin and dopamine; and 4. vitamin D and vitamin D responsive elements are found throughout the midbrain regions and are especially concentrated in the hypothalamus, a region that encompasses the circadian timing systems and much of its neural circuitry. We also consider the variable of skin pigmentation as this may affect levels of vitamin D in the body. We hypothesize that people with darker skin pigmentation may experience greater risks for lower vitamin D levels that, especially following their migration to regions of higher latitude, could contribute to the emergence of SAD and other psychiatric and physical health problems.

Health and disease: exploring the relation between parasitic infections, child nutrition status, and markets.

Research in bioarchaeology and among living people provides insight into the biological and biocultural consequences of subsistence, political, and economic transitions. Central to this effort is examining infectious disease, such as diarrheal disease, respiratory infections, and parasitic infections because they are an important source of nutritional and energetic stress in both past and current groups. Although infection may not always result in overt disease, frequent exposure results in biological stress with a negative effect on child growth and, by extension, health. The goal of this article is to examine the association between a common class of infectious disease, soil-transmitted helminth worms, and nutritional status among youth living in communities that vary with respect to their distance from a commercial center. In 2007, anthropometric measurements and parasitological surveys were collected for 338 2-14-year-old children and adolescents living in lowland Bolivia as part of the Tsimane' Amazonian Panel Study. Associations between the presence of helminth infections and markers of both short- and long-term nutritional status were overall weak. Youth living in communities distant from the commercial center were more likely to be positive for multiple parasite species than youth in near communities, but youth in mid-distance communities had lower infection rates. This article demonstrates the challenge of identifying associations between nutritional and disease stress when individual and household factors are nested in a larger context of socioeconomic and environmental change. Increased collaboration between bioarchaeology and human biology should continue to examine the connections between stress and disease across time.

The consequences of linear growth stunting: influence on body composition among youth in the Bolivian Amazon.

Stunting, or linear growth retardation, has been documented in up to half of all children in rural indigenous populations of South America. Stunting is well understood as a signal of adverse conditions during growth, and has been associated with developmentally induced modifications to body composition, including body fat and muscularity, that stem from early growth restriction. This article examines the relation between short stature and three anthropometric indicators of body composition during childhood and adolescence among a rural, indigenous population of forager-horticulturalists. Anthropometric data were collected annually from 483 Tsimane' youth, ages 2-10 years, in 13 communities in the Beni region of Bolivia for 6 consecutive years (2002-2007). Baseline height-for-age was used to indicate stunting (HAZ < -2.0) and compared with z-scores of body mass index (BMI), sum of two skinfolds, and arm muscle area. Multilevel regression models indicate baseline stunting is associated with lower BMI z-scores (B = -0.386; P < 0.001), body fatness (ZSkinfold, B = -0.164; P < 0.001), and arm muscularity (AMAZ, B = -0.580; P < 0.001) in youth across a period of 6 years. When split by sex, there was a stronger relation between baseline stunting and lower skinfold body fat scores among girls (B = -0.244; P < 0.001) than boys (B = -0.080; P = 0.087). In contrast, baseline stunting was associated with lower arm muscularity in both girls (B = -0.498; P < 0.001) and boys (B = -0.646; P < 0.001). The relation between linear growth restriction and indicators of body composition persist into adolescence, providing additional insight into the influence of adverse conditions during growth.

Precursors to overnutrition: the effects of household market food expenditures on measures of body composition among Tsimane' adults in lowland Bolivia.

Nutrition transitions are characterized by shifts in diet and activity levels that lead to changes in weight and body fatness over a relatively short time. Research has linked these nutritional shifts to socio-economic factors, including wealth and income. However, few studies have examined household spending patterns on market foods among subsistence populations, which may reveal food access, choice, and indicate household nutritional environment. This paper examines the relation between household monetary expenditures on "market" foods and measures of body composition among Tsimane', a forager-horticulturalist indigenous group in the Bolivian Amazon. Economic and anthropometric surveys were conducted for adults (n = 1199) 16 years or older in 563 households in 40 Tsimane' villages in 2008. Results indicate that overweight status (19% of men and 24% of women) is more common than obesity (1% of men and 4% of women). Sixty-one percent (61%) of households reported purchasing market foods during the previous week. Multiple linear and logistic regressions suggest that men living in households in the top third of monetary expenditures on market foods had significantly higher BMI (0.69 kg/m(2); p = 0.027), weight (1.80 kg; p = 0.048), percent body fat (1.06%; p = 0.025), and probability of being overweight/obese (Odds ratio = 1.83; p = 0.042) than men in households that reported not spending money on market foods in the previous week. We discuss the possibility that the division of labor may help explain the differences between men and women in this sample. This research suggests household expenditures on market foods may mediate the relation between wealth and body composition.

'Sometimes the simplest interventions can make a big difference'.

London dentists Andrew Dawood and Susan Tanner speak to the BDJ ahead of their presentation at the 2013 British Dental Conference & Exhibition. The London practice owners talk about Channel 4's Embarrassing Bodies, facial reconstruction, implant inventions and more.

Adult obesity: panel study from native Amazonians.

This paper examines three morphological indicators measuring obesity among a native Amazonian population of foragers-farmers in Bolivia (Tsimane') and estimates the associations between them and standard covariates of obesity (e.g., socioeconomic status [SES]). We collected annual data from 350 non-pregnant women and 385 men ≥20 years of age from all 311 households in 13 villages during five consecutive years (2002-2006). We used three indicators to measure obesity: body-mass index (BMI), waist circumference (WC), and body fat using bioelectrical impedance analysis (BF-BIA). We ran separate individual random-effect panel multiple regressions for women and men with wealth, acculturation, health, and household food availability as key covariates, and controlled for village and year fixed effects and village×year interaction effects. Although BMI increases by a statistically significant annual growth rate of 0.64% among women and 0.37% among men over the five years, the increase does not yield significant biological meanings. Neither do we find consistent and biologically meaningful covariates associated with adult obesity.

Sibling composition during childhood and adult blood pressure among native Amazonians in Bolivia.

Sibling configuration, including birth order, or the number, age, and sex of siblings is associated with parental resource allocation between children and is thus associated with a person's well-being. Little is known about the association between specific types of siblings and adult health outcomes. Here we test several hypotheses about sibling composition (number of older brothers, older sisters, younger sisters, younger brothers) and adult blood pressure in a foraging-farming society of native Amazonians in Bolivia (Tsimane'). We collected data in 2007 from 374 adults (16-60years of age) from 196 households in 13 villages. Household random-effects multiple regressions were run using systolic (SBP) or diastolic blood pressure (DBP) as outcomes; covariates included the four sibling categories and control variables (e.g., sex, age, education, body mass index [BMI]). Mean SBP and DBP were 114 (SD=14) and 66 (SD=11)mmHg. The prevalence of hypertension was 5.08%. Having an additional younger brother bore a small (3.3-5.9%) positive association with both SBP and DBP, with the effect weakening as people aged. Having an additional younger sister was associated with a small (3.8%) increase in SBP among women, with the magnitude shrinking as people aged. In a large family, the number of younger brothers may exert an impact on an individual's blood pressure.

Computer guided surgery for implant placement and dental rehabilitation in a patient undergoing sub-total mandibulectomy and microvascular free flap reconstruction.

A 58-year-old patient presented with an extensive, destructive, recurrent pleomorphic adenoma occupying the mandibular body and the soft tissues of the mouth and neck. Resection of the mandible from right ramus to left condylar process, and implant rehabilitation in both jaws with fixed bridgework was planned. Comprehensive presurgical prosthetic work up was carried out to record the existing dental relationship and guide all stages of the reconstruction. The jaw was first grafted with a segmented, fibular microvascular free-flap, which was fixed in place with a fixation plate prebent on a Rapid Prototype Anatomical Model of the jaw. Reconstruction with implant supported fixed partial dentures took place to the dental scheme planned preresection, using a computer guided approach to implant placement in the complex and unfamiliar anatomy of the extensively grafted mandible. This approach facilitated and expedited implant surgery such that treatment could take place using a minimally invasive approach relatively soon after surgery, prior to commencement of radiotherapy, and highlights the importance of a multidisciplinary approach to treatment for patients having extensive surgery to the jaws. The patient's personal assessment 2 years post surgery was recorded using 1999 University of Washington Quality of Life Questionnaire.