Life history tradeoffs in humans: increased life expectancy with sperm count reduction.

Although not without controversy, as a general trend, the human sperm count is declining world-wide. One major reason for such a decline is an increase in the human life-span.  According to the life history tradeoff theory, fecundity is inversely related to the lifespan; the longer the lifespan, the lower the fecundity. This is essential to the maintainance of diversity and balance of different species. Such a corrleation validated by experimental data that show that the extension of life in Caenorhabditis elegans, Drosophila and Rodents is  associated with reduction in fecundity. The demographic data from a public data source, shows that the total fertility rate is positively correlated with the infant death rate, it is inversely correlated with the life expectancy. We postulate that the fall in spermatogenesis might be regulated by the neuroendocrine system that underlie human longevity.

The leprosarium of Saint-Thomas d'Aizier: The cementochronological proof of the medieval decline of Hansen disease in Europe?

This study compares the adult survivorship profiles of people interred in the Saint-Thomas d'Aizier leprosarium, estimated by cementochronology, to eight archaeological series in northern France dated from Late Antiquity to the Late Middle Ages, periods of significant visibility for Hansen's disease (leprosy). The goals are to understand the impact of leprosy on various social groups and to explore the cause of leprosy's decline by analyzing male and female fertility. Survival rates differed between medieval leprosy-free sites and the Saint-Thomas d'Aizier leprosarium, although this difference was statistically significant only for the female leprosarium sample. The selective female frailty, a consequence of social exclusion and the collapse of the quality of life, combined with the infertility of lepromatous couples, offer a multi-causal explanation to the end of the expansion and then decline of leprosy in southern and western European countries.

Anti-social welfare functions: a reply to Hansen et al.

We could reasonably expect society to give at least the same weight to the marginal utility of the poor as to the rich, and to the marginal utility of the ill as compared to the healthy. Whilst Hansen et al. [Journal of Health Economics (2004)], may be said to link CEA and CBA within a welfarist framework, the assumptions they require are inconsistent with these types of ethical preferences. Thus, the degree to which they employ a reasonable social welfare function is doubtful. This paper argues that any link between CEA and CBA will occur not within a welfarist framework but instead within a non-welfarist one in which it is unlikely that CBA results could be easily transformed into cost-effectiveness ratios.

Cured tuberculoid patients have a greater life expectancy than cured lepromatous patients in Japan.

Leprosy patients lack specific cellular immunity against Mycobacterium leprae, but other immunological functions are thought to be preserved. However, in a leprosy sanatorium in South Japan between 1982 and 2000, we found that the average age at death of cured lepromatous leprosy patients was about 5 yrs younger than that of cured tuberculoid patients; [male/lepromatous, 76.0 +/- 10.0 yrs old vs. male/tuberculoid, 79.7 +/- 9.4 yrs old, p = 0.026], and [female/lepromatous, 78.0 +/- 10.5 vs. female/tuberculoid, 85.3 +/- 9.8, p = 0.0001]. This trend was also observed in autopsy records of two other leprosy sanatoria in Japan. In a prospective study based on their age in 1982, among females in the age group between 60 and 69, lepromatous patients (75.3 +/- 6.0 yrs) died earlier than tuberculoid patients (81.0 +/- 5.1 yrs) (p < 0.01). These findings suggest that lepromatous patients have higher risk of death even in a post-chemotherapy era.

Leprosy in Nkhotakota District Hospital.

OBJECTIVE: To study the profile of leprosy cases at Nkhotakota District Hospital in Central Region of Malawi. DESIGN: Retrospective cross-sectional study of all registered cases of leprosy from records over a nine year period (January 1992 to April 2001) SETTING: Nkhotakota District Hospital-Central Region of Malawi. RESULTS: In total 526 cases of leprosy were identified from the records. The prevalence rates gradually increased from 0.998 per 10,000 cases in 1992 to 3.39 cases per 10,000 in 1995. There was however a gradual decline of prevalence rates from 1997/1998 that had 3.17 cases per 10,000 to 1.3 cases per 10,000 in 2001. 1996 registered 2.34 cases per 10,000. Fifty seven cases (10.8%) were found with children of the age of 14 or below and 469 (89.2%) cases were of adults. Paucibacillary leprosy presented with more cases than multibacillary leprosy (p < 0.0000001). There were 80 (15.2%) cases of multibacillary leprosy compared to 446 (84.8%) cases of paucibacillary leprosy. In addition more males were affected by multibacillary leprosy than females (p < 0.0001) and females were more affected by paucibacillary leprosy (p < 0.01) than males. CONCLUSION: The results show that paucibacillary leprosy though minor in Malawi can become endemic as paucibacillary leprosy is a reflection of leprosy contacts in the population. We therefore recommend continued epidemiological surveys of leprosy. Training in leprosy detection should be encouraged so that this disease can be totally eradicated in Malawi.

Diseases in European historical populations and their effects on individuals and society.

Traditionally, populations are considered "historical" when first written evidences appear. Cultural development with all it's features--agricultural innovations and as a consequence--population growth, social specialisation and stratification, and finally--urbanisation trigger new environmental conditions, among them also in epidemiological situation, that have the feedback effects on the population and the individual. At this time only qualitative evaluations on many of questions can be presented. This paper is an attempt to synthesize available data on the following specific topics related to Medieval/Early Modern European population welfare: nutritional intake, malnutrition and famine; great epidemics and their consequences; spreading of specific infectious diseases (tuberculosis, syphilis, leprosy), which also had a great social resonance in those times, professional diseases. Considerations on their impact on demographical situation (life expectancy, birth rate), life quality and physical development and body build of an individual are also presented. Finally, possibilities for directional selection and impact on modern genetic diversity in Europe are discussed.

Drug supply in Nigeria.

The health situation in Nigeria is typical of tropical Africa. It is characterised by high childhood and maternal mortality and a relatively short life expectancy. Mortality in childhood in due mainly to diseases like malaria, measles, poliomyelitis, tetanus, diarrhoea and acute respiratory tract infections. Diseases like filariasis, schistosomiasis and leprosy which are now readily controlled by drugs cause considerable morbidity in later life. Although the technology and tools (particularly vaccines and drugs) for the control of most of these diseases are now available, it has not been possible to make optimal use of them in Nigeria and other tropical African countries because of unfavourable social and economic conditions. The non-availability of drugs most needed for healthcare and disease control has been found to be due not only to insufficient funds but also to the use of the limited funds on expensive drugs that have little bearing on the disease pattern. The Essential Drug Programme initiated by the World Health Organisation, now adopted by Nigeria and about 100 other countries mostly in the Third World, aims to correct this unsatisfactory drug supply situation by ensuring that the available funds are used to provide those drugs needed by the large majority of the people and are made available at all times at prices that most people can afford. The Bamako Initiative in the African Region of the World Health Organization is also designed to ensure regular availability of drugs particularly to primary healthcare facilities. Seed drugs are provided to the health institutions either by the National Government or through external aid. These are sold to patients at a small profit margin. The proceeds are then used to replenish stocks and the small profit used to improve services in the health centre. The introduction of these programmes in Nigeria has improved drug availability considerably in the past couple of years and should soon start yielding further dividend in the form of measurable improvement in the health situation.

Assessing the health impact of urbanization.

Several components of urbanization influence health status, but it is difficult to attribute changes in health status to any particular component. The overall impact may be estimated by relating the degree of urbanization of populations to some proxy measure, like the under-5 mortality rates. In this respect the net effect of urbanization is shown to be beneficial. A variety of survey and computational methods have been used to clarify the relationship. Some illustrate the effects of urbanization upon particular clinical conditions, such as promoting the eradication of leprosy, others of particular components, such as overcrowding and pollution, on infant mortality. To help set goals, excess or avoidable mortality may be computed for a country or region by relating its experience to current mortality levels in a developed country; and changes in the levels of avoidable mortality from sentinel conditions such as infectious diseases may be related to changes in particular aspects of urbanization, e.g. improvements in levels of sanitation. Migration to the urban environment imparts the tendency to acquire the health characteristics of the host population. Rapid urbanization causes problems of psychosocial adjustment for older children. Urbanization may impact upon the incidence and prevalence of disability. Where sex-age disability-survey data exist, they may be combined with age-specific mortality data to construct an index of disability-free life expectancy, a more subtle measure for assessing the progressive impact of urbanization. Up to now, however, there have been no international studies of how levels of disability change according to the progress of urbanization, and there are no international census or survey recommendations for harmonizing the classification of disabled people.(ABSTRACT TRUNCATED AT 250 WORDS)

Togo.

PIP: This compendium on Togo contains a summary of current and projected demographic indicators, of government population policies and attitudes, and of the current status of the country's population data collecting system. The information is further summarized in a 1-page fact sheet. In 1981 the total population was 2.7 million. In 1980-85, the annual population growth rate was 2.9%, and the annual natural increase rate was 2.9%, life expectancy at birth was 48.7 years, the infant mortality rate was 113, and the crude birth rate was 45.4. Per capita income was US$406 in 1979, and in 1981, 67% of the labor force was engaged in agriculture. Currently the government has no policies in regard to population growth and is satisfied with the current fertility level. Earlier the government's position was pronatalist; but, in 1976, the government approved the establishment of the Togolese Family Welfare Association (ATBEF), an affiliate of the International Planned Parenthood Federation. In addition, the government is promoting the integration of family planning services in the nation's primary health program. The government is concerned with the problem of teenage pregnancy. Abortion, except to save the life of the mother, is illegal, and there are no legal provisions concerning sterilization. In recent years, the government adopted several measures aimed at improving the status of women. These measures included the passage of a new family code. The major concerns of the government are to improve the health status of the population and to promote rural and regional development. The primary health care program was expanded in 1977, and the country has a fairly successful immunization program. It also operates a leprosy control program and is improving the country's water supply. Currently the level of international migration, both emigration and immigration, is low, and the government has no migration policy. Togo has a low urban rate (17.4%), and between 1970-80, the rate of annual urban growth rate was 5.3%. The government is concerned about the high rate of growth in Lome, the capital city. Togo conducts a census every 10 years, and the last one was conducted in 1981. Birth and death registration is incomplete. There is no institutionalized mechanism for promoting the integration of population and development planning.^ieng

Primary health care in India.

PIP: Concurrently with the development of the general health services infrastructure in India, serveral special health programs were instituted at the national level to provide a massive and concentrated assault on the major public health problems of malaria, smallpox, cholera, trachoma, tuberculosis, leprosy, filariasis, and the rapid population growth. These vertical programs were expected to reduce the heavy morbidity and mortality within the shortest possible time to where they were no longer major public health problems. The impact was variable. Major steps toward providing integrated health care were taken during the first 5-year plan. Emphasis was on the provision of a packet of inttegrated health, family planning, and nutrition services to the vulnerable groups, i.e., children, pregnant women, and nursing mothers. To rectify past shortcomings ssuch as the failures of the national health programs, ineffective coordination in the nutrition programs, and slow rate of development as a result of interdependence of different sectors, it was necessary to improve the health infrastructure and to launch a frontal attack on poverty. The Multipurpose Health Workers Scheme was planned to rationalize the organization and use of available manpower to reduce the area and population covered by each of the field staff in order to reduce travel time and to make services more effective and more satisfactory. Each multipurpose health worker was entrusted with the task of providing comprehensive health care to about 5000 people. Communicable diseases were the main public health problems, and many specific control/eradication programs were launched. the immunization programs against common childhood diseases have not taken deep roots and coverage continues to be poor. The adoption of the Western model of medical services has resulted in emphasis on "cure" rather than on "care". Another problem is maldistribution of the facilities. Overemphasis on medical education has resulted in the relative neglect of development of health manpower for nursing, environmental engineering, and other technical and paramedical personnel. Community involvement and participation were at a minimum if they existed at all. The basic concern about primary health care for all continued unabated however. To realize the goal of health care for all, 3 programs will have to be pursued simultaneously during the next 2 decades: integrated overall development including family planning; improvement in nutrition, environment, and health education; and the provision of adequate health care services for all, particularly the poor and underprivileged. It is necessary to redefine the roles of the central and state governments in view of the large power powers delegated to local bodies at the district level and below. Voluntary agencies will have to function within the overall plan/aid down by the state.^ieng

Efeito da terapeutica sulfonica na sobrevida dos doentes de hanseniase / Effect of the therapeutical sulfonic in the supervened one of the sick people of leprosy

Utilizando a técnica das tábuas de sobrevida modificada para seguimento de moléstias crônicas, estudam-se as probabilidades acumuladas de sobrevida de 5.000 doentes de hanseníase da era pressulfônica e 5.000 da era sulfônica. Foram calculadas as probabilidades acumuladas de sobrevida, segundo a modalidade do diagnostico inicial e a idade do paciente por ocasião do mesmo

Esperancas de sobrevida na hanseniase / Hopes of supervened in leprosy

Calculam-se as tábuas de sobrevida adaptadas às moléstias crônicas segundo técnica de Chiang, de 5000 hansenianos do Estado de São Paulo, diagnosticados entre 1947 e 1950. As esperanças de sobrevida de cada uma das três modalidades clínicas da moléstia são comparadas entre si e com as da população brasileira em 1950. Conclui-se que as modalidades indeterminadas e virchovianas têm esperanças de sobrevida parecidas e que o tipo tuberculóide em termos de sobrevida, é a mais grave.