Pathophysiology in a model of Gulf War Illness: Contributions of pyridostigmine bromide and stress.

During the Gulf War, prophylactic treatment with pyridostigmine bromide (PB) along with the stress of deployment may have caused unexpected alterations in neural and immune function, resulting in a host of cognitive deficits which have become clinically termed Gulf War Illness (GWI). In order to test this interaction between PB and stress, the following study used a rodent model of GWI to examine how combinations of repeated restraint stress and PB induced alterations of peripheral cholinesterase (ChE) activity, corticosterone (CORT) levels, and cytokines on the last day of treatment, and then 10 days and three months post-treatment. Results indicate that PB decreases ChE activity acutely but sensitizes it by three months post-treatment selectively in rats subjected to stress. Similarly, while stress increased CORT levels acutely, rats in the PB/stressed condition continued to exhibit elevations in CORT at the delayed time point, indicating that PB and stress interact to progressively disrupt homeostasis in several peripheral measures. Because memory deficits are also common in clinical populations with GWI, we examined the effects of PB and stress on contextual fear conditioning. PB exacerbates stress-induced impairments in contextual fear conditioning ten days post-treatment, but protects against stress-induced augmentation of contextual fear conditioning at three months post-treatment. Collectively, these results provide critical insight as to how PB and stress may interact to contribute to the pathophysiological progression of GWI.

Maoris take up the fight against ill health.

The beginnings of grass-roots primary care are taking shape in New Zealand's Maori community. By referring to a scheme initiated in the Waikato area, the authors explain the difficulties encountered by this ethnic minority in striving towards self-help in matters of health.

PIP: This paper discusses the establishment of a Maori health center in Waikato, New Zealand. The center was staffed by 3 health care female workers, and registered nurses, and emphasized disease prevention, nutrition, and family planning services. In addition, an antenatal component having midwives and obstetric nurses was later added to the center. This center was set up at a time of political and social revitalization in the "Nga Ringa Aroba" tribe. Among the responsibilities of the health center was to reach out to the community and provide preventive and educational services. Clearly, the efforts of these health workers influenced peoples' awareness of health related disorders and good health habits. Also this program proved that health improvement through personal commitment was feasible. However, this establishment faced strong resistance from the existing government agencies; the staff from Maori health center were denied diagnostic tools and their responsibilities were reduced to referral services only. Consequently, the Maori community has received mixed messages from the government bodies in New Zealand as to what is expected of them. With regards to the community as a whole, there is mounting evidence of dissatisfaction with the health services and in turn people are increasingly relying on potentially dangerous alternatives, such as traditional healers.

Culture and 'compliance' among leprosy patients in Pakistan.

In Pakistan approx. 30% of the 18,000 known leprosy patients have dropped out of their treatment programs. To investigate reasons for such widespread noncompliance, 128 diagnosed leprosy patients--59 outpatients and 69 inpatients--were interviewed in Karachi. More than half of the 'noncompliant' outpatients denied having the disease. Denial was found to be an understandable coping mechanism in view of the severe stigma associated with leprosy. The presence of close-knit extended families, in which joint decision-making was the norm and in which such a dread diagnosis could spell the end of job and marriage prospects for even distant relatives, contributed to the likelihood of denial. In such a setting, the very term 'noncompliant' appeared to be an oversimplification since it covered so many different types of culturally-constrained behavior. In addition, many of the patients who initially seemed most 'compliant' by virtue of being long-term hospital inpatients in fact owed their hospitalization to the fact that they had been markedly noncompliant in the past. Thus the usual view that adherence to a biomedical treatment regimen constitutes 'compliance' and that nonadherence to such a regimen constitutes 'noncompliance' proved inadequate for understanding the health behavior of these Third World leprosy victims. The study also showed that many patients had initially consulted traditional healers, inadequately-trained physicians, and/or untrained medical practitioners for treatment of their symptoms, which resulted in lengthy delays before they were correctly diagnosed. Further, even after the diagnosis was made and appropriate medications were prescribed by trained personnel, most patients were not told what had caused their leprosy and how the drug regimen worked to combat it: when questioned, only 4% of the 128 respondents attributed the disease to infectious organisms. In addition, patients were usually not warned in advance of the possibility of undesirable side effects from their leprosy medications, which led to further 'compliance' problems. The findings of this study emphasize the need for better training of physicians and other health care providers in early diagnosis of leprosy and better health education of diagnosed patients. To be truly effective, the treatment of leprosy must include counseling of extended families and education of the public at large as well as enhanced communication with the patients themselves.

Contrasting patterns of blood pressure and related factors within a Maori and European population in New Zealand.

Contrasting patterns of blood pressure are found for contiguous populations of Maori and Europeans living in New Zealand. Among the 511 participants in this study, approximately one-fifth manifested elevated levels of blood pressure. The Maori adults were found to have generally higher pressure levels compared with the Europeans; however, the opposite relationship appears when Maori and European youth are compared. Consistently lower blood pressure levels are found in the Maori youth. An examination of the trends by age shows a distinct crossover in early adulthood when the Maori begin to manifest blood pressure elevations at a sharply increased rate compared with the Europeans. Differences in body mass are found between the youthful segments of the populations. Body mass index is found to be significantly higher among the Maori youth; nonetheless, the European youth demonstrate higher levels of blood pressure. The study examines possible interactions between blood pressure and possible stress-related factors such as career aspirations in the presence of varying social and academic pressures. For both ethnic groups we find that, relative to the group means, those with the highest academically-related ambitions, demonstrate the highest levels of blood pressure.

Early childhood, the critical stage in human interactions with disease and culture.

This paper examines the continuous interactions between evolving Homo sapiens and the multiple health-related factors that significantly have shaped the course of human evolution. Early childhood, particularly the precarious post-weaning stage, is seen to be the most critical period determining survival in disease confrontations. Selection for the fundamental biological defenses predated human emergence; however, human cultures add a significant dimension to disease patterns. Specific configurations of disease are intimately related to human economies, social structure and political interactions as well as macro- and micro-environmental factors.