The Social and Political Dimensions of the Ebola Response: Global Inequality, Climate Change, and Infectious Disease

The 2014 Ebola crisis has highlighted public-health vulnerabilities in Liberia, Sierra Leone, and Guinea – countries ravaged by extreme poverty, deforestation and mining-related disruption of livelihoods and ecosystems, and bloody civil wars in the cases of Liberia and Sierra Leone. Ebola’s emergence and impact are grounded in the legacy of colonialism and its creation of enduring inequalities within African nations and globally, via neoliberalism and the Washington Consensus. Recent experiences with new and emerging diseases such as SARS and various strains of HN influenzas have demonstrated the effectiveness of a coordinated local and global public health and education-oriented response to contain epidemics. To what extent is international assistance to fight Ebola strengthening local public health and medical capacity in a sustainable way, so that other emerging disease threats, which are accelerating with climate change, may be met successfully? This chapter considers the wide-ranging socio-political, medical, legal and environmental factors that have contributed to the rapid spread of Ebola, with particular emphasis on the politics of the global and public health response and the role of gender, social inequality, colonialism and racism as they relate to the mobilization and establishment of the public health infrastructure required to combat Ebola and other emerging diseases in times of climate change

Variations of the Circle of Willis in 100 Cadavers in Kerman Province

Abstract: Background & Aims: The relationship between variations of Willis circle and some cerebrovascular diseases has been shown in previous studies. A few studies have been conducted in Iran on these variations. Methods: This study was performed on 100 recently deceased Iranians due to car accidents who had been referred to Kerman Forensic Medicine Center for autopsy. The length and diameter of cerebral vessels were measured using glass plate method and variations of Willis circle were determined according to Lazorthes classification. Results: The sample included 81 males and 19 females aged 16-81 years. The two most prevalent forms of Willis circle were type 1 (50%) and type 4 (38%) according to Lazorthes classification. Asymmetry and hypoplasia were seen in 51% and 61% of cases respectively. Asymmetry was most often seen in the left posterior communication artery. There was no significant relationship between the presence of asymmetry in anterior cerebral arteries and the size of anterior communicating artery. Moreover, the size of the posterior communication artery had not been affected by the presence of asymmetry in the posterior cerebral arteries. Conclusion: However, the anatomical variations found in this study were similar to those in the literature, racial similarities among the studied populations do not allow to exclude the role of race on the variations of Willis circle. The difference between common variations in the cadaver and in vivo studies hypothesizes that radiological studies during life are more appropriate to show the role of race on the variations of the circle of Willis. Nonsignificant relationships between the size of communication arteries and anterior and posterior cerebral arteries support this hypothesis. Keywords: Aneurysm, Circle of Willis, Kerman, Variatio

Childhood abuse as a risk factor for injection drug use: A systematic review of observational studies

Issues: Childhood abuse is a public health challenge with lifelong impacts, including future drug use. However, previous research has been mixed regarding impacts on injection drug use. This systematic review examines the impact of childhood abuse (sexual, physical and emotional) on adult injection drug use. Approach: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science and grey literature to identify relevant studies from database inception to 26 September 2018. Studies were eligible if: (i) they were empirical original research published in English; (ii) considered childhood abuse as potential risk factors for lifetime history of injection drug use; and (iii) included adult participants. Risk of bias was assessed using the modified Newcastle-Ottawa Scale. Key Findings: Of the 1994 articles screened, 17 studies met the inclusion criteria. Most studies were conducted in the USA and utilised cross-sectional research designs. All of the 17 studies measured sexual abuse, six studies measured physical abuse and three studies measured emotional abuse; most (N = 11) of which reported a statistically significant and positive association between at least one sub-scale of childhood abuse and injection drug use. Implications: Our findings highlight the need for devising interventions to reduce the harms associated with childhood abuse. Conclusions: The evidence base suggests a significant positive association between experiences of childhood physical abuse and elevated risks of injection drug initiation with mixed results for sexual and emotional abuse. © 2019 Australasian Professional Society on Alcohol and other Drug

HIV and Other Sexually Transmitted Infections Among Female Sex Workers in Iran: A Systematic Review and Meta-Analysis

Given the high burden of HIV and other sexually transmitted infections (STIs) among female sex workers (FSW) and their potential role in bridging HIV/STIs into the general population, estimating the prevalence of HIV/STIs among FSW is essential for future research and policy developments. This systematic review and meta-analysis synthesize the available HIV/STIs data among FSW in Iran. We searched MEDLINE, PsycINFO, CINAHL, Embase, Web of Science, Google Scholar, and Iranian databases from inception through to January 2018. Inclusion criteria were original quantitative studies that measured HIV/STIs prevalence among FSW. Pooled prevalence estimates were calculated using random-effects meta-analyses. Out of a total of 299 screened studies, 12 were included with total study participants of 4328 FSW. Heterogeneity was present but meta-regression analyses revealed no significant association between HIV prevalence and year of publication, city, and age. Pooled HIV prevalence was 2.23 (95 confidence interval CI 0.82, 3.64). We estimated the prevalence of other STIs as 0.77% (95% CI 0.01, 1.53) for hepatitis B, 6.18% (95% CI 1.32, 11.04) for hepatitis C, 0.33% (95% CI 0.00, 0.66) for syphilis, 1.47% (95% CI 0.22, 2.71) for gonorrhea, 9.80% (95% CI 4.70, 14.91) for chlamydia, and 6.18% (95% CI 4.92, 7.43) for trichomonas vaginalis. Based on the existing evidence, HIV and STIs prevalence among FSW are relatively low in Iran. Strategies for timely diagnosis and treatment of HIV and other STIs among FSW and their sexual and injecting partners are needed to reduce the burden of HIV/STIs among these vulnerable populations in Iran. © 2019, Springer Science+Business Media, LLC, part of Springer Nature

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Abstract: Car accidents and gun-shot injuries are the most common causes of spinal cord injury. Five percent of those patients who have a complete spinal cord injury will experience improvement, to some extent. The lack of speci¿c data in the literature regarding the outcome of earthquake related spinal cord injury justi¿ed us to design this study where we evaluated the neurological outcome and related factors of SCI in the Bam earthquake. We retrospectively evaluated the neurological outcome of patients with spinal cord injury who survived the Bam earthquake. In this study all patients with spinal cord injury that resulted from the Bam earthquake who registered in the Welfare Organization of Kerman were studied. The neurological conditions of patients eighteen months after the earthquake were compared with their neurological conditions at the time of the earthquake. A total of 17 (23.9%) patients with grade A impairment based on ASIA impairment Scale (AIS) at the time of the earthquake had signi¿cant neurological recovery. In addition, younger patients had better neurological outcomes. Those who had fracture dislocations had a worse outcome. Spinal cord injuries that are due to earthquakes have a better neurological outcome in comparison with other causes of this injury. The patients' ages and types of spinal fractures were signi¿cantly related to the neurological outcome