Eco-psychiatry and Environmental Conservation: Study from Sundarban Delta, India

Aims This study attempts to examine the extent and impact of human-animal conflicts visa-vis psychosocial stressors and mental health of affected people in two villages adjacent to Sundarban Reserve Forest (SRF) in the Gosaba Block, West Bengal, India. Methods Door to door household survey for incidents of human-animal conflicts, Focus Group Discussions, In-depth Interviews, Case studies, Community Mental health clinics and participatory observation. Results A total of 3084 households covering a population of 16,999 were surveyed. 32.8% people live on forest-based occupation. During the last 15 years 111 persons (male 83, female 28) became victims of animal attacks, viz, Tiger (82%), Crocodile (10.8%) and Shark (7.2%) of which 73.9% died. In 94.5% cases the conflict took place in and around the SRF during livelihood activities. Tracking of 66 widows, resulted from these conflicts, showed that majority of them (51.%) are either disabled or in a very poor health condition, 40.9% are in extreme economic stress and only 10.6% remarried. 1 widow committed suicide and 3 attempted suicide. A total of 178 persons (male 82, female 96) attended the community mental health clinics. Maximum cases were Major Depressive Disorder (14.6%), followed by Somatoform Pain Disorder (14.0%), Post Traumatic Stress Disorder-animal attack related (9.6%) and Adjustment Disorder (9%). 11.2% cases had history of deliberate self-harm attempt, of which 55% used pesticides. Conclusions Improvement of quality of life of this deltaic population by appropriate income generation and proper bio-forest management are the key factors to save their life as well as the mangrove environment of the Sundarban region

Ecopsychosocial Aspects of Human–Tiger Conflict: An Ethnographic Study of Tiger Widows of Sundarban Delta, India

Aims Human–tiger conflict (HTC) is a serious public health issue in Sundarban Reserve Forest, India. HTC is a continued concern for the significant mortality and morbidity of both human and tiger population. This is the first comprehensive report on Sundarban tiger–human conflicts and its impact on widows whose husbands were killed by tigers. The study attempts to explore the situation analysis of HTC and the aftermath of the incident including bereavement and coping, the cultural stigma related to being killed by a tiger and the consequent discrimination, deprivation, and social rejection, and the impact on the mental health of the tiger-widows. Methods This is a three-phase ethnographic research with a mix of quantitative and qualitative methods. In the first phase, a door-to-door village survey (3,084 households) was carried out in two villages of Sundarban, which are adjacent to the Reserve Forest, in which the incidents of human-animal conflicts and the 65 tiger-widows identified were documented. In the second phase, the 65 tiger-widows were studied to explore the ecodemography of tiger attacks and tiger-widows alongside the stigma issue by using a stigma questionnaire ( n = 49). The stigma burden was compared with normal widows ( n = 21) and snake-bite widows ( n = 18). In the third phase, the psychosocial and cultural dimensions related to tiger attacks were studied by using in-depth interviews (IDI) of the tiger-widows, focus-group discussions (FGD), and participatory mapping in the community. Clinical examinations of the mental health of the widows were also carried out in this phase. Results The mean age of the 65 widows was 43.49 ± 9.58 years. Of this, 12.3% of the widows had remarried and only 4.6% of the widows were literate. In all, 67.2% of all tiger attacks occurred as a result of illegal forest entry. The main livelihood of the former husbands of the widows were 43.8% wood cutting, 28.1% fishing, 10.9% crab catching, 9.4% tiger prawn seed (juvenile prawn), and 4.7% honey collection. The maximum number of attacks took place in the months of December (24.6%) and November (13.9%). The majority of incidences happened during the morning hours (47.7%) of the day. Of the cases, 86.1% were attacked while the person was engaged in livelihood activity. In all, 57.4% widows are recorded as living “below the poverty line”. Currently, 45.5% widows earn their living by laboring work followed by forest-based livelihood activities (30%) and begging (5.2%). Tiger-widows differed significantly ( P < 0.001) from both normal and snake-bite widows on all stigma cluster scores and the total score. Of the tiger-widows, 44% were shown to be suffering from some designated mental illness. IDIs and FGDs helped to unfold the cultural construct of stigma related to tiger-killing. This can be seen in how the tiger-widows’ quality of life has been negatively impacted in the way their economic and social security, health, remarriage opportunities, and child upbringing is restricted, along with a multitude of posttrauma psychological scars, deprivation, abuse, and exploitation. Conclusions The study highlights the multitude of sufferings experienced by the tiger-widows including the issues of the gender aspect of HTC and the ecopsychiatric risk factors of tiger attacks combined with the background of local sociocultural beliefs and practices. It is well known that a similar problem also exists in Bangladesh Sundarban as well, in which case it may be that a strong and practical administrative strategy for sustainable alternative income generation and a balanced conservation policy with integrated participatory forest management may go to save both human and tiger. A community ecocultural mental health program involving all the stakeholders (community, gram panchayat, and forest department) and aiming to address and even eradicate the cultural stigma of tiger attack may help to reduce the stigma burden and socicultural discrimination currently experienced by the tiger-widows

Human papillomavirus prevalence in postradiotherapy uterine cervical carcinoma patients: correlation with recurrence of the disease

Singh RK, Maulik S, Mitra S, Mondal RK, Basu PS, Roychowdhury S, Panda CK. Human papillomavirus prevalence in postradiotherapy uterine cervical carcinoma patients: correlation with recurrence of the disease. Int J Gynecol Cancer 2006;16:1048–1054. To understand the role of human papillomavirus (HPV) in recurrence of uterine cervical cancer (CA-CX) after radiotherapy, we have analyzed the HPV prevalence in the exfoliated cells of 56 patients and their corresponding plasma. HPV DNA was detected in exfoliated cells of 78% (44/56) patients (HPV-16, 68%; HPV-18, 14%; HPV-X [other than 16, 18], 11%; and mixed infection of HPV-16 and HPV-18 in three cases). HPV DNA in plasma was present in only 25% (11/44) of the HPV-positive exfoliated cells (positive predictive value, 100%; negative predictive value, 27%) with concordance in HPV types. The recurrence of the disease was significantly associated with the presence of HPV in the exfoliated cell (P ¼ 0.01) and plasma (P ¼ 0.007) as well as high viral load in the exfoliated cell (P ¼ 0.0002). Kaplan–Meier disease-free estimates have also shown the significant association between HPV prevalence in plasma and recurrence of the disease (P ¼ 0.045). Thus, it indicates that in postradiotherapy CA-CX patients, the high viral load in the exfoliated cell as well as HPV presence in the plasma samples could be used in early detection of the patients at increased risk for disease recurrence and progressio

Inactivation of SLIT2-ROBO1/2 Pathway in Premalignant Lesions of Uterine Cervix: Clinical and Prognostic Significances

The SLIT2-ROBO1/2 pathways control diverse biological processes, including growth regulation. To understand the role of SLIT2 and ROBO1/2 in cervical carcinogenesis, firstly their RNA expression profiles were screened in 21 primary uterine cervical carcinoma (CACX) samples and two CACX cell lines. Highly reduced expressions of these genes were evident. Concomitant alterations [deletion/methylation] of the genes were then analyzed in 23 cervical intraepithelial neoplasia (CIN) and 110 CACX samples. In CIN, SLIT2 was deleted in 22% samples compared to 9% for ROBO1 and none for ROBO2, whereas comparable methylation was observed for both SLIT2 (30%) and ROBO1 (22%) followed by ROBO2 (9%). In CACX, alteration of the genes were in the following order: Deletion: ROBO1 (48%) > SLIT2 (35%) > ROBO2 (33%), Methylation: SLIT2 (34%) > ROBO1 (29%) > ROBO2 (26%). Overall alterations of SLIT2 and/or ROBO1 (44%) and SLIT2 and/or ROBO2 (39%) were high in CIN followed by significant increase in stage I/II tumors, suggesting deregulation of these interactions in premalignant lesions and early invasive tumors. Immunohistochemical analysis of SLIT2 and ROBO1/2 in CACX also showed reduced expression concordant with molecular alterations. Alteration of all these genes predicted poor patient outcome. Multiparous (≥5) women with altered SLIT2 and ROBO1 along with advanced tumor stage (III/IV) and early sexual debut (<19 years) had worst prognosis. Our data suggests the importance of abrogation of SLIT2-ROBO1 and SLIT2-ROBO2 interactions in the initiation and progression of CACX and also for early diagnosis and prognosis of the disease

RBSP3 is frequently altered in premalignant cervical lesions: clinical and prognostic significance

To understand the importance of frequent deletion of 3p22.3 in cervical carcinogenesis, alterations (deletion/methylation/expression) of the candidate genes STAC, MLH1, ITGA9, and RBSP3, located in the region, were analyzed in 24 cervical intraepithelial neoplasia (CIN) and 137 uterine cervical carcinoma (CACX) samples. In CIN, RBSP3 deletion (48%) and methylation (26%) were high compared with the other genes (4–9%). In CACX, alterations of these genes were as follows: deletion: STAC (54%) &#x003E; MLH1 (46%) &#x003E; RBSP3 (45%) &#x003E; ITGA9 (41%), methylation: RBSP3 (25%) &#x003E; ITGA9 (24%) &#x003E; STAC (19%) &#x003E; MLH1 (13%). Overall, alterations of RBSP3 showed association with CIN, whereas for STAC and MLH1, this frequency increased significantly from CIN → Stage I/II and for ITGA9 from CIN → Stage I/II and also from Stage I/II → Stage III/IV. Quantitative mRNA expression analysis showed differential reduced expression of these genes in CACX concordant to their molecular alterations. The more active RBSP3B splice variant was underexpressed in CACX. RB1 was infrequently deleted in CACX. Concordance was seen between (i) inactivation of RBSP3 and intense p-RB1 nuclear immunostaining and (ii) low/absence of MLH1 expression and its molecular alterations in CACX. In normal cervical epithelium, p-RB1 immunostaining was low in differentiated cells, whereas MLH1 staining was seen in both nucleus and cytoplasm irrespective of differentiation stage. Alterations of the genes were significantly associated with poor prognosis. High parity (&#x2265;5)/early sexual debut (#x2264;19 years) coupled with RBSP3 alterations/RB1 deletion predicted worst prognosis. Thus, inactivation of RBSP3 might be one of the early events in cervical carcinogenesis

Representative autoradiographs showing deletion and microsatellite size alteration (MA) of cervical lesions, at different marker loci.

<p>(i) LOH: loss of heterozygosity, (ii) MA-1: microsatellite size alteration of one allele. (iii) LOH + MA: loss of one allele and microsatellite size alteration of the other. (iv) Hemizygous (HE) deletion of <i>ROBO2</i> locus as shown by D3S2515. (v) & (vi) HE deletion as shown by exonic markers (EM) from <i>ROBO1</i> and <i>ROBO2</i> respectively, <i>SST</i> used as control. The sample numbers and marker loci are indicated above and below the figure respectively. →: allelic loss, “*”: allelic size alteration. Deletion of <i>ROBO1/2</i> and <i>SLIT2</i> analyzed by microsatellite and exonic markers in (<b>B</b>) CIN and (<b>C</b>) CACX. T: Tumor DNA, N: DNA from normal cervix/PBL. (<b>D</b>) Pattern of deletion and methylation of <i>ROBO1/2</i> and <i>SLIT2</i> during disease progression. Asterisk denotes statistical significance (P<0.05). (<b>E</b>) Overall alteration patterns of the individual genes, <i>SLIT2-ROBO1</i> and <i>SLIT2-ROBO2</i> ligand-receptor pairs, during disease progression. Asterisk denotes statistical significance (P<0.05).</p

Kaplan-Meier analysis of survival (up to 5 years) of CACX patients.

<p>Alterations of (<b>A</b>) <i>SLIT2</i> and/or <i>ROBO1</i> and (<b>B</b>) <i>SLIT2</i> and/or <i>ROBO2</i> ligand-receptor pairs were significantly associated with poor patient outcome [OS]. (<b>C</b>) Representation of Cox Multivariate analyses of genetic, clinical and etiological parameters in predicting outcome of CACX patients. N: total number of samples and P<0.05 denotes statistical significance.</p