Sociology and Medicine Interactions and Emerging Disciplines

This brief essay places the work of Professor Siri Hettige in the context of understanding of social origins of health and disease. The origin of the term ‘social medicine’ dates to the French Revolution in 1848, which called for the medical profession to integrate knowledge in medical issues, population health, social factors and public policies. During this period, similar views were expressed elsewhere e.g. in Germany by Virchow’s famous statement that “medicine is a social science, and politics nothing but medicine on a grand scale”. In the early 20th century, another wave of social medicine originated in South America, a key figure being Salvador Allende. As the Minister of Health, he introduced these concepts to model the health services in Chile and later elected as the President. He was assassinated in a CIA sponsored military coup in 1973. In contrast, the early British and US traditions focused on a model where priority was on applying sociology in relation to individual behaviors. It was later that social structural determinants of health and diseases were addressed e.g. the Black Report of 1980. The US followed different trends, attempting to integrate concepts of the two disciplines (i.e. sociology in medicine) and studying the sociology of medicine (e.g. explaining health-seeking behaviors) and more recently, social epidemiology and politics of health. Professor Hettige’s extensive work covers almost all the above topics, trends and developments. His research publications and writings in the lay press have stimulated much discussion and contributed to sociopolitical changes in Sri Lanka. His name will be remembered as a pioneer in the field where sociology intersects with health in Sri Lanka and even in Asia

Hypokalemic paralysis associated with cystic disease of the kidney: case report

<p>Abstract</p> <p>Background</p> <p>Severe hypokalemia is known to cause muscle paralysis, and renal tubular acidosis is a recognized cause. Cystic disease of the kidney is associated with severe hypokalemia.</p> <p>Case presentation</p> <p>We report a 33-year-old male patient who presented with generalized limb weakness caused by severe hypokalemia due to renal tubular acidosis, who was found to have renal medullary cysts.</p> <p>Conclusion</p> <p>The association of cystic renal disease with hypokalemia, and the possible pathophysiological basis of the development of renal cysts in patients with severe hypokalemia, are discussed.</p

Erosion of trust in humanitarian agencies: what strategies might help?

Aid agencies (AAs) provide a range of humanitarian and health related assistance globally. However, the trust placed on them is eroding. Evidence for this includes accusations of a decline in their humanitarianism, and the increasing number of conflicts with host states. An analysis of the concerns expressed yields two possible reasons: a relative lack of transparency of their work and weak accountability mechanisms. This is further supported by the existing milieu: an absence of internationally accepted instrument or mechanism to check the credentials of INGOs and an opaque system of close links between some of the INGOs and their donors. The article suggests two global strategies to tackle these issues: (a) Increase transparency by establishing a global register of aid agencies. This should have basic information: their main goals and activities, countries they are active in, number of employees, annual turnover of funds (updated regularly), principal financing sources and nature of links with donors. This could also be available as printed manual that should be freely available to client countries. (b) Ensure accountability by developing templates of fair legal instruments (to facilitate and regulate work), and a set of generic rules and procedures of engagement for the interactions between agencies and client states. These should be institutionalized within the regulatory frameworks of countries and included in the Codes of Conduct of NGOs

Slum Health: Arresting COVID-19 and Improving Well-Being in Urban Informal Settlements.

The informal settlements of the Global South are the least prepared for the pandemic of COVID-19 since basic needs such as water, toilets, sewers, drainage, waste collection, and secure and adequate housing are already in short supply or non-existent. Further, space constraints, violence, and overcrowding in slums make physical distancing and self-quarantine impractical, and the rapid spread of an infection highly likely. Residents of informal settlements are also economically vulnerable during any COVID-19 responses. Any responses to COVID-19 that do not recognize these realities will further jeopardize the survival of large segments of the urban population globally. Most top-down strategies to arrest an infectious disease will likely ignore the often-robust social groups and knowledge that already exist in many slums. Here, we offer a set of practice and policy suggestions that aim to (1) dampen the spread of COVID-19 based on the latest available science, (2) improve the likelihood of medical care for the urban poor whether or not they get infected, and (3) provide economic, social, and physical improvements and protections to the urban poor, including migrants, slum communities, and their residents, that can improve their long-term well-being. Immediate measures to protect residents of urban informal settlements, the homeless, those living in precarious settlements, and the entire population from COVID-19 include the following: (1) institute informal settlements/slum emergency planning committees in every urban informal settlement; (2) apply an immediate moratorium on evictions; (3) provide an immediate guarantee of payments to the poor; (4) immediately train and deploy community health workers; (5) immediately meet Sphere Humanitarian standards for water, sanitation, and hygiene; (6) provide immediate food assistance; (7) develop and implement a solid waste collection strategy; and (8) implement immediately a plan for mobility and health care. Lessons have been learned from earlier pandemics such as HIV and epidemics such as Ebola. They can be applied here. At the same time, the opportunity exists for public health, public administration, international aid, NGOs, and community groups to innovate beyond disaster response and move toward long-term plans

Acute coronary ischemia during alcohol withdrawal: a case report

<p>Abstract</p> <p>Introduction</p> <p>The potential of alcohol withdrawal to cause acute coronary events is an area that needs the urgent attention of clinicians and researchers.</p> <p>Case presentation</p> <p>We report the case of a 52-year-old heavy-alcohol-using Sri Lankan man who developed electocardiogram changes suggestive of an acute coronary event during alcohol withdrawal. Despite the patient being asymptomatic, subsequent echocardiogram showed evidence of ischemic myocardial dysfunction. We review the literature on precipitation of myocardial ischemia during alcohol withdrawal and propose possible mechanisms.</p> <p>Conclusions</p> <p>Alcohol withdrawal is a commonly observed phenomenon in hospitals. However, the number of cases reported in the literature of acute coronary events occurring during withdrawal is few. Many cases of acute ischemia or sudden cardiac deaths may be attributed to other well known complications of delirium tremens. This is an area needing the urgent attention of clinicians and epidemiologists.</p

Conceptualising population health: from mechanistic thinking to complexity science

The mechanistic interpretation of reality can be traced to the influential work by René Descartes and Sir Isaac Newton. Their theories were able to accurately predict most physical phenomena relating to motion, optics and gravity. This paradigm had at least three principles and approaches: reductionism, linearity and hierarchy. These ideas appear to have influenced social scientists and the discourse on population health. In contrast, Complexity Science takes a more holistic view of systems. It views natural systems as being 'open', with fuzzy borders, constantly adapting to cope with pressures from the environment. These are called Complex Adaptive Systems (CAS). The sub-systems within it lack stable hierarchies, and the roles of agency keep changing. The interactions with the environment and among sub-systems are non-linear interactions and lead to self-organisation and emergent properties. Theoretical frameworks such as epi+demos+cracy and the ecosocial approach to health have implicitly used some of these concepts of interacting dynamic sub-systems. Using Complexity Science we can view population health outcomes as an emergent property of CAS, which has numerous dynamic non-linear interactions among its interconnected sub-systems or agents. In order to appreciate these sub-systems and determinants, one should acquire a basic knowledge of diverse disciplines and interact with experts from different disciplines. Strategies to improve health should be multi-pronged, and take into account the diversity of actors, determinants and contexts. The dynamic nature of the system requires that the interventions are constantly monitored to provide early feedback to a flexible system that takes quick corrections

The International Society of Nephrology's International Consortium of Collaborators on Chronic Kidney Disease of Unknown Etiology: report of the working group on approaches to population-level detection strategies and recommendations for a minimum dataset.

There is an epidemic of chronic kidney disease (CKD) clustering in rural communities, predominantly in a number of low- and middle-income countries. 1 Tens of thousands of working-aged adults are estimated to have died from the disease in Central America 2 with similar numbers in Sri Lanka. 3 Similar diseases have been reported elsewhere, such as rural regions or communities in India and North and West Africa. Those affected do not have common risk factors or underlying conditions that lead to CKD, such as diabetes, immune-mediated glomerulonephritis, or structural renal disease. In instances where histopathology is available, the predominant feature is tubular atrophy and interstitial fibrosis. Although it is currently unclear whether there is a unified underlying cause, these conditions have been collectively termed CKD of unknown cause (CKDu). Other terms used include “CKD of nontraditional cause,” “Mesoamerican nephropathy,” “chronic intestinal nephritis in agricultural communities,” and “kidney disease of unknown cause in agricultural laborers,” but we have chosen CKDu as the most agnostic terminology