The Impact of HIV/AIDS in the Context of Socioeconomic Stressors: an Evidence-Driven Approach

In this paper, we present an agent-based simulation model of the social impacts of HIV/AIDS in villages in the Sekhukhune district of the Limpopo province in South Africa. AIDS is a major concern in South Africa, not just in terms of disease spread but also in term of its impact on society and economic development. The impact of the disease cannot however be considered in isolation from other stresses, such as food insecurity, high climate variability, market fluctuations and variations in support from government and non-government sources. The model described in this paper focuses on decisions made at the individual and household level, based upon evidence from detailed case studies, and the different types of networks between these players that influence their decision making. Key to the model is that these networks are dynamic and co-evolving, something that has rarely been considered in social network analysis. The results presented here demonstrate how this type of simulation can aid better understanding of this complex interplay of issues. In turn, we hope that this will prove to be a powerful tool for policy development.Agent-Based Social Simulation, Evidence-Driven Modeling, Socioeconomic Stressors, HIV/AIDS Impact

Majoon-E-Piyaz: A Potent Unani Formulation for Premature Ejaculation

Surʻat-e-Inzāl (Premature Ejaculation) is the most prevalent male sexual dysfunction affecting 25 - 40% global population of men. It is a universal disorder and is independent of age, social or marital status. It has a significant impact on both- patients and their partners, causing distress, anxiety and relationship difficulties affecting the quality of life. Several aetiologies have been proposed by various researchers which are not evidence-based but speculative. Accordingly the International Society for Sexual Medicine (ISSM) issued treatment guidelines for Premature Ejaculation (PE) recommending Serotonergic Antidepressants (SSRIs) and Local Anaesthetics (LA) for its management in modern medicine. However, these treatments were not actually developed for PE, and have limitations associated with their off-label use. Furthermore, nearly all the recommended drugs have a wider spectrum of adverse effects and serious drug interactions which sometimes could be fatal. On the other hand, centuries old Unani medicine offers a complete line of treatment for Surʻat-e-Inzāl based on traditional knowledge and experience. Unani physicians devised a large number of poly-herbal recipes which are still in vogue.  Majoon-e-Piyaz (MP) is one of the compound Unani formulations which are in use for the treatment of premature ejaculation since centuries. This article is an attempt to summarize scientific investigations in support of the claim made by Unani physicians regarding Majoon-e-Piyaz (MP).  Keywords: Surʻat-e-Inzāl, Premature Ejaculation, Majoon-e-Piyaz, Unani Medicin

SURʻAT-E-INZĀL (PREMATURE EJACULATION) AND ITS MANAGEMENT BY UNANI MEDICINE

Surʻat-e-Inzāl (Premature Ejaculation) is the most prevalent male sexual dysfunction affecting 25 - 40% global population of men. It is a universal disorder and is independent of age, social or marital status. It has a significant impact on both- patients and their partners, causing distress, anxiety and relationship difficulties affecting the quality of life. Several aetiologies have been proposed by various researchers which are not evidence-based but speculative. Accordingly the International Society for Sexual Medicine (ISSM) issued treatment guidelines for Premature Ejaculation (PE) recommending Serotonergic Antidepressants (SSRIs) and Local Anaesthetics (LA) for its management in modern medicine. However, these treatments were not actually developed for PE, and have limitations associated with their off-label use. Furthermore, nearly all the recommended drugs have a wider spectrum of adverse effects and serious drug interactions which sometimes could be fatal. On the other hand, centuries old Unani medicine offers a complete line of treatment for Surʻat-e-Inzāl based on traditional knowledge and experience. Firstly, various single as well as compound Unani formulations have been in use since long for the treatment of Surʻat-e-Inzāl and found effective and safe. Secondly, the benefits of herbal and other natural products are increasingly being sighted because of their lesser side effects. Keeping the limitations and adverse effects posed by conventional treatment of PE in mind, an attempt has been made in this paper to review the use of age old Unani System of Medicine for the treatment and management of Premature Ejaculation. Keywords: Premature; Ejaculation; Unani; Surʻat-e-Inzāl; Quwwat-e-Masik

CONCEPT AND MANAGEMENT OF WAJA‘AL-MAFᾹSIL (ARTHRITIS) IN UNANI SYSTEM OF MEDICINE

Arthritis is described in Unani system of Medicine under a broad term Waja‘al-Mafāsil which covers entire joint disorders like inflammatory, non-inflammatory, infectious, metabolic and other musculoskeletal disorders. According to Unani concept, the pathological changes in the joints are caused mainly by derangement of humoural (Akhlat) temperament and accumulation of Fasid madda (Morbid material) in the joint spaces. The main principles of treatment in Unani system of Medicine include Ilaj Bil Ghiza (Dieto-therapy), Ilaj Bit Tadbeer (Regimenal therapy) and Ilaj Bid Dawa (Pharmacotherapy). All the said principles are recommended for the treatment of Waja‘al-Mafāsil. The aim of treatment for patient with Waja‘al-Mafāsil is to reduce morbidity and disability. In India it affects 15% (180 million) people. Ancient Unani scholars have elaborately described Waja‘al-Mafāsil and managed with multidimensional approach, where as with the present day management of disease mainly with non-steroidal anti-inflammatory drugs (NSAIDs) which have large number of adverse effects. This review article highlight the salient features describing arthritis with reference to Waja‘al-Mafāsil for empathizing disease condition as enunciated by Unani scholars to provide a better alternative in terms of cost effective managements and side effects. Keywords: Waja‘al-Mafāsil, Arthritis, Joints pain, Unani medicin

Majoon Suranjan: A Potent Unani formulation for Arthritis

 Unani System of medicine is one among the oldest systems that prevails till date with its efficient drugs derived from animal, plant and mineral resources. Over 2400 years ago the father of medicine, Hippocrates practiced it, however His medicine included a great deal of ancient Egyptian medicine as well as important components of the ancient Mesopotamian traditions. In Unani system of medicine, arthritis is described under a broad term Waja-ul-Mafasil which encompasses entire joint disorders like inflammatory, non-inflammatory, infectious, metabolic and other musculoskeletal disorders. A large number of drugs, single and compound formulations, have been mentioned in the context of the treatment of Waja-ul-Mafasil. Among them, Majoon Suranjan is one of the most reputed poly pharmaceutical preparations of Unani system of Medicine used in Waja-ul-Mafasil. It is attributed to Indrumakhas of Greece (Andromachos, the elder, court physician to King Nero) who formulated it in consultation with several other philosophers of his time. This Unani compound formulation contains twenty ingredients, which is used as digestive, purgative, anti inflammatory, stomachic, deobstruent, antiarthritic, nervine tonic. It is also indicated for use in phlegmatic diseases. Keywords: Majoon Suranjan, Ingredients, Arthritis, Unani Medicine

Riverbank erosion and rural food security in Bangladesh

The erosion of riverbanks has a negative impact on many nations across the world, costing them land, buildings, food, fish, and other living things, which forces people to relocate. Both the frequency and severity of riverbank erosion are alarming in Bangladesh. In Zajira Upazila, a baseline investigation was carried out to evaluate the effects of river erosion on the local availability of food. The results show how erosion threatens the majority of residents in the research territory. Additionally, as a consequence of the depletion of farmland brought on by the disaster and its effects, crop production is steadily dropping. Occasionally, people lose whole properties, leaving them with few employment options and little spending power. As a result, they are always in danger of experiencing a shortage of food. The suffering people use various coping strategies to deal with these challenging circumstances, such as shifting to cheaper or less appealing eating options. Despite the fact that local governing bodies have put in place various programs to help them, including food assistance and social protection programs, these are inadequate because of the government’s constrained organizational assets and competence The study’s findings will aid scientists and decision-makers in Bangladesh and abroad in better comprehending the requirements of vulnerable riverine populations and in designing programs that would increase those societies’ food safety Therefore, these results imply that developing and implementing efficient rural development strategies could increase the food security of those residing in Bangladeshi regions threatened by riverbank erosion

Effectiveness of unani regimen in protecting high risk population from COVID -19: A pilot study

The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread globally. COVID-19 presents varied clinical features. The present study focuses on number of patients turning COVID-19 positive, change in Immune Status Questionnaire (ISQ) and WHO quality of life- Bref (WHO Qol – BREF) scales after taking intervention. This open labelled, double arm, controlled, interventional, clinical trial was conducted on high-risk individuals i.e., those residing with a COVID-19 positive member in the identified quarantine area. This twin armed study was conducted on asymptomatic individuals exposed to COVID -19. The test group were prescribed Unani poly-herbal decoction together with Unani formulations Khamira Marwareed and Tiryaq e Arba whereas the control group was not on any intervention. The duration of intervention was 20 days; follow ups were planned on day 10 and day 20. Of the 81 participants enrolled, none of the patients turned COVID-19 positive. However, 13.58% (n=11) developed COVID like symptoms and 70 patients completed the study. The mean age of the participants was 41.42±16.9 years; however, majority of the participants were 18-28 years male with Damvi (Sanguine) temperament. The quality of life of the intervention group improved significantly however, the immune status in both the groups increased with P <0.001. The Unani prophylactic regimen provides a 62% (relative risk reduction) protection against COVID -19. This pilot study paves for a study on a larger population. No adverse effects were observed during the study. Absence of biochemical investigations were limitations to the study

Experiments in Globalisation, Food Security and Land Use Decision Making

The globalisation of trade affects land use, food production and environmentsaround the world. In principle, globalisation can maximise productivity andefficiency if competition prompts specialisation on the basis of productive capacity.In reality, however, such specialisation is often constrained by practical or politicalbarriers, including those intended to ensure national or regional food security.These are likely to produce globally sub-optimal distributions of land uses. Bothoutcomes are subject to the responses of individual land managers to economicand environmental stimuli, and these responses are known to be variable and often(economically) irrational. We investigate the consequences of stylised food securitypolicies and globalisation of agricultural markets on land use patterns under avariety of modelled forms of land manager behaviour, including variation inproduction levels, tenacity, land use intensity and multi-functionality. We find that asystem entirely dedicated to regional food security is inferior to an entirelyglobalised system in terms of overall production levels, but that several forms ofbehaviour limit the difference between the two, and that variations in land useintensity and functionality can substantially increase the provision of food and otherecosystem services in both cases. We also find emergent behaviour that results inthe abandonment of productive land, the slowing of rates of land use change andthe fragmentation or, conversely, concentration of land uses following changes indemand levels

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions