Surviving polio in a post-polio world.

Excitement mounts as the global health and international development communities anticipate a polio-free world. Despite substantial political and logistical hurdles, only 223 cases of wild poliovirus in three countries were reported in 2012. Down 99% from the estimated 350,000 annual cases in 125 countries in 1988-this decline signals the imminent global eradication of polio. However, elimination of new polio cases should not also signal an end to worldwide engagement with polio. As many as 20 million continue to live with the disabling consequences of the disease. In developed countries where polio immunization became universal after dissemination of the polio vaccine in the 1950s, almost all individuals who have had polio are now above age 50. But in many developing countries where polio vaccination campaigns reached large segments of the population only after 1988, millions disabled by polio are still children or young adults. Demographically, this group is also different. After three decades of immunization efforts, those children unvaccinated in the late 1980s were more likely to be from poorer rural and slum communities and to be girls-groups not only harder to reach than more affluent members of the population but also individuals who, if they contract polio, are less likely to have access to medical and rehabilitation programs or education, job training, employment and social support services. The commitment to eradicate polio should not be considered complete while those living with the disabling sequelae of polio continue to live in poor health, poverty and social isolation. This paper reviews what is currently known about disabled survivors of polio and highlights areas of need in public health research, policy and programming. Based on a literature review, discussion and field observations, we identify continuing challenges posed by polio and argue that the attention, funding and commitment now being directed towards eradication be shifted to provide for the rehabilitative, medical, educational and social needs of those for whom the disabling sequelae of polio will remain a daily challenge for decades to come

Group treatments for sensitive health care problems : a randomised controlled trial of group versus individual physiotherapy sessions for female urinary incontinence

Background: The aim was to compare effectiveness of group versus individual sessions of physiotherapy in terms of symptoms, quality of life, and costs, and to investigate the effect of patient preference on uptake and outcome of treatment. Methods: A pragmatic, multi-centre randomised controlled trial in five British National Health Service physiotherapy departments. 174 women with stress and/or urge incontinence were randomised to receive treatment from a physiotherapist delivered in a group or individual setting over three weekly sessions. Outcome were measured as Symptom Severity Index; Incontinence-related Quality of Life questionnaire; National Health Service costs, and out of pocket expenses. Results: The majority of women expressed no preference (55%) or preference for individual treatment (36%). Treatment attendance was good, with similar attendance with both service delivery models. Overall, there were no statistically significant differences in symptom severity or quality of life outcomes between the models. Over 85% of women reported a subjective benefit of treatment, with a slightly higher rating in the individual compared with the group setting. When all health care costs were considered, average cost per patient was lower for group sessions (Mean cost difference £52.91 95%, confidence interval (£25.82 - £80.00)). Conclusion: Indications are that whilst some women may have an initial preference for individual treatment, there are no substantial differences in the symptom, quality of life outcomes or non-attendance. Because of the significant difference in mean cost, group treatment is recommended

Associations between annual and seasonal variations in body mass and reproductive success and blood biochemical parameters in semi-domesticated reindeer

The main objective of the study was to follow reproductive performance and blood biochemical parameters associated with fat and carbohydrate metabolism in a herd of free-ranging, semi-domesticated reindeer (Rangifer tarandus tarandus) over a two-year period, with extreme between-year variation in forage availability. The effects of climatic factors on reindeer reproductive performance were investigated by analysing whether time of onset of luteal function in autumn and calf survival were associated with changes in body mass and weather conditions, such as snow depth, precipitation, and temperature. Considerable between-year variation in the onset of luteal activity was found. In 1997, 4.2% of the female reindeer were either cycling or pregnant in the second week of October, whilst in 1998, in the same week, 100% were cycling or pregnant. Although energy balance was important for timing of the onset of luteal activity, delayed conception had no apparent effect on calf survival. The results indicated that maternal body mass (BM) in spring was of primary importance for calf survival, and the productivity of the herd. Since climatic factors influence the availability of forage, and hence female BM, it also has an indirect impact on calf survival. Females with low BM demonstrated greater seasonal variation in BM than heavier females. Plasma concentrations of free fatty acids and β-hydroxy butyric acid responded to changes in forage availability, but the initial condition of the reindeer and their fat reserves also seemed to have a major influence on these parameters.Abstract in Norwegian / Sammendrag:Sammenheng mellom års- og sesongvariasjon i kroppsvekt og henholdsvis reproduksjonssuksess og biokjemiske blodparametre hos tamreinHovedformålet med studien var å følge reproduksjonen og blodparametre knyttet til fett og karbohydratmetabolismen hos en tamreinflokk (Rangifer tarandus tarandus) gjennom en toårs periode med stor årlig variasjon i næringstilgang. Effekten av klima på reinens reproduksjonssuksess ble undersøkt ved å analysere om værdata som snødybde, nedbørsmengde og temperatur og forandringer i vekt hadde innvirkning på igangsetting av lutealfunksjonen hos simlene og på kalvenes overlevingsevne gjennom sommeren. Det ble funnet en betydelig forskjell mellom år når det gjaldt igangsetting av lutealfunksjon. I oktober 1997, var kun 4,2% av simlene drektige eller i lutealfasen av brunstsyklusen mens i den samme uken i 1998 var alle dyrene drektige eller i brunstens lutealfase. Selv om energibalanse var viktig for igangsetting av lutealfunksjonen, hadde forsinkelse i drektighetene ingen innflytelse på kalveoverlevelsen. Resultatene våre indikerte at simlenes vårvekt var av størst betydning for kalveoverlevelsen, og dermed også for produktiviteten til flokken. Siden de til enhver tid gjeldene værforhold påvirket tilgangen av fôr, påvirket dette også simlenes vekt med en indirekte effekt på kalveoverlevelsen. Simler med lav levendevekt viste større sesongvariasjon i vekt enn tyngre simler. Plasmakonsentrasjonen av frie fettsyrer, β-hydroxy-smørsyre forandret seg i takt med beitegrunnlaget, men den initiale kondisjonen og fettreservene hos simlene syntes også å påvirke disse parametrene

Conflicting rights: How the prohibition of human trafficking and sexual exploitation infringes the right to health of female sex workers in Phnom Penh, Cambodia

While repressive laws and policies in relation to sex work have the potential to undermine HIV prevention efforts, empirical research on their interface has been lacking. In 2008, Cambodia introduced anti-trafficking legislation ostensibly designed to suppress human trafficking and sexual exploitation. Based on empirical research with female sex workers, this article examines the impact of the new law on vulnerability to HIV and other adverse health outcomes. Following the introduction of the law, sex workers reported being displaced to streets and guesthouses, impacting their ability to negotiate safe sex and increasing exposure to violence. Disruption of peer networks and associated mobility also reduced access to outreach, condoms, and health care. Our results are consistent with a growing body of research which associates the violation of sex workers’ human rights with adverse public health outcomes. Despite the successes of the last decade, Cambodia’s AIDS epidemic remains volatile and the current legal environment has the potential to undermine prevention efforts by promoting stigma and discrimination, impeding prevention uptake and coverage, and increasing infections. Legal and policy responses which seek to protect the rights of the sexually exploited should not infringe the right to health of sex workers.NIH grants: U01AI0154241, 1R21 DA025441, and 1R01NR010995 and additional funding from a Faculty Initiative grant from the Pacific Rim Research Program of the University of California. Lisa Maher is supported by a National Health and Medical Research Council Senior Research Fellowshi

The Global Polio Eradication Initiative-polio eradication cannot be the only goal.

No abstract available

Validation of AIDS-related mortality in Botswana

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Cervical Human Papillomavirus Infection among Young Women Engaged in Sex Work in Phnom Penh, Cambodia: Prevalence, Genotypes, Risk Factors and Association with HIV Infection

Background Although cervical cancer is the leading cancer in Cambodia, most women receive no routine screening for cervical cancer and few treatment options exist. Moreover, nothing is known regarding the prevalence of cervical HPV or the genotypes present among women in the country. Young sexually active women, especially those with multiple sex partners are at highest risk of HPV infection. We examine the prevalence and genotypes of cervical HPV, as well as the associated risk factors among young women engaged in sex work in Phnom Penh, Cambodia. Methods We conducted a cross-sectional study among 220 young women (15–29 years) engaged in sex work in different venues including brothels or entertainment establishments, and on a freelance basis in streets, parks and private apartments. Cervical specimens were collected using standard cytobrush technique. HPV DNA was tested for by polymerase chain reaction (PCR) and genotyping using type-specific probes for 29 individual HPV types, as well as for a mixture of 10 less common HPV types. All participants were also screened for HIV status using blood samples. Multivariate logistic regression analyses were conducted to assess risk factors for any or multiple HPV infection. Results The prevalence of cervical HPV 41.1%. HPV 51 and 70 were the most common (5.0%), followed by 16 (4.6%), 71 (4.1%) and 81 (3.7%). Thirty-six women (16.4%) were infected with multiple genotypes and 23.3% were infected with at least one oncogenic HPV type. In multivariate analyses, having HIV infection and a higher number of sexual partners were associated with cervical HPV infection. Risk factors for infection with multiple genotypes included working as freelance female sex workers (FSW) or in brothels, recent binge use of drugs, high number of sexual partners, and HIV infection. Conclusions This is the first Cambodian study on cervical HPV prevalence and genotypes. We found that HPV infection was common among young FSW, especially among women infected with HIV. These results underscore the urgent need for accessible cervical cancer screening and treatment, as well as for a prophylactic vaccine that covers the HPV subtypes present in Cambodia

Constitutional Analogies in the International Legal System

This Article explores issues at the frontier of international law and constitutional law. It considers five key structural and systemic challenges that the international legal system now faces: (1) decentralization and disaggregation; (2) normative and institutional hierarchies; (3) compliance and enforcement; (4) exit and escape; and (5) democracy and legitimacy. Each of these issues raises questions of governance, institutional design, and allocation of authority paralleling the questions that domestic legal systems have answered in constitutional terms. For each of these issues, I survey the international legal landscape and consider the salience of potential analogies to domestic constitutions, drawing upon and extending the writings of international legal scholars and international relations theorists. I also offer some preliminary thoughts about why some treaties and institutions, but not others, more readily lend themselves to analysis in constitutional terms. And I distinguish those legal and political issues that may generate useful insights for scholars studying the growing intersections of international and constitutional law from other areas that may be more resistant to constitutional analogies