Why disgust matters Curtis, Valerie
Philosophical transactions of the Royal Society of London. Series B. Biological sciences,
12/2011, Letnik:
366, Številka:
1583
Journal Article
Recenzirano
Odprti dostop
The new synthesis about disgust is that it is a system that evolved to motivate infectious disease avoidance. There are vital practical and intellectual reasons why we need to understand disgust ...better. Practically, disgust can be harnessed to combat the behavioural causes of infectious and chronic disease such as diarrhoeal disease, pandemic flu and smoking. Disgust is also a source of much human suffering; it plays an underappreciated role in anxieties and phobias such as obsessive compulsive disorder, social phobia and post-traumatic stress syndromes; it is a hidden cost of many occupations such as caring for the sick and dealing with wastes, and self-directed disgust afflicts the lives of many, such as the obese and fistula patients. Disgust is used and abused in society, being both a force for social cohesion and a cause of prejudice and stigmatization of out-groups. This paper argues that a better understanding of disgust, using the new synthesis, offers practical lessons that can enhance human flourishing. Disgust also provides a model system for the study of emotion, one of the most important issues facing the brain and behavioural sciences today.
Highlights • The biology of host resistance and tolerance is better understood than infection avoidance behavior. • Parasite avoidance behaviour in animals and humans is governed by the disgust ...adaptive system. • Animals can defend themselves against parasites using four fundamental avoidance strategies. • Avoidance behaviour is first in a continuum of resistance and tolerance responses.
Acute intestinal inflammation involves early accumulation of neutrophils (PMNs) followed by either resolution or progression to chronic inflammation. Based on recent evidence that mucosal metabolism ...influences disease outcomes, we hypothesized that transmigrating PMNs influence the transcriptional profile of the surrounding mucosa. Microarray studies revealed a cohort of hypoxia-responsive genes regulated by PMN-epithelial crosstalk. Transmigrating PMNs rapidly depleted microenvironmental O2 sufficiently to stabilize intestinal epithelial cell hypoxia-inducible factor (HIF). By utilizing HIF reporter mice in an acute colitis model, we investigated the relative contribution of PMNs and the respiratory burst to “inflammatory hypoxia” in vivo. CGD mice, lacking a respiratory burst, developed accentuated colitis compared to control, with exaggerated PMN infiltration and diminished inflammatory hypoxia. Finally, pharmacological HIF stabilization within the mucosa protected CGD mice from severe colitis. In conclusion, transcriptional imprinting by infiltrating neutrophils modulates the host response to inflammation, via localized O2 depletion, resulting in microenvironmental hypoxia and effective inflammatory resolution.
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•Infiltrating PMNs consume sufficient O2 to render adjacent colonic epithelia hypoxic•Hypoxia reporter mice demonstrate PMN-dependent hypoxia in inflamed colitic lesions•CGD mice do not incite mucosal hypoxia and develop severe nonresolving colitis•Mucosal HIF stabilization ameliorates colitis severity in wild-type and CGD mice
Summary
Objective To determine the effect of handwashing on the risk of respiratory infection.
Methods We searched PubMed, CAB s, Embase, Web of Science, and the Cochrane library for articles ...published before June 2004 in all languages. We had searched reference lists of all primary and review articles. Studies were included in the review if they reported the impact of an intervention to promote hand cleansing on respiratory infections. Studies relating to hospital‐acquired infections, long‐term care facilities, immuno‐compromised and elderly people were excluded. We independently evaluated all studies, and inclusion decisions were reached by consensus. From a primary list of 410 articles, eight interventional studies met the eligibility criteria.
Results All eight eligible studies reported that handwashing lowered risks of respiratory infection, with risk reductions ranging from 6% to 44% pooled value 24% (95% CI 6–40%). Pooling the results of only the seven homogenous studies gave a relative risk of 1.19 (95% CI 1.12%–1.26%), implying that hand cleansing can cut the risk of respiratory infection by 16% (95% CI 11–21%).
Conclusions Handwashing is associated with lowered respiratory infection. However, studies were of poor quality, none related to developing countries, and only one to severe disease. Rigorous trials of the impact of handwashing on acute respiratory tract infection morbidity and mortality are urgently needed, especially in developing countries.
Objectif Déterminer l'effet du lavage des mains sur le risque d'infections respiratoires.
Méthodes Nous avons effectué des recherches sur PubMed, CAB s, Embase, Web of Science et la bibliothèque Cochrane pour des articles publiés avant Juin 2004 en toutes langues. Nous avons aussi recherché manuellement les listes de références de toute publication primaire ou des articles de révision. Les études ont été incluses dans notre révision si elles rapportaient l'impact d'une intervention à promouvoir le lavage des mains sur les infections respiratoires. Les études portant sur les infections acquises à l'hôpital ou dans les services de santé avec prise en charge à long terme ou par des personnes à immunité compromise ou âgées ont été exclues. Nous avons évalué chaque étude indépendamment et les décisions pour l'inclusion ont été prises par consensus. D'une liste de départ de 410 articles, 8 études d'intervention ont satisfait aux critères d’éligibilitè.
Résultats Toutes les 8 études ont rapporté que le lavage des mains diminuait le risque d'infections respiratoire. La diminution du risque allait de 6 à 44% (valeurs cumulées 24%; IC95%: 6–40%). Le seul cumule des résultats de 7 études homogènes a donné un risque relatif de 1,19 (IC95%: 1,12–1,26%), suggérant que le lavage des mains peu réduire le risque d'infection respiratoire de 16% (IC95%: 11–21%).
Conclusion Le lavage des mains est associé avec une diminution des infections respiratoires. Cependant, les études étaient de pauvre qualité, aucune ne portait sur des pays en développement et une seule portait sur des maladies sévères. Des essais plus rigoureux de l'impact du lavage des mains sur la morbidité et la mortalité des infections respiratoires aigues sont urgemment nécessaires et plus particulièrement dans les pays en voie de développement.
Objetivo Determinar el efecto del lavado de manos en el riesgo de infección respiratoria
Método Se hizo una búsqueda en PubMed, CAB s, Embase, Web of Science, y la Cochrane library de artículos publicados, en todos los idiomas, antes de Junio del 2004. Se buscó a mano las listas de referencias de todos los artículos primarios y de revisión. Se incluyeron en la revisión aquellos estudios que reportaran el impacto sobre infecciones respiratorias de una intervención para promover el lavado de manos. Se excluyeron los estudios relacionados con infecciones nosocomiales, instalaciones de cuidados a largo plazo, personas inmuno‐suprimidas o personas mayores. Nosotros, independientemente, evaluamos todos los estudios, y la decisión de incluirlos o excluirlos fue consensuada. De una lista inicial de 410 artículos, ocho estudios de intervención tenían los criterios para ser elegidos.
Resultados Los ocho estudios elegibles reportaban que el lavado de manos disminuía el riesgo de infecciones respiratorias, con reducción del riesgo de entre un 6 a un 44% (valor combinado 24% (95% IC 6%‐40%). Agrupando los resultados de los sete estudios homogéneos se obtenía un riesgo relativo del 1.19 (95% IC 1.12 – 1.26), lo cual implica que el lavado de manos puede disminuir el riesgo de infección respiratoria en un 16% (95% IC 11 a 21%).
Conclusiones El lavado de manos está asociado con una disminución de la infección respiratoria. Sin embargo, los estudios analizados eran de baja calidad, ninguno relacionado con países de baja renta, y solo uno de ellos con enfermedad severa. Se requieren con urgencia ensayos rigurosos sobre el impacto del lavado de manos en la morbilidad y mortalidad por infecciones respiratorias, especialmente en países de baja renta.
Handwashing with soap (HWWS) may be one of the most cost-effective means of preventing infection in developing countries. However, HWWS is rare in these settings. We reviewed the results of formative ...research studies from 11 countries so as to understand the planned, motivated and habitual factors involved in HWWS. On average, only 17% of child caretakers HWWS after the toilet. Handwash ‘habits’ were generally not inculcated at an early age. Key ‘motivations’ for handwashing were disgust, nurture, comfort and affiliation. Fear of disease generally did not motivate handwashing, except transiently in the case of epidemics such as cholera. ‘Plans’ involving handwashing included to improve family health and to teach children good manners. Environmental barriers were few as soap was available in almost every household, as was water. Because much handwashing is habitual, self-report of the factors determining it is unreliable. Candidate strategies for promoting HWWS include creating social norms, highlighting disgust of dirty hands and teaching children HWWS as good manners. Dividing the factors that determine health-related behaviour into planned, motivated and habitual categories provides a simple, but comprehensive conceptual model. The habitual aspects of many health-relevant behaviours require further study.
Hygiene has been studied from multiple perspectives, including that of history. I define hygiene as the set of behaviours that animals, including humans, use to avoid infection. I argue that it has ...an ancient evolutionary history, and that most animals exhibit such behaviours because they were adaptive. In humans, the avoidance of infectious threats is motivated by the emotion of disgust. Intuition about hygiene, dirt and disease can be found underlying belief about health and disease throughout history. Purification ritual, miasma, contagion, zymotic and germ theories of disease are ideas that spread through society because they are intuitively attractive, because they are supported by evidence either from direct experience or from authoritative report and because they are consistent with existing beliefs. In contrast to much historical and anthropological assertion, I argue that hygiene behaviour and disgust predate culture and so cannot fully be explained as its product. The history of ideas about disease thus is neither entirely socially constructed nor an “heroic progress” of scientists leading the ignorant into the light. As an animal behaviour the proper domain of hygiene is biology, and without this perspective attempts at explanation are incomplete. The approaches of biological anthropology have much to offer the practice of cultural history.
Objective
To estimate the burden of diarrhoeal diseases from exposure to inadequate water, sanitation and hand hygiene in low‐ and middle‐income settings and provide an overview of the impact on ...other diseases.
Methods
For estimating the impact of water, sanitation and hygiene on diarrhoea, we selected exposure levels with both sufficient global exposure data and a matching exposure‐risk relationship. Global exposure data were estimated for the year 2012, and risk estimates were taken from the most recent systematic analyses. We estimated attributable deaths and disability‐adjusted life years (DALYs) by country, age and sex for inadequate water, sanitation and hand hygiene separately, and as a cluster of risk factors. Uncertainty estimates were computed on the basis of uncertainty surrounding exposure estimates and relative risks.
Results
In 2012, 502 000 diarrhoea deaths were estimated to be caused by inadequate drinking water and 280 000 deaths by inadequate sanitation. The most likely estimate of disease burden from inadequate hand hygiene amounts to 297 000 deaths. In total, 842 000 diarrhoea deaths are estimated to be caused by this cluster of risk factors, which amounts to 1.5% of the total disease burden and 58% of diarrhoeal diseases. In children under 5 years old, 361 000 deaths could be prevented, representing 5.5% of deaths in that age group.
Conclusions
This estimate confirms the importance of improving water and sanitation in low‐ and middle‐income settings for the prevention of diarrhoeal disease burden. It also underscores the need for better data on exposure and risk reductions that can be achieved with provision of reliable piped water, community sewage with treatment and hand hygiene.
Objectif
Estimer la charge des maladies diarrhéiques provenant de l'exposition à l'eau, l'assainissement et l'hygiène des mains inadéquats, dans les pays à revenus faibles et intermédiaires et fournir un aperçu de l'impact sur d'autres maladies.
Méthodes
Pour l'estimation de l'impact de l'eau, de l'assainissement et de l'hygiène sur la diarrhée, nous avons sélectionné des niveaux d'exposition avec à la fois des données suffisantes d'exposition mondiale et une relation exposition‐risque correspondante. Les données d'exposition mondiale ont été estimées pour l'année 2012 et les estimations du risque ont été prises à partir des analyses systématiques les plus récentes. Nous avons estimé les décès attribuables et les années de vie ajustées sur l'incapacité (DALY) par pays, âge et sexe pour l'eau, l'assainissement et l'hygiène des mains, séparément et comme un ensemble de facteurs de risque. Les estimations d'incertitude ont été calculées sur la base de l'incertitude entourant les estimations d'exposition et les risques relatifs.
Résultats
En 2012, une estimation de 502 000 décès par diarrhée causés par l'eau non potable et 280 000 décès dus à un assainissement inadéquat, a été calculée. L'estimation la plus probable de la charge de morbidité due à l'hygiène inadéquate des mains s’élève à 297 000 décès. Un total de 842 000 décès par diarrhée causés par cet ensemble de facteurs de risque a été estimé, ce qui équivaut à 1,5% de la charge de morbidité totale et 58% des maladies diarrhéiques. Chez les enfants de moins de cinq ans, 361 000 décès pourraient être évités, ce qui représente 5,5% des décès dans ce groupe d’âge.
Conclusions
Cette estimation confirme l'importance de l'amélioration de l'eau et de l'assainissement dans les pays à revenus faibles et intermédiaires pour la prévention de la charge des maladies diarrhéiques. Il souligne également la nécessité d'améliorer les données sur l'exposition et les réductions du risque qui peuvent être obtenues grâce à la fourniture de raccordement à l'eau fiable, à des égouts communautaires avec traitement et à l'hygiène des mains.
Objetivo
Calcular la carga de diarreas por exposición a agua, saneamiento e higiene de manos inadecuados en lugares con ingresos bajos y medios, y ofrecer una visión general del impacto sobre otras enfermedades.
Métodos
Para calcular el impacto del agua, saneamiento e higiene sobre la diarrea, hemos seleccionados niveles de exposición que tuviesen suficientes datos de exposición global y una relación exposición‐riesgo conjunta. Los datos de exposición global se calcularon para el año 2012, y los cálculos de riesgo se obtuvieron de los análisis sistemáticos más recientes. Hemos calculado las muertes atribuibles y los años de vida ajustados por la discapacidad (AVADs) por país, edad y sexo para agua, saneamiento y lavado de manos inadecuados de forma separada, y como un conglomerado de factores de riesgo. Los cálculos de incertidumbre se hicieron basándose en la incerteza alrededor de los cálculos de exposición y los riesgos relativos.
Resultados
En el 2012, se calculó que 502 000 muertes por diarrea estaban causadas por beber un agua inadecuada y 280 000 muertes por un saneamiento inadecuada. El cálculo de carga de enfermedad más probable por una higiene de manos inadecuada es de 297 000 muertes. En total, se calculó que 842 000 de muertes eran causadas por este conglomerado de factores de riesgo, siendo responsables de un 1.5% de la carga total de enfermedades y del 58% de las enfermedades diarreicas. En niños menores de cinco años, 361 000 muertes podrían prevenirse, representando un 5.5% de las muertes en este grupo de edad.
Conclusiones
Este cálculo confirma la importancia de mejorar la calidad del agua y del saneamiento en lugares con ingresos bajos y medios para prevenir la carga de enfermedad por diarreas. También subestima la necesidad de mejores datos sobre exposición y la reducción del riesgo que podría alcanzarse con el suministro de agua fiable mediante redes de tuberías, sistemas de alcantarillado comunitario con tratamiento de residuos e higiene de manos.
Infiltration of myeloid cells in the tumor microenvironment is often associated with enhanced angiogenesis and tumor progression, resulting in poor prognosis in many types of cancer. The polypeptide ...chemokine PK2 (Bv8, PROK2) has been shown to regulate myeloid cell mobilization from the bone marrow, leading to activation of the angiogenic process, as well as accumulation of macrophages and neutrophils in the tumor site. Neutralizing antibodies against PK2 were shown to display potent anti-tumor efficacy, illustrating the potential of PK2-antagonists as therapeutic agents for the treatment of cancer. In this study we demonstrate the anti-tumor activity of a small molecule PK2 antagonist, PKRA7, in the context of glioblastoma and pancreatic cancer xenograft tumor models. For the highly vascularized glioblastoma, PKRA7 was associated with decreased blood vessel density and increased necrotic areas in the tumor mass. Consistent with the anti-angiogenic activity of PKRA7 in vivo, this compound effectively reduced PK2-induced microvascular endothelial cell branching in vitro. For the poorly vascularized pancreatic cancer, the primary anti-tumor effect of PKRA7 appears to be mediated by the blockage of myeloid cell migration/infiltration. At the molecular level, PKRA7 inhibits PK2-induced expression of certain pro-migratory chemokines and chemokine receptors in macrophages. Combining PKRA7 treatment with standard chemotherapeutic agents resulted in enhanced effects in xenograft models for both types of tumor. Taken together, our results indicate that the anti-tumor activity of PKRA7 can be mediated by two distinct mechanisms that are relevant to the pathological features of the specific type of cancer. This small molecule PK2 antagonist holds the promise to be further developed as an effective agent for combinational cancer therapy.
Objective
To assess the impact of inadequate water and sanitation on diarrhoeal disease in low‐ and middle‐income settings.
Methods
The search strategy used Cochrane Library, MEDLINE & PubMed, Global ...Health, Embase and BIOSIS supplemented by screening of reference lists from previously published systematic reviews, to identify studies reporting on interventions examining the effect of drinking water and sanitation improvements in low‐ and middle‐income settings published between 1970 and May 2013. Studies including randomised controlled trials, quasi‐randomised trials with control group, observational studies using matching techniques and observational studies with a control group where the intervention was well defined were eligible. Risk of bias was assessed using a modified Ottawa–Newcastle scale. Study results were combined using meta‐analysis and meta‐regression to derive overall and intervention‐specific risk estimates.
Results
Of 6819 records identified for drinking water, 61 studies met the inclusion criteria, and of 12 515 records identified for sanitation, 11 studies were included. Overall, improvements in drinking water and sanitation were associated with decreased risks of diarrhoea. Specific improvements, such as the use of water filters, provision of high‐quality piped water and sewer connections, were associated with greater reductions in diarrhoea compared with other interventions.
Conclusions
The results show that inadequate water and sanitation are associated with considerable risks of diarrhoeal disease and that there are notable differences in illness reduction according to the type of improved water and sanitation implemented.
Objectif
Evaluer l'impact de l'eau et de l'assainissement inadéquats sur les maladies diarrhéiques dans les régions à revenus faibles et intermédiaires.
Méthodes
La stratégie de recherche a utilisé Cochrane Library, MEDLINE, PubMed, Global Health, Embase et BIOSIS, complétés par la recherche dans les listes de références des revues systématiques publiées antérieurement, pour identifier les études rapportant sur des interventions examinant l'effet de l'amélioration de l'eau potable et de l'assainissement dans les régions à revenus faibles et intermédiaires, publiées entre 1970 et mai 2013. Les études comprenant des essais randomisés contrôlés, des essais quasi‐randomisés avec un groupe témoins, des études d'observation utilisant des techniques d'appariement et des études observationnelles avec un groupe témoins où l'intervention a été bien définie, étaient éligibles. Le risque de biais a été évalué à l'aide d'une échelle modifiée d'Ottawa‐Newcastle. Les résultats de l’étude ont été combinés en utilisant une méta‐analyse et une méta‐régression pour déduire des estimations du risque globales et spécifiques à l'intervention.
Résultats
Sur 6819 rapports identifiés sur l'eau potable, 61 études répondaient aux critères d'inclusion et sur 12 515 rapports sur l'assainissement, 11 études ont été incluses. Dans l'ensemble, l'amélioration de l'eau potable et de l'assainissement a été associée à une diminution des risques de diarrhée. Des améliorations spécifiques, telles que l'utilisation de filtres à eau, la fourniture de raccordement à l'eau courante de haute qualité et à des égouts, ont été associées à des réductions plus importantes de la diarrhée par rapport à d'autres interventions.
Conclusions
Les résultats montrent que l'eau et l'assainissement inadéquats sont associés à des risques considérables de maladies diarrhéiques et qu'il existe des différences notables dans la réduction des maladies selon le type d'amélioration de l'eau et de l'assainissement mis en place.
Objetivo
Evaluar el impacto del agua y saneamiento inadecuados sobre la enfermedad diarreica en lugares con ingresos medios y bajos.
Métodos
La estrategia de búsqueda utilizó la Biblioteca de Cochrane, MEDLINE & PubMed, Global Health, Embase y BIOSIS suplementado con una búsqueda en las listas de las referencias de revisiones sistemáticas previamente publicadas, con el fin de identificar estudios en los que se reportasen intervenciones que examinaran el efecto de mejoras en el agua para consumo y el saneamiento en lugares con ingresos medios y bajos, publicados entre 1970 y Mayo 2013. Los estudios elegibles incluían ensayos aleatorizados controlados, ensayos cuasi‐aleatorizados con grupo control, estudios observacionales pareados y estudios observacionales con un grupo control en donde la intervención estaba bien definida. El riesgo de sesgo se evaluó utilizando la escala de Ottawa‐Newcastle modificada. Los resultados del estudio se combinaron utilizando el meta‐análisis y la meta‐regresión para derivar los cálculos específicos de riesgo generales y específicos de la intervención.
Resultado
De 6,819 registros identificados para agua de consumo humano, 61 estudios cumplieron con los criterios de inclusión y de 12,515 registros identificados para saneamiento, se incluyeron 11 estudios. En general, las mejoras en el agua para consumo y el saneamiento estaban asociadas con una disminución en el riesgo de diarrea. Las mejoras específicas, tales como el uso de filtros de agua, el suministro de agua de calidad mediante conexión al acueducto y al alcantarillado, estaban asociadas con mayores reducciones en la diarrea, comparadas con otras intervenciones.
Conclusiones
Los resultados muestran que un suministro de agua y saneamiento inadecuados estaban asociadas con riesgos considerables de enfermedad diarreica, y que existen diferencias notables en la reducción de la enfermedad según el tipo de mejoras en el agua y el saneamiento implementados.
A substantial proportion of the total infectious disease burden world-wide is due to person-to-person spread of pathogens within households. A questionnaire-based survey on the determinants of ...hand-washing with soap and cleaning of household surfaces was conducted in at least 1000 households in each of twelve countries across the world (N = 12,239). A structural equation model of hygiene behaviour and its consequences derived from theory was then estimated on this dataset for both behaviours, using a maximum likelihood procedure. The analysis showed that the frequency of handwashing with soap is significantly related to how automatically it is performed, and whether or not someone is busy, or tired. Surface cleaning was strongly linked to possessing a cleaning routine, the perception that one is living in a dirty environment and that others are doing the behaviour, whether one has a strong sense of contamination, as well as a felt need to keep one's surroundings tidy. Being concerned with good manners is also linked to the performance of both behaviours. This study is the first to identify the role of manners, orderliness and routine on hygiene behaviours globally. Such findings should prove helpful in designing programs to improve domestic hygiene practices.
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