More than a decade ago Singer (2009) described Gibraltar's experience with cholera and smallpox in 1865 as a syndemic. In this study, we provide a reassessment of that event and, consequently, ...propose a methodology to identify a syndemic at the population level. We propose that the concept of the harvesting effect from demographic studies on crisis mortality provides a useful framework for evaluating the presence of a syndemic. Our research begins by establishing a normative baseline mortality (BM) through life table analysis, where changes in life expectancy (LE) around BM can be used to show a distinctive pattern of significant decline and increase. Such was the case with the presence of both cholera and smallpox in the fall of 1865, when LE fell significantly to 19.64 years from the background LE of 32.88 years. A year later, this decline was followed by a significant increase in LE to 41.34 years. Excessive mortality followed by a fallow (healthy) period represents a signature feature of a syndemic driven by a short-term infectious disease epidemic. The presence of both cholera and smallpox in 1860 did not produce similar results, evidence which suggests that the presence of two infectious epidemics in an impoverished population was not sufficient to produce a syndemic. The presence of a protracted state of quarantine, with its concomitant social and economic consequences, was a driving force responsible for amplifying the disease burden in 1865, and elevating to a syndemic status.
Multivariate Poisson regression revealed patio level limiting factors (such as, presence of a cistern, a well, a live-in servant, and a Jewish co-resident), as well as risk factors (such as, a smallpox death in the building; the presence of a foreign-born individual). From the two-phase assessment of the syndemic in Gibraltar, we developed a conceptual framework for identifying, contributing, driving, and limiting factors.
•The 1865 Gibraltar cholera syndemic displayed features of the harvesting effect.•Driving syndemic factors were cholera and smallpox deaths, and quarantine.•Contributing factors were overcrowding, poor sanitation, and the daily influx of transients.•Poor relief was a limiting factor in the syndemic.•Patio-level limiting factors were, cistern, well, servant, and Jewish co-resident.
Over half a century ago, McKeown and colleagues proposed that economics was a major contributor to the decline of infectious diseases, including respiratory tuberculosis, during the 19th and 20th ...centuries. Since then, there is no consensus among researchers as to the factors responsible for the mortality decline. Using the case study of the islands of Malta and Gozo, we examine the relationship of economics, in particular, the cost of living (Fisher index) and its relationship to the secular trends of tuberculosis mortality. Notwithstanding the criticism that has been directed at McKeown, we present results that improvement in economics is the most parsimonious explanation for the decline of tuberculosis mortality. We reaffirmed that the reproductively aged individuals were most at risk of dying of tuberculosis, seeing that 70 to 90% of all deaths due to tuberculosis occurred between the ages of 15 and 45. There was a clear sex differential in deaths in that, prior to 1930, rates in females were generally higher than males. During times of extreme hardship, the sex differential was exacerbated. Over the course of World War I, the sex gap in tuberculosis rates increased until peaking in 1918 when there was also the influenza pandemic. The heightened differential was most likely a result of gendered roles as opposed to biological differences since female tuberculosis rates again surpassed male rates in 1945 during World War II. Respiratory tuberculosis in both urban and rural settlements (in Malta proper) was significantly influenced by the Fisher index, which explains approximately 61% of the variation in TB death rates (R = 0.78; p<0.0001). In Gozo, there was no significant impact on respiratory tuberculosis (R = 0.23; p = 0.25), most likely a consequence of the island's isolation, a self-sufficient economy and limited exposure to tuberculosis.
ABSTRACT
Background
Human brucellosis, otherwise known as undulant fever, is one of the most widespread zoonotic diseases in the world. Even though 9%–15% of stillbirths are known to be caused by ...infectious diseases, the study of the link between human Brucella melitensis and the termination of births in humans is a topic that has received little attention. This study examines if there was an association between infection of undulant fever, an endemic zoonotic disease in the Maltese Islands from 1919 until 1954, and reproductive loss through stillbirths.
Methods
A univariate descriptive analysis was used to show the temporal trend of undulant fever time, as well as the age and sex distribution. Time series analysis was used to assess the relationship between time (months) and undulant fever cases with stillbirth proportions.
Results
On the island of Gozo, the majority of undulant fever cases for both males and females occurred in their reproductive period between 15 and 45 years of age. Based on regression analysis, undulant fever had a statistically significant effect on the stillbirth rate for males (t = 2.8986, p = 0.0039). The effect of undulant fever on stillbirths was not significant for females (p = 0.9103).
Conclusion
This paper highlights the importance of undulant fever as having implications for the health burden in pregnant women and potential fetal loss through stillbirths in the contemporary context.
In Malta, where there has been a long history of endemic brucellosis, we found a relationship between undulant fever infections and male stillbirths; this relationship has been largely ignored in the literature. This study points to health implications for locations where undulant fever is endemic today.
The Gibraltar macaques are a transplanted species that originated in the Barbary States (Morocco and Algeria). Their origin on the Rock under British rule dates back to the eighteenth century, but ...most likely preceded the British period. We question the argument that the reason for the introduction of monkeys to Gibraltar was based on hunting the species for sport. Rather, we argue that the presence of macaques may have arisen for multiple reasons: for the purpose of trade and for pets; for partial realization of colonial officials' desire to botanize the Rock; and for the fulfilment of our human affinity with nature. Whatever the factors at play, the macaques had acquired the status of a protected species by the late eighteenth century at least, and their continuous presence to this very day is still the product of human agency.
This study contributes to our understanding of health in late nineteenth-century communities in Ontario and the major factors contributing to the high mortality of the period. The focus of the study ...is Belleville, Ontario, from 1876 to 1885. Life expectancies at birth in the low forties characterized the community with infant mortality rates in the very high range, 160 per 1000 live-births. Major contributors to the observed pattern of mortality included tuberculosis, weanling diarrhea, and scarlet fever. Significant differences in the likelihood of dying from these three major causes varied by gender and religious affiliation. It is possible that more extended patterns of breast-feeding among Catholics led to lower levels of weanling diarrhea mortality in their infants.
This study examines the morbidity experience of the island populations of Malta and Gozo during the 1918–1919 influenza pandemic. The epidemic pattern for the two islands showed considerable ...diversity that was manifested in Gozo’s lack of a herald wave and significantly higher morbidity rates during wave 2 (September–November 1918), followed by a distinctly muted pattern of morbidity in wave 3 relative to Malta. Common features or noncontributory factors that reduced the morbidity disparity across the two islands included poverty, female gendered roles and children aged to 10–14 as introducers of sickness to the household, mass gatherings as effective means of disease transmission, and tuberculosis as a syndemic potential. A rarely available resource, the register of notifiable diseases in Gozo, enabled our research to gain a far deeper appreciation of intrapopulation variation at the empirical level, which in turn allowed for a better understanding of how elements of isolation, exposure history, and rurality could play important roles shaping the epidemic experience.
Neurogenesis continues in various regions of the central nervous system (CNS) throughout life. As the mitogen basic fibroblast growth factor (bFGF) can proliferate neuronal precursors of CNS neurons ...in culture, and is also upregulated within adult dorsal root ganglia following axotomy, it is possible that the postnatal dorsal root ganglia contain bFGF-responsive neuronal precursors. We undertook cell culture of postnatal mouse dorsal root ganglia to demonstrate neurogenesis. Basic FGF induced a cellular proliferative response in dorsal root ganglia cell culture. After 2 weeks in serum-free medium containing bFGF, neurons were rarely observed. However, following removal of bFGF and addition of trophic factors, many cells were observed that morphologically resembled dorsal root ganglia neurons, stained for neuronal markers, and generated action potentials. Furthermore, bromodeoxyuridine, used as a marker of cytogenesis, was detected in neurofilament-160+ and/or microtubule-associated protein-2+ cells that morphologically resembled neurons. In addition to bFGF, epidermal growth factor, nerve growth factor, and sonic hedgehog were also capable of generating spherical cell clusters that contained cells that stained for neuronal markers following the addition of trophic factors. These results suggest that early postnatal dorsal root ganglia contain neural precursors that appear to proliferate in response to various factors and can then be induced to differentiate into neurons. In conclusion, the existence of neural precursors and the possibility of neurogenesis in postnatal dorsal root ganglia may provide a greater range of plasticity available to somatosensory systems during growth or following injury, perhaps to replace ineffectual or dying neurons.
This study prospectively evaluates hypercoagulable states in patients under 51 years of age undergoing lower extremity revascularization for ischemia and assesses early outcome after operation. ...Twenty patients whose ages range from 23 to 50 years (mean 40.8 years) were identified prospectively who underwent lower extremity revascularization and evaluation of hypercoagulability. Fifteen patients were male (75%), 10 were black (50%), six had hypertension (30%), and four were diabetic (20%). All but two were cigarette smokers (90%). Seven aortoiliac procedures and 13 infrainguinal procedures were performed. Six patients had one or more abnormalities of regulatory proteins (protein S deficiency, four; protein C deficiency, three; presence of lupus-like anticoagulant, three; plasminogen deficiency, two). Eight of 17 patients in whom platelet aggregation profiles were obtained showed increased reactivity (47%). Only 4 of 17 patients (24%) were normal when tested for all parameters. Arterial or graft thrombosis developed in four of the 20 patients within 30 days after operation. Hypercoagulability was found in all four patients whose revascularizations failed. A high incidence of hypercoagulable states was found in patients under 51 years of age with lower limb ischemia requiring revascularization. Hypercoagulability may have contributed to early postoperative thrombosis of the vascular procedure.
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