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3 - Plagues and Medicine
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- By Leszek Borysiewicz, University of Cambridge
- Edited by Jonathan L. Heeney, University of Cambridge, Sven Friedemann, University of Bristol
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- Book:
- Plagues
- Published online:
- 24 March 2017
- Print publication:
- 09 February 2017, pp 66-91
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Summary
Throughout history many plagues have struck mankind. For nearly as long, mankind has endeavoured to fight the diseases underlying plagues. This chapter highlights the importance of integrating academic disciplines to sustain the considerable progress that we have made in the control of infectious diseases. It is also a personal reflection, which comes with a health warning. Out of necessity it is selective and not comprehensive.
Scientific discoveries have changed the field of infectious diseases rapidly. New technologies constantly impact on the approaches that can be brought to bear on the problem. However, the study of the prevention of infectious diseases is not just about the biology underlying disease, but also about understanding society and individual behaviour. Ultimately, this is the conclusion I wish to deliver: the issues raised by our attempts to prevent plagues affect every member of society, not just the few fascinated by pathogens or our response to them.
Plagues’ Impact on Society
Most appropriately, the start of my analysis is 1347 and The Plague, known as the Black Death, that hit Europe. The historical details of The Plague are discussed in the preceding chapter ‘Plagues and History’ by Mary and Christopher Dobson. However, the importance of The Plague in Europe was that it was the first well-documented large-scale population pandemic. It affected everybody and spread to all parts of Europe, but leaving certain geographical pockets less affected than others.
To examine how to prevent the spread and impact of pathogens, it is important to consider the impact of The Plague on medieval society. Pieter Bruegel in his masterpiece The triumph of death (c.1562) depicts every conceivable grisly way of ending your life in medieval times. From scaffolds to being tortured on the wheel, a variety of ways of being decapitated or having other gruesome injuries inflicted on you are all there. But if this reflects the mind of medieval man, right in the centre is The Plague, with the characteristic plague cart filled with bodies.
So here is a perception of how plague affects individuals and in particular medieval man. Despite the fact that life was short and very hard by today's standards, the plague was perceived as a terrifying terminal event.
How did medieval man respond to this fearsome event? There were three possible options:
The first instinct, if you could afford it and the feudal system allowed it, was to run.
Foreword
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- By Professor Sir Leszek Borysiewicz, Vice-Chancellor, University of Cambridge
- M. S. Swaminathan
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- Book:
- Combating Hunger and Achieving Food Security
- Published online:
- 18 December 2015
- Print publication:
- 08 January 2016, pp vii-x
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Summary
It is no accident that the ‘eradication of extreme poverty and hunger’ was first on the list of the United Nations’ Millennium Development Goals. Access to food and proper nutrition has a direct impact on our capacity to reduce child mortality, to enhance maternal health and even to boost primary school attendance – all of which were announced in the year 2000 as development priorities. Crucially, the ways in which we grow food are profoundly linked to our ability to ensure environmental sustainability – another Millennium Development Goal.
Few people have understood the urgency of tackling the complex challenge of global food security better than Professor M. S. Swaminathan. Few have advocated so effectively for the need to bring scientists, non-governmental organisations, global policymakers and local communities together to achieve the objective of a hunger-free world.
There are some staggering facts to consider. We know that the world's current food production is enough to feed its entire population one and half times. And yet, according to the UN's Food and Agriculture Organization, one in eight people suffer from chronic malnutrition. Meanwhile, more food is wasted per year in the developed world than is produced in the whole of sub-Saharan Africa in the same period. As many of the essays in this collection demonstrate, the main issue is not scarcity, but poverty and equality. And the answer does not lie in the increasing yields, but in improving them.
For decades Professor Swaminathan has campaigned for the introduction of enriched food crops, for a greater emphasis on nutrition-sensitive agriculture, for a more balanced integration of the world's food and energy security strategies, and for better communication between scientists and the public. In India, he is rightly acknowledged as the man behind the country's ‘Green Revolution’, which propelled the country to self-sufficiency in grain production in the 1960s. A more recent achievement is his influential role in the enactment of India's National Food Security Act (2013), which makes provision of nourishment for the country's poorest a legal entitlement.
But his continued and ever-developing thoughts on the questions surrounding food security, and his promotion of an ‘evergreen revolution’, point to the global scale of the challenge. While the effects of biodiversity loss and climate change are felt locally, the task of managing them has to be international, and concerted.
4 - Vaccinia-based human papillomavirus vaccines in cervical cancer
- Edited by Peter L. Stern, Paterson Institute for Cancer Research, Manchester, Peter C. L. Beverley, University College London, Miles Carroll, Oxford BioMedica (UK) Ltd
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- Book:
- Cancer Vaccines and Immunotherapy
- Published online:
- 06 January 2010
- Print publication:
- 17 August 2000, pp 62-81
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Summary
Introduction
The Poxviridae are a family of double-stranded DNA viruses that characteristically replicate in the cytoplasm of infected cells and, by encoding a wide range of hostindependent enzymes, are able to express gene products and replicate DNA, even in enucleated cells. They are further subclassified but only two members of the subfamily Chordopoxviridae (poxviruses of vertebrates), molluscum contagiosum virus and variola (smallpox), are specifically human viruses. Infection with poxviruses of other species can occur with cowpox, vaccinia and monkeypox, sometimes resulting in localized outbreaks. In addition, skin infections from inadvertent local inoculation with orf (a virus of sheep and goats), pseudocowpox (producing milker's nodules), tannapox and yabapoxvirus occur. The most notorious member of this family – variola virus – was historically the cause of widespread pandemics of smallpox. It is estimated that 400000 people died each year in Europe at the turn of the eighteenth century with a consequent major impact on communities. Clinically, it has been recognized that immunity was lifelong following exposure to variola, resulting in the practice of variolation (direct inoculation of infected scabs from patients into healthy recipients). Although immunity to variola and a significant reduction in mortality was achieved, a substantial morbidity and mortality associated with the procedure remained. This provided the background to the classical experiments of Jenner, who used direct inoculation of cowpox to induce protective immunity to experimental exposure to variola.
Screening for Psychiatric Morbidity in Subjects Presenting with Chronic Fatigue Syndrome
- Anne Farmer, Helen Chubb, Irene Jones, Janis Hillier, Andy Smith, Leszek Borysiewicz
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- Journal:
- The British Journal of Psychiatry / Volume 168 / Issue 3 / March 1996
- Published online by Cambridge University Press:
- 02 January 2018, pp. 354-358
- Print publication:
- March 1996
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Background
There is a need for a valid self-rating questionnaire to screen for psychiatric morbidity in patients with chronic fatigue syndrome (CFS). This study had the aim of assessing the utility and validity of two commonly used measures.
MethodScores obtained on the General Health Questionnaire (GHQ) and the Beck Depression Inventory (BDI) were compared with various diagnostic and severity ratings obtained via a validating clinical interview, the Schedules for the Clinical Assessment of Neuropsychiatry (SCAN) in 95 consecutively referred subjects at a medical out-patient clinic who fulfilled standard criteria for CFS, and 48 healthy controls. Outcome measures were validating coefficients and receiver operating characteristics (ROC) for different thresholds and scoring on GHQ and BDI and index of definition (ID) as measured by SCAN; and Pearson and point by serial correlation coefficients for different diagnostic groups derived via SCAN and defined according to ICD–10 and DSM–III–R.
ResultsGHQ and BDI perform poorly as screeners of psychiatric morbidity in CFS subjects when compared with various SCAN derived ratings although results for controls are comparable with other studies.
ConclusionsNeither the GHQ nor BDI alone can be recommended as screeners for psychiatric morbidity in CFS subjects.
Neuraesthenia Revisited: ICD–10 and DSM–III–R Psychiatric Syndromes in Chronic Fatigue Patients and Comparison Subjects
- Anne Farmer, Irene Jones, Janis Hillier, Meirion Llewelyn, Leszek Borysiewicz, Andrew Smith
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- Journal:
- The British Journal of Psychiatry / Volume 167 / Issue 4 / October 1995
- Published online by Cambridge University Press:
- 02 January 2018, pp. 503-506
- Print publication:
- October 1995
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Background
Different definitions of chronic fatigue syndrome (CFS) have different psychiatric exclusion criteria and this affects the type and frequency of associated psychiatric morbidity found. The operational criteria for neuraesthenia in ICD–10 vary in this and other respects from the Centers for Disease Control and Prevention (CDC) criteria for CFS. Neuraesthenia and associated psychiatric morbidity in CDC-defined CFS are evaluated.
MethodCFS subjects and controls were interviewed with the Schedule for the Clinical Assessment of Neuropsychiatry (SCAN). The computerised scoring program for SCAN (CATEG05) facilitates the assignment of operational definitions according to DSM–III–R and ICD–10. Subjects were re-interviewed with SCAN an average of 11 months later. No specific treatments or interventions were given during this period.
ResultsThe majority of subjects fulfilled ICD–10 operational criteria for neuraesthenia and had two and a half times the rate of psychiatric morbidity as the healthy comparison group according to the CATEG05 Index of Definition (ID). Approximately 80% of subjects fulfilled both DSM–III–R and ICD–10 criteria for sleep disorders. There was a significant fall in the number of subjects fulfilling criteria for depression and anxiety disorders and a significant increase in the number of subjects with no diagnosis for DSM–III–R criteria over time. There were no significant changes over time for any diagnosis according to ICD–10 criteria or for overall levels of psychopathology as reflected in CATEG05 ID levels.
ConclusionsThe ICD–10 ‘neuraesthenia’ definition identifies almost all subjects with CDC-defined CFS. Fifty per cent of CFS subjects also had depressive or anxiety disorders, some categories of which remit spontaneously over time.