Cyclospora Infection: What it is, where it came from, and why you want to avoid it.

Cyclospora_cayetanensisRecently, the Centers for Disease Control and Prevention (CDC) issued warnings concerning infection by a parasitic protozoan named Cyclospora cayetanensis. This pathogen was first identified in the late 1970s, making it a relative newcomer in the realm of human misery. The protozoan was first identified as a form of blue-green algae, and later as a form of Cryptosporidium (the cause of cryptosporidiosis), before being properly identified and cataloged as a pathological protozoan. The Food and Drug Administration of the United States (FDA) recently (2017) banned some cilantro for Mexico due to the use of infected human waste used to fertilize some fields.

Since its first discovery, Cyclospora has been identified as the cause of some cases of where patients complained of severe diarrhea, abdominal cramping, nausea, and weight loss. In cases of early diagnosis, treatment is relatively straightforward and often consists of antibiotics, (Sulfamethoxazole/trimethoprim), or in cases of allergy to sulfa drugs, Ciprofloxacin (a non-sulfa antibiotic) can be used. Cyclospora can only be positively identified through Laboratory test of stool, and identification they require samples over the course of several days. Likely symptoms include frequent watery diarrhea, loss of appetite and weight loss, bloating and flatulence, stomach cramps, fever, and bouts of constipation. Some people will experience muscle aches and fever as well as a general fatigue. In developing countries, diarrheal diseases can be a significant threat to health, however safe drinking water may not always be available. To assess dehydration watch for dry mouth and tongue, reduced tear production, decreased urine output it, and in severe cases, sunken eyes. Dehydration is a serious symptom and may require hospitalization for intravenous fluids for some patients due to high risk of desiccation, including people suffering from serious illnesses, aged adults, and especially infants and small children.

Epidemiology. Cyclospora infection has only one known path, ingesting the protozoans in contaminated food or water. For this reason, outbreaks are reported following the consumption of contaminated fruits and vegetables. Because the protozoan is most common in tropical and subtropical regions, recent cases in the United States have been linked to imported produce coming from Central America and included cilantro, basil, lettuce, snow peas, and even raspberries. Investigators discovered that some farmers were using human excrement to fertilize fields, thus spreading the disease. When an Oocyst (an encapsulated egg-shell-like structure that allows the Cyclospora zygote a protective environment to transfer to a new host) is ingested, either suspended in water or on food, it enters the small intestine where it attaches to the mucosa (intestine wall) where it incubates for a week or so. The Oocyst emerges in the gastrointestinal tract, freeing the sporozoites that invade the epithelial cells of the small intestine. Inside the cells they undergo asexual multiplication and sexual development to mature into Oocyst, which will be shed in waste before emerging as adult protozoa. There has never been a better time to start your kitchen garden.

Pathology. In cases where Cyclospora infection is not identified and treated, chronic complications can occur such as Guillain-Barre Syndrome, acalculous cholecystopathy (a form of inflammation of the gallbladder), biliary disease (a form of biliary cirrhosis damaging the liver), and Reiter’s Syndrome (a form of reactive arthritis that develops as the immune system attempts to rid the body of the infection). Cyclospora infection is a nationally notifiable disease in the United States. The National Notifiable Diseases Surveillance System is a nationwide collaboration that enables all levels of public health, from local to international, to monitor, control, and prevent the occurrence and spread of infectious and noninfectious diseases. The CDC urges healthcare providers to watch for cases where patients have prolonged or reoccurring symptoms including watery diarrhea, particularly if they have recently traveled to tropical and subtropical regions. If such cases occur, health care providers should consider ordering a test for Cyclospora infection, however, most laboratories in the United States do not routinely test for Cyclospora, even when a stool sample has been tested for parasites in general. Therefore health  providers must request this test specifically.

New Cases in the U.S. Since May 1 of 2017, over 200 new cases of cyclospora infection have occurred. This is more than double the total new cases for the same period in 2016 according to the CDC.  The CDC reported that cases were reported in nearly 30 states. Of the 200 cases, nearly 20 patients were hospitalized.

Prevention. As the CDC points out, prevention is limited to avoiding food or water that may be contaminated, and to observe safe food handling procedures including thoroughly washing all fruits and vegetables will help, but may not remove all of the organisms. Cyclospora is often not killed by currently used disinfectants, and its ability to transmit as an Oocyst makes it a difficult protozoan to prevent. Primary risk factors include traveling in developing countries, as Cyclospora infection can be found worldwide, and anyone consuming food or water contaminated with this protozoan can be infected.

 

For more information, or to learn about other protozoans and parasites, go to the CDC website at https://www.cdc.gov/parasites/about.html

On Inference, Causation, Correlation, and Association: How Scientists Assign Outcomes of Research, and why it is Important.

Thanks to my friend and associate Michael Lo for his input on this.

chi-eq1Recently, the media seems intent on furthering the scientific ignorance that seems to be rampant in American culture. From Alternative facts to inconvenient truths, science is taking a beating at the hands of pseudoscientists, politicians, and others who have no business making scientific pronouncements. A pet peeve of mine is when those who don’t understand statistics start quoting statistics, particularly cause-and-effect. The most recent example of this is the statement that marijuana causes depression. But before we get into these ridiculous ideas, it is necessary to outline the terms of scientific research, as the media doesn’t seem to think this is important.

Without delving too far into multivariate analysis or regression, and in keeping with the brevity of this article, I shall keep short, limiting the discussion to the relationship between two variables. In the case given above, the use of marijuana causes in 100% of the cases depression. No one has ever used marijuana that did not suffer depression, and that that depression could be proved directly from the use of marijuana. You can easily see how ridiculous and unscientific such statements are.

This is because when we state there is a causal relationship between two variables, we are stating that one causes the other. Every time, even after adjusting for any other variable or modifier, we are stating empirically that in 100% of the cases, correcting for any bias, one variable creates or directly affects the other variable always. As you might imagine, cause is a term that scientists very rarely, if ever use. So what terms should you look for instead?

Correlation. When we say there is a correlation between two variables, this does not mean that they are somehow connected. A prime example is an increase in global mean temperature that corresponds with the reduction of the number of pirates. One need not be a scientist to say that, although there is a correlation between these variables, they are not likely related in any way. Few research scientists use the term correlation. Politicians use it frequently as it infers a connection between two variables however it truly says nothing. Clearly, there is a correlation between global mean temperature and the total number of pirates; however, to suggest that these two variables are somehow associated (one affecting the other) would be naïve at best, and deceptive at worst.

2000px-PiratesVsTemp(en).svgAssociation. Now we’re starting to talk the scientific lingo. When we examine two or more variables, and we find that one influences the other to a greater degree (based on a percentage or confidence interval to denote how certain we want to be about the relationship). In my dissertation, I examine the relationship between variables related to child abuse and chronic disease, among them type-2 diabetes, hypertension, and dyslipidemia. Because I wanted to be as certain as reasonably possible, I used a confidence interval of 95%. A confidence interval of 95% will give you a P-value <0.05. What this means is that there is a less than 5% chance that the results of your statistical test are merely chance.

While this is the standard in medical research, you may decide that you want to be as certain as possible that the relationship among your variables is really present. You would then use a 99% confidence interval, and you would expect a P-value of <.01. With a confidence interval (CI) of 99%, you are essentially saying that the outcome you found is as near to 100% as possible. In fact, even if you were to use a CI of 99.99999999999%, and the resulting P-value was <.0000000001 (with statistical software this is very easy to do), this would still not prove cause. You see how difficult it is for a scientist to say that one thing causes another? So you can imagine how ridiculous it sounds to scientists when politicians claim it.

Even if we find an association (we like to use the term statistically significant association) there maybe other variables that can account for or affect our outcome. For example, in my own research, where I studied the association between child abuse and chronic disease, I had to control for other variables, for example socioeconomics, family history of disease, behavioral variables (tobacco use, alcohol use, physical activity, physical fitness level, vocation, income, and several others) that may modify (affect in some way) my results.

To measure association, we use a few simple tests, among them the Chi-square test. Chi-square tests of association generally assess whether the observed association has less than a 5% (or less than 1%) chance of occurring due to NO effect of the other variable. To be certain our sample size is sufficient, we run a G*Power Analysis which will give us our minimum sample size. For example, if I wanted to test for association between two variables with a CI of 95%, we would need at least 34 subjects. Now, if we wish to be really, really certain, we wanted a CI of 99%, this would require just under 11,000 (10,881) subjects! If we have too small a sample group we can use a different association test called the Fisher’s Exact Test.

In the case of the article claiming that use of marijuana causes depression, I was unable to find any corresponding data to support the conclusions. Had the data been available (as a medical research scientist I have access to most studies conducted in the United States), locating the corresponding data to this study proved impossible. Had I been able to locate the data and review it, ensuring that the researcher did indeed control for other variables, I could conclude that they had performed their due diligence to ensure that the association between marijuana use and depression is supported. However, this is not the case.

One quick method of ascertaining whether or not a study has been conducted using the scientific method is to look for the data tables. If there are no data tables, then most likely there was no data. Another way is to look for the verbiage. Watch for terms such as causation, causes, or anything that seems inflammatory.

In a culture of alternative facts and scientific ignorance, the reader should be cognizant of what they’re reading and how to tell if it’s science or something else that begins with S.

How Targeted Drugs Fight Disease, and why Funding Research is Critical

Antibody_diagramRecently our family has been once again forced to deal with a diagnosis of cancer. I have avoided writing on this subject in the past but have decided to write a brief article on the advances in cancer treatments. I enlisted the help of my good friend and research molecular biologist, Vera Chang from Oregon State University.

Anyone who has been diagnosed with cancer, or has a family member afflicted with this disease, knows all too well how difficult it can be to treat. Beyond the disease itself, there is the stigma and gloom that accompanies it. Despite the promises of new treatments, it is still a horrifying and gut wrenching illness.

Diagnosed early, cancer is often curable, and the survivability of many forms of cancer has risen steadily as new research and new treatments have been discovered. If the diagnosis is not made early, prospects for a full recovery are remote.

Most of the various forms of cancer are not caused by pathogens for which we can develop a vaccine. It is a particular degeneration of our cells that multiply and changes into entirely new cell-forms that become a tumor. The tumor then sends out cells and spreads in processes known as invasion and metastasis.

Traditional methods of treating cancer are surgical removal of the tumor and adjacent tissues followed by chemotherapy and radiotherapy. The problem with these treatments is their lack of specificity. Chemotherapies and radiotherapies target both cancer cells and healthy cells. Today, researchers are developing new ways to battle this disease by targeting the mechanisms that allow cancer cells to form, grow and spread.

All cells in our bodies require oxygen and nutrients (and the removal of waste products) to survive. Cancer cells are no different. As a cluster of cancer cells grows larger, those cells at the center get further away from the blood vessels that bring the necessary oxygen and nutrients to the body’s cells.

Cancer cells are still OUR cells, and like all cells, they cannot survive without oxygen and nutrient. When the cancer cells begin to grow rapidly, they become starved for oxygen and nutrients. These cells release chemicals called angiogenic factors (FGF-1 and VEGF) that stimulate proliferation of nearby endothelial cells to form new blood vessels to bring oxygen and nutrients to the cancer cells. Without angiogenesis, the cancer cells cannot grow or spread.

Once new blood vessels form, cancer cells have access to other tissues and organ systems; as the tumor grows, it takes up all the resources that the blood vessels provide causing pressure on surrounding tissues. Because cancer cells grow much faster than normal tissue, they can spread through the lymphatic system, part of our immune system, invade nearby tissues, and travel through the blood stream.

Cancer researchers have identified three ways tumors can invade surrounding tissue. First, tumors can grow too large and force themselves mechanically into nearby soft tissue. Second, tumors can break down cell tissues using enzymes. These same enzymes are found in normal cells and are used to break down invading bacteria or viruses or to repair damage to the cell structure. They are a critical part of the healing process. Unfortunately, some cancer cells contain significant amounts of these enzymes, far more than normal cells. The third way tumors invade by is by producing cells that move around far more efficiently than normal cells. Researchers have discovered a substance produced by cancer cells that enable them to move, although they are not yet certain how this material plays a part in the spreading of cancer.

cancer cell pushing outwardAs resources become scarce at the origin of tumor growth, some cancer cells travel a long distance in the body. This process is called metastasis. Some cancer cells change their shape or digest the wall of the blood vessels or lymphatic vessels to get into the blood stream. Once in the blood stream, these cells can travel to other organ systems (for example, breast cancer cells metastasize to the lungs for the unlimited supply of oxygen, while colon cancer cells metastasize to the liver for an endless source of nutrition).

Targeted Therapies

Scientists are developing custom-made treatments, called targeted therapies, to block the growth and spread of cancer directly without harming healthy cells. One of the targeted therapies uses our immune system as the weapon.

Our immune system is a complex arrangement of different cell types and more than 100 different chemicals whose mission is to protect us from foreign organisms like bacteria and viruses. These cells are imbued with the ability to recognize any substance as either belonging to the body or foreign (invader). Once the immune system recognizes a material as an invader, various cells and hundreds of different chemicals come together to coordinate an attack and remove the invader. Our immune system has evolved over millions of years to protect us from the continual onslaught by invading organisms. However, cancer cells are not invaders. They are an enemy from within that has developed ways to mask themselves from our immune system.

The primary purpose of targeted drugs is to help our immune system recognized these cancer cells by targeting unusual substances found in cancer cells like the proteins cancer cells require for growing and moving. Once cancerous proteins are found, our immune system will start attacking either the proteins themselves or the cell producing them. Targeting these proteins, and aiding the immune system to attack cancer is exciting research because these drugs can prevent or reduce cancer cells ability to grow, move and spread, and eventually lead to their isolation and destruction. One area of research that is showing great promise is called Monoclonal antibodies.

Monoclonal antibodies first entered research in the early 1980s to treat non-Hodgkin’s lymphoma. Since that time, researchers have made great strides using these targeted therapies in cancer treatment. These treatments began by identifying which therapies may prove useful. This process, known as biomarker identification, is the identification of antigens that uniquely present on the surface of cancer cells. One of the promising monoclonal antibodies in fighting breast cancer functions by recognizing a human epidermal growth factor receptor 2 (HER2) protein. HER2 is an oncogene that can transform a cell into a tumor cell and is amplified in 20-30% of early stage breast cancers. Thus, breast cancer patients treated with HER2- targeted antibodies can improve disease-free survival rates.

Unfortunately, no one treatment is effective for every cancer, or every person. Therefore, research in targeted therapies is critical and life-saving.

 

 

Tick-Bourne Disease: Separating Fact from Fiction.

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Recently, during an outing, a family friend tried to explain to me the dangers of a new disease. She said she had learned all about “Powassan disease” from a friend on social media. Now, this person knows well what I do, yet in an excited tone, proceeded to explain to me about this new disease, how it was caused by ticks and, if anyone is infected, would die within days. She then told me that she heard that almost a dozen people had died from this disease so far this year, and it was only May. While she is, for the most part, a reasonable adult, when it comes to diseases, from infections to cancers, she prefers to listen to hair stylists, people she meets at the check out at the grocers, anyone it seems who has an opinion based on anything, except of course education and experience.

When we stop to consider where most people gather their information, social media, we can easily see why there is so much misunderstanding about, well, everything. A recent analysis found that almost 90% of the health-related information on Facebook was inaccurate, and with summer now in full swing, and tick season in over-drive, the opinions on Tick-Bourne disease are everywhere. And almost universally wrong. Some clarification is evidently needed.

Old Lyme, Connecticut.

In the early 1970’s a group of people living around Old Lyme, Connecticut, began suffering from a number of puzzling, debilitating symptoms. Chronic fatigue, swollen joints, skin rashes, agonizing headaches, and in some cases paralysis. The cause of these symptoms went unidentified, and therefore untreated, for years. Even those rare physicians who accepted their patient’s symptoms as real could do little to treat them. The medical community seemed to be at a loss for the cause of these unusual symptoms. Unusual, as many of the victims were small children.

Patients began conducting their own research, and it was concluded that those suffering from the symptoms had one thing in common besides their geographical location: each recalled having been bitten by a Tick before the onset of a skin rash, followed quickly by arthritic conditions.

Tick Bourne Diseases

Tick-Bourne diseases and the Ticks that carry them have existed in the American wilderness for tens of thousands of years. The disease we know today as Lyme disease was first identified ago by Alfred Buchwald, a German doctor who described the chronic skin rash and other symptoms that occurred after a Tick Bite, over 130 years. However, Borrelia burgdorferi, the bacteria that has been identified as the cause of Lyme disease, was not officially classified until in 1981. Medical research scientist Dr. William Burgdorfer was busy studying Rocky Mountain Spotted Fever (also caused by a Tick bite) when he began to look at Ticks as a source of the newly identified Lyme disease. He discovered that a spirochete bacterium carried by ticks was the cause of disease in humans (Dr. Burgdorfer was rewarded for his discovery when the medical community named the bacterium after him, Borrelia burgdorferi).

lyme

When Borrelia burgdorferi infection is suspected today, there are varying approaches to treatment. Some doctors treat the disease as a severe infection, while others believe the infection can be treated with a prescription of Doxycycline. Still, other physicians are convinced the disease is mostly psychosomatic. Today, with thousands of patients suffering from persistent and often extreme symptoms, Lyme disease is finally becoming recognized as a serious, endemic illness.

Lyme disease has been identified in all states except Hawaii. In the Northeastern US, the disease has become a critical public health problem and is one of the top notifiable diseases by the CDC.

Symptoms of Lyme disease

The most common sign of a Lyme infection is an expanding area of redness on the skin, erythema migrans, which starts with a Tick bite. While the rash is neither itchy nor painful, only about half of those infected with Lyme disease develop the rash. Other early symptoms are typical of an infection, including fever, headache, and feeling tired. If left untreated, the symptoms may quickly include the loss of the ability to move one or both sides of the face (Palsy), arthritic-like joint pain, severe headaches, and stiffness in the neck. While some symptoms may clear up, they my return months later, and the patient may experience repeated episodes of joint pain and swelling. Even when diagnosed and treated immediately, about one-in-five people develop recurrent joint pain, memory problems, and fatigue for months.

Powassan Encephalitis

The name Powassan encephalitis comes from Powassan, Ontario, where a small child died of encephalitis that was traced to a Tick bite in 1958. There has been a surge in the number of cases of Powassan virus infection, along with geographic range since about the year 2000. In the United States, cases have been recorded in the Northeastern U.S. and the Great Lakes Area.

Unlike Lyme disease, which is caused by a bacterium, Powassan encephalitis is caused by a flavivirus (A form of positive‐stranded RNA virus). This type of virus is responsible for several diseases in humans, including Zika, Dengue Fever, and West Nile. Flavivirus are Zoonosis, or animal-vectored diseases, meaning they are spread through invertebrate vectors, generally insects or ticks. The diseases do not seem to harm the Ticks, and the virus is spread to humans through a Tick bite. Since both the bacterium that causes Lyme disease and the virus that causes Powassan are found in the same Tick species, it is possible to be infected with both.

Symptoms

Like Lyme disease, some people who are bitten do not develop symptoms. And like Lyme disease, the incubation period ranges from several days to a few weeks. The symptoms, at least the initial ones are very similar to Lyme disease, including fever and headache; however, those infected to Powassan may also suffer from vomiting, weakness, memory loss, confusion, coordination problems, and seizures. In some cases, the virus infects the central nervous system, causing inflammation of the brain (encephalitis) or the membranes that surround the brain and spinal cord (meningitis). About 50% of infected survivors will suffer permanent neurological symptoms (recurrent headaches, muscle wasting, and memory problems); about one-in-ten Powassan encephalitis cases prove fatal. Currently, there are no vaccines to prevent Powassan infection, and treatment often includes hospitalization, respiratory support, fluids, and medications to reduce swelling in the brain or meninges.

Preventing Lyme and Powassan Infections

While Western medicine is geared toward treatment, we must take a public health approach in regards to zoonosis: prevention. Avoid Tick bites by wearing long pants and sleeved shirts; apply products that contain DEET to clothing (I apply repellants to outdoor areas). Check yourself and children carefully after being outdoors, especially in wooded areas. Ticks prefer warm, moist areas to bite, so check carefully. If found, Ticks can be removed carefully with tweezers. If you are bitten, notify your medical provider and seek treatment as soon as possible. Your medical provider may prescribe an antibiotic like doxycycline, amoxicillin, or cefuroxime.

Retrospective

Lyme disease is the most common Tick disease in the Northern Hemisphere, affecting over a quarter-million people each year. While most infections occur in spring and early summer but can occur at any time. While there is no current vaccine to prevent Lyme disease, due to a large number of infections each year, along with the spread of the disease, research to develop new vaccines is ongoing.

 

For more information, go to the Infectious Disease website for the State of Maine http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vector-borne/lyme/tick-prevention.shtml

 

 

 

Climate Disruption and Changes in Infectious Disease Patterns: The Worst is Yet to Come.

 

humanhealth-copy-cdcMost scientists will tell you that evolution does not favor the fastest, the strongest, or even the cleverest. Evolution favors the most adaptable. Humans, as a species (race is an antiquated and dishonest ideology), are highly adaptable, having populated, at least to some degree, every continent on planet earth regardless of how inhospitable. While there are few areas that remain completely unexplored on our planet, there are some areas that are so remote that few Westerners, or even natives, have visited.

The New Kids on the Block

In our comparatively short tenure, amounting to perhaps 1000,000 years or so, we are a relatively young species, especially when compared to bacteria and viruses that have existed for hundreds of millions of years. Nevertheless, we have established dominance over the planet, at least the drier parts. Certainly, in time we will master the aquatic domains as well. Perhaps this is the reason that the disruption in climate cycles does not alarm everyone, as many believe that humans will thrive regardless of what the weather does. And I tend to agree that humanity will persevere, although it may not be so easy as many think. One area that is of great interest is the migration of different species that have been isolated by either geography or climate into new areas, bringing them into contact with native species.

Even a tertiary review of the scientific literature demonstrates a clear migration of plants and animals away from historical domains, and we see certain tree species slowly moving northward as the overall climate in North America warms. Along with this slow progression of plants into these new domains come the animals, birds, and insects that feed or live upon them. And while this northward movement may not be rapid, it is steady.

Over time, species never seen in northern locales are beginning to push into new areas where they often out-compete native species. And while native species evolved over thousands of years along with insects or animals that feed upon them, many invasive plants and insects (and arachnids) have no natural agents to keep them from overwhelming existing species.

Climate Disruption

Scientists are in agreement that the disruption of the climate is the primary driving force behind this migration. It doesn’t matter if you believe that climate change is spurred on by human civilization or by the solar maximum, or a combination, denying that the Earth’s climates are undergoing rapid change is simply refusing to see the obvious.

The appearance of non-native plants and trees may be a nuisance; the animals, particularly the insects and arachnids, pose a far more serious threat. This is because some are vectors for disease.

Expanding Vectors and Pathogens

A vector in epidemiology refers to an animal or plant on which (or in which) pathogens of disease live. While these vectors do not suffer from the disease itself, they can spread it to other species, and while there are some infections diseases that are carried by larger animals, for example rabies, the primary threats come from insects and arachnids. Research has established that the geographical locations and populations of insects and arachnids change along with disrupted patterns in weather. This was first identified in sub-Saharan Africa. As temperatures increased, insect species began to move into higher elevations, spreading infectious diseases like malaria and trypanosomiasis. This has now been observed in North America with tick-borne diseases including Lyme disease, Tick-borne encephalitis, Human granulocytic, Monocytic Ehrlichiosis, Babesiosis, and Tularemia. Virtually every week we receive updates from the Centers for Disease Control and Prevention (CDC) in our northern states warning of Tick-born disease.

Life is opportunistic.

Parasites, viruses (more or less), and bacteria are all life forms, and like other species will take every advantage to survive. This is often at the expense of other life forms that, for any number of reasons, have some exploitable weakness in their defenses. This weakness may have resulted in the failure to vaccinate against a known virus (Mumps or Measles), consuming unclean vegetables (Giardia lamblia) or improperly cooked meats (Salmonella, E. Coli, and any host of parasites found in beef, pork, poultry, or fish). Another example of this opportunistic reality is when two species, separated by geography (a mountain range or deep forest), are brought into contact, as in the case of Ebola. Certainly the farmers had no interest in traveling deeper into the jungles; however, the charcoal trade that supports most of the poor in areas of sub-Saharan Africa has used up the forest immediately surrounding the villages. As Western societies move into these areas to capitalize on forestry and heavy-metal mining, the charcoal makers are forced deeper and deeper into the forest, bringing them into contact with species that have been historically separated. If an area in habited by humans becomes significantly wetter, waterborne disease will become endemic. If an area becomes dryer, other viruses may increase.

Natural Borders

Infectious disease agents can be separated by geography including oceans, deep jungles, or mountain ranges that can effectively isolate species. Time can also separate infectious agents from vulnerable populations; one example is the widespread vaccination against polio in the United States starting in 1954, and in just 25 years, polio was effectively eliminated from the United States. Thus time, in this case, a quarter century separates polio from American populations. However, failure to maintain vigilance against a virus greatly reduces this separation, making an outbreak more likely, particularly if the virus is introduced from another location where it has not been eradicated. Oceans may have separated populations at one time, but with the advent of world travel, this no longer limits the spread of infections. Dozens of new cases of polio are reported from African nations, including Chad and Nigeria, and many are diagnosed annually in Afghanistan and Pakistan. Not surprisingly, these areas are marked with abject poverty and religious suppression of science and medicine. When ignorance and poverty are combined, disease is often the result.

Other aspects of shifting climates include floods, droughts, severe storms, and ocean changes including salinity, temperature, and level, which may further affect the migration of species into new areas. Moreover, climate disruption has been positively associated with increases in diseases, particularly vector-borne disease. El Niño has been linked to increasing in emerging disease, in particular malaria, and other waterborne disease, particularly diarrheal diseases in areas prone to coastal flooding. La Niña has been linked to outbreaks of Chikungunya, and increases in West Nile Virus and Japanese encephalitis, and in areas of drought increases have been seen in Hantavirus pulmonary syndrome, and increases in West Nile Virus. Globally, these climate-driven weather patterns such as increases in hurricane or typhoons have been associated with increases in waterborne disease, increases in viruses, and increases in bacteriological infections including leptospirosis.

Displaced Populations

As extreme weather and climate change affect human populations as well as their domesticated livestock, areas lost to flooding or drought force populations closer together in habitable areas and along with them, and their animals come they are infectious disease. Displaced populations, either from conflict or extreme weather are often in precarious situations. They are universally underfed, often have difficulty obtaining clean water, and are forced to live in less than sanitary conditions, all of which combined to make these populations extremely susceptible to infections disease. Combined with the stress of forced relocation, and the impact of that stress on the immune response, it is not surprising that these populations experience significantly shorter lifespans and poor health.

In the end, it doesn’t matter if you understand climate change as a natural process, one that is man-made, or a combination, to deny that climate disruption is occurring is denying the obvious and measurable environmental changes linked to increasing infectious diseases.

 

The Willow, the Tortoise, and The Master: The Use of Symbolism in Positive Psychology, Mindfulness, and Self-Help

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As Desdemona is preparing for bed on the night she will be murdered, she sings a song about a willow tree. In Hamlet we learn that the prince’s love, Ophelia, falls from a willow tree into a brook where she drowns. Shakespeare may have understood the willow as a symbol of loss and grief, and he was not alone. The willow tree figures prominently in mythology and literature as a symbol of both grief and healing, but also everlasting life. The willow’s regenerative properties, associated with everlasting life, probably stem from the ability of a new tree to grow from a twig pushed into moist soil. The Christian connection between rebirth, water, and the willow is thought to originate with Psalm 137, which refers to the willow as growing along the banks of the rivers in Babylon.

The pain-relieving properties of salicylic acid were documented in Greek literature as early as 500 BC, and Native Americans chewed willow bark to relieve pain, fever, rheumatism and inflammation. The willow is even featured in children’s literature by Hans Christian Andersen’s “Under the Willow Tree” and Kenneth Grahame’s “Wind in the Willows.” References to the willow tree are found in Celtic Traditions that speaks to its flexibility and perseverance. The willow prefers to bend rather than to resist; a powerful metaphor for those who have learned to adapt to the changing winds of life. In the Far East, the willow is seen as a source of ancient wisdom and adaptableness. The message of the willow is to adjust with life, rather than against it, to surrender the belief in control.

In Chinese symbolism, the tortoise represents longevity and wisdom, while in Indian mythology, the tortoise is the first living creature, attributing to it both longevity and adaptability. To the Native peoples of North America, the turtle is the oldest symbol known to depict the planet Earth. In modern depiction, the tortoise has been promoted as a character of infinite patience, of profound wisdom, and of longevity. In the DreamWorks series Kung Fu Panda, the master of the Jade Temple is Oogway, the thoughtful Tai Chi master who happens to be a tortoise. The Cantonese word for Tortoise is Wugwai, which is, not surprisingly pronounced Oogway.

In mindfulness, the conscious mind is not full, but empty of all but the present. In a way, the focus is mindful of the current moment. This is most easily attained through a focus of the consciousness on the breath. Breathing is an aspect of the autonomic nervous system, which is we do not have to think about breathing, it just happens. When we move the breath from the autonomic to the intentional, and concentrate on the active breathing, we are in the moment. This sounds much easier that it actually is. We live in a world with Constant intrusions from both the past and the future, those being events, thoughts, or feelings about things in the past.

Our thoughts are also intruded upon by perceived events resulting in similar thoughts or feelings about the future. If we carefully consider the emotional aspects of these intrusions, we find that they elicit too possible responses: regret, in the form of depression, or trepidation, in the form of anxiety. The benefit of focusing on the present moment is that it is virtually impossible, with practice, for these intrusions to occur. Allow me to repeat that: with practice. The practice of mindfulness meditation, the focus on each breath, and living within the moment has the enormous health benefits that we will explore. The Willow, the Tortoise, and the Master, are all symbols of adaptability, of thoughtful consideration, and above all, of patience. These are learned skills, ones that anyone can benefit from with practice.

The reality is that these skills can be obtained with practice, and one need not become a Tai Chi Master or spend years sitting in solitude to discover these skills. One need not even be a Willow tree or even a Tortoise.

The Eyes of a Child

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“The wanting of a thing is far better than the having of that thing. The Delight that never fades, the bliss that is eternal, is yours only so long as that which you most desire is just beyond reach.” ~C. S. Lewis.

People from very different cultures and backgrounds, religions, and philosophies, have sought for thousands of years a method to live a more peaceful, happier life. They wish to discover this method on their terms. In the United States, many people to turn to psychologist, psychiatrist, religion, and even psychopharmaceuticals, in what for many must be a desperate search for relief from the anxiety, depression, fear, and the myriad personal and cultural demons, both real and imagined that they face daily.

As a community health expert, I once practiced in the field of community psychology. During the time I worked closely with families, the overall positive outlook of children astonished me. Children, at least young children anyway, can see the good in others, even those who may have been unkind to them. I found them nonjudgmental and accepting of others regardless of race, religion, color or creed. At least until they were taught to be judgmental (and self-judgmental) by their caregivers.

It would seem the adage by Christopher Marlowe, “Solamen miseris socios habuisse doloris”, roughly translated Misery loves company, is sadly true. Why parents feel the need to inflict upon their children the very same burdens of hatred and fear I cannot say. Perhaps it is simply because their parents instilled these same afflictions upon them. The worst possible excuse for horrible things is the statement “that is the way we have always done it.” These same fears, hatreds, and the resulting conditioning this instills in children results in the sexism, racism, ageism, and other irrational fears (homophobia and xenophobia) that we face as adults.      These “isms” are among the most clinically destructive handicaps parents can inflict on their children. I find it strange that so many parents seek happiness and contentment for their children, yet they saddle them with the same fear and hatred that robbed them of their joy.

We can understand that when a parent strikes a child with a closed fist or a strap that this is abuse. When parents inflict their psychological and emotional baggage upon their children, destroying the child’s ability to be happy, our society pays little if any attention. With very few exceptions, happiness and contentment are purely internal, psychological conditions.

We may remember as children the joy and excitement of an empty cardboard box or a new friend. As adults our imaginations have been blunted, our joy of the simple things taken away extinguished. As adults many of us are suspicious of new people; we guard our hearts carefully. In the last 1960’s, musical artist Glenn Campbell released a song titles “The Eyes of a Child” that he had co-written with Jerry Capeheart. The ballad is a haunting one, speaking of the innocence and acceptance. The world is a dreamland, or so the song goes. It is not difficult to understand that the loss of our imaginations and our ability to be happy in virtually any situation were critical aspects of our childhood selves, and we all mourn the loss of these things, even if we don’t acknowledge it. And while it is impossible for us to become children again, we do have the option to return to that state of clarity and acceptance we once possessed. But it will require patience. And practice. A great deal of practice.