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This introduction outlines the scope of the book titled “Challenges in Tackling Antimicrobial Resistance: Economic and Policy Responses”, and then summarises the main messages of each chapter which focus on the following big questions around AMR policy. What is the evidence on the rise of AMR and its health and economic impact? How can it be most effectively addressed in the community and in hospitals? What role is played by antimicrobial use in the food and livestock sector and what can be done about it? How can the discovery of new antibiotics be reinvigorated to replace those rendered ineffective by resistance? What needs to be done to develop new diagnostic tests so that infections can be speedily identified or ruled out and unnecessary antibiotic use avoided? Can more use be made of vaccines to tackle AMR? How have civil society movements contributed to policy development in the fight against AMR? What does the international community need to do in terms of global collective action to tackle AMR?
Chapter 7 highlights the centrality of the history of Mediterranean plague and quarantine to the birth of the public health movement in Britain. Even though bubonic plague is often considered to be a premodern problem, its diffuse and dramatic reputation thoroughly shaped conceptions of other nineteenth-century killer epidemics –– cholera in particular. The chapter reconsiders the much-discussed “contagion debate” within this wider, transnational genealogy of public health. The fight between those who believed epidemic disease was communicated by contact and proximity (“contagionists”) and those who believed that epidemics spread because of atmospheric factors, such as temperature, winds, marsh exhalations, or other putrefying matter (“anticontagionists” or “miasmatists”) has achieved a tired reputation in recent historiography, which casts it as professional posturing in the midst of broad agreement. While this may be true when it comes to cholera, by focusing on quarantine and plague, the broader significance of these medical arguments is more readily apparent. In part thanks to quarantine, public health reformers tended to present problems in explicitly national terms or within dichotomies of national versus foreign. Because of the way they undergirded this national framing, plague and quarantine are an influential part of the genesis of what has been called the “Condition of England Question.”
The introduction sets out the main themes of the book and establishes the context from which the West India Regiments emerged in the late eighteenth century. The British had successfully expanded their control in the Caribbean during the eighteenth century even though mortality in the army remained stubbornly high. On some campaigns enslaved people had been used in short-term auxiliary military roles, setting a precedent that would be followed to its logical conclusion after 1795. Slavery remained the bedrock of Caribbean society, and while racial concepts remained somewhat in flux during the eighteenth century, they were gradually hardening. West Indian physicians, however, generally agreed that black and white bodies were fundamentally the same.
Increasing clinical and experimental evidence accumulated during the past few decades support an important role for dietary advanced glycation end products (AGEs) in the pathogenesis of many chronic non-infectious diseases, such as type 2 diabetes, cardiovascular disease and others, that are reaching epidemic proportions in the Western world. Although AGEs are compounds widely recognized as generated in excess in the body in diabetic patients, the potential importance of exogenous AGEs, mostly of dietary origin, has been largely ignored in the general nutrition audience. In this review we aim to describe dietary AGEs, their mechanisms of formation and absorption into the body as well as their main mechanisms of actions. We will present in detail current evidence of their potential role in the development of several chronic non-infectious clinical conditions, some general suggestions on how to restrict them in the diet and evidence regarding the potential benefits of lowering their consumption.
Psychopathologists have been arguing forever about whether psychiatric syndromes are some variety of “biological,” “genetic,” or “brain disorders.” This argument has been hobbled by the lack of a coherent theory of what it means for a complex behavioral entity to be biological, or what the alternative to being biological might be. In the absence of a well-articulated theory, there has been a tendency to assume that the question at issue is whether or not behavioral entities are correlated with chemical, neurological, or genetic variables; and since the answer to this question is always affirmative, the consensus has generally been to move psychiatric syndromes farther and farther down the hierarchy of the sciences. I make the case that questions of whether complex behavioral categories correlate with physical ones is misplaced. Instead, I suggest that questions about the proper location of entities involve determining the level at which the entity is most clearly defined; at other levels the entity is out of focus: detectible but blurry. Blurry entities are poor candidates for successful scientific analysis.
Public health emergencies of international concern, in the form of infectious disease outbreaks, epidemics, and pandemics, represent an increasing risk to the world's population. Management requires coordinated responses, across many disciplines and nations, and the capacity to muster proper national and global public health education, infrastructure, and prevention measures. Unfortunately, increasing numbers of nations are ruled by autocratic regimes which have characteristically failed to adopt investments in public health infrastructure, education, and prevention measures to keep pace with population growth and density. Autocratic leaders have a direct impact on health security, a direct negative impact on health, and create adverse political and economic conditions that only complicate the crisis further. This is most evident in autocratic regimes where health protections have been seriously and purposely curtailed. All autocratic regimes define public health along economic and political imperatives that are similar across borders and cultures. Autocratic regimes are seriously handicapped by sociopathic narcissistic leaders who are incapable of understanding the health consequences of infectious diseases or the impact on their population. A cross section of autocratic nations currently experiencing the impact of COVID-19 (coronavirus disease 2019) are reviewed to demonstrate the manner where self-serving regimes fail to manage health crises and place the rest of the world at increasing risk. It is time to re-address the pre-SARS (severe acute respiratory syndrome) global agendas calling for stronger strategic capacity, legal authority, support, and institutional status under World Health Organization (WHO) leadership granted by an International Health Regulations Treaty. Treaties remain the most successful means the world has in preventing, preparing for, and controlling epidemics in an increasingly globalized world.
“Honesty is worth a lot more than hope…” The Economist, February 17, 2020.
This chapter analyses the rationale behind the founding of the West India Regiments in 1795. It argues that, while various trial runs with black soldiers during the eighteenth century had created a fertile ground for the idea, what forced Britain’s hand was an outbreak of a new strain of yellow fever in 1793. Only those of African descent were believed to be resistant to the disease (many West Africans had experienced a childhood form of the disease and were therefore immune), and when faced with the French arming large numbers of black soldiers in St. Domingue, the British determined to do the same. The decision, however, was principally a medical one rather than simply a military one. European troops would be replaced by Africans – the only men whom physicians had stated were immune to yellow fever in the West Indies.
Health psychology and behavioral medicine are founded on the biopsychosocial model, in which health and disease reflect reciprocal influences among biological, psychosocial, and sociocultural processes. As a result, research methods in these fields draw on concepts and methods from several disciplines and often require their integration. Health psychology and behavioral medicine include three major topics: health behavior and risk reduction; psychosocial aspects of medical illness and medical care; and psychosocial and psychobiological influences on disease. This chapter emphasizes methodological challenges in the third topic, although the issues discussed are broadly relevant to the others. Conceptualization and measurement of health endpoints presents evolving challenges in which measured outcomes must capture specific and well-defined aspects of health and disease. In the identification of psychosocial predictors of health outcomes, psychosocial epidemiology research must address a variety of challenges, including the conceptualization, measurement, and analysis of overlapping risk factors. In research on the psychobiological mechanisms linking risk and resilience factors with health outcomes, theory-driven research should consider a broad range of interrelated physiological processes and multiple sources of pathogenic physiological activation. Across the various research topics, clear ties to conceptual models, consideration of developmental issues across the lifespan, the need to examine both between- and within-person associations in many research questions, and the importance of health disparities and related aspects of ethnic and cultural diversity are important in measurement, design, and analysis of biopsychosocial research.
Statistics relating to troop mortality in the British Empire had been collected systematically from 1816, but the first serious analysis came in the late 1830s. Alexander Tulloch investigated the causes of sickness and mortality among soldiers, specifically concentrating on establishing the relationship between race and mortality. The reports of West India Regiment surgeons provided him with the largest and most comprehensive data available for any people of African descent. Although it was readily apparent that black soldiers generally had lower sickness and mortality rates than white troops in the West Indies, in Tulloch’s opinion the mortality of black troops should have been even lower. If the black soldier was naturally suited to a West Indian climate, then mortality should be closer to that of Africans in Africa or Europeans in Europe. They fact that it was higher meant, according to Tulloch, that Africans were unsuited to life beyond Africa. The importance of Tulloch’s publications on military mortality was that they appeared just as public interest in statistics exploded, and his research was circulated widely in military and medical publications, helping to shape ideas about black bodies far beyond military circles.
Marine n-3 PUFA exert beneficial effects that might inhibit atherosclerosis and reduce vascular disease. Previous studies have, however, reported conflicting results and here we have summarised the early history and the most recent findings from follow-up studies and randomised clinical trials investigating marine n-3 PUFA in relation to the risk of atherosclerotic CVD. Most follow-up studies have suggested that the intake of marine n-3 PUFA may be associated with a lower risk of CVD. Recent studies have also shown that it is important to focus on substitution issues and dietary patterns. Further, the use of gold standard biomarkers of fatty acid exposure such as adipose tissue should be encouraged. Findings from clinical supplemental trials have shown conflicting results and findings from previous meta-analyses and guidelines have generally not supported the use of fish oil supplements for the prevention of CVD. However, a recent meta-analysis including three recent large clinical trials with fish oil supplements reported a moderate beneficial effect on cardiovascular endpoints. Interestingly, results from a large clinical trial (REDUCE-IT) have suggested that supplementation with a high dose of purified EPA ethyl ester for 4⋅9 years significantly and markedly reduced the risk of cardiovascular events in patients with CVD and mild hypertriglyceridaemia; findings that need to be confirmed. While it seems appropriate to recommend consumption of fish, particular fatty fish for prevention of CVD, an effect of fish oil supplements is probably at best marginal perhaps apart from patients with hypertriglyceridaemia.
Italy is fighting against one of the worst medical emergency since the 1918 Spanish Flu. Pressure on the hospitals is tremendous as for official data on March 14th: 8372 admitted in hospitals, 1518 in ICU, 1441 deaths (175 more than the day before). Unfortunately hospitals are not prepared: even where a plan for massive influx of patients is present, it usually focuses on sudden onset disaster trauma victims (the most probable case scenario), and it has not been tested, validated or propagated to the staff. Despite this, the All Hazards Approach (AHA) for management of major incidents and disasters is still valid and the “4S” theory for surge capacity can guide to respond to this disaster.
To describe the epidemiologic features of an outbreak of coronavirus disease (COVID-19) in Tianjin caused by a novel coronavirus (2019-nCoV) and to provide scientific basis for prevention and control measures.
Data from COVID-19 cases were collected from daily notifications given to the National Health Commission of the People's Republic of China and Tianjin Health Committee. All of the data were analyzed with SPSS version 24.0 software.
As of February 24, 2020, there have been 135 confirmed cases, 3 deaths, and 87 recoveries in Tianjin, China. The incidence of COVID-19 was 8.65/1,000,000 with a 2.22% case fatality rate. Regarding geographic distribution, the incidence was 8.82 per 1,000,000 in urban areas and 8.00 per 1,000,000 in suburbs. During the early stage of the epidemic, most cases came from urban areas and in patients with a history of sojourning in Hubei Province. The majority of patients were 31–70 years old (75.97%). A familial cluster was the most important characteristic of COVID-19 (accounting for 74.81%).
Current information suggests that people are generally susceptible to COVID-19, which has shown a familial cluster in Tianjin.
Online learning has become an increasingly expected and popular component for education of the modern-day adult learner, including the medical provider. In light of the recent coronavirus pandemic, there has never been more urgency to establish opportunities for supplemental online learning. Heart University aims to be ‘the go-to online resource’ for e-learning in congenital heart disease and paediatric acquired heart disease. It is a carefully-curated open access library of pedagogical material for all providers of care to children and adults with congenital heart disease or children with acquired heart disease, whether a trainee or a practicing provider. In this manuscript, we review the aims, development, current offerings and standing, and future goals of Heart University.
One in four cases of acute aortic syndrome are missed. This national survey examined Canadian Emergency physicians’ opinion on risk stratification, the need for a clinical decision aid to risk stratify patients, and the required sensitivity of such a tool.
We surveyed 1,556 members of the Canadian Association of Emergency Physicians. We used a modified Dillman technique with a prenotification email and up to three survey attempts using electronic mail. Physicians were asked 21 questions about demographics, importance of certain high-risk features, investigation options, threshold for investigation, and if a clinical decision tool is required
We had a response rate of 32%. Respondents were 66% male, and 49% practicing >10 years, with 59% in an academic teaching hospital. A total of 93% reported a need for a clinical decision aid to risk stratify for acute aortic syndrome. A total of 99.6% of physicians were pragmatic accepting a non-zero miss-rate, two-thirds accepting <1%, and the remaining accepting a higher miss-rate.
Our national survey determined that emergency physicians would use a highly sensitive clinical decision aid to determine which patients are at low, medium, or high-risk for acute aortic syndrome. The majority of clinicians have a low threshold (<1%) for investigating for acute aortic syndrome, but accept that a zero miss-rate is not feasible.
The epidemiology of mosquito-borne diseases is changing. This is a fact. Diseases that were mostly “confined” to tropical regions are now becoming real threats for temperate countries – for instance, the chikungunya outbreak in Northern Italy in 2007, the chikungunya epidemic in the Americas and the Caribbean beginning in late 2013, the major Zika epidemic in 2015, which also led to local transmission in the USA, and the recent surge of yellow fever cases in previously unaffected areas of Brazil. In this chapter, we propose a mathematical framework to emulate the dynamics of the spreading of a mosquito-borne disease in an urban environment. The main innovation of the proposed modeling framework is to improve on the current compartmental epidemiological models by considering not only vector-to-human transmission at fixed favorite cells, but also the probability of transmission along mobility pathways. This modus operandi allows us to improve the understanding of the interplay between human mobility and mosquito-borne disease in urban environments.
Clinical studies have revealed decreased exercise capacity in adults with small, unrepaired ventricular septal defects. Increasing shunt ratio and growing incompetence of the aortic and pulmonary valve with retrograde flow during exercise have been proposed as reasons for the previously found reduced exercise parameters. With MRI, haemodynamic shunt properties were measured during exercise in ventricular septal defects.
Patients with small, unrepaired ventricular septal defects and healthy peers were examined with MRI during exercise. Quantitative flow scans measured blood flow through ascending aorta and pulmonary artery. Scans were analysed post hoc where cardiac index, retrograde flows, and shunt ratio were determined.
In total, 32 patients (26 ± 6 years) and 28 controls (27 ± 5 years) were included. The shunt ratio was 1.2 ± 0.2 at rest and decreased to 1.0 ± 0.2 at peak exercise, p < 0.01. Aortic cardiac index was lower at peak exercise in patients (7.5 ± 2 L/minute/m2) compared with controls (9.0±2L l/minute/m2), p<0.01. Aortic and pulmonary retrograde flow was larger in patients during exercise, p < 0.01. Positive correlation was demonstrated between aortic cardiac index at peak exercise and previously established exercise capacity for all patients (r = 0.5, p < 0.01).
Small, unrepaired ventricular septal defects revealed declining shunt ratio with increasing exercise and lower aortic cardiac index. Patients demonstrated larger retrograde flow both through the pulmonary artery and the aorta during exercise compared with controls. In conclusion, adults with unrepaired ventricular septal defects redistribute blood flow during exercise probably secondary to a more fixed pulmonary vascular resistance compared with age-matched peers.
We investigated the extent to which combining cognitive markers increases the predictive value for future dementia, when compared to individual markers. Furthermore, we examined whether predictivity of markers differed depending on a range of modifying factors and time to diagnosis.
Neuropsychological assessment was performed for 2357 participants (60+ years) without dementia from the population-based Swedish National Study on Aging and Care in Kungsholmen. In the main sample analyses, the outcome was dementia at 6 years. In the time-to-diagnosis analyses, a subsample of 407 participants underwent cognitive testing 12, 6, and 3 years before diagnosis, with dementia diagnosis at the 12-year follow-up.
Category fluency was the strongest individual predictor of dementia 6 years before diagnosis [area under the curve (AUC) = .903]. The final model included tests of verbal fluency, episodic memory, and perceptual speed (AUC = .913); these three domains were found to be the most predictive across a range of different subgroups. Twelve years before diagnosis, pattern comparison (perceptual speed) was the strongest individual predictor (AUC = .686). However, models 12 years before diagnosis did not show significantly increased predictivity above that of the covariates.
This study shows that combining markers from different cognitive domains leads to increased accuracy in predicting future dementia 6 years later. Markers from the verbal fluency, episodic memory, and perceptual speed domains consistently showed high predictivity across subgroups stratified by age, sex, education, apolipoprotein E ϵ4 status, and dementia type. Predictivity increased closer to diagnosis and showed highest accuracy up to 6 years before a dementia diagnosis.
Overconsumption of fructose time dependently induces the development of non-alcoholic fatty liver disease (NAFLD). We investigated whether ursolic acid (UA) intake by new-born rats would protect against fructose-induced NAFLD. One hundred and seven male and female Sprague Dawley rat pups were randomly grouped and gavaged (10 ml/kg body weight) with either 0.5% dimethylsulphoxide (vehicle control), 0.05% UA, 50% fructose mixed with UA (0.05%) or 50% fructose alone, from postnatal day 6 (P6) to P20. Post-weaning (P21–P69), the rats received normal rat chow (NRC) and water to drink. On P70, the rats in each group were continued on water or 20% fructose to drink, as a secondary high fructose diet during adulthood. After 8 weeks, body mass, food and fluid intake, circulating metabolites, visceral adiposity, surrogate markers of liver function and indices of NAFLD were determined. Food intake was reduced as a result of fructose feeding in both male and female rats (p < 0.0001). Fructose consumption in adulthood significantly increased fluid intake and visceral adiposity in female rats (p < 0.05) and had no apparent effects in male rats (p > 0.05). In both sexes of rats, fructose had no significant (p > 0.05) effects on body mass, circulating metabolites, total calorie intake and surrogate markers of hepatic function. Fructose consumption in both early life and adulthood in female rats promoted hepatic lipid accumulation (p < 0.001), hypertrophy, microvesicular and macrovesicular steatosis (p < 0.05). Early-life UA intake significantly (p < 0.001) reduced fructose-induced hepatic lipid accumulation in both male and female rats. Administration of UA during periods of developmental plasticity shows prophylactic potential against dietary fructose-induced NAFLD.
The parasite-stress theory of values or sociality is a recent, encompassing perspective in human social psychology and behavior. As an ecological and evolutionary theory of peoples’ cultural values/core preferences, it applies widely across many domains of human social life and human affairs. It is a general theory of human culture and sociality. Fundamental to the theory is the behavioral immune system. The human behavioral immune system includes: psychological traits and manifest behaviors for avoiding contact with infectious diseases; behaviors of in-group social preference, altruism, alliance, and conformity that manage the negative effects of infectious diseases; mate choice to increase personal and offspring defense against parasites; culinary behavior; and components of personality. The contagion-avoidance aspect of behavioral immunity is much more than out-group avoidance and dislike (xenophobia). It also includes the preference for the natal or local region (philopatry) and hence avoidance of foreignness in people and places where novel parasites may occur. The parasite-stress theory has produced a cornucopia of newly discovered patterns and informed and reinterpreted previously described patterns in the behavior of individuals and at the level of cultures/societies and regions. In novel ways, it informs and synthesizes knowledge of major features of the social lives and societal-level affairs of people, ranging from prejudice and egalitarianism to personality, economic patterns, core values, interpersonal and intergroup violence, governmental systems, gender relations, family structure, and the genesis and maintenance of cultural diversity across the world.