Health professionalism and health profession education in the 21st century

The dramatic, rapid and uncertain changes from the 20th to the 21st century are called global megatrends. Such trends are the emerging and re-emerging infectious diseases, an aging society, environmental hazards, behavioural risks, and more complicated lifestyles of humans in the digital age with advanced information technology (IT) that impact much on epidemiological transitions, health security and healthcare. Health professionals are the key persons for dealing with these challenging healthcare trends. The next generation of health professionals should be equipped with high professionalism especially for the components of humanism that artificial intelligence (AI) cannot replicate. Moreover, interprofessional collaborative teamwork among health professionals is a required skill for working in dynamic transitions such as the coronavirus disease 2019 (COVID-19) pandemic. Interprofessional education (IPE) is one of the essential strategies for enhancing teamwork skills in learners. Six previously reported trends in health profession education for the 21st century are summarized, including interprofessional education, longitudinal integrated clinical education, understanding partnerships and social determination of health in patients, life-long learning, competency-based skills changeable over time, and AI and IT integrated in education. The connection among megatrends, trends in healthcare, health professionalism and health professional’s education will be important issues in academia for both health educators and health professionals.

Population Demography

This chapter reviews population measurements and the demographic and epidemiological transitions and how these may change over time. Knowledge of the population age and sex structure and distribution are essential to estimate those people at most risk and for estimating population access to services and programmes. Sources of population information are presented and factors highlighted for the quality of population data. Definitions of demographic rates and life expectancy, population growth, census procedures, death certification, and demographic surveillance are all outlined.

Incidence Trends of Gastric Cancer in Southern Iran: Adenocarcinoma and Non-Cardia Gastric Cancer Are More Rising Among Younger Ages

Background Gastric cancer (GC) is still one of the major causes of cancer mortality. Due to health-related transitions, the epidemiology of GC subtypesmaybe changed. These changes may have profound effects on the clinical approaches, and public health management of GC. Iran, as a developing country, has experienced huge demographic and epidemiological transitions during recent decades. We aimed to investigate subtype-specific population-based incidence trends of GC in southern Iran. Methods We used data on GC incidence in southern Iran for 2001–2015. Data preparation and subtype grouping were done based on the ICD-O-3. Trends of age-standardized incidence rate (ASR), truncated ASRs, the incidence rate of early-onset, adenocarcinoma, and cardia GC, and age-gender specific rates were analyzed applying joinpoint regression modeling. Annual percentage change (APC) and its 95%confidence intervals (CI) were estimated. Results Overall APC was estimated at 7.2 for males and 8.7 for females. Estimated APCs for trends of overall GC, and gastric adenocarcinoma were stable for both genders during 2009 to 2015, while the trends of cardia GC were increasing for both genders. Estimated APCs for trends of non-cardia GC wasalso stable. Conclusion Overall trends of incidence of GC in southern Iran have been stable for the last decade. However, significant and different changes in the pattern of GC have occurred.Etiological and prognostic studies are needed in Iran for improvement of the GC management.

Epidemiological transitions in human evolution and the richness of viruses, helminths, and protozoa

Background and objectives In absolute terms, humans are extremely highly parasitized compared to other primates. This may reflect that humans are outliers in traits correlated with parasite richness: population density, geographic range area, and study effort. The high degree of parasitism could also reflect amplified disease risk associated with agriculture and urbanization. Alternatively, controlling for other variables, cultural and psychological adaptations could have reduced parasitism in humans over evolutionary time. Methodology We predicted the number of parasites that would infect a nonhuman primate with human phenotypic characteristics and phylogenetic position, and then compared observed parasitism of humans in eight geopolitical countries to the predicted distributions. The analyses incorporated study effort, phylogeny, and drivers of parasitism in 33 primate species. Results Analyses of individual countries were not supportive of either hypothesis. When analyzed collectively, however, human populations showed consistently lower than expected richness of protozoa and helminths, but higher richness of viruses. Thus, human evolutionary innovations and new parasite exposures may have impacted groups of parasites in different ways, with support for both hypotheses in the overall analysis. Conclusions and implications The high level of parasitism observed in humans only applies to viruses, and was not extreme in any of our tests of individual countries. In contrast, we find consistent reductions in protozoa and helminths across countries, suggesting reduced parasitism by these groups during human evolution. We propose that hygienic and technological advances might have extinguished fecal-orally or indirectly transmitted parasites like helminths, whereas higher human densities and host-shifting potential of viruses have supported increased virus richness. Lay Summary Vastly more parasite species infect humans than any other primate host. Controlling for factors that influence parasite richness, such as the intensity of study effort and body mass, we find that humans may have more viruses, but fewer helminths and protozoa, than expected based on evolutionary analyses of parasitism in other primates.

Impact of COVID-19 on Pharmacy Education

Morocco, home to nearly 36 million inhabitants has undergone demographic and epidemiological transitions over the past 50 years. Alongside this transition is the prevalence of Non-Communicable Diseases (NCDs) which has also risen substantially and has contributed remarkably to the rise in the population's need for healthcare services. In order to respond to the increasing healthcare needs of the Moroccan population, it is necessary to ensure that healthcare providers are readily accessible and sufficient. As one of the most accessible healthcare providers, pharmacists are well positioned to address these demands. It is therefore essential to build a competent pharmaceutical workforce in Morocco with a specialized focus on pharmacy education and training. However, the education and training of pharmacy students in the country has been grossly disrupted by the present COVID-19 pandemic. In this paper, we examine the impact of the COVID-19 pandemic on pharmacy education in Morocco. The net impact of this unprecedented pandemic on pharmacy education in Morocco has become well pronounced with a lot of accompanying challenges. If not addressed, the results in the long-run may be devastating. Doi: 10.28991/SciMedJ-2020-02-SI-8 Full Text: PDF

Reconstructing the Origin, Evolution, and History of Leprosy

This chapter synthesizes the skeletal evidence for leprosy documented in the previous chapter to explore the origin, evolution, and spread of leprosy. The relevance of the three epidemiological transitions to the frequency of leprosy since the transition to agriculture is also discussed. This is in tandem with extant modern and ancient leprosy genomic data. Ancient DNA evidence for the strains of the bacterium that affected people in the past is also furthering knowledge of the spread of leprosy. More work in this area is recommended, in concert with stable isotope analysis, providing information on the mobility and dietary histories of people in the past, and mitochondrial DNA to document ancestry. The historical evidence suggests that leprosy declined in the fourteenth century, but at the moment archaeological evidence is lacking to support such a hypothesis. Many reasons for this have been suggested (for example the plague, and improved diet and living conditions), but cross-immunity created by exposure to tuberculosis remains the strongest possibility. The two diseases have many characteristics in common, and tuberculosis and leprosy have been found together in skeletons in a number of instances. Co-infection with tuberculosis may be another hypothesis to consider as an explanation for leprosy’s decline.

The Historical Evolution оf the Population оf Ukraine in the Light of the Theory of Demographic Transition

The main results of scientific investigations of long-time trends in population dynamics and population replacement in deep retrospect for Ukraine are presented. Perceptions of the transformational changes in the structure of population of Ukraine are expanding — both for the statistical era and for the population nonstatistical era of national history. Th e investigation is based on the author’s reconstructions of historical series of demographic dynamics in Ukraine, which for the fi rst time made it possible to reconstruct the real trajectory of population trends in regions of Ukraine for the long time period (since beginning of Common Era). Th e transformation of population replacement in our country in the con- text of the theories of demographic modernization and comparison with similar changes in other European countries is investigated.Novelty: For the fi rst time, it is clear that the overall trend in the numerical effi ciency of our country has been ambiguous for thousands of years, especially in the past. Th e periods of perturbation (wars, famines, epidemics, natural disas- ters) made the trend undulatory; over the second millennium, annual growth rates have fallen 150 times below zero. Th e results of the study allowed for the fi rst time to carry out correct periodization of the demographic and epidemiological transitions: it is scientifi cally estab- lished that the demographic transition has been going on since the mid-1890s, and epide- miological — since the mid-1920s. In the course it was established that demographic deve- lopment of Ukraine continues in both the well-known tendencies of demographic transition and under the infl uence of national diff erences. Th e Ukrainian way of modernization in the twentieth century was very dramatic — our country has been described as one of the coun- tries with the largest loss of population. The peculiarity of the dynamics of demographic modernization in Ukraine in the twentieth century lies primarily in the fact that it has a de- formed intermittent nature due to the multimillion-dollar hecatomb of human victims, and in recent times there has been demodernization of the processes of reproduction of the popu- lation of our country. Key words: population, vital event, reconstruction, population growth, historical series, demographic modernization, Ukraine.

Towards the elimination of dog-mediated rabies: development and application of an evidence-based management tool

Background International organizations advocate for the elimination of dog-mediated rabies, but there is only limited guidance on interpreting surveillance data for managing elimination programmes. With the regional programme in Latin America approaching elimination of dog-mediated rabies, we aimed to develop a tool to evaluate the programme’s performance and generate locally-tailored rabies control programme management guidance to overcome remaining obstacles. Methods We developed and validated a robust algorithm to classify progress towards rabies elimination within sub-national administrative units, which we applied to surveillance data from Brazil and Mexico. The method combines criteria that are easy to understand, including logistic regression analysis of case detection time series, assessment of rabies virus variants, and of incursion risk. Subjecting the algorithm to robustness testing, we further employed simulated data sub-sampled at differing levels of case detection to assess the algorithm’s performance and sensitivity to surveillance quality. Results Our tool demonstrated clear epidemiological transitions in Mexico and Brazil: most states progressed rapidly towards elimination, but a few regressed due to incursions and control lapses. In 2015, dog-mediated rabies continued to circulate in the poorest states, with foci remaining in only 1 of 32 states in Mexico, and 2 of 27 in Brazil, posing incursion risks to the wider region. The classification tool was robust in determining epidemiological status irrespective of most levels of surveillance quality. In endemic settings, surveillance would need to detect less than 2.5% of all circulating cases to result in misclassification, whereas in settings where incursions become the main source of cases the threshold detection level for correct classification should not be less than 5%. Conclusion Our tool provides guidance on how to progress effectively towards elimination targets and tailor strategies to local epidemiological situations, while revealing insights into rabies dynamics. Post-campaign assessments of dog vaccination coverage in endemic states, and enhanced surveillance to verify and maintain freedom in states threatened by incursions were identified as priorities to catalyze progress towards elimination. Our finding suggests genomic surveillance should become increasingly valuable during the endgame for discriminating circulating variants and pinpointing sources of incursions.

Being a Hunter-Gatherer in the 21st Century: Health Knowledge System, Problems and Paradoxes

In due course of evolution, maintaining health and coping with aggrievances and illness for survival or adaptation has always been the goal of organisms, which has been verified by the narrative aeons of ancient culture and archaeological shreds of evidence of natural, non-natural/synthetic diseases, accidents and injuries. The earlier discussion on hunter-gatherer’s health, illness, and healthcare management knowledge system involves the discourse of epidemiological transitions. This research aims to understand the health knowledge system of present-day hunter-gatherers through cross-cultural comparison beyond the dichotomy of natural diseases and rational treatments. The researcher has focused on four contemporary hunter-gatherer’s communities i.e. Arana-dan, Cholanaicken, Kattunayakan, Paniyan/Kattupaniyan of Nilambur valley, Kerala to understand the hunter-gatherer’s perception/conception of health and illness and what are mechanisms of healthcare and healing among them. This research has highlighted the problem of static versus dynamic in the conception of health in the time spatiotemporal transition and the existing uniformity in the conception of health despite the diversity in socio-cultural practices. The research also delineates of hunter-gatherers relation to landscape (in the context of health and healthcare), and questions assumptions of ecofeminism and axioms of knowledge distribution system among the hunter-gatherers based on a Marxian division of labour. The study includes the appropriate ethnographic survey among the colonies of the selected tribes to understand the placement of land, life and living of hunter-gatherers in a contemporary context.