Search

Abstract Background Since the early 1990s there has been a burgeoning interest in global health teaching in undergraduate medical curricula. In this article we trace the evolution of this teaching and present recommendations for how the discipline might develop in future years. Discussion Undergraduate global health teaching has seen a marked growth over the past ten years, partly as a response to student demand and partly due to increasing globalization, cross-border movement of pathogens and international migration of health care workers. This teaching has many different strands and types in terms of topic focus, disciplinary background, the point in medical studies in which it is taught and whether it is compulsory or optional. We carried out a survey of medical schools across the world in an effort to analyse their teaching of global health. Results indicate that this teaching is rising in prominence, particularly through global health elective/exchange programmes and increasing teaching of subjects such as globalization and health and international comparison of health systems. Our findings indicate that global health teaching is moving away from its previous focus on tropical medicine towards issues of more global relevance. We suggest that there are three types of doctor who may wish to work in global health – the ‘globalised doctor’, ‘humanitarian doctor’ and ‘policy doctor’ – and that each of these three types will require different teaching in order to meet the required competencies. This teaching needs to be inserted into medical curricula in different ways, notably into core curricula, a special overseas doctor track, optional student selected components, elective programmes, optional intercalated degrees and postgraduate study. Summary We argue that teaching of global health in undergraduate medical curricula must respond to changing understandings of the term global health. In particular it must be taught from the perspective of more disciplines than just biomedicine, in order to reflect the social, political and economic causes of ill health. In this way global health can provide valuable training for all doctors, whether they choose to remain in their countries of origin or work abroad.

Abstract Background There has long been debate around the definition of the field of education, research and practice known as global health. In this article we step back from attempts at definition and instead ask what current definitions tell us about the evolution of the field, identifying gaps and points of debate and using these to inform discussions of how global health might be taught. Discussion What we now know as global health has its roots in the late 19th century, in the largely colonial, biomedical pursuit of ‘international health’. The twentieth century saw a change in emphasis of the field towards a much broader conceptualisation of global health, encompassing broader social determinants of health and a truly global focus. The disciplinary focus has broadened greatly to include economics, anthropology and political science, among others. There have been a number of attempts to define the new field of global health. We suggest there are three central areas of contention: what the object of knowledge of global health is, the types of knowledge to be used and around the purpose of knowledge in the field of global health. We draw a number of conclusions from this discussion. First, that definitions should pay attention to differences as well as commonalities in different parts of the world, and that the definitions of global health themselves depend to some extent on the position of the definer. Second, global health’s core strength lies in its interdisciplinary character, in particular the incorporation of approaches from outside biomedicine. This approach recognises that political, social and economic factors are central causes of ill health. Last, we argue that definition should avoid inclusion of values. In particular we argue that equity, a key element of many definitions of global health, is a value-laden concept and carries with it significant ideological baggage. As such, its widespread inclusion in the definitions of global health is inappropriate as it suggests that only people sharing these values may be seen as ‘doing’ global health. Nevertheless, discussion of values should be a key part of global health education. Summary Our discussions lead us to emphasise the importance of an approach to teaching global health that is flexible, interdisciplinary and acknowledges the different interpretations and values of those practising and teaching the field.

Legumes house nitrogen-fixing endosymbiotic rhizobia in specialised polyploid cells within root nodules. This results in a mutualistic relationship whereby the plant host receives fixed nitrogen from the bacteria in exchange for dicarboxylic acids. This plant-microbe interaction requires the regulation of multiple metabolic and physiological processes in both the host and symbiont in order to achieve highly efficient symbiosis. Recent studies have showed that the success of symbiosis is influenced by the circadian clock of the plant host. Medicago and soybean plants with altered clock mechanisms showed compromised nodulation and reduced plant growth. Furthermore, transcriptomic analyses revealed that multiple genes with key roles in recruitment of rhizobia to plant roots, infection and nodule development were under circadian control, suggesting that appropriate timing of expression of these genes may be important for nodulation. There is also evidence for rhythmic gene expression of key nitrogen fixation genes in the rhizobium symbiont, and temporal coordination between nitrogen fixation in the bacterial symbiont and nitrogen assimilation in the plant host may be important for successful symbiosis. Understanding of how circadian regulation impacts on nodule establishment and function will identify key plant-rhizobial connections and regulators that could be targeted to increase the efficiency of this relationship., (© 2024 The Author(s).)

Objectives: Scalp hair has the greatest number of hairs (typically 1-5) per follicular unit but is also the most susceptible body site to hair loss with age. Hence, we set-out to determine the degree to which scalp hair parameters change with age in women and men, any sex differences thereof and whether hair loss is random across follicular units., Methods: A retrospective cross-sectional study of 200 Chinese men and 200 Chinese women (30-69 years). Image analysis and manual counting methods were used to measure occipital located hair parameters from 6 × 8 mm shaved scalp photographs and plucked hair microscopy images., Results: Of the five hair parameters, the number of hairs per follicular unit had the greatest (negative) correlation with age in both men and women. Men had a greater number of hairs and follicular units than women on average but had a greater decrease in the number of hairs per follicular unit with age, particularly for the loss of multi-hair (3+) follicular units. The loss of hairs with age was significantly different to that expected by a random loss of hairs across follicular units and better described by a model of increased hair loss risk the greater number of hairs per follicular unit., Conclusions: We have found evidence of hair loss preferentially occurring in multi-hair follicular units, which was more pronounced in men. These data suggest that part of the reason scalp hair is more susceptible to hair loss than on other body sites is due to the greater presence of multi-hair follicular units on the scalp., (© 2023 Society of Cosmetic Scientists and Societe Francaise de Cosmetologie.)

Legumes house nitrogen-fixing endosymbiotic rhizobia in specialized polyploid cells within root nodules, which undergo tightly regulated metabolic activity. By carrying out expression analysis of transcripts over time in Medicago truncatula nodules, we found that the circadian clock enables coordinated control of metabolic and regulatory processes linked to nitrogen fixation. This involves the circadian clock-associated transcription factor LATE ELONGATED HYPOCOTYL (LHY), with lhy mutants being affected in nodulation. Rhythmic transcripts in root nodules include a subset of nodule-specific cysteine-rich peptides (NCRs) that have the LHY-bound conserved evening element in their promoters. Until now, studies have suggested that NCRs act to regulate bacteroid differentiation and keep the rhizobial population in check. However, these conclusions came from the study of a few members of this very large gene family that has complex diversified spatio-temporal expression. We suggest that rhythmic expression of NCRs may be important for temporal coordination of bacterial activity with the rhythms of the plant host, in order to ensure optimal symbiosis., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Society for Experimental Biology.)

The widespread use and development of inertia friction welding is currently restricted by an incomplete understanding of the deformation mechanisms and microstructure evolution during the process. Understanding phase transformations and lattice strains during inertia friction welding is essential for the development of robust numerical models capable of determining optimized process parameters and reducing the requirement for costly experimental trials. A unique compact rig has been designed and used in-situ with a high-speed synchrotron X-ray diffraction instrument to investigate the microstructure evolution during inertia friction welding of a high-carbon steel (BS1407). At the contact interface, the transformation from ferrite to austenite was captured in great detail, allowing for analysis of the phase fractions during the process. Measurement of the thermal response of the weld reveals that the transformation to austenite occurs 230 °C below the equilibrium start temperature of 725 °C. It is concluded that the localization of large strains around the contact interface produced as the specimens deform assists this non-equilibrium phase transformation., (open access.)

Transdisciplinary research approaches are being applied to today's complex health problems, including the climate crisis and widening inequalities. Diverse forms of disciplinary and experiential knowledge are required to understand these challenges and develop workable solutions. We aimed to create an updated model reflective of the strengths and challenges of current transdisciplinary health research that can be a guide for future studies. We searched Medline using terms related to transdisciplinary, health and research. We coded data deductively and inductively using thematic analysis to develop a preliminary model of transdisciplinary research. The model was tested and improved through: (i) a workshop with 27 participants at an international conference in Xiamen, China and (ii) online questionnaire feedback from included study authors. Our revised model recommends the following approach: (i) co-learning, an ongoing phase that recognizes the distributed nature of knowledge generation and learning across partners; (ii) (pre-)development, activities that occur before and during project initiation to establish a shared mission and ways of working; (iii) reflection and refinement to evaluate and improve processes and results, responding to emergent information and priorities as an ongoing phase; (iv) conceptualization to develop goals and the study approach by combining diverse knowledge; (v) investigation to conduct the research; (vi) implementation to use new knowledge to solve societal problems. The model includes linear and cyclical processes that may cycle back to project development. Our new model will support transdisciplinary research teams and their partners by detailing the necessary ingredients to conduct such research and achieve health impact., (© The Author(s) 2021. Published by Oxford University Press.)

Chronic and emerging infectious diseases and antimicrobial resistance remain a substantial global health threat. Microbiota are increasingly recognised to play an important role in health. Infections also have a profound effect beyond health, especially on global and local economies. To maximise health improvements, the field of infectious disease epidemiology needs to derive learning from ecology and traditional epidemiology. New methodologies and tools are transforming understanding of these systems, from a better understanding of socioeconomic, environmental, and cultural drivers of infection, to improved methods to detect microorganisms, describe the immunome, and understand the role of human microbiota. However, exploiting the potential of novel methods to improve global health remains elusive. We argue that to exploit these advances a shift is required in the teaching of infectious disease epidemiology to ensure that students are well versed in a breadth of disciplines, while maintaining core epidemiological skills. We discuss the following key points using a series of teaching vignettes: (1) integrated training in classic and novel techniques is needed to develop future scientists and professionals who can work from the micro (interactions between pathogens, their cohabiting microbiota, and the host at a molecular and cellular level), with the meso (the affected communities), and to the macro (wider contextual drivers of disease); (2) teach students to use a team-science multidisciplinary approach to effectively integrate biological, clinical, epidemiological, and social tools into public health; and (3) develop the intellectual skills to critically engage with emerging technologies and resolve evolving ethical dilemmas. Finally, students should appreciate that the voices of communities affected by infection need to be kept at the heart of their work., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Tea has historically been associated with mood benefits. Nevertheless, few studies have empirically investigated mood changes after tea consumption. We explored immediate effects of a single cup of tea up to an hour post-consumption on self-reported valence, arousal, discrete emotions, and implicit measures of mood. In a parallel group design, 153 participants received a cup of tea or placebo tea, or a glass of water. Immediately (i.e. 5 min) after consumption, tea increased valence but reduced arousal, as compared to the placebo. There were no differences at later time points. Discrete emotions did not differ significantly between conditions, immediately or over time. Water consumption increased implicit positivity as compared to placebo. Finally, consumption of tea and water resulted in higher interest in activities overall and in specific activity types compared to placebo. The present study shows that effects of a single cup of tea may be limited to an immediate increase in pleasure and decrease in arousal, which can increase interest in activities. Differences between tea and water were not significant, while differences between water and placebo on implicit measures were unexpected. More servings over a longer time may be required to evoke tea's arousing effects and appropriate tea consumption settings may evoke more enduring valence effects., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Purpose: The aim of this study was to investigate if the duration of decaffeinated green tea extract (dGTE) ingestion plays a role in augmenting fat oxidation rates during moderate-intensity exercise., Methods: In a crossover, placebo-controlled design, 19 healthy males (mean ± SD; age = 21 ± 2 yr, weight = 75.0 ± 7.0 kg, body mass index = 23.2 ± 2.2 kg·m, maximal oxygen consumption [V˙O2max] = 55.4 ± 4.6 mL·kg·min) ingested dGTE and placebo (PLA) for 28 d, separated by a 28-d washout period. On the first day (dGTE 1 or PLA 1) and after 7 d (dGTE 7 or PLA 7) and 28 d (dGTE 28 or PLA 28), participants completed a 30-min cycle exercise bout (50% Wmax), 2 h after ingestion. Indirect calorimetry was used to calculate rates of whole-body fat and carbohydrate oxidation during exercise. Blood samples were collected at rest and during exercise for analysis of plasma fatty acids, glycerol, and epigallocatechin gallate., Results: The ingestion of dGTE did not significantly change whole-body fat oxidation rates during exercise on day 1, 7, or 28 compared with PLA. There were also no changes in plasma concentrations of fatty acids and glycerol at rest and during exercise as a result of dGTE ingestion at any time point compared with PLA. Plasma epigallocatechin gallate concentrations, immediately before the exercise bout, in the three dGTE trials were elevated compared with PLA but not different between 1, 7, and 28 d., Conclusion: In contrast to previous reports, we found that the duration of dGTE ingestion had no effect on whole-body fat oxidation rates or fat metabolism-related blood metabolites during exercise in physically active healthy males.

Environmental risk assessment of chemicals is reliant on good estimates of product usage information and robust exposure models. Over the past 20 to 30 years, much progress has been made with the development of exposure models that simulate the transport and distribution of chemicals in the environment. However, little progress has been made in our ability to estimate chemical emissions of home and personal care (HPC) products. In this project, we have developed an approach to estimate subnational emission inventory of chemical ingredients used in HPC products for 12 Asian countries including Bangladesh, Cambodia, China, India, Indonesia, Laos, Malaysia, Pakistan, Philippines, Sri Lanka, Thailand, and Vietnam (Asia-12). To develop this inventory, we have coupled a 1 km grid of per capita gross domestic product (GDP) estimates with market research data of HPC product sales. We explore the necessity of accounting for a population's ability to purchase HPC products in determining their subnational distribution in regions where wealth is not uniform. The implications of using high resolution data on inter- and intracountry subnational emission estimates for a range of hypothetical and actual HPC product types were explored. It was demonstrated that for low value products (<500 US$ per capita/annum required to purchase product) the maximum deviation from baseline (emission distributed via population) is less than a factor of 3 and it would not result in significant differences in chemical risk assessments. However, for other product types (>500 US$ per capita/annum required to purchase product) the implications on emissions being assigned to subnational regions can vary by several orders of magnitude. The implications of this on conducting national or regional level risk assessments may be significant. Further work is needed to explore the implications of this variability in HPC emissions to enable the HPC industry and/or governments to advance risk-based chemical management policies in emerging markets., (© 2013 SETAC.)

Tea has previously been demonstrated to better help sustain alertness throughout the day in open-label studies. We investigated whether tea improves attention and self-reported alertness in two double-blind, randomised, placebo-controlled, crossover studies. Participants received black tea (made from commercially available tea bags) in one condition and placebo tea (hot water with food colours and flavours) similar in taste and appearance to real tea in the other condition. Attention was measured objectively with attention tests (the switch task and the intersensory-attention test) and subjectively with a self-report questionnaire (Bond-Lader visual analogue scales). In both studies, black tea significantly enhanced accuracy on the switch task (study 1 p<.002, study 2 p=.007) and self-reported alertness on the Bond-Lader questionnaire (study 1 p<.001, study 2 p=.021). The first study also demonstrated better auditory (p<.001) and visual (p=.030) intersensory attention after black tea compared to placebo. Simulation of theanine and caffeine plasma time-concentration curves indicated higher levels in the first study compared to the second, which supports the finding that tea effects on attention were strongest in the first study. Being the second most widely consumed beverage in the world after water, tea is a relevant contributor to our daily cognitive functioning., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The non-proteinic amino acid L-theanine and caffeine, a methylxanthine derivative, are naturally occurring ingredients in tea. The present study investigated the effect of a combination of 97 mg L-theanine and 40 mg caffeine as compared to placebo treatment on cognitive performance, alertness, blood pressure, and heart rate in a sample of young adults (n = 44). Cognitive performance, self-reported mood, blood pressure, and heart rate were measured before L-theanine and caffeine administration (i.e. at baseline) and 20 min and 70 min thereafter. The combination of moderate levels of L-theanine and caffeine significantly improved accuracy during task switching and self-reported alertness (both P < 0.01) and reduced self-reported tiredness (P < 0.05). There were no significant effects on other cognitive tasks, such as visual search, choice reaction times, or mental rotation. The present results suggest that 97 mg of L-theanine in combination with 40 mg of caffeine helps to focus attention during a demanding cognitive task.

Rwanda is making substantial progress towards improvement of health and is working towards achievement of the Millennium Development Goals, which is a challenging task because the country has had genocide in 1994, has few natural resources, is landlocked, and has high population growth. Like many impoverished sub-Saharan countries, Rwanda's health system has had an uncoordinated plethora of donors, shortage of health staff, inequity of access, and poor quality of care in health facilities. This report describes three health system developments introduced by the Rwandan government that are improving these barriers to care-ie, the coordination of donors and external aid with government policy, and monitoring the effectiveness of aid; a country-wide independent community health insurance scheme; and the introduction of a performance-based pay initiative. If these innovations are successful, they might be of interest to other sub-Saharan countries. However, Rwanda still does not have sufficient financial resources for health and will need additional external aid for some time to attain the Millennium Development Goals.

The impact of many human variables on the response to skin irritating substances has been studied to varying degrees, including the impact of age, sex, and atopic status. However, the importance of ethnic origin has been more difficult to investigate, leading to a relative paucity of compelling data, either for or against the existence of differences. A primary reason for this lack is that studies on different ethnic groups often have to be undertaken in different locations thus introducing variables, e.g. time, environmental conditions that confound interpretations. In the present work, an attempt has been made to eliminate all variables except ethnicity by conducting a study on 2 distinct populations (Punjabis and Tamils) at the same location on the same day with a single assessor of the skin reactions, using sodium lauryl sulfate as the skin irritant. The skin reactions were assessed visually, and it was demonstrated that the modality of the reactions in these 2 populations had clear differences, but that the dose-response profiles were very similar. Thus, although the irritant response was expressed differently (e.g. erythema was much less evident in the darker Tamil population), the overall outcome was that the populations reacted in an equivalent manner.

Profilaggrin is a key epidermal protein, critical for the generation and maintenance of the stratum corneum barrier. It is encoded by a gene located in the epidermal differentiation complex of Chromosome 1q21 and is composed of multiple filaggrin repeats connected by highly conserved linker peptides. Within the human population the number of filaggrin repeats encoded by this gene varies between 10, 11 or 12 repeats. Using a PCR-based approach we have determined individual profilaggrin allelotypes in a group of 113 subjects and identified preliminary evidence of an inverse association between the 12 repeat allele and self-perceived frequent dry skin (P=0.0293). This is the first demonstration of a potential association between a genetic marker and cosmetic skin condition and suggests that cosmetic skin dryness may in part be genetically determined and associated with specific profilaggrin allelotypes.

There exists within the population subsets of individuals who display heightened skin reactivity to materials the majority find tolerable. In a series of investigations, we have examined interrelationships between many of the endpoints associated with the term 'sensitive skin'. In the most recent work, 58 volunteers were treated with 10% lactic acid, 50% ethanol, 0.5% menthol and 1.0% capsaicin on the nasolabial fold, unoccluded, with sensory reactions recorded at 2.5 min, 5 min and 8 min after application. Urticant susceptibility was evaluated with 1 m benzoic acid and 125 mM trans-cinnamic acid applied to the volar forearm for 20 min. A 2 x 23-h patch test was also conducted using 0.1% and 0.3% sodium dodecyl sulfate, 0.3% and 0.6% cocamidopropyl betaine and 0.1% and 0.2% benzalkonium chloride to determine irritant susceptibility. As found in previous studies, increased susceptibility to one endpoint was not predictive of sensitivity to another. In our experience, nasolabial stinging was a poor predictor of general skin sensitivity. Nevertheless, it may be possible to identify in the normal population individuals who, coincidentally, are more generally sensitive to a range of non-immunologic adverse skin reactions. Whether such individuals are those who experience problems with skin care products remains to be addressed.

The problems for poor people generated by 'disorganised health care markets' in the developing world have grave consequences for their health. In many countries, processes of liberalisation and commercialisation have generated a number of dilemmas for policy-makers, non-governmental organisations and individuals seeking health care. Complex markets for health care provision and financing exist, regulation is lacking and rates of exclusion are high due to the effects of prices and a lack of concerted efforts to make health systems more accessible to the poor. Analysis of health systems and the problems they create for the poor should lead to responses that protect and enhance the rights of poor people to health.

We describe a number of pitfalls that may occur with the push to rapidly expand access to antiretroviral therapy in sub-Saharan Africa. These include undesirable opportunity costs, the fragmentation of health systems, worsening health care inequities, and poor and unsustained treatment outcomes. On the other hand, AIDS "treatment activism" provides an opportunity to catalyze comprehensive health systems development and reduce health care inequities.However, these positive benefits will only happen if we explicitly set out to achieve them. We call for a greater commitment toward health activism that tackles the broader political and economic constraints to human and health systems development in Africa, as well as toward the resuscitation of inclusive and equitable public health systems.

Agreements negotiated at the World Trade Organization already have important implications for health and health policy. They impact on the ability of governments to regulate trade in the interests of health; on national and international governance and public health standards; and on the future of the precautionary principle. Agreements on trade-related aspects of intellectual property rights and trade in health services could benefit the multi-national health care and pharmaceutical industries, and impact negatively on cost and equity.

Globalization is happening. But it appears that it has been associated with a rise in inequalities both between and within nations. Financial and trade liberalization, the main motors of the current phase of globalization, have been introduced with reckless abandon and little thought to the consequences. Future policy advice must bolster the role of the state in defending populations from the excesses of market forces, and there should be rigorous analysis of the health and other social impacts of economic policies.

Article 25 of the Universal Declaration of Human Rights clearly emphasizes health as a human right. Poverty and social exclusion are the most important drivers of ill-health. The causes of increasing poverty are complex but one significant factor is international debt. This affects mainly sub-Saharan Africa but, with the global economic crisis in South East Asia, may spread. Structural adjustment policies which cut social spending compound the health effects of debt and poverty. Privatization of health care and user charges particularly affect women, children, the disabled, and other marginalized communities. To improve health, governments and international institutions have a duty to examine the determinants of health, including human rights and economic policy.

Human volunteer studies of skin irritation have been carried out for decades, both for research and for safety evaluation purposes. For the majority of this time, and consequently for the majority of the studies, assessment of the skin reactions has been made visually. Typical endpoints include erythema, oedema, dryness and scaling, some or all of which would be rated on a simple scale, eg 0, +/-, +, ++, + + +. Such approaches can be criticized as subjective, of poor reproducibility, lacking in sensitivity and highly variable between observers and/or institutions. In consequence, instrumental methods of assessment have been strongly promoted and do indeed offer several advantages, not least their objectivity. However, it is possible to use the human eye, which is a very sensitive tool, to make detailed, accurate and reproducible descriptions of skin irritation reactions. To achieve this, it is necessary to give prolonged and thorough training to each observer. In this paper, 3 examples of human volunteer studies, in which different pairs of trained observers independently carried out double blinded scoring of the irritation reactions, are reported. The grading patterns produced were almost identical; statistical analysis showed that properly trained observers are in fact able to reliably measure a grade of erythema to within +/- 1 on a 10 point scale; 97.6% of scores were within 2 grade points on this scale. These results provide evidence that visual scoring can be sensitive, reliable and reproducible within a testing institution.