Healthy Précis Quarterly | Issue 28 | December 2017 | adarash.net | [email protected]Page 1 -—-——-—--—————-———————-————----------------------------Panel Adarash, |December 2017 ——-———--——-——-——-——--———————-—————-—----- Healthy Précis Quarterly Primer Simply put, “life” is nothing but conscious existence, in which health and disease are its two critical elements. Of diseases known to humankind, infectious diseases are the worst. Causation is being connected to omen, miasma, germs, the epidemiologic triad, and to multi-factorial causation – in that chronological order. Life is also a marvelous and taxing journey, in which a protracted war and endless battles, against infectious diseases, are horrific realities ever told inside “travelers’” stories – devastations of biblical proportions, transforming the social fabric, in their own eccentric ways. Environmental sanitation and personal hygiene; developing antimicrobials, antitoxins, and vaccines are being instrumental in the obvious decline of the burden of infectious diseases. Advances in guidelines and technology help identify, track, and control infectious agents, safeguarding the complex journey. So far, accomplishments are extraordinary, particularly in nations with high-income economies. While semi-similar patterns are being seen, nations with low-income economies remain improving, but at slower than snail pace. Worldwide, despite successes on record – resistant strains, emerging and re-emerging infectious agents, coupled with population increase, social-economic-political instability, massive and frequent travel, and climate change – the war continues protracted; the battles, potentially devastating, but winnable; and life goes on, nonetheless. As most critical issues in life, infectious diseases are not only health issues, but human rights issues, as well – a question of morality. Indifference is inexcusable! With that overture, you are cordially invited, for a conversation on “life,” as you see it, in the context of infectious diseases. As always – a coffee table conversation starter, with family and friends Introduction Trying to define the word/term “life,” may be a mistake, rather a challenge, if you will. Anyways, here in the galaxy of HPQ, we consider life as a conscious existence — living and non-living, the surrounding universe, the known and unknown, the objectives and subjective, actions, reactions, interactions, communications, and the resultant realities of presence. Obviously, the state of a conscious existence dictates, health and disease, as everybody’s concerns. Living level of knowledge on health and diseases is a survival tool, indispensable. To that effect, conversation on the subject, with colleagues, family and friends, will serve as enabler. Based on textbooks and articles, in the public domain — HPQ, our informal, ultra- synoptic flyer, is here to further that intent. Prior to the twentieth century, diseases like cholera, diphtheria, poliomyelitis, tuberculosis, plague, malaria and smallpox, among others; were dominant causes of the burden of disease. The burden of infectious diseases has been on a decline since the dawn of the twentieth century. By mid-twentieth century, major causes of the disease burden in nations with high-income economies, shifted from infectious to non- infectious diseases. While similar patterns are being noted, progress continues at a slower than snail pace, and as such, infectious diseases remain as major causes of the diseases burden, in nations with low-income economies. [“…It is time to close the books on infectious diseases, declare the war against pestilence won, and shift national resources to such chronic problems as cancer and heart disease”: William H. Stewart, US Surgeon General, 1967] Yet, infectious agents are all over [in the environment and in/on our bodies ;) may evolve, become resistant to treatment, and are easily transmissible. That profile enables infectious agents to emerge [SARS, HIV/AIDS, Ebola, Zika, etc], and re-emerge [malaria, tuberculosis, influenza, and measles, etc] on a continual basis.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
-------—-————-—--———-—————-——-————-—--------------Panel Adarash, |December 2017 ---------—-——-—------------——————-————--— Moreover, population increase, massive and
frequent travel, deforestation, growing contact
between humankind and other animals, climate
change; social-economic-political instabilities;
poverty, and the lack of withstanding healthcare
systems – intensify the continual threat, on a
global scale.
The Journey Life, as a conscious existence, takes a marvelous and
taxing journey. Health and disease are part of the
inherent itinerary – in which countless infectious
agents, by default, come bundled in the natural
contract. It remains mystery, for how long the
journey continues, but we are here in time and
space. Therefore, to add structure to the rather
intricate subject matter, and for nothing much
but convenience, we put forward four segments
of concept transitions, around the dynamics of
infectious diseases – time zero to the present.
[1) Superstition to miasma, 2) miasma to germs, 3) germs
to the theory of epidemiologic triad, and 4) the theory of
epidemiologic triad to the theory of multi-factorial
causation]
Superstition to the theory of miasma:
Superstition, that attaches omen [good and evil]
to every surprise of the time – in its essence and
of its nature, was never much of a help in the
war and battles against diseases in general and
infectious diseases in particular. [It] nonetheless,
out of necessity, might have helped triggering
the inherent human potential, igniting the prime
“tinkering out of the box” phenomena – the first
fundamental jump onto the theory of miasma.
Short of prophesying on infectious agents and
contagiousity, miasmatic theory serendipitously
connects, of course firstly infectious diseases to
the surrounding environment – aka, “bad air.”
The theory of miasma provides the basis for
actions by sanitary reforms that result in initial
declines of the burden of infectious diseases.
The theory of miasma to germ theory: History
has it, a connection between germ and disease
was proposed far earlier during the sixteenth
century. However, it was during the nineteenth
century when Pasteur, Koch, and Snow are
regarded pioneers of germ theory, in their own
ways. Ever since, germ theory remains rooted in
science, playing transformational role in finding
disease causing microorganisms, life cycles, and
mode of transmissions; the bases for developing
antimicrobials, antitoxins, and vaccines – plus
prevention, control, and eradication strategies.
As result, most of the known infectious diseases
controlled, and the burden noticeably declined.
However, germ theory, possesses soft spot, in
fully explaining models of causation, and
criticized for simplifying [agent – disease,] the
more complex dynamics of occurrences of
infectious diseases.
Germ theory to the theory of epidemiologic
triad [agent, host, and the environment]:
Beginning in early twentieth century, the theory
of the epidemiologic triad came to rescue germ
theory, unfolding the complex dynamics of
infectious disease causation.
[Stallybrass: Principles of Epidemiology and the Process of
Infection, 1931: Three factors are coined as key in the
spread of disease – the host, the environment and the
reservoir. Am J Epidemiol, 2003; 157:856-857]
The theory of epidemiologic triad states, for a
disease to occur, the involvement of [agent,
host, and environment] is necessary. Meaning,
the mere presence of the “agent” is not always
sufficient for a disease to occur. In doing so, it
-------—-————-—--———-—————-——-————-—--------------Panel Adarash, |December 2017 ---------—-——-—------------——————-————--— The theory of epidemiologic triad to the theory
of multi-factorial causation: The theory of multi-
factorial (web of) causation refers to a chain of
causation, in which each link is a result of
complex actions and interactions of preceding
events – individual factors (component causes),
one or more causal pathway (sufficient cause),
and a component that appears in every pathway
(necessary cause)).
The theory of multi-factorial causation serves
well the fields of infectious and non-infectious
diseases that are likely to have complex diseases
processes – but still, the way the theory lends
itself to prevention and control measures is not
straightforward, to put it lightly.
On a related note, contributions of the four
consecutive industrial revolutions and precise
translations in the fields of health and disease
are astounding. From direct cell culture and
gram stain, to genomics and proteomics and all
the rest in between – from hardcopy registries
and hand calculations to big data and quantum
computing – advances in technology remain
pivotal in many aspects of transformations,
including in the prevention, treatment, control,
and eradication of infectious diseases. The ever-
evolving Koch’s postulates are still important.
[Genomics and proteomics have the potential to ((provide
accurate and rapid identification of infectious agents),
(determine specificity, sensitivity, resistance and
mutations), and (guide effective, specific, and direct
treatment options)) – vital in the fields of public health!]
Well, life goes on – and in a global aggregate,
every resultant moment of the future is a little
better than the previous. Else, we would not be
where we are today. In such a complex journey,
social order and responsible governance are
critical. When it comes to health and disease,
infectious diseases in particular – nations that
succeeded building a solid social order and
responsible governance are light-years ahead of
nations that are still engulfed in social,
economic, and political instabilities.
The War and the Battles As a conscious existence and complicated
journey, life, comes with a state of “war and
battles,” between humankind [leaving aside
other animals and plants for now,] on one hand
and risk factors in general and infectious agents
in particular, on the other – the war protracted,
and the battles endless and devastating but
winnable. While, the involvement of infectious
agents in the war and the battles is obviously
passive, the mission, for both parties essentially
is preserving their presence – survival!
[There is a long list of known infectious agents, including
-------—-————-—--———-—————-——-————-—--------------Panel Adarash, |December 2017 ---------—-——-—------------——————-————--— burden, resulting in a distinct transformation in
disease prevention and control strategies.
[“The top-ten causes of death in nations with high- Income