Addressing health workforce inequities in the Mindanao regions of the Philippines: tracer study of graduates from a socially-accountable, community-engaged medical school and graduates from a conventional medical school

Developing and retaining a high-quality medical workforce in low-resource countries is a worldwide challenge. The Filipino Ateneo de Zamboanga University–School of Medicine (ADZU-SOM) has adopted a strong focus on socially accountable health professional education (SAHPE) in order to address the shortage of physicians across rural and urban communities in the Western Mindanao region. A cross-sectional survey of graduates from two Philippines medical schools: ADZU-SOM in the Mindanao region and a medical school with a more conventional curriculum, found ADZU-SOM graduates were more likely to have joined the medical profession due to a desire to help others (p=0.002), came from lower socioeconomic strata (p¼0.001) and had significantly (p<0.05) more positive attitudes to community service. ADZU graduates were also more likely to currently work in Government Rural Health Units (p<0.001) or be generalist Medical Officers (p<0.001) or Rural/Municipal Health Officers (p=0.003). ADZU graduates were also less likely to work in private or specialist Government hospitals (p=0.033 and p=0.040, respectively) and be surgical or medical specialists (p=0.010 and p<0.001, respectively). The findings suggest ADZU-SOM’s SAHPE philosophy manifests in the practice choices of its graduates and that the ADZUSOM can meet the rural and urban health workforce needs of the Western Mindanao region

The 1.2 A resolution crystal structure of TcpG, the Vibrio cholerae DsbA disulfide-forming protein required for pilus and cholera-toxin production

The enzyme TcpG is a periplasmic protein produced by the Gram-negative pathogen Vibrio cholerae. TcpG is essential for the production of ToxR-regulated proteins, including virulence-factor pilus proteins and cholera toxin, and is therefore a target for the development of a new class of anti-virulence drugs. Here, the 1.2 Å resolution crystal structure of TcpG is reported using a cryocooled crystal. This structure is compared with a previous crystal structure determined at 2.1 Å resolution from data measured at room temperature. The new crystal structure is the first DsbA crystal structure to be solved at a sufficiently high resolution to allow the inclusion of refined H atoms in the model. The redox properties of TcpG are also reported, allowing comparison of its oxidoreductase activity with those of other DSB proteins. One of the defining features of the Escherichia coli DsbA enzyme is its destabilizing disulfide, and this is also present in TcpG. The data presented here provide new insights into the structure and redox properties of this enzyme, showing that the binding mode identified between E. coli DsbB and DsbA is likely to be conserved in TcpG and that the [beta]5-[alpha]7 loop near the proposed DsbB binding site is flexible, and suggesting that the tense oxidized conformation of TcpG may be the consequence of a short contact at the active site that is induced by disulfide formation and is relieved by reduction

Methyltransferase Dnmt3a upregulates HDAC9 to deacetylate the kinase TBK1 for activation of antiviral innate immunity

The DNA methyltransferase Dnmt3a has high expression in terminally differentiated macrophages; however, its role in innate immunity remains unknown. Here we report that deficiency in Dnmt3a selectively impaired the production of type I interferons triggered by pattern-recognition receptors (PRRs), but not that of the proinflammatory cytokines TNF and IL-6. Dnmt3a-deficient mice exhibited enhanced susceptibility to viral challenge. Dnmt3a did not directly regulate the transcription of genes encoding type I interferons; instead, it increased the production of type I interferons through an epigenetic mechanism by maintaining high expression of the histone deacetylase HDAC9. In turn, HDAC9 directly maintained the deacetylation status of the key PRR signaling molecule TBK1 and enhanced its kinase activity. Our data add mechanistic insight into the crosstalk between epigenetic modifications and post-translational modifications in the regulation of PRR signaling and activation of antiviral innate immune responses

Insights into Improving Risk and Safety Communication through Environmental Health Literacy

Messages and materials developed to communicate risk to the public are often misunder-stood because the public misperceives risk, science information is too complex, leading to audience misunderstandings, and an overarching focus on the details of the problem without supplying solutions or actions to keep the public safe. This article describes the creation of a communication model to improve risk communication that includes safety information. The authors describe essential components of Risk and Safety Communication based on features of Environmental Health Literacy (EHL), which informed the creation of a protocol for developing risk communication messages and materials. An online training module was developed to aid communicators in creating information to enable the public to protect themselves, their family, and their community, leading to improved comprehension of how the environment impacts health. These principles were developed in a series of focus groups, identifying how the public perceives risk, how they prefer to receive communication, and how participants respond to materials developed using the principles. Important topics discussed are understanding the literacy levels of the target audience, applying that understanding to developing messages, how risk perception leads to misperceptions and how to address those misperceptions by using plain language when developing focused messages and materials. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

The next pandemic: antimicrobial resistance

The current and continual emergence of antimicrobial-resistant bacteria remains an ‘invisible pandemic’ for now. Antimicrobial resistance (AMR) is a serious threat to global health and development and requires urgent action. The current rate of development of new antibiotics is not sufficient to prevent antimicrobial-resistant infections globally that currently kill 700,000 people each year. Antimicrobial-resistant bacterial infections are untreatable with current antibiotics. Australian research is addressing AMR, but policies supporting greater translation of research into products and solutions are required.<br/

Positive implications from socially accountable community-engaged medical education across two Philippines regions

Introduction: Hundreds of millions of people worldwide lack access to quality health services, largely because of geographic and socioeconomic maldistribution of qualified practitioners. This study describes differences between the practice locations of Philippines medical graduates from two 'socially accountable, community-engaged' health professional education (SAHPE) schools and the practice locations of graduates from two 'conventionally trained' medical schools located in the same respective geographic regions. Licensed medical graduates were currently practising in the Philippines and had been practising for at least 6 months. Graduates were from two Philippines SAHPE schools (Ateneo de Zamboanga University -School of Medicine (ADZU-SOM) on the Zamboanga Peninsula (n=212) and the University of the Philippines Manila-School of Health Sciences (SHS-Palo) in Eastern Visayas (n=71), and from two 'conventional' medical schools Methods: Current graduate practice locations in municipalities or cities were linked with their respective population size and socioeconomic income class, and geocoded using Geographical Information System software onto a geospatial map of the Philippines. Bivariate analysis compared the population size and socioeconomic class of communities where the SAHPE medical graduates practised to communities where 'conventional' medical school graduates practised. Results: Thirty-one percent of ADZU-SOM medical graduates practised in communities <100 000 population versus 7% of graduates from the conventional school in the Zamboanga region (p<0.001), while 61% of SHS-Palo medical graduates practised in communities <100 000 population versus 12% of graduates from the conventional school in the Visayas region (p<0.001). Twenty-seven percent of ADZU-SOM graduates practised in lower income category communities (categories 2-6) versus 8% of graduates from the conventional school in the same region (p<0.001), while 49% of SHS-Palo graduates practised in lower income category communities (categories 2-6) versus 11% of graduates from the conventional school in the same region (p<0.001). Conclusions: SAHPE has contributed to increased medical coverage across rural and/or economically disadvantaged areas in two Philippines regions. The extensive community-based medical student placements associated with SAHPE likely play a significant role in graduates choosing to practice in rural and/or economically disadvantaged communities. Governments experiencing medical workforce maldistributions similar to those in the Philippines should consider SAHPE as a potentially cost-effective strategy in recruiting and retaining health graduates to underserved areas