On the relationship between individual and population health

The relationship between individual and population health is partially built on the broad dichotomization of medicine into clinical medicine and public health. Potential drawbacks of current views include seeing both individual and population health as absolute and independent concepts. I will argue that the relationship between individual and population health is largely relative and dynamic. Their interrelated dynamism derives from a causally defined life course perspective on health determination starting from an individual’s conception through growth, development and participation in the collective till death, all seen within the context of an adaptive society. Indeed, it will become clear that neither individual nor population health is identifiable or even definable without informative contextualization within the other. For instance, a person’s health cannot be seen in isolation but must be placed in the rich contextual web such as the socioeconomic circumstances and other health determinants of where they were conceived, born, bred, and how they shaped and were shaped by their environment and communities, especially given the prevailing population health exposures over their lifetime. We cannot discuss the “what” and “how much” of individual and population health until we know the cumulative trajectories of both, using appropriate causal language

Ancient mitochondrial DNA provides high-resolution time scale of the peopling of the Americas

The exact timing, route, and process of the initial peopling of the Americas remains uncertain despite much research. Archaeological evidence indicates the presence of humans as far as southern Chile by 14.6 thousand years ago (ka), shortly after the Pleistocene ice sheets blocking access from eastern Beringia began to retreat. Genetic estimates of the timing and route of entry have been constrained by the lack of suitable calibration points and low genetic diversity of Native Americans. We sequenced 92 whole mitochondrial genomes from pre-Columbian South American skeletons dating from 8.6 to 0.5 ka, allowing a detailed, temporally calibrated reconstruction of the peopling of the Americas in a Bayesian coalescent analysis. The data suggest that a small population entered the Americas via a coastal route around 16.0 ka, following previous isolation in eastern Beringia for ~2.4 to 9 thousand years after separation from eastern Siberian populations. Following a rapid movement throughout the Americas, limited gene flow in South America resulted in a marked phylogeographic structure of populations, which persisted through time. All of the ancient mitochondrial lineages detected in this study were absent from modern data sets, suggesting a high extinction rate. To investigate this further, we applied a novel principal components multiple logistic regression test to Bayesian serial coalescent simulations. The analysis supported a scenario in which European colonization caused a substantial loss of pre-Columbian lineages.Bastien Llamas, Lars Fehren-Schmitz, Guido Valverde, Julien Soubrier, Swapan Mallick, Nadin Rohland, Susanne Nordenfelt, Cristina Valdiosera, Stephen M. Richards, Adam Rohrlach, Maria Inés Barreto Romero, Isabel Flores Espinoza, Elsa Tomasto Cagigao, Lucía Watson Jiménez, Krzysztof Makowski, Ilán Santiago Leboreiro Reyna, Josefina Mansilla Lory, Julio Alejandro Ballivián Torrez, Mario A. Rivera, Richard L. Burger, Maria Constanza Ceruti, Johan Reinhard, R. Spencer Wells, Gustavo Politis, Calogero M. Santoro, Vivien G. Standen, Colin Smith, David Reich, Simon Y. W. Ho, Alan Cooper and Wolfgang Haa

The establishment and utility of Sweha-Reg: a Swedish population-based registry to understand hereditary angioedema

<p>Abstract</p> <p>Background</p> <p>The importance of acquiring comprehensive epidemiological and clinical data on hereditary angioedema has increasingly caught the attention of physicians and scientists around the world. The development of networks and creation of comprehensive policies to improve care of people suffering from rare diseases, such as hereditary angioedema, is a stated top priority of the European Union.</p> <p>Hereditary angioedema is a rare disease, that it may be life-threatening. Although the exact prevalence is unknown, current estimates suggest that it is 1/10,000–1/150,000 individuals. The low prevalence requires combined efforts to gain accurate epidemiological data on the disease and so give us tools to reduce morbidity and mortality, and improve quality of life of sufferers.</p> <p>Methods</p> <p>Sweha-Reg is a population-based registry of hereditary angioedema in Sweden with the objectives of providing epidemiological data, and so creates a framework for the study of this disease. The registry contains individual-based data on diagnoses, treatments and outcomes.</p> <p>Conclusion</p> <p>The present manuscript seeks to raise awareness of the existence of Sweha-Reg to stimulate the international collaboration of registries. A synthesis of data from similar registries across several countries is required to approach an inclusive course understanding of HAE.</p

Massive migration from the steppe is a source for Indo-European languages in Europe

We generated genome-wide data from 69 Europeans who lived between 8,000-3,000 years ago by enriching ancient DNA libraries for a target set of almost four hundred thousand polymorphisms. Enrichment of these positions decreases the sequencing required for genome-wide ancient DNA analysis by a median of around 250-fold, allowing us to study an order of magnitude more individuals than previous studies and to obtain new insights about the past. We show that the populations of western and far eastern Europe followed opposite trajectories between 8,000-5,000 years ago. At the beginning of the Neolithic period in Europe, ~8,000-7,000 years ago, closely related groups of early farmers appeared in Germany, Hungary, and Spain, different from indigenous hunter-gatherers, whereas Russia was inhabited by a distinctive population of hunter-gatherers with high affinity to a ~24,000 year old Siberian6 . By ~6,000-5,000 years ago, a resurgence of hunter-gatherer ancestry had occurred throughout much of Europe, but in Russia, the Yamnaya steppe herders of this time were descended not only from the preceding eastern European hunter-gatherers, but from a population of Near Eastern ancestry. Western and Eastern Europe came into contact ~4,500 years ago, as the Late Neolithic Corded Ware people from Germany traced ~3/4 of their ancestry to the Yamnaya, documenting a massive migration into the heartland of Europe from its eastern periphery. This steppe ancestry persisted in all sampled central Europeans until at least ~3,000 years ago, and is ubiquitous in present-day Europeans. These results provide support for the theory of a steppe origin of at least some of the Indo-European languages of Europe

The meaning of actualization of self-care resources among a group of older home-dwelling people&#x2014;A hermeneutic study

Self-care is an activity of mature persons who have developed their abilities to take care of themselves. Individuals can choose to actualize their self-care abilities into self-care activities to maintain, restore, or improve health and well-being. It is of importance to understand the meaning of the actualization of self-care resources among older people. The aim of this study was to investigate the meaning of the actualization of self-care resources, i.e., actions taken to improve, maintain, or restore health and well-being, among a group of older home-dwelling individuals with a high sense of coherence. The design of this study was to reanalyse narratives revealing self-care activities from 11 (five females and six males) Norwegian older home-dwelling people (65 years or older) identified as having a high sense of coherence. In order to reveal the meaning and get an understanding of why these self-care resources were realized or actualized, a Gadamerian-based research method was chosen. The analysis revealed four themes that showed the meaning of actualization of self-care resources in the study group: &#x201C;Desire to carry on&#x201D;, &#x201C;Be of use to others&#x201D;, &#x201C;Self-realization&#x201D;, and &#x201C;Confidence to manage in the future&#x201D;. The findings showed what older people found meaningful to strive for, and this information can be used as a guide for health professionals when supporting older people in their self-care. Older people with self-care resources can also be an important resource for others in need of social contact and practical help. These resources have to be asked for in voluntary work among older people in need of help and, thereby, can be a valuable supplement to the community health care system

Simulation of dilated heart failure with continuous flow circulatory support

Lumped parameter models have been employed for decades to simulate important hemodynamic couplings between a left ventricular assist device (LVAD) and the native circulation. However, these studies seldom consider the pathological descending limb of the Frank-Starling response of the overloaded ventricle. This study introduces a dilated heart failure model featuring a unimodal end systolic pressure-volume relationship (ESPVR) to address this critical shortcoming. The resulting hemodynamic response to mechanical circulatory support are illustrated through numerical simulations of a rotodynamic, continuous flow ventricular assist device (cfVAD) coupled to systemic and pulmonary circulations with baroreflex control. The model further incorporated septal interaction to capture the influence of left ventricular (LV) unloading on right ventricular function. Four heart failure conditions were simulated (LV and bi-ventricular failure with/ without pulmonary hypertension) in addition to normal baseline. Several metrics of LV function, including cardiac output and stroke work, exhibited a unimodal response whereby initial unloading improved function, and further unloading depleted preload reserve thereby reducing ventricular output. The concept of extremal loading was introduced to reflect the loading condition in which the intrinsic LV stroke work is maximized. Simulation of bi-ventricular failure with pulmonary hypertension revealed inadequacy of LV support alone. These simulations motivate the implementation of an extremum tracking feedback controller to potentially optimize ventricular recovery. © 2014 Wang et al

Dignity and Narrative Medicine

Critiques of the dehumanising aspects of contemporary medical practice have generated increasing interest in the ways in which health care can foster a holistic sense of wellbeing. We examine the relationship between two areas of this humanistic endeavour: narrative and dignity. This paper makes two simple arguments that are intuitive but have not yet been explored in detail: that narrative competence of carers is required for maintaining or recreating dignity, and that dignity promotion in health care practice is primarily narrative in form. The multiple meanings that dignity has in a person’s life are what give the concept power and can only be captured by narrative. This has implications for health care practice where narrative work will be increasingly required to support patient dignity in under-resourced and over-subscribed health care system

Autonomous weapons systems, killer robots and human dignity

One of the several reasons given in calls for the prohibition of autonomous weapons systems (AWS) is that they are against human dignity (Asaro in Int Rev Red Cross 94(886):687–709, 2012; Docherty in Shaking the foundations: the human rights implications of killer robots, Human Rights Watch, New York, 2014; Heyns in S Afr J Hum Rights 33(1):46–71, 2017; Ulgen in Human dignity in an age of autonomous weapons: are we in danger of losing an ‘elementary consideration of humanity’? 2016). However there have been criticisms of the reliance on human dignity in arguments against AWS (Birnbacher in Autonomous weapons systems: law, ethics, policy, Cambridge University Press, Cambridge, 2016; Pop in Autonomous weapons systems: a threat to human dignity? 2018; Saxton in (Un)dignified killer robots? The problem with the human dignity argument, 2016). This paper critically examines the relationship between human dignity and AWS. Three main types of objection to AWS are identified; (i) arguments based on technology and the ability of AWS to conform to international humanitarian law; (ii) deontological arguments based on the need for human judgement and meaningful human control, including arguments based on human dignity; (iii) consequentialist reasons about their effects on global stability and the likelihood of going to war. An account is provided of the claims made about human dignity and AWS, of the criticisms of these claims, and of the several meanings of ‘dignity’. It is concluded that although there are several ways in which AWS can be said to be against human dignity, they are not unique in this respect. There are other weapons, and other technologies, that also compromise human dignity. Given this, and the ambiguities inherent in the concept, it is wiser to draw on several types of objections in arguments against AWS, and not to rely exclusively on human dignity