Despite sound scientific knowledge and evidence that any exposure to asbestos fibers in all of its forms, are carcinogenic to humans, its presence, use and trade is still substantial, including in the World Health Organization (WHO) European Region. Banning the production and use of all forms of asbestos, as recommended by the International Labour Organization (ILO) and WHO, has been proven as the most efficient evidence-based strategy to eliminate Asbestos Related Diseases (ARDs). To effectively move elimination of ARDs forward, attaining a greater understanding of key stakeholders perspectives was identified as an important action. The WHO Regional Office for Europe, the European Centre for Environment and Health, undertook semi-structured interviews, and follow-up discussions with diverse representatives dealing professionally with asbestos. The interview questionnaire was developed based on the current ARDs WHO Report, the Evidence Implementation Model for Public Health and categories of the theory of diffusion. Data were attained on three main questions within the interview questionnaire: (1) Identifying barriers to implementation of WHO evidence-based asbestos recommendations; (2) Describing roles of key stakeholders; and, (3) Proposing possible solutions. The results demonstrated use of sound and convincing scientific evidence along with economic evidence and facilitators can be used to achieve evidence-based policy development, and comprehensive diverse actions. Despite sound scientific knowledge and evidence that any exposure to asbestos fibers in all of its forms, are carcinogenic to humans, its presence, use, and trade is still substantial, globally and regionally, including in the World Health Organization (WHO) European Region ,2,3. GloEvidence-based strategies for the elimination of asbestos related diseases (ARDs) exist. Banning the production and use of all forms of asbestos as recommended by the International Labour Organization (ILO) and WHO, has been proven as the most efficient evidence-based strategy to eliminate ARDs . Still, In addition to detecting diseases, establishing appropriate surveillance systems, and protection, while undertaking asbestos removal, appropriate replacement, and safe and efficient waste management should be consistently occurring throughout the WHO European Region, to address inequities created by harmful exposure to asbestos ,8.(1)There are no observable mid-or-long-term negative economic impacts from bans or a decline in asbestos production or consumption at the country-level, and no observable persistent negative effects at the regional level;(2)There are substantial and increasing costs associated with the continuing production and use of asbestos, with the potential to far outweigh the short-term economic benefits.Currently, some of the countries that did not introduce the ban of the use of asbestos are challenging this recommendation, often using economic arguments. They argue that the introduction of the ban of the use of all forms of asbestos will have negative economic impacts on national, private sector, and household income at national and regional levels . Yet, avTo effectively move elimination of ARDs forward, attaining greater understanding of key stakeholders perspectives and needs was identified as an important action. Therefore, the WHO Regional Office for Europe, the European Centre for Environment and Health , undertook in 2016 a stakeholder analysis.The aim of this analysis was to attain deeper insights of key stakeholders opinions and perspectives across different sectors and policy fields regarding the promotion of evidence-based national policies for the elimination of ARDs and the potential influence and ability of the stakeholders concerned to make the change towards non-asbestos working and living environments. This stakeholder analysis contributed, in particular, to one of the commitments of the Parma Declaration to develop national programmes to eliminate ARDs by 2015 and reconfirmed in the Ostrava Declaration 2017 ,10.(1)dentifying barriers to the implementation of WHO evidence-based asbestos recommendations;(2)describing necessary and effective roles and actions of key sectors and stakeholders;(3)proposing possible solutions, facilitators and next steps towards non-asbestos working and living environments, including policies for the elimination of ARDs.The research method was qualitative and explorative, combining interviews and discussions with stakeholders. The questionnaire for the semi-structured interviews was developed based on information from a current ARDs WHO report  and the Interviewees were identified by WHO/ECEH and contained a selected sample of country representatives, experts, intergovernmental organisations, nongovernmental organisations, and European Commission (EC) representatives, dealing with asbestos issues in their respective professional area. All of the interviewees gave their informed consent for inclusion before they participated in the interviews and the study was conducted in accordance with the Declaration of Helsinki and WHO protocol. Interviews were conducted using telephone or Skype by the first author. Language of the interviews was English or Russian (with the assistance of a Russian interpreter). The first interview conducted also served as a pre-test and adjustments for clarity were made accordingly. Confidentiality of interviews was communicated to the interviewee and agreed upon. Interviews were transcribed verbatim into a corresponding questionnaire template. Clarifications to the participant’s comments were obtained by e-mail where required.Content analysis of the interviews was undertaken to provide concise summaries of participants’ responses. Findings were grouped corresponding to the three interview themes noted above ,13.A preliminary report of this analysis was circulated and presented to participants of the WHO meeting: “Assessing the economic costs of the health impacts of environment and occupational factors: the economic dimension of asbestos”, 18–19 May 2016, Bonn, Germany. The preliminary results were validated by a plenary session, question, and answer discussion period, working group discussions and a final plenary reporting session. The results of the working group and plenary discussions were integrated into a preliminary and final text to prepare this article.A total of 21 stakeholders from 18 organisations participated in the stakeholder analysis interview process. A further 24 country representatives from 12 WHO European Countries and 20 temporary advisors from 16 institutions participated in the above cited WHO asbestos meeting. Data from stakeholders are presented on the three main questions within the interview questionnaire.Lack of political will, commitment, clear vision, goals, and targets to effectively address the negative impact of asbestos is often not identified, agreed upon or achieved by policy makers.Introducing a total ban of the use of all forms of asbestos is a complex undertaking that requires the collaboration of many sectors and disciplines to achieve effective action. Often collaborators may take some of the tasks or actions within their remit, but responsibility to lead and manage the whole chain of events is lacking.Often financial and political interests are placed above health concerns, including the assumed important positive economic impact of the production, and marketing of asbestos on national, private sector, and household income. Currently the economic health costs of ARDs are predominately the burden of society  and not industry. Costs for safe asbestos identification, removal, replacement, and waste management are high. Illegal removal of asbestos is underway (at reduced costs) that does not meet safety requirements, leaving the general public exposed to even greater health risks.There is a lack of awareness, understanding and knowledge regarding the issue of the negative health impacts of asbestos. This includes how to effectively address the harmful effects of under-reporting the negative impacts of asbestos and knowledge gaps of the real economic dimension of the use and production of asbestos in parts of Europe. This lack of information, knowledge, and expertise to undertake and finance asbestos removal, safe waste disposal, and replacement with safe alternatives affects many countries at this time.Data and registries on exposures, risk groups, mortality, morbidity, trends, short and long-term costs, essential to demonstrate the true impact of asbestos, are not readily available in many countries. Data are also not standardised in Europe to allow for cross-country comparisons. There is a need for evaluation methodologies, such as cost benefit analysis to support policy-solutions. Understanding when and how much asbestos needs to be removed, the associated costs of removal and replacement, and then how that compares to the negative health impact costs are needed.Banning the use of all forms of asbestos as recommended by the ILO and WHO can be a challenging strategy to adopt, implement and enforce due to its inherent complexity. Few Member States with no asbestos banning legislation are not in agreement with this recommendation, claiming that in their countries there is no evidence of negative impacts on health from all forms of asbestos. Several Member States stated that more and better knowledge and awareness are required to meet European Union (EU) regulations/directives for occupational health and safety of asbestos removal and building renovations.Currently, there is a lack of political will amongst policy-makers from several asbestos producing and using countries in banning asbestos as the most efficient way to eliminate asbestos-related diseases, as the benefits are only realised decades later and not during their immediate political term. Varying economic and social settings in countries create additional barriers to reducing the negative impact of asbestos. These include communities with: mines, natural forms of asbestos, extensive existence of asbestos in road infrastructure, and the majority of public and private buildings containing asbestos. Furthermore, research related to health is sometimes financed by the asbestos industry itself, and in some cases are used as questionable “evidence” for policy solutions. As well, an influx of migrant workers with limited language skills in their newly employed location may also lead to limited awareness or knowledge of asbestos risks and a challenge to monitor. This includes lack of training and training material not available in migrant workers native language and often no migrant worker occupational health protection.Key messages to the public and decision-makers are lacking regarding: risks, impacts, revealing false claims, illegal trade, international conventions, and declarations not being upheld, prevention measures, safe removal, total real costs, and valid information sources.Interviewees and workshop participants expressed their strong opinion that a whole-of-government and whole-of-society approach would be required to successfully address all of the negative impacts of asbestos. This means that all levels of government and all related sectors, using cross-ministerial committees. Governments need to consider the long-term health effects to balance the immediate financial or political demands and interests asbestos appears to provide.Even in the countries that introduced the total ban of use of all forms of asbestos, removal of the existing asbestos is still potentially a significant risk to health if the appropriate measures are not applied. Having that in mind, the responsibility of the industry, both in asbestos producing and asbestos using countries, as well as in the countries with introduced bans, can not disregard including compensation funds for ARD victims. Industry also needs to share knowledge on safe removal practices and safe alternatives to asbestos to help build a win/win situation.Stakeholders with knowledge and information should ensure evidence and good practices are shared, widely communicated, and advocated to increase their adoption, implementation, and monitoring. Research also needs to be accessible and widely communicated, including the use of plain language summaries, tailored to each target audience to help move research into practice and thereby support effective knowledge translation.Communicators also have a strong role to bring greater attention to the issue and apply pressure to attain action to protect and safeguard workers and the society as a whole. They need to be engaged and empowered as key stakeholders in the process. Therefore, all of society has an important role to play to address the negative impacts of asbestos.Government plans, programmes, and policies to support early identification, removal, transition, and waste management of asbestos to new, safer, and efficient alternatives, with the involvement of all key stakeholders should be investigated. This should include investigation of funding schemes, such as a percentage of programme funds for victims’ compensation from asbestos producing industries, as already demonstrated in some Member States.Establishment of an agency/task force/observatory/knowledge centre at the European level to provide support to countries for the adoption and implementation of evidence-based strategies to enhance awareness raising; capacity building; standardisation; and, consistency and stability of various approaches for diagnosis, surveillance, trends, policy approaches, funding, and budgeting models was proposed by stakeholders. This would include implementing more effective legislation to protect employees and the health of the general public, as well as, the identification of funding sources and should be discussed in collaboration with WHO, EC, European Agency for Safety and Health at Work (EU-OSHA), ILO, Organization for Economic Co-operation and Development (OECD) see , and othKey stakeholders and especially intergovernmental organisations and nongovernmental organisations should jointly advocate for a total ban on the use of all forms of asbestos throughout the WHO European Region. Economic arguments learnt from the Bonn workshop should provide additional evidence and proposals to support this action.The total impact costs of asbestos at the local, regional, and national levels, including long-term health consequences, asbestos identification, removal, replacement, and waste management are needed, and the cost responsibilities of all the parties should be calculated. This could include, short-mid-long term budgeting strategies, impact assessments, cost benefit analysis, such as cost of asbestos substitutes, and case examples of building costs with asbestos when compared to safer alternatives, as well as landfill management costs.Collaboration with industry and other key stakeholders for effective and efficient strategies on identification, safe removal, transition to safe alternatives and waste management of asbestos need further investigation.Further research on the effective use of new technologies and availability of low cost, safe, and easy to use alternatives should be conducted and communicate results widely.More case studies and good examples of how countries are addressing the issue of asbestos, specifically including removal guidelines/legal criteria and cost examples of safe removal, waste management, and replacement schemes, as compared to the negative health impact costs could be shared.Standardised and harmonised data registration systems for ARDs in all of the countries to ensure effective monitoring should be put in place. Countries with long-established, effective data collection systems, could share methodologies for establishing and sustaining such data collection systems. The sharing of misinformation that are contrary to evidence and positions widely accepted and published by the majority of the scientific and expert community need to be immediately addressed. False statements are to be rejected and widely communicated.Visibility, awareness, and education of all target audiences, from the general public, workers, professionals, and governments on such topics as early detection and risk group identification for youth and migrant workers exposed to asbestos, require improvement. Targeted tools and resources should be determined on evidence-based strategies and include better use of science.Further to these proposed solutions and next steps, participants also provided specific suggestions WHO should undertake to facilitate actions to address the negative health impacts of asbestos. These are described in Even though addressing the elimination of ARDs is a challenging issue within a complex system, use of sound and convincing scientific evidence along with different types of economic evidence and or facilitators can be used to achieve evidence-based policy development, and comprehensive diverse actions . ExposurEnhanced, early engagement and cooperation of diverse sectors and stakeholders throughout the entire process of adoption, implementation, and monitoring of evidence-based policies and programmes to eliminate ARDs, based on a whole-of-government and whole-of-society approach, will support the knowledge translation process, as seen in other evidence implementation research . OverallGreater efforts to transfer evidence-based strategies and knowledge into practice are essential to reduce ARDs. Particularly, attention in synthesising, translating, and disseminating evidence into concise, clear, easy to understand, and convincing information is needed, such as, economic arguments designed for each specific target audience, context, and cultural setting . This shWell-established national cancer registers and national registers of occupational diseases are the key resources for registering asbestos-related morbidity. Awareness, diagnostic procedures, and criteria, notification and registration of ARDs vary between countries and are in need of strengthening and harmonisation. There is still a need to strengthen research on the prevention, diagnosis, and treatment of ARDs. The main areas for action include capacity building of health care providers for the appropriate diagnostics of ARDs, active surveillance of ARDs; better diagnoses of ARDs; and, epidemiological investigation of individual cases of ARDs. In addition to establishing appropriate links between exposures and ARDs; medical research into the treatment of mesothelioma to improve the quality of life and the survival rate, effective early intervention followed by early detection of ARDs is essential.Identifying barriers that impact the uptake of policies and programmes for the elimination of ARDs, and standardise and harmonise ways these can be addressed is critical ,20. SuchIt should be noted that some contexts in interview statements made may not be precise, as not all of the participants and interviewees were fluent in both English and Russian and should be viewed as a limitation of the study. Assistance of English/Russian interpreters were used to support the data and information gathering for both the interviews and the workshop to allow participants to fully engage and enhance the accuracy of communication.The substantial and increasing costs associated with the continued production and use of asbestos far outweigh the short-term and often only local economic benefits, and use of sound and convincing scientific and economic evidence in combination can be used to make convincing arguments to support the uptake of evidence-based policy actions. Key stakeholders, including WHO needs to be empowered to take on a leadership role to advance the uptake of evidence-informed policies and programmes to further the 2030 Agenda for achieving the United Nations Sustainable Development Goals that includes goal number 12, “Responsible Consumption and Production” . This sh


Genomes, Proteomes and Bioinformatics – a special database article entitled “GSA: Genome Sequence Archive” In the 2017 first issue of this Journal – The past half century has witnessed great advances in molecular biology. The deciphering of the genetic code and the establishment of the central dogma following the discovery of the DNA double helix formed a solid theoretical basis for the field of life sciences. On the other hand, the influential works by Frederick Sanger and others to determine the peptide, tRNA, and DNA sequences, as well as the fundamental endeavor by John Kendrew and Max Perutz to solve the three-dimensional structure of proteins, marked the beginning of the accumulation of molecular biological data.https://en.wikipedia.org/wiki/Margaret_Oakley_Dayhoff). Two years later, Amos Bairoch, a graduate student at the University of Geneva, Switzerland started to annotate protein sequences by manually adding functional and other information into each entry, and created another protein sequence database Swiss-Prot (https://en.wikipedia.org/wiki/Amos_Bairoch).The first efforts to collect protein sequence data were made by Margaret Dayhoff, a bioinformatics pioneer at the US National Biomedical Research Foundation (NBRF). In 1965, she published a book “Atlas of protein sequence and structure” with 65 sequences she can find then, and updated it in several new editions in the following years. This is the prototype of the first protein sequence database Protein Information Resource (PIR). Based on the sequences of several protein families, she constructed the amino acid substitution scoring matrix PAM, which is still widely used in sequence alignment and database similarity search. PIR went online in 1984 and can be searched through telephone line (The first protein structure database Protein Data Bank (PDB) was established in 1971. Different from the protein sequence databases, in terms of the organization history, it was a joint effort by partners from the Europe and the US. As stated in its first announcement as Crystallography News on Nature New Biology i.e., EMBL-Bank, or sometimes simply refer to EMBL.By the end of the 1970s, Sanger sequencing became a routine work and DNA sequences started to accumulate. It was foresighted by prominent scientists that it was time to set up a nucleotide sequence database since large-scale DNA sequencing was on its way. In 1979, a group of computational biologists headed by Walter Goad at the Los Alamos National Laboratory in the US began to collect nucleotide sequences and developed algorithms to analyze DNA and protein sequences. The popular Smith-Waterman algorithm for local sequence alignment was just one of these tools. The nucleotide sequence database GenBank started to operate in 1982 sponsored by the National Institutes of Health (NIH), together with several other US funding agencies including the National Science Foundation (NSF), the Department of Energy (DOE), and the Department of Defense (DOD). In the same year, the European Molecular Biology Laboratory (EMBL) located in Heidelberg, Germany announced the first release of the European Nucleotide Data Library under the same name of the organization, By the end of 1980s, the sequence databases of nucleic acids and proteins, as well as the protein structure databases, already contained considerable number of entries, while software tools for analyzing the sequence and structure data became available on mini- and micro-computers. At the same time, the NSFnet, a pilot project of research and education network supported by the NSF started to serve several computing centers in the US. Proposed by the late senator Claude Pepper, the National Center for Biotechnology Information (NCBI) located at the north capital was set up in November, 1988, as a division of the National Library of Medicine. As a biomedical information resource center, NCBI has been serving not only NIH partners, but also the worldwide community of molecular biologists. Under the leadership of David Lipman, the director of the center, NCBI became the largest bioinformatics center in the world. Hundreds of databases and software tools, such as the biomedical abstract database PubMed, the reference sequence database RefSeq, and the database similarity search tool BLAST, are available freely for everyone. In 1989, NCBI started to maintain and distribute GenBank as one of the core data resources.The European Bioinformatics Institute (EBI) was created in 1994. It is located in the Wellcome Trust genome campus in south Cambridge, UK. As an outstation of the EMBL, EBI is funded mainly by the European Community and most of the EBI staff are from the European member states. It has been playing a significant role in bioinformatics services for more than 20 years not only for Europe but also for the rest of the world, as the second largest resource center next to NCBI. In addition to the nucleotide database EMBL-Bank, EBI also hosts various databases including the genome repository ENSEMBL, the database of protein families and domains InterPro, and the ontology of gene functions and processes Gene Ontology.http://www.wwpdb.org/). Soon after, the International Nucleotide Sequence Database Collaboration , another triple alliance originating from GenBank of NCBI, EMBL-Bank of EBI, and the Japanese newcomer DDBJ, was launched in 2005. In the same year, the international universal protein sequence database UniProt was founded (http://www.uniprot.org/). UniProt consists of three components, Swiss-Prot from the Switzerland, PIR from the US, and TrEMBL, a database of automatically translated amino acid sequences from the coding regions of EMBL nucleotide sequences.The creation of the NCBI, a US government-supported center, and the EBI sponsored by the European Community secures the long-term sustainability of bioinformatics services at national and international levels. In the meantime, the formation of the international collaboration of three core databases of molecular biology, the nucleotide sequence, the protein sequence, and the protein structure, came into age. In 2003, three partners responsible for the maintenance and distribution of macromolecular structures, PDBe at EBI, PDBj from Japan, and the Research Collaboratory for Structural Bioinformatics (RCSB) PDB in the US, signed an agreement to form a world-wide consortium  https://gold.jgi.doe.gov/), a total of 265,734 organisms have already been, or are being sequenced The birth of the Internet at the beginning of the 1990s opens a new era, the era of information age. Proposed by Nobel Prize laureate Walter Gilbert in his prospective article published on Nature in January 1991 To meet the need of big data demands, it is of essence to build a national infrastructure for bioinformatics resources and services in China. Unfortunately, it remains as a dream for bio-scientists despite endless advocacy and efforts from two generations of prominent scientists of the field in the last three decades http://www.embnet.org/), and other international bioinformatics centers came to exchange experiences on bioinformatics research and services. Most recently, the first meeting of the international scientific advisory board of BIGD was held. The efforts were well appreciated by the field’s experts, such as board members from NCBI, EBI, DDBJ, and other international bioinformatics institutions.Fortunately, the GSA project is the first step toward this direction. Sequence data generated by around 200 projects from 39 institutions have already been submitted to this system since it went online in December 2015, and it is recognized internationally as indicated by the publication of these projects on several international journals. Moreover, the GSA project is just one of the main activities of the BIGD I don’t think we can get a Nobel prize by what we are doing so, but the Nobel prize winners know what we are doing for”.Although the BIGD is still in its infancy, I hope that, it can grow up quickly and healthily, with steady support from governmental funding agencies and from the community, and ultimately become a national bioinformatics center. Finally, I would also like to say a few words borrowed from the UK bioinformatician Alan Bleasby, to the members of the BIGD, “The author declares no competing interests.


In clinical practice, patients can present with many different diseases, often both somatic and mental. Holistic medicine will try to see the diseases as a whole, as symptoms of a more fundamental imbalance in the state of being. The holistic physician must help the patient to recover existence and a good relationship with self. According to the life mission theory, theory of character, and holistic process theory of healing, recovering the purpose of life (the life mission) is essential for the patient to regain life, love, and trust in order to find happiness and realize the true purpose of life. We illustrate the power of the holistic medical approach with a case study of an invalidated female artist, aged 42 years, who suffered from multiple severe health problems, many of which had been chronic for years. She had a combination of neurological disturbances , immunological disturbances , hormonal disturbances (14 days of menstruation in each cycle), muscle disturbances (neck tensions), mental disturbances , abdominal complaints, hemorrhoids, and more. The treatment was a combined strategy of improving the general quality of life, recovering her human character and purpose of life , and processing the local blockages, thus healing most of her many different diseases in a treatment using 30 h of intense holistic therapy over a period of 18 months.


Arboviruses have been emerging in different parts of the world due to genetic changes in the virus, alteration of the host and vector population dynamics, or because of anthropogenic environmental factors. These viruses’ capacity for adaptation is notable, as well as the likelihood of their emergence and establishment in new geographic areas. In Brazilian epidemiologic scenario, the most common arboviruses are DENV, CHIKV, and ZIKV, although others may spread in the country. Little is yet known of the impact of viral co-circulation, which would theoretically result in more intense viremia or other immunological alterations that could trigger autoimmune diseases, such as Guillain-Barré syndrome. The impact on morbidity and mortality intensifies as extensive epidemics lead to a high number of affected individuals, severe cases, and implications for health services, mainly due to the absence of treatment, vaccines, and effective prevention and control measures. Culex and Aedes genera, although a number of arboviruses can be transmitted by other arthropods, such as sand flies and ticksArboviruses (ARthropod-Borne VIRUS) have caused much concern in public health worldwide. This set is composed of hundreds of viruses that share the characteristic of transmission by arthropods – mostly hematophagous mosquitoes –, although they are not necessarily phylogenetically relatedAlphavirus (Togaviridae family) and Flavivirus (Flaviviridae family) genera; other members important to human health are from the Bunyaviridae, Reoviridae, and Rhabdoviridae familiesMost arboviruses belong to the Haemagogus genus, for which the vertebrate hosts are mammal. In humans, it causes fever, headache, exanthema, and arthralgia; however, cases of sustained transmission were not observed. There is evidence of the adaptive capacity of MAYV to alternative cycles involving birds and humansThis group of RNA viruses represents major genetic plasticity and high mutation frequency, which allows them to adapt to vertebrate and invertebrate hostsCulex genus, and its main host is birdsThe West Nile Virus (WNV) can cause epidemics even in urban areas, as occurs in the United States. It is transmitted by mosquitoes of the Haemagogus leucocelaenus as the main vector and Aedes serratus for transmissionThe emergent lineage of yellow fever virus in the South region in 2008The dramatic dissemination of dengue in the Americas in the last decades has been well documented, with over two million notified cases in 2015 (until December 8th), adding up to 1.5 million in Brazil, with 811 deaths and an incidence rate of 763 per 100 thousand inhabitantsA. albopictus vector through the alteration of a protein in the viral envelope E1 (E1-A226V), which was followed by other adaptive steps. This increased the ability of CHIKV to infect and spread in that vector, an abundant species in the Indian Ocean islands and in other regions of Asia,Another forthcoming arbovirus is CHIKV, which began pandemic expansion in 2004. A mutation in an African lineage of CHIKV allowed it to adapt well to the ,A. aegypti. Genetic changes among viral lineages allowed the virus to better adapt to the vector and to human transmissionThe ZIKV, identified for the first time in Uganda in 1947, had its first documented outbreak only in 2007 in Micronesia. Since then, the transmission area has spread to islands in the Pacific Ocean, especially during a great epidemic in Polynesia in October 2013,,,The co-circulation of infection by DENV, CHIKV, and ZIKV in Brazil makes clinical management difficult due to similarities; it has implications in the transmission in older people, pregnant women, and young children, and presents a still limited laboratorial rear-guard. Little is yet known of the impact of the co-circulation of this virus. As in the case of reinfection by different serotypes of DENV, the interaction of arboviruses  could theoretically result in more intense viremia or other immunological alterations which, in turn, would trigger autoimmune diseases such as Guillain-Barré syndromeFlaviviridae family pose a real threat of epidemic circulation in Brazil, including WNV, the most common arbovirus in the world. Since its introduction in 1999, this virus has rapidly expanded throughout the Americas. In the first decade of the 21st century, a phenotypical variation increased the efficiency of transmission in Culex ssp. mosquitoes,Alphavirus genus, and the Oropouche virus (OROV), of the Orthobunyavirus genus from the Bunyaviridae family, have been frequently identified in the Amazonian region in patients with nonspecific feverish conditions or with neurological damage,,Flavivirus genus), suggesting possible emergence.Other arboviruses of the The clinical manifestations of infection by arbovirus can vary from light feverish undifferentiated disease to neurological, articular, and hemorrhagic feverish syndromes. Frequently, severe cases are only identified after viral circulation in extensive epidemics, many times reflecting the unpredictable impact on morbidity and mortality, while the occurrence, until now, has been restricted to isolated cases or small outbreaks.,,Deaths by CHIKV in epidemics were not known until the epidemic of Reunion Island in the Indian Ocean, where severe neurological cases were registered  and perinatal transmission with encephalitis and retardation of neuro-psychomotor development in childrenDengue, after its re-emergence in the context of major epidemics, hyperendimicity and co-circulation of various serotypes, has also been associated with the rise in severe cases throughout the world. Immunity obtained in previous infections leads to the amplification mediated by ADE (antibody dependent enhancement) antibodies, with high viremia and release of inflammatory markers in reinfections by different serotypes, particularly in the second infectionsUntil the emergence of WNV in Romania, with a fatality rate of 10%, the neurological forms were considered rareThe impact of arboviruses on morbidity and mortality intensifies as the extended epidemics assume a great number of affected individuals, with implications on the health services, mainly in light of the absence of treatment, vaccines, and other effective methods of prevention and control.Flaviviridae family), Oropouche (Bunyaviridae family), Venezuelan encephalitis virus, and Mayaro (Togaviridae family), all of which can be associated with severe cases, especially if extensive epidemics occur. All of them have proven to be capable of transmission via potentially urban arthropods of the Diptera order, such as Culicoides paraensis, Aedes ssp., and Culex ssp., which are widely occurring in the countryOn the other hand, environmental pressure has led to the selection of viral lineages that cause more intense viremia and, consequently, higher pathogeny of the disease, as in the case of CHIKV and WNV. These viruses are highly adaptable, and can easily emerge and establish themselves in new geographic areas, suggesting that new and old viruses could potentially reappear. A few arboviruses with higher potential of circulation in Brazil are Saint Louis and West Nile , possibility of causing extensive epidemics, universal susceptibility, and occurrence of high numbers of severe cases, with neurological, articular, and hemorrhagic damage. The introduction of any arbovirus in an indemnified environment or one with the presence of the vector should never be neglected.The fight against emerging arboviruses requires wide-ranging policies and interventions involving various sectors of society, not only the health sector.Aedes in the Americas was associated with climate change, deforestation, disorganized urbanization, growth of cities, absence of water and basic sanitation, and population displacement. These factors define the paths of the diseases, influenced by the pressure of the viral mutation and genetic adaptations of the viruses to hosts, vectors, and new environments. Despite difficulties regarding socioeconomic and environmental factors, the health sector has responsibilities, such as investments in the prevention, diagnosis, and treatment of infections; for example, in the particularly critical case of pregnant women affected by ZIKV.The definitive establishment of The development of vaccines has been a challenge for many study groups in Brazil and worldwide, considering its proven viability for various Flaviviruses.Investments in the qualification of the actions of epidemiologic, virologic, vectorial, and epizootic surveillance are urgent in the country, especially during times of risks important to public health. International collaboration is essential for the early identification of the entrance of new pathogens in indemnified regions; however, integrated policies and actions are particularly strategic in a country the size of Brazil.Perplexity regarding the spread of ZIKV and CHIKV and their impact in Brazil were sufficient to establish a state of public health emergency by the Ministry of Health and World Health Organization, almost two years after the entrance of the virus in the country. This condition implied an intense mobilization of resources and articulations among states and municipals to combat viral circulation, which took on huge proportions. Thus, the epidemiologic investigation and suspicion of other arboviruses must be part of the epidemiologic surveillance routines and concerns of national public health to predict new epidemiologic emergences. On the other hand, the efforts are essential to the development and improvement of agile, sensitive diagnostic exams with little cross-reactions with other arboviruses – specific immunobiologicals and synthesis of antiviral medication, mainly due to the infection of pregnant women by ZIKV. Joint actions in research and the fight against the vectors could affect the expansion of emerging viruses, such as infection by CHIKV and ZIKV, the greatest concerns in the country at the moment.


Large programmatic grants advance the missions of funding agencies or organizations. This article describes the programmatic impact of using “hierarchical” logic models in two Centers funded by the National Institute of Occupational Safety and Health (NIOSH) that were designed to achieve NIOSH goals. Such models are supportive of priority setting, policy implementation, and effective evaluation.Two NIOSH Centers, an Agricultural Center and an Occupational Safety and Health Education and Research Center, used the same hierarchical logic model process to support the NIOSH programmatic goal of improving worker health and safety in their respective occupational categories. The logic model development processes were led by the same evaluator.Case studies describe the utilization of “hierarchical” logic models: in each case, NIOSH was the “grandparent”, the Center was its descendant (parent) and the cores were the children. This lineage was articulated through the Center-wide logic model and through the logic model of each of its core programmatic areas (core). The Center-wide logic model ensured that the Center’s goals, and the intended outcomes and impact of its work were linked to the mission and goals of NIOSH. Each core’s logic model articulated how its goals, activities, and outcomes were specifically linked to the Center-wide model.A hierarchical logic model process ensures that the objectives of the funding agency or organization are addressed, and enables stakeholders to articulate the linkages between each layer. This facilitates the process of developing, implementing and evaluating programmatic elements within the framework of strategic planning. Program planners, evaluators and other stakeholders use logic models to clearly articulate the links between proposed program goals, resources, activities, outcomes, and impacts of their initiatives. This systemic approach to program planning and evaluation provides a road map for the program and assists programs to define strategies that will lead to success. In building logic models, stakeholders must define a program theory to provide a rationale for how the activities will lead to outcomes –5. InvolLogic models can provide a productive framework for effective planning and a depiction of the process of change of an intervention. Most often presented as sequenced diagrams or flow charts, logic models demonstrate relationships among the following components: Statement of a problem, various causal and mitigating factors related to that problem, available resources to address the problem, intervention goals and planned activities, and anticipated short and long-term outcomes. This traditional logic model framework may be augmented to include consideration of key factors that may hinder and/or enhance the well-being of the target population, or attainment of the goal set, and may affect the program at the individual, family, programmatic/organizational or policy level.Institutes and organizations often fund large programmatic grants to support a specific mission or goal. In that case, it is particularly important that the programmatic grant demonstrate the ways in which it will serve to advance that mission. A “hierarchical” logic model process is one way to depict these relationships . The purhttp://www.cdc.gov/niosh/oep/agctrhom.html). The NIOSH-supported Ag/ERC Centers also conduct research and implement prevention projects to address the Nation’s occupational health and safety problems. These programs are all operated out of the Office of the Director and managed by the Director of the Office of Extramural Coordination and Special Projects. As special projects of the Education and Information Division, Training Research and Evaluation Branch, they are vulnerable to budget cuts. Therefore, it is even more important that they demonstrate that they advance the NIOSH mission of improving worker occupational health and safety.NIOSH funds programs to support occupational safety and health research and education. Their theoretical framework  is that in creating infrastructure to support programmatic activities with sets of “core” resources, worker occupational health and safety will be improved and occupational injury and fatalities will be decreased. NISOH has invested resources in 10 Agricultural Safety and Health Research Centers (Ag Centers); 18 regional university-based Education and Research Centers (ERCs); and 34 Training Project Grants that train occupational health professionals and researchers to help meet the increasing demand for occupational physicians, occupational nurses, industrial hygienists and safety professionals , which is organized into 10 programs representing different industry sectors. Since 1996, NORA has become the national research framework for occupational safety and health. NIOSH collaborates with many organizations  to advance occupational health and safety research. The collaboration may be as research partners, users of NIOSH technology and scientific findings, peer reviewers, recipients of research grants and contracts, or sources of equipment, technology, or knowledge for advancing research.Over time NIOSH guidance for program evaluation and requirements improved. Yet, at the time of this study, the program announcements listed evaluation as one of required administrative components, but did not provide substantive direction as to how the evaluation should be conducted.In order to assist in the NIOSH mission of improving the health of farmers, fishers, and foresters, 10 Ag Centers were established in 1990 as part of the National Program for Occupational Safety and Health in Agriculture. Each Ag Center conducts surveillance, research, education, and prevention projects to address regional agricultural safety and health issues. Each Ag Center fills a unique geographic niche to engage community stakeholders in initiatives to reduce health disparities among disadvantaged groups. A 2012 review of the Ag Center initiatives found their impact to be notable, and highlighted the significant reduction in child death rates due to exposure to agricultural worksite risk and the adoption of safer technologies and/or devices in some agricultural worksites .Each Ag Center re-competes for NIOSH funding every 5 years. In the 2010 proposal application request (PAR), applicants were required to include three major components: Internal cores, research projects and an evaluation program. Internal cores included (1) Administrative and Planning, (2) Feasibility/Pilot Studies and Emerging Issues, and (3) Outreach. Research projects were categorized as Research, Education/Translation or Prevention/Intervention. Each applicant was required to have internal and external advisory committees.Established in 1977, the ERCs are part of a network of training grants that ensure an adequate supply of qualified professional occupational safety and health practitioners (OS&H) and researchers. The ERCs, located in each of the 10 Federal Department of Health and Human Services (DHHS) Regions, offer multidisciplinary educational training, continuing education and outreach programs to train OS&H professionals.http://www.cdc.gov/niosh/oep/ercreports.html).Currently, ERCs are housed in 18 academic institutions that address OS&H training and research in a cross-cutting, integrated manner. Each institution provides interdisciplinary graduate training in the core areas of Industrial Hygiene, Occupational Health Nursing, Occupational Medicine, Occupational Safety, and allied OS&H fields. The multidisciplinary approach results in cross-fertilization among the various disciplines. The number of professionals engaged in research and practices to promote occupational safety and health has substantially increased through ERCs initiatives  activities that are implemented in collaboration with other institutions, businesses, community groups, or agencies located within the region. ERCs are encouraged to address geographic needs and to implement innovative strategies to impact the practitioner environment.The Southwest Center for Agricultural Health, Injury Prevention, and Education (SW Center) was created in late 1995 at the University of Texas Health Northeast to serve Arkansas, Louisiana, New Mexico, Oklahoma and Texas through research and outreach aimed at reducing injuries and fatalities among agriculture, forestry and fishing (AFF) workers and their families. The mission of the SW Center, to improve the safety and health of agricultural, forestry and fishing workers, is accomplished through research, intervention and education projects. These projects build and leverage a network of strategic partners who represent the diversity of the workforce and the range of agricultural production in the region. The SW Center is guided by an External Advisory Committee (EAC) and an Internal Advisory Committee (IAC). The EAC is composed of a multidisciplinary group of experts in dairy, agriculture, forestry, logging, beef cattle, veterinary medicine, migrant farmworkers and commercial fishing. These advisors represent expertise from each of the states served by the SW Center. The IAC provides advice to the SW Center director to support effective management of the Center.The Mountain and Plains Education and Research Center (MAP ERC) was established in 2007 and includes the University of Colorado, Colorado State University, National Jewish Health, Denver Health and Hospital Authority and the University of New Mexico Health Sciences Center. Spanning from the borders of Canada to Mexico, the MAP ERC helps meet the occupational health education and research needs of Colorado, New Mexico, Arizona, Montana, Wyoming, North Dakota and South Dakota. The MAP ERC is guided by an External Advisory Panel (EAP) and an Internal Executive Committee (IEC). The EAP represents labor, industry, government, academic, and professional organizations. The IEC provides advice to the MAP ERC director to support effective management of its Center.The senior author was the evaluator. She worked with the SW Center and the MAP ERC to create logic models for their Centers, programmatic cores and research projects. In both cases, the mission of NIOSH and the purpose of the Centers in attaining NIOSH goals were considered in the development of the program components. Although there was no requirement to use logic models for program planning and evaluation, the evaluator coordinated the effort to incorporate logic models in the program development and evaluation process. This process helped articulate the connection between the Center’s goals and NIOSH objectives, and ensured that the program components supported the Center goals. As a result, both Centers developed Center-wide logic models to address NIOSH goals, the NORA goals, and the specific activities in the NIOSH logic model . Within The logic model development process began during the preparation phase for the renewal application for the SW Center in the fall of 2010. The SW Center staff and research PIs worked with the evaluator to create the SW Center-wide logic model and the logic models for the individual components and research projects. Most of the work was done virtually, over the phone and through email. The format used in the SW Center logic models includes six columns: Assumptions, Resources, Outputs, Activities, Intermediate Outcomes, and Overall Impact (Sector and Center) .The group of hierarchical logic models for the SW Center was: Center-wide (parent), Outreach and Program Evaluation Pilot Studies/Emerging Issues (children), and four Research Projects (grandchildren).The SW Center staff set out to revise and re-envision its strategic plan at the time the renewal grant was awarded. The logic models were used as resources for this process. A committee was formed from EAC, IAC, PIs, evaluation experts and staff to update the existing SW Center strategic plan. Goals are shown in Strategic planning for the MAP ERC occurred after initial funding and again after the award of the competing renewal in 2010. The MAP ERC goals were developed as part of the application for the Center funding in a process that involved reviewing NIOSH and MAP ERC goals and setting priorities for the funding cycle . These pThe group of logic models for MAP ERC was: Center-Wide (parent), Outreach, Continuing Education, Residency Programs, Interdisciplinary Coordination, Research Training, Community, Diversity, and Program Evaluation . As compared to the set of logic models for the SW Center, the MAP-ERC suite of logic models represents programmatic initiatives; thus there were no grandchildren.For this paper, we highlight the hierarchical thread (the family tree) from the NIOSH goal to its corresponding Center goals. As described above, NIOSH was the “grandparent”, the Center was its descendant (parent) and the cores were the children. To demonstrate the hierarchy, each case study below demonstrates the links between one of the Center goals to the goals, objectives, and activities of its Outreach Core, as this component was a requirement for both the SW Center and MAP ERC. In the case of the SW Center, we include the linkages between the Outreach Core and a research project to complete our example. In the ERC, we depict the relationships between the Center and its Outreach and Research Training Cores.The SW Center Outreach Core engages and expands its network of strategic partners to design, deliver and evaluate educational products and programs to raise awareness of safety and health issues, diminish exposure risks, improve the adoption of best practices, and consequently reduce injuries and fatalities to AFF workers and their families. This is accomplished through regular communication with stakeholders, capacity building activities, and topic/population based interventions that are informed by regional experts. The Outreach Core has its own goals.The Outreach Core is designed to help the SW Center meet NIOSH Strategic Goals 2 and 3 . The NIODuring the logic model development process, the Outreach Core aligned its activities to the SW Center-wide Strategic Plan. The items in the activities, outcomes and impact columns from the Outreach Core logic model align with those in the SW Center-wide logic model outcomes and impacts in The Outreach Core itself had goals , which bSimilarly, the evaluation followed a hierarchical pathway. Progress reports collected information about the activities in the Vietnamese Shrimper research project and the Outreach Core. The summative evaluation examined the attainment of the Center-Wide goals, the evidence for which are the data documenting activities, intermediate outcomes and impact of the Outreach Core and the Vietnamese Shrimper research project.One role of the MAP ERC Outreach Core was to convene the community OS&H workforce in the region, in collaboration with professional societies, labor organizations, Native American and Latino communities, government, industry groups, community organizations, and other ERCs. Hundreds of organizations were engaged in raising the profile of OS&H issues among the broader community.The MAP ERC Outreach Core logic model provides detail about the relationship between the MAP ERC Center-wide goals and the goals and outcomes for the Outreach Core. Similar to the SW Center, the Outreach Core created its own goals . Within The case studies described above demonstrate the ways in which a hierarchical logic model process may be used to link goals and outcomes between the funder , and two of its major initiatives, the Ag Centers and the ERCs. NIOSH articulated its goals for the Ag Centers and the ERCs  in its lThe senior author worked as the leader of the evaluation for both the SW Center and the MAP ERC. In both cases, the logic model process began in the application period and was refined once the Center was funded. The SW Center was funded in September 2012 and the MAP ERC was funded in August 2010. The results described in this manuscript depict evaluation in action: each set of hierarchies was tailored to the structure and lineage of each Center and what was needed to accomplish each Center’s goals, which were determined by the NIOSH goals. The major difference between the two hierarchies is that one favors depth (SW Center) and the other favor breadth (MAP ERC).The logic model hierarchy mirrors the multi-level and nested characteristics that underlie the rationale for hierarchical linear modeling in statistics  and the Hierarchical logic models are appropriate for all large intramural and extramural program projects, because they reflect the goals of the agency (in this case NIOSH) and therefore the rationale for the program project or initiative. The hierarchical logic model process helps agencies prepare funding announcements and reports to Congress or other constituencies that assess the degree to which an agency is attaining its own goals. As an example, the evaluation of the Ag Centers by the National Academies of Science was facilitated by explicit linkages between agency goals, objectives and initiatives and the corresponding goals, objectives and activities of the Centers .The hierarchical logic model approach is very helpful at the Center level for orientation of all stakeholders to include internal and external advisory boards, site monitors and study sections to understand program goals, practices, and rationale. Furthermore, the hierarchical logic model process offers a common purpose between the evaluation team, program staff, and stakeholders.The hierarchical logic model approach allowed the MAP ERC personnel to further prioritize areas where multiple programmatic areas were designed to meet the same goals and coordinate activities, tracking and increased impact. This coordination of activities minimizes duplication of efforts and central tracking allows for higher level decisions about what activities are more successful than others, across programs.The logic models are a living portrait of evaluation in action. The use of a hierarchical logic model process aids the federal government to manage, integrate and coordinate a large complex system of varied and diverse programmatic elements, thereby ensuring that its goals are attained.


Global Breast Cancer (BC) is the most common non-skin malignancy, nearly a third of newly diagnosed cancers in the United States and the second leading cause of mortality in women throughout the world was BC , 2. BetwIn GLOBOCAN project, the expected number of new cancer cases or deaths in a country or region in 2015–2035 is computed by multiplying the age-specific incidence/mortality rates estimated for 2012, by the corresponding expected population for 2015–2035. In Iran, based on the GLOBOCAN project in 2012, the number of BC in woman was 9795 case and the number of new case have an increase in the next few years, so in 2015, 2020, 2025, 2030 and 2035 the number of new cases were 10982, 12684, 14920, 17346 and 19328, respectively. Therefore, in 2035 compare 2012 the numbers of new case were nearly 2 times. In addition, in 2012, the numbers of death from BC was 3304 and in the next few years, we have increase in the number of death from BC, so in 2015, 2020, 2025, 2030 and 2035 the numbers of deaths were 3742, 4394, 5248, 6220 and 7138. We expect that Iranian population structure, the greatest increase in the number of new cases and deaths from BC observe in age group (ages >= 65), so in 2035 compared to 2012, the number of new case and mortality will be 3 times, while in the age group below 65 yr, the increase is about 1.8 times , Fig. 1.We predicted the number of incidence and mortality of BC in Iran between 2012 and 2035. Although these results should be taken with caution given that they were obtained using prediction methods, it is important to highlight that there is a trend for increased incidence and mortality of BC in Iran. For this reason, in addition to planning for prevention of disease occurrence in the population at risk, the health policy makers should anticipate and provide diagnostic tools, therapeutic facilities, and skilled healthcare workers to cope with these additional patients in the next few years.


Psycho-oncology in Korea was introduced among the circle of consultation-liaison psychiatrists, in the 1990s. For almost 25 years, the field has been developing at a steady pace as the psychosocial needs of patients with cancer continue to increase. In this study, we review the history of psycho-oncology in Korea, in a chronological order, within the domains of clinical practice, research activity, training, and public policy.Before the 1990s, patients with cancer with psychiatric comorbidities were usually taken care of by consultation-liaison psychiatrists in general hospitals. In 1993, psycho-oncology was first introduced by psychiatrists. Psychologists, nurses, and social workers have also been increasingly involved in providing psychosocial care for patients with cancer. Professionals from various disciplines began to communicate, and agreed to found the Korean Psycho-Oncology Study Group (KPOSG) in 2006, the first academic society in this field. In 2009, National Cancer Center published the “Recommendations for Distress Management in Patients with Cancer”, which are consensus-based guidelines for Korean patients. In 2014, the KPOSG was dissolved and absorbed into a new organization, the Korean Psycho-Oncology Society (KPOS). It functions as a center of development of psycho-oncology, publishing official journals, and hosting annual conferences. There are many challenges, including, low awareness of psycho-oncology, presence of undertreated psychiatric disorders in patients with cancer, shortage of well-trained psycho-oncologists, stigma, and suicide risk. It is important to improve the cancer care system to the extent that psycho-oncology is integrated with mainstream oncology. Considering the socio-cultural characteristics of Korean cancer care, a Korean model of distress management is being prepared by the KPOS.This article provides an overview of the development, current issues, and future challenges of psycho-oncology in Korea. Through its long journey to overcome the many barriers and stigmas of cancer and mental illnesses, psycho-oncology is now acknowledged as an essential part of integrated supportive care in cancer. Active research and international cooperation can gradually shape the Korean model of distress management. The age-standardized rate (ASR) of cancer incidence in Korea has decreased from 303.8 per 100,000 in 2011, to 290.5 in 2013. Cancer has, however, been the most common cause of deaths in Korea since 1983; the disease accounted for 28.3% of all deaths in 2013. The age-standardized rate of cancer mortality has decreased by 2.7%, annually, from 2002 to 2013. The 5-year cancer relative survival rate has improved, from 41.2% in 1993–1995, to 69.4% in 2009–2013. The number of Korean cancer survivors has increased steadily, with 1,370,049 having been identified, as of January 1, 2014 [The diagnosis and treatment of cancer is often accompanied by psychosocial distress of patients and their families. Psychosocial distress increases the risk of psychopathology, lowers the quality of life of patients with cancer, and has a direct, or indirect negative impact on treatment and prognosis –4. BecauPsycho-Oncology, dealing with the psychological, social, and spiritual aspects of cancer, is recognized as an essential part of integrated cancer care in many developed countries. Since the World Health Organization (WHO) declared “no health without mental health” and emphasized on the importance of mental health, the need for psycho-oncological intervention has increased even further , 7. PsycSeveral studies that review the history of psycho-oncology have been published in Korea –10. HoweThe psychiatric problems of patients with cancer had been recognized in Korea long before the field of psycho-oncology was introduced, in the 1990s. Psychiatrists were interested in cancer-related psychiatric disorders, such as delirium and adjustment disorder. Consultation and liaison activities were carried out by psychiatrists mainly at general hospitals. As early as the 1970s, and through the 1980s, research papers were published in the areas of diagnosis and treatment of psychiatric disorders, truth-telling practice, hospice and end-of life care, and psychosocial interventions for patients with cancer and families. In the 1990s, hospice/palliative care, such as pain management for patients with advanced cancer, was extensively studied with the development of the hospice movement in the 1980s, and 1990s, in Korea. That was the basis of the establishment of the current hospice care system. Although studies on the quality of life, psychological symptoms of caregivers and patients with cancer, and the adaptation of the family of patients with cancer had begun to increase in the 1990s, there were limitations because of the lack of objective tools to measure such parameters.In 1993, the concept of psycho-oncology was introduced for the first time at a symposium in the annual conference of the Korean Society of Psychosomatic Medicine . The hisIn 1996, the Ministry of Health and Welfare of the Korean Government launched a National Cancer Control Planning Board, which embarked on the First Cancer Control 10-Year Plan (1996–2005). As the control tower of the national cancer control programs, the National Cancer Center (NCC) was established in 2000. The first decade of the 21st century witnessed a big increase of cancer centers and hospitals, in order to accommodate the increasing numbers of patients with cancer. Because issues regarding the quality of life of patients, during and after treatment, were raised, their psychosocial needs were increasingly addressed.Although the Cancer Control Act, legislated in 2003, did not stipulate the psychosocial aspects of cancer, the importance of quality of life and palliative care were stressed in the Second 10-year Cancer Control Plan (2006–2015).Research activities in the related fields of psycho-oncology were enriched with the establishment of the Korean Society for Hospice and Palliative Care in 1998 and the Korean Oncology Nursing Society established in 2002.Since the 2000s, with Korean the validation of assessment tools for the symptoms and quality of life of patients with cancer and their caregivers, psycho-oncological studies using such tools have increased dramatically.The Korean Psycho-Oncology Study Group (KPOSG) was founded in 2006, with members from multidisciplinary mental health, and related professionals. It was organized by a core group of psychiatrists, psychologists, and nurses. They shared expertise in the field of psycho-oncology through participating in monthly seminars and cooperative clinical studies. The first conference on psycho-oncology, led by members of the KPOSG, was held in April 2007. They presented topics on the overview of psycho-oncology, research, and clinical practice, at the symposium of the Institute of Human Behavioral Medicine, Seoul National University. They also organized a symposium titled, “Mental Suffering of Patients with Cancer, How to Help?” at the 9th Cancer Control Forum, sponsored by the National Cancer Control Planning Board, in November of 2007. The KPOSG has continued to hold annual academic conferences since 2010. Those conferences have attracted attention from both people in academia and the general public.In 2008, the group conducted at reliability and validity study of the Korean version of the problem list and distress thermometer , one of “The Recommendations for Distress Management in Korean Patients with Cancer” was published in 2009, by the National Cancer Center, with a grant from the National Research and Development Program for Cancer Control , 12. In With an increasing acceptance of the importance of communication in quality cancer care, NCC introduced communications skills training (CST), using the manual of the Japanese SHARE protocol translated into Korean. NCC continues to hold CST workshops for its doctors, nurses, and other employees and is trying to expand this training nationwide.The Korean Psycho-Oncology Society (KPOS) was founded on September 26, 2014 [The diagnosis of cancer is not considered a death sentence any more. Cancer will, however, continue to be a major health threat to people all over the world, because of the fatality and chronicity associated with the disease. Because there is an increased acceptance of the importance of quality of life in patients with cancer and families, a steady development of psycho-oncology in Korea has become possible. Awareness of psycho-oncology is still low, and the psychiatric disorders of patients with cancer tend to be under-diagnosed, and undertreated, in actual clinical practice , 16. OnlAccording to the International Federation of Psycho-oncology Societies’ report on the disparities in psychosocial care, the development of psycho-oncology in Korea was graded as “isolated care provision’ , compareIt is important to improve the cancer care system, so that psycho-oncology is well integrated with mainstream oncology. In the Third National Cancer Control Plan (2016–2020), the scope of cancer care has been expanded, to include the quality of life of cancer survivors. The Korean government is planning to establish 13 regional integrated supportive care centers in provinces, for cancer survivors living in the community, by 2020. Those centers are going to provide comprehensive supportive care, including psychosocial service, rehabilitation, and nutritional counseling. Korean psycho-oncologists are moving toward integrated cancer care that incorporates psychosocial care as an essential component of patient care.Although the needs for mental health professionals in the field of psycho-oncology are increasing, there is a shortage of well-trained psycho-oncologists in Korea. The Advanced Program for Psycho-Oncology (APPO), developed by NCC in 2015, is the first course to train psycho-oncologists. It is a 12-week program for psychiatrists, psychologists, social workers, and other healthcare professionals interested in psycho-oncology. Further development and expansion of training programs for psycho-oncologists would help expand the number of experts in psycho-oncology in Korea.The effectiveness of psychosocial interventions should be proved further in order to raise awareness of psycho-oncology. Large-scale clinical studies need to be done to support the biopsychosocial model for cancer treatment.Cancer stigma often causes psychosocial distress. According to a national survey in Korea, more than half of the public had negative attitudes, stereotypes, and discriminating attitudes toward patients with cancer in spite of clinical progress and improved survivorship . A recenCancer is an illness that increases the risk of suicide in Asian countries –22. One With the development of information and communication technology, e-health and m-health are emerging. In psycho-oncology, there have been various studies to improve self-management and support patients with cancer, using mobile applications , tablet Psycho-oncological knowledge can be universally applied, and it is beyond race, culture, and socioeconomic status; however, it is necessary to consider the socio-cultural specificity of each country. Considering the socio-cultural characteristics of Korean cancer care, a Korean model of distress management is being prepared by the KPOS, with a revision in the recommendation published in 2008.The KPOS, as the only academic group of psycho-oncology in Korea, should tighten the cooperation with the International Psycho-Oncology Society (IPOS) and other academic communities in the world.International cooperation with many East-Asian experts who share similar cultural and healthcare system backgrounds would help with the promotion of psycho-oncology in Korea.The introduction of psycho-oncology to Korea was relatively late, and its growth was not fast enough, compared to Western countries and Japan. There has, however, been a steady development of psycho-oncology, with a successful launching of a national academic society and growing numbers of enthusiastic professionals in Korea. This article provided a brief overview of the development, current issues, and future challenges of psycho-oncology in Korea. Psycho-oncology should be an integral part of integrated supportive care for cancer in Korea.


Independent of who made the first Review in health literature, it is possible to state that the development of the fundamental concepts on Systematic Review and Meta-analysis is attributable to the Cochrane initiative, that signalized the need to gather scientific evidence based on the opinion of medical specialists . It is nKey elements of the model are transparency and reproducibility search methods, which include registration of the title, publication of the protocol and periodic updating in subsequent systematic reviews. At same time at the UK Cochrane Center in Oxford, it was initiated the development of statistical methods for data synthesis, which great influenced on the specifications of the software, especially in relation to meta-analysis . ThroughThe items involved in the development of the systematic review, specifically for interventions based on randomized assays, also had their initial definition by the Cochrane Handbook 1994), inserted in its software (RevMan). But in the same way as systematic revisions, it has become a universal process, as well as initiatives have emerged to disseminate these fundamental elements, such as the PRISMA  , which h, inserteSome major phenomena justified the improvement, the democratization and the expansion of the checklist for systematic reviews, through the creation of PRISMA (2005): the knowledge of driving and publication of systematic reviews has expanded, the concepts of risk of bias were extended, including observational studies, and the synthesis of the evidence used by the authors has become increasingly focused on to address practical issues, making the eligibility criteria of the increasingly inclusive evidence. The PRISMA consists of a “checklist” of 27 items and a 4-stage flow diagram essential for the dissemination and publication, transparent and rigorous, of the methods and results of the systematic review .In the same way, to broaden the global Systematic Reviews of quality, the Center for Reviews and Dissemination (CRD), at York University, which is part of the National Institute of Health Research (NIHR) in the UK, and produces systematic reviews and evaluations of health technology, has developed a record of systematic reviews, the international prospective register of systematic reviews (PROSPERO) . PROSPERSo Int Braz J Urol is adopting the PRISMA checklist, including the PROSPERO’s register, within the rules needed to submitted any systematic review with or without meta-analysis. The authors can access the checklist and flow diagram at Prisma-Statement and the registration at Prospero electronic address, that need to be sent with the whole submission.Certainly, with this initiative, the level of the Systematic Review and Meta-analysis available in the Int Braz J Urol will be with highest level, consistence and credibility.Faculdade de Medicina da Universidade de São Paulo (FMUSP),Projeto Diretrizes - Associação Médica Brasileira (AMB),São Paulo, SP, BrasilWanderley Marques Bernardo


The Physician's Pledgend General Assembly of the World Medical Association, Geneva, Switzerland, September 1948 and amended by the 22nd World Medical Assembly, Sydney, Australia, August 1968 and the 35th World Medical Assembly, Venice, Italy, October 1983 and the 46th WMA General Assembly, Stockholm, Sweden, September 1994 and editorially revised by the 170th WMA Council Session, Divonne-les-Bains, France, May 2005 and the 173rd WMA Council Session, Divonne-les-Bains, France, May 2006 and the WMA General Assembly, Chicago, United States, October 2017.Adopted by the 2AS A MEMBER OF THE MEDICAL PROFESSION:I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;I WILL RESPECT the autonomy and dignity of my patient;I WILL MAINTAIN the utmost respect for human life;I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing, or any other factor to intervene between my duty and my patient;I WILL RESPECT the secrets that are confided in me, even after the patient has died;I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice;I WILL FOSTER the honour and noble traditions of the medical profession;I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of health care;I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;I MAKE THESE PROMISES solemnly, freely, and upon my honour.©2017 World Medical Association Inc. All Rights Reserved. All intellectual property rights in the Declaration of Geneva are vested in the World Medical Association.


Biennial Conference of the European Association for the History of Medicine and Health – The Body Politic: States in the History of Medicine and Health, an extremely important European meeting in the field of history of medicine, whose main organizer was the European Association for the History of Medicine and Health, took place in the amphitheatre of “Carol Davila” University of Medicine and Pharmacy, Bucharest, during August 30 and September 02, 2017.Hosted for the first time by a East European country, the conference enjoyed the participation of some remarkable personalities in the academic world such as doctors, historians, anthropologists, demographers, and occasioned an interesting and useful exchange of opinions, mainly regarding the role of politics in the development of medicine in history, benefitting from the participation of some prestigious publishing houses and raising the interest of many participants.Prof. Dr. Octavian Buda, President of the European Association for the History of Medicine and Health, EAHMH, and the Head of Discipline of History of Medicine in the Preclinical 3 Department, “Complimentary Sciences”, affirmed: “I hope this conference will have positive outcomes, so that we will be able to raise the interest of the researchers in the Occident regarding the study of history of medicine of these complex fields in the Eastern Europe, such as Romania, with the starting of some academic collaboration projects between the Western and Eastern Europe”.Prof. Dr. Mircea Beuran, President of the Senate of “Carol Davila” University of Medicine and Pharmacy, Bucharest performed the welcoming speech of the conference. Other speakers were Prof. Dr. Catalin Cirstoiu, Dean of “Carol Davila” University of Medicine and Pharmacy, Bucharest; Prof. Dr. Mircea Dumitru, Rector of the University of Bucharest and Prof. Dr. Octavian Buda, President of EAHMH.The conference took place under the patronage of two important academic institutions: Academy of Medical Sciences and Academy of Scientists, and reunited over 150 participants from 22 countries, also enjoying the presence of four keynote speakers.Among the most important personalities who activate in the fields of human and medical sciences and took part in the event were Prof. Dr. Roberta Bivins - University of Warwick, England; Prof. Dr. Harry Oosterhuis - University of Maastricht, Netherlands; Prof. Dr. Constantin Goschler – University of Bochum, Germany and of course, Prof. Dr. Mircea Dumitru, Rector of the University of Bucharest.2017 EAHMH Book Award Prize was awarded for the best book published in the field of history of medicine and went to Cristian Berco for his book “From Body to Community. Venereal Disease and Society in Baroque Spain”, published by University of Toronto Press in 2016 and Pieter van Foreest Student Prize, which is offered to students and PhD students for the best paper presented in the conference, prize that was awarded to Kinga Jeczminska for the paper “Political Factors in Abandoning Lobotomy in Poland in the 1950s”.Executive EditorProfessor Eng. Victor Lorin Purcarea, PhD.


This global humanitarian crisis has spurred vigorous local, national, and international debates regarding the risk of infectious diseases that migrants pose to the countries and citizens who offer them shelter. In these debates, some have advocated tightened control and oversight of immigration, acceptance of refugees, and international travel. In this context, it is essential to maintain established U.S. policy toward human migration and global health that is evidence based and upholds the value of compassion, as well as key principles in international human rights law.Human migration is at an all-time high, with one in every 122 humans now either a refugee, internally displaced, or seeking asylum , experience informs us that limiting migration and the flow of refugees will, by itself, have little impact on the control of infectious diseases. Migrants represent only a small fraction of international travelers entering the United States. Thus, preventing their entry will not have a major impact on the influx of infections. International travel, once considered exotic, is now commonplace. Over 70 million U.S. citizens travel abroad yearly for commerce, trade, tourism, teaching, faith-based missions and other public service efforts, and military deployment. In contrast, about 1 million legal immigrants and 70,000–90,000 refugees enter the United States yearly.Although travel restrictions may be warranted under extreme circumstances of epidemics and pandemics, as spelled out by the World Health Organization International Health Regulations (cdc.gov/zika/geo/united-states.html). Furthermore, some “tropical” infections we may fear from migrants are already endemic, albeit uncommon, in parts of the United States, including viral infections, tuberculosis, Chagas disease, leishmaniasis, and soil-transmitted helminth infections. Restrictions on travel and population movement cannot keep these diseases out of our country. They are already here.Unlike U.S. citizens, who travel freely without health screenings or restrictions, legal migrants and refugees who enter the country must meet entry criteria that include thorough screening and treatment of infectious diseases. American travelers returning to the United States have proven to be highly efficient in spreading some infectious diseases. For example, of the almost 4,500 recognized cases of Zika virus infection to date in the United States, over 95% were travel related (In addition to maintaining a humane and evidence-based U.S. policy on migration, we must continue to engage and invest in programs that improve the health of vulnerable populations worldwide. Reaching out to enhance the well-being of those whose lives has been torn apart by war and oppression should be a fundamental and perhaps defining American principle. Programs for populations in need around the world should not be considered antiquated historical notions or reflective of an outmoded inscription on the Statue of Liberty. Indeed, U.S. government leaders from both sides of the political aisle have championed programs aimed at global health, including the creation of the Peace Corps by President John F. Kennedy in 1961, and the President's Emergency Plan for AIDS Relief and President's Malaria Initiative by President George W. Bush in 2003 and 2005, respectively. Additional efforts have been shared with other developed countries, notably the Global Fund to Fight AIDS, Tuberculosis, and Malaria. These well-managed programs have offered enormous benefits to the citizens of the developing world, but they have also directly benefitted the United States, by helping to control some of the most important infectious diseases that threaten all of us, by building diplomatic bridges of good will with populations around the world, and by exemplifying the best of American values of kindness and compassion.Progress in diagnosing, managing, and preventing tropical infectious diseases will be facilitated by biomedical research in the developing world, where greater prevalence of many infections allows adequate sample size for studies that would not be possible through research conducted only in the United States. New drugs, vaccines, and control measures that result from these research efforts will be available for the benefit of all, including those in the United States. Maintaining this research will require continued funding for U.S.-based agencies and programs that support global health research and service, including the National Institutes of Health, Centers for Disease Control and Prevention, U.S. Agency for International Development, and many Department of Defense programs.The American Society of Tropical Medicine and Hygiene, the largest international organization of experts dedicated to reducing the worldwide burden of tropical infectious disease and improving global health, deeply understands that vigilance in the control of global disease is in the best interest of all. To that end, we will continue to work with the U.S. Congress, the White House, and global health stakeholders in support of evidence-based policies and programs to protect the health of people both inside and outside the United States. Maintenance of evidence-based policies concerning migration and strong investment in global infectious disease research and programs are the right thing to do, and they are the smart thing to do.


After an introduction by Dr Johanna Takkinen, Head of Disease Programme Food- and Waterborne Diseases and Zoonoses at the European Centre for Disease Prevention and Control, Stockholm, Sweden, Professor Sylvie van der Werf, Head of the Molecular Genetics of RNA Viruses Unit, Institut Pasteur, Paris, France, will talk about viral zoonotic diseases and point out intrinsic and extrinsic factors influencing the dynamics of spillover from animals to humans. Professor Luca Guardabassi, Department of Veterinary Disease Biology, University Copenhagen, Denmark, will then speak about the need for antimicrobial stewardship in animals and highlight the possible role of companion animals in the direct transmission of resistant pathogens to humans resulting from their close physical contact.The connection between the environment, food, animals and humans with respect to human well-being, sustainable development and health is intuitive. The ‘One Health’ concept encompasses a multidisciplinary, holistic approach to sustain the health and well-being of humans and animals as well as their living environment. One Health has gained increasing attention and importance in the past years owing to the continued growth of the world’s population, predicted to be 9 billion by the year 2050, the opportunities and challenges of a technology-driven, interconnected world, as well as man-made and other changes in our environment that influence the emergence and re-emergence of communicable diseases and conditions.The seminar will be open to all ESCAIDE participants. Due to the limited number of seats in the room, participants are welcome on a first come, first serve basis.here .Read more about ESCAIDE here .Read more about the Seminar


To the Editor: Drancourt and Raoult ( pestis by ectoparasites, such as lice and fleas, by close contact with infected humans can sustain outbreaks and epidemics. The outbreak of pneumonic plague in Madagascar in 2017 (Y. pestis should not be dismissed. However, until a substantial epidemic has been documented with this proven etiology, this explanation of plagues, both historical and modern, must remain in the realm of conjecture.The role of ectoparasites in the transmission of


Revista de Saúde Pública (RSP), between 1967 and 2015. All the fascicles of RSP, in the period, were accessed via SciELO platform, which provides all articles online. We selected and classified the articles according to the main topics of scientific production in the area of Policy, Planning and Management. Revista de Saúde Pública has published 343 articles on this subject, with significant growth in the last two decades. The most discussed topics were Health Economics, Primary Health-care, Access and Use of Health Services, and Evaluation of Services and Programs. In the last decade, the topics of Policy and Access to Medicines and Public-Private Relationship, including judicialization, gained importance. The pages of RSP embraced the vast and diverse production of Policy, Planning and Management in its first 50 years, contributing to the consolidation of the area in Brazil.We carried out a narrative review of the scientific production in the area of Policy, Planning and Management in  Revista de Saúde Pública (RSP), a Rodolfo Mascarenhas’ articleIn the first pages of ,The period of emergence of RSP coincides with the international consolidation of the field of study of Public Policies, Policy Science or Policy Studies, which in Brazil was named Public Policy Analysis, among them those of HealthIn the last 50 years, Brazil has substantively changed its demographic, social, political, and economic profile. The Brazilian health system also changed: the meritocratic model, with access conditioned to formal labor market integration, was replaced by a universal system with the creation of the Brazilian Unified Health System (SUS). The achievements and challenges faced in that process were countless. However, despite the significant increase in the access to health services, ensuring universality and integrality is still a challengeThe great changes described in the paragraph above can be read in the pages of RSP published in the past 50 years, as well as the several discussions by researchers of the area. Nothing more appropriate than, on the occasion of the 50th anniversary of RSP, revisiting all this period. Thus, this study aimed to describe the articles on PPM published between 1967 and 2015 in RSP.In this study of narrative review, all fascicles of RSP were accessed via SciELO platform, which provides all articles online. The articles were selected and classified according to the main topics of the scientific production in the area of PPM, listed previously in researches conducted by Levcovitz et al.We included all published articles, classified as: original articles, special articles, comments, notes, updates, and reviews. We also analyzed Institutional Technical Notes and, more recently, articles published in the section of Public Health Practice.In the pages of RSP of the last 50 years, 343 articles were published in the area of PPM. During this period, RSP has gone from biannual publication in the first five years, to quarterly in the nine subsequent years, and bimonthly and in the last 36 years. Approaches with quantitative methods were the most common ones; the topics directly related to power issues in the analysis of Health Policies (Politics) were published more rarely.A cross-sectional look over the five decades of RSP shows the permanence of some topics. The most covered ones were: Economics of Health, Primary Health-care, Access and Use of Health Services, and Evaluation of Services and Programs. More recently, the topics of Policy and Access to Medicines and Public-Private Relationship, including judicialization, gained importance.,The evolution of the number of articles published over the decades (blocks) and triennia (row) can be viewed in the -From 1967 to 1976, 44 articles that talked about the national and state political scenario were published. João Yunes’ studies,,The provision of ambulatory and hospital health services to the welfare population, by the National Institute of Social Security, has been discussed in the articles by Lima Gonçalves et al.The 1980s were a moment of production growth in the area of PPM: proposals for reform of the sector in the Country; the end of the military dictatorship; the establishment of several local health systems; and the proposal for the creation of SUS inspired several studies,,,,,,,Between 1987 and 1996, 44 articles were published in the area of PPM. The main topics discussed were Health EconomicsTeixeira,,,,,,,,,The field of PPM has increased significantly in the last years of the 20th century and in early 21st century, with progressive inclusion of topics of interest and new theoretical approaches,During the same period, the Institutional Technical Reports presented central topics of health policies: Family Health Program,,,,,,Specific policies were an important topic in RSP, especially Oral Healthquilombola populationIn recent years, RSP has started to address the Policy and Access to Medicines, an issue that lies at the center of agendas of the most distinguished health systems around the world. The article by Granjeiro et al.The access to medicines has interface with two central topics in the analysis of health policies in the 21st century: judicialization and evaluation of technological incorporation, which will be highlighted below.,,SUS has been affected by increasing litigations that, if on the one hand make explicit the overlapping between health and juridical systems in Brazil, on the other, refer to the issues of equality and of the relation between individual and collective rights. The articles of Marques and Dallari,,,,,,,,Articles on the evaluation of medicines acquisition, from cost effectiveness studies, were published recently on RSP,,,,,,More recently, several criticisms have been made to the more formalist character of Health Economics. Proposals have been developed to discuss health from its specificities as commodity and economic good, as social right and space of capital accumulation, and the contradictions arising therefromThe pages of RSP sheltered a wide and diverse production of PPM in its 50 years, contributing to the consolidation of the area in Brazil. The academic community and policy makers found, in RSP, a place for fraternal debate, for discussion of the main policy proposals for health systems and services in Brazil and Latin America, for new methodological approaches, and for introducing new topics of interest.The goal of Brazilian Public Health of building a universal health system in a country with immense social inequalities as Brazil was reflected in many of the lines published in RSP. The challenges and obstacles of this goal have been the subject of increasingly frequent reflection on RSP issues.In its 50 years of trajectory, RSP showed its commitment to the principles of SUS and to the improvement of living and health conditions of more than 200 million Brazilians. The area of PPM has many challenges; among them, the study of the complex political and economic relations of the Brazilian health system is an eternally unfinished task, which will surely continue in the next pages of RSP.