An Interdisciplinary Approach to One Health: Course Design, Development, and Delivery.

One Health is an approach to studying health by recognizing the interconnections between people, animals, plants, and their shared environment. This article describes the process of designing a new course on One Health at the University of Illinois at Urbana-Champaign (UIUC). We brought together faculty and students from across campus to develop a multidisciplinary course dedicated to One Health and infectious diseases. This group met over 9 months to brainstorm course goals, objectives, and ideas. The group also organized a workshop to explore One Health's existing knowledge and ongoing work on the UIUC campus. We solicited the help of experts throughout the university to co-teach the course. The course curriculum and course materials included 13 unique case studies. The course was offered in fall 2019, and its goals were to add to the existing training and coursework on One Health at the University of Illinois campus, offer a course that would be suitable for students from all fields of study, and develop helpful case studies to be made available to other educators. Student feedback highlights the course's successes as well as areas for future improvement. This article describes this entire process of course development, provides recommendations to guide improvements in the next offering of the course, and details our contributions to the field of One Health education.

Retrospective Study of Kyasanur Forest Disease and Deaths among Nonhuman Primates, India, 1957-2020.

Kyasanur Forest disease (KFD) is a tickborne hemorrhagic disease affecting primates along the Western Ghats mountain range in India. Our retrospective study indicated that >3,314 monkey deaths attributed to KFD were reported in KFD-endemic states in India during 1957-2020. These data can help guide surveillance to protect animal and human health.

Zoonoses-specific resources, collaborative networks, and enhanced communication can help US veterinarians tackle zoonotic diseases: results from a national survey.

Increased incidence of zoonoses, coupled with veterinarians' occupational exposure, led to this study examining the knowledge of licensed US veterinarians on zoonoses and their disease prevention practices. This online survey supported by the National Association of State Public Health Veterinarians received 466 responses from 36 US states; 67% of the respondents were female, and 72.5% were small animal medicine practitioners. The One Health concept was familiar among 82% of respondents, 51.3% knew of continuing education training on zoonoses, and 68% had attended such a training in the last 5 years. Respondents were unaware of which zoonoses to report to public health departments. For 3 out of 8 questions on standard operating procedures, statistically significant differences in protocols followed among small, large, and mixed animal medicine practitioners were observed. Most respondents believed they play a critical role in zoonoses prevention but would like more information on zoonotic diseases. Results indicate that assisting veterinarians with regularly updated information on zoonoses, providing targeted education and training to adhere to standardized infection control measures, and increasing communication with public health agencies and physicians may help prevent and reduce incidence of zoonoses.

Sociodemographic factors associated with Kyasanur forest disease in India - a retrospective study.

Objectives: Kyasanur forest disease (KFD) is a tick-borne disease in India affecting humans and two local non-human primate species. A critical knowledge gap in the scientific literature is the lack of information on how people's sociodemographic factors influence KFD occurrence. Methods: We analyzed available data on KFD from three data sources: (a) 104 peer-reviewed articles using keyword searches on PubMed Central and Google Scholar, (b) 116 Program for Monitoring Emerging Diseases reports, and (c) an acute febrile illness surveillance data set on KFD from a report by the government of India. We performed statistical analyses to calculate the prevalence of KFD by state and differences in KFD cases by sex and age group. Results: All three data sets used indicate that KFD cases and deaths have occurred predominantly in the 15-64 years age group (literature: 87% cases and 95% deaths, Program for Monitoring Emerging Diseases: 78% cases and 78% deaths, acute febrile illness: 96% cases [no breakdown for acute febrile illness death data]). Data reporting varies across states and is non-standardized. Conclusions: The inconsistent reporting of sociodemographic data on KFD in India has created a gap in our understanding of its impact on different social groups. Collecting and reporting data on sociodemographic factors is critical to understanding the epidemiology of KFD and designing effective public health interventions.

Effects of cattle on vector-borne disease risk to humans: A systematic review.

Vector-borne pathogens (VBPs) causing vector-borne diseases (VBDs) can circulate among humans, domestic animals, and wildlife, with cattle in particular serving as an important source of exposure risk to humans. The close associations between humans and cattle can facilitate the transmission of numerous VBPs, impacting public health and economic security. Published studies demonstrate that cattle can influence human exposure risk positively, negatively, or have no effect. There is a critical need to synthesize the information in the scientific literature on this subject, in order to illuminate the various ecological mechanisms that can affect VBP exposure risk in humans. Therefore, the aim of this systematic review was to review the scientific literature, provide a synthesis of the possible effects of cattle on VBP risk to humans, and propose future directions for research. This study was performed according to the PRISMA 2020 extension guidelines for systematic review. After screening 470 peer-reviewed articles published between 1999-2019 using the databases Web of Science Core Collection, PubMed Central, CABI Global Health, and Google Scholar, and utilizing forward and backward search techniques, we identified 127 papers that met inclusion criteria. Results of the systematic review indicate that cattle can be beneficial or harmful to human health with respect to VBDs depending on vector and pathogen ecology and livestock management practices. Cattle can increase risk of exposure to infections spread by tsetse flies and ticks, followed by sandflies and mosquitoes, through a variety of mechanisms. However, cattle can have a protective effect when the vector prefers to feed on cattle instead of humans and when chemical control measures (e.g., acaricides/insecticides), semio-chemicals, and other integrated vector control measures are utilized in the community. We highlight that further research is needed to determine ways in which these mechanisms may be exploited to reduce VBD risk in humans.

Farmers' Knowledge and Practices About Ticks and Tickborne Diseases in Illinois.

OBJECTIVE: Tickborne diseases (TBDs) in Illinois have increased in recent years. A growing body of literature indicates that the risk of exposure to ticks and tickborne diseases is higher among outdoor workers, including farmers. However, information is lacking on awareness of ticks and tickborne diseases among this demographic. This study aimed to determine the knowledge and awareness among Illinois farmers regarding ticks and tickborne diseases. METHODS: A Knowledge, Attitudes & Prevention practices (KAP) survey was developed and administered to capture information regarding farmers' knowledge and attitudes about ticks and TBDs. Tick drags were conducted on a subset of properties as an incentive to complete the survey and to compare farmers' knowledge or expectations of ticks on their land with ticks collected. RESULTS: Fifty farmers participated in the survey, and 17 allowed tick drags. Only 60% of respondents had at least moderate knowledge about ticks gained through family and friends (56%), medical and healthcare personnel (48%), and the internet (44%). Responses varied by the type of commodity produced by the farmer. Fifty percent of participants reported knowledge about the blacklegged tick, 34% for the American dog tick, and 42% for the lone star tick; this knowledge also varied by farm type. Most farmers (54%) agreed that preventative behaviors could protect against tickborne diseases. Self-reported knowledge was significantly and directly associated with knowledge scores (p < .001). CONCLUSION: Knowledge of ticks and TBDs was lower among crop farmers than beef or mixed commodity farmers, but farmers generally have moderate knowledge of tick species in Illinois. Many participants expressed low concern over contracting a TBD, but many were also dissatisfied with the level of tick prevention measures that they follow. These results can be utilized to fill in knowledge gaps and develop informational materials to help farmers protect themselves against ticks and TBDs.

Impact of Unexplored Data Sources on the Historical Distribution of Three Vector Tick Species in Illinois.

We updated the Illinois historical (1905-December 2017) distribution and status (not reported, reported or established) maps for Amblyomma americanum (L.) (Acari: Ixodidae), Dermacentor variabilis (Say) (Acari: Ixodidae), and Ixodes scapularis (Say) (Acari: Ixodidae) by compiling publicly available, previously unexplored or newly identified published and unpublished data (untapped data). Primary data sources offered specific tick-level information, followed by secondary and tertiary data sources. For A. americanum, D. variabilis, and I. scapularis, primary data contributed to 90% (4,045/4,482), 80% (2,124/2,640), and 32% (3,490/10,898) tick records vs 10%, 20%, and 68%, respectively from secondary data; primary data updated status in 95% (62/65), 94% (51/54) and in 90% (9/10) of the updated counties for each of these tick species; by 1985 there were tick records in 6%, 68%, and 0% of the counties, compared to 20%, 72%, and 58% by 2004, and 77%, 96%, and 75% of the counties by 2017, respectively for A. americanum, D. variabilis, and I. scapularis. We document the loss of tick records due to unidentified, not cataloged tick collections, unidentified ticks in tick collections, unpublished data or manuscripts without specific county location, and tick-level information, to determine distribution and status. In light of the increase in tick-borne illnesses, updates in historical distributions and status maps help researchers and health officials to identify risk areas for a tick encounter and suggest targeted areas for public outreach and surveillance efforts for ticks and tick-borne diseases. There is a need for a systematic, national vector surveillance program to support research and public health responses to tick expansions and tick-borne diseases.

Primary palliative care competency framework for primary care and family physicians in India-Collaborative work by Indian Association of Palliative Care and Academy of Family Physicians of India.

The discrepancy in the demand for palliative care and distribution of specialist palliative care services will force patients to be eventually cared for by primary care/family physicians in the community. This will necessitate primary care/family physicians to equip themselves with knowledge and skills of primary palliative care. Indian National Health Policy (2017) recommended the creation of continuing education programs as a method to empower primary care/family physicians. With this intention, a taskforce was convened for incorporating primary palliative care into family/primary care practice. The taskforce comprising of National and International faculties from Palliative Care and Family Medicine published a position paper in 2018 and subsequently brainstormed on the competency framework required for empowering primary care/family physicians. The competencies were covered under the following domains: knowledge, skills and attitude, ethical and legal aspects, communication and team work. The competency framework will be presented to the National Board of Examinations recommending to be incorporated in the DNB curriculum for Family Medicine.

Joint position statement Indian Association of Palliative Care and Academy of Family Physicians of India - The way forward for developing community-based palliative care program throughout India: Policy, education, and service delivery considerations.

PURPOSE: This joint position statement, by the Indian Association of Palliative Care (IAPC) and Academy of Family Physicians of India (AFPI), proposes to address gaps in palliative care provision in the country by developing a community-based palliative care model that will empower primary care physicians to provide basic palliative care. EVIDENCE: India ranks very poorly, 67th of 80 countries in the quality of death index. Two-thirds of patients who die need palliative care and many such patients spend the last hours of life in the Intensive care unit. The Indian National Health Policy (NHP) 2017 and other international bodies endorse palliative care as an essential health-care service component. NHP 2017 also recommends development of distance and continuing education options for general practitioners to upgrade their skills to provide timely interventions and avoid unnecessary referrals. METHODS: A taskforce was formed with Indian and International expertise in palliative care and family medicine to develop this paper including an open conference at the IAPC conference 2017, agreement of a formal liaison between IAPC and AFPI and wide consultation leading to the development of this position paper aimed at supporting integration, networking, and joint working between palliative care specialists and generalists. The WHO model of taking a public health approach to palliative care was used as a framework for potential developments; policy support, education and training, service development, and availability of appropriate medicines. RECOMMENDATIONS: This taskforce recommends the following (1) Palliative care should be integrated into all levels of care including primary care with clear referral pathways, networking between palliative care specialist centers and family medicine physicians and generalists in community settings, to support education and clinical services. (2) Implement the recommendations of NHP 2017 to develop services and training programs for upskilling of primary care doctors in public and private sector. (3) Include palliative care as a mandatory component in the undergraduate (MBBS) and postgraduate curriculum of family physicians. (4) Improve access to necessary medications in urban and rural areas. (5) Provide relevant in-service training and support for palliative care to all levels of service providers including primary care and community staff. (6) Generate public awareness about palliative care and empower the community to identify those with chronic disease and provide support for those choosing to die at home.