Research and Advanced Education
Masters Course In Emerging Infectious Diseases (2003-2009)
A SUCCESS STORY IN ADVANCED TRAINING AT THE FACULTY OF MEDICINE OF THE UNIVERSITY OF LISBON
1. INTRODUCTION
In 1962, Sir Macfarlane Burnet declared that the battle against infectious diseases had been won (1), reflecting what was thought by some experts in infectious diseases at the time. The post-war optimism, with the appearance of antibiotics, vaccines and insecticides, had led to a belief that infectious diseases in Man were under control and that this tendency would increase. This led to the beginning of a period of complacency in relation to infectious diseases. Public health priorities became directed towards chronic diseases, for which a cause was understood. The public health infrastructures deteriorated, and recent years have seen an increase in known infectious diseases, as well as new infectious diseases or ones that had not previously been recognised. In 1997 about one thirds of the deaths in the world were caused by infectious diseases (2).
About thirty previously unknown diseases have appeared over the last three decades, for which there are no efficient treatments. Infectious diseases do not respect borders, so an emerging disease in one part of the world has to be seen as potentially important for any other region or country. HIV infection was only recognized at the beginning of the eighties. At the end of 2007, according to an estimate by the Joint United Nations Programs on HIV/AIDS (UNAIDS), over 33 million people had been infected by HIV, and only in 2007 about three million people were affected by this pandemic.
In 1918, on the world level, the flu pandemic led to the death of 25 million people. The current pandemic provoked by the Swine Flu virus (H1N1) 2009, the first flu pandemic of the XXI century, is in its second wave, and we do not know what its impact will be on morbility and mortality nor its influence on the world economy.
Infection by the Ebola virus emerged in the Sudan and in Zaire in 1976. Up until now these epidemics have been restricted to a limited number of geographical areas.
The variant strain of the Creutzfeldt-Jackob was recognised for the first time in 1996, and one still does not know the true dimension of the problem.
The appearance of new emerging infectious diseases seems to be inevitable given the dynamic balance between micro-organisms and Man and the recent alterations in human behaviour and in the environment.
Growth in the world population (about 10 billions in 2050), global warming (with the increase of the population of vectors and hosts to infectious diseases), alterations in farming practices and the consequent deforestation, alterations in lifestyle, technological advances and alterations in sexual behaviour are the determining factors for the emerging and re-emerging of infectious diseases.
The possibility of genetic alterations in the etiological agents themselves may be an important factor in the emerging of some diseases, with the classic example being that of influenza. Bacterial resistance to pharmaceuticals, including the worrying resistance of Mycobacterium tuberculosis, are examples of how resistance to antibiotics has affected the emerging of some diseases (2-7).
Complacency resulting from the general consideration that infectious diseases were no more than an important public health problem resulted in a reducing in investment in infectious diseases. Public health infrastructures started to deteriorate, and in the eighties they were in a critical state in most countries in the world (8).
Existing knowledge about some infectious diseases is enough for the developing of efficient prevention and control programmes. The most important one would probably be to invert the demographic growth of the last fifty years. However, the impact of emerging infectious diseases may be less is the public health structures were reactivated in order to be able to deal with these diseases effectively. On the other hand, one needs to go back to thinking about disease prevention through adequate financing and political will for the development and implementation of prevention strategies.
2. MASTERS COUNCIL, STUDY PLAN AND TEACHING STAFF
The Masters Council, coordinated by Professor Francisco Antunes, is made up of Professor Rui Victorino, Doctor Teresa Paixão, Professor Maria do Carmo Fonseca, Professor Melo Cristino, Professor Olga Matos, Professor Ana Espada de Sousa and Professor Emília Valadas. The Masters Assistant in Emerging Infectious Diseases is António Santos (MSc), from the Masters and PhDs Office in the Institute of Advanced Training of the Faculty of Medicine of the University of Lisbon.
The study plan for the Masters Course in Emerging Infectious Diseases is made up of the following modules:
Approximately seventy teachers participate in this masters course, of which over half of them, about 40 (57%) are from outside the University of Lisbon and about 15 (21%) are foreign, not just from other European countries, but also from the United States of America and from Africa.
3. CHARACTERISATION OF THE MASTERS STUDENTS AND RESULTS OBTAINED
The Masters Course in Emerging Infectious Diseases was created on the 19th of April 2002, with its first edition in 2003, with 13 students being chosen. In this first edition all the students were approved in the curricular component, and all of them except one defended a Masters thesis (Fotografia). This academic year was the beginning of the seventh edition (the first edition of the second Bologna-adapted Study Cycle), with 15 students, four of whom have a first degree in medicine, and one of them being a doctor in Mozambique (up to now three students from the Portuguese-speaking countries have enrolled in the Masters Course). Of the 103 students who have enrolled in the seven editions of the Masters Course in Emerging Infectious Diseases (figure 1 shows the different areas of first degrees), 42% have been directly linked to the area of health; that is doctors and nurses, of whom 72% doctors. In the present edition, out of the fifteen students, four are doctors and two are nurses, which represents 40% of those enrolled.
Of the 88 who attended the first six editions of the Masters Course in Emerging Infectious Diseases, 96% were successful in the curricular component, with 15 on 20 being the average mark. In the first three editions (2003/2004/2005), which are now concluded, out of the 44 students enrolled, 59% defended the Masters thesis, all successfully. Figure 2 shows the distribution of the number of students enrolled and the number of students approved over the first three editions. Despite the final results obtained in the third edition, with a success rate of 31%, which was far lower than the 98% and 67%, respectively, of the first and second editions, the overall success rate in the first three editions was 61%.
Figure 1. Distribution of the 103 students enrolled in the Masters Course in Emerging Infectious Diseases, by areas of first degree course
Figure 1. Distribution of the number of students enrolled and of the number of students who obtained pass grades in their defence of Masters theses, for the first three editions (2003, 2004 and 2005) of the Masters Course in Emerging Infectious Diseases
4. CREATION OF THE PHD PROGRAMME IN EMERGING INFECTIOUS DISEASES
Through Legal Dispatch nº 12994/2009, of the 2nd of June, and approved by the Chancellor’s Dispatch nº R-55-2008(8), of the 19th of December, saw the creating of the PhD Programme in Emerging Infectious Diseases. The University of Lisbon will from then on grant the title of PhD through the PhD Programme in Emerging Infectious Diseases:
1. In the area of medical knowledge, in the specialty of Infectious and Parasite-born Diseases
2. In the area of knowledge in Health Sciences and technologies, in the specialty of Epidemiology and Microbiology
3. In the area of knowledge of Biomedical Sciences, in the specialty of Epidemiology
The creating of the PhD Programme in Emerging Infectious Diseases naturally reflects the success of the Masters Programme, from which it emerged.
Francisco Antunes
ip231874@sapo.pt
Emília Valadas
evaladas@fm.ul.pt
António Santos
antoniosantos@fm.ul.pt
5. BIBLIOGRAPHY
1. Burnet, Sir Macfarlane. Natural History of Infectious Diseases. 3rd Edition. Cambridge University Press, New York, N.Y., 1962:1-377.
2. WHO. The World Report. Life in the 21st century: A vision for all. World Health Organization, Geneva, Switzerland, 1998: 1-241.
3. World Resources. The Urban Environment. Oxford University Press, New York, N-Y., 1996: 1-365.
4. Murphy FA. Emerging zoonoses. Emerg Infect Dis 1998; 4: 429-35.
5. Reiter P, Sprenger D. The used tire trade: A mechanism for the worldwide dispersal of container breeding mosquitoes. J Am Mosqu Cont Associ 1987, 3:15-26.
6. Osterholm MT. Emerging infectious diseases. A real public health crisis? Post Graduate Med 1996, 5:15-26.
7. Gubler DJ. Resurgent vector-borne diseases as a global health problem. Emerg Infect Dis 1998; 4:442-50.
8. Lederberg J, Shope RE, Oaks SC (eds.) Emerging Infections. In. Microbial Threats to Health in the United States. (1992) National Academy Press, Washington, D.C., 1992:1-298.
1. INTRODUCTION
In 1962, Sir Macfarlane Burnet declared that the battle against infectious diseases had been won (1), reflecting what was thought by some experts in infectious diseases at the time. The post-war optimism, with the appearance of antibiotics, vaccines and insecticides, had led to a belief that infectious diseases in Man were under control and that this tendency would increase. This led to the beginning of a period of complacency in relation to infectious diseases. Public health priorities became directed towards chronic diseases, for which a cause was understood. The public health infrastructures deteriorated, and recent years have seen an increase in known infectious diseases, as well as new infectious diseases or ones that had not previously been recognised. In 1997 about one thirds of the deaths in the world were caused by infectious diseases (2).
About thirty previously unknown diseases have appeared over the last three decades, for which there are no efficient treatments. Infectious diseases do not respect borders, so an emerging disease in one part of the world has to be seen as potentially important for any other region or country. HIV infection was only recognized at the beginning of the eighties. At the end of 2007, according to an estimate by the Joint United Nations Programs on HIV/AIDS (UNAIDS), over 33 million people had been infected by HIV, and only in 2007 about three million people were affected by this pandemic.
In 1918, on the world level, the flu pandemic led to the death of 25 million people. The current pandemic provoked by the Swine Flu virus (H1N1) 2009, the first flu pandemic of the XXI century, is in its second wave, and we do not know what its impact will be on morbility and mortality nor its influence on the world economy.
Infection by the Ebola virus emerged in the Sudan and in Zaire in 1976. Up until now these epidemics have been restricted to a limited number of geographical areas.
The variant strain of the Creutzfeldt-Jackob was recognised for the first time in 1996, and one still does not know the true dimension of the problem.
The appearance of new emerging infectious diseases seems to be inevitable given the dynamic balance between micro-organisms and Man and the recent alterations in human behaviour and in the environment.
Growth in the world population (about 10 billions in 2050), global warming (with the increase of the population of vectors and hosts to infectious diseases), alterations in farming practices and the consequent deforestation, alterations in lifestyle, technological advances and alterations in sexual behaviour are the determining factors for the emerging and re-emerging of infectious diseases.
The possibility of genetic alterations in the etiological agents themselves may be an important factor in the emerging of some diseases, with the classic example being that of influenza. Bacterial resistance to pharmaceuticals, including the worrying resistance of Mycobacterium tuberculosis, are examples of how resistance to antibiotics has affected the emerging of some diseases (2-7).
Complacency resulting from the general consideration that infectious diseases were no more than an important public health problem resulted in a reducing in investment in infectious diseases. Public health infrastructures started to deteriorate, and in the eighties they were in a critical state in most countries in the world (8).
Existing knowledge about some infectious diseases is enough for the developing of efficient prevention and control programmes. The most important one would probably be to invert the demographic growth of the last fifty years. However, the impact of emerging infectious diseases may be less is the public health structures were reactivated in order to be able to deal with these diseases effectively. On the other hand, one needs to go back to thinking about disease prevention through adequate financing and political will for the development and implementation of prevention strategies.
2. MASTERS COUNCIL, STUDY PLAN AND TEACHING STAFF
The Masters Council, coordinated by Professor Francisco Antunes, is made up of Professor Rui Victorino, Doctor Teresa Paixão, Professor Maria do Carmo Fonseca, Professor Melo Cristino, Professor Olga Matos, Professor Ana Espada de Sousa and Professor Emília Valadas. The Masters Assistant in Emerging Infectious Diseases is António Santos (MSc), from the Masters and PhDs Office in the Institute of Advanced Training of the Faculty of Medicine of the University of Lisbon.
The study plan for the Masters Course in Emerging Infectious Diseases is made up of the following modules:
Approximately seventy teachers participate in this masters course, of which over half of them, about 40 (57%) are from outside the University of Lisbon and about 15 (21%) are foreign, not just from other European countries, but also from the United States of America and from Africa.
3. CHARACTERISATION OF THE MASTERS STUDENTS AND RESULTS OBTAINED
The Masters Course in Emerging Infectious Diseases was created on the 19th of April 2002, with its first edition in 2003, with 13 students being chosen. In this first edition all the students were approved in the curricular component, and all of them except one defended a Masters thesis (Fotografia). This academic year was the beginning of the seventh edition (the first edition of the second Bologna-adapted Study Cycle), with 15 students, four of whom have a first degree in medicine, and one of them being a doctor in Mozambique (up to now three students from the Portuguese-speaking countries have enrolled in the Masters Course). Of the 103 students who have enrolled in the seven editions of the Masters Course in Emerging Infectious Diseases (figure 1 shows the different areas of first degrees), 42% have been directly linked to the area of health; that is doctors and nurses, of whom 72% doctors. In the present edition, out of the fifteen students, four are doctors and two are nurses, which represents 40% of those enrolled.
Of the 88 who attended the first six editions of the Masters Course in Emerging Infectious Diseases, 96% were successful in the curricular component, with 15 on 20 being the average mark. In the first three editions (2003/2004/2005), which are now concluded, out of the 44 students enrolled, 59% defended the Masters thesis, all successfully. Figure 2 shows the distribution of the number of students enrolled and the number of students approved over the first three editions. Despite the final results obtained in the third edition, with a success rate of 31%, which was far lower than the 98% and 67%, respectively, of the first and second editions, the overall success rate in the first three editions was 61%.
Figure 1. Distribution of the 103 students enrolled in the Masters Course in Emerging Infectious Diseases, by areas of first degree course
Figure 1. Distribution of the number of students enrolled and of the number of students who obtained pass grades in their defence of Masters theses, for the first three editions (2003, 2004 and 2005) of the Masters Course in Emerging Infectious Diseases
4. CREATION OF THE PHD PROGRAMME IN EMERGING INFECTIOUS DISEASES
Through Legal Dispatch nº 12994/2009, of the 2nd of June, and approved by the Chancellor’s Dispatch nº R-55-2008(8), of the 19th of December, saw the creating of the PhD Programme in Emerging Infectious Diseases. The University of Lisbon will from then on grant the title of PhD through the PhD Programme in Emerging Infectious Diseases:
1. In the area of medical knowledge, in the specialty of Infectious and Parasite-born Diseases
2. In the area of knowledge in Health Sciences and technologies, in the specialty of Epidemiology and Microbiology
3. In the area of knowledge of Biomedical Sciences, in the specialty of Epidemiology
The creating of the PhD Programme in Emerging Infectious Diseases naturally reflects the success of the Masters Programme, from which it emerged.
Francisco Antunes
ip231874@sapo.pt
Emília Valadas
evaladas@fm.ul.pt
António Santos
antoniosantos@fm.ul.pt
5. BIBLIOGRAPHY
1. Burnet, Sir Macfarlane. Natural History of Infectious Diseases. 3rd Edition. Cambridge University Press, New York, N.Y., 1962:1-377.
2. WHO. The World Report. Life in the 21st century: A vision for all. World Health Organization, Geneva, Switzerland, 1998: 1-241.
3. World Resources. The Urban Environment. Oxford University Press, New York, N-Y., 1996: 1-365.
4. Murphy FA. Emerging zoonoses. Emerg Infect Dis 1998; 4: 429-35.
5. Reiter P, Sprenger D. The used tire trade: A mechanism for the worldwide dispersal of container breeding mosquitoes. J Am Mosqu Cont Associ 1987, 3:15-26.
6. Osterholm MT. Emerging infectious diseases. A real public health crisis? Post Graduate Med 1996, 5:15-26.
7. Gubler DJ. Resurgent vector-borne diseases as a global health problem. Emerg Infect Dis 1998; 4:442-50.
8. Lederberg J, Shope RE, Oaks SC (eds.) Emerging Infections. In. Microbial Threats to Health in the United States. (1992) National Academy Press, Washington, D.C., 1992:1-298.