Major RNA types and their features
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 179 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 252 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
\n'}],latestNews:[{slug:"stanford-university-identifies-top-2-scientists-over-1-000-are-intechopen-authors-and-editors-20210122",title:"Stanford University Identifies Top 2% Scientists, Over 1,000 are IntechOpen Authors and Editors"},{slug:"intechopen-authors-included-in-the-highly-cited-researchers-list-for-2020-20210121",title:"IntechOpen Authors Included in the Highly Cited Researchers List for 2020"},{slug:"intechopen-maintains-position-as-the-world-s-largest-oa-book-publisher-20201218",title:"IntechOpen Maintains Position as the World’s Largest OA Book Publisher"},{slug:"all-intechopen-books-available-on-perlego-20201215",title:"All IntechOpen Books Available on Perlego"},{slug:"oiv-awards-recognizes-intechopen-s-editors-20201127",title:"OIV Awards Recognizes IntechOpen's Editors"},{slug:"intechopen-joins-crossref-s-initiative-for-open-abstracts-i4oa-to-boost-the-discovery-of-research-20201005",title:"IntechOpen joins Crossref's Initiative for Open Abstracts (I4OA) to Boost the Discovery of Research"},{slug:"intechopen-hits-milestone-5-000-open-access-books-published-20200908",title:"IntechOpen hits milestone: 5,000 Open Access books published!"},{slug:"intechopen-books-hosted-on-the-mathworks-book-program-20200819",title:"IntechOpen Books Hosted on the MathWorks Book Program"}]},book:{item:{type:"book",id:"6529",leadTitle:null,fullTitle:"Bismuth - Advanced Applications and Defects Characterization",title:"Bismuth",subtitle:"Advanced Applications and Defects Characterization",reviewType:"peer-reviewed",abstract:"Bismuth (Bi) is a post-transition metal element with the atomic number of 83, which belongs to the pnictogen group elements in Period 6 in the elemental periodic table. 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The use of ultrasound in regional anesthesia has shown the reduction of complications, which makes it mandatory to knowledge and acquire skills in all ultrasound-guided techniques.
\r\n\r\n\tUltrasound-guided regional blocks will be reviewed extensively, as well as intravenous regional anesthesia, thoracic spinal anesthesia. The role of regional anesthesia and analgesia in critically ill patients is of paramount importance. In addition, we will review the current role of regional techniques during the Covid-19 pandemic. Complications and malpractice is another topic that should be reviewed. Regional anesthesia procedures in some specialties such as pediatrics, orthopedics, cancer surgery, neurosurgery, acute and chronic pain will be discussed.
",isbn:"978-1-83969-570-4",printIsbn:"978-1-83969-569-8",pdfIsbn:"978-1-83969-571-1",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,hash:"264f7f37033b4867cace7912287fccaa",bookSignature:"Prof. Víctor M. Whizar-Lugo and Dr. José Ramón Saucillo-Osuna",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/10708.jpg",keywords:"Regional Anesthesia, Ultrasound-Guided Regional Anesthesia, Local Anesthetics, Preventive Analgesia, Peripheral Blocks, Pediatric Regional Anesthesia, Intravenous Regional Anesthesia, Techniques, Complications, Adjuvants in Regional Anesthesia, Opioids, Alfa2 Agonists",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"February 23rd 2021",dateEndSecondStepPublish:"March 23rd 2021",dateEndThirdStepPublish:"May 22nd 2021",dateEndFourthStepPublish:"August 10th 2021",dateEndFifthStepPublish:"October 9th 2021",remainingDaysToSecondStep:"18 days",secondStepPassed:!1,currentStepOfPublishingProcess:2,editedByType:null,kuFlag:!1,biosketch:"Dr. Whizar-Lugo has published more than 100 publications on Anesthesia, Pain, Critical Care, and Internal Medicine. He works as an anesthesiologist at Lotus Med Group and belongs to the Institutos Nacionales de Salud as an associated researcher.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"169249",title:"Prof.",name:"Víctor M.",middleName:null,surname:"Whizar-Lugo",slug:"victor-m.-whizar-lugo",fullName:"Víctor M. Whizar-Lugo",profilePictureURL:"https://mts.intechopen.com/storage/users/169249/images/system/169249.jpg",biography:"Víctor M. Whizar-Lugo graduated from Universidad Nacional Autónoma de México and completed residencies in Internal Medicine at Hospital General de México and Anaesthesiology and Critical Care Medicine at Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in México City. He also completed a fellowship at the Anesthesia Department, Pain Clinic at University of California, Los Angeles, USA. Currently, Dr. Whizar-Lugo works as anesthesiologist at Lotus Med Group, and belongs to the Institutos Nacionales de Salud as associated researcher. He has published many works on anesthesia, pain, internal medicine, and critical care, edited four books, and given countless conferences in congresses and meetings around the world. He has been a member of various editorial committees for anesthesiology journals, is past chief editor of the journal Anestesia en México, and is currently editor-in-chief of the Journal of Anesthesia and Critical Care. 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Dr. Saucillo-Osuna has lectured at multiple national and international congresses and is an adjunct professor at the Federación Mexicana de Colegios de Anestesiología, AC, former president of the Asociación Mexicana de Anestesia Regional, and active member of the Asociación Latinoamericana de Anestesia Regional.",institutionString:"Centro Médico Nacional de Occidente",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:null},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"16",title:"Medicine",slug:"medicine"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"347258",firstName:"Marica",lastName:"Novakovic",middleName:null,title:"Dr.",imageUrl:"//cdnintech.com/web/frontend/www/assets/author.svg",email:"marica@intechopen.com",biography:null}},relatedBooks:[{type:"book",id:"6550",title:"Cohort Studies in Health Sciences",subtitle:null,isOpenForSubmission:!1,hash:"01df5aba4fff1a84b37a2fdafa809660",slug:"cohort-studies-in-health-sciences",bookSignature:"R. 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Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"878",title:"Phytochemicals",subtitle:"A Global Perspective of Their Role in Nutrition and Health",isOpenForSubmission:!1,hash:"ec77671f63975ef2d16192897deb6835",slug:"phytochemicals-a-global-perspective-of-their-role-in-nutrition-and-health",bookSignature:"Venketeshwer Rao",coverURL:"https://cdn.intechopen.com/books/images_new/878.jpg",editedByType:"Edited by",editors:[{id:"82663",title:"Dr.",name:"Venketeshwer",surname:"Rao",slug:"venketeshwer-rao",fullName:"Venketeshwer Rao"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"4816",title:"Face Recognition",subtitle:null,isOpenForSubmission:!1,hash:"146063b5359146b7718ea86bad47c8eb",slug:"face_recognition",bookSignature:"Kresimir Delac and Mislav Grgic",coverURL:"https://cdn.intechopen.com/books/images_new/4816.jpg",editedByType:"Edited by",editors:[{id:"528",title:"Dr.",name:"Kresimir",surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"44276",title:"Genomic Rearrangements and Evolution",doi:"10.5772/55456",slug:"genomic-rearrangements-and-evolution",body:'All genomes in living organisms can change under influence of internal or external factors. That is why genomic materials are commonly defined as dynamic entities and it is believed that they have been repeatedly altered and rearranged since the beginning of the life on the planet [1-4]. Understanding this dynamism is a valuable key to unlock the chest of the mysterious existence story in an evolutionary manner. Therefore, a lot of studies have been conducted on the dynamism of genomic materials in organisms and the count of related researches has gradually risen by the day. An enormous data from these studies call attention to recombinational, tranpositional and mutational processes as three main sources of genomic changes [1,2,5-18].
Recombinational changes of genomes are mainly dependent on internal factors which are closely associated with a great many of intracellular and intercellular interactions. Enzyme catalyzed pathways and predetermined timing are the most descriptive properties for many types of recombination events. For instance, usual meiotic crossing over, the best known recombinational event, always occurs under control of specified enzymatic reactions at a certain time period in the cell cycle [2,4,19-22].
Transpositional events are also important sources for sequential rearrangements in genomes and induced by external or internal genomic material pieces that are described as mobile or transposable elements. In mechanism of transposition, a transposable element changes its relative position within the genome. “Copy and Paste” or “Cut and Paste” postulates work in this process. A transpositional event occurring with the copy and paste mechanism is called as replicative transposition that a transposable element is duplicated during the process and copied sequence transferred into the target genomic sequence, and the other one with the cut and paste mechanism is called as non-replicative transposition that duplication of the transposable element does not occur and the original sequence is transferred from one region into another [5,23-24]. In both cases, a transpositional event is commonly resulted in a mutational phenomenon and alteration in genomic sizes that makes them attractive for genomic evolution studies [6-7,23-26].
Mutations are described as sudden changes in genomic materials induced by internal and external factors [27]. They have importance in medicinal, agricultural and other related researches due to their deleterious, beneficial or functional effects on organisms [5,9,28]. Moreover, enormous potential for construction of novel genes and other types of genomic sequences, they are considered as the most attractive subject for genome evolution [2,29-32].
Genetic recombination is a process that is catalyzed by many different enzymes called as recombinases. It can take place in all living cells from bacteria to eukaryota as well as viral genomes. This process mainly results in DNA repair, genomic rearrangements, variations and evolutional forces. Genetic recombinations are assigned to one of two groups according to their mechanism, which can be described as either homologous or non-homologous recombination [2,4,20,22,33-35].
Homologous recombinational events are sequential changes that occur between similar or identical parts of genomic material. In the beginning of 20th century, initial descriptions of homologous recombinations were introduced by W. Bateson and R. Punnett to explain diversions from predicted Mendelian inheritance phenotypic ratios [4,36-37]. This process, which is commonly found in many organisms from bacteria to higher organized eukaryotes, plays a significant role in DNA repair mechanisms and genome evolution by producing variations [2,38-40].
In prokaryotic cellular organisms, the most known types of homologous recombinational events are transformation, conjugation and transduction [41]. All of these events are resulted in genomic variations that have great value for evolution [42].
Transformation was discovered by Frederick Griffith in the late 1920s. His transformation experiments are considered as the beginning mile stone of the molecular biology discipline [5]. In the mechanism of natural prokaryotic transformation, a naked DNA fragment released from a cell is taken up by another under appropriate conditions, thus an exogenous genetic material is introduced into a prokaryotic cell that result in genomic variation. Transformation occurs in several groups of Gram positive, Gram negative and Archaea. A healthy double strand DNA molecule with a homological property and specific size (mostly smaller than 1000 nucleotides) is the most fundamental requirement for transformation [2,41]. Figure 1 illustrates a summarized scheme for transformation.
Simple mechanism of transformation
Bacterial conjugation, discovered in 1946 by Joshua Lederberg and Edward Tatum [43], is another process to transfer the genetic information in Prokaryotes. In its mechanism, the transfer of genetic material involves cell to cell contact and a plasmid encoded pathway. The process occurs between a donor cell, which includes a certain type of conjugative plasmid, and a recipient cell, which does not. In this process, the plasmid plays a key role by carrying all related genes on tra region. These genes encode the sex pilus (F pili) formation, which allow specific pairing to take place between the donor cell and the recipient cell. After generation of sex pilus mediated cell to cell contact, a copy of the plasmid is transferred to the recipient under control of various enzyme systems encoded by tra region. In most cases, this type of recombination does not cause genetic variation at high level because the transferred genetic information is restricted by sequential contents of the plasmid. However, in certain circumstances, conjugative plasmid may integrate into the main genomic material, resulting in the formation of Hfr (High Frequency Recombination) cells. These cells, commonly seen in Gram negative bacterial groups, have significant potential for recombination at higher levels due to leading transfer of genes from the host chromosome [2,41]. Figure 2 shows regular bacterial conjugation events and Hfr formation.
An illustrative scheme for bacterial conjugation of F+ (a) and Hfr (b) cells
Transduction, initially discovered by Norton Zinder and Joshua Lederberg in 1951 [44], refers to virus-mediated transfers of genetic materials. There are two fundamental mechanisms as generalized and specialized transduction. In generalized transduction, any bacterial genomic sequence may be transferred to another bacterium via a modified bacteriophage that accidentally involves bacterial DNA instead of viral DNA. However, in specialized transduction, bacteriophage includes both bacterial and viral DNA at the same time [2,41]. Both types of transduction events are summarized at Figure 3.
In eukaryotic organisms, meiotic crossing over (chromosomal cross over) is the most well-known example for homologous recombination. This event occurs between homologous chromosomes at prophase I stage in meiosis and results in variation of genetic materials [2,5,45-46]. The scheme of meiotic crossing over is showed in Figure 4.
Mechanism of generalized (a) and specialized (b) transduction events
Mechanism of meiotic crossing over
Homologous recombination also plays a significant role in DNA repair mechanisms in both prokaryotic and eukaryotic organisms. It is one of the major DNA repair processes in bacteria [2,46]. For example, double-strand breaks in bacteria are repaired by the RecBCD pathway of homologous recombination [42,47-49]. Moreover, it is well known that similar mechanisms work in eukaryotic organisms.
Homologous recombination also includes non-allelic ones that have been not well documented. These events occur between sequences arisen from duplications or deletions that show high homology, but are not alleles. It is believed that non-allelic homologous recombination has a great importance for evolution due to generating a decrease or an increase in copy number of sequences [50-52].
Non-homologous recombination, also named as non-homologous end joining (NHEJ), is a pathway that mainly associated with DNA repair that especially works on double strand breaks. Contrary to the mechanisms of homologous recombination, it does not require sequential homology. However, this pathway has been identified in many groups of living organisms from bacteria to multicellular organisms, even in human being, recent studies have mainly focused on eukaryotes much more than bacteria. One reason for this is that prokaryotic DNA repair is heavily done by various processes of homologous recombination.
Nuclease, polymerase and ligase activities play the major role in NHEJ process. Despite its conservative mechanism, this process is generally resulting in variations of genetic materials [2,53-55].
Mobile genetic elements are described as DNA segments that can move within the genome. These include transposons, group II introns, plasmids and viral elements [56]. All these events result in genomic alterations that cause rising of evolutional forces [6,8,24-26,57-61].
Transposons, also named as transposable elements, are major forces in the evolution and rearrangement of genomes [6,26,56]. Discovery of transposable elements was achieved in 1943 by Barbara McClintock who was awarded with a Nobel Prize after 40 years in 1983 [2,58]. Since that time, the importance of transposons has been well established and much more attention has been given to their formation and consequences [62]. To get more easily comprehensive information, they are divided into three main groups as retrotransposons, DNA transposons and insertion sequences.
Retrotransposons can be considered as the biggest group of transposable elements due to their abundance in many eukaryotic genomes (i.e. 49-78% of the total genome in maize and 42% in human) [63-64]. The term “retrotransposon” is attributed to the transposition mechanism that involves via RNA intermediates. In the mechanism, a retrotransposon is initially copied to RNA (transcription), then converted to DNA (reversetranscription) and finally inserted to the genome (integration), and this process is mainly under control of the gene region of retrotransposons encoding reverse transcriptase. These elements can increase genome size and induce mutational events by disturbing genes [2,24,26,56,59,62,65].
Retrotransposons are divided into three main groups according to the operation mechanisms: long terminal repeats (LTRs) encode reverse transcriptase, similar to retroviruses; long interspersed elements (LINEs) do not have LTRs and encode reverse transcriptase and small interspersed elements (SINEs) do not encode reverse transcriptase. LINEs and SINEs are transcripted by RNA polymerase II and III, respectively [66-68].
DNA transposons are the first discovered ones of transposable elements, initially named as “jumping genes” by Barbara McClintock in 1943 [69]. These are also called as Class II transposons, operate with a “cut and paste” mechanism. In this mechanism, transposition event mainly requires to transposase enzymes. Under control of the enzymatic processes, a DNA transposon is cut out of its location and inserted into a new location on the genome. Some transposases require a specific sequence as their target site; others can insert the transposon anywhere in the genomic material [2,24,41,62].
These are also known as IS elements. They are short DNA sequences that act as a simple form of transposable elements. Characterized properties of IS elements are that they have shorter sizes than other types of transposable elements (approximately 700 – 2500 bp), and carry some specific genes such as antibiotic resistance. Insertion sequences are usually flanked by inverted repeats [23,24,70].
Group II introns were discovered by Alexandre de Lencastre and his teammates in 2005 [71]. These elements, an important group of self-catalytic ribozymes, are generated during RNA splicing, and may cause genetic alterations [71].
Plasmids are circular and extra chromosomal genomic materials naturally found in bacteria, but rarely in several yeasts as eukaryotic organisms [41]. These elements show intracellular or intercellular mobility (see section 2.1.) that result in genomic alterations and evolutional forces.
Viral elements are genomic materials transferring between living organisms via virus infections. According to the mechanism of infection, viruses are divided into two categories as lytic and lysogenic. Lytic ones complete their eclipse phase in the cell and cause lysis of the host. However, lysogenic ones integrate their genomic materials into the host genome and directly cause genomic alterations [41]. For example, some retroviruses are common type of lysogenic viral elements and their effect mechanism is similar to retrotransposons.
The “Mutation” term was initially used by Hugo de Vries in 1905 to describe the phenotypic changes in evening-primrose plant (Oenothera lamarckiana). However, it commonly describes any sequential change in the genomic material of living organisms in the present day. Their various effects resulting in genotypic and phenotypic alterations that cause diseases, gaining or loss of advantageous or deleterious properties, attract the scientific attention on mutation focused investigations. In these researches, mutations are generally classified according to the effect mechanisms and size of effected genomic sequences to perform more apparent and comprehensive evaluations [1-3,5,29-31,34].
Effect size of mutations on genomes is one of the most widely-accepted criteria for classification. According to this, mutations can be divided into two groups named as gene mutations and chromosome mutations [5,27].
Gene mutations are small-scale mutations that effect one or few bases in a genome. However, they can induce many important phenomenon depend on properties of effected genomic sequences. For example, a gene mutation in a protein coding region of genomic material can result in synthesis of a non-functional protein that mostly causes deleterious effects for the organism. Gene mutations are also divide subcategories as base substitution and insertion/deletion [2,5,27,34].
Base Substitutions: They are also called as point mutations. These types of mutations are characterized by taking place of a different base instead of original one in the genome. When a purine base replaces with another purine or a pyrimidine base with another pyrimidine (A↔G or C↔T), it is called as transition. On the other hand, if a purine base replaces with a pyrimidine or a pyrimidine base with a purine (A↔C, A↔T, G↔C or G↔T), then it is called as transversion.
Base substitutions type of gene mutations
Insertions/Deletions: The insertion term means addition of one or few bases into a genomic material. Contrary to this, deletions are defined as removing of one or few bases from a genome.
Insertion/Deletions type of gene mutations
Chromosomal mutations are described as phenomenon that causes bigger sequence alterations than gene mutations. These are also called as macro-mutations due to their microscopically examination capabilities. There are two main subcategories as structural and numerical alterations in chromosomal mutations [5,9,27,34].
These types of mutations mainly cause alterations in chromosome numbers in the living cells. Euploidy and aneuploidy are two essential subgroups.
Euploidy: The word “euploidy” refers to cumulative alterations in chromosome numbers. For example, diploid (2n) chromosome number of an organism can be changed to tetraploid (4n) form after these kind of mutations.
Aneuploidy: The word “aneuploidy” refers to non-cumulative alterations in chromosome numbers. For example, diploid (2n) chromosome number of an organism can be changed to nullisomy (2n-2), monosomy (2n-1) or trisomy (2n+1) form after these kind of mutations.
These types of mutations do not change chromosome numbers. However, their effects are mainly on chromosomal structure. According to their effect mechanisms, structural mutations are grouped in four subcategories including deletions, inversions, duplications and translocations [5,9,27,72].
Deletions: Chromosomal deletions include losing of chromosomal pieces resulting in gene losses from the genome.
Inversions: An inversion refers to a phenomenon in which a chromosome break following by 180° rotation and reattachment of the broken piece on the same chromosomal region. It does not cause gene losses, but results in an inverted genetic material.
Duplications: Duplication is a case having two or more copies of a chromosomal region.
Translocations: These types of alterations are arisen from non-homologues chromosomal piece exchanges.
Structural chromosome mutations
The origin of life on the earth has always been an attractive subject for all human beings. The question about formation of the first active biomolecule is one of the most important perspectives in this subject, and has been heavily researched for many years. Initial studies referred to proteins as first biomolecules due to their catalytic activities that operates various reactions for maintaining of life. Although this view was confirmed for a long time, their lack of potential to carry genetic information was the major handicap. In 1982, the commonly accepted thought about the first biomolecule was drastically changed by Thomas Cech and co-workers who published a paper that demonstrate the single intron of the large ribosomal RNA of Tetrahymena thermophila has self-splicing activity in vitro. This was the first report about catalytic RNA molecules. A year later, Sydney Altman and co-workers pointed out that the RNA component of ribonuclease P (RNase P) from Escherichia coli is able to carry out processing of pre-tRNA in the absence of its protein subunit in vitro. These studies lead to formation of “RNA world” perspective in genome evolution, and both scientists were awarded by Nobel Prize in 1989. In the recent view, the RNA world term means that ribonucleic acids have both the informational function of DNA and the catalytic function of proteins at the same time [2,12,73-78]. According to this concept, various types of RNAs can be proposed as initial genomes evolved on the planet. Major RNA types and their characteristic properties are given in Table 1.
Although the first genome has a potential to be ribonucleic acid form, instability and limited life of RNA molecules may have forced evolution of a more complex genomic material called as deoxyribonucleic acid (DNA). In this stage, there are several gaps and unanswered questions. However, the most discussed scenario about formation of DNA based genomes from initial RNA molecules (protogenome) proposes a phenomenon that is catalyzed by a reverse transcriptase [2,78,84].
Contrary to the high stability property, evolutional changes are continuously occurring in DNA based genomes that result in development of valuable features for adaptation. These changes have been mainly dependent on external forces since the beginning of the life on the planet (approximately 3.5 billion years ago) [2]. Understanding of this evolutional dynamism in genomic materials requires recognizing definitions of several important terms given in Table 2, prepared according to Eugene V. Koonin (2005) who is senior investigator at National Central of Biotechnology Information (NCBI) and studies on empirical comparative and evolutionary genomics [8].
Up to this point, all mentioned events cause changes in size and construction of genomic materials acting as evolutional forces. The genomic size is referred as “C value”. Although the genomic size may reduce via deletions, it has generally intended to increase when compared to the first genome of universal common ancestor (UCA). This expansion is controlled by rearrangement forces, especially duplications and mobile genetic elements. There are two fundamental hypotheses for why genome sizes vary. According to the “Selfish-DNA hypothesis”: genome size expansion is due to insertion and proliferation selfish genetic elements such as retrotransposons, and “Bulk-DNA hypothesis”: having more genetic bulk can be adaptive because genome size effects nuclear volume, cell size, cell division rate in turn effecting developmental rate and size at maturity, thus it results in organisms with larger body size have larger cell sizes, and organisms with larger cells generally have larger genomes [15,24-26,63,65,68,85-90]. In his paper, Zhang [88] underlined the positive correlation between duplicated gene amount and evolutional status of an organism. Table 3 represents prevalence of gene duplications in all three domains of life.
\n\t\t\t\tType\n\t\t\t | \n\t\t\t\n\t\t\t\tFeatures\n\t\t\t | \n\t\t\t\n\t\t\t\tReferences\n\t\t\t | \n\t\t
mRNA (Messenger RNA) | \n\t\t\t- responsible for coding - represents 4% of whole RNA amount in a cell - called as hnRNA or pre-mRNA before processing in eukaryotes | \n\t\t\t[2] | \n\t\t
rRNA (Ribosomal RNA) | \n\t\t\t- composes ribosomes - the most abundant RNA in a cell (over 80%) - named as pre-rRNA before processing in all living organisms | \n\t\t\t[2] | \n\t\t
tRNA (Transfer RNA) | \n\t\t\t- responsible for carrying amino acids to ribosomal complexes - specific for each amino acid - named as pre-tRNA before processing and modification in all living organisms | \n\t\t\t[2] | \n\t\t
snRNA (Small Nuclear RNA) | \n\t\t\t- responsible for operation of splicing mechanism - found in nuclei of eukaryotes - also called as U-RNA - has a lot of sub-types with various catalytic activities | \n\t\t\t[2] | \n\t\t
snoRNA (Small Nucleolar RNA) | \n\t\t\t- responsible for chemical modification of rRNA - found in nucleolar region of eukaryotic nuclei - shows catalytic activities | \n\t\t\t[2] | \n\t\t
miRNA (MicroRNA) | \n\t\t\tresponsible for regulation of gene expression double strand molecule intracellular origin (nucleus) | \n\t\t\t[2] | \n\t\t
siRNA (Short Interfering RNA) | \n\t\t\t- responsible for regulation of gene expression - double strand molecule - extracellular origin (commonly synthetic) - called as small interfering or silencing RNA | \n\t\t\t[2] | \n\t\t
piRNA (Piwi-interacting RNA) | \n\t\t\t- interacts with piwi proteins - the largest class of small non-coding RNA molecules | \n\t\t\t[76] | \n\t\t
gRNA (Guide RNA) | \n\t\t\t- acts in mitochondrial mRNA processing - guides insertional or deletional events in mitochondrion | \n\t\t\t[77] | \n\t\t
tmRNA (Transfer-messenger RNA) | \n\t\t\t- have tRNA and mRNA properties - also known as 10Sa RNA - found in bacterial genomes | \n\t\t\t[78] | \n\t\t
shRNA (Small hairpin RNA) | \n\t\t\t- responsible for regulation of gene expression - makes a tight hairpin - extracellular origin | \n\t\t\t[79] | \n\t\t
stRNA (Small Temporal RNA) | \n\t\t\t- regulates gene expression (down regulation) | \n\t\t\t[80] | \n\t\t
Major RNA types and their features
\n\t\t\t\tHomologs\n\t\t\t | \n\t\t\t\n\t\t\t\tGenes sharing a common origin\n\t\t\t | \n\t\t
Orthologs | \n\t\t\tGenes originating from a single ancestral gene in the last common ancestor of the compared genomes. | \n\t\t
Pseudoorthologs | \n\t\t\tGenes that actually are paralogs but appeared to be orthologous due to differential, linage-specific gene loss. | \n\t\t
Xenologs | \n\t\t\tHomologous genes acquired via xenologous gene displacement (XGD) by one or both of the compared species but appearing to be orthologous in pairwise genome comparisons. | \n\t\t
Co-orthologs | \n\t\t\tTwo or more genes in one lineage that are, collectively, orthologous to one or more genes in another lineage due to a lineage-specific duplication(s). Members of a co-orthologous gene set are inparalogs relative to the respective speciation event. | \n\t\t
\n\t\t\t\tParalogs\n\t\t\t | \n\t\t\t\n\t\t\t\tGenes related by duplication\n\t\t\t | \n\t\t
Inparalogs (Symparalogs) | \n\t\t\tParalogs genes resulting from a lineage-specific duplication(s) subsequent to a given speciation event (defined only relative to a speciation event, no absolute meaning). | \n\t\t
Outparalogs (Alloparalogs) | \n\t\t\tParalogs genes resulting from a duplication(s) preceding a given speciation event (defined only relative to a speciation event, no absolute meaning) | \n\t\t
Pseudoparalogs | \n\t\t\tHomologous genes that come out as paralogs in a single-genome analysis but actually ended up in the given genome as a result of a combination of vertical inheritance and horizontal gene transfer. | \n\t\t
Homology: terms and definitions from Koonin 2005 [8].
\n\t\t\t | \n\t\t\t\tTotal number of genes\n\t\t\t | \n\t\t\t\n\t\t\t\tNumber of duplicate genes (% of duplicate genes)\n\t\t\t | \n\t\t|
\n\t\t\t\tBacteria\n\t\t\t | \n\t\t\t\n\t\t\t | \n\t\t | |
\n\t\t\t\tMycoplasma pneumoniae\n\t\t\t | \n\t\t\t677 | \n\t\t\t298 (44) | \n\t\t|
\n\t\t\t\tHelicobacter pylori\n\t\t\t | \n\t\t\t1590 | \n\t\t\t266 (17) | \n\t\t|
\n\t\t\t\tHaemophilus influenzae\n\t\t\t | \n\t\t\t1709 | \n\t\t\t284 (17) | \n\t\t|
Archaea | \n\t\t\t\n\t\t\t | \n\t\t | |
\n\t\t\t\tArchaeoglobus fulgidus\n\t\t\t | \n\t\t\t2436 | \n\t\t\t719 (30) | \n\t\t|
Eukarya | \n\t\t\t\n\t\t\t | \n\t\t | |
\n\t\t\t\tSaccharomyces cerevisiae\n\t\t\t | \n\t\t\t6241 | \n\t\t\t1858 (30) | \n\t\t|
\n\t\t\t\tCaenorhabditis elegans\n\t\t\t | \n\t\t\t18424 | \n\t\t\t8971 (49) | \n\t\t|
\n\t\t\t\tDrosophila melanogaster\n\t\t\t | \n\t\t\t13601 | \n\t\t\t5536 (41) | \n\t\t|
\n\t\t\t\tArabidopsis thaliana\n\t\t\t | \n\t\t\t25498 | \n\t\t\t16574 (65) | \n\t\t|
\n\t\t\t\tHomo sapiens\n\t\t\t | \n\t\t\t40580a\n\t\t\t | \n\t\t\t15343 (38) | \n\t\t
Prevalence of gene duplications in all three domains of lifeb from Zhang 2003 [88].
a The most recent estimate is ~30000.
b Use of different computational methods or criteria results in slightly different estimates of the number of duplicated genes.
Besides, Xue et al. [91] laid emphasis on the roles of duplications in genomic size and compositional changes in their studies via exploring the evolution of segmental gene duplication in haploid and diploid populations by analytical and simulation approaches. The result of this study highlighted that duplications do not only cause alterations in genome size but they are also result in many recombinational events that closely related to formation of variations that have value in rising evolutional forces. In another paper, Force et al. [92] focused on the DDC (duplication-degeneration-complementation) model for the alternative fates (nonfunctionalization, neofuctionalization and subfuctionalization) of duplicate genes, and underlined their roles in genome evolution.
Mobile genetic elements also affect genome size. For example, horizontal transfer of transposable elements plays a key role in genome evolution. In their “copy-and-paste” operation mechanisms, retrotransposons, as common examples of mobile genetic elements that may cause horizontal gene transfer, transpose via an RNA-intermediated process, and this increases genomic material size [26,93-94]. Furthermore, all advanced biology sources covering microbial genetic title mention the role of other types of mobile genetic elements including plasmids and viral genomes in formation of variations in genomic size and structure [41].
On the other hand, reduction of genomic size in certain periods is an inevitable fact for genome evolution. In this manner, smaller genomes are more advantageous for selection than bigger ones due to their high replication potentials and metabolic inexpensiveness. Deletions can be given as the main force to diminish genomic size that causes gene losses [95-96]. In a recent paper, Pettersson and co-workers emphasized the role of deletions in regulation of genomic size and its coding density by using a mathematical model to determine the evolutionary fate [97].
A genomic material may accept deletions and reduce its size up to reach minimal genome limits that have the smallest number of genetic elements sufficient to build a modern-type free-living cellular organism. In addition, under some exceptional conditions, genomic materials of several endo-symbionts and co-symbionts carry much less genes than predicted minimal genome rates. For example, although Pelagibacter ubique (α-Proteobacteria) is known as a free-living organism with the smallest genome (only 1308 Kb in size and potentially contains 1354 genes), endo-symbiont Hodgkinia cicadicola (α-Proteobacteria) has the smallest genome (only 144 Kb in size and potentially contains 188 genes) among known-living organisms [98-102]. According to Juhas and co-workers’ study [102], the extremely small genomes of endosymbionts usually encode only the most fundamental process, suggesting that some of their genes might have been transferred into the host cell genome. The endosymbiont Wolbachia strains that transfer ~1 Mb fragments of its genomic material to the host genome can be given as a good example for this phenomenon [98-102].
Contrary to the genomic material of P. ubique in which there is no pseudogenes, introns, transposons, or extrachromosomal elements, modern-type organism genomes need some or all of these differentiated genetic parts [97]. In this regard, genomic rearrangements have a critical potential via causing structural changes, especially new alleles and new regulatory regions in the genomes can be created by only mutations. There is a huge data giving information about the roles of mutations in evolution in the scientific literature [1-3,5,8,9,11,12,29-33]. For instance, Halligan and Keightley [103] reviewed the relationship between mutagenesis and its role in genome evolution, and introduced mutational events as the ultimate source of genetic variation.
Recent attention of evolutionary studies has shifted to genetics, molecular and cellular biology as a result of finding out principles of genetics and DNA is the main molecule responsible for inheritance. Thus, the popularity of genome-wide studies has increased. In this regard, genomic rearrangement mechanisms (recombinations, mutations or mobility of several genetic elements) are major research topics for evolution of genomes because any change in the DNA molecule of the organisms may cause a valuable process for evolution when it has inheritable potential.
Thus, aim of the present study was conducted to emphasize potential value of genomic rearrangements for evolution, and therefore, basic rearrangement mechanisms were explained in detail, and their evolutionary effects on genomes were briefly discussed via giving important samples in this chapter.
According to Tannahill [1], health promotion is an umbrella term covering overlapping fields of health education, prevention and attempts to protect public health through social engineering, legislations, fiscal measures and institutional policies which entail the combination of the best in terms of both theory and practice from a wide range of expert groups (educationists, behavioral scientists, medical practitioners) and non-professionals including the communities involved. For him, health promotion stems largely from a new focus for health services that recognize some basic facts: many contemporary health problems are preventable or avoidable through lifestyle change; modern technology is a bundle of mixed blessings bringing both benefits and risks to health; medical technology is at the phase of diminishing returns (losing efficacy and connection to ordinary people); such non-medical factors as better nutrition, improved living conditions and public health measures have contributed to both health and longevity even more than medical measures; that doctors can cause as well as cure disease; and increasing public desire to attain better or improved quality of life and at the same time demystifying and demedicalising the attainment (achievement) of good health [1].
For the World Health Organization (WHO), health promotion is essentially about engendering a context in which the health and well-being of whole populations or groups are owned mainly by the people concerned, i.e., enabling citizens of local communities to achieve political control and determination of their health [2, 3]. Therefore, health promotion goes beyond mere healthcare but puts health on the policymaking agenda in all sectors and at all levels, directing policymakers to be cognisant or conscious of the health consequences of their decisions and accept responsibilities for health.
Health promotion can be seen as the whole process of enabling or empowering people to increase control over and improve their overall health. It focuses on creating awareness of health issues, engendering behaviour modification consistent with prevention and attitudes to ill health and motivating increased usage of available health facilities. In the pursuit of good health (physical, mental and social well-being), individuals and groups through health promotion are enabled to identify and realize aspirations, satisfy needs and change or cope with the environment in manners consistent with complete good health.
Health promotion is expected to contribute to programme impact by enabling prevention of disease, reduction of the risk factors or behaviors associated with given diseases, promoting and fostering lifestyles and conditions that are conducive to good health and enabling increasing use of available health facilities. Therefore, health promotion creates both the awareness and conscientisation that leads to disease prevention, control of health situations and usage of health services and facilities. It implies individual and collective control and participation in health focusing on behavioral change, socio-economic lifestyles and the physical environment.
Without doubt the WHO’s Ottawa Charter definition of health promotion is very comprehensive and encompasses the core values and guiding objectives of health promotions [3]. It summarily sees health promotion as the process of enabling people to increase control over and improve their health. In line with the above definition, Macdonald and Davies [4] contend that it calls attention to the critical role of the concepts of process and control as the real essence of health promotion. For them, “the key concepts in this definition are ‘process’ and ‘control’, and therefore effectiveness and quality assurance in health promotion must focus on enablement and empowerment. If the activity under consideration is not enabling and empowering it is not health promotion” [4], p. 6.
As the burgeoning literature on health promotion over the years indicate it is a community-driven (inspired), multifaceted and multidisciplinary area of concern that also involves critical sociopolitical, economic and environmental elements and dynamics (see [4, 5, 6, 7, 8, 9, 10]).
It is important to also understand that even though one can make a distinction between public health and health promotion, in reality both are interconnected and hardly practically separable. In other words, public health is built on health promotion and health promotion is imperative for public health delivery. As has been argued, public health “is synonymous with health promotion in that it aims to implement co-ordinated community action to produce a healthier society” [11], p. 315.
There is no gainsaying the fact that health promotion nowadays has an overwhelming sociopolitical component that is really definitive. In fact, as has been posited, “health promotion activities are by their nature inherently politically based and driven, thus making it impossible to divorce them from the political arena” [11], p. 314. Health promotion becomes a dynamic area of interface between public policy institutions (the state and its agencies), the public (community/people) and the professionals (ranging from the media professionals, public health advocates, social workers to medical practitioners).
The chapter depended on the desk review of extant literature and documents for its information. The main exclusionary criteria in this regard were materials not related to health promotion and materials published before 1984, which were considered extreme-dated. The inclusive criteria were determined by such concepts as public health, public health in Africa, health promotion, health education and awareness and theories and models in health promotion. Such prominent Internet information sites like the WHO, American Public Health Association (APHA), Health Resources and Services Administration (HRSA) and the Universitats Bibliothek Leipzig (UBL) Online Resources were utilized in gathering materials for the chapter.
There is no gainsaying the fact that effective and result-oriented health promotion practice depends on sound theory [12]. In other words, theory becomes very informative of health promotion practice and activities. In recognition of the above, one would examine briefly the main theories that have implicated health promotion globally. It is important, however, to state here that the choice of a theory or model to guide health promotion should be determined largely by the specific nature of the health issue being addressed, the community or population in view and the sociopolitical context in question. This is because theories and models are simply used in practice in order to plan health programmes, explain and understand health behaviour as well as underpin the identification of appropriate intervention and implement such intervention in ways that are both effective and sustainable.
Despite a plethora of theories and models utilized in health promotion, I will only focus on five of the most popular and commonly used. These are ecological models of health promotion, the Health Belief Model (HBM), Stages of Change Model or the Trans-theoretical Model, Theory of Reasoned Action or Planned Behaviour and the Social Cognitive Theory.
As the name implies, these models focus on the interaction of people with their physical and sociocultural environments. The approach thus recognizes that there are multiple levels of influence on health and health behaviour especially the health seeking behaviour and choices that people make. The ecological models are anchored on five overriding influences which determine and guide health behaviour and response to health issues [13, 14, 15, 16]. These influences are intrapersonal or individual factors (these impact on individual behaviour, e.g., beliefs, knowledge, attitude, etc.); interpersonal factors (these are produced through living with and interacting with other people, e.g., family, friends and social groups/networks; these other people can function as both the source of solidarity and support as well as sources of barriers and constraints to health-promoting behaviour of the individual, e.g., dwelling among chronic smokers or having intense interaction with them may expose one to the dangers of either smoking or the influence of second-hand smoke); community factors (these make reference to social norms that are shared by groups or communities, and such norms whether formal or informal can influence health behaviour and health seeking behaviour of the individual and group members, e.g., relationship between institutions, groups and organizations); institutional factors (policies, rules, regulations and institutional structures that may constrain or even promote healthy behaviour in a given society, e.g., the workplace and voluntary organizations to which the individual belongs are prime examples); public policy factors (policies at different level of governance that regulate, structure or support actions and practices targeted at health outcomes like disease prevention policies and structures enabling early detection, control or response and management of health crisis in the society; these stem from the position of the government and are critical in achieving the goals of public health delivery) (Figure 1).
Ecological models of health promotion (simplified).
As the above pyramid, suggests the individual, interpersonal and community factors are at the base. These factors therefore exert more influence and pressure over the individual’s health behaviour than the institutional and public policy factors as these are more important. In other words, the institutional and public policy factors are literally far from the individual and do not exert as much pressure on his behaviour as those factors that are very close to him both spatially and otherwise. In an age of increasing pessimism in government, people are much driven by interpersonal and community factors than what comes from a typical further off entity.
Given the above, it is obvious that the ecological approach is very pertinent in the understanding of the range of factors that influence people’s health. Its main strength is that it can provide what is called a complete perspective on factors that affect health behaviour and response to health issues especially the role of social and cultural factors or normative patterns on health in the society. It is perhaps very well suited to health intervention and practice in developing societies with an overbearing influence of sociocultural factors on behaviour, attitudes and practice of the people.
This is a theoretical model that has been found useful in guiding both health promotion and strategies for disease prevention. As the name suggests, it focuses on individual beliefs about specific health conditions which predict or direct individual health behaviour [17, 18]. The specific components of this belief that influence health behaviour include perceived susceptibility to the disease; perceived severity of the disease in question; perceived benefits of action (positive benefits of such action) as well as cues to action (awareness of factors that engender action); self-efficacy (belief that action would lead to success); and perceived barriers or obstacles to action (especially if such obstacles are seen as daunting or insurmountable or otherwise).
In the utilization of the HBM in health promotion, there are five main action-related segments that would help in identifying key decision-making points and thus facilitate the utilization of knowledge in guiding health intervention. These are: collection of information (through needs assessments; rapid rural appraisal, etc. in order to determine those at risk of the disease or affliction and specify which population or component of the population to be targeted in the intervention); conveying in unambiguous and clear terms the likely consequences of the health issue in question and its associated risk behaviors in order to facilitate a clear apprehension of its severity; communication (getting information to the target population on the recommended steps to take and the perceived or likely benefits of the recommended action); provision of needed assistance (help the people in both the identification of and reduction of barriers or constraints to action); and demonstration (actions and activities that enable skill development and support aimed at enhancing self-efficacy and increased chances of successful behaviour modification targeted at the health issue in question) (Figure 2).
Health belief model (HBM).
In Africa, the HBM has been very useful in understanding people’s response and behaviour to HIV/AIDS and other chronic diseases. Being a society very flushed with beliefs, the degree of responsiveness to a health situation is often the direct product of a set of beliefs held by the individual and/or by his immediate community.
This model is focused on examining and explaining the individual’s readiness to change his behaviour and sees such change as occurring or happening in successive stages. It therefore adopts a quasi-evolutionary framing of behaviour change in which behaviour change, sustenance and termination are encompassed in six stages. These stages are pre-contemplation (existence of no intention to take any action by the individual); contemplation (thinking about taking action and ruminating on plans to do this soon); preparation (signifies intention to take action and includes the possibility that some steps or preliminary steps to action have been taken already); action (discernible change in behaviour for a brief period of time); maintenance (sustenance of the action taken; behaviour change that is maintained in the long run or long-term behaviour change); and termination (the expressed and discernible desire never to return to prior negative behaviour by the individual concerned).
The above stages are very important in planning behaviour change or modification and recognize that behaviour change is both gradual and takes time. What is needed from the health promoter is that at each of these stages specific interventions or programmes are devised to help the individual progress to the next stage. Also, the recognition that the model may in reality be cyclical rather than lineal, i.e., individuals may progress to the next stage or even regress to previous or lower stages, is important in planning health promotion interventions utilizing this model. It also calls attention to understanding that there are individual differences in the adoption of change, i.e., some people may be swift in behaviour modification, while others may take longer time; but each needs support in order to pull through.
The main contention of this theory is that an individual’s health behaviour is usually determined by his intention to exhibit or display a given behaviour. Therefore, the intention to exhibit a given behaviour (or behaviour intention) is predicated upon or predicted by two main factors, viz. personal attitude to the behaviour in question and subjective or personal norms (an individual’s social and environmental context and the perception the individual has over that behaviour) related to that behaviour.
The basic assumption here is that both positive attitudes and positive subjective norms will generate greater perceived control of behaviour and increase the chances of intentions towards changes in behaviour. The theory generally provides information that can be used in predicting people’s health behaviour and thus in planning and driving through health interventions. It anchors in recognizing the predictors of behaviour-oriented action and the need for supportive social and environmental contexts that facilitate and sustain desirable health behaviour.
This theory combines both the cognition of the individual and the social context of the individual in offering explanation and understanding of health behaviour and response. It seeks to describe the influence of the experience of the individual, his perception of the actions of other people near him and the factors in the person’s immediate environment on health behaviour of the individual. It moves from this general perspective to provide opportunities for social support (defined as conducive to healthy behaviour) and reinforcements that generate behaviour change or modification. In this sense, the SCT depends on the idea of reciprocal determinism which denotes the continuing or uninterrupted interaction among the person’s characteristics, his behaviour and the social context or environment in which the behaviour takes place.
However, the best way to appreciate the SCT is to examine the main components the theory isolates as related to behaviour change at the individual level. These are self-efficacy (belief in one’s ability to control and execute behaviour within a given context); behaviour capability (thorough comprehension of behaviour and the ability to exhibit or perform it); expectations (outcomes or outputs of the behaviour change in question); expectancies (the assignation of value to the above outcome of behaviour and which is important in sustaining the behaviour); self- control (the regulation and monitoring of behaviour of the individual); observational learning (the act of watching others performing the desired behaviour and the outcomes therein as well as modeling that behaviour in question); and reinforcements (incentives and rewards seen as eliciting, encouraging and sustaining behaviour change in the individual) [19].
The three components as the above diagram shows reinforce each other and in the process condition and determine behaviour of the individual even in the context of health as well as choices made therein (Figure 3). The SCT is very pertinent in contexts where desirable health outcomes can be achieved by behaviour modification or change. For instance, certain chronic diseases or health conditions can be tackled through healthy lifestyles and dieting that reduce risk factors and chances of individuals succumbing to such conditions. Therefore, the theory can help frame intervention programmes in this area that focus on changing people’s behaviour and in the process achieve desirable health outcomes.
Illustration of the social cognitive theory (SCT).
Theories and perspectives or models as already indicated are critical in providing explanations of a problem or issue (broadening our understanding and perspective as it were) and also very important in the effort to tackle a given problem or issue in the society especially by way of developing and implementing programmes and interventions. Perhaps, the above underscores why some scholars [20, 21, 22] would highlight the difference between the so-called theories of the problem and theories of action, meaning that while the former aids our apprehension of a given issue or social reality, the latter is important in terms of taking actions or evolving activities to tackle the issue in question.
Health promotion generally implicates a huge element of politics and power dynamics in the sense that only political will and cognition can build discernible changes in health. Lobbying and advocacy are critical tools of health promotion and function within the political arena. The sociopolitical contexts and influences are especially recognizable in the public health sector in the developing world where political will and doggedness are often necessary to drive through even the most salutary change or innovation in the health sector. Also, political forces are equally dominant in the provision of crucial health infrastructure and facilities as well as the reasonable funding demanded by any effective public health system. As Harrison opines health promotion “requires concerted, sophisticated and integrated political action to bring about change and requires professionals concerned with public health to engage with the politics of systems and organizations” [5], 165.
Therefore, health promotion seeks to empower and transform communities by getting them involved in activities that influence public health especially through agenda setting, lobbying and advocacy, consciousness raising and social education [11, 22]. All these are accomplished on terms that are either defined or strictly affected by the socio-economic realities of the people themselves. By its emphasis on the community, health promotion has a heavy sociological frame that prioritizes the values of society as well as mobilization and solidarity in the quest for good and sustainable health. It thus makes assumption that individual members of the society would give equal weight to their own health and the health of their neighbors. In other words, it is often anchored on the uncanny assumption that the health of the individual member of a given society is intertwined with the health of the community as a collective. This means the reference point of health promotion is that one’s health is as good as the health of the members of the community or society as a whole, i.e., common health destiny. Therefore, such things as community empowerment, community competence and overwhelming sense of community are all apprehended as contributing to the health of the communities [23].
Traditionally there are five approaches utilized in health promotion. These are medical (the focus here is to make people free from medically defined diseases and afflictions; it is mainly anchored on prevention strategies and the role of the medical practitioner or expert in ensuring that the patients comply with recommendations); behavioural change (behaviour modification approach that recognizes that people’s behaviour and lifestyles can be changed in order to enable them attain good health, i.e., facilitate adoption of healthy lifestyle); educational (provision of information and knowledge that enable understanding of health issues and build awareness for informed decision-making and choice among people); client-centred (in this situation health practitioners work with clients in order to identify what they know about a given disease and take appropriate action; emphasis on perceiving the client as equal and building the clients self-empowerment that enable them make good choices and control their health outcomes); and societal change (the focus here is on the society or community rather than the individual and seeks to change or modify both the physical and social environments in order to make them consistent with or conducive to good health).
The conventional health promotion methods (modes of operationalizing health promotion and achieving its goals) include health education (the conscious and systematic effort at providing education or knowledge to people on particular and general aspects of health; it is about enabling people through proper and right knowledge on what to do and how to do it; it is empowering and improving people’s capacity to act with regard to their health issues and conditions), information, communication (the above three are often captured in the popular acronym IEC), social mobilization, mediation, community theater and advocacy and lobbying. However, while these methods are okay in differing contexts, a decision on the specific medium to use should be guided by both environment (community conditions) and the nature of the health issue involved. The use of more than one method in any given case is highly recommended especially in Africa where there are broad inequalities in access to social goods and the media. The increasing use of social media especially among young Africans calls attention to their deployment equally in core health promotion. Social media platforms like WhatsApp and blogs can be very potent in this regard.
There is an undeniable need to give high priority to health promotion research in Africa. Such research should aim at enabling a realistic and focused achievement of the goals of health promotion. Broadly, health promotion aims inter alia at:
The prevention of communicable and non-communicable diseases
The reduction of risk factors associated with diseases
The fostering of lifestyles and conditions in the general population that are consistent with overall well-being or good health
The effective/maximal utilization of existing health services and stimulating demand for others where/when necessary
According to the WHO [24] Health Promotion Strategy for the African Region, the contributions of health promotion to the achievement of health objectives include increasing individual knowledge and skills especially through IEC; strengthening community action through the use of social mobilization; enabling the emergence of environments supportive and protective of health by making optimal use of mediation and negotiation; enabling the development of public policies, legislation and fiscal controls which enhance and support health and overall development using advocacy and lobbying; and making prevention and consumer needs the core focus of health services delivery. All these can be positively influenced by research and studies which evaluate the effectiveness of what has been done as well as explore new strategies suitable to the socio-environmental context in question.
However, while research is very critical to achieving the goals of health promotion, it should be concise and focus essentially on the priority health programmes which have been identified by the WHO for the continent. Some of such programmes include the Global Fund for Malaria, HIV/AIDS and Tuberculosis, Immunization, Mental Health, the Tobacco Free Initiative and Reproductive Health as well as the fight against recurrent scourge of Ebola, etc. Such research should focus on identifying effective health promotion approaches and communication media to embody and convey the outcomes to communities through community participation; the extent or effectiveness of these means and seeking to still improve overall programme effectiveness and sustainability. Therefore, health promotion research should focus on ascertaining goals/outcomes of health promotion (to guide policy), provide reliable conditions associated with these outcomes or goals, precisely define the changes intended and delineate reliable mechanisms and indicators of M and E of health promotion strategies in specific country/community contexts.
The importance of research is essentially derived from the fact that it calls attention to the need for verification and evidence-based activities in health promotion. These are without doubt the ways of knowing if real empowerment and enabling has been achieved in the process. Thus,
Health promotion is about enabling people to improve their health; and secondly, evidence relevant to health promotion should bear directly on factors that support or prevent enablement and empowerment (determinants of health) activities that support enablement and empowerment (health promotion) and assessing whether these activities have been successful (evaluation of health promotion). [25], p. 357
The above clearly suggest that health promotion should be anchored on evidence or should rest on experience and reality regarding what works or what is possible and effective in any context. In this manner, “evidence-based health promotion involves explicit application of quality research evidence when making decisions” [26], p. 126. Research is even more foundational in health promotion since health promotion efforts need to be anchored on agreed definitions and values of health promotion. As Seedhouse contends the failure to be explicit about definitions and values generates conceptual confusion in research as well as sloppy practice [27].
The evaluation of health promotion which should be a core research activity may be based on the three main forms of evidence/knowledge associated with health promotion [28]: instrumental (controlling social and physical environments), interactive (understanding of diseases/health issues; lived experiences; solidarity) and critical (reflection and action; raising consciousness regarding causes and means of overcoming them). These three evidences are anchored on the given scientific/philosophical traditions, viz. instrumental (positivism, quantitative, experimental, scientific knowledge), interactive (constructivist, naturalistic, ethnographic/qualitative knowledge) and critical (materialist, structural and feminist theory).
There is also an overwhelming need for health promotion research to be aware of the difference between health promotion outcomes and health outcomes. Health outcomes crudely imply the consequences or benefits of healthcare delivery (e.g., reduction of mortality rate) related to a disease (which may be the case in spite of an increment in number of those affected by the disease). But health promotion outcomes signify the form of control and attitudinal re-orientation groups and individuals adopt in facing a given disease which may impact on the number of people affected by the disease and improve attitudes and behaviour towards those affected by the disease. Health promotion outcomes can be seen directly through community members’ perception and interpretations of a given health issue which makes the achievement of control possible.
Health promotion research should utilize both quantitative and qualitative methods. In addition to complementing quantitative methods in health promotion research, qualitative research enables the researcher reach the heart of issues in engagement with community members. In Africa, where a good percentage of the population are still domiciled in the rural areas, qualitative approach offers the possibility of profound insights into the why and how of health behaviors which may not be possible or easily achieved with the quantitative or traditional biomedical approaches. As a result, “the increasing popularity of qualitative methods is as a result of perceived failure of traditional methods to provide insights into the determinants – both structural and personal – of whether people pursue or do not pursue health-promoting actions” [25], p. 359.
It is important to recognize that in spite of apparent good intentions, health promotion can actually generate negative or counterproductive effects when not well managed. Thus, “negative outcomes occur where professionally paternalistic and disempowering health policy decisions force health-related outcomes that are irrelevant to sustained community development and are not based on or resourced according to the social reality of the community” [11], p. 315. The above sentiments caution one against embarking on health promotion activities and initiatives that are not anchored on the health realities of the community concerned. Often, overzealous health professionals unintentionally betray the health priorities of communities by assuming knowledge of all there is to know about the health situations and needs of the people.
Perhaps a critical shortfall of some health promotion activities and processes is the adoption of what can be termed the pathogenic paradigm which over-relies on risk instead of emphasizing protective mechanisms. This essentially entails a focus on the failure of communities and individuals to avoid disease or their apparent susceptibility to diseases instead of seeking to unleash their potential and capacity to engender and sustain good health and development. It is an approach that relies too much on health practitioners and experts and hardly gives voice to the people and their own knowledge cum realities.
Generally health promotion in Africa suffers from some of the debilitating challenges which confront the practice of health promotion broadly in many countries in the continent. These challenges, among others, include:
Poor definition and rudimentary elaboration of expected health outcomes
Ambiguous elaboration of factors and conditions to be targeted in health promotions
Ambiguity of health promotion policies and guidelines
Lack of capacity (or inadequate capacity) to develop, implement and evaluate health promotion programmes
A general context of inadequate investment in health promotion
Underdeveloped sectoral collaboration
Low political will and commitment to health promotion programmes as well as institutional corruption and resource mismanagement
The above challenges have implications for research in health promotions in the continent. There is no gainsaying the need for health promotion to be evidence based because essentially it is the only way to make it responsive to the health needs and interests of the people.
Health promotion combines varied but complementary indicators like legislation, health finance including fiscal measures and taxation, gender inclusiveness, mapping of priorities and organizational change. In spite of their differences, these issues are in reality intertwined or systematically connected in the sense that, for the public health system to function well and optimally, there should be a synergy between these indicators. Briefly:
This revolves around having the political will to make and drive through policies and laws that improve and sustain healthcare delivery. It also involves public health sector governance and leadership which aim at ensuring that only competent and qualified people lead the sector and that activities are governed by a democratic and free process which place emphasis on human rights, dignity and self-worth of all stakeholders.
Without doubt efficient health promotion and by implication the entire health delivery system cannot function without finance. In fact, the extent and impact of health promotion depend to a significant extent on the availability of funds. The problem of finance is especially critical in developing nations in Africa where political corruption and competing needs whittle down whatever gets to health from the yearly appropriation of government. However, there is a need to understand that a lot needs to be done in terms of the fiscal policies in these nations in order to achieve the desire for good health and improved life expectancy. In other words, the process of fiscal policymaking and budgetary allocation should prioritize health promotion and health delivery in these countries.
There is no gainsaying the fact that the health system as a whole is dynamic especially so in Africa where apart from battling known ailments new ones (or novel presentation of the old ailments) spring up now and then. The above entails that the health system calls for dynamic organizational setting that is robust enough to deal with changes while making improvements in the system. There is apparently no denying the fact that health promotion as a critical component of health delivery would benefit from organizational change. This is particularly so in the face of the reality that health promotion in most of the continent is still below the expectation. This is not to deny that health promotion has worked well in specific instances like the HIV/AID scourge and maternal health. However, such grab and slash system which focuses on only one of such delimited issues in the system cannot be seen as either robust or effective in the long run.
There is an obvious need to ‘en-gender’ health promotion as a very critical issue in Africa. This would entail ensuring that those involved in health promotion ensure that in all key phases of health promotion (planning, implementation and evaluation) women and men should be equal partners and collaborators. Gender, in this case, while calling attention to the needs of women, should also ensure that the men are not left behind even in approaching health issues traditionally seen as the concerns of women. Typical example here is in the area of family planning or reproductive health which demands the active collaboration or participation of both men and women to achieve desired results.
For the WHO [24], the priority interventions in Africa in respect of health promotions include capacity building, development of plans, incorporation of health promotion components in non-health sectors and strengthening of priority programmes using health promotion interventions. These essentially mean pursuing health promotion through capacity building, action planning, advocacy and multisectoral orientation. They are also in tune with relating to the determinants of health promotion in the continent. These include socio-economic conditions and physical (environment), biological, and behavioral lifestyles which impact on health in Africa. Countries can be encouraged to map out their priorities taking into consideration such factors as disease and financial burdens, threats, intervention tools and agencies, acuity, management capabilities, persistent challenges, etc.
Generally, there is a need for stepping up health promotion research in Africa in the areas of family and reproductive health targeting such issues as VVF, antenatal care, diabetes, cardiovascular issues, new disease forms/resurgence of old diseases (including Ebola), etc. especially in terms of communicating with those who are marginal to the formal sector of the society or who are less privileged by virtue of education, economic opportunities or physical/mental challenges, etc. in both urban and rural contexts. Health promotion can profit from an acute awareness of the fact that what works in one socio-geographical setting may not work in another since no two societies are exactly the same. This would entail designing programmes that even where the general principles or goals remain the same embody recognition of the socio-geographical peculiarities of the society/community concerned.
Given the usual paucity of funds in the continent, it makes sense that to minimize cost and save time, there should be incorporation of both needs assessment and evaluation into ongoing health promotion activities. This approach offers a smart way of pursuing health promotion goals without elaborate budget.
In spite of country differences and specific structural challenges, there is a need to build a culture of sharing and documenting outcomes and evidences of health promotion between different countries and organizations. This is a step towards achieving the desirable goal of multinational coordination especially for infectious diseases and epidemics. Equally, African nations need to invest more in capacity building for media and theater practitioners in both private and public sectors on health promotion. There is no gainsaying the media’s crucial role in health information dissemination. Actually, health promotion is largely media driven and should be programmed as such.
In addition to media practitioners, there should be health programme or intervention specific to health promotion capacity building for different cadres of public sector workers. Such capacity building or training should be anchored on acute awareness of current research trends and best practices globally. There should also be increased attention to the need for specific health promotion for under-represented health issues and priority to non-communicable diseases should be targeted. It should also improve capacity on how to incorporate methods of targeting members of the society marginal or vulnerable within each country context.
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