Global Health Updates 8
Global Health Updates. Issue 8. Vol 2
Content
Abstract
1.??????Taking Self Care Seriously
2.??????Relevance of Health Equity Audits
3.??????'Nocebo effect'
4.??????Global Burden of?Anti Microbial?Resistance
Abstract
In the context of Covid19, there is a need to re-visit the idea of ‘Self-care”, an area under-researched from the Public Health perspective. When the advice is given –to be at home to the persons affected by Covid19, a piece of clear advice on ‘self-care’ needs to be issued.
There is an urgent need to identify effective interventions to address health inequalities. ?More evidence is needed to explore whether HEA implementation can reduce inequalities and which factors are influencing effectiveness.
Adverse events (AE) seemingly elicited by placebos are often called 'nocebo' responses and are thought to be caused by misattribution of common background symptoms, anxiety and expectations of AEs.
The study by the Antimicrobial Resistance Collaborators presents the most comprehensive estimates of AMR burden to date.
1.??????Taking 'Self Care' Seriously
According to WHO, a global shortage of an estimated 18 million health workers is anticipated by 2030, a record 130 million people require humanitarian assistance, and there is the global threat of pandemics such as COVID-19. At least 400 million people worldwide lack access to essential health services, and every year 100 million people are plunged into poverty because they have to pay for healthcare out of their own pockets. Therefore, there is an urgent need to find innovative strategies beyond the conventional health-sector response and promote 'self-care' that may contribute to this challenge. However, it seems the research on 'self-care' is an under-researched public health area
One of the often-repeated advice from health care providers is that people affected by the Omicron variant of Covid19 can manage themselves at home if they are not critical. However, people with COVID-19, particularly with the omicron variant, often have symptoms in the long term (Long COVID), including fatigue, breathlessness, and neurocognitive difficulties. The biomedical mechanisms causing long COVID are vastly unknown. As a result, there are no evidence-based treatment options available from the physicians. Clinical guidelines focus on symptom management, and various treatment options are still being evaluated. However, the scarcity of medical advice has often left people with long COVID feeling isolated and frustrated in their search for therapies. In addition, advice from the health care providers not to visit hospitals with 'minor ailments' adds to patients' confusion and anxiety.
In the correspondence section of the Lancet, Brown and colleagues from the University of Birmingham highlighted some of the issues related to the Self-management of Long Covid. People with long COVID reported turning to a vast range of over-the-counter medicines, remedies, supplements, other therapies, and dietary changes to manage relapsing and remitting symptoms. However, there are potential risks of self-prescription, such as harmful drug-drug interactions and the use of inappropriate treatments. In addition, unguided Self-management is often costly, contributing to the existing health inequalities.
According to WHO, Self-care interventions are among the most promising and exciting new approaches to improve health and well-being, both from a health systems perspective and for people who use these interventions. Self-care interventions can contribute substantially to achieving Universal Health Care and supports target 3.8 of Sustainable Development Goal 3 (to ensure healthy lives and promote well-being for all ages).
A cursory review of the definition of Self-care on the Pub Med database did not provide a satisfactory answer. Therefore, the available data on self-care is presented in diabetes care,?Nurses self-care, pharmacists, and occupational therapists on self-care.
Dorothea Orem's Self-Care Deficit theory focuses on "individual's ability to perform self-care", defined as 'the practice of activities that individuals initiate and perform on their behalf in maintaining life, health, and well-being. Orem believed that patients could perform their care to maximize their health well-being and would only require care from a medical professional when they could not care for themselves.
Research is needed to understand the best practices of self-care that could be used to manage long COVID symptoms and other minor illnesses. It appears that Patients Self-care is an under-researched public health challenge. There is an urgent need to develop 'self-care' models for some common ailments.
References
Kirsty Brown, Asma Yahyouche, Shamil Haroon, Jenny Camaradou, Grace Turner (2022) Long COVID and self-management. Correspondence. www.thelancet.com Vol 399 January 22, 2022. https://www.thelancet.com/action/showPdf?pii=S0140-6736%2821%2902798-7
Younas A. A (2017) ?Foundational Analysis of Dorothea Orem's Self-Care Theory and Evaluation of Its Significance for Nursing Practice and Research. Creat Nurs. 2017 Feb 1;23(1):13-23. DOI: 10.1891/1078-4535.23.1.13. PMID: 28196563. https://pubmed.ncbi.nlm.nih.gov/28196563/
WHO Guideline on self-care interventions for health and well-being. July 13 2021. https://www.who.int/publications/i/item/9789240030909
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There is an urgent need to identify effective interventions to address health inequalities. However, we have identified limited evidence to support their use. More evidence is needed to explore whether HEA implementation can reduce inequalities and which factors are influencing effectiveness. Meaningfully impacting health outcomes and healthcare delivery inequalities is a complicated, challenging task faced by overburdened and under-resourced health systems. Van Daalen KR, Davey F, Norman and colleagues carried out a systematic review to explore whether health equity audits (HEAs) effectively improve the equity of service provision and reduce health inequalities. (Van Daalen KR et al.2021)?
The???COVID-???19???pandemic has exacerbated structural, longstanding and unjust drivers of health inequalities, including economic disparities, geographical deprivation, occupational risks and systematic racism. In response to the emerging inequalities related to COVID- 19, Public Health England recommended using health equity audits?(HEA) and proposed Health Equity Assessment Tool (HEAT) to carry out the assessment. HEAT is a tool consisting of a series of questions and prompts designed to help you systematically assess health inequalities related to your work programme and identify what you can do to help reduce inequalities. HEAs are generally implemented at a higher organizational level, such as across a local government level or healthcare system, and it is not always clear what actions are needed to reduce the inequalities gap. There is an urgent need to find effective interventions to reduce health inequalities. Public Health England recommends using HEAs and has published accompanying guidance describing step-by-step processes of HEA implementation. Daalen KR et al.2021)?
?References
Van DaalenKR, et al. (2021) ?Health equity audits: a systematic review of the effectiveness. BMJ Open 2021;11:e053392. doi:10.1136/bmjopen-2021-053392. https://bmjopen.bmj.com/content/11/11/e053392
Public Health, UK. Health Equity Assessment Tool (HEAT): executive summary. Updated May 25 2021. https://www.gov.uk/government/publications/health-equity-assessment-tool-heat/health-equity-assessment-tool-heat-executive-summary
3.??????'Nocebo effect': Two-thirds of Covid Jab Reactions Not Caused by the #vaccine ????????????
The?COVID-19 pandemic has caused more than 5 million deaths worldwide and led to tremendous physical, mental, and economic consequences. Several vaccines have been developed and tested within short periods as a response. Currently, public vaccination programs have already succeeded in reducing the number of new infections in several countries. However, a substantial proportion of the population (internationally estimated at approximately 20%) intends to refuse vaccination. In 2019, before the COVID-19 pandemic, the World Health Organization claimed vaccination hesitancy as a global health threat; this threat is particularly salient in the case of COVID-19. Counteracting the underlying motivations for vaccination hesitancy is crucial to overcome this worldwide crisis.
Although the reasons for vaccination hesitancy are diverse and complex, concerns about potential Adverse Events (AEs) from the COVID-19 vaccines seem to be a significant factor. According to a global survey from January 2021, 47% of respondents were worried about AEs from a COVID-19 vaccine. There is broad evidence of an association between concerns about AEs and vaccination refusal concerning influenza vaccination. Several systematic reviews of randomized clinical drug trials have demonstrated that the occurrence of AEs can also be substantial in placebo arms.
Adverse events seemingly elicited by placebos are often called 'nocebo' responses and are thought to be caused by misattribution of common background symptoms, anxiety and expectations of AEs. Emerging research has shown that informing patients about nocebo responses and providing a positive framing of potential AEs may be associated with reduced AE-related anxiety and nocebo responses. Although nocebo phenomena have been investigated in many contexts involving medication, evidence of their influence in vaccination remains scarce. However, a recent meta-analysis suggested that a significant proportion of placebo recipients in influenza vaccine trials experienced systemic AEs, such as headache or fatigue, owing to nocebo responses.
Researchers of nocebo response have called attention to ubiquitous nocebo responses in COVID-19 vaccination, but systematic quantification is needed. Therefore, the current systematic review and meta-analysis aimed to assess the frequencies of AEs reported in the placebo groups of COVID-19 vaccine trials and compared them with the frequencies of AEs reported in the vaccine groups. AEs in placebo arms ("nocebo responses") accounted for 76% of systemic AEs after the first COVID-19 vaccine and 52% after the second.
4.??????Global Burden of?Anti-Microbial?Resistance?in 2019
Antimicrobial resistance (AMR) poses a significant threat to human health worldwide. Previous publications have estimated the effect of AMR on incidence, deaths, hospital length of stay, and healthcare costs for specific pathogen–drug combinations in select locations. This study by the Antimicrobial Resistance Collaborators presents the most comprehensive estimates of AMR burden to date.
This study provides the first comprehensive assessment of the global burden of AMR and an evaluation of the availability of data. AMR is a leading cause of death worldwide, with the highest burdens in low-resource settings.
The Review on Antimicrobial Resistance, commissioned by the UK Government, argued that AMR could kill 10 million people per year by 2050. Understanding the burden of AMR and the leading pathogen contributing to it is crucial to making informed and location-specific policy decisions, particularly about infection prevention and control programmes, access to essential antibiotics, and research and development of new vaccines and antibiotics. However, there are serious data gaps in many low-income settings, emphasizing the need to expand microbiology laboratory capacity and data collection systems to improve our understanding of this crucial human health threat.
The Antimicrobial Resistance study Collaborators commented on the need to identify strategies that can work to reduce the burden of bacterial AMR—either across a wide range of settings or those that are specifically tailored to the resources available and leading pathogen–drug combinations in a particular setting—is an urgent priority.
Reference
Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Antimicrobial Resistance Collaborators, References, Antimicrobial Resistance. Collaborators (2022) Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. January 20, 2022. https://doi.org/10.1016/S0140-6736(22)00087-3https://www.thelancet.com/action/showPdf?pii=S0140-736%2821%2902724-0