We fully agree with the authors in terms of need for a paradigm shift. We have called it a 'pandemic' but response has been largely country centric and not at all global.
We would also like to highlight a typical reactionary response globally leading to exclusion of fathers from maternity and neonatal units.
The Covid-19 pandemic is dividing families all over the world, especially at a time when togetherness is particularly important, such as at the time of birth, death and illness. Many families are experiencing situations that are prone to leave life-long scars.
While the protection of the health of staff and mothers is of paramount importance, social distancing, curbs to travel and additional restrictions to presence of parents instituted by maternity and neonatal units across the world have created obvious difficulties for families. Having a sick baby in a neonatal unit during this pandemic is a particularly intense hardship for families. We are well aware of negative impacts of separation on children and families and the pandemic related restrictions have made this worse for the whole family, perhaps more so for parents of preterm and sick newborns.
We have previously highlighted, along with many others, the importance of optimising fathers’ experiences in the neonatal unit (Ref 1-8) and suggested a focus on a co-parenting paradigm with a clear set of recommendations for neonatal and maternity services (Ref 1).
Even though we...
We fully agree with the authors in terms of need for a paradigm shift. We have called it a 'pandemic' but response has been largely country centric and not at all global.
We would also like to highlight a typical reactionary response globally leading to exclusion of fathers from maternity and neonatal units.
The Covid-19 pandemic is dividing families all over the world, especially at a time when togetherness is particularly important, such as at the time of birth, death and illness. Many families are experiencing situations that are prone to leave life-long scars.
While the protection of the health of staff and mothers is of paramount importance, social distancing, curbs to travel and additional restrictions to presence of parents instituted by maternity and neonatal units across the world have created obvious difficulties for families. Having a sick baby in a neonatal unit during this pandemic is a particularly intense hardship for families. We are well aware of negative impacts of separation on children and families and the pandemic related restrictions have made this worse for the whole family, perhaps more so for parents of preterm and sick newborns.
We have previously highlighted, along with many others, the importance of optimising fathers’ experiences in the neonatal unit (Ref 1-8) and suggested a focus on a co-parenting paradigm with a clear set of recommendations for neonatal and maternity services (Ref 1).
Even though we have seen some progress internationally on this front, concerns related to the spread of Covid-19 have led to restrictions, which many would argue, are significant backward steps in our journey to improve fathers’ engagement, experience and enjoyment of their newborn. Beyond the father, these restrictions may also adversely impact the infant and the family. While we understand the rationale for considering the restrictions, the restrictions per se are concerning on many levels and raise many questions.
The restrictions on father’s presence seem more like an ‘easy’ knee jerk reaction rather than based on evidence. If they were based on evidence, how can we explain the wide variation in restrictions across the world? There is no suggestion that the variation is based on rates of community transmission and risk. This begs the question whether there is a lack of understanding of the negative impacts of the restriction.
In areas of low risk of community transmission it would have been useful to explore alternatives to blanket restrictions, for example, more vigorous surveillance in terms of history, temperature check and use of PPE (personal protective equipment).
In situations where restrictions were considered the most appropriate strategy, it would have been useful to put in place systems to try to mitigate some of the risks especially in very vulnerable families with very preterm and sick newborns where neonatal stay may last for months. In some places technology including apps have been used to minimise isolation and improve family bonding.
We urge healthcare providers to closely monitor how restrictions have disrupted the support that parents of a sick baby provide each other or how early father-baby attachment and development of co-parenting is being disrupted. They need to explore what measures need to be put in place for fathers and families to minimise any on-going risks and optimise outcomes.
We hope that these insights and the pandemic experience will help us to understand how better practices can be implemented in the future, when confronted with similar circumstances.
The overall economic and societal cost of the Covid-19 pandemic should not overshadow the psychological burden of parents with a preterm/sick newborn during the pandemic. Policy makers will need to consider inclusion of psychological reparation tools and actions within the recovery programmes as well as a more consistent evidence based strategy for any future pandemics.
Minesh Khashu*, MBBS MD FRCPCH FRSA; Consultant Neonatologist, Poole Hospital NHS Foundation Trust, United Kingdom
Esther Adama, RN, PhD: School of Nursing and Midwifery, Edith Cowan University, Perth, Australia
Livio Provenzi, PhD; Psychologist, Child Neurology and Psychiatry Unit, IRCCS
Mondino Foundation, Pavia, Italy
Craig F. Garfield, MD, MAPP; Professor, Northwestern University Feinberg School of Medicine and Attending Pediatrician, Lurie Children’s Hospital, Chicago, Illinois, USA
Flora Koliouli, PhD; Psychologist, Université de Toulouse II-Jean Jaurès, Toulouse, France
Duncan Fisher OBE; FamilyIncluded.com, U.K.
Betty Nørgaard, ; Department of Paediatrics, Lillebaelt Hospital, Sygehusvej 24, 6000, Kolding, Denmark
Frances Thomson-Salo, Royal Women's Hospital, Carlton, 3053, Australia
Edwin van Teijlingen, Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, BU1 3LH, UK
Jilly Ireland, RM, MSc, Professional Midwifery Advocate, Poole Hospital NHS Foundation Trust, Dorset, UK and Visiting Associate, Bournemouth University, UK
Nancy Feeley, RN PhD, Associate Professor, Ingram School of Nursing, McGill University, and Centre for Nursing Research & Lady Davis Institute - Jewish General Hospital, Montréal, Quebec, Canada
*Corresponding Author: minesh.khashu@nhs.net on behalf of the
FINESSE group ( Fathers In Neonatal Environment-Supporting Salubrious Experiences)
References:
1. Fisher D, Khashu M, Adama EA, Feeley N, Garfield CF, Ireland J, Koliouli F, Lindberg B, Nørgaard B, Provezi L, Thomson-Salo F, & van Teijlingen E. Fathers in neonatal units: Improving infant health by supporting the baby-father bond and mother-father coparenting. J Neon Nurs. 2018; 24(6): 306-312.
2. Stefana A, Padovani EM, Biban P, Lavelli M. Fathers' experiences with their preterm babies admitted to neonatal intensive care unit: A multi-method study. J Adv Nurs. 2018;74(5):1090-1098.
3. Arockiasamy V, Holsti L, Albersheim S. Fathers' experiences in the neonatal intensive care unit: a search for control. Pediatrics. 2008; 121(2):e215-22.
4. Sisson H, Jones C, Williams R, Lachanudis L. Metaethnographic Synthesis of Fathers' Experiences of the Neonatal Intensive Care Unit Environment During Hospitalization of Their Premature Infants. J Obstet Gynecol Neonatal Nurs. 2015; 44(4):471-80.
5. Valizadeh S, Mirlashari J, Navab E, Higman W, Ghorbani F. Fathers: The Lost Ring in the Chain of Family-Centered Care: A Phenomenological Study in Neonatal Intensive Care Units of Iran. Adv Neonatal Care. 2018; 18(1):E3-E11.
6. Noergaard B, Ammentorp J, Garne E, Fenger-Gron J, Kofoed PE. Fathers' Stress in a Neonatal Intensive Care Unit. Adv Neonatal Care. 2018; 18(5):413-422.
7. Chen YL, Lee TY, Gau ML, Lin KC. The Effectiveness of an Intervention Program for Fathers of Hospitalized Preterm Infants on Paternal Support and Attachment 1 Month After Discharge. J Perinat Neonatal Nurs. 2019; 33(2):160-169.
8. Ireland, J., Khashu, M., Cescutti-Butler, L., van Teijlingen, E., Hewitt-Taylor, J. Experiences of fathers with babies admitted to neonatal care units: A review of the literature. Journal of Neonatal Nursing. 2016; 22 (4):171–176.
After reading the article, we would like to sincerely congratulate the authors Heidi Oi-Yee Li, Adrian Bailey, David Huynh and James Chan on their successful piece titled ‘YouTube as a source of information on COVID-19: a pandemic of misinformation?’ published in the British Medical Journal. This is a very relevant piece of work and we would like to offer some contributions.
As the Covid-19 pandemic progresses daily, social media platforms such as YouTube, unfortunately can become victims to showcasing anecdotal and premature evidence that can lead to fatal consequences and further spread of the so called ‘infodemic’(1). The article we are responding to worryingly demonstrates the large viewership, 62,042,609, of the non-factual videos on YouTube (2). Despite this representing only a quarter of the videos used in the study this shows these videos are perhaps more popular to watch which risks miseducating a large number of viewers.
However, it appears that since the publication of this article in March 2020 this issue has come to light and been addressed. YouTube has now updated its policies and created a ‘COVID-19 medical misinformation policy’ (3) . Assumingly, this policy has been created to protect its audiences from misinformation, going against viewing algorithms that would normally display videos higher up on the suggestions based on viewing number levels. The policy enforces that the spread of medical misinformation regarding coron...
After reading the article, we would like to sincerely congratulate the authors Heidi Oi-Yee Li, Adrian Bailey, David Huynh and James Chan on their successful piece titled ‘YouTube as a source of information on COVID-19: a pandemic of misinformation?’ published in the British Medical Journal. This is a very relevant piece of work and we would like to offer some contributions.
As the Covid-19 pandemic progresses daily, social media platforms such as YouTube, unfortunately can become victims to showcasing anecdotal and premature evidence that can lead to fatal consequences and further spread of the so called ‘infodemic’(1). The article we are responding to worryingly demonstrates the large viewership, 62,042,609, of the non-factual videos on YouTube (2). Despite this representing only a quarter of the videos used in the study this shows these videos are perhaps more popular to watch which risks miseducating a large number of viewers.
However, it appears that since the publication of this article in March 2020 this issue has come to light and been addressed. YouTube has now updated its policies and created a ‘COVID-19 medical misinformation policy’ (3) . Assumingly, this policy has been created to protect its audiences from misinformation, going against viewing algorithms that would normally display videos higher up on the suggestions based on viewing number levels. The policy enforces that the spread of medical misinformation regarding coronavirus that is not align with or is against the recommendations of WHO and local health authorities, is now not allowed on YouTube (3) This raises the question of whether the results of this study would still be applicable now, given that it was initially conducted relatively early on in the pandemic when limited information was available from scientific bodies.
There is a lack of evidence supporting whether this new policy actually helps to reduce the number of non-factual videos gaining views on YouTube as a source of information, likely due to the fact the policy was only implemented in May 2020. It is however a positive step in a direction to combating medical misinformation.
As mentioned by the authors, the numerous ways YouTube presents content ensures that important healthcare information has the potential to reach over 2 billion users (4) of all demographic backgrounds. Although this study provides insight into the use of YouTube to disseminate reliable information during the current pandemic, as an advancement it would be useful to determine the impact of these videos on public health efforts. The YouTube videos are seen by viewers that use keywords to search for information on the virus but may not reach the wider audience needed to successfully manage the crisis. To address this concern, further studies are needed to evaluate the impact healthcare information available on YouTube is having and explore how to improve outreach of the videos containing the accurate information. This research has shown that 27.5% of the YouTube videos included spread non-factual information about COVID-19 to 24.1% of viewers (2) thus highlighting the need for social media platforms, such as YouTube, to use algorithms to prevent upload and viewing of misleading information. These changes would further the effort of public health agencies to present more of the population with accurate information to help successfully manage future public health crises.
Finally, YouTube, and social media platforms in general, may be criticised for acting as a vector in allowing misinformation to be released into the public without proper factual checks. However, there are plenty of useful roles for YouTube to play in a situation such as a pandemic. Hand washing has been proven to be one of the most effective methods of fighting the virus. (5) A study into the educational usefulness of YouTube videos about proper hand washing found 55.7% of 70 videos analysed were described as educationally useful. (6) This was a similar sample size to the original article, and demonstrates a positive role YouTube has played in providing education on a simple yet highly effective method of infection control. Social media platforms have a large influence in society and continue to grow, this creates a need for government and professionals to ensure they are effectively utilising platforms used by their populations to provide factual content to a wide audience; this is critical in a situation such as a pandemic to prevent non-factual information becoming more dominant and potentially hindering the public health initiative.
Again, we send our appreciation to the authors for bringing this very topical piece of research to light and hope the insight gained from such work can be acted upon by local, national and international governments and professional bodies in the future.
REFERENCE LIST:
Limaye RJ, Sauer M, Ali J, et al. Building trust while influencing online COVID-19 content in the social media world. The Lancet Digital Health. 2020;2;e277-e278
Li HO, Bailey A, Huynh D, et al. YouTube as a source of information on COVID-19: a pandemic of misinformation?. BMJ Global Health 2020;5:e002604.
Youtube. YouTube Policy Update 2020: Help Centre. Available at: https://support.google.com/youtube/answer/9891785 [Accessed: 10 June 2020]
Google. Press, 2020. Available at: https://www.youtube.com/about/press/ [Accessed: 11 Jun 2020]
Lotfinejad N, Peters A, Pittet D. Hand hygiene and the novel coronavirus pandemic: The role of healthcare workers. Journal of hospital infection. 2020
Lim K, Kilpatrick C, Storr J, et al. Exploring the use of entertainment-education Youtube videos focused on infection prevention and control. AM J Infect Control. 2018;46(11):1218-1223
Richardson (1) argues three substantive points:
1. Models are merely fables dressed in formal language.
2. Fables are unscientific.
3. Models serve as epistemic confines to our understanding.
We argue that 2., a premise he makes implicitly, is wrong. Formal language in fables cannot produce an ‘illusion’ of scientific-ness, because there is no division between ‘fables’ and ‘science’. We suggest that scientific models are stories (2) in some real sense, and therefore it does not make sense to say that models are unscientific because they are fables. Science is composed of a complex web of interacting models (stories) whose aims are to explain and understand the world. This would be consistent with Sugden’s (3) view of economic models as credible worlds.
Richardson cites Rubinstein (4) to buttress his argument that models are merely fictions. This misuses Rubinstein, who argues ‘The models presented… are nothing but fables. Neither of them describes reality, but both of them still describe something from reality… studying both of them together helps to some extent in understanding economic mechanisms.’ (p.182). It does not seem fair to brand models as ‘merely’ fables on this reading, and nor does this give us licence to dismiss fables as unscientific.
Epidemiologists often make significant assumptions in order to model disease progression. Many parameters are unknown, and there are often practical constraints to modelling significant hete...
Richardson (1) argues three substantive points:
1. Models are merely fables dressed in formal language.
2. Fables are unscientific.
3. Models serve as epistemic confines to our understanding.
We argue that 2., a premise he makes implicitly, is wrong. Formal language in fables cannot produce an ‘illusion’ of scientific-ness, because there is no division between ‘fables’ and ‘science’. We suggest that scientific models are stories (2) in some real sense, and therefore it does not make sense to say that models are unscientific because they are fables. Science is composed of a complex web of interacting models (stories) whose aims are to explain and understand the world. This would be consistent with Sugden’s (3) view of economic models as credible worlds.
Richardson cites Rubinstein (4) to buttress his argument that models are merely fictions. This misuses Rubinstein, who argues ‘The models presented… are nothing but fables. Neither of them describes reality, but both of them still describe something from reality… studying both of them together helps to some extent in understanding economic mechanisms.’ (p.182). It does not seem fair to brand models as ‘merely’ fables on this reading, and nor does this give us licence to dismiss fables as unscientific.
Epidemiologists often make significant assumptions in order to model disease progression. Many parameters are unknown, and there are often practical constraints to modelling significant heterogeneity in the population, for example computing power. When an epidemiologist assumes ‘symptomatic individuals are 50% more infectious than asymptomatic individuals,’ [https://www.imperial.ac.uk/media/imperial-college/medicine/mrc-gida/2020... they are explaining how the world might be under this assumption. This is just one example, but we are not the first to suggest that models in science describe the world as it might be rather than necessarily as it is (5–7).
Therefore, science is composed of a network of interconnected stories (models), and it does not make sense to think that because models are stories, they are unscientific.
Richardson’s description of models appears to grant them agency (8). This means it is the models themselves that warp our understanding of the spread of SARS-CoV-2. He thinks this happens in a similar fashion to philanthropists obscuring economic exploitation. We argue, however, that this is an unhelpful inflation of models’ agency: if models restrict COVID-19 discourse and impose epistemic confines, it is humans, political actors, who make them do so. Thus, just as billionaire philanthropists (humans) marginalise discussions over more equitable taxation regimes, it is human political actors who instrumentalise models to suppress contemplation of potential worlds. Concern over one or another model’s agency seems to lead only to more discussion over models - if the model has too much or too little agency, this is a problem for the model, and the question of how humans use models is vanished.
Even if we accept that models are indeed agentic, we argue his remedy of ‘liberation by model’ is misplaced. More modelling with ‘radical wealth redistribution as its moral’ feels unlikely to move discussion away from the modelling and towards the other causes of poor health. Instead, we suggest looking to other materials to aid our understanding of COVID-19. Models must sit alongside (e.g.) history and politics as tools to usefully describe what is happening (and what could) - but models cannot tell us what ought to.
References
1. Richardson ET. Pandemicity, COVID-19 and the limits of public health ‘science.’ BMJ Glob Heal [Internet]. 2020 Apr 1;5(4):e002571. Available from: http://gh.bmj.com/content/5/4/e002571.abstract
2. Frigg R. Models and Fiction. Synthese [Internet]. 2010 Apr 18;172(2):251–68. Available from: http://www.jstor.org/stable/40496038
3. Sugden R. Credible worlds: the status of theoretical models in economics. J Econ Methodol [Internet]. 2000 Jan 1;7(1):1–31. Available from: https://doi.org/10.1080/135017800362220
4. Rubinstein A. Economic fables. Open book publishers; 2012.
5. Frigg R, Nguyen J. The turn of the valve: representing with material models. Eur J Philos Sci [Internet]. 2018;8(2):205–24. Available from: https://doi.org/10.1007/s13194-017-0182-4
6. Frigg R, Hartmann S. Models in Science. In: The Stanford Encyclopedia of Philosophy [Internet]. Spring 202. Metaphysics Research Lab, Stanford University; 2020. Available from: https://plato.stanford.edu/archives/spr2020/entries/models-science/
7. Rhodes T, Lancaster K, Rosengarten M. A model society: maths, models and expertise in viral outbreaks. Crit Public Health [Internet]. 2020 Mar 31;1–4. Available from: https://doi.org/10.1080/09581596.2020.1748310
8. Latour B. On actor-network theory: A few clarifications. Soz Welt [Internet]. 1996 Apr 18;47(4):369–81. Available from: http://www.jstor.org/stable/40878163
Paul et al [1] argue for a systemic approach to global health policy. This shift is long overdue, and as they pointed out systems thinking has long been suppressed by the all-powerful reductionist research industry.
Part of the problem is understanding of health and disease as distinctly dichotomous. However, the experience of health and dis-ease are dynamic as much in the presence as absence of identifiable disease [2]. In addition, health, illness dis-ease and disease occur on a continuum in the same person over time. It entails a continuous change in the physiological dynamics within the person that ultimately leads to changes that we recognise as one or the other disease. The process can lead to multiple expressions of disease, nevertheless, they are nothing more than the result of the overall physiological dysfunction within the same person [3].
As is well known health and disease disparities follow the socioeconomic gradient [4]. The question arises – how? There is increasing evidence from psychoneuroimmunology research that shows the longterm effects of psychosocial stress on the physiological stress response pathways resulting in chronic inflammatory dysregulation and its link to disease burden [5, 6].
Taken together, these findings provide a complex adaptive system explanation of the nature of health and disease arising through the network interaction between our environmental, socio-cultural and economic-political contexts and our biological...
Paul et al [1] argue for a systemic approach to global health policy. This shift is long overdue, and as they pointed out systems thinking has long been suppressed by the all-powerful reductionist research industry.
Part of the problem is understanding of health and disease as distinctly dichotomous. However, the experience of health and dis-ease are dynamic as much in the presence as absence of identifiable disease [2]. In addition, health, illness dis-ease and disease occur on a continuum in the same person over time. It entails a continuous change in the physiological dynamics within the person that ultimately leads to changes that we recognise as one or the other disease. The process can lead to multiple expressions of disease, nevertheless, they are nothing more than the result of the overall physiological dysfunction within the same person [3].
As is well known health and disease disparities follow the socioeconomic gradient [4]. The question arises – how? There is increasing evidence from psychoneuroimmunology research that shows the longterm effects of psychosocial stress on the physiological stress response pathways resulting in chronic inflammatory dysregulation and its link to disease burden [5, 6].
Taken together, these findings provide a complex adaptive system explanation of the nature of health and disease arising through the network interaction between our environmental, socio-cultural and economic-political contexts and our biological blueprint [3], and should be the basis for the redesign of effective, efficient and equitable health systems [7].
It is encouraging to see that systems thinking is slowly emerging in a wide range of health-related disciplines. Those involved ought to more closely collaborate to gain influence and impact [8].
References
1. Paul E, Brown GW, Ridde V. COVID-19: time for paradigm shift in the nexus between local, national and global health. BMJ Global Health. 2020;5(4):e002622. doi: https://dx.doi.org/10.1136/bmjgh-2020-002622
2. Sturmberg JP. The personal nature of health. J Eval Clin Pract 2009;15(4):766-69.doi: https://dx.doi.org/10.1111/j.1365-2753.2009.01225.x
3. Sturmberg JP, Picard M, Aron DC, Bennett JM, Bircher J, deHaven MJ, et al. Health and Disease—Emergent States Resulting From Adaptive Social and Biological Network Interactions. Frontiers in Medicine. 2019;6:59. doi: https://dx.doi.org/10.3389/fmed.2019.00059
4. Marmot M. The Influence Of Income On Health: Views Of An Epidemiologist. Health Aff. 2002;21(2):31-46. doi: https://dx.doi.org/10.1377/hlthaff.21.2.31
5. Slavich GM, Cole SW. The Emerging Field of Human Social Genomics. Clinical Psychological Science. 2013;1(3):331-48. doi: https://dx.doi.org/10.1177/2167702613478594
6. Seeman M, Stein Merkin S, Karlamangla A, Koretz B, Seeman T. Social status and biological dysregulation: the "status syndrome" and allostatic load. Social science & medicine (1982). 2014;118:143-51. doi: https://dx.doi.org/10.1016/j.socscimed.2014.08.002
7. Sturmberg JP. Health System Redesign. How to Make Health Care Person-Centered, Equitable, and Sustainable. Cham, Switzerland: Springer; 2018.
8. International Society for Systems and Complexity Sciences for Health. [Internet] www.isscsh.org
Implementation research is crucial to determining effectiveness and appropriateness of interventions that are urgently needed in many contexts, constituting "global health". There is, however, an ongoing surprising relative lack of discussion on the need for appropriate understand of the ethical implications of Implementation research. Ethics committees and researchers are often not well versed in the ethics implications, and how these differ form traditional clinical research. the potential for unintended harm is great in the vulnerable circumstances wheer implementation research is often conducted. It is vital that if implementation research is conducted, ethical implications are considered throughout the process (i.e. continuing throughout the implementation itself and post-research). These issues have been laid out in an online teaching tool (by TDR/Global health Ethics Unit at WHO) and in the following publications: https://www.who.int/tdr/publications/year/2019/ethics-in-ir-course/en/ https://implementationscience.biomedcentral.com/articles/10.1186/s13012-... https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30310-9/fulltext
Responding to https://gh.bmj.com/content/5/4/e002094
‘The Commonwealth Pharmacists Association (CPA) https://commonwealthpharmacy.org/welcomes the publication of this systematic review which confirms the views held by the CPA that usable, point of prescribing decision information in low and middle income countries, is often not readily available where it is most needed. This of particular concern when we consider the prescribing and appropriate use of antimicrobials.
The UK DHSC Fleming Fund (https://www.flemingfund.org/) Commonwealth Partnership for Antimicrobial Stewardship (CwPAMS) Project has for the last 6 months been piloting an App for use in Ghana, Tanzania, Uganda and Zambia. This is part of the wider CwPAMS programme which is a collaboration between CPA and The Tropical Health and Education Trust (THET) https://www.thet.org/our-work/grants/cwpams/
The App guides prescribers as per national guidelines, and contains links to WHO resources and other training materials. It is explained clearly in this short u-tube video https://www.youtube.com/watch?v=MJ7fa_aLgCI It is free, to download to a smart phone or device anywhere in the world where there is access to the internet and then...
Responding to https://gh.bmj.com/content/5/4/e002094
‘The Commonwealth Pharmacists Association (CPA) https://commonwealthpharmacy.org/welcomes the publication of this systematic review which confirms the views held by the CPA that usable, point of prescribing decision information in low and middle income countries, is often not readily available where it is most needed. This of particular concern when we consider the prescribing and appropriate use of antimicrobials.
The UK DHSC Fleming Fund (https://www.flemingfund.org/) Commonwealth Partnership for Antimicrobial Stewardship (CwPAMS) Project has for the last 6 months been piloting an App for use in Ghana, Tanzania, Uganda and Zambia. This is part of the wider CwPAMS programme which is a collaboration between CPA and The Tropical Health and Education Trust (THET) https://www.thet.org/our-work/grants/cwpams/
The App guides prescribers as per national guidelines, and contains links to WHO resources and other training materials. It is explained clearly in this short u-tube video https://www.youtube.com/watch?v=MJ7fa_aLgCI It is free, to download to a smart phone or device anywhere in the world where there is access to the internet and then may be used off line. Whilst the analysis of the CwPAMS programme is ongoing, positive impacts are emerging. We believe that the CwPAMS App may have significant and far reaching benefits beyond this initial four country pilot https://viewer.microguide.global/CPA/CWPAMS’
Sarah Cavanagh CPA International Partnerships Lead and Victoria Rutter Executive Director CPA on behalf of the CPA App development team Chloe Tuck, Diane Ashiru-Oredope, Omotayo Olaoye, WeiPing Khor, Roisin McMenamin
We read with great interest the original research by Coll CVN, Ewerling F, García-Moreno C, et al which found that domestic violence in low- and middle-income countries was more prevalent amongst certain groups of women.
The ongoing COVID-19 pandemic has already ravaged countries within Asia, Europe and the United States, defined as high-income by the World Bank Group. [1] Actions taken to prevent the spread of the virus has meant a large proportion of the population in these countries is currently under some degree of confinement, and consequently, an alarming increase in domestic violence has been reported by the news. [2]
Coll CVN, Ewerling F, García-Moreno C, et al recognises Africa and SouthEast Asia to have a higher prevalence of domestic violence. At the time of writing (29/03/2020), the WHO has already reported 3005 cases and 51 deaths in Africa and 3709 cases and 139 deaths in SouthEast Asia, with no doubt that these numbers will continue to grow. [3]
Resources to fight the COVID-19 epidemics in these regions are limited and thus, efforts aiming to curb the transmission will soon undoubtedly follow other countries’ mitigation plans; police enforcing a lockdown, healthcare workers treating COVID-19 patients and government officials attempting to gather the necessary equipment for the care of its citizens. This means an extensive proportion of the workforce needed to help women undergoing domestic violence will already be si...
We read with great interest the original research by Coll CVN, Ewerling F, García-Moreno C, et al which found that domestic violence in low- and middle-income countries was more prevalent amongst certain groups of women.
The ongoing COVID-19 pandemic has already ravaged countries within Asia, Europe and the United States, defined as high-income by the World Bank Group. [1] Actions taken to prevent the spread of the virus has meant a large proportion of the population in these countries is currently under some degree of confinement, and consequently, an alarming increase in domestic violence has been reported by the news. [2]
Coll CVN, Ewerling F, García-Moreno C, et al recognises Africa and SouthEast Asia to have a higher prevalence of domestic violence. At the time of writing (29/03/2020), the WHO has already reported 3005 cases and 51 deaths in Africa and 3709 cases and 139 deaths in SouthEast Asia, with no doubt that these numbers will continue to grow. [3]
Resources to fight the COVID-19 epidemics in these regions are limited and thus, efforts aiming to curb the transmission will soon undoubtedly follow other countries’ mitigation plans; police enforcing a lockdown, healthcare workers treating COVID-19 patients and government officials attempting to gather the necessary equipment for the care of its citizens. This means an extensive proportion of the workforce needed to help women undergoing domestic violence will already be significantly stretched.
We propose that countries of low- and middle income must quickly recognise and prevent this likely occurrence by raising awareness of the matter and putting in place a special human resource, whose sole focus would be to identify and help women who find themselves in these difficult circumstances, whilst at the same time considering the implications of the country's epidemic on such interventions. More specifically, we call for particular attention to be given to the groups of women identified by Coll CVN, Ewerling F, García-Moreno C et al. as being at an increased risk of domestic violence.
We are in complete agreement with Coll CVN, Ewerling F, García-Moreno C et al.’s policy of leaving no one behind and through our rapid response, hope to have highlighted the need for preventing rather than mitigating domestic violence in low- and middle income countries, especially amongst more vulnerable groups of women, during these uncertain and unsettling times.
As highlighted by Bowe and colleagues, air pollution is closely linked to burden of Chronic Kidney Disease (CKD). (1) A recent article on cardio-pulmonary mortality also highlighted similar issue, with a focus on provision of ventilation. (2)
India faces similar issues due to air pollution attributable to wide spread traditional habit of cooking with biomass. The contribution of CKD to Disability Adjusted Life Years (DALY) in the country has increased from 0.8% in 1990 to 1.6% in 2016 and it is the 9th common cause of mortality. (3)
With focus on prevention, CKD has been included under National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke, the flagship program for Non-Communicable Diseases (NCD). Through NCD Clinics, diabetes and hypertension, two common risk factors for CKD, are being addressed. Population based screening is also underway for prevention, awareness and early diagnosis of these two morbidities. (4) Pradhan Mantri National Dialysis Program has been put in place to meet the need of dialysis services by the poor people at free of cost. (5) Ujjwala scheme has recently been introduced, under which more than 80 million families have been provided clean fuel. The scheme specifically targets rural areas where biomass is considered as one of the major mean for cooking. (6)
With so many initiatives, researches are warranted from India to estimate their effects in mitigating CKD burden and to tailor hea...
As highlighted by Bowe and colleagues, air pollution is closely linked to burden of Chronic Kidney Disease (CKD). (1) A recent article on cardio-pulmonary mortality also highlighted similar issue, with a focus on provision of ventilation. (2)
India faces similar issues due to air pollution attributable to wide spread traditional habit of cooking with biomass. The contribution of CKD to Disability Adjusted Life Years (DALY) in the country has increased from 0.8% in 1990 to 1.6% in 2016 and it is the 9th common cause of mortality. (3)
With focus on prevention, CKD has been included under National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke, the flagship program for Non-Communicable Diseases (NCD). Through NCD Clinics, diabetes and hypertension, two common risk factors for CKD, are being addressed. Population based screening is also underway for prevention, awareness and early diagnosis of these two morbidities. (4) Pradhan Mantri National Dialysis Program has been put in place to meet the need of dialysis services by the poor people at free of cost. (5) Ujjwala scheme has recently been introduced, under which more than 80 million families have been provided clean fuel. The scheme specifically targets rural areas where biomass is considered as one of the major mean for cooking. (6)
With so many initiatives, researches are warranted from India to estimate their effects in mitigating CKD burden and to tailor health policies according to the need.
References
1. Bowe B, Xie Y, Li T, Yan Y, Xian H, Al-Aly Z. The global and national burden of chronic kidney disease attributable to ambient fine particulate matter air pollution: a modelling study. BMJ Glob Health 2020;5:e002063.
2. Yu K, Lv J, Qiu G, et al. Cooking fuels and risk of all-cause and cardiopulmonary mortality in urban China: a prospective cohort study. Lancet Glob Health 2020; 8(3):e430-e439.
3. Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation. India: Health of the Nation's States - The India State-level Disease Burden Initiative. New Delhi, India: ICMR, PHFI, and IHME. 2017.
4. Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India. National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke. (Available at http://dghs.gov.in/content/1363_3_ NationalProgrammePreventionControl.aspx, last accessed on 1st April, 2020).
5. Ministry of Health and Family Welfare. Pradhan Mantri National Dialysis Program. (Available at https://mohfw.gov.in/basicpage/pradhan-mantri-national-dialysis-programm..., last accessed on 1st April, 2020).
6. Pradhan Mantri Ujjwala Yojana. (available from www.pmuy.gov.in, last accessed on 1st April, 2020)
Why the first sentence of this article with its exaggerated claim about the health outcomes of Aboriginal and Torres Strait Islander Australians? The reference cited, 1 does not support the comparison with other populations globally, and the article itself seeks to move beyond negative images of Aboriginal and Torres Strait Islander people. Beginning with this negative statement – regardless of its veracity - continues the long history of deficit discourse used in discussing Aboriginal and Torres Strait Islander people. Rather than contribute to improved outcomes deficit discourse can actually reinforce and perpetuate approaches and behaviours such as those the article seeks to address. 2
Overall the article presents important new research moving beyond negative stereotypes of Aboriginal and Torres Strait Islander people, highlighting their perspectives and insights, and encouraging a more culturally driven approach. This makes the opening even more inappropriate and unnecessary.
References
1. Gracey M, King M. Indigenous health part 1: determinants and disease patterns. Lancet. 2009;374:65-74.
2. Fogarty W, Bulloch H, McDonnell S et al. Deficit Discourse and Indigenous Health: How narrative framings of Aboriginal and Torres Strait Islander people are reproduced in policy. Melbourne: The Lowitja Institute; 2018 [cited 20 Jan 2020]. Available from:...
Why the first sentence of this article with its exaggerated claim about the health outcomes of Aboriginal and Torres Strait Islander Australians? The reference cited, 1 does not support the comparison with other populations globally, and the article itself seeks to move beyond negative images of Aboriginal and Torres Strait Islander people. Beginning with this negative statement – regardless of its veracity - continues the long history of deficit discourse used in discussing Aboriginal and Torres Strait Islander people. Rather than contribute to improved outcomes deficit discourse can actually reinforce and perpetuate approaches and behaviours such as those the article seeks to address. 2
Overall the article presents important new research moving beyond negative stereotypes of Aboriginal and Torres Strait Islander people, highlighting their perspectives and insights, and encouraging a more culturally driven approach. This makes the opening even more inappropriate and unnecessary.
References
1. Gracey M, King M. Indigenous health part 1: determinants and disease patterns. Lancet. 2009;374:65-74.
2. Fogarty W, Bulloch H, McDonnell S et al. Deficit Discourse and Indigenous Health: How narrative framings of Aboriginal and Torres Strait Islander people are reproduced in policy. Melbourne: The Lowitja Institute; 2018 [cited 20 Jan 2020]. Available from: https://www.lowitja.org.au/page/services/resources/Cultural-and-social-d....
While liking the idea, I find two main problems with the suggested definition of global health as "public health somewhere else": 1) it is too narrow and 2) it sounds dismissive. In "global health", the word "global" is inclusive and suggests a health agenda embracing all the communities of the rest of the world. This is lost in the definition. Then there is the dismissive sound of "somewhere else" ("You can join our club or go somewhere else", "This could be Paradise or it could be somewhere else", etc.). I may be thin-skinned, but disdaining to specify a location sounds to me like a slur. For these reasons, and for all the other good reasons offered in the original Commentary, I suggest amending the definition to "public health everywhere else". This follows the original in asserting "elseness", while being inclusive and positive.
We fully agree with the authors in terms of need for a paradigm shift. We have called it a 'pandemic' but response has been largely country centric and not at all global.
We would also like to highlight a typical reactionary response globally leading to exclusion of fathers from maternity and neonatal units.
The Covid-19 pandemic is dividing families all over the world, especially at a time when togetherness is particularly important, such as at the time of birth, death and illness. Many families are experiencing situations that are prone to leave life-long scars.
Show MoreWhile the protection of the health of staff and mothers is of paramount importance, social distancing, curbs to travel and additional restrictions to presence of parents instituted by maternity and neonatal units across the world have created obvious difficulties for families. Having a sick baby in a neonatal unit during this pandemic is a particularly intense hardship for families. We are well aware of negative impacts of separation on children and families and the pandemic related restrictions have made this worse for the whole family, perhaps more so for parents of preterm and sick newborns.
We have previously highlighted, along with many others, the importance of optimising fathers’ experiences in the neonatal unit (Ref 1-8) and suggested a focus on a co-parenting paradigm with a clear set of recommendations for neonatal and maternity services (Ref 1).
Even though we...
Dear Editor,
After reading the article, we would like to sincerely congratulate the authors Heidi Oi-Yee Li, Adrian Bailey, David Huynh and James Chan on their successful piece titled ‘YouTube as a source of information on COVID-19: a pandemic of misinformation?’ published in the British Medical Journal. This is a very relevant piece of work and we would like to offer some contributions.
As the Covid-19 pandemic progresses daily, social media platforms such as YouTube, unfortunately can become victims to showcasing anecdotal and premature evidence that can lead to fatal consequences and further spread of the so called ‘infodemic’(1). The article we are responding to worryingly demonstrates the large viewership, 62,042,609, of the non-factual videos on YouTube (2). Despite this representing only a quarter of the videos used in the study this shows these videos are perhaps more popular to watch which risks miseducating a large number of viewers.
Show MoreHowever, it appears that since the publication of this article in March 2020 this issue has come to light and been addressed. YouTube has now updated its policies and created a ‘COVID-19 medical misinformation policy’ (3) . Assumingly, this policy has been created to protect its audiences from misinformation, going against viewing algorithms that would normally display videos higher up on the suggestions based on viewing number levels. The policy enforces that the spread of medical misinformation regarding coron...
Richardson (1) argues three substantive points:
1. Models are merely fables dressed in formal language.
2. Fables are unscientific.
3. Models serve as epistemic confines to our understanding.
We argue that 2., a premise he makes implicitly, is wrong. Formal language in fables cannot produce an ‘illusion’ of scientific-ness, because there is no division between ‘fables’ and ‘science’. We suggest that scientific models are stories (2) in some real sense, and therefore it does not make sense to say that models are unscientific because they are fables. Science is composed of a complex web of interacting models (stories) whose aims are to explain and understand the world. This would be consistent with Sugden’s (3) view of economic models as credible worlds.
Show MoreRichardson cites Rubinstein (4) to buttress his argument that models are merely fictions. This misuses Rubinstein, who argues ‘The models presented… are nothing but fables. Neither of them describes reality, but both of them still describe something from reality… studying both of them together helps to some extent in understanding economic mechanisms.’ (p.182). It does not seem fair to brand models as ‘merely’ fables on this reading, and nor does this give us licence to dismiss fables as unscientific.
Epidemiologists often make significant assumptions in order to model disease progression. Many parameters are unknown, and there are often practical constraints to modelling significant hete...
Paul et al [1] argue for a systemic approach to global health policy. This shift is long overdue, and as they pointed out systems thinking has long been suppressed by the all-powerful reductionist research industry.
Part of the problem is understanding of health and disease as distinctly dichotomous. However, the experience of health and dis-ease are dynamic as much in the presence as absence of identifiable disease [2]. In addition, health, illness dis-ease and disease occur on a continuum in the same person over time. It entails a continuous change in the physiological dynamics within the person that ultimately leads to changes that we recognise as one or the other disease. The process can lead to multiple expressions of disease, nevertheless, they are nothing more than the result of the overall physiological dysfunction within the same person [3].
As is well known health and disease disparities follow the socioeconomic gradient [4]. The question arises – how? There is increasing evidence from psychoneuroimmunology research that shows the longterm effects of psychosocial stress on the physiological stress response pathways resulting in chronic inflammatory dysregulation and its link to disease burden [5, 6].
Taken together, these findings provide a complex adaptive system explanation of the nature of health and disease arising through the network interaction between our environmental, socio-cultural and economic-political contexts and our biological...
Show MoreImplementation research is crucial to determining effectiveness and appropriateness of interventions that are urgently needed in many contexts, constituting "global health". There is, however, an ongoing surprising relative lack of discussion on the need for appropriate understand of the ethical implications of Implementation research. Ethics committees and researchers are often not well versed in the ethics implications, and how these differ form traditional clinical research. the potential for unintended harm is great in the vulnerable circumstances wheer implementation research is often conducted. It is vital that if implementation research is conducted, ethical implications are considered throughout the process (i.e. continuing throughout the implementation itself and post-research). These issues have been laid out in an online teaching tool (by TDR/Global health Ethics Unit at WHO) and in the following publications:
https://www.who.int/tdr/publications/year/2019/ethics-in-ir-course/en/
https://implementationscience.biomedcentral.com/articles/10.1186/s13012-...
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30310-9/fulltext
Responding to https://gh.bmj.com/content/5/4/e002094
Show More‘The Commonwealth Pharmacists Association (CPA) https://commonwealthpharmacy.org/welcomes the publication of this systematic review which confirms the views held by the CPA that usable, point of prescribing decision information in low and middle income countries, is often not readily available where it is most needed. This of particular concern when we consider the prescribing and appropriate use of antimicrobials.
The UK DHSC Fleming Fund (https://www.flemingfund.org/) Commonwealth Partnership for Antimicrobial Stewardship (CwPAMS) Project has for the last 6 months been piloting an App for use in Ghana, Tanzania, Uganda and Zambia. This is part of the wider CwPAMS programme which is a collaboration between CPA and The Tropical Health and Education Trust (THET) https://www.thet.org/our-work/grants/cwpams/
The App guides prescribers as per national guidelines, and contains links to WHO resources and other training materials. It is explained clearly in this short u-tube video https://www.youtube.com/watch?v=MJ7fa_aLgCI It is free, to download to a smart phone or device anywhere in the world where there is access to the internet and then...
Dear Editor,
We read with great interest the original research by Coll CVN, Ewerling F, García-Moreno C, et al which found that domestic violence in low- and middle-income countries was more prevalent amongst certain groups of women.
The ongoing COVID-19 pandemic has already ravaged countries within Asia, Europe and the United States, defined as high-income by the World Bank Group. [1] Actions taken to prevent the spread of the virus has meant a large proportion of the population in these countries is currently under some degree of confinement, and consequently, an alarming increase in domestic violence has been reported by the news. [2]
Coll CVN, Ewerling F, García-Moreno C, et al recognises Africa and SouthEast Asia to have a higher prevalence of domestic violence. At the time of writing (29/03/2020), the WHO has already reported 3005 cases and 51 deaths in Africa and 3709 cases and 139 deaths in SouthEast Asia, with no doubt that these numbers will continue to grow. [3]
Resources to fight the COVID-19 epidemics in these regions are limited and thus, efforts aiming to curb the transmission will soon undoubtedly follow other countries’ mitigation plans; police enforcing a lockdown, healthcare workers treating COVID-19 patients and government officials attempting to gather the necessary equipment for the care of its citizens. This means an extensive proportion of the workforce needed to help women undergoing domestic violence will already be si...
Show MoreAs highlighted by Bowe and colleagues, air pollution is closely linked to burden of Chronic Kidney Disease (CKD). (1) A recent article on cardio-pulmonary mortality also highlighted similar issue, with a focus on provision of ventilation. (2)
Show MoreIndia faces similar issues due to air pollution attributable to wide spread traditional habit of cooking with biomass. The contribution of CKD to Disability Adjusted Life Years (DALY) in the country has increased from 0.8% in 1990 to 1.6% in 2016 and it is the 9th common cause of mortality. (3)
With focus on prevention, CKD has been included under National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke, the flagship program for Non-Communicable Diseases (NCD). Through NCD Clinics, diabetes and hypertension, two common risk factors for CKD, are being addressed. Population based screening is also underway for prevention, awareness and early diagnosis of these two morbidities. (4) Pradhan Mantri National Dialysis Program has been put in place to meet the need of dialysis services by the poor people at free of cost. (5) Ujjwala scheme has recently been introduced, under which more than 80 million families have been provided clean fuel. The scheme specifically targets rural areas where biomass is considered as one of the major mean for cooking. (6)
With so many initiatives, researches are warranted from India to estimate their effects in mitigating CKD burden and to tailor hea...
Why the first sentence of this article with its exaggerated claim about the health outcomes of Aboriginal and Torres Strait Islander Australians? The reference cited, 1 does not support the comparison with other populations globally, and the article itself seeks to move beyond negative images of Aboriginal and Torres Strait Islander people. Beginning with this negative statement – regardless of its veracity - continues the long history of deficit discourse used in discussing Aboriginal and Torres Strait Islander people. Rather than contribute to improved outcomes deficit discourse can actually reinforce and perpetuate approaches and behaviours such as those the article seeks to address. 2
Overall the article presents important new research moving beyond negative stereotypes of Aboriginal and Torres Strait Islander people, highlighting their perspectives and insights, and encouraging a more culturally driven approach. This makes the opening even more inappropriate and unnecessary.
References
1. Gracey M, King M. Indigenous health part 1: determinants and disease patterns. Lancet. 2009;374:65-74.
Show More2. Fogarty W, Bulloch H, McDonnell S et al. Deficit Discourse and Indigenous Health: How narrative framings of Aboriginal and Torres Strait Islander people are reproduced in policy. Melbourne: The Lowitja Institute; 2018 [cited 20 Jan 2020]. Available from:...
While liking the idea, I find two main problems with the suggested definition of global health as "public health somewhere else": 1) it is too narrow and 2) it sounds dismissive. In "global health", the word "global" is inclusive and suggests a health agenda embracing all the communities of the rest of the world. This is lost in the definition. Then there is the dismissive sound of "somewhere else" ("You can join our club or go somewhere else", "This could be Paradise or it could be somewhere else", etc.). I may be thin-skinned, but disdaining to specify a location sounds to me like a slur. For these reasons, and for all the other good reasons offered in the original Commentary, I suggest amending the definition to "public health everywhere else". This follows the original in asserting "elseness", while being inclusive and positive.
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