Li et al.[1] analyzed misinformation about the Covid-19 pandemic generated by social media, as well as that from traditional means of communication.[2] We focus here on a further, more insidious form of misinformation: that generated by institutions, by paradigmatically analyzing the case of Italy.
It was well known on January 31, 2020 that Covid-19 had the potential to become pandemic and detailed measures for adoption by health authorities to combat the disease had already been indicated.[3] On the same day, the Italian government declared a state of emergency.[4] However, while neglecting scientific data [3] and in contrast to the seriousness of the decision,[4] institutional figures (government officials and health authorities), reassured the population through statements in the media that the situation was under control even when the virus had demonstrated its contagiousness and lethality. For weeks prior to the outbreak in Lombardy, the population was told that COVID-19 was little more than a flu. Authorities reassured the population that the measures being adopted to prevent/limit the epidemic were the most stringent in Europe. On February 26th, with 330 infected individuals and 11 dead, the Italian Prime Minister declared that the number of infections should not cause alarm. In the coming days, citizens became aware of the magnitude of the outbreak and found themselves psychologically/materially unprepared, in a stupor in the face of the collapse of the Lomb...
Li et al.[1] analyzed misinformation about the Covid-19 pandemic generated by social media, as well as that from traditional means of communication.[2] We focus here on a further, more insidious form of misinformation: that generated by institutions, by paradigmatically analyzing the case of Italy.
It was well known on January 31, 2020 that Covid-19 had the potential to become pandemic and detailed measures for adoption by health authorities to combat the disease had already been indicated.[3] On the same day, the Italian government declared a state of emergency.[4] However, while neglecting scientific data [3] and in contrast to the seriousness of the decision,[4] institutional figures (government officials and health authorities), reassured the population through statements in the media that the situation was under control even when the virus had demonstrated its contagiousness and lethality. For weeks prior to the outbreak in Lombardy, the population was told that COVID-19 was little more than a flu. Authorities reassured the population that the measures being adopted to prevent/limit the epidemic were the most stringent in Europe. On February 26th, with 330 infected individuals and 11 dead, the Italian Prime Minister declared that the number of infections should not cause alarm. In the coming days, citizens became aware of the magnitude of the outbreak and found themselves psychologically/materially unprepared, in a stupor in the face of the collapse of the Lombardy health care system.[5]
In democratic regimes in the era of mass communications, an institutional line of communication based on misinformation is a fallacious attempt, presumably dictated by a desire to avoid alarm among the population while preparing health measures not taken in due time. For example, it was not until February 25th that the Italian Civil Defense purchased personal protective equipment for health care workers. Reasons of state cannot justify the sacrifice of the public’s right to information either: they exist to protect the integrity of the state in general and need to find legal formalization. Misinformation has had the effect of disorienting the population and has not prevented the country from spiraling into catastrophe.[5] Sadly, the traditional media has contributed to spreading misinformation, merely reporting government reassurances or, even worse, passing on fake news.[2]
By speeding up the process of publishing articles on Covid-19, scientific publishers have enabled timely dissemination of clinically relevant information to members of the scientific community. In addition, by making journal content free and easily accessible, verified information has become available to the public. The question is: how many individuals currently turn directly to these sources? Institutional voices are the only ones the public should be able to turn to with total trust. Governments must disseminate honest information in such a way to improve awareness among the general public regarding the true seriousness of the epidemic. Conversely, misinformation on the part of institutions betrays the public’s relationship of trust in institutions. Furthermore, it generates dangerous discrimination in knowledge of the phenomenon and access to treatment and exposure to epidemic risk, especially among weaker individuals who are more likely to be without access to scientific information and to glean unverified information from social networks.
Competing interests: none. The paper did not receive funding.
References
1. Li HO, Bailey A, Huynh D, et al. YouTube as a source of information on COVID-19: a pandemic of misinformation? BMJ Global Health2020;pii: e002604. DOI:10.1136/ bmjgh-2020-002604.
2. Zarocostas J. “How to fight an infodemic”, Lancet 2020;395,10225:676.
3. Wu TJ, Leung K, Leung GM. Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study. Lancet2020;395,10225:689-697.
4. Consiglio dei Ministri. Dichiarazione dello stato di emergenza in conseguenza del rischio sanitario connesso all'insorgenza di patologie derivanti da agenti virali trasmissibili. Gazzetta Ufficiale della Repubblica Italiana. Serie Generale n. 26. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=2ahU...
5) Lazzerini, Putoto G. “COVID-19 in Italy: momentous decisions and many uncertainties”. Lancet Global Health2020 8:e641-e642. DOI:10.1016/S2214-109X(20)30110-8.
I thank both Rajan et al. and Bali et al. for highlighting a lack of inclusivity in the governance of the coronavirus disease 2019 (COVID-19) response.1,2 While the pandemic raises societal concerns, decision-making bodies remain unrepresentative of civil society and suffer from a dearth of diversity – with, for instance, an underrepresentation of women’s perspectives.1,2 I would add that inclusivity may have been thus far derogated by the popular discourse of some traditional, paternalistic leadership – namely, that which is conveyed through wordings worthy of warlords.
“We are at war”, as declared the Director-General of the World Health Organization, before exhorting G20 leaders to “fight like hell” and calling for “aggressive action” to combat the COVID-19 pandemic.3 This rhetoric of war echoes that of some men country leaders and scientists, pressing authorities for immediate action. Yet, as metaphors frame the way people act,4 triggering civil and societal responsiveness should instead begin with wordings of compassion, cooperation and emancipation.
First, the rhetoric of war may monopolize the public attention to a unique, imminent goal: mustering all forces to defeat and annihilate an enemy (here, the severe acute respiratory syndrome coronavirus, SARS-CoV-2) – any other objectives being put aside as under war economy. This imposed monopoly may contrast with population concerns: Do we – civil society – strive merely to exterminate SARS-CoV-2, or rathe...
I thank both Rajan et al. and Bali et al. for highlighting a lack of inclusivity in the governance of the coronavirus disease 2019 (COVID-19) response.1,2 While the pandemic raises societal concerns, decision-making bodies remain unrepresentative of civil society and suffer from a dearth of diversity – with, for instance, an underrepresentation of women’s perspectives.1,2 I would add that inclusivity may have been thus far derogated by the popular discourse of some traditional, paternalistic leadership – namely, that which is conveyed through wordings worthy of warlords.
“We are at war”, as declared the Director-General of the World Health Organization, before exhorting G20 leaders to “fight like hell” and calling for “aggressive action” to combat the COVID-19 pandemic.3 This rhetoric of war echoes that of some men country leaders and scientists, pressing authorities for immediate action. Yet, as metaphors frame the way people act,4 triggering civil and societal responsiveness should instead begin with wordings of compassion, cooperation and emancipation.
First, the rhetoric of war may monopolize the public attention to a unique, imminent goal: mustering all forces to defeat and annihilate an enemy (here, the severe acute respiratory syndrome coronavirus, SARS-CoV-2) – any other objectives being put aside as under war economy. This imposed monopoly may contrast with population concerns: Do we – civil society – strive merely to exterminate SARS-CoV-2, or rather to preserve common societal goods, such as population health and welfare? According to a Danish survey, citizens may be more worried about having their relatives or the society impaired, than about becoming themselves infected by the virus.5 Limiting the spreading of SARS-CoV-2 has a major role in maintaining population health; however, addressing citizens requires a discourse of compassion engaging with their concerns.
Second, the rhetoric of war may imply a form of heroic storytelling: a distinction between heroes (the army of health professionals, who are sent to the frontline to fight the pandemic) and non-heroes (citizens, who are asked to follow orders). Yet, if their position were reconsidered, these excluded followers could play a central role in solving the crisis, for groups of diverse individuals might outperform groups of experts alone on complex problems.6 Funding agencies offer support to scientific environments; citizens should also be encouraged to join their various skills and complement those of health professionals. As learnt from the Ebola crisis, artists could for instance help enhance the clarity of health messages via culturally relevant narratives to the community.7 Hence, the need for a cooperation discourse.
Third, while promoting diversity of perspectives is pivotal to solving complex problems,6 the rhetoric of war may instil the antithetical dogma in the population mind: discipline and obedience to a common thinking. Such war conditions might in fact hinder societal creativity,8 thereby posing a paradox: terming the current societal problem as “war” may repress its own resolution. Non-violent forms of storytelling and public-minded discourses (e.g. in Denmark, “samfundssind” [“community spirit”]) are therefore needed to emancipate and include citizens in building societal responsiveness to the COVID-19 pandemic.
References
1. Rajan D, Koch K, Rohrer K, et al. Governance of the Covid-19 response: a call for more inclusive and transparent decision-making. BMJ Global Health 2020; 5(5).
2. Bali S, Dhatt R, Lal A, Jama A, Van Daalen K, Sridhar D. Off the back burner: diverse and gender-inclusive decision-making for COVID-19 response and recovery. BMJ Global Health 2020; 5(5).
3. Organization WH. WHO Director General's remarks at the G20 Extraordinary Leaders’ Summit on COVID-19 - 26 March 2020. https://www.who.int/dg/speeches/detail/who-director-general-s-remarks-at....
4. Lakoff G, Johnson M. Metaphors we live by. Chicago & London: The University of Chicago Press; 1980.
5. Department of Public Health at the University of Copenhagen. What concerns the Danish population about the corona crisis? 2020. https://healthsciences.ku.dk/coronadata/results/resultat-1/.
6. Hong L, Page SE. Groups of diverse problem solvers can outperform groups of high-ability problem solvers. Proceedings of the National Academy of Sciences of the United States of America 2004; 101(46): 16385-9.
7. Sonke J, Pesata V. The arts and health messaging: Exploring the evidence and lessons from the 2014 Ebola outbreak. BMJ Outcomes, 2015. http://s15762.pcdn.co/wp-content/uploads/2016/08/BMJ-Outcomes-Article-Co...
8. Simonton DK. Political pathology and societal creativity. Creativity Research Journal 1990; 3(2): 85-99.
The report on "Safe management of bodies of deceased persons with suspected or confirmed COVID-19: a rapid systematic review" is intetresting [1]. Yaacoub et al. concluded that "there is a need for contextual evidence in relation to these proposed management strategies (ie, acceptability, feasibility, impact on equity, resources considerations) [1]". Indeed, the safety issue on practicing with death body during COVID-19 pandemic is interesting but little mentioned. The evidences on possibility of disease transmission from corpse to a living person is not available. Although there is a report on infection in a medical worker who has an occupational job relating to corpse, there is still no scientific confirmation by molecular diagnostic test to confirm that there is a spreading of disease from dead body [2 - 3]. It is apparently that there are attempts for control of possible disease spreading by any settings but the important question is ont he efficacy of rpreventive methods. A simple question is whether we require a routine screening for COVID-19 pathogen in all dead bodies in the present COVID-19. crisis.
Conflict of inteterest
none
References
1. Yaacoub S, Schünemann HJ, Khabsa J, El-Harakeh A, Khamis AM, Chamseddine F, El Khoury R, Saad Z, Hneiny L, Cuello Garcia C, Muti-Schünemann GEU, Bognanni A, Chen C, Chen G, Zhang Y, Zhao H, Abi Hanna P, Loeb M, Piggott T, Reinap M, Rizk N, Stalteri R, Duda S, Solo K, Chu DK, Akl E...
The report on "Safe management of bodies of deceased persons with suspected or confirmed COVID-19: a rapid systematic review" is intetresting [1]. Yaacoub et al. concluded that "there is a need for contextual evidence in relation to these proposed management strategies (ie, acceptability, feasibility, impact on equity, resources considerations) [1]". Indeed, the safety issue on practicing with death body during COVID-19 pandemic is interesting but little mentioned. The evidences on possibility of disease transmission from corpse to a living person is not available. Although there is a report on infection in a medical worker who has an occupational job relating to corpse, there is still no scientific confirmation by molecular diagnostic test to confirm that there is a spreading of disease from dead body [2 - 3]. It is apparently that there are attempts for control of possible disease spreading by any settings but the important question is ont he efficacy of rpreventive methods. A simple question is whether we require a routine screening for COVID-19 pathogen in all dead bodies in the present COVID-19. crisis.
Conflict of inteterest
none
References
1. Yaacoub S, Schünemann HJ, Khabsa J, El-Harakeh A, Khamis AM, Chamseddine F, El Khoury R, Saad Z, Hneiny L, Cuello Garcia C, Muti-Schünemann GEU, Bognanni A, Chen C, Chen G, Zhang Y, Zhao H, Abi Hanna P, Loeb M, Piggott T, Reinap M, Rizk N, Stalteri R, Duda S, Solo K, Chu DK, Akl EA; COVID-19 Systematic Urgent Reviews Group Effort (SURGE) group. Safe management of bodies of deceased persons with suspected or confirmed COVID-19: a rapid systematic review. BMJ Glob Health. 2020 May;5(5):e002650.
2. Sriwijitalai W, Wiwanitkit V. COVID-19 in forensic medicine unit personnel: Observation from Thailand. J Forensic Leg Med. 2020 May;72:101964.
3. Sriwijitalai W, Wiwanitkit V. Corrigendum to "COVID-19 in forensic medicine unit personnel: Observation from Thailand" [J Forensic Legal Med 72 May 2020, 101964]. J Forensic Leg Med. 2020 May;72:101967.
We were pleased to read the review by Eisenhut K, Sauerborn E, García-Moreno C, et al. and appreciated their insights on the landscape of mobile apps addressing violence against women.
We read with great interest the authors’ observation that “collaborations between mHealth and ‘traditional’ approaches should be actively sought, subordinating the technology to the overall aims of preventing violence against women and mitigating its impacts.” In that spirit, we would like to highlight Physicians for Human Rights’ (PHR) experience implementing a “tech” solution within a larger “low-tech” programmatic ecosystem to address violence against women (VAW).
The Program on Sexual Violence in Conflict Zones at Physicians for Human Rights works with medical, legal, and law enforcement partners in Central and East Africa to address impunity for sexual violence in conflict. Since 2011, we and our partners have trained more than 2,000 professionals in the collection, documentation, and use of court-admissible forensic evidence of sexual violence. As part of this initiative, PHR developed MediCapt, an award-winning mobile application, which standardizes and digitizes the collection of forensic documentation of medical evidence of sexual violence and combines it with a mobile camera to capture and securely store forensic photographic evidence of injuries. MediCapt was “co-designed” with clinician-partners in Kenya and the Democratic Republic of the Congo a...
We were pleased to read the review by Eisenhut K, Sauerborn E, García-Moreno C, et al. and appreciated their insights on the landscape of mobile apps addressing violence against women.
We read with great interest the authors’ observation that “collaborations between mHealth and ‘traditional’ approaches should be actively sought, subordinating the technology to the overall aims of preventing violence against women and mitigating its impacts.” In that spirit, we would like to highlight Physicians for Human Rights’ (PHR) experience implementing a “tech” solution within a larger “low-tech” programmatic ecosystem to address violence against women (VAW).
The Program on Sexual Violence in Conflict Zones at Physicians for Human Rights works with medical, legal, and law enforcement partners in Central and East Africa to address impunity for sexual violence in conflict. Since 2011, we and our partners have trained more than 2,000 professionals in the collection, documentation, and use of court-admissible forensic evidence of sexual violence. As part of this initiative, PHR developed MediCapt, an award-winning mobile application, which standardizes and digitizes the collection of forensic documentation of medical evidence of sexual violence and combines it with a mobile camera to capture and securely store forensic photographic evidence of injuries. MediCapt was “co-designed” with clinician-partners in Kenya and the Democratic Republic of the Congo and is currently in use with patients in Naivasha, Kenya (Mishori et al., 2017; Naimer et al., 2017).
While MediCapt was not included in the study as it did not meet the inclusion criteria for number of downloads, it provides a clear example of an app that is deeply integrated into non-tech programmatic approaches to combat the social and institutional challenges that survivors face in accessing justice and health services. MediCapt serves as one element of a progressive series of interventions that partners engage in with PHR, helping to reinforce the overall goal of the program. In Kenya, the team at the Naivasha County Referral Hospital first engaged with PHR in 2013 through a multisectoral training with legal and law enforcement colleagues focused on forensic evidence of sexual violence and survivor-centered care.
Following more than five years of collaborating with and training clinicians at Naivasha Hospital on forensic documentation with the tools available in resource-constrained settings, we introduced MediCapt in 2018 and worked closely with the hospital team to ensure the app was integrated effectively into the clinician workflow and patient pathway. As the end users in Naivasha noted in a recent report, the MediCapt pilot was successful in part because of the multiple trainings and how the initiative fit into our joint long-term capacity development and mentoring model with the health facility (PHR, 2019).
It is critical for organizations and companies developing apps focused on sexual violence to recognize that these apps do not exist in a vacuum. Our experience with MediCapt has consistently illustrated that integration with “low-tech” approaches is critical for the success of these projects.
“mJustice: Preliminary Development of a Mobile App for Medical-Forensic Documentation of Sexual Violence in Low-Resource Environments and Conflict Zones.” Ranit Mishori, Michael Anastario, Karen Naimer, Sucharita Varanasi, Hope Ferdowsian, Dori Abel, Kevin Chugh. Global Health: Science and Practice Mar 2017, 5 (1) 138-151; DOI: 10.9745/GHSP-D-16-00233.
"MediCapt in the Democratic Republic of the Congo: The Design, Development, and Deployment of Mobile Technology to Document Forensic Evidence of Sexual Violence." Karen Naimer, Widney Brown, and Ranit Mishori. Genocide Studies and Prevention: An International Journal 2017, 11 (1) 25-35, DOI: http://doi.org/10.5038/1911-9933.11.1.1455.
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
Li et al.[1] analyzed misinformation about the Covid-19 pandemic generated by social media, as well as that from traditional means of communication.[2] We focus here on a further, more insidious form of misinformation: that generated by institutions, by paradigmatically analyzing the case of Italy.
Show MoreIt was well known on January 31, 2020 that Covid-19 had the potential to become pandemic and detailed measures for adoption by health authorities to combat the disease had already been indicated.[3] On the same day, the Italian government declared a state of emergency.[4] However, while neglecting scientific data [3] and in contrast to the seriousness of the decision,[4] institutional figures (government officials and health authorities), reassured the population through statements in the media that the situation was under control even when the virus had demonstrated its contagiousness and lethality. For weeks prior to the outbreak in Lombardy, the population was told that COVID-19 was little more than a flu. Authorities reassured the population that the measures being adopted to prevent/limit the epidemic were the most stringent in Europe. On February 26th, with 330 infected individuals and 11 dead, the Italian Prime Minister declared that the number of infections should not cause alarm. In the coming days, citizens became aware of the magnitude of the outbreak and found themselves psychologically/materially unprepared, in a stupor in the face of the collapse of the Lomb...
I thank both Rajan et al. and Bali et al. for highlighting a lack of inclusivity in the governance of the coronavirus disease 2019 (COVID-19) response.1,2 While the pandemic raises societal concerns, decision-making bodies remain unrepresentative of civil society and suffer from a dearth of diversity – with, for instance, an underrepresentation of women’s perspectives.1,2 I would add that inclusivity may have been thus far derogated by the popular discourse of some traditional, paternalistic leadership – namely, that which is conveyed through wordings worthy of warlords.
“We are at war”, as declared the Director-General of the World Health Organization, before exhorting G20 leaders to “fight like hell” and calling for “aggressive action” to combat the COVID-19 pandemic.3 This rhetoric of war echoes that of some men country leaders and scientists, pressing authorities for immediate action. Yet, as metaphors frame the way people act,4 triggering civil and societal responsiveness should instead begin with wordings of compassion, cooperation and emancipation.
First, the rhetoric of war may monopolize the public attention to a unique, imminent goal: mustering all forces to defeat and annihilate an enemy (here, the severe acute respiratory syndrome coronavirus, SARS-CoV-2) – any other objectives being put aside as under war economy. This imposed monopoly may contrast with population concerns: Do we – civil society – strive merely to exterminate SARS-CoV-2, or rathe...
Show MoreThe report on "Safe management of bodies of deceased persons with suspected or confirmed COVID-19: a rapid systematic review" is intetresting [1]. Yaacoub et al. concluded that "there is a need for contextual evidence in relation to these proposed management strategies (ie, acceptability, feasibility, impact on equity, resources considerations) [1]". Indeed, the safety issue on practicing with death body during COVID-19 pandemic is interesting but little mentioned. The evidences on possibility of disease transmission from corpse to a living person is not available. Although there is a report on infection in a medical worker who has an occupational job relating to corpse, there is still no scientific confirmation by molecular diagnostic test to confirm that there is a spreading of disease from dead body [2 - 3]. It is apparently that there are attempts for control of possible disease spreading by any settings but the important question is ont he efficacy of rpreventive methods. A simple question is whether we require a routine screening for COVID-19 pathogen in all dead bodies in the present COVID-19. crisis.
Conflict of inteterest
none
References
Show More1. Yaacoub S, Schünemann HJ, Khabsa J, El-Harakeh A, Khamis AM, Chamseddine F, El Khoury R, Saad Z, Hneiny L, Cuello Garcia C, Muti-Schünemann GEU, Bognanni A, Chen C, Chen G, Zhang Y, Zhao H, Abi Hanna P, Loeb M, Piggott T, Reinap M, Rizk N, Stalteri R, Duda S, Solo K, Chu DK, Akl E...
Dear Editor,
We were pleased to read the review by Eisenhut K, Sauerborn E, García-Moreno C, et al. and appreciated their insights on the landscape of mobile apps addressing violence against women.
We read with great interest the authors’ observation that “collaborations between mHealth and ‘traditional’ approaches should be actively sought, subordinating the technology to the overall aims of preventing violence against women and mitigating its impacts.” In that spirit, we would like to highlight Physicians for Human Rights’ (PHR) experience implementing a “tech” solution within a larger “low-tech” programmatic ecosystem to address violence against women (VAW).
The Program on Sexual Violence in Conflict Zones at Physicians for Human Rights works with medical, legal, and law enforcement partners in Central and East Africa to address impunity for sexual violence in conflict. Since 2011, we and our partners have trained more than 2,000 professionals in the collection, documentation, and use of court-admissible forensic evidence of sexual violence. As part of this initiative, PHR developed MediCapt, an award-winning mobile application, which standardizes and digitizes the collection of forensic documentation of medical evidence of sexual violence and combines it with a mobile camera to capture and securely store forensic photographic evidence of injuries. MediCapt was “co-designed” with clinician-partners in Kenya and the Democratic Republic of the Congo a...
Show MoreWe 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...
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