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Despite concern that a patient-centered approach will take more time, the study further re- inforces that exploring all of the patient’s concerns does not decrease efficiency. Physicians and veterinarians have much to learn and benefit from each other. “The world’s last endemic case of smallpox: surveillance and con- tainment measures.” Bull World Health Organi- zation.1980; 58: 279-283. In a study carried out in 2006, the prevalence of anti­biotic storage in Span- ish households was 37% [14]. Some early monitoring results from the University of Utah has suggested such ac- tion, whilst by no means eliminating the problem, it has proven effective in so far as reducing the difficulties [10]. Smart phones and tablets as well as various wear- able devices, e.g.

The tendency of even experienced family physicians not to seek the patient’s com- plete agenda is similar to the finding of Beckman and Frankel 15 years ago. Pets and other small animals can develop symptoms of lead poisoning from very small doses and should serve as sentinels for potential human cases if they become sick [14, 15]. Antibiotics available at home have been found to be an important risk factor for this practice [13], and leftover medication may later be considered for self- medication,leading to inappropriate usage of these drugs. Over- the-counter suboptimal dispensing of antibiot- ics in Uganda.(2013) Journal of Multidisciplinary Healthcare;6, 303–10. This legisla- tion not only clarified the statutory remit of the USA’s medicines agency to be in- volved in resolving medicine shortages problem, but also addressed problems in relation to the legal responsibilities of manufacturers to report likely disrup- tions to supply at an early stage in order to enable better contingency planning. BACK TO CONTENTS 72 73 GERMANYGERMANY Mobile Health Mobile Health The rapid advancement of technology does not stop at mobile devices: For most people, these sophisticated gadgets have become an integral part of their daily life.

Humans and animals cannot be healthy if the environment in which they live is sick. Another factor is patients’ non-adherence to antibiotic therapy. Almacenamiento de antibióticos en los hogares españoles. Conflicts like these are well known to medicine at large, but m Health in its ubiquity, availabil- ity and accessibility may provoke a new and enhanced debate about some ethical aspects that are already being discussed in medicine in general.

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The physician will search for additional clues – information that will aid in the solu- tion of the person’s problem. As with hu- mans, an increase in canine and feline obe- sity has led to an increase in diabetes [10]. Drawbacks of the over-the- counter sale of antimicrobials The link between the over-the-counter sale of antibiotics and antibiotic overconsump- tion is clearly established. Many respondents then went on to provide examples including: • The aggravation caused to patients, main- ly elderly, when explaining the required changes or delays to their treatment; • The distress caused by delays or interrup- tions to chemotherapy treatments; • The confusion experienced by prescrib- ers and nurses when out-of-stock but familiar medicines must be replaced by available alternatives, and the potential increase in medication error risk; • Heightened risk of hospital acquired in- fection as a result of antibiotic shortage; • Deterioration in patients’ condition due to shortage of the most efficacious medi- cines; • Raised risk levels from the required use of unlicensed alternatives to a medicine in shortage; and, • Additional hospital admissions as a result of some shortages (e.g. As suggested by the title, however, simply drawing attention to the problems caused by medicines shortages is not enough. 57% 55% 30% 30% 26% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% Antimicrobilalagents(Antibiotics/ Antivirals/Antifungals) Oncology Emergency Cardiovascularmedicines Anaestheticagents Endocrinemedicines Preventivemedicines (e.g.vaccines) Haematologymedicines Other Paediatricmedicines Respiratory Topicaltreatments Gastrointestinal Orphan Renal Urology Transplant Figure 3. The categories with the highest responds include antimirobials (56.7%), oncology (54.5%), emergency medicines (30.4%) and cardiovascular medicines (30.4%).

Very often the physician will have a very good idea of the likely diagnosis of the pa- tient’s problem within the first two minutes through his or her experienced pattern rec- ognition of the common disease processes. Dis- coveries in veterinary medicine can benefit human medicine and vice versa. found that antibiotics, which are considered as pre- scription-only medicines in Finland, were purchased by 41% of the immigrants who admitted having taken an antibiotic in the previous 6 months [9]. Over 75% of the respondents to the survey either agreed or strongly agreed with the statement “medicines shortages in my hos- pital are having a negative impact on patient care”. This indicates the many categories of medicine are affected by shortage.

Whilst one of the most difficult tasks for physicians is to convey bad news, physicians who are emotionally supportive can influence patients’ emotional functioning with little effort and time [13]. Ac- cording to the last Eurobarometer available, carried out in November 2013, 84% of re- spondents were aware that the overuse of antibiotics makes them ineffective. Is self- medication with antibiotics in Europe driven by prescribed use? Earnshaw S., Mancarella G., Mendez A., To- dorova B., Magiorakos A. (2013) International Jour- nal of Infectious Diseases,17, e168–72. World Health Organization Advisory Group on Integrated Surveillance of Antimicro- bial Resistance (AGISAR). (2009) Interdisciplinary Perspective of Infectious Diseases, 513609. Tuberculosis control and the private health sector in Bolivia: a survey of pharmacies. Never- theless, despite the perceived benefits mo- bile technologies can offer in healthcare, the highly sensitive nature of this field of appli- cation raises a number of ethical questions that need to be answered [3].

These points have been defined as fundamental for effective patient- physician communication. Public awareness of the issue is low, with many people still believing that antibiot- ics are effective against viral infections. European Antibiotic Awareness Day 2010: why doesn’t promoting antibiotic awareness always work? A study of ad- herence to antibiotic treatment in ambulatory respiratory infections. Over-the-counter availability of antituberculosis drugs in Tbilisi, Georgia in the setting of a high prevalence of MDR-TB. L., Delgado R., Michaux G., Volz A., Van der Stuyft P. For patients, the main aspect is the added comfort of such mobile solutions compared to conventional methods, while from a professional point of view, better ad- herence to a prescribed regimen as well as meticulous monitoring may serve to prevent long-term damages that might be caused as a result of a more careless approach.

Microbes do not necessarily recognize the differences between species and could infect across them if given the right conditions. (1999)”Narrative based medicine: Why study narrative” BMJ 318,:48–50)De Salvo L. (1996) Patient-centered medicine: a professional evolution. For instance, in our study carried out in 2007, fluoroquinolones, which are consid- ered as critically important antimicrobials by the World Health Organization as also are third- and fourth-generation cephalo- sporins and macrolides) [19], accounted for 40% of the antibiotics sold for urinary tract infections [7]. At the same time apps have already proven to be effective tools for boosting adherence to therapies (for example, via text messag- ing reminders) or for disease management [5].

Zoonotic disease risks from wildlife, livestock, and pets cannot be ad- equately addressed without meaningful collaboration and cooperation between vet- erinarians and physicians. Over-the-counter sale of antimicrobials of- ten leads to a wrong choice of these drugs. Also, they believe that being well informed may also serve to mitigate potential risks.

The danger is that at this stage other pertinent information may not be given by the patient or sought by the physician. B, (1999) Soliciting the Patient’s Agen- da Have We Improved? In another example,a ca- nine vaccine for oral melanoma was the first therapeutic vaccine approved for the use in either animals or humans [11]. Committee to Update Science, Medicine, and Animals, National Research Council. Frequency of the sale of antimicrobials based on simulated client method surveys Author, year Country Type URTI OM Sin. UTI STI Specific anti- microbials Vari- ousa EUROPE Contopoulos-Ioannidis DG, 2000 Greece D 78% Plachouras D, 2008 Greece D 53–100%b Marković-Peković V, 2010 Bosnia&Herzegovina D 58% Simó S, 2006c Spain I 12% Llor C, 2007 Spain D 35% 16% 80% Gastelorrutia, 2009 Spain D 17% Simó S, 2012c Spain I 6% Guinovart M, 2014 Spain D 48% 33% 81% AMERICA Gellert GA, 1994 Mexico I 100% Bartoloni A, 1992 Bolivia D, Id 24% 91% 24% 40–92%e 58% 67%f Volpato DE, 2002 Brazil I 74% Vacca CP, 2007 Colombia D 80% AFRICA Nyazema N, 2004 Zimbabwe D 9% 8–65%g MIDDLE EAST Amidi S, 1975 Iran D 60% 40% Tomson G, 1985 Yemen I 9% Al-Faham Z, 2009 Syria I 97% Dameh H, 2005 United Arab Emirates D 69% Al-Ghamdi MS, 1999 Saudi Arabia D 82% Bin Abdulhak AA, 2010 Saudi Arabia I 51% 40% 90% 73% 90% 75% ASIA Wolffers I, 1983 Sri Lanka D 100% Tomson G, 1985 Sri Lanka I 41% Tomson G, 1985 Bangladesh I 68% Hadi U, 2006 Indonesia D 74% Puspitasari HP, 2010 Indonesia D 91% Quagliarello AB, 1999 Vietnam D 99% 75% Chalker J, 1999 Vietnam D 98% Wachter DA, 1996 Nepal D, Ih 97% 38% Thajlikitkul V, 1986 Thailand D 50– 100% Chalker J, 1999 Thailand I 76% Apisarnthanarak A, 2006 Thailand I 80% 74% 65% 76% 100% Type=type of simulated patient (D, direct: the patient him-/herself; I, indirect: simulating having a relative or friend with an infectious disease); URTI=upper respira- tory tract infection (including rinorrhoea, sneezing, with or without fever); OM=otitis media; Sin.=sinusitis; LRTI=lower respiratory tract infection; Dia.=diarrhoea; UTI=urinary tract infection; STI=sexually transmitted infection a Various infectious diseases considered; b Mistery shoppers requested ciprofloxacin (53% of success) and amoxicillin/clavulanate (100% of success); c Related to a 9-month old baby with an upper respiratory tract infection and fever; d The indirect simulated patients corresponded to children; e 40% in case of a 6-month old child and 92% when an adult with this infection was simulated; f Case of male urethral discharge; g 8% in the case of a male urethritis and 65% when a vaginal discharge was simulated; h The direct simulated patient corresponded to the case of UTI; the indirect case corresponded to his 5-year son with diarrhoea BACK TO CONTENTS 66 67 SPAINSPAINAntimicrobials use Antimicrobials use terms of the consumption of antibiotics, as described in the last report issued by the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) [10]. With the causes of shortages acknowledged to be so multi-fac- eted, as well as situation and region-specific, it need barely to be mentioned that it is a list of mitigating policy actions that are re- quired, rather than any single answer. Most hospital pharmacists responded that they are affected by shortages on a weekly basis.

There is then a tendency to move to gather more specific information to exclude other possibilities and confirm the presumptive diagnosis. Studying disease similarities and differences between species could shed important new information on disease progression, treat- ment,and control. Southern Euro- pean countries usually rank at the top in Carl Llor Pros and Cons of the Over-the-counter Sales of Antimicrobials Ana Moragas Table 1. Ef- fort, energy and awareness must be drawn to potential solutions. n=418 Approximately how often does your hospital pharmacy experience shortages?

Some of the greatest discoveries in the histo- ry of medicine and public health were made at the intersection between human and ani- mal health. Edward Jenner, an apprentice surgeon, learned from dairy- maids that they were immune from smallpox because they had had cowpox. This easy access and inappropriate use of these drugs clearly constitute risk factors for further de- velopment of multidrug resistant tuberculo- sis, which is nowadays challenging due to the associated high morbidity and mortality [22]. This refers as much to using the apps them- selves as to targeted advertising users may receive which is specifically adapted to their “health”-related data or their health pro- file.

Indeed, approximately 75 percent of emerging infectious diseases and approximately 60 percent of all human pathogens are zoonotic in origin [1]. (1999) Writing as a Way of Healing: How Telling Our Stories Transforms Our Lives. Similarly, essential antitu- berculosis drugs are available without pre- scription in many areas, with streptomycin, rifampicin and isoniazid being sold for indi- cations other than tuberculosis as over-the- counter antimicrobials [20,21]. However, these developments go hand in hand with technical challenges and ethi- cal concerns: Above all, the medicalisation of apps results in limited consumer choices.

61 Medical World Journal Official Journal of The World Medical Association, Inc. 2, July 2015 Contents The General Assembly in Moscow . In another study carried out in Taiwan, patients with detectable ­antibiotic concentrations in urine were nearly twice as likely to have a missed diagnosis of a true bacterial infection compared to the patients without any antimicrobial detected [26]. Obtaining antibiotics without prescription in Spain in 2014: even easier now than 6 years ago. (2007) Journal of Antimicrobial Chemotherapy, 60, 698–701. In a nut- shell, we propose m Health specific ethical principles to be developed that – while they are still based on established principles and guidelines – also take the specific require- ments of m Health under consideration. A Plea for Developing a Consistent Framework What Constitutes m Health?

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