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COVID-19: Testing still vital even as vaccines roll out

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A healthcare worker at a testing facility collects samples for the coronavirus at Mimar Sinan State Hospital, Buyukcekmece district in Istanbul, Turkey. © UNDP Turkey/Levent Kulu

Testing will still be a critical tool against COVID-19, even as vaccines are deployed against the disease, the head of the World Health Organization (WHO) said on Friday during his regular briefing on the crisis. 

WHO chief Tedros Adhanom Gheybreyesus emphasized how testing has been common among countries which have worked to control the virus. 

“As vaccines are rolled out, testing will continue to play a vital role”, he said

“Initially, health workers, older people and other at-risk groups will be prioritised for vaccination. That will still leave the virus with a lot of room to move, and testing will remain a vital tool for controlling the pandemic.” 

However, Tedros stressed that though vital, testing is only part of the strategy against COVID-19

“Testing is the spotlight that shows where the virus is. Investments in testing must be matched by investments in isolation facilities, clinical care, protecting health workers, contact tracing, cluster investigation and supported quarantine”, he stated. 

More evaluation needed 

Meanwhile, WHO said more information is needed concerning the vaccine developed by the pharmaceutical company AstraZeneca and Oxford University. 

The partners announced this week that clinical trials showed a regimen consisting of one half-dose of the vaccine, followed by a full dose a month later, was more effective than two full doses. 

Dr. Katherine O’Brien, Director of Immunization, Vaccines and Biologicals at WHO, underlined the need for further evaluation as the data were reported in a press release. 

“I think what we can emphasize, though, is that from what we understand about the press release, there is certainly something interesting that has been observed. But there are many reasons that could underlie the differences that were observed,” she said. 

WHO’s Chief Scientist, Dr. Soumya Swaminatha, pointed out that less than 3,000 people were given the lower-dose regimen, according to the press release, all of whom were 55 years old or younger.  

She added that the other group consisted of more than 8,000 people of varying ages, thus making it very hard to compare the two, while overall, their numbers were too small to come to any definitive conclusions. 

“It would be speculation at this point,” Dr. Swaminathan told reporters. 

She said AstraZeneca has informed WHO that it intends to run a full trial of the lower-dose regimen. 

Lessons from Ebola 

Global experience with storage and distribution of the Ebola vaccine could inform delivery of any potential inoculation against COVID-19 once developed, according to WHO. 

“There is demonstrated experience of delivering ultra-cold chain vaccines, even in some of the most difficult and remote areas,” said Dr. O’Brien.  “But that has also taken enormous resources to do that.” 

The WHO official was responding to a journalist’s question concerning the experimental vaccine developed by pharmaceutical companies Pfizer and BioNTech, which was recently submitted to authorities in the United States for emergency approval. 

The vaccine, which has shown a more than 90 per cent efficacy rate, requires very cold storage of -70 degrees Celsius or below, prompting concerns about potential distribution in African countries. 

No one vaccine is enough 

“We do have experience in a number of countries, specifically in Africa, being able to deploy a vaccine with that ultra-cold chain requirement”, said Dr. O’Brien, referring to the Merck Ebola vaccine used in outbreaks in the Democratic Republic of the Congo. 

“So, as we anticipate the use of the Pfizer vaccine, the intention is certainly to be able to use it along with other vaccines because no one vaccine is going to have adequate supply, nor will any one vaccine necessarily have suitable operational characteristics to meet all of the needs.” 

Dr. O’Brien added that Pfizer has developed a special “shipper” which can maintain the vaccine’s temperature for up to 10 to 15 days. 

Furthermore, the vaccine can be stored at refrigerated temperatures for five days, she continued, while portable freezers that do not run on electricity, and even dry ice, also can be used. 

Innovate for delivery 

As ultra-cold chain logistics are not in place everywhere, including in high-income nations, Dr. O’Brien suggested that countries will have to “innovate” around systems for delivering COVID-19 vaccines that have this requirement.   

One approach could be to use them for immunizing certain segments of the population.   

She cited health professionals as an example, because they work in facilities where immunization would take place and where it would be easier to install the ultra-cold chain freezers. 

Move your body 

Although the pandemic has imposed many restrictions on our lives, there is no excuse to sit on the couch, WHO affirmed on Friday, announcing new guidelines on physical activity and sedentary behaviour, published this week. 

Exercise is essential for physical and mental health throughout life, the agency said, but one in four adults, and four in five adolescents, do not move enough. 

The guidelines recommend between 150 and 300 minutes of moderate to vigorous activity per week for adults, and an average of 60 minutes per day for children and adolescents.

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HL7 FHIR, the Future of Health Information Exchange?

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Health Level 7 International is an association that calls itself a non profit organization, ANSI-accredited standards developing organization devoted to creating a thorough structure and standards set for the exchange, incorporation, sharing, and retrieval of digital health data that endorses clinical practice and the management, delivery, and evaluation of health services.

A next-generation standards framework developed by HL7, FHIR is described as such on the HL7 website. The best aspects of HL7’s v2, v3, and CDA product lines are combined in FHIR, which also makes use of the most recent web standards and places a strong emphasis on implementation.

Do you wonder what’s the difference between HL7 and FHIR? The core development technologies are the fundamental distinction between HL7 and FHIR. FHIR depends on open web technologies like JSON and RDF data formats as well as RESTful web services. FHIR reduces the learning curve for developers because they are already familiar with these technologies, allowing them to start working more immediately.

The “Resources” of FHIR and How They Help the Provider

FHIR is essentially an effective mechanism for healthcare professionals to communicate data about patients in a range of settings, including in-patient, ambulatory, acute, long-term, community, allied health, etc. The implementation of FHIR through its Resources is the aspect of it that matters the most to providers. The resources are comparable to “paper ‘forms’ indicating various types of medical and administrative data that can be gathered and shared,” as stated on their website. Each Resource or “form” is assigned a template by FHIR.

Why is FHIR important?

Data was locked in proprietary structures for many years. Providers, payers, and patients frequently had to revert to outdated, time-consuming techniques to transmit information, such as faxing chart notes or physically transferring paper-based records. Or systems had to transmit whole papers to answer a doctor’s demand for specific health information. Doctors have to search through entire paperwork to find a single piece of information, which drains them and takes lots of time. Luckily, each Resource can be provided using FHIR without the whole clinical record. This enables a quicker and significantly more effective interchange of health information.

Why is HL7 FHIR the future of health information exchange?

Sharing data is made easier, implementation is greatly simplified, and mobile apps are support FHIR better. Additionally, it provides crucial use cases that are advantageous to patients, payers, and providers.

To expedite decision-making, physicians can exchange patient data more effectively among teams. Medical data can be added to claims data by insurance companies to enhance risk assessment, reduce costs, and enhance outcomes. Additionally, patients can have more influence over their health by getting access to medical data via user-friendly apps that operate on smartphones, tablets, and wearables.

What makes FHIR different from the rest of the previous standards?

Although FHIR differs from earlier standards in numerous ways, there are two fundamental distinctions that make it so remarkable:

Security: TLS/SSL encryption is necessary for any production health data exchanged over FHIR. This makes it significantly safer than earlier HL7 standards.

Resources: FHIR makes use of uniform data components and formats, also referred to as “Resources.” The lowest feasible transactional unit in FHIR is a Resource, which provides significant data through a known identity.

FHIR can be used in a wide range of situations, such as mobile apps, cloud communications, data sharing based on electronic health records, server communication in large institutional healthcare providers, and more. Open source, cost-free, scalable, and adaptable summarize FHIR.

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Time to address mental health issues in the workplace

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With an estimated 12 billion workdays lost annually due to depression and anxiety, costing the global economy nearly $1 trillion, more action is needed to tackle mental health issues at work, the World Health Organization (WHO) and the International Labour Organization (ILO) said on Wednesday. The UN agencies have launched two publications which aim to prevent negative work situations and cultures while also offering mental health protection and support for employees.  

Performance and productivity affected 

“It’s time to focus on the detrimental effect work can have on our mental health,” said Tedros Adhanom Ghebreyesus, Director-General at WHO, which has issued global guidelines on the issue. 

“The well-being of the individual is reason enough to act, but poor mental health can also have a debilitating impact on a person’s performance and productivity.” 

The WHO guidelines contain actions to tackle risks to mental health at work such as heavy workloads, negative behaviours, and other factors that can create distress. 

For the first time, the UN health agency recommends manager training, to build their capacity to prevent stressful work environments and respond to workers’ needs. 

A workplace taboo 

WHO’s World Mental Health Report, published in June, revealed that of one billion people estimated to be living with a mental disorder in 2019, 15 per cent of working-age adults experienced a mental disorder.  

The workplace amplifies wider societal issues that negatively affect mental health, including discrimination and inequality, the agency said.

Bullying and psychological violence, also known as “mobbing,” is a key complaint of workplace harassment that has a negative impact on mental health. However, discussing or disclosing mental health remains a taboo in work settings globally. 

The guidelines also recommend better ways to accommodate the needs of workers with mental health conditions and proposes interventions that support their return to work. 

Increasing opportunities 

They also outline measures to ease entry into the jobs market, for those workers with severe mental health conditions. 

Importantly, the guidelines call for interventions for the protection of health, humanitarian, and emergency workers. 

A separate policy brief with ILO explains the WHO guidelines in terms of practical strategies for governments, employers and workers, and their organizations, in both the public and private sectors.  

The objective is to support the prevention of mental health risks, protect and promote mental health at work, and support those with mental health conditions, so they can participate and thrive at work.  

“As people spend a large proportion of their lives in work – a safe and healthy working environment is critical,” said, Guy Ryder, the ILO Director-General. 

“We need to invest to build a culture of prevention around mental health at work, reshape the work environment to stop stigma and social exclusion, and ensure employees with mental health conditions feel protected and supported.” 

ILO’s Convention on occupational safety and health, and a related recommendation, provide legal frameworks to safeguard workers.  

Lack of national programmes 

However, only 35 per cent of countries reported having national programmes for work-related mental health promotion and prevention. 

The COVID-19 pandemic triggered a 25 per cent increase in general anxiety and depression worldwide, according to a WHO study published in March. 

The crisis exposed how unprepared governments were for its impact on mental health, as well as a chronic global shortage of mental health resources.  

In 2020, governments worldwide spent an average of just two per cent of health budgets on mental health, with lower-middle income countries allocating less than one per cent. 

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A good night’s sleep is a tonic to remember

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BY ANTHONY KING

Everyone suffers restless nights from time to time. Chewing over failures or worries at the end of the day undermines rest, especially deep sleep. ‘A ruffled mind makes a restless pillow,’ wrote author Charlotte Brontë.  

A good night’s sleep serves as a tonic. What’s more, it is long recognised that shuteye gives learning and memory a boost. More recently, scientists revealed that the early phase of deep slow-wave sleep is especially important.

‘When you learn something in the evening, that information becomes reactivated during sleep,’ said Dr Bjoern Rasch, who took part in the Horizon-funded MemoSleep project and is a professor at the University of Fribourg.

The Swiss researcher added that ‘Ruminations and negative thoughts increase our awakenings during sleep, make us wake earlier than we want and make us sleep less deeply.’ 

Reactivated thoughts

But there is good news too. Positive thoughts can also be reactivated in brain circuits and, in the process, improve sleep, according to Dr Rasch. He organized an experiment around the whole idea.  

His test was a small boon to students in his university who received 50 Swiss francs (EUR 52) for every night they spent snoozing in a comfortable four-bed sleeping laboratory.

The students were connected to an electroencephalogram that monitored their brain waves. They also had their muscles monitored to record when they fell into slumber and what sleep-state they were in.

Some relaxation strategies allow people to fall asleep faster, but don’t change the quality of sleep afterwards, according to Dr Rasch. He played hypnotic tapes with imagery such as a fish swimming in deep water, and with words suggestive of safety and relaxation, for the students.

‘The subjects spent more time in the deeper slow-wave sleep stage after listening to the hypnotic tape,’ said Dr Rasch. ‘We would explain this by an increased reactivation of relaxing and reassuring thoughts during sleep, heard previously during the hypnosis tape.’

In future studies, Dr Rasch hopes to help patients who suffer from insomnia. 

‘It could not only help them fall asleep but could actually make their sleep more restful,’ he said. Furthermore, this could aid people with psychological illnesses, such as post-traumatic stress disorder, who sleep poorly.

Seahorses and learning

The seahorse-shaped part of the brain called the hippocampus (from the Greek word for seahorse) is especially important for learning and memory. Scientists often use rodents to investigate their hippocampus in learning and sleep.

Rats, for example, are masters at remembering paths through mazes to find foods. The hippocampus is key to this recall.  

Dr Juan Ramirez-Villegas uses rodents to probe how mammalian brains store memories – work that could eventually contribute to fighting human illnesses such as Alzheimer’s. 

As part of the Horizon-funded DREAM project, he discovered that another part of the brain – the brainstem – plays a crucial role along with the hippocampus and becomes active beforehand.

‘It seems like the brainstem is setting up some scenery so that the hippocampus can reactivate memories across different stages of sleep,’ said Dr Ramirez-Villegas, who is a postdoctoral fellow at the Institute of Science and Technology Austria. 

He has attached electrodes to record activity in the brains of rats as they navigate a maze and afterwards as they sleep. Sleeping allows the brain to replay daytime events and etch them as long-term memories. 

‘It is very striking that the cells fire in the same order during sleep that they did during learning, but they are more compressed in time during sleep,’ said Dr Ramirez-Villegas.

How we remember

The discovery was surprising because it suggests that the brainstem has an overlooked function in stimulating and changing memory formation. This seems to be true for rodents as much as for primates and, as a result, is likely to be a basic mechanism of the brains of mammals, including people. 

The research, while crucial to understanding the basic operation of the brain, could have clinical benefits too. ‘We are untangling the basic principles of memory processes, but we can also use these to ameliorate the effects of memory-related illnesses,’ said Dr Ramirez-Villegas.

The research in this article was funded via the EU’s European Research Council and the Marie Skłodowska-Curie Actions (MSCA). This article was originally published in Horizon, the EU Research and Innovation Magazine. 

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