The state of rural healthcare today, and what technology can do to help

The state of rural healthcare today, and what technology can do to help

Wellness disparities have the potential to negatively impression rural Us residents substantially more than urban Us citizens. No doubt, rural healthcare at present is facing many challenges, this kind of as deficiency of mattress availability – even as COVID-19 decreases.

Dr. Richard Watson is co-founder of Motient, a well being IT vendor that equips well being methods, accountable treatment companies and individual services with instruments and information made to help assure high quality in medical transports.

Healthcare IT News interviewed Watson to discuss the state of rural healthcare right now, the purpose technologies can engage in in preserving rural healthcare, how CIOs can assist assure sustainable good quality in medical transports, and how having the proper tools and info when it comes to affected individual transportation can profit a hospital or health and fitness procedure in terms of individual results, company fulfillment and overall expenditures.

Q. What is taking place with rural health care, and especially mattress availability in rural healthcare?

A. We immediately moved from a pandemic crisis to a staffing disaster. This is not anything new, and a ton of rural amenities had been already dealing with staffing troubles prior to the pandemic.

The initially spherical of COVID-19 analyzed the process, even though the second round crippled it. The increase of company nursing and the mobility of nurses lured to big paychecks, as nicely as attrition in rural locations, has genuinely hurt hospitals’ ability to team.

The in general challenge for rural hospitals right now is sustainability. We have a lot of hospitals that are at a vital crossroads in selecting what they will be in the coming 10 to 20 yrs.

They provide a reducing population that nevertheless wishes to have an acute inpatient facility. What will the medical center of 2030 glance like? Assisting services understand their legitimate objective and their probable for profits is directly dependent on the data they have close to their individual inhabitants.

Q. What do you see with these tendencies in the upcoming calendar year?

A. There’s no question that 2022 will be a instant to appear up for air. As the economics of rural healthcare alter, hospitals’ investigation (or deficiency thereof) about how they in shape into their ecosystem will establish how rural health care is equipped to transfer ahead.

The means to do extra with what you have, and the versatility to treatment for those in your local community, are core hallmarks of rural healthcare. I think amenities will have to capitalize on these strengths in order to arrive out in a optimistic way from the pandemic.

Q. How can technology play a function in preserving healthcare in rural The usa?

A. A large amount has been designed of the function technology can enjoy in rural healthcare. I believe there are several alternatives that get passed on to rural facilities that conclusion up starting to be onerous for those people who are using them. A lot more time is invested keeping the devices and educating the customers than something else there is minimal of profit or benefit.

In the coming ten years, immediate obtain to details, the ability to do telehealth, and the resources to allow information assessment all-around the character of rural services will be significant. Amenities need to turn out to be very focused on who they are and what their mission is.

By employing technology to have an understanding of the overall health designs of their communities and concentrating on delivering companies that retain men and women close to property for the greater part of their care, healthcare organizations can uncover the respond to to top quality and sustainability concerns.

I do believe we have to glimpse at reimbursement in rural regions and fully grasp that much of what comes down the pike, with regard to quality metrics and edicts, does not fit very well with the actuality of rural well being. All of the geographic and demographic offsets will do minimal to counterbalance that. It seems the existing reimbursement schema will allow rural facilities to hardly continue to keep their heads previously mentioned water.

Q. You recommend it is a precedence for healthcare supplier corporation CIOs to get the information essential to ensure sustainable high-quality in professional medical transports. Why? And how can they do that?

A. This is a concern I imagine is forgotten by most lesser services. We speak a ton about population health and the capacity to control the habits of people today with serious sickness to guidance best results. It can be a lofty aim and definitely a little something we have to have to strive for, but even extra significant is a facility’s comprehending of affected person movement all through their ecosystem.

If a facility can truly get a grasp on who is heading out their door and what is the make-up of the providers that sufferers are becoming transferred for, they can start to recognize additional avenues for sustainability and increased quality. They can determine out how these individuals can be returned to their household foundation for treatment, and start furnishing the solutions people today need closer to household.

The means to fully grasp how people move in the technique is the vital to transforming the technique. We shell out a great deal of time hoping to conserve bandages and use the suitable antibiotic, but in truth, these measures are worthy of just nickels and dimes in contrast to the dollars that shift when people are transferred to the incorrect desired destination and the wrong stage of care.

Most crucial, individual movement and fiscal sustainability are instantly tied to excellent. We can waste a large amount of pounds striving to generate good quality systems and lose the potential to be sustainable.

Q. How can having the proper applications and information when it arrives to client transportation reward a healthcare facility or well being process when it comes to patient outcomes, service provider satisfaction and overall prices?

A. Visibility is the most important matter in this region. Most services will do the appropriate factor if they have the correct data in the correct time body. So usually, the info is there, but it really is only readily available months immediately after the fact. Then it becomes just yet another line on a spreadsheet that never ever receives applied in any significant way.

The skill to know in real time how sufferers are moving and where by they are relocating to, and for what rationale, allows hospitals to take motion in relation to those transfers. Numerous times, facilities are sending conditions out the door that they truly could establish a assistance line for internally.

Much larger methods frequently will have obtained smaller sized amenities or techniques that have specialized solutions inside of that ecosystem. It is not uncommon for these massive programs to have individuals likely out of community for services that could be presented in community, if only there was true-time visibility into that activity.

Most companies will react positively to adjust if they are given the prospect to fully grasp the dynamics of how that adjust will positively effect the facility. I assume this amount of management provides every person a greater sensation about the career they’re accomplishing and the facility’s means to present the very best treatment for the client.

Supplying vendors authorization to keep patients they could possibly come to feel pressured to deliver to an additional place – and allowing for them to truly feel justified in applying a certain stage of source, whether that be mode of transportation or a specialty clinic – is an critical prerequisite for vendors generating very good decisions.

When sending services, getting amenities and transportation businesses all are viewing the similar data and the exact facts, good factors can transpire. I genuinely believe that specified the ideal information and facts, these teams will opt for to do what is actually finest for the affected person.

Covid-19’s death toll is nearly three times higher than reported, WHO data suggests

Covid-19’s death toll is nearly three times higher than reported, WHO data suggests

There have been 5.4 million Covid-19 fatalities claimed to WHO through that timeframe, resulting in an extra mortality estimate of 9.5 million additional deaths than what was reported.

“Excessive mortality is the change in between the variety of fatalities that have been recorded and those that would be anticipated in the absence of the pandemic,” reported Samira Asma, assistant director-typical for the Data, Analytics and Shipping and delivery for Impact Division of WHO.

The 14.9 million fatalities include “fatalities instantly attributed to Covid-19 that have been noted to WHO, fatalities immediately attributed to Covid-19 that have been not counted or reported … fatalities indirectly involved with the pandemic thanks to the broader impact on health devices and modern society,” Asma explained. The figure also subtracts any deaths that ended up averted owing to modifications in social behaviors, this kind of as fewer fatalities from motor vehicle wrecks mainly because of lockdowns or travel limitations.

The approximated range of surplus deaths was 13.3 million to 16.6 million above the 24-thirty day period interval, in accordance to the methodology utilized in the WHO report.

In the United States, the variety of excessive fatalities was 932,458 by December 31, 2021, in accordance to WHO. The estimated amount of deaths ranges from 886,917 to 978,225.

That is about 100,000 extra persons than the 824,338 deaths the United States documented on December 31, 2021, according to facts from Johns Hopkins University.

“Being aware of how numerous men and women died due to the pandemic will support us to be better prepared for the subsequent,” Asma stated at a information convention Thursday, adding, “We require to honor the life tragically reduce shorter, lives we dropped, and we should maintain ourselves and our policymakers accountable.”

The metrics paint a fuller picture of the extent of the pandemic and can be employed to tutorial and employ general public well being procedures, according to Asma.

“When we underestimate, we could underinvest. And when we undercount, we might skip focusing on the interventions exactly where they are desired most, and this also deepens inequalities,” she explained.

William Msemburi, technical officer with WHO’s Department of Data and Analytics, explained that about 57{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the excess fatalities were in gentlemen, and 82{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} have been in people today earlier mentioned the age of 60.

Just about 70{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the extra fatalities were being concentrated in 10 nations around the world, Msemburi mentioned, listing them alphabetically: Brazil, Egypt, India, Indonesia, Mexico, Peru, Russia, South Africa, Turkey and the United States.

The Indian governing administration Thursday elevated many objections on the “validity and robustness” of the mathematical products applied by WHO to estimate a new estimate of the Covid-19 loss of life toll in India.

Dr. Gupta: One year of living in the shadow of a pandemic

India noted 481,000 Covid-19 deaths more than the 24-month interval — but WHO’s methodology displays that there ended up just about 10 occasions as numerous, estimating 4.74 million extra fatalities, with a selection of 3.3 million to 6.5 million extra deaths.

“All over the approach of dialogue, engagement and conversation with WHO, WHO has projected diverse extra mortality figures for India citing a number of types, which by itself raises queries on the validity and robustness of the designs used … A modeling solution which provides mortality estimates on the foundation of an additional estimate, although completely disregarding the precise data out there within just the Country reveals lack of academic rigour,” study a statement released by the Indian Ministry of Health and fitness and Spouse and children Welfare.

India has repeatedly dismissed stories of extra dying or underreported Covid-19 fatalities considering that the begin of the pandemic, in particular throughout its devastating 2nd wave in 2021.

In accordance to the health ministry Thursday, the total range of Covid-19 instances recorded because the get started of the pandemic stands at 43 million, with 523,975 fatalities.

At a briefing Wednesday, Asma explained WHO will carry on to engage with India to appear to a “mutual consensus with regard to the distinctive estimates” in the knowledge.

Somnath Chatterji, senior adviser with the Office of Information and Analytics, emphasized the significance of the surplus mortality numbers in WHO’s report.

“These are not quantities for the sake of quantities,” Chatterji stated, noting that in addition to the selection of fatalities straight attributable to Covid-19, the info “estimate the collateral injury that has transpired because of Covid, because of disruptions in overall health expert services.”

“So if these figures have been to be tracked in a timely fashion, then basically, governments would have been equipped to push interventions to the correct folks at the appropriate time at the right area, proper? Which has clearly not happened, and which is why we are seeing these excessive fatalities,” he explained.

“These sobering information not only place to the influence of the pandemic but also to the will need for all countries to spend in more resilient wellness devices that can maintain critical wellbeing products and services all through crises, together with much better health and fitness info systems,” WHO Director-Normal Tedros Adhanom Ghebreyesus claimed in a information release. “WHO is fully commited to working with all nations to strengthen their health and fitness facts methods to deliver greater facts for far better decisions and better results.”

CNN’s Swati Gupta and Virginia Langmaid contributed to this report.

More cases of unusual liver damage reported in the U.S.

More cases of unusual liver damage reported in the U.S.

Doctors at Cincinnati Kid’s Hospital in Ohio say they have dealt with at least six scenarios of severe hepatitis in formerly healthier younger youngsters aged 18 months by means of 10 a long time. A single necessary a liver transplant.

These circumstances incorporate to a rising variety of puzzling reviews of youthful little ones globally who are producing acute hepatitis devoid of a recognised result in.

Dr. Jorge Bezerra, director of the Pediatric Liver Care Heart at Cincinnati Children’s Clinic, stated that his workforce has seen an increasing selection of this sort of clients considering the fact that December.

“We have witnessed six,” Bezerra instructed NBC Information Wednesday. “Currently, we’re going to be viewing a seventh patient,” he claimed. “They’re however coming.” The children dealt with for the liver disorder at Cincinnati Kid’s are all from Ohio.

No just one has been in a position to figure out why these kids are building hepatitis, which just means swelling of the liver.

“There is certainly no hyperlink to 1 geographic region, widespread publicity to particular foods or animals, vacation or to contaminants,” Dr. Philippa Easterbrook, an infectious condition doctor with the Entire world Health and fitness Group, claimed throughout a media briefing Wednesday.

At the very least 228 this sort of conditions have been described in 20 countries, she stated. Ten percent of the kids have required liver transplants.

The regular suspects, hepatitis viruses A through E, have been dominated out. Youngsters are not displaying up with proof of Covid-19, and most are much too young to have acquired the Covid vaccines.

A lot of but not all the kids have analyzed beneficial for an adenovirus.

Adenoviruses can cause a selection of symptoms — from the sniffles to diarrhea — and, in uncommon conditions, hepatitis. These intense cases are usually found in little ones with fundamental health and fitness troubles or immune deficiencies, Bezerra mentioned.

But the kids addressed at Cincinnati Children’s are in any other case healthful.

“We are all putting our heads together to attempt to comprehend what is likely on,” Bezerra stated.

When did hepatitis scenarios start off?

At minimum nine other states have suspected scenarios: Alabama, Delaware, Ga, Illinois, Louisiana, New York, North Carolina, Tennessee and Wisconsin.

Officials in Wisconsin are investigating the loss of life of one little one.

Scenarios started popping up in Alabama past October. Bezerra stated his workforce in Ohio is now examining instances that may have introduced as early as June 2021.

“I believe I’m obtaining that the quantity of clients is going to exceed 10,” he stated.

Bezerra sees about 10 this kind of people in a regular calendar year. “To have 7 to 10 in the very first quarter of the calendar year is higher than standard.”

In April, the Facilities for Illness Control and Prevention issued a wellbeing notify so medical professionals nationwide could be on the lookout for this kind of abnormal situations of pediatric hepatitis.

Other than liver transplant in extreme situations, there is no specific cure for impacted youngsters. They ordinarily will need to be monitored and supported with correct hydration and nourishment to give their liver time to mend.

What are indicators of hepatitis?

Physicians say that people frequently have vomiting, as very well as delicate abdominal ache, diarrhea, fever and nasal congestion.

People indicators, nevertheless, are quite prevalent in youthful children who routinely produce stomach bugs.

But Bezerra mentioned that if individuals indications last extended than a number of days and are accompanied by yellowing of the skin and eyes, it can be time to call the medical doctor.

“The most vital factor is, if there is an onset of jaundice, or yellow discoloration of the eyes,” he mentioned, “seek out healthcare assistance.”

Follow NBC Wellness on Twitter & Facebook.

Marina Kopf contributed.

Can tea prevent cancer and improve overall health?

Can tea prevent cancer and improve overall health?

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Drinking tea may improve heart and brain health, immune function, and reduces cancer risk, a study found. BONNINSTUDIO/Stocksy
  • During a recent symposium on the health benefits of tea, researchers from across the globe shared evidence suggesting that tea consumption may improve cardiovascular health, immune function, cognitive health, and reduce the risk of cancer.
  • The researchers noted that better quality evidence is needed to further establish these beneficial effects of tea consumption, including larger cohort studies and randomized clinical trials.
  • The researchers advocated that people incorporate 2-4 cups of unsweetened tea into the daily diet as a source of flavonoids, which are responsible to a large extent for these beneficial effects.

Leading scientists in the field of tea research recently met virtually at the Sixth International Scientific Symposium on Tea and Human Health to discuss the current state of knowledge and the gaps in understanding about the benefits of tea. Researchers discussed many topics at the symposium, which included the potential beneficial effects of tea on cardiovascular health, cognitive function, and the prevention of cancer.

The conference was organized by the Tea Council of the USA, the public relations arm of the Tea industry whose primary aim is to encourage greater tea consumption. It accomplishes this by furthering tea science and “establishing tea as a healthy, good for you beverage.”

Here is a breakdown of the main findings, and why it may be too early to draw definitive conclusions.

Tea is the second most consumed beverage in the world, after water. The four primary types of tea include white, green, Oolong, and black. All four teas are derived from the same plant, Camellia sinensis, but differ in how they are processed after harvesting.

Tea contains a wide array of components that have biological activity, including flavonoids, L-theanine, and caffeine. Many of the beneficial effects of tea are due to the high levels of flavonoids, such as catechins, which have antioxidative and anti-inflammatory properties.

The differences in the manufacturing process can influence the chemical composition and the beneficial effects of the different tea types. For instance, green tea is roasted before it can oxidize and hence, contains higher levels of catechins. In contrast, black tea is allowed to oxidize and has lower levels of catechins. Meanwhile, black tea contains larger amounts of other flavonoids called thearubigins and theaflavins, which also possess antioxidant properties.

A number of observational studies suggest that tea consumption is associated with improvements in cognitive function. A few small randomized controlled trials have suggested tea intake may result in short-term improvements in attention.

Each cup of tea contains about 35-60 mg of caffeine, which may contribute to the increase in attention and improvements in mood some people experience after consuming tea. Tea also contains theanine, which has been suggested to enhance attention while reducing anxiety and stress.

Researchers think that the presence of theanine and caffeine may potentially produce a simultaneous feeling of calmness while improving attention. In addition, limited evidence suggests that the intake of theanine and caffeine together may result in a greater increase in attention than either component alone.

The flavonoids present in tea may also exert protective effects against common age-related cognitive decline and dementia. Dr. Jonathan Hodgson, a professor at the University of Western Australia, told Medical News Today:

“Several recent large long-term prospective cohort studies have explored the relationships of tea intake and intake of flavonoids found in tea with dementia outcomes. The two main types of dementia are Alzheimer’s disease and vascular dementia. Flavonoids are components of tea that are believed to play an important role in the prevention of vascular diseases.”

“[S]tudies have shown that higher intakes of tea, starting at as little as 1 cup and up to 5-6 cups [a day], are associated with reduced risk for dementia, moderate intakes of flavonoids present in ~2-4 cups of tea are associated with reduced risk for dementia, and for both tea and its flavonoids, maximal benefit may be obtained from moderate intakes of ~2-4 cups[ a day].”
— Dr. Jonathan Hodgson

However, Dr. Hodgson said high intakes may not be needed to see tea’s full benefits.

“Finally, these studies indicate that the protection provided may be strongest for vascular dementia,” he added.

A higher intake of dietary flavonoids is associated with a lower risk of cardiovascular diseases and metabolic conditions, including diabetes.

According to a meta-analysis synthesizing data from 39 studies, the daily intake of each additional cup of tea was associated with a 2{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} lower risk of a cardiovascular event, a 4{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} decline in the risk of stroke, and a 4{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} lower risk of mortality due to cardiovascular disease. These positive effects of flavonoids on cardiometabolic health are associated with lower inflammation and oxidative stress, improved regulation of blood glucose and lipid levels, healthier gut microbiome, and protective effects on blood vessels.

Thus, consumption of tea could be especially beneficial for individuals whose diets are deficient in other sources of flavonoids, including whole grains, fruits, and vegetables.

Dr. Taylor Wallace, a professor in the Department of Nutrition and Food Studies at George Mason University, says, “Adding two cups of unsweet tea to the diet can be a simple and cost-effective [preventive] healthcare approach for cardiovascular diseases.”

After cardiovascular disease, cancer is the second leading cause of mortality. Modifying lifestyle factors such as diet, physical inactivity, smoking, and obesity can prevent 30-40{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of all cancers.

Thus, adopting healthier lifestyle choices that increase levels of flavonoids could reduce the risk of cancer incidence, although the evidence for tea reducing cancer remains limited.

Commenting on the evidence, Dr. Raul Zamora-Ros, a professor at IDIBELL Bellvitge Biomedical Research Institute, told MNT:

“There is a lot of plausible preclinical evidence showing anticarcinogenic properties of tea, and mainly its bioactive compounds (flavonoids), against cancer initiation promotion and progression.”

However, he pointed out that more research was needed to confirm these benefits in humans.

“In humans, there is limited-suggestive evidence showing that tea consumption may reduce the risk of biliary tract, breast, endometrial, liver, and especially, oral cancer. The evidence for the rest of cancer sites is still inconclusive,” he said.

Dr. Zamora-Ros noted that larger observational studies and clinical trials are needed to further assess the association between tea consumption and cancer incidence. Moreover, some of the studies have not distinguished between the effects of green and black tea, and future studies must address this shortcoming.

Tea consumption may also improve immune health, with studies suggesting a potential role of green tea in preventing bacterial and viral infections. For instance, a number of human studies, including randomized controlled trials, suggest that green tea consumption could reduce the risk of incidence of influenza infection.

Dr. Dayong Wu, a professor at Tufts University, Massachusetts, said the health benefits of consuming tea on the immune system fell into two categories.

“First is the protective effect against infection. Current research shows that tea/tea catechins may directly act on a variety of viruses and bacteria to prohibit them from attaching to and thus blocking their entry into the host tissues, inhibit their replication, and limit their spread. Tea/tea catechins may also enhance the anti-pathogen response of the host immune cells to help fight pathogens and clear the infection,” he explained.

Second, the antioxidant and anti-inflammatory properties of green tea may also help prevent tissue damage caused by excessive inflammation in response to an infection. Given its anti-inflammatory properties, green tea could also help alleviate symptoms of autoimmune diseases, such as inflammatory bowel disease and rheumatoid arthritis.

“Autoimmune disease represents a disrupted immune balance, and it is characterized by immune cells of a host attacking its own tissues. Tea/tea catechins have been shown to modulate complex immune cell function in a way to help correct this disorder, perhaps by suppressing overactive response and promoting tolerance,” Dr. Wu elaborated.

However, he also cautioned that most of these results are based on cell culture and animal studies, and more studies assessing the impact of green tea on immune function in humans are needed.

The studies discussed at the symposium suggest that tea consumption is associated with a multitude of health benefits. However, before changes are made to dietary guidelines, more research may be needed on individual compounds within tea to negate the negative effects.

Addressing some of the key areas of future research in tea science, Dr. Johanna Dwyer, a professor of medicine and senior scientist at Tufts University, said, she believes “it would be profitable [..] to pin down the continuing puzzle of why it is that some green tea supplements seem to be associated with liver toxicity and what compounds are responsible for these effects.”

Tea has also been associated with side effects such as reduced iron absorption as well as increased anxiety, and restlessness, largely owing to the caffeine it contains.

Experts point out that there are caffeine-free ways to consume the beneficial flavonoids present in tea, such as by eating vegetables and fruits, which also contain fiber.

“On a more basic level, it is still important to study the health-related properties of the various compounds in tea,” added Dr. Dwyer.

There is growing research examining the health benefits of green tea extracts enriched in flavonoids and other components.

The role of beverages in diet

Dr. Mario Ferruzzi, professor and chief of the section of Developmental Nutrition in the Department of Pediatrics at the University of Arkansas for Medical Sciences, touched on tea’s place in current dietary guidelines.

“Currently, dietary bioactive compounds like flavan-3-ols are not part of food-based dietary guidance. Polyphenols make up 30 to 40 percent of the solids in a cup of green and black tea. The dietary guidelines have mentioned phytochemicals as a beneficial part of fruit and vegetables, but not beverages.”

To rectify these shortcomings, Dr. Feruzzi noted that current guidelines on healthy beverages need to be expanded to include tea and coffee as a source of bioactive components, such as flavonoids.

Moreover, dietary guidelines should include an adequate intake value for dietary flavonoids to ensure sufficient intake of these nutrients that can help reduce the risk of chronic diseases.

Dr. Feruzzi cautioned that ready-to-drink products tend to have lower levels of flavonoids, and hence, consumers should favor brewed tea over these products.

COVID-19 and antibiotic resistance: What is the link?

COVID-19 and antibiotic resistance: What is the link?

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Antibiotic resistance has been on the rise in the United States during the COVID-19 pandemic. Dana Neely/Getty Images
  • A new analysis suggests that hospital-acquired, antibiotic-resistant infections increased in the United States during the pandemic.
  • The spike in antibiotic resistance in hospitals was particularly high among patients with COVID-19.
  • The researchers speculate that increased antibiotic prescribing and reduced infection control during the crisis may be partly responsible.
  • By contrast, the frequency of resistant infections that originated in the community appeared to decrease during the pandemic.

Over time, bacteria and other microorganisms can evolve resistance to antimicrobial drugs, which include antibiotics, antivirals, antifungals, and antiparasitics. This makes common infections increasingly hard to treat and potentially fatal.

In 2019, 1.2 million people died from antimicrobial-resistant (AMR) infections worldwide, and the World Health Organization (WHO) estimates that the annual death toll will increase 10-fold by 2050.

Overprescribing of antibiotics and poor infection control promote the development of drug resistance.

There have been concerns that increased antibiotic use to treat secondary infections associated with COVID-19 has accelerated the development of AMRs, but direct evidence has been lacking.

According to a new U.S.-based study, the pandemic increased the rate of hospital-acquired AMR infections compared with pre-pandemic levels.

The authors reported their findings to this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID), which took place April 23rd — April 26th in Lisbon, Portugal.

The researchers compared the rate of AMR infections in 271 U.S. hospitals between July 1, 2019, and February 29, 2020, with the rate between March 1, 2020, and October 30, 2021.

The total number of hospital admissions increased from 1,789,458, in the pre-pandemic period, to 3,729,208 during the pandemic. The number of admissions with at least one AMR infection was 63,263 and 129,410, respectively.

Overall, the AMR rate was 3.54 per 100 admissions before the pandemic and 3.47 per 100 admissions during the pandemic.

However, the rate was 4.92 among patients who tested positive for SARS-CoV-2, which is the virus that causes COVID-19.

Among those who tested negative for SARS-CoV-2 the rate was 4.11, whereas the rate was 2.57 among those who did not receive a test.

The researchers also investigated if the patients developed their infection before or after they were admitted to the hospital.

They defined infections that were cultured in the hospital lab 2 days or less after admission as “community-onset,” and those cultured more than 2 days after admission as “hospital-onset.”

There was a decline in the community-onset AMR rate, from 2.76 before the pandemic to 2.61 during the pandemic.

Among patients whose infection began in the hospital, however, the AMR rate increased from 0.77 to 0.86.

The hospital-onset AMR rate was highest among those who tested positive for SARS-CoV-2, at 2.18 for every 100 admissions.

“This is probably a reflection of multiple factors during the pandemic, including the potential higher severity of illness for COVID-19 patients, longer hospital length of stay, and infection control and antimicrobial stewardship practices, particularly early in the pandemic,” said one of the authors, Dr. Karri Bauer, a pharmacist working with the pharmaceutical company Merck.

Dr. Bauer told Medical News Today that as the pandemic proceeded, clinicians gained a better understanding of which patients were at risk of developing bacterial infections.

“It is always important that infection control and antimicrobial stewardship are optimized to minimize hospital-associated infections,” said Dr. Bauer.

“It is imperative to continue to evaluate AMR and determine strategies to mitigate this global health threat,” she added.

Dr. Aaron E. Glatt, chair of the department of medicine and chief of infectious diseases at Mount Sinai South Nassau in Oceanside, NY, said he believes a surge in antibiotic prescribing in hospitals during the pandemic contributed to the increase in resistance.

“There are potentially long-term consequences if this is not addressed,” said Dr. Glatt, who was not involved in the study.

“Certainly, our knowledge of COVID-19 has tremendously improved and it is not necessary to normally prescribe antibiotics for the treatment of new COVID-19 infection,” he told MNT.

He added that other factors probably contributed to the increase in resistance during the pandemic, including longer hospital stays, and secondary bacterial and fungal infections in patients with severe COVID-19.

High use of steroids and other immune-suppressing agents may also have played a part, said Dr. Glatt.

“I think there are many lessons that physicians can learn from this pandemic that could mitigate resistance development in future outbreaks,” he said.

Physicians should not prescribe antibiotics when there is no clear evidence that they are needed or beneficial, said Dr. Glatt, who is a spokesperson for the Infectious Diseases Society of America:

“[W]hile it is very difficult to watch and do nothing for a very sick patient, sometimes it is actually preferable to do nothing than to provide inappropriate therapy because you are desperate. A basic rule of medicine remains — Primum non nocere — first, do no harm.”

The impact on physical and mental health

The impact on physical and mental health

People’s physical and mental health is influenced by a large and diverse array of factors. But how can the attitudes of other people affect individuals’ well-being? In this Special Feature, we examine the impact that microaggressions have on health.

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Microaggressions are an insidious form of discrimination. How do they impact health? Photo editing by Steve Kelly; image credit: kkgas/Stocksy.

Prof. Derald Wing Sue — a leading psychologist at Columbia University — and his collaborators give the definition of microaggressions as “the everyday verbal, nonverbal, and environmental slights, snubs, or insults, whether intentional or unintentional, which communicate hostile, derogatory, or negative messages to target persons based solely upon their marginalized group membership.”

The origin of the term “microaggression” dates back to the 1970s, and was coined by African American Harvard University psychiatrist Chester Pierce, specifically in relation to race.

Since then it has expanded to include other marginalized groups including women, LGBTQIA+ people, religious minorities, people with disabilities, and those from low socioeconomic backgrounds.

As conceptualized by Prof. Sue and his colleagues, microaggressions can pertain to three distinct categories:

  • microassaults – the most overt form of microaggressions, which come in the form of slights and insults that can be verbal or behavioral
  • microinsults — which assert prejudiced stereotypes through insensitive comments that make presumptions about an individual’s intelligence, morality, or belonging to an in-group
  • microinvalidations — comments that have the effect of devaluing or denying the lived experience of marginalized people.

Microaggressions may be a result of conscious bias, but they can also reveal unconscious prejudices. Oftentimes a person may deliver a microaggression without consciously admitting that the attitude expressed by their words or actions is discriminatory.

Emerging research suggests that, like more explicit forms of discrimination, this covert type of discrimination has concrete negative impacts on the health of those at the receiving end.

Chronic exposure to microaggressions can have both a direct impact on health, and an indirect impact when it occurs within a system of healthcare.

When a person experiences stress, it can lead to physiological responses, including elevated blood pressure, increased heart rate, and the secretion of certain hormones, such as cortisol. Discrimination is a social stressor and it acts on the body in the same way.

One impact of this increased stress response was revealed in a study on racial differences in sleep. African American participants who reported experiencing more discrimination achieved less deep slow-wave sleep — the deep state of sleep associated with rest.

Sleep is critical for the healthy physiological functioning of the body, including the immune system, hormone systems, and mental function.

Two separate 2009 analyses of existing research — one from the Journal of Behavioral Medicine, the other from the Psychological Bulletin — examined the link between perceived discrimination and a multitude of physical conditions.

They both concluded that discrimination was a stressor with a negative impact on health and morbidity, particularly hypertension and cardiovascular disease.

Although there is a growing body of scientific literature on the relationships between discrimination and physical health outcomes, more research is needed to show the true impact of different forms of discrimination and discriminatory aggression.

Discrimination is associated with an increased incidence of mental illness, violence, poverty, and inequities in quality of treatment and access to healthcare, all of which have their own impacts on health. Isolating the direct physical impact of microaggressions is challenging when there are so many co-factors at play.

This is compounded by data suggesting that discrimination increases the likelihood of individuals engaging in unhealthy behaviors such as smoking, drinking, or overeating, which may serve as an immediate stress-reducing strategy but are high-risk factors for disease in the long term.

Among the better-understood impacts of microaggressions are those on mental health.

A 2015 investigation into the relationship between microaggressions and suicidal thoughts focused on 405 students from racial and ethnic minorities at a large midwestern university. Participants scored the frequency with which they encountered different types of microaggressions alongside answering questions on their mental well-being.

The trend in the data showed that the more often the students experienced microaggressions, the higher the incidence of suicidal ideation for four out of their six categories of microaggressions.

This corroborated the findings of a study from the previous year across a dataset of 506 adults from various racial groups, which found that higher frequencies of racial microaggressions were a significant predictor of negative mental health amongst the participants, in particular depressive symptoms, anxiety, negative view of the world, and lack of behavioral control.

Microaggressions may often be unconscious, but they reveal underlying biases that can impact the treatment of individuals.

A successful relationship between patient and healthcare provider requires trust. When biases are revealed, that trust may be damaged, and the patient may develop a negative association with seeking medical care.

A 2015 study into the healthcare of American Indian patients with diabetes found that more than one in three of the study’s 218 participants had experienced racial microaggressions from their healthcare professionals.

Alongside this, they scored the patients’ depressive symptoms, the incidence of heart attacks, and hospitalizations in the past year. A significant positive correlation emerged between the number of microaggressions experienced and each of the study’s three measures of health and well-being.

For LGBTQIA+ people, one of the most common forms of microaggressions in healthcare is the assumption that people are heterosexual and cisgender.

It is well documented that these communities are at significantly higher risk of tobacco, alcohol and drug misuse, sexually transmitted diseases, psychological distress, and suicide as a result of a higher prevalence of discrimination, rejection, and violence.

If healthcare professionals make assumptions as to patients’ sexuality and gender, this may block the patients’ access to the appropriate health services. Patients may also seek medical attention less readily as a result.

The same trend occurs in mental healthcare settings, too. According to a 2014 study, over half of counseling clients from marginalized racial and ethnic backgrounds reported that they had been subject to microaggressions from their therapists.

The perception of microaggressions negatively correlated to their satisfaction with their counseling and their relationship with their therapists.

To learn more about how these biases arise, Medical News Today spoke to Dr. Elinor Cleghorn, a scholar of medical humanities and author of the book Unwell Women, which chronicles the history of gender bias in healthcare from Ancient Greece through to present times.

“We have a tendency to think about medicine within the framework of science, which annexes it out to this place of impartiality and objectivity,” said Dr. Cleghorn. “In actual fact, the roots of medicine are embedded in society and culture, and because medicine is dealing with the most foundational matters of life and death it has, throughout its history, absorbed and reflected society’s ideas about who we are as people.”

“[Medicine] has really only become the science we understand it to be — an evidence-based science — over the last century […] [before that] we had centuries where practitioners of medicine had to rely on assumptions of who people were, what their bodies did and what they were for,” she explained.

Yet much of this status quo persists to this day, giving rise to systematic discrimination in healthcare settings.

“It made sense to Ancient Greeks that women existed [only] to procreate […] that was ‘science’ to them, it was irrefutable. You begin to create a medical discourse around women’s bodies centered around these presumed facts […] that everything in their health pivoted around their reproductive life,” noted Dr. Cleghorn.

“This has been reiterated and reiterated across the centuries because medicine has always been dominated by male practitioners who have tended, in the most part, to uphold these gender divisions,” she pointed out.

She went on to describe how this historic context may manifest in microaggressions in a healthcare setting in the present day:

“[Microaggressions] can take so many forms, and they’re very intersectional. The microaggressions that [one] might experience as an educated white woman may derive from a historical precedent that those women who worry about their pains must be ‘hysterical’ […] whereas for a woman of color, the perception of her pain carries the burden of [a] different historical context, insofar as she might experience racialized microaggressions emerging through.”

“The majority of doctors, if called out on this, would say ‘of course I don’t believe that Black women are invulnerable to pain,’ but those attitudes have shaped [medical] culture. It’s there because it’s gone unchecked, because the mold in which the science has been forged has not been looked at and remade,” she emphasized.

The Institute of Medicine agrees that implicit bias and stereotyping may play a role in the health inequities observed among marginalized groups, and suggests that one strategy to reduce their impact is the recruitment of more healthcare professionals from underrepresented communities.

As with any form of unconscious bias, tackling microaggressions requires critical self-reflection. Training, which increases awareness of one’s own biases, and promotes inter-group contact can be an effective tool in improving patient care.

Providing such training also increases the likelihood of workers feeling able to be open about their own sexuality and gender identity amongst their colleagues, further increasing the opportunity for inter-group contact.

Asked what she felt would help, Dr. Cleghorn cited the value of research:

“One step is using testimonies, voices and experiences of women and other marginalized people in a meaningful research context […] In terms of this issue being studied from a sociological perspective, it’s really new. What we’ve had since the early 2000s are these groundbreaking studies like The Girl Who Cried Pain, which showed that statistically women are much more likely to be prescribed a sedative or an antidepressant when they report chronic pain, whereas men are more likely to be prescribed an analgesic, that women are much more likely to have the cause of pain diagnosed as psychological or emotional, whereas men, [as] physical.”

“Studies [like this] exposed how deep-rooted the issue is, but they also showed how it can be studied! Quite often when we talk about things like microaggressions […] it feels amorphous. To know there are mechanisms by which we can look at these issues critically is really important,” she pointed out.

“That study [The Girl Who Cried Pain] was a combination of patient testimonies, but also things like admission records. It was a real qualitative and quantitative exploration. The more we look at this issue as something that can be studied objectively the more we can move towards undoing it,” concluded Dr. Cleghorn.