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However, unexpressed patient concerns may lead to a prolonged investigation of a concern hypothesized to be the “chief com- plaint” but which in reality was the second most important problem. Animals have served as sentinels for toxic environmental contamination. In a study on pharmaceutical surveillance in Spain, Campos et al. Emergency department visits for antibi- otic-associated adverse events. In 2013 FIP brought together pharmacy professionals from across the globe in an in- ternational summit on medicines shortages Richard Price Medicines Shortages: Global Problems Need Global Solutions BACK TO CONTENTS 70 71 Medicines shortages Medicines shortages held in Toronto, Canada [8]. (2013) SAMJ: South African Medical Journal, 103, 600- 602. (2013) Canadian Journal of Hospital Pharmacy, 66(1), 39–40 5. The situation for the majority of those who replied was that they experience shortages at least weekly, 45.2% (n=238) selecting this response. Some physicians may avoid eliciting multiple concerns due to the fear of extending the encounter when time is limited. An impor- tant benefit to studying diseases in animals is that they do not experience the placebo effect, so improvements resulting from nov- el treatments demonstrate actual benefits that warrant further study in humans. Indeed, over-the-counter sale of antibiot- ics is reportedly common in countries such as Italy, Greece, and Spain [5]. The reflections of the International Phar- maceutical Federation (FIP) and, indeed, the regulatory action advocated for by our colleagues at the American Society of Health System Pharmacists (ASHP) have certainly informed the outlook of the ­European Association of Hospital Pharma- cists on the matter of potential solutions to the medicines shortages problem. Drug stock-outs: Inept supply- chain management and corruption. Drug shortages in health care institutions: perspec- tives in early 2013. (2014) Available: patients-suffering-medicines-shortages-all-eu- ropean-countries. Hospital pharmacists are affected by shortages on a daily basis, with 21.1% (n=111) replying that they experience a shortage of a medicine every day. This encourages a more flexible and conversational style. Grant and Olsen found that assessing zoonotic disease risks in this vulnerable population often gets ignored because physicians are not familiar with the diseases while veterinarians defer to physi- cians for human health care [8]. However, according to the Euroba- rometer, the percentage of Spanish people who admitted having bought an antimicro- bial at the pharmacy was only 4% [6]. However, if the medicines shortages prob- lem was simply a question of inefficiency it would not excite the attention and momen- tum that the matter has been gaining at the international level [8]. The pharmaceu- tical markets of Bulgaria, Ireland, Switzerland, Italy, Norway, France, and Poland also expressed that patented products were the most common category of shortages. Nature of the shortages reported from all of the respnseces. It proposes the whole person in con- text as the Centre and goal of clinical care and public health [10]. For people who live with chronic immuno- suppression such as organ transplant recipi- ents or people taking immunosuppressive medications, the risk of zoonotic disease transmission becomes much greater than for the general population. “Factors in the Emergence of Infec- tious Diseases.” Emerging Infectious Diseases. This percentage was slightly higher at 54.1% when the study was repeated in 2014 using the same methodol- ogy [8]. Indeed, some respondents reported the need to em- ploy full time equivalents dedicated solely to locating new sources for out-of-stock medicines. Generic 36.5% Unlicensed medicines 11.7% Originator 51.8% The countries with highest recordes prevalence of originator (patented) shortages are Belgium (78.3%, n=69), Spain (64.5%, n=62), Austria (73.3%, n=15) and Slovakia (78.6%, n=14). Collabo- ration between medicine and veterinary medicine waned, but the challenges of the ­communication between the patient and physician. International Journal of Person Centered medi- cine,(), 10–13 2. Linked to this, low-quality and counterfeit antimicrobials have been more frequently reported among antimicrobials sold without a medical prescription, mainly in develop- ing countries, resulting in a possible direct harm and treatment failure [25]. Self- medication with antibiotics–does it really hap- pen in Europe? Summary of the latest data on antibi- otic consumption in the European Union, No- vember 2014. eu/en/eaad/Documents/antibiotic-consumptio- ESAC-Net-201411. Campos J., Ferech M., Lázaro E., de Abajo F., Oteo J., Stephens P., Goossens H. Our objective in this article is to provide some starting points for the clearly need- ed discussion about ethics in m Health. As the twentieth century progressed, sci- entific knowledge exploded, and medicine became increasingly specialized. (2011) Building Peron Centered medicine through dialogue and partnerships. Antimicrobials frequently cause side effects, despite most being mild; however, side effects accounted for nearly one fifth of all visits to the emergency room for adverse drug events in a US study [24]. European Centre for Disease and Prevention Control. Thus, m Health ethics is not so much about find- ing out which rules people want m Health providers to follow, but about which rules m Health providers promise to follow in the future.

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?

The One Health concept is important for many reasons. (2001) Narrative medicine: form, function,and ethics. Although a relationship between in- tentional non-compliance and the storage of antibiotics has not been proven, the fact that approximately one third of individuals store antibiotics in their households and a similar percentage intentionally do not take them as requested makes this association very likely. ­Users often make excessive use of mobile technologies when it comes to monitoring their health because they have been told this may help to reduce their risk for disease.

The One Health concept seeks to increase communication and collaboration between human, animal, and environmental health professionals. Our group observed an intentional non-adherence to antibiotic regimens of 35% for respiratory tract in- fections with the use of Medication Event Monitoring System or MEMS contain- ers [18], resulting in the presence of some leftover drugs that might be used on future occasions by the members of the house- hold. The power of m Health apps to medicalise [4] the behaviour of individuals causes us to start a debate about ethics in m Health.

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.

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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].

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