Damian Sendler For decades, social and developmental psychologists have been studying racial issues (e.g., Aboud, 1988). There have been and continue to be racial issues in public debates and conflicts in modern societies, despite the fact that cultural diversity has existed for a long time. To illustrate how racial issues continue to be at the core of important social and political conflicts today, despite all attempts at integration policies, the Black Lives Matter movement in the United States (Atkins, 2019).

Damian Jacob Sendler Intergroup processes that precede prejudice and discrimination are rooted in social categorization (Bigler and Liben, 2006). Among children, the development of racial categorization is influenced by factors such as ingroup size and social status (Verkuyten and Thijs, 2001; Gedeon et al., 2021). These variables affect how children perceive themselves in a given environment, such as how important their group membership is and how much their social identity is valued, and how this influences the formation of racial stereotypes.

Dr. Sendler Intergroup relations studies often fail to distinguish between the effects of group size and social status on intergroup relations. Indeed, it is not uncommon for members of minorities to have a low social standing (economically and in terms of prestige). In some instances, these two variables are not linked, however (e.g., White people in South Africa). Do all of these things have a negative impact on children’s relationships within their own peer groups? When it comes to prejudice and discrimination, does one’s social status have a greater impact than one’s ingroup’s size?

The purpose of this review is to look at how children’s social categorization and intergroup relations are affected by their environment’s characteristics (such as the size of their ingroup and their social status). To begin, we’ll talk about how racial categorization has evolved, how prevalent it is in certain social settings, and how it influences interpersonal interactions. Then, we’ll try to identify the specific effects of group size and social status that have been found in the research literature. We used the academic search engine Psychinfo to find relevant studies published between the year 2000 and the middle of August 2020. Only peer-reviewed studies that include a dependent measure of intergroup bias and use a child sample (mostly preschoolers but all under the age of 13 – preteens) are eligible for consideration. These were the key terms: “racial categorization,” and the study focused on “intergroup relations,” “social status,” and “numerical group size.” According to our criteria, we identified 73 papers and checked their titles and abstracts.

Being able to discern one’s race from others based on physical characteristics is referred to as “race awareness” (Aboud, 1988). When it comes to children’s development, this can be considered a foundation for the racial categorization process (Kelly, 2005; Hirschfeld, 2008; Hailey, 2013). Skin tone, hair type, and facial features all play a role in how people define their race. The tendency for race to be perceived as a psychologically salient and meaningful basis for grouping others can be defined as “racial categorization” (Pauker et al., 2016, p. 33).

The saliency of the criterion used in the categorization process is one of the factors influencing social categorization. The self-categorization theory says that the saliency of a criterion is determined by the proportion of perceived intergroup differences to ingroup similarities (Turner and Reynolds, 2011). As a result, children must be able to compare these perceptual differences in order to use any criteria for grouping individuals.

Children’s ability to form social categories is influenced by both their cognitive development and their experiences in the social world (Gedeon et al., 2021). It is true that social categories do not develop at the same time, and their emergence depends on the age of the child and his or her social environment. Under three-year-old children lack an understanding of race as a meaningful social category, according to developmental studies. In their attitudes and behaviors, children seem to be better guided by factors like gender, age, and language (for a review, see Esseily et al., 2016).

On the ontogenetic and phylogenetic levels, this late racial categorization development can be explained. When long-distance migrations began, humans’ tendency to encode coalitional alliances was based on gender and age, and those based on race only appeared later (Cosmides et al., 2003). Children’s later use of racial criteria may be explained by the fact that social categorization is heavily influenced by familiarity, making it extremely vulnerable to the children’s surroundings (Pauker et al., 2017). Children, on the other hand, are more likely than adults to be exposed to the differences between races and genders because they have been around people of both genders since birth (Quintana, 2012). In contrast, their interactions with people of other races are highly dependent on the surrounding circumstances (Kurtz-Costes et al., 2011). If a child grows up in a highly diverse environment, he or she is more likely to interact with people from different ethnic backgrounds.

Research conducted by Bigler and Liben (2006) and others suggests that in order to better understand how children develop stereotyping and prejudice, it is necessary to look at the context in which they grow up. DIT’s psychological salience depends on the group’s proportional size, which is one of the DIT’s components (Bigler and Liben, 2006, 2007). According to social norms, belonging to an underrepresented minority group is more important than being a member of the majority (Badea and Askevis-Leherpeux, 2005). Assume a woman finds herself in an elevator with only men. If there are equal numbers of men and women in the membership category, she is more likely to think of this category (i.e., woman). Those who belong to an ingroup that is numerically smaller than the majority are more likely to be aware of their group membership.

The ingroup characteristics of group size are not taken into account in most studies on social categorization with children, but rather, social status is the primary focus. Next, we’ll discuss these studies, and then we’ll show a handful of studies that took group size into account. According to the literature, the impact of group size has not been studied in detail. As a result, we’ll include research on the influence of student diversity, measured in terms of class size, on interpersonal relationships. The term “minority” refers only to numerical group size in our proposal, and we will try to separate the social and numerical effects of the term.

Damian Jacob Markiewicz Sendler Children from lower socioeconomic status groups are more likely to be aware of race than children from higher socioeconomic status groups (Akiba et al., 2004). Compared to high social status children, low status children are more likely to categorize others by race and integrate race concepts earlier (Ho et al., 2015). Kinzler and Dautel (2012), for example, compared the reasoning of 5- and 6-year-olds about the stability of race and language throughout an individual’s life. It was decided to randomly pair images of children from both races with audio clips in either English or French for the benefit of English-speaking children (both White and Black). Images of adults of varying ethnicity and language were then shown to participants, who were asked to match each child photograph with an adult photograph based on how they envisioned the child growing up. While white children matched the images based on language criteria, Black children matched the images based on race, suggesting that children from low-status environments have a more stable race-based categorization.

In low-status children, the ability to classify others based on race grows with time (for a review, see Bonvillain and Huston, 2000; Hailey and Olson, 2013). Children from low-status racial groups are more aware of racial stereotypes and discrimination than children from high-status racial groups, according to research on middle-school-aged children (Dulin-Keita et al., 2011). The authors investigate whether or not children from lower-status racial groups are more likely than those from higher-status racial groups to be aware of their race and whether or not they have been subjected to racial discrimination. Race discrimination was more prevalent among children of lower socioeconomic status than among children of higher socioeconomic status, according to the results of the study (i.e., White children). For example, children from high- and low-status racial groups may have different socialization experiences. Parents of low-status children are more likely than parents of high-status children to explain to their children the differences they may notice based on race at an earlier age (for a review, see Priest et al., 2014).

Damian Sendler

The use of social categories and stereotypes by children from high status groups is also influenced by their socialization. Based on children’s actual observations of differences between groups, the social learning approach proposes that stereotypes are learned from the social environment in which children live (e.g., Eagly et al., 2000). As an example, Bar-Tal (1996) examines social categorization in 2.5–6.5 year old Israeli children in a conflict-ridden environment. Research shows that children’s daily surroundings have a significant impact on their conceptions of social groups. Using stereotypes that they hear or see on a regular basis, children as young as 2.5 years old are able to categorize the “Arabs” negatively.

Social categorization has ramifications for intergroup relations once it is internalized through socialization. To maintain a positive view of one’s group and a fulfilling social identity, racial categorization allows children and adults to identify as members of a particular group (Tajfel and Turner, 1986). Those who belong to lower social strata, on the other hand, may favor the outgroup (Jost and Burgess, 2000). Adults show a similar pattern when it comes to intergroup attitudes, with children from high-status racial groups showing strong ingroup favoritism while children from low-status groups show a more mixed outcome (e.g., out-group favoritism, pro-White bias, or neither in-group or out-group favoritism; Corenblum and Annis, 1993; Griffiths and Nesdale, 2006; Gedeon et al., 2021). Low-status children’s out-of-group bias may be a reflection of societal prejudices and intergroup discrimination (Bonvillain and Huston, 2000; Masse et al., 2009). One study found that Native Indian children, ages 5 to 8, had more positive attitudes toward the White group than their own-group, indicating a preference for the outsiders (Corenblum and Annis, 1993).

Study after study demonstrates how groups’ social standing can affect the development of racially-based social categorization and the intergroup relationships of children. It is possible that the school environment, where children are exposed to different racial groups in different proportions, may play a role in racial categorization (i.e., ingroup size).

Diversity in an environment affects intergroup processes like categorization and in-group favoritism, as well as the perception of cultural distance between groups (Pauker et al., 2017). Research suggests that children who grow up in multiracial households are more likely than those who do not to learn about the differences between races sooner than those who grow up in monoracial households (Ramsey, 2008). When children attend a racially homogeneous or racially diverse school, the results are very different. Three- to five-year-olds in racially mixed preschool classrooms showed no evidence of bias in favor of their White in-group, while those in homogeneous classrooms did show evidence of bias. These findings were also confirmed in studies involving older kids: A study by McGlothlin and Killen (2010) found that White American children aged 7 to 10 who attended homogeneous schools were less likely than their counterparts in racially diverse schools to view cross-race dyads (Black and White children) as friends.

Damien Sendler School environments that are homogeneous or heterogeneous refer to the percentage of minority students in a school. Even though the high-status racial group typically makes up the majority of studies, the numbers can be flipped in low-income areas. To put it another way, in a predominantly high-status racial environment, there aren’t many kids from lower-status backgrounds. Children from different racial groups are equally represented in a diverse school community. School diversity allows us to examine the influence of group size on intergroup relations, in addition to the familiarity children have with other racial groups.

Damian Jacob Sendler

Gedeon et al. (2021) investigated the effect of ingroup size in a low-diversity school environment on racial categorization and perceived cultural distance in a French study with preschool children (4–6 years old). Images of children from various racial groups (Europeans, Black-, and North-Africans) were used for a spontaneous social categorization task and an evaluation of the perceived cultural distance between participants’ in-group and the racial group represented in the picture (language, eating habits, and music). The older the children were, the better they did at correctly classifying them as one of several races. According to their findings, people in the majority group saw minority peers as more distinct than their peers in the minority group. Participants from minority groups, on the other hand, saw no differences in the photographs when they were grouped together based on race.

For children from a minority group, the distinction between “ingroup” and “outgroup” becomes more pronounced because of their numerical disadvantage (Brewer et al., 1993; Fishbein, 1996; Brewer and Brown, 1998). Minority children tend to show less ingroup bias than majority children, just like the impact of social status (Aboud, 1988). This proclivity appears to manifest itself early on in life. Pun et al. (2016) found that infants can infer social dominance between two groups using numerical group size cues as early as 6 months of age, suggesting that intergroup relationships and social dominance have evolved over time in this way. Children aged 6 to 9 months were shown short animations depicting the actions of two individuals (cartoons) from two groups that differed in numerical size, as part of a study by the University of British Columbia. First, the cartoons were shown to the babies, and then they saw the characters accidentally bumping into each other. Each trial’s looking time was recorded by the infants. To understand why infants are more surprised and look longer at the individual from the numerically smaller group than the numerically larger group, researchers looked at the number of people in each group. There were no surprises in the findings, and this was the only study to examine group size as a whole.

Separate studies have examined the impact of ingroup social status and ingroup size on racial social categorization and intergroup relations, and these studies have been presented in this paper. When it comes to social status in Western societies, the size of the group and the social status of the group are often conjoined. Studies have shown that children use race and the size of their group to determine their social status. Racism has been shown to be an important factor in predicting wealth (i.e., who lives in a nicer house, which is linked to social status) as early as the age of 3. The results also showed that this prediction remained stable with respect to the passage of time (Mandalaywala et al., 2020). Theoretically, it is important to understand whether these factors have cumulative effects or interact in a different manner, especially in the early stages of children’s interactions, in order to design specific and efficient educational and preventive interventions.

According to Brown and Bigler (2002), children’s intergroup attitudes are influenced by their relative group size and social status. There were two types of novel groups in the classrooms for elementary school students attending a summer school program: large (majority) and small (minority) (denoted by colored tee-shirts). In addition, there were subliminal messages about social standing in the classroom. The traits associated with belonging to a group were displayed in large posters (spelling ability, leadership ability, athletic prowess, classroom behavior, or occupational prestige). The two variables (size and status) were not combined in this study, however. There was a clear divide between the majority group and the minority group in terms of social status. After a few weeks in the classroom, children’s intergroup attitudes (e.g., trait ratings, group evaluations) were assessed. If a child is part of a minority group, they show more biased trait ratings (ie, they characterize the outgroup with more negative traits) than majority children regardless of their age. Children with lower social status exhibited greater ingroup favoritism than their high-status majority peers, even after controlling for age. Lower status minority groups expressed lower ingroup favoritism than higher status majority children, but this result was not found with older children. One possible explanation for ingroup favoritism persisting through the ages is that size of the group matters. It’s possible that social status can reduce or even reverse this favoritism in favor of outgroup favoritism, which helps maintain inequalities in society.

Importantly, most studies included in this theoretical note were conducted within WEIRD populations, where White people tend to be in the majority and have a high social status; this is an important point to keep in mind (see Supplementary Table 1). To better understand the relationship between group size and social status in non-WEIRD populations, it may be worthwhile to look at the overlap between the two factors.

When examining children’s intergroup processes, this review focused on the interplay between group size and social status. Low-income and minority children appear to develop racial categorization earlier than children from wealthier families. These findings could be explained by the fact that children are socially taught prejudices and discrimination against their own group (Priest et al., 2014). For low-status children, there is a disconnect between the positive attitudes that go hand in hand with the development of their own group identity and the awareness of the perceived negative value that goes hand in hand with this identity in society (Corenblum and Annis, 1993). Prejudice and discrimination as well as a general social hierarchy are maintained by this lack of ingroup favoritism or even an outgroup positive bias.

That review also found that social and numerical group size are frequently combined in the literature. Low-status students are, in fact, a numerical minority in their educational setting in the majority of these studies. It is important to keep in mind that even though we attempted to separate them here in order to examine their specific effects, this distinction remains hypothetical because in real life they tend to merge. Even so, future research should focus on determining the specific effects of social status and ingroup size and their interaction. It would be possible to implement early and efficient intervention programs that target the social status of the general population or the proportion of racial groups in the school environment (e.g., Nasie et al., 2021). (e.g., Verkuyten and Kinket, 2000; Gaias et al., 2018).

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: With their high rates of occurrence and detrimental effects on a child’s physical health as well as their mental well-being, childhood obesity, eating disorders, and other unhealthy eating habits are major public health concerns. We present evidence that the same interventions can be used in pediatrics to treat or prevent obesity and eating disorders. Obesity in children increases the likelihood of developing eating disorders because of the prevalence of disordered eating habits. Bulimia nervosa and binge-eating disorders, both of which are characterized by abnormal eating or weight-control behaviors, are the most common in obese individuals. Numerous underlying mechanisms, both environmental and personal, underlie the interaction, and numerous strategies exist to minimize its negative effects. Treatments for childhood obesity and eating disorders that are based on scientific evidence include weight loss through nutritional management and lifestyle modification through behavioral psychotherapy, as well as treatment of psychiatric comorbidities that are not the result of the eating disorder. Drugs and bariatric surgery should only be used when necessary. Research is needed to identify risk factors for prevention, better understand the mechanisms that underpin these issues, and provide timely treatment in cases where it is necessary. Efforts to reduce disparities in health and improve public health necessitate collaboration between different fields.

Damian Jacob Sendler: With a global population of more than 100 million [1], childhood and adolescent obesity, eating disorders (EDs), and unhealthy eating habits are major public health concerns. Despite the fact that obesity and eating disorders (EDs) have traditionally been treated as distinct conditions, new research shows that they share many similarities, including etiology, comorbidity, risk factors, and prevention methods [2]. EDs may be facilitated by environmental and social factors, such as weight-related teasing by family members or peers, thin beauty ideal perceptions by the social environment or media [3]. Occurring additional EDs in the presence of obesity could worsen current health status and future outcomes [4]. Starting with the definitions, common pathogenesis, and possible treatment outcomes, we outline the rationale for the awareness and recognition of risk factors that increase the vulnerability of obese adolescents to eating disorders. EDs and obesity can be managed or prevented using the same interventions in childhood.

Dr. Sendler: There is ample evidence that obesity affects people of all sexes, all ages, and every region and ethnicity in the world. Body mass index (BMI) is a simple way to estimate body fat indirectly (BMI). Overweight is defined as a body mass index (BMI) score of 85 or higher, while obesity is defined as a BMI score of 95 or higher [5]. [6] The World Health Organization (WHO) has recommended the use of the BMI z-score to define overweight and obesity, respectively. [6] Since the 1990s, there has been a dramatic rise in the number of overweight and obese children around the world. Children and youth between the ages of 5 and 19 years old accounted for 124 million of these obese children and youth in 2016, while 41 million children under the age of 5 were overweight or obese [1]. Obesity in children is more common in developed countries, but it is also on the rise there [1]. The long-term health consequences of obesity, such as an increased risk of chronic disease, should be given more attention. Immediate and long-term effects on mental and emotional well-being, such as low self-esteem and depression, are also possible.

Environmental, behavioral, genetic, and metabolic factors all play a role in the development of obesity [7]. As a result of this complex interaction, a chronic disease with a wide range of symptoms and phenotypes is formed. As a result, management and treatment responses can be difficult [8]. The rise in obesity worldwide is largely due to environmental and behavioral factors. Obesity has been linked to changes in the child’s environment, including the availability of high-calorie fast food, larger portion sizes, increased consumption of sugar-sweetened beverages (SSBs), and a sedentary lifestyle [9].

Dietary habits are a well-known contributor to obesity, with numerous studies supporting this theory. Obesity has been linked to eating habits as early as infancy, according to research. At the age of three, the prevalence of obesity among children of mothers who did not smoke or gain excessive weight during pregnancy was only 6 percent, compared to 29 percent among children of mothers who did the opposite of these four mother/child behaviors, according to an observational study by Gillman et al [10]. Obesity is caused in large part by a person’s eating habits and the food that they consume. It’s important to mention “discretionary food,” which is a significant factor in childhood obesity, when discussing diet. SSBs with a high sugar content are a typical example of this type of food. SSB consumption was linked to an increase in BMI z-scores in a birth cohort studied from the ages of 2 to 17 [12].

Physical activity is essential in addition to a healthy diet. Sedentary behavior among children and adolescents has increased as a result of technological advancements. Time spent in front of a screen includes watching television, using a computer, playing video games, and talking on a cell phone. Even in infancy, screen time has become the most common form of sedentary behavior. The amount of time spent in front of a screen can have a negative impact on a child’s physical and mental health [14]. Numerous studies [15] have documented the negative effects of excessive screen time on physical strength, obesity, and sleep disturbances. In children and adolescents, sleep disturbance is often overlooked as a risk factor for high blood pressure. Poor sleep can be caused by a lack of parental education, a lack of enforcement of rules about caffeine, and the presence of electronics in the child’s bedroom at night. There should also be consideration given to the presence of socioeconomic hardship, family dysfunction, offspring anxiety, and junk food, in addition to the previously mentioned well-known factors [17].

There has been a great deal of investigation into how genes play a role in obesity. Obesity can be genetically influenced by environmental factors, but the likelihood of gaining weight varies among individuals [18]. It is common for multiple genes to make small contributions to the overall phenotype in the majority of cases of obesity. Genetic predisposition to obesity, when considered in conjunction with one’s lifestyle and the environment, may have an impact on one’s ability to maintain a healthy weight. Monogenic obesity, on the other hand, is relatively uncommon, accounting for only 3 to 5 percent of all obese children [18]. The most common gene defect associated with severe, early obesity in children is a mutation in the melanocortin 4 receptor gene (MC4 R) [19].

The link between obesity and adverse childhood experiences (ACEs) has gotten more attention in recent years. Children with higher levels of intrafamilial adversity [20] were found to be more likely to be overweight in a recent study. Meta-analysis of 41 studies looking at the link between child maltreatment and obesity supports these findings [21]. ACE is now recognized as a potentially modifiable obesity risk factor.

A wide range of maladaptive cognitions and behaviors relating to eating and weight are covered by both EDs and disordered eating behaviors, but they differ in their diagnosis [22]. Disorders characterized by abnormal eating or weight-control behaviors are referred to as eating disorders [23]. Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) lists anorexia, bulimia, and binge-eating disorder (BE) as specific EDs. [24] If you’re concerned about your health, psychosocial functioning and quality of life, it’s important to know that the prevalence of eating disorders varies depending on study populations and the criteria used to define them [25, 26]. Adolescence is the most common time for EDs to appear, but they can affect children as young as 5 to 12 years old [27]. It is possible that recognizing EDs may help prevent obesity or aid weight loss in cases of long-term obesity. Obesity-related eating disorders can develop in children and adolescents before or after weight-loss surgery or other weight-loss programs.

In an effort to identify possible risk factors for EDs, researchers have tested a wide range of environmental and genetic factors. Childhood sexual abuse has been linked to BN and appearance-related teasing victimization for any ED by an umbrella review of published meta-analyses, which included 50 associations from nine meta-analyses. Due to the small number of large-scale collaborative longitudinal studies examining the relationship between conditions preceding ED onset and their development, there were no ED risk factors with convincing evidence [34].

Food insecurity, characterized by limited or uncertain access to nutrient-dense food in a safe and socially acceptable manner, is now a factor to consider. There is increasing evidence that food insecurity is associated with the adult bulimic spectrum. Adults across the United States were surveyed and found to be in agreement. Diagnoses of bulimic-spectrum disorders, mood disorders, and anxiety disorders were more common among people who had experienced food insecurity over the course of a year than among those who had not. The study found that bulimic-spectrum eating disorders had the greatest impact [35]. In light of these findings, it’s possible that pediatric patients should be considered. In order to better understand this issue, more research is needed.

Because there is a lack of both prospective studies and possible selection bias in clinical samples, it is difficult to determine whether ACEs are a risk factor for developing eating disorders. In the studies that are currently available, there are a lot of discrepancies. According to a population-based research, experiences of life events are linked to specific eating behaviors in children aged 10 years. Emotional overeating is linked to adverse life events [37,38], according to these findings.

Damian Sendler

Disordered eating behaviors are more common in children who are obese, which raises their risk of developing eating disorders (EDs). BN and BE are the most common EDs in obese individuals, both of which are characterized by abnormal eating or weight-control behaviors [39,40]. Binge eating disorder (BED) and binge-eating disorder (BN) are both characterized by recurrent episodes of BE in which the sufferer loses control over the amount of food consumed. For BED, attempts to avoid weight gain through inappropriate compensatory behaviors such as self-inducing vomiting are distinct from those of BN [40,41].

EDs and obesity may share some common risk factors in the context of certain social and environmental factors. Family and peer teasing, perceived social pressure, and frequent criticism or bullying are among the most common forms of bullying. [43] Body dissatisfaction can be exacerbated by images on television or social media that emphasize the ideals of thinness and beauty [44,45]. Additionally, a number of other factors can be linked to family BE behaviors like parental mood, anxiety or substance abuse, as well as family discord, high parental demands or perfectionism, and parental separation, which have been identified as possible causes of obesity and EDs. Negative childhood experiences (including sexual and physical abuse) also raise the stakes [46], as do past life traumas.

For obesity, the strongest known susceptibility locus is the FTO gene [47,48,49]. The role of FTO variants in obesity is not fully understood, but they have been linked to several EDs, including binge eating disorder (BED). There is evidence that the FTO gene plays a role in the development of BED and poor behavioral regulation [50]. By controlling appetite and satiety pathways, as well as the regulation of brain reward systems, genetic factors have a significant impact on the regulation of neural circuits. Genes linked to the hypothalamic appetite and satiety mechanisms may be involved in the emergence of EDs associated with obesity like BED and BN, according to some SNP studies [51].

When it comes to EDs and obesity, the brain plays a critical role in basic research, prevention, and treatment [56]. Neuropsychological mechanisms of EDs and obesity were previously unknown. hedonic hotspots in the brain, specific subregions that can increase the hedonic effect of palatable tastes causally, are one type of mesocorticolimbic mechanism that increases “liking.” However, a larger mesocorticolimbic circuit generates the desire to “want” or “induce” to obtain and eat food rewards [57].

Damian Jacob Markiewicz Sendler: Reward-related regions, including ventral and dorsal striatum, amygdala, orbitofrontal cortex and dopamine release in the dorsal striatum in humans as well as other animals [58], are activated by eating palatable food. Obesity and eating disorders (EDs) like anorexia nervosa and binge eating disorder have been linked to brain abnormalities and neural fragility factors by functional, molecular, and genetic neuroimaging [58]. Having a better understanding of the mechanisms of desire and linkage that are unique to each type of ED and obesity could lead to better treatment strategies and help those who wish to more effectively create stop signals to their own needs.

Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which is a critical part of the neuroendocrine system that regulates eating behavior, has been linked to EDs [61,62].

Damian Jacob Sendler

Inhibitory executive function of serotonin on eating behavior is also known [63]. The noradrenergic system and EDs have been examined in a number of studies. EDs and the noradrenergic system: a recent systematic review uncovered a slew of important findings. Noradrenergic system involvement in various endocrine networks that control human nutrition is not limited to its direct, hypothalamus-based actions on feeding regulation [64]. Neurotransmitter dopamine regulates food’s enticing properties [65]. Neuropeptide Y is a hunger-inducing hormone that also slows down metabolism [66]. Inducing a feeling of satiety is a key role of Leptin’s inhibitory executive function in regulating appetite. Hormone ghrelin is produced in the stomach and upper small intestine, and it stimulates the appetite. When it comes to weight loss, the hormones leptin and ghrelin play a significant role. Anorexia nervosa and BN have been linked to hormones and related executive functions, despite the fact that obesity is commonly associated with these disorders [67,68].

In the case of childhood obesity and EDs, evidence-based treatments include weight loss through nutritional management and lifestyle modification through behavioral psychotherapy as the first line of attack [27]. ED risk profiles may improve or remain unchanged in the majority of children and adolescents receiving supervised obesity treatment [72]. Increased rates of early dropout from the intervention program have been linked to higher baseline dietary restraint scores in obese children, regardless of gender, age, and BMI z-score at baseline, and the education level of the mother [73]. A secondary analysis of an RCT focused on changes in energy intake and diet quality during obesity treatment with post-treatment eating pathology in adolescents found no correlation between intensity of diet and EDs [74].. Dietary restriction and dieting are not linked to an increased risk of erectile dysfunction (ED) in the short term, according to a systematic review [75].

In the fight against childhood obesity, the majority of organizations recommend either weight maintenance or loss as a treatment objective. Adolescents who are overweight or obese can benefit from lifestyle intervention programs that take a multifaceted approach to nutrition and eating habits. Experiencing weight-related teasing as a child or adolescent can lead to emotional eating, which can impede long-term weight loss maintenance [76]. There were significant differences in weight status even when programs aimed at treating shared risk factors resulted in little difference in body dissatisfaction, dieting and weight-control behaviors [22].

Damien Sendler: Cognitive behavioral therapy (CBT) focuses on reshaping negative patterns of behavior that creep into day-to-day life and on altering the attitudes and behaviors that underlie mental health issues. One of the most promising treatments for eating disorders and obesity is cognitive behavioral therapy (CBT). In cases where family-based multicomponent behavioral weight loss treatment (FBT) has failed or cannot be used, CBT may be considered as a backup option [77,78].

Weight loss is more likely to occur with multi-component interventions. FBT is recommended as a treatment option for children with obesity and eating disorders [79]. An intervention aimed at improving the health of families may be more effective than an effort aimed at improving the health of adolescents [27]. After four months of FBT and an additional eight months of weight maintenance, researchers found that the weight loss that occurred as a result of both FBT and maintenance was not influenced by any concurrent physiopathology or eating disorders [80].

Patients may benefit from regular counseling to keep them motivated to lose weight [81]. Motivating the patient to explore and plan the necessary changes is the focus of motivational interviewing (MI), which avoids stigmatizing language about weight that could negatively impact a teen and lead to BE, decreased physical activity, social isolation, avoidance of health care services, and increased weight gain [27]. The use of MI techniques to improve patient-provider communication has been shown to result in positive behavioral changes [5].

Even though a better approach to preventing and treating obesity in children and adolescents is always being sought, current population-based interventions and traditional medical care have failed to produce the desired results. This demonstrates the need for new approaches to the fight against obesity. “Personalized Approach in Obesity Management” is an example of a long-term, family-based, multi-professional weight management program in Estonia. Real goals for the child’s lifestyle change were selected using the LINE chair Visual Analogue Scale (VAS—1–10 points) in a motivational interview method [82]. Only 14% of children and only 9% of parents felt that their children’s health was comparable to that of healthy children, as reported by the children themselves. The indicator of children’s physical and emotional health (90–92 percent of respondents) was found to be the most frequently disturbed. According to the EU Joint Action on Nutrition and Physical Activity (JANPA), the project’s results can be seen as an example of best practice in Estonia.

Few studies have examined the impact of bariatric surgery on the symptoms of disordered eating. When 19 obese adolescents underwent a reversible bariatric procedure, improvements in emotional and behavioral factors were observed [89]. Adolescents who underwent bariatric surgery had better weight loss and disordered eating symptoms one year later, according to a sub-study of the Teen-LABS Consortium [90], than those who only underwent lifestyle changes. Following Roux-en-Y gastric bypass surgery, adolescents in the Adolescent Morbid Obesity Surgery (AMOS) study had a median improvement in BE and uncontrolled eating after five years of follow-up [91]. It has been found that emotional eating decreased and cognitive restraint increased over the course of five years following surgery, as well. Higher scores for BE and emotional eating at Lang 2 years and 5 years, and for uncontrolled eating at 2 years after surgery, were also significantly associated with smaller percentage changes in BMI at 5 years relative to baseline.. Adolescents who have undergone bariatric surgery do not seem to benefit from it in terms of their eating habits, which suggests the necessity of a multidisciplinary team for long-term health support following the procedure [91].

As obesity and EDs continue to rise, there is a need to better understand and identify risk factors that increase vulnerability. Pediatricians are in a unique position to identify and disrupt the progression of disease at an early stage. Despite numerous studies showing a connection between obesity and poor mental health in children and adolescents, little attention is paid to the mental health consequences. Risk factors for both obesity and eating disorders should be identified as an important focus for an intervention designed to simultaneously address these two issues. Obesity and erectile dysfunction (ED) are serious health concerns for children and adolescents, and more research is needed to identify risk factors early and prevent the onset of these problems, better understand the underlying mechanisms, and, finally, provide effective treatment for those who need it. Efforts to reduce disparities in health and improve public health necessitate collaboration between different fields.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: People now understand that loneliness is a painful subjective experience when the social connections they have do not meet their interpersonal needs in terms of quality of or quantity. It is possible to feel lonely while surrounded by others, and this is distinct from other measures of social connection, such as the size of a person’s social network or the number of friends one has (number of social connections).

Damian Jacob Sendler: Loneliness is linked to poor mental and physical health, which increases the risk of early mortality, according to research done primarily with undergraduates and the elderly.3,4 5 To put it another way, interventions for loneliness are only based on the limited knowledge about the experience of loneliness in these specific populations because of this focus in literature. It’s not clear if and how the experience of loneliness varies among different populations. ‘

Dr. Sendler: When it comes to the study of loneliness, parents are one group that has received little attention. Surveys and research studies show that around a third of parents in the UK report experiencing loneliness often or always, and 30 percent of parents experience high and persistent levels of loneliness over time. 7 Though many parents are affected, there is no comprehensive review of existing knowledge on the impacts and experiences of loneliness in this population despite the high number of parents affected. There are currently. What we know about the health consequences of loneliness in parenthood and whether there is evidence of intergenerational effects, impacting the health and well-being of their offspring, is important to establish. An understanding of how loneliness affects parents, and which parents are more likely to suffer from it, is critical to determining appropriate strategies, support, and future research.

There were only six studies that looked at the theory behind parent loneliness. Three of these studies looked at the effect of becoming a parent on loneliness. One used a longitudinal design and found that mothers and fathers’ loneliness remained constant throughout pregnancy, the early years of their children’s lives, and the toddler years. 22 This effect was strongest among married parents, indicating that problems in the marriage are more likely to be the cause of increased loneliness than the birth of a child, as found in another study. 23 Despite this, a study involving data from 17 countries found that marital status was associated with lower levels of loneliness. 24 Male loneliness was protected by marriage and having children, but female loneliness was not, according to the findings of this study. Adults who have children are less likely to be lonely than those who don’t, which suggests that there may be cultural differences in the prevalence of parental isolation.

Another three studies looked at how loneliness is conceptualized and whether it is different for mothers. Using a methodology developed by the authors, participants in these studies were given a loneliness questionnaire, and the differences in responses between mothers and non-parents on various subscales were examined. Rokach 25 found that pregnant women and new mothers had lower levels of emotional distress, social inadequacy and alienation, interpersonal isolation and self-alienation in relation to loneliness than women in general. Other studies have shown that pregnant women and new mothers are less likely to report feeling lonely because of their own personal inadequacies, such as mistrust or low self-esteem or social marginalization (i.e, isolation and alienation). Women who were not parents scored higher than new parents and pregnant women on reflection and acceptance, distancing and denial of loneliness, according to a second study by Rokach 27. According to these findings, parents’ loneliness and coping mechanisms differ from those of other age groups.

Loneliness is a common problem for some parents, according to a number of studies included in the review. It’s difficult to draw conclusions about whether these parents are more lonely or at greater risk of loneliness because few of these studies included comparison or control groups.

Parents who have a child who has a long-term illness or disability are the most likely to suffer from loneliness (n = 25). Qualitative designs were used in most of these studies (n = 10). Loneliness was experienced by the mothers in this group due to a lack of psychosocial resources, feeling burdened by their child’s needs, lack of support from others or support available that did not meet their needs, and changes in their relationship. A range of 28 to 31 Three studies compared parents who had a child with a chronic illness or disability to a control group that did not have a child who was ill or disabled. There was a higher level of loneliness among parents of children with chronic illnesses or disabilities in two of the three studies,32,33 but there was no difference between the two groups in the other study. 34 According to another six studies, the percentage of parents of children with chronic illness or disability reporting loneliness ranged from 19.1 percent to 70 percent. A range of 35 to 40

The parents of immigrant or ethnic minority children were also found to be lonely (n = 11). There were no comparison studies in any of these studies, and the majority of them used a qualitative design with only mothers as participants. When their mother or mother-in-law wasn’t around to help, these mothers felt lonely. The mothers in this study reported feeling alone in the postpartum period because the culture in the country they were visiting was different from their own in terms of the availability of family and community support for caring for their baby. 41–44 When things went wrong with their baby, the loneliness was amplified even further. 41 Even more so, they were isolated because of prejudice and language barriers. 45,46

Loneliness in adolescent mothers was examined in a number of studies (n = 11), but the evidence was less consistent and yielded conflicting results. Two studies found that adolescent mothers were more likely to be lonely than mothers in other age groups,47,48 but a third study found that non-parent adolescents were more likely to be lonely than adolescent mothers. 49 Loneliness was not found to be an issue for adolescent mothers in another study. 50 When adolescent mothers were able to maintain or make new friendships, they did not experience feelings of loneliness, according to the results of qualitative studies. 51,52

Studies show that between 8% and 21% of single parents report feeling lonely, which is consistent with the findings of this study.

53–55 For single parents, the absence of a partner and lack of companionship led to feelings of loneliness (particularly someone to share experiences with). 56 Single parenthood can bring loneliness for some, but it can also bring a newfound sense of self-awareness, independence, and self-actualization for others. 57

Loneliness in first-time parents was examined in seven studies (n = 7). First-time parents were more likely to report feelings of loneliness after becoming parents because they found parenthood difficult, felt vulnerable as a parent, and had fewer social interactions following the birth of a child. 58

It was possible to synthesize findings from a small number of studies, such as those that looked at loneliness in low-income parents (n = 4) and mothers in poor physical health (n = 3). Researchers looked into whether housing (e.g., in a flat or shelter) and partner violence and abuse (n = 2), returning to work after paternity leave (n = 2), drug use and abuse in the home or being a parent of a child of a transgender person (n = 2) or being a military wife (n = 1) contributed to parents’ feelings of loneliness.

Only stress/distress and depression outcomes have been measured in studies looking at the effects of loneliness on parent health and well-being. A total of five studies were conducted to investigate the link between parental stress and loneliness. Using a correlational design, two of these studies found a link between loneliness and parenting stress and distress. 59,60 Another cross-sectional study of mothers of different ages found that loneliness was highest in preschool and middle school years, and although the study didn’t directly examine an association with stress, stress followed a similar pattern of change over time as loneliness. 61 Parents who were experiencing burnout were recruited for a separate qualitative study in which they were asked to describe their experiences of loneliness. 62 Research found that burnout can be caused by feelings of exhaustion and a sense of being strange and disconnected. According to another study 63, parental distress was the most common reason for referral to parenting support services, followed closely by loneliness and a lack of emotional well-being (38 percent ). All studies were cross-sectional, so the direction of the effect isn’t clear; it could be that parenting stress causes loneliness, or that feeling lonely as a parent causes stress/distress for a parent.

Damian Sendler

Nine more studies looked at the connection between parental loneliness and depression. Loneliness was reported by parents with postnatal depression in two qualitative studies,64,65 with loneliness stemming from a lack of social support and a feeling of not being understood. 65 In two cross-sectional studies, we found that loneliness was more common or more severe in groups of mothers with depression symptoms or postnatal depression compared to those who were not depressed. 66,67 Loneliness has been linked to postpartum depression and chronic depression in mothers in two separate studies. 69 In yet another long-term study, depression was found to be more prevalent in mothers and fathers who had been isolated for an extended period of time. 70 Even though loneliness and depression were linked in one study, marital dissatisfaction was a better predictor of depression in mothers than loneliness. 71 It was found that new fathers became lonely because they didn’t know if their support efforts were making a difference to their children’s mothers.

All but one of the studies (n = 4) used a longitudinal design to examine parent and child loneliness over the course of several months or years. The other five studies used a cross-sectional design to examine parent and child loneliness over the course of a single month or series of months. The loneliness measures used in all nine studies differed greatly. Loneliness can have a negative impact on children in four studies, but only in five did researchers examine the effects of mother’s loneliness on children. Parents who are lonely affect their children’s development, but there are gender-specific effects. Problem-solving skills, internalizing problems,73,86 social competence, hostility and fear of negative evaluation and social anxiety were all linked to mothers’ loneliness (but in girls only). 78 Parental loneliness was linked to a decrease in girls’ peer-reviewed cooperation skills. 75 In one cross-sectional study, loneliness in mothers was linked to loneliness in children, but loneliness in fathers was not, whereas in another study, loneliness in fathers was predictive of the persistence of sons’ loneliness and loneliness in mothers’ daughters. 77 Loneliness in parents was found to be related to low parenting self-efficacy, which in turn was linked to children’s feelings of loneliness in only one study.

Damian Jacob Markiewicz Sendler: It was found in two studies that mothers who felt lonely were more likely to choose to stop breastfeeding. After the birth of a child, new mothers often feel isolated and alone because they don’t have anyone to turn to for support in their breastfeeding difficulties. 87 It was also found that women sought out social connections in order to alleviate feelings of loneliness, which was in line with their decisions about whether or not they should keep breastfeeding their babies. 88 Because they feared being judged as incompetent, useless, and different by others, women who wanted to or had stopped breastfeeding sought out other women who had made the same decision. Others sought out others who could support them in continuing to breastfeed, and their loneliness was reduced as a result of these social connections and a sense of being part of something bigger.

Although some research looked at the connection between loneliness and child abuse or neglect, the studies that examined this relationship ranged in publication date from 1980 to 2011 and were all conducted more than 10 years ago with the exception of one. This category also lacks a cross-cultural comparison because all studies were conducted in the United States. Except for one, all of the studies looked at mother-only loneliness in families where neglect or abuse of children has been identified, while the others looked at mother and father-only loneliness in families where abusers have been identified. A loneliness scale was used to assess loneliness in all of the studies included in this category. The UCLA scale was used by five people, the Child Abuse Potential Inventory (CAPI) Loneliness subscale by two people, and the Emotional Social Loneliness and Isolation Scale by one person.

Damian Jacob Sendler

One study examined whether or not loneliness is associated with child abuse/neglect, and another examined whether mothers in families with neglectful behaviors are more likely to be lonely (n = 5). Both studies looked at the relationship between loneliness and abuse/neglect in two different ways. Even though regression models are used to examine predictors of abuse and neglect in this category, the studies can only show an influence or association. There was no correlation between parental punishment and child neglect in two of the three studies that examined the relationship between loneliness and parental behavior. 92 In the other study, mothers of disabled children were found to be more likely to engage in abusive behavior toward their children due to their loneliness. 93 Loneliness was higher in neglectful parents, 94 abusive parents, 95 and mothers in neglectful families when compared to a control group. 96,97 Loneliness was more prevalent among mothers in families at risk of child abuse who did not have a father present than among mothers who did have a father present.

Damien Sendler: New parents were the focus of the majority of these studies, with some focusing on mothers who had postnatal depression or were at risk of child abuse or neglect. One intervention aimed to reduce social isolation in parents of children with cerebral palsy, while another aimed to increase social support in parents at risk of child maltreatment. However, none of the interventions were specifically designed to reduce loneliness. 99 All but one study relied on a quantitative approach, while the other two used a qualitative approach. One intervention study used UCLA, but the version differed from one study to another. Randomized trials only appeared in three of the studies. As many as 101 to 103 Only six of the 14 studies that examined the effectiveness of interventions showed a decrease in loneliness. It was found that interventions such as tele-health, peer support, universally provided child development parenting, interpersonal skills training, and short-term cognitive therapy reduced or showed promising results in reducing loneliness.

Loneliness among parents appears to be a constant and distinct from that of other generations.

22.25-27.3 As a result, there were no studies to identify the underlying mechanisms of parental loneliness, and no prospective studies that began in the pre-conception period to help understand the changes in the level of parental loneliness throughout the course of parenthood. There is evidence to suggest that becoming a parent may actually increase one’s feelings of loneliness, despite the fact that there is a baby to care for. In other life transitions, such as going off to college or retiring, people report feeling more isolated due to the loss of social connections and friendships. 105

Loneliness has been linked to an increased risk of depression, anxiety, and increased stress in a wide range of studies, including those included in the scoping review61,63,86.

3,106 Other studies have shown a link between depression and loneliness, and our results confirm this. Loneliness among children has been found to be associated with depression in parents, and depression has been linked to loneliness in children. 70 There is still a need for further research (i.e. using cross-lagged designs where reciprocal relationships between loneliness and depression over time can be examined, allowing for the direction of the effect to be explored) in this population. We found no studies that looked at the link between loneliness in parents and physical health outcomes, despite the fact that loneliness has been linked to poor physical health in other cohorts.

The effects of parental loneliness on children’s health and well-being, such as breastfeeding cessation, mental health, and social competence, were found to be similar to other evidence of the negative effects of poor parental mental health (108). According to the scoping review, there may be some gender-specific effects of intergenerational transmission of loneliness and social competence from parent to child. However, because there are so few studies, this merits further investigation. Other studies have found gender-specific effects for the intergenerational transmission of internalizing behaviors (depression and irritability) 109 and depression 110.

Concerns should be taken with the findings that parental loneliness was also linked to child abuse and neglect because the evidence base consists only of cross-sectional studies and other factors were not taken into account (e.g. social isolation, being in an abusive relationship or poor mental health). As a result of the lack of comparison studies and further research, it is difficult to say definitively whether parents who face additional challenges (such as those with children who are ill or disabled, those who are immigrants or members of an ethnic minority, and parents who are single) are more likely to experience loneliness. Rather than assuming that all outcomes associated with loneliness are negative, it may be beneficial to consider factors that can mitigate adversity, such as personal or community assets, and to identify more resilience-based factors that can help to combat loneliness. 111,112 Additionally, more research is needed with fathers and wider partners, as well as international studies to examine cross-national and cross-cultural differences.

This scoping review has identified some key mechanisms of effectiveness that should be taken into account when designing future interventions to reduce loneliness. Involving women in peer support can help them improve their communication skills and build social networks. A growing body of evidence shows that peer support can alleviate negative emotional effects (such as social isolation) by creating social connections and networks, which is in line with other studies.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: Patients with acute coronavirus disease 2019 (COVID-19) and convalescent COVID-19 (sometimes referred to as “long-COVID”) report fatigue lasting from weeks to months. After completing a systematic review of post-COVID fatigue as well as a narrative review of fatigue following other infections, the COFFI investigators made recommendations for clinical and research approaches to assessing fatigue following COVID-19.

Damian Jacob Sendler: At 16–20 weeks after the onset of symptoms, a significant minority of patients in most COVID-19 cohort studies reported persistent fatigue, ranging from 13% to 33%. Many acute systemic infections, such as infectious mononucleosis, are associated with fatigue, according to data from the COFFI and other prospective cohort studies. Case rates of clinically significant Post-infective fatigue, after recognized medical and psychiatric causes have been excluded, range from 10 percent to 35 percent after six months.

Dr. Sendler: Post-COVID fatigue can be better understood by using standardized interviews, validated screening questionnaires, and investigative methods to identify end-organ damage as well as mental health conditions. COFFI investigators recommend the following:

Acute coronavirus disease 2019 (COVID-19) has been linked to some patients who do not fully recover. Long-haulers” and “long-COVID” are terms used to describe patients who continue to experience symptoms for weeks or months after the onset of the acute illness [1]. Long-COVID does not have a case definition, but fatigue and other symptoms reminiscent of an acute infection predominate. The media, the public, and the scientific and medical communities have all paid attention to the condition [2].

Many people use the term “fatigue” to describe a variety of feelings, including that of “everyday” or “physiological” fatigue, as well as that of “pathological” or “diseased” fatigue. Obvious signs of exhaustion include decreased force generation efficiency (as in myopathy) and weakness on physical examinations, but fatigue can also be a subjective experience (ie, fatigue as a symptom). Rather than simply referring to tiredness, patients who express fatigue may actually be describing symptoms such as weakness, dyspnea, difficulty concentrating, sleepiness, or depression. Because of this, it is critical to accurately describe and categorize each symptom complaint in both clinical and research settings. In the same way that pain is automatically interpreted in light of other concurrent brain processes like perceptions, emotions and thoughts, the subjective experience of fatigue is [3] automatically interpreted as well.

The acute sickness response to a wide range of pathogens is well-exemplified in evolutionary terms as a homeostatic alarm aimed at energy preservation [3]. Fever, tiredness, hypersomnia and musculoskeletal pain, anorexia and mood disturbance are just some of the physical, behavioral and psychological manifestations of this response. In many cases, symptoms persist for weeks or months after the acute infection stage has ended [5]. Patients often describe their fatigue as having both “physical” and “mental” aspects, such as a lack of energy and a general sense of heaviness (a feeling of brain fog). One of the most common characteristics is that even a small amount of physical or cognitive activity can cause a long-lasting increase in fatigue and other symptoms.

Chronic fatigue is defined as lasting more than six months [7]. As long as there are no other plausible explanations for the persistent exhaustion, and if other symptoms such as muscle and joint pain and cognitive difficulties are present, the patient may be diagnosed with CFS or, more specifically, PIFS [5, 7].

For this reason, researchers from the international Collaborative on Fatigue Following Infection (COFFI) [5] have conducted a systematic review on the epidemiology of fatigue after COVID-19 infection and a narrative review on the literature on fatigue following other infections to provide guidance on these complexities. Fatigue after COVID-19 can be assessed using clinical and research methods.

Collectively, these findings from post-infective cohorts show that (1) fatigue is a common and sometimes disabling post-infection, (2) the natural history of long-term persistent fatigue is frequently long-term, (3) the severity of acute illness and baseline psychological status and cognitive and behavioral responses to acute illness predict PIFS, (4) structured medical and psychiatric treatment is effective in alleviating fatigue after infections of various kinds, and

Damian Sendler

A validated definition of chronic fatigue after COVID-19 infection is needed for both clinical and research purposes because of the limitations of the studies in COVID-19 and evidence from other post-infective cohorts. Following current definitions of postinfective fatigue [5], we recommend that the label “post-COVID fatigue” be used when the fatigue is as follows: chronic; incapacitating to the point of interfering with most, if not all, of one’s normal activities (such as going to work or school or participating in social activities), lasting at least three months in children or adolescents, and emerging during confirmed acute COVID-19 (i.e. with a positive severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] test), with no symptom-free interval since the onset.

Damian Jacob Markiewicz Sendler: Identifying the underlying causes of post-COVID fatigue should include the following: end-organ sequelae of acute COVID-19 illness and hospitalization; mental health conditions precipitated or exacerbated by COVID-19; and other premorbid or intercurrent disorders of which fatigue is a symptom. As a result, we recommend a thorough diagnostic process (see Supplementary Tables 2 and 3 for summaries of instruments and references). Clinical and research settings can benefit from short screening questionnaires to assess the fatigue state, such as the Chalder Fatigue Scale or the SPHERE (Supplementary Table 2), which follow the National Institute of Neurological Disorders and Stroke Common Data Elements recommendations for identifying “clinically-significant” fatigue. Given the frequency with which fatigue occurs in conjunction with other issues such as a variety of physical and mental health issues, it is reasonable to use other validated screening tools in addition to the SPHERE in order to identify patients who may also be suffering from related physical symptoms or mental health issues (Supplementary Table 2). Pain and sleep quality can also be assessed with validated instruments to screen for other relevant symptom domains. Concurrent assessment of functional status using an instrument like the SF-36 is strongly recommended for patients with clinically significant fatigue (Supplementary Table 2).

Damian Jacob Sendler

The semistructured, clinician-administered diagnostic interview schedules for (1) fatigue states (Structured Clinical Interview for Neurasthenia [SCIN]) [6] and (2) psychiatric disorders (Composite International Diagnostic Interview [CIDI]) offer an ideal approach to further assessment for research purposes in particular. The Structured Diagnostic Interview for Sleep Patterns and Disorders can also be used if screening questionnaires raise the possibility of sleep disturbance as a contributor (Supplementary Table 3).

Damien Sendler: A thorough medical history and physical examination should be performed on patients with persistent fatigue following COVID in order to determine the nature of the symptoms, their onset time, and their impact on their functional status. Premorbid and concurrent mental health issues, such as depression, anxiety, and PTSD, should be examined as part of this clinical evaluation. As a last resort, a chest x-ray is recommended, as well as a restricted list of laboratory testing (e.g., blood count; C-reactive protein, blood glucose; ferritin; B type natriuretic polypeptide) [43]. If the patient’s history or examination reveal anything concerning, it may be necessary to conduct additional tests or consult with a specialist. Pediatric services should be contacted if a child or teenager experiences post-COVID fatigue.

The diagnosis of “idiopathic post-COVID fatigue” should be used in cases where this process does not reveal an explanatory condition. A post-infectious fatigue syndrome after COVID-19 may be diagnosed in these patients [7]. As a starting point for clinical care, a diagnosis such as this provides reassurance of a generally self-limiting natural history and supportive care [44]. Additional symptoms and comorbid conditions should be documented thoroughly for research purposes, so that statistical analyses can be conducted that take these factors into account.

Idiopathic post-COVID fatigue (PIFS) remains unresolved, so a biopsychosocial approach is recommended to conceptualize research approaches to PIFS, including predisposing, precipitating and sustaining factors. Genetic and psychosocial vulnerabilities may play a role in the development of PIFS. Co-occurring disorders, such as COVID-19-related death or job loss, can exacerbate the symptoms of depression and lead to its inception [47]. It is possible that sleep disturbance, autonomic dysfunction, endocrine disturbances, reactive mood disorders like depression or anxiety, and abnormal illness beliefs and behavioral changes, such as activity patterns that are boom-bust or avoidant, can all play a role in the onset and progression of illness and disability. [48, 49, 50, 51]. The pathophysiology of idiopathic post-COVID fatigue is likely to be similar to that of PIFS. Large sample sizes, stratification by multiple contributory variables, and careful matching by, or controlling for, these variables in case-control designs are recommended for research on the predictors or associations of post-COVID fatigue.

For both clinical and research purposes, there are many unknowns about long COVID, but the lessons learned from decades of research into fatigue states after other infections highlight the need for careful clinical characterization, protocols, and a broad bio-psychosocial approach.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: It is a constant awareness of one’s thoughts and feelings as well as one’s physical sensations and surroundings. Being mindful means being open, non-judgmental, friendly, curious, accepting, compassionate, and kind to oneself and others. 1 Consciousness is the ultimate goal of all mindfulness practices. Formal (such as deep breathing, sitting still, walking slowly, or performing a body scan) or informal (e.g. mindfulness in everyday life). There are a large number of mindfulness-based intervention (MBI) programs. The most widely used MBIs are Jon Kabat-19792 Zinn’s introduction of mindfulness-based stress reduction (MBSR) and Segal, Teasdale, and Williams’ MBCT, which is based on MBSR3,4. One-day retreats are included in both of these programs, which run for eight weeks.

Damian Jacob Sendler: Buddhism has a long history of cultivating mindfulness. Secular populations in health care, education, and the workplace, ranging from preschoolers to senior citizens, have begun using it more frequently in recent years. The number of articles addressing the topic of mindfulness has skyrocketed in the last decade. Increasingly, publications on mindfulness are being compared to those on cognitive behavioral therapy (CBT), a psychotherapy that is very commonly used in the United States.

Dr. Sendler: The efficacy of MBIs for depression and anxiety has been confirmed by meta-analyses that show moderate to strong reductions in the two conditions. Although MBIs can help reduce perinatal anxiety of moderate to large magnitude, the effects are less consistent in reducing perinatal depression, according to an extensive review of studies. 9 The web-based interventions on mindfulness that are becoming increasingly popular are also effective in reducing depression and anxiety in people with anxiety disorders. 10 As a stand-alone intervention, mindfulness practices may still have some benefits, but it is difficult to separate the effects of social interaction and psychoeducation, which are integrated in many MBIs (e.g. group MBCT), from the effects of standalone mindfulness practices due to the complex nature of these interventions.

However, more rigorous studies are needed to draw clear conclusions about MBIs’ effects on stress in different populations. In healthy adult populations, a meta-analysis of five randomized control trials examined the effects of MBIs on cortisol levels, a stress-mediated hormone. However, the overall effect size (g = 0.41; P = 0.025) was moderately low. Nonetheless, another meta-analysis found that meditation interventions had a significant, medium effect on cortisol levels in at-risk populations such as those who were living in stressful situations. Some studies have shown inconclusive results among specific populations, such as tertiary students14 and older adults15. Interventions for stress management had a moderate effect size (g = 0.42, 95 percent CI: 0.27–0.57) among college students, but the majority of the studies were of poor quality. 14 In older adults, there was no clear evidence that MBIs could reduce stress.

Current research suggests that MBIs may be effective in treating insomnia and other sleep-related problems. When compared to attention/education and waitlist control, MBIs have medium to large effects (g = 0.67, 95 percent CI = 0.30–1.05) and appear to have lasting effects at 3 months postintervention (g = 1.06, 95 percent CI = 0.48–1.64), according to a meta-analysis. 16 The Pittsburgh Sleep Quality Index, used in several other meta-analyses, consistently found improvements in insomnia and sleep quality.

MBIs may have some impact on eating disorders, according to recent research (EDs). In a systematic review and meta-analysis, anorectic and bulimic participants were found to benefit from MBIs in terms of ED symptoms, emotional eating, negative affect, and body dissatisfaction, as well as BMI, compared to pre-assessment. 20 Another meta-analysis and systematic review found that MBIs may help reduce negative feelings and concerns about one’s body image while promoting an appreciation for one’s own physical appearance. 21 For the efficacy of MBIs to be confirmed, more rigorous studies need to be done.

MBIs have been found to be effective in treating both substance and behavioral addictions, according to research. Addiction symptoms like dependence, craving, and emotional dysregulation were all reduced and mood and emotion dysregulation were improved by MBIs in a systematic review of 54 randomized controlled trials. 22 It has been found that MBIs have small to large effects in reducing craving levels, stress severity, substance misuse frequency and severity, anxiety and depressive symptomatology (including major depression), negative affectivity (such as sadness or irritability), and post-traumatic symptoms (such as depression or irritability). More research is needed on long-term follow-up assessments and diverse populations, despite the promising results.

It appears that MBIs may be beneficial for people suffering from psychosis, but more research is needed.

25 MBIs have moderate short-term effects on total psychotic symptoms, positive symptoms, hospitalization rates, length of hospitalization and mindfulness in patients with psychosis. MBIs also have long-term effects on total psychotic symptoms and hospitalization duration. 26 Other studies show that MBIs can help people with mental health issues, such as improving their negative symptoms and measures of functioning, as well as enhancing their quality of life. 27 To better understand the mechanisms and long-term efficacy of MBIs in people with psychosis, future large trials using randomization procedures are recommended.

Participants with PTSD were more likely to have less conclusive results from MBIs. A meta-analysis of ten randomized controlled trials examining the effects of meditation on post-traumatic stress disorder (PTSD) found some benefit, but the results were not statistically significant. 28 Meditation intervention types, short follow-up times, and high-quality studies hampered the evaluations of the findings. 28 However, a number of systematic reviews have come to similar conclusions regarding the efficacy of MBIs such as mindfulness, yoga, and relaxation in the treatment of post-traumatic stress disorder (PTSD). 29,30 Increased confidence in the efficacy of MBIs among PTSD-diagnosed participants requires additional high-quality studies.

Before concluding on the effectiveness of MBIs in the treatment of attention-deficit hyperactivity disorder (ADHD), further research is needed. ADHD core symptoms like inattention, hyperactivity, and impulsivity can be reduced by MBIs, according to a systematic review and meta-analysis (children and adolescents: Hedge’s g = –0.44, 95 percent confidence interval (CI): 0.69 to 0.19, I2 zero percent; adults: Hedge’s g = –0.66, 95 percent confidence interval (CI): 1.21 to 0.01; I2 81.81%). 31 Even though there are only a few studies, there is a high risk of bias and a lack of sufficient evidence to support the efficacy, according to the authors. 31 A number of other systematic reviews have come to similar conclusions and findings. 32–34

Currently, there is very little research on MBIs for people with autism spectrum disorders (ASD) or their caregivers. People with autism and their caregivers may benefit from MBIs, but the results of a 2017 systematic review of 16 eligible studies were inconclusive. 35 Due to their diverse age groups and outcomes, these studies covered a wide range of ASD sufferers and their families’ subjective well-being. 35 People with autism spectrum disorder (ASD) may benefit from MBIs in the following ways: they can help alleviate anxiety and rumination; they can help alleviate parental stress; they can help improve their mental health; and they can help improve the mental health of their loved ones.

There is currently insufficient evidence to support the use of MBIs to improve cognition. MBIs have been shown to improve cognitive function and everyday activity functioning in older adults with mild cognitive impairment, according to a systematic review. 39 However, the available studies had small sample sizes, lacked control comparisons, and lacked follow-up to understand the effects on delaying dementia progression. 39 MBIs’ cognitive benefits need to be tested in more rigorous studies and on a wider range of populations.

MBIs have been shown to reduce pain in a wide range of populations.

40,41 An RCT meta-analysis of 30 RCTs on chronic pain in 2017 found that mindfulness meditation improved chronic pain management. 40 There was a statistically significant difference in the percentage change of the mean in pain between the intervention and control groups (0.19 percent (SD, 0.91; min, 0.48; max, 0.110)). 40 Even though more studies are needed to confirm this, a network meta-analysis found MBSR to be effective for chronic pain and that the effects are not significantly different between MBSR and CBT. 41 In addition, current evidence is insufficient to support the efficacy of brief MBIs with a total contact time of less than 1.5 hours on acute and chronic pain.

Multiple studies and meta-analyses show that MBIs can lower blood pressure (BP).

43–45 People with hypertension or elevated blood pressure saw a reduction in systolic and diastolic blood pressure after a meta-analysis of five studies on MBSR. There is a lack of evidence on ambulatory blood pressure due to the fact that most studies focused solely on clinical blood pressure. 43 In people with non-communicable diseases, the systolic and diastolic BPs were reduced after the eight-week MBSR, the 12-week breathing awareness meditation, and the eight-week mindfulness-based intervention. 44 The systolic blood pressure (d+ = 0.89, 95 percent confidence interval [CI] = 0.26, 1.51) and psychological symptoms (d+s = 0.49–0.64) improved, but the diastolic blood pressure (d+s = 0.49–0.64) did not. 45 Another systematic review by Zou found that mindful exercises for stroke patients improved sensorimotor function in both the lower and upper limbs (SDM = 0.79; 95 percent CI, 0.43–1.15; I2 = 62.67 percent). 46 Gait speed, leg strength, aerobic endurance, motor function, cognitive function, and gait parameters can be measured in additional studies, as well.

The comorbidities that accompany being overweight or obese are a significant source of disease burden. 47 If you’ve ever struggled with weight gain, mindful eating can be a useful weight-loss strategy. Conventional diet programs, which restrict energy intake and limit food choices, may not have long-term effects because mindful eating tends to be more sustainable and also addresses emotional issues that may influence unhealthy diets. 48–52 Ten studies on mindful eating and weight control were reviewed in 2019 and found significant weight loss after the program (0.348 kg, 95 percent confidence interval [CI], 0.591–0.105) compared to control groups. 53 In addition, the effects of MBIs were comparable to those of conventional diets. 53 Short study durations and biased samples were found to be flaws in the research (unbalanced sex ratio, source and place of living). Longer studies and different methods of subject selection may be necessary in the future to assess long-term improvements in various populations.

There is currently no conclusive evidence that MBIs have any effect on the physiological outcomes of diabetes. The effectiveness of MBIs in controlling physiological outcomes (such as blood sugar and blood pressure) in patients with type 1 and type 2 diabetes was found to be mixed in a systematic review. 54 An additional meta-analysis found that meditative movements significantly improved glycemic control in type 2 diabetes mellitus (T2DM) patients, including fasting glucose, glycated hemoglobin (HbA1c), and postprandial glucose. 55 In spite of this, the authors pointed out that it’s difficult to draw any firm conclusions about the effectiveness of MBIs because of the small sample sizes, short study durations, and wide variety of delivery methods that have been reported so far on. 55 The improvement in psychological symptoms such as anxiety,54 depressive symptoms,54,56, and quality of life, in addition to better glycaemic control, was also found in systematic reviews. 57 To determine whether MBIs are effective in the treatment of diabetes, more research is needed to address the limitations.

The physical health outcomes of cancer patients may benefit from MBIs, particularly cancer-related fatigue and pain, as well as psychological benefits.

There was a statistically significant decrease in cancer-related fatigue (CRF) score amongst cancer patients (SMD = -0.51, 95 percent CI [0.81–0.20]),59 particularly among lung cancer patients. 60 Another systematic review and meta-analysis found improvements in sleep disturbances, pain, and other psychological symptoms such as anxiety, depression, and fear of cancer recurrence. 61 Further high-quality studies are still required, even though MBIs appeared to be effective in reducing CRF and other symptoms, to provide additional insights and to confirm the existing evidence.

MBIs’ ability to improve respiratory health remained a mystery. A meta-analysis of 16 studies found that patients with chronic obstructive pulmonary disease (COPD) may benefit from meditative movement to improve lung function and physical activity. 62 Walking distance and forced expiratory volume in one second (FEV1) were both improved by the intervention when compared to the nonexercised group (3 months: MD = 25.40 m, 95 percent CI; 16.25–34.54; 6 months: MD = 35.75 m, 95 percent CI: 22.23–49.27) and when compared to the nonexercised group (6 months: MD = 35.75 m, 95 percent CI: 22.23–49.27). 62 However, the authors cautioned that further studies are needed to confirm the findings due to the small sample sizes, inconsistency in study quality, and the variety of meditative movement styles in studies. 62 Further high-quality studies are needed to confirm the effectiveness of MBIs on respiratory health in COPD65 and asthma63, according to other systematic reviews and meta-analysis.

Damian Sendler

MBIs have been shown to have a positive impact on social well-being and prosocial behavior (i.e. voluntary behaviour intended to benefit another).

65,66 Study after study has found medium effects on prosocial behavior, and the results are consistent with known and unknown effects. 65 Research shows that mindfulness promotes ethical and cooperative behaviors in a variety of interpersonal contexts and may reduce intergroup bias. 65 Also, according to a recent review of 29 studies, MBIs reliably improve compassionate helping and reduce prejudice and retaliation with effect sizes ranging from small to medium. 66 As a further benefit, MBIs have been shown to reduce anger, violence, and aggression. 69 Social and ecological sustainability may also be improved through improved well-being and connection to others, the community, as well as the natural world. 70

A public health issue, especially during COVID-19 and among the elderly, is loneliness and social isolation. It appears that mindfulness training may help reduce feelings of isolation and loneliness, according to some preliminary research. 71–74 An early study found that MBSR was effective in reducing loneliness in senior citizens. 71 Another study found that social support for HIV-positive women had a positive impact on their feelings of isolation. 72 In a study of Chinese college students, mindfulness was found to have a positive effect on the reduction of loneliness. 73 In a study comparing smartphone-based mindfulness training to an active control program, Lindsay et al. found that mindfulness training decreased feelings of isolation while increasing social interactions.

More and more schools are implementing mindfulness programs. Schools around the world have implemented a variety of mindfulness programs, including “.b,” “Mindful Schools,” “WELL,” and “Resilience.” 79,80 Many of these programs are aimed at both students and educators. 81 MBIs have the potential to improve resilience to stress, cognitive performance such as attention, and emotional problems in children and adolescents, according to recent systematic reviews. 82,83 Results showed that resilience had a significant effect when it came to well-being (positive and constructive emotional states), as well as social and interpersonal skills, and self-esteem. In the meta-analysis, the results showed that the effects (effect size = 0.36–0.80) were comparable to or better than those of school-based social and emotional learning programs (overall effect size = 0.30). 84 It’s encouraging to see MBIs being taught in preschools, elementary schools, middle schools, and high schools as a life skill. Students may benefit from a weekly 90-minute mindfulness session (i.e. 18 minutes on average per day). 85 Integrating mindfulness into the curriculum, teacher training, leadership development, and other aspects of the learning environment is important when establishing mindful schools.

Damian Jacob Markiewicz Sendler: Nonclinical samples showed that trait mindfulness was linked to higher levels of self-confidence, greater job satisfaction, and better interpersonal relations; it was also linked to higher levels of burnout and work withdrawal. It has been found that mindfulness-based interventions (MBIs) reduce stress, burnout, mental distress and somatic complaints in the workplace as well as improve mindfulness and well-being in the workplace with small to large effect sizes ranging from Hedge’s g = 0.32–0.77. However, the effect on work engagement and productivity was limited by a small number of studies.

They can be used in a variety of ways, including in groups or as individual self-help interventions.89 MBIs can also be integrated into educational programs for clinicians and other professionals in order to benefit themselves as well as their students as well as the people in their immediate environment.

90 Even though cognitive behavioral interventions have nearly identical benefits, mindfulness may require less training and less time for both workers and clients to master, and they may be less expensive to provide. 91 According to studies, teachers in a mindfulness program can expect to pay between US$515 and US$1850 per teacher for their training, which varies depending on the number of teachers being trained and the ancillary and opportunity costs. 92 There must be more research done, however, to prove their effectiveness. Early evidence suggests that it is cost-effective93, including but not limited to the treatment of breast cancer-related pain, fibromyalgia-related pain, low back pain, and training for caregivers 97 Online and face-to-face MBCT are both effective treatments for improving the quality of life of cancer patients in need of emotional support. 98 Many health problems still need to be studied for their cost-effectiveness in the workplace,99 as well as in other areas.

Learning mindfulness can be hindered by non-compliance. As much as a quarter of high school students fail to graduate as a result of a variety of factors.

Damian Jacob Sendler

There have been conflicting findings in previous studies about who will or will not adhere to MBIs. Even though women in general showed higher levels of compliance, those with higher levels of openness to experience, resistance to change and severer symptoms. 103,104 One systematic review of 28 studies found a small but significant correlation between participants’ self-reported home practice and intervention outcomes (r = 0.26, 95 percent CI: 0.19–0.34), but the relationship between participants’ compliance and intervention outcomes is inconsistent.105 106 A good natural setting is important, especially for beginners, in terms of factors associated with better compliance. 100 Furthermore, some researchers have advocated for the identification of meditation exercises that are both effective and adherent to MBIs. 107 There is still a need for more research to determine which types of MBIs are most likely to be adhered to and benefit from, as well as factors and strategies that can help increase compliance.

Changes in mindfulness, rumination, worry, self-regulation, compassion or meta-awareness are some of the mechanisms suggested by studies as being responsible for MBIs. These changes predicted or mediated the treatment effects.

Damien Sendler: It has been suggested that changes in attention, memory specificity, self-discrepancy, emotional reactivity, and momentary positive and negative affect, may be part of the mechanisms. 108 Recently, the MMT approach has also been recognized as providing a theoretical framework for the investigation of specific mindfulness components and their contributions to positive health outcomes. 112,113 Through an iterative process of appraisal, decentering, and metacognition, this approach would help people eliminate negative emotions and replace them with positive ones while also promoting eudaimonic meaning in their lives. 112,113 However, there are numerous unanswered questions concerning the mechanisms of MBIs.

It is possible that the changes in the brain and biomarkers of immune function and stress may have provided a neurophysiological basis for explaining the positive effects of MBIs. Medical brain imaging (MBI) has been found to affect the processing of self-relevant information, the regulation of behavior and the solution of problems, adaptive behavior and interoception in healthy and diseased individuals in systematic reviews. 114–119 It was found to be true in all of the eight areas of the brain that are linked to meta-awareness (frontopolar), body awareness, memory consolidation (hippocampus) as well as self- and emotion regulation (anterior cingulate; orbital frontal cortex) that mindfulness practices had a medium effect size. 118 Short-term meditators have not been shown to have structural brain changes, but experts have, especially in the areas of their brains that are involved in self-referential processes like self-awareness and self-regulation. 114 MBIs have modulatory effects on several brain regions in people with major depressive disorders, for example (e.g. the prefrontal cortex, the basal ganglia, the anterior and posterior cingulate cortices and the parietal cortex). 115 According to yet another systematic review of 78 studies using functional neuroimaging (fMRI and PET) to examine the effects of meditation on brain activity and deactivation, there were moderate effects on brain activation and deactivation for common meditation practices (focused attention, mantra recitation, open monitoring, and compassion/loving-kindness), suggesting practical significance. 116 It was found that increased alpha and theta power in both healthy and patient groups was associated with a relaxed alertness state that may contribute to mental health in the systematic review of EEG results. 117

RCTs have shown that mindfulness meditation can reduce stress and immune-related physiological markers of inflammation, cell-mediated immunity, and biological aging: NF-kB activity is reduced, C-reactive protein levels are reduced, CD4+ T cell counts are increased, and telomerase activity increases.

120 mindfulness meditation has been shown to reduce physiological markers of stress such as cortisol, C-reactive protein and systolic blood pressure, as well as triglycerides and tumor necrosis factor-alpha in various populations, according to another systematic review of RCTs. 121 More hours of meditation have been shown to have a greater impact on telomere biology than fewer hours of meditation. 122 These preliminary findings, however, require further replication, and the authors of the review call for studies to include physiological markers as a primary outcome of RCTs.

MBIs should not overestimate the importance of organizational and social determinants in ill health, and ethical questions are essential in guiding the future direction of MBIs. Ethics of mindfulness are extensively discussed in the books “Practitioner’s Guide to Ethics and Mindfulness-Based Interventions” (edited by Lynette Monteiro, Jane Compson and Frank Musten) and “Handbook of Ethical Foundations of Mindfulness” (edited by Stanley Steven, Ronald Purser and Nirbhay Singh). For MBIs, there are many ethical issues that need to be addressed. The paradox of teaching mindfulness in business and military settings, for example, is that it prevents superiors from making use of subordinates through mindfulness regardless of other organizational factors causing stress or depression at work. While MBIs can provide personally meaningful and prosocial values, they can also improve ethical standards, as research shows that people who are more mindful place a higher value on moral principles than people who are less aware.124 This suggests that MBIs can help raise ethical standards.

MBIs are considered to be relatively risk-free.

126 Adverse events and side effects of MBIs, like many other psychological intervention studies, go largely unreported. MBSR and MBCT have been shown to be safe in a previous systematic review, but only one in five trials mentioned monitoring for adverse effects. 126 Factors associated with the program, with participants, and with clinicians or teachers all have the potential to cause negative outcomes. 1,126–132 As a result of previous research and real-world experience, a safety checklist is still needed. MBI practitioners and researchers are encouraged to report any potential adverse events using a checklist, as well as to continue taking safety precautions, such as screening and caring for vulnerable individuals, in future MBI programs. Seizures/epilepsies/acute psychosis/mania/suicidal thoughts may be among the health issues of concern for these individuals.

Despite the growing popularity of mindfulness research and applications, many questions remain. The first step is to improve the quality of research studies. A lack of quality study design, small sample size, short follow-up period, and inconsistent terminology and measurement tools are among the most frequently cited limitations in systematic reviews of MBI effectiveness and cost effectiveness. These caveats need to be addressed in future studies. More research is needed to determine whether online MBIs intervention and training can have the same or better effects and cost-effectiveness as face-to-face MBIs, though preliminary benefits have been observed. 10,134,135 In light of the current COVID-19 pandemic, online alternatives may be critical. Integrating both empirical and neurophysiological findings to gain a better understanding of the mechanisms. Fourth, more research is needed to examine the acceptance and compliance of MBIs in consideration of safety issues and ethical concerns in order to understand who might benefit more from MBIs and barriers and respective strategies (e.g. better meditation environment) for improving the acceptance and compliance. An examination of long-term compliance is also necessary. A large-scale cohort study on MBIs may be necessary. The fifth step is to develop more guidelines and regulations for mindfulness-related research and services, such as guidelines on adverse events monitoring and safety guarantee, as well as qualifications for mindfulness teachers. ‘ When MBIs are provided as a collective action in schools, businesses, or organizations, these may be important considerations. As a sixth option, consider Mindfulness Plus (or “Mindfulness+”), which is a combination of MBIs and other proven interventions (such as medication or behavioral activation in addition to MBIs, for example)136. Also, consider MBIs combined with reflection training and Qigong movement therapy138. This would allow for a wider range of applications for MBIs.

Different populations benefit from MBIs for a wide range of common health conditions. Depression, anxiety, stress, insomnia, addiction, psychosis, pain, high blood pressure, obesity, and cancer-related symptoms have all been found to be alleviated by MBIs. However, more research is still needed to examine MBIs’ efficacy on a wide range of biopsychosocial health conditions, such as depression, anxiety, and schizophrenia. MBIs are generally considered safe. During mindfulness-based trainings and interventions, ethical considerations must always be taken into account. Both empirical and neurophysiological findings have suggested mechanisms for MBIs. Some health issues can be cost-effectively addressed (e.g. breast cancer, fibromyalgia, low back pain or caregiver training). Studies with larger sample sizes and longer follow up periods are needed for a wide range of other issues and sub-groups to confirm its effectiveness and cost-effectiveness.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler, M.D. – One out of every five children and adolescents around the world suffers from a mental health disorder, and there are few options for treatment and rehabilitation. Throughout their lives, children face a variety of challenges that could lead to mental illness. There have been numerous natural disasters and civil unrest in Uganda, which has resulted in large numbers of refugees and internally displaced people, and there is a significant burden of infectious diseases, such as acute respiratory tract infections, malaria, and HIV/AIDS, which have plagued the country for decades.

Damian Jacob Sendler: According to WHO’s definition of health, mental health is a critical component, but funding and access to mental health services, including CAMHS (Child and Adolescent Mental Health Services) that assess and treat young people with emotional, behavioral or mental health difficulties [1] are lacking. The number of child and adolescent psychiatrists in Uganda is just five for a population of more than 20 million children and adolescents. In addition to peer and school pressure and difficulties accepting one’s sexual orientation and one’s own identity, children and adolescents around the world may also be subjected to stress from other sources [4, 5]. One in five children and adolescents in the world suffers from a mental illness as a result of the stress they experience, and treatment is either unavailable or unevenly distributed [5]. Early intervention is critical for better outcomes for the half of those with mental illness who show symptoms before the age of 14 percent [6]. As a result, there is a pressing need to expand mental health services for children and adolescents around the world.

Dr. Sendler: Over half of Ugandans (57 percent) are under 15 years old, making them particularly vulnerable to the problems listed above. This vulnerability is exacerbated by widespread poverty, with 20 percent of the population living below the national poverty line [3]. Many of the Lord’s Resistance Army (LRAvictims )’s were children who had been separated from their parents for more than 20 years. Orphans are more likely to suffer from higher levels of emotional distress, lack of security, and poverty [8]. As a result, many young people in Uganda are forced to deal with additional hardships that contribute to a significant burden of suffering [9, 8].

The Lord’s Resistance Army conflict also led to the abduction of children and adolescents to serve as child soldiers [10]. Abducted children who were forced to carry out raids and kill and mutilate others are still afflicted with Post-traumatic stress disorder (PTSD) up to 97.7 percent of the time [8]. Abducted girls are more likely to have been sexually abused than boys. Furthermore, the stigma and discrimination that former child soldiers and their families have endured as a result of their involvement with the Lord’s Resistance Army raises their vulnerability to the development of mental illnesses [5, 8, 10]. Prevention and reduction of current and future mental health symptoms are possible with early intervention.

More money is being spent on health care in Uganda because of the country’s recent progress in peaceful development and reducing poverty. Although funding is still low by international standards, for example, only 9.8% of GDP was allocated to health in 2019 and only 1% of GDP was allocated for mental health services [12]. Adults, adolescents, and children are all included in the funding for mental health services [12]. Despite the adoption of the Child and Adolescent Mental Health Policy Guidelines in 2017 [13], mental health services in Uganda remain a low priority in the distribution of resources. These recommendations were created to help children and adolescents maintain a healthy mental state and avoid mental, neurological, and substance use disorders [13]. The specific goals of these guidelines are [13]: Policymakers, service providers, family members and other stakeholders should be educated about the importance of promoting mental health and preventing disorders such as mental, neurological and substance abuse in children and adolescents. CAMHS should be built up to provide comprehensive care for children and adolescents affected by them. The guidelines were adopted in 2017 and are intended to be used for a period of ten years by all government and civil society stakeholders. As the WHO Mental Health Gap Action Program (mhGAP) and its accompanying mhGAP Intervention Guide have attempted to address the substantial needs for mental health services in Uganda, these guidelines are not a stand-alone effort. For the long term integration of mental health into primary health care, WHO recommends the use of the mhGAP-IG in both pre- and in-service training [14]. A number of studies have looked at the current state of CAMHS in the country, but there is no overall overview of the situation that would allow recommendations for the future to be made. Uganda’s Child and Adolescent Mental Health Policy Guidelines for 2017 are the focus of this paper, which will examine how CAMHS are currently being implemented in Uganda.

There was a lack of continuity and coverage for CAMHS in one study due to the fact that services were not child and adolescent-friendly and were absent from lower-level health centers (primary health care centers) because of limited service capacity, understaffing, and the burden of other diseases. It is also possible that traditional healers may refuse to refer children to CAMHS because they do not trust biomedical health systems [17] (Table 1). This could be another barrier to the availability of CAMHS for children.

In Uganda, there is a lack of collaboration between CAMHS and other sectors, such as traditional healers and primary health care, both within and outside the health system [11]. Primary health care has yet to incorporate CAMHS, which would make these services more readily available to those who need them, as well. There is a need for this kind of collaboration, but primary health care training has not yet begun [18–22] In accordance with the WHO frameworks [27], this could provide CAMHS with greater continuity and accessibility.

Due to the prevalence of co-occurring conditions, such as mental illness and HIV, other studies have advocated for collaboration between the two. Stigma, orphanhood, poverty, and neglect are all factors that put HIV-infected children at risk for mental health problems. A person’s mental health can be harmed or made worse by the stress that comes with being infected. Despite the fact that youth are receiving HIV treatment, mental health support and counseling are rarely provided in the country’s health systems [16]. Children and adolescents with alcohol and substance use disorders were found to be another vulnerable group, but they were rarely approached aside from a few outreach activities in schools [18].

Results indicated that there was a lack of CAMHS resources including personnel, facilities and funding; there were also insufficient numbers of CAMHS professionals and students in training [16, 18, 11]. (See Table 1) There is a need for an upgrade in both human resources and service facilities because of understaffing and low capacity issues [16]. Fewer than one traditional healer out of every 500 people in the country currently specializes in treating children’s mental health issues [17, 21] (Table 1). In order to better integrate CAMHS into primary health care, more task sharing and in-service and pre-service training are urgently needed [22, 22].

Component of health system policy and regulation that can draw on individual, facility, and population-level data as well as public health surveillance. In Uganda, health management information systems were found to be adequate at the national level, but districts did not have the same level of competency. A separate policy paper for CAMHS was written in 2017 to address the problem of underutilization of mental, neurological, and substance health services by children and adolescents due to the insensitivity of country health services, missed and mismanaged early symptoms by parents, limited knowledge of mental health disorders, and inadequate availability of quality CAMHS and CAMHS and CAMHS.

Health management information systems were found to be inadequate for service planning, and resources were not distributed equally. As a result of this, both children and adolescents, as well as medical professionals, are forced to deal with an increased amount of stress [17].

Damian Sendler

Lower-level health centers were also found to have adequate medication access. Medical supplies were restricted to those on Uganda’s Essential Drug List, but this was contingent on the presence of staff who were properly trained in their use [18]. However, these services are not given the attention and resources they deserve, which contributes to further stigma and patients not seeking treatment and medication [16]. Stigma and attitudes toward CAMHS are also influenced by caregivers’ educational attainment: a lack of education or a low level of education can increase stigma, but it can also lead to low incomes, limiting their ability to pay for drugs and treatment [16]. It is also possible that parents or caregivers may not use the formal healthcare system to treat symptoms or mental health issues and instead turn to alternative treatments such as those provided by traditional healers [17].

Overall, studies found a lack of public awareness and a lack of willingness to seek treatment for mental disorders, in addition to stigma. Drug costs and family pressure may also play a role in preventing people from seeking treatment [16]. Other obstacles to treatment included family, community, and individual attitudes, which contributed to the disease burden and a lack of help-seeking behavior, respectively.

[18] There was no donor funding for services provided by the government. funding for mental health treatment in general, rather than specifically for children and adolescents. All health services, including primary care, were found to have the same problem. This problem could be alleviated, however, by providing in-kind support in the form of collaborations and infrastructure renovations (Table 1).

CAMHS services are not yet available in the primary health sector because they are not available at lower-level health centers [11]. The services available were found to be underfunded and concentrated in urban areas, resulting in long travel distances and high costs for those in need [16]. Children and adolescents in rural areas may be unable to access these services because of the difficulty, time commitment, and expense of travel. Only the national referral hospital provided psychosocial services, as were most of the services provided by the lower-level health centers.

It was found that existing national mental health policies were insufficient in a 2015 paper included in the study. However, in 2015, there was no separate policy for CAMHS that was based on the United Nations Convention for Rights of Children, Uganda’s 1995 Constitution or Uganda’s Mental Health Treatment Act 1964 or Children Act 1996. At the national level, the laws and guidelines were accepted, but little awareness was found at the district level [18]. New policy guidelines for CAMHS were implemented in 2017 [13] despite this.

Damian Jacob Markiewicz Sendler: Research and support for mental health needs are severely lacking, and this presents an enormous burden that urgently needs cost-effective solutions [16, 11]. Many strategies and policies have been developed, but most are geared toward treating adults rather than children and adolescents [18] (see Table 1). Patients and medical professionals alike bear an increased burden as a result of this disregard for service and policy planning.

Twelve studies were eligible for inclusion, five of which were qualitative and six of which were quantitative. Many vulnerable groups, such as orphaned or HIV/AIDS-affected youth and ex-child soldiers need more attention from the country’s CAMHS system in order to be better served. To address their limitations, there are numerous ways to collaborate with other sectors, integrate into primary health care, reduce stigma and strengthen the health workforce. These services show potential.

All of the studies reviewed found that the current CAMHS in Uganda is understaffed and lacking in collaboration. Health care professionals are in short supply, according to a number of studies. As a result, effective public health interventions and collaboration with the HIV/AIDS health care system are essential because of the double burden of HIV/AIDS and mental distress [16]. Traditional healers and biomedical professionals could work together and share referral systems to fill each other’s gaps, according to one proposed solution. Traditional healers are already using a number of biomedical methods, and because of their large numbers and presence in communities, they may be perceived as more approachable than health care providers [17]. This solution has a lot of potential. The biomedical health care system is viewed with suspicion by some traditional healers, and vice versa. As a result, collaboration may be more difficult to achieve [11]. There are also suggestions that CAMHS should be implemented in primary health care, such as at lower-level health care centers. Increasing access to and effective use of mental health services should be a goal of this implementation, as should raising public awareness of CAMHS [21, 22].

Damian Jacob Sendler

Effective dissemination of national policies, such as a new policy on children’s and adolescents’ mental health, is needed but such policies must be implemented [13, 18]. Increased funding and consideration of the previously mentioned aspects are both necessary for successful policy implementation [18].

Some of the most effective mental health services may be developed through collaboration with nongovernmental organizations (NGOs) and international organizations. As previously stated, only 1% of Uganda’s GDP is currently spent on mental health care, which is not enough (even if there are other sources of funding such as AIDS or NGOs for mental health services which are not captured by the scientific publications included in this study). Collaboration with stakeholders, such as NGOs and policymakers, should also be encouraged, as should their involvement in policy processes [18].

Primary health care workers must be trained in child and adolescent mental health in order to integrate services, and all mental health care professionals, including nurses, must have their training improved and additional training introduced. This could help primary care clinics better identify and report cases of mental illness in children and adolescents. There must be an emphasis on both medical and public health-related factors when training health workers, and services and the workforce must be maximized [22].

In order to provide mental health interventions, it is necessary to utilize and train lay workers and peers already present in the health and education systems. Primary health care providers should be trained and CAMHS should be integrated with other services to improve accessibility and increase funding, according to recommendations [21, 22].

Educating lower-level health care workers on how and when to use medications to help children and adolescents could improve access to medicines [18]. Because of the stigma attached to mental illness, both society and individuals must change their attitudes in order for new interventions and greater access to care to be successful. Early signs of poor mental health, such as signs of distress, reduced ability to function and other indicators of poor mental health must be recognized and responded to by young people. This is why asset-based interventions, such as child development accounts that focus on reducing the risk associated with mental health challenges are recommended [19].

Damien Sendler: Multiple studies also suggest and investigate new interventions for the development of CAMHS, such as collaborations between different sectors. HIV/AIDS and mental illness are two such examples where primary health care providers should work to improve patient access to and effective utilization of services by taking into account both physical and mental health.

In-service training based on the mhGAP-IG can help primary health care workers better understand child and adolescent mental health. For this reason, more research is needed to examine how to better integrate community mobilization and task-sharing into the primary healthcare system in order to improve CAMHS attendance [21, 22]. Pre- and in-service training should both include this type of instruction. Because staff don’t have to take time off work, and students who haven’t finished their education can get an early introduction to the field, pre-service training is a more cost-effective option [28, 29, 30].

Another option is to distribute additional responsibilities among local groups and to employ a variety of treatment modalities. A reduction in PTSD and other mental health disorders was found in a study in which community-implemented trauma therapy was used, particularly in the narrative exposure therapy group [23]. Children and adolescents suffering from PTSD and other mental illnesses may benefit from interventions carried out in the context of the community at large. For the treatment of mental health disorders, it has been found that involving members of the community is beneficial [23].

Economic empowerment is another common intervention. This treatment improved the mental health function of female participants over the course of one study. Economic empowerment was implemented in the form of peer mentoring or economic strengthening for HIV/AIDS-affected females living in low-income settings [19]. This type of intervention has shown positive results for children, including reduced levels of hopelessness and depressive symptoms. Additional implications for long-term care of children in resource-poor or AIDS-affected communities can be drawn from these findings [24]. The effects of economic empowerment interventions on children’s well-being, including their self-rated health and mental health functioning, were also confirmed by a second study. For children who had to deal with both HIV/AIDS and mental illness, this was especially true, and it underscores the importance of better public policy and health programming for this population [24, 25].

We looked at the current state of CAMHS in Uganda using the WHO Frameworks for Monitoring Health System Performance [27]. In the end, we hope to increase the availability and distribution of these services by developing and implementing new interventions. Because of the high proportion of youth in Uganda’s population, diseases like HIV/AIDS, conflicts, and poverty make children and adolescents even more vulnerable than they were before. In countries like Uganda, this vulnerability is exacerbated even further.

It’s not just Uganda that’s grappling with mental health issues for children and adolescents; the continent as a whole is experiencing a widening treatment gap for this population [32]. Mental health services for children and adolescents are underfunded or understaffed in the region [32]. Children’s and adolescents’ mental health resources are scarce, as shown by a recent Tanzanian study that sought to identify, assimilate, and analyze literature on the subject.

The findings of this study have important implications for new policies and initiatives. Young people’s mental health care has only recently been developed as a separate policy or plan; services are limited and concentrated in urban areas. Few of them are geared toward children and adolescents, and those who are most in need, such as orphans and youth living with HIV/AIDS, should receive special attention. Public campaigns and the integration of mental health into primary health care are also necessary to reduce stigma and raise awareness. Children and adolescents in Uganda, a country with a turbulent past marred by war, adversity, and the spread of HIV/AIDS, deserve better access to mental health services.

To improve CAMHS in Uganda, the health system needs to be improved and research-driven changes implemented. Collaboration with other sectors, such as traditional healers and primary health care, is required to address the lack of human resources and facilities. This can be done with the help of the mhGAP-IG and the use of both in-service and pre-service training for health professionals. Mental health guidelines have already been created, but they need to be revised so that children and adolescents are given top priority, as well as the 2017 standalone policy be implemented. In addition, to encourage more people to seek help, interventions must focus on educating the public about the importance of reducing stigma. Some other options include community-based therapy and economic empowerment programs for children and adolescents who live in low-resource settings, as well as CAMHS facilities. As a result, the primary goal of CAMHS in Uganda is to build on existing resources and facilities, increase accessibility, build a skilled workforce and extend collaboration, while reducing stigma and barriers to help-seeking.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian

Damian Sendler: Events affecting public health, as a matter of global concern, necessitate a global response. The outbreak of the COVID-19 has highlighted the challenges facing the global governance of international public health, including limited functions of international organizations and difficulties in achieving objectives, poor collaboration between governance subjects and their limited performance, overlapping legal basis of governance and blurred core function, and lack of solutions to specific problems. There are several ways to increase the effectiveness of global public health governance, including supporting the role of international organizations, enhancing coordination among international governance subjects to create synergy, promoting compliance with IHR2005 to avoid conflict of law applications, and upholding the vision of a community with a shared future for mankind to respond jointly to global public health challenges.

Damian Jacob Sendler: More than a million people have been infected and thousands of people have died as a result of COVID-19, which emerged in December 2019. COVID-19 has a long incubation period and is extremely contagious, posing a serious threat to human health and even life (1). It was determined that the outbreak met the criteria for a PHEIC on the evening of January 30th, 2020, after an increasing number of patients and reports from countries around the world, in accordance with the International Health Regulations (2005) (IHR2005). Because of the increasing global interdependence in the face of disasters, PHEIC has become a global issue.

Dr. Sendler: The impact of international public health events became a global concern as early as the second half of the nineteenth century (2). An international health conference was held in New York in July 1946 by the UN Economic and Social Council, where the World Health Organization’s constitution and a plan to establish the WHO were adopted. A major role has been played by WHO since its establishment by promoting international health cooperation, infectious disease control, biomedical research and practice, the development of health programs in member countries as well as improving people’s health…. The value of health to an individual and to society cannot be overstated (3). This aspiration is enshrined in the preamble of the WHO Constitution. Public health has also become more globalized as a result of the development of society and frequent international economic, trade, and personnel exchanges. The importance of public health has risen to a new level in our global age. Pathogens are being propelled by globalization, putting us all at risk (4). Disease and its transmission have been the subject of a variety of beliefs and political ideologies for centuries (5). The first recorded outbreak of smallpox occurred in Egypt around 1350 BCE. By the year 49 CE, it had reached China; by 700 CE, Europe; by 1,520 CE, the Americas; by 1789, Australia. Pestilence spread from Asia to Europe, where it killed a third to a fourth of the continent’s population during the fourteenth century. In the fifteenth and sixteenth centuries, Europeans brought diseases to the Americas that decimated up to 95 percent of the indigenous population (6). More than 12,000 major outbreaks of novel diseases, 215 infectious diseases, and 44 million cases in 219 countries occurred between the 1980s and the mid-twentieth century (4). The political, economic, and social dynamics of domestic and international affairs have never before been so dominated by public health issues (7).

Almost universally, as the twenty-first century begins, people recognize the interdependence of national and international health (8). In less than a month, the COVID-19 virus spread to a number of countries. This unprecedented and enormous impact on global economy, governance structures, and the lives of people is not yet fully understood (5). Human efforts to control these global public health crises are now mired in even more ambiguity and difficulty. scholars of law and politics have long been fascinated by the governance challenges of global health (9). International health cooperation is currently based on a variety of legal norms, processes, and institutions, which should be examined in light of the recent COVID-19 outbreak (10). The IHR and the WHO’s legitimacy as a global health agency will once again be put to the test by the outbreak of COVID-19 (10). Once again, it has brought the issue of international public health governance back into the international community’s attention.

When it comes to 2020, COVID-19 has been likened to “black swan events” that can cause catastrophic damage to businesses and disrupt entire economic systems at a level never seen before (11). However, the WHO has been lauded for its quick response to the more technical aspects of a global pandemic, countries are implementing their own strategies. China appears to have been successful in implementing early lockdown and quarantine measures, but these measures can’t be easily implemented elsewhere (12). Free, massive testing has been used in South Korea to track and treat those who have been infected by the virus. School closures, telework, and bans on large gatherings have been used to encourage social isolation, but quarantine has not been implemented (13). Despite the worsening conditions in both countries, Italy and Spain chose less restrictive lockdown methods, delaying their containment strategies (14). Local and regional governments in Germany are primarily responsible for addressing health issues. Most of the time, the federal government’s role is limited to coordinating regional efforts and formulating national policy recommendations (15). The United States and the United Kingdom were ill-prepared and inept in responding to the coronavirus, which was a major threat to global health (16). There have been mixed results in the United Kingdom with a strategy of containment, delay, research, and mitigation. Early restrictions targeted the most vulnerable, such as the elderly and those with comorbid conditions, in the United Kingdom, where schools remained open for longer than in other countries on the continent. Delaying action may have helped the UK avoid some of the social and economic costs of the virus, but it does not appear to have significantly reduced the spread of COVID-19. (17). Several African countries have taken a more robust approach to border security, including flight restrictions, visa denials, and two-week quarantines for foreign visitors. Uncertainty persists as to whether Africa’s more restrictive borders are to blame for the decline in infection rates (18).

COVID-19 remains the primary focus of the World Health Organization and the governments of the affected countries. There is a need to think and act locally, but we must also think and act globally. In addition, concepts of global caring, global compassion, and strong international institutions are crucial (4). Many of the most significant global efforts have been challenged by COVID-19, and the subsequent enormous impacts have posed new challenges to the global governance of international public health.

The International Health Regulations 2005 (IHR2005) and the World Health Organization (WHO) are the foundations of global public health governance. International normative documents lay out the groundwork and provide the assurances necessary for international organizations to carry out their responsibilities, as well as the means by which they can do so. As a result of a world order dominated by independent nations, WHO’s ability to influence national health decisions that have a significant impact on economic and social life is limited (20). According to the International Covenant on Civil and Political Rights (IHR2005), international and national interests must be balanced. The WHO, the world’s primary health organization, does not have the legal authority to ensure that medical supplies and equipment, vaccines and treatments are distributed equally and based on need during a pandemic, increasing the vulnerability of people in less developed countries (21). Governments like the World Trade Organization, on the other hand, prioritize the protection of intellectual property over the development of low-cost biotechnologies (22). User fees and structural adjustment mandated by the World Bank and the International Monetary Fund have resulted in shrinking national health budgets (22). Moreover, laissez-faire capitalism gives transnational corporations the green light to relocate to low-tax and low-regulation states, thus depleting domestic resources for health and failing to regulate corporate marketing, products and workplace safety and environmental impacts that harm the public health and safety (22).

There has been significant influence on public health response by the UN General Assembly, its Human Rights Council, and the UN Environment Program (UNEP). The OIE and the International Plant Protection Convention (IPPC) also have the right and authority to regulate plant, animal, and organism protections related to public health emergencies. The causal mechanism for selection seems even weaker at the global level than with respect to competition among states and thus does not warrant a functionalist account of how governance arrangements for globalization would emerge (23). Lack of a strong restraint mechanism will lead to poor communication and coordination between PHEIC-infected countries. International organizations will also be hindered in their joint response to PHEIC.

Globalization has increased economic interdependence, global communication, and international migration, resulting in a new urgency for addressing health issues globally and a new era of global health governance to replace the previous international health governance model (24). From its twentieth-century origins in the WHO Constitution, global health law has moved on to include other United Nations (UN) agencies, the World Trade Organization (WTO), arbitral tribunals and the UN Security Council as well as large corporations in health-related sectors such as food, medicine and tobacco (19). The twenty-first century’s more globalized world has led to multi-layered and trans-scalar governance (25). International public health governance encompasses a wide range of issues.

When an epidemic like COVID-19 breaks out, it reveals our collective vulnerability to an enemy that can easily cross national borders (10). In the face of PHEIC, the efforts of international organizations, countries, non-governmental organizations, businesses, and individuals are required. International public health governance bodies’ inability to coordinate their efforts in the fight against COVID-19 was an ongoing issue.

First and foremost, the issue of uneven global development and limited medical supplies is clear. As a result of their health care systems and social and economic infrastructure, people in low- and middle-income countries are particularly vulnerable to the effects of climate change (26). (27). People in low- and middle-income countries are the most likely to be affected by corruption, violence, and other forms of political instability. Wealthier countries have more affordable access to high-tech medical treatments like gene therapy and precision medicine (21). Worrying current trends show that the United States and Europe, which can afford to pay more for critical medical supplies and equipment, are the primary recipients of these goods (28). There are vast numbers of people in the world who have not reaped the benefits of global health advancements (21). Inequities within countries are mirrored by these enormous global health disparities – sometimes narrowing, but often widening (21). However, global forces make it extremely difficult to achieve health and justice at the same time. Governments around the world have vastly different amounts of resources at their disposal. Health care in low and middle-income countries is frequently underfunded, especially in areas with high rates of disease and a large or rapidly growing population. COVID-19 has the potential to unleash a global pandemic in countries with weak healthcare and social support systems.

Damian Jacob Markiewicz Sendler: It’s also important to keep in mind that no single country can guarantee a healthy environment for all its citizens. Think about global forces such as greenhouse gas emissions, or global rules and norms in areas such as trade and investment (22), or transnational corporations that actively seek low-tax, low-regulation destinations like COVID-19. In terms of location, the disparity in development can be seen both between and within states. In the event of an outbreak of an epidemic, the country or region most directly affected is the first to respond and is dependent on the active involvement of other countries. Even though they bear the greatest burden of disease, the countries that do have the wherewithal to make a real difference in global health care are loath to spend the political capital and economic resources necessary to do so (29). Despite IHR2005’s demands that its members improve their domestic health conditions, developing countries, which are economically and technologically backward, are still unable to improve their domestic public health systems. Responding to a pandemic poses different difficulties in urban and rural areas of the same country due to differences in population density and infrastructure (15). When dealing with PHEIC, it’s difficult for them to quickly provide adequate medical supplies. However, global health with justice, in which everyone, regardless of location or race, can reap the benefits of health advancements, is still a long way off (21).

Even in states where economic and medical development is uneven, the ability to respond to PHEIC can vary greatly from one region to the next. When a state lacks a strong central government, it is easy for the various regions to respond to a crisis in an uncoordinated fashion. The willingness of a country to regulate public health and safety standards is also influenced by trade (30). There is a conflict between these incentives and mechanisms of cooperation and equitable access to health resources such as international law and scientific decision-making (16). As a result, the effectiveness of governance was severely hampered due to the aforementioned lack of cooperation or poor collaboration among the various governance subjects.

International law may be applied to a PHEIC event for various reasons, and this may cause a misunderstanding of the main legal basis for international public health management provided by IHR2005 and other treaties. Failure to comply with these obligations has no legal consequences or responsibility under these agreements (31). When it comes to public health issues in trade, there are many roadblocks to overcome, including institutional resistance and a lack of coordination and resources, as well as issues of “institutional overload” and inconsistent standard setting (32). (30). IHR2005 empowers its members to enact laws to implement health policies in accordance with their own circumstances, provided that they adhere to IHR2005’s purposes in accordance with article 3.4 of IHR2005. This is to balance health, trade, and human movement.

Damian Sendler

As a result of the COVID-19 outbreak, globalization was affected. For many governments, free trade is no longer a top priority when the pace of globalization slows (33). IHR aligns with international trade law under WTO, which recognizes the right of the state to restrict trade for health purposes, but limits this right to ensure that restrictions are necessary (34). Tweak the TRIPS Agreement’s broad protections for intellectual property holders by referring to articles 7 and 8 as “context” and “purpose,” respectively, in accordance with Vienna Convention on Treaty Law article 31.1. As a result of their ambiguous wording and the “ordinary meaning” of treaty terms, such as compulsory licensing for patented pharmaceuticals, these provisions are unlikely to address issues. This is especially true when it comes to ambiguous drafting and “ordinary meaning” (35). Unified coordination is still lacking, even though it has become a consensus among international organizations and regions to strengthen international cooperation to address global health issues. International lawmaking has the potential to become fragmented, uncoordinated, and inefficient due to the involvement of numerous international organizations and other health actors in the international legislative process (9). Lack of enforceable sanctions is IHR’s most significant structural flaw. In other words, there are no legal consequences if a country fails to explain why it has implemented trade and traffic restrictions that are stricter than those recommended by WHO. The IHR2005 has many operational issues based on the experiences of handling COVID-19 up to the time of writing this paper. As far as guiding States Parties in combating the outbreak, the IHR2005 does not appear to have much of a role (36). Pandemics like Ebola and SARS have shown that global health governance does not have an effective system of law (16).

Because of its sudden and comprehensive nature, many of the problems with the COVID-19 were previously unknown. In the context of broader concerns about democratic backsliding around the world in recent years, the government response to the COVID-19 pandemic raises concerns over potential erosions of democracy and human rights (37). Some experts have warned of a “parallel epidemic” of government repression as governments around the world respond to the COVID-19 with lockdowns, travel restrictions, and other measures (38). When health-related limitations can be defended, the way they are implemented can raise human rights issues in some cases. Meanwhile (37). Abuse and arbitrary state power could be facilitated by the “securitization” of health law (39). Surveillance cell phone technologies have been used in several states to track people who may have been exposed to COVID-19 and their contacts (40). Take a look at the Infodemic as a case study. It is a term that describes the rapid spread of information of all kinds, including rumors, gossip and unreliable information. At present, we live in a time when networks are ubiquitous and data is swarming everywhere at breakneck speed As soon as a public health emergency occurs anywhere, it becomes the focus of the entire world’s attention, resulting in a flurry of rational analysis and irrational outrage. The use of infodemics in outbreak response is critical. Three main areas are covered: (1) monitoring and identifying health threats, (2) investigation of outbreaks, and (3) actions for mitigation and control (41). There are two reasons for this. As a first step, affected cities and countries may implement a lockdown policy, which raises the likelihood of information and security concerns.. It won’t help to make people afraid of reality, either. Many different opinions have been expressed since the outbreak of COVID-19 in public media and on the Internet. This has seriously harmed the morale and zeal of those who have been affected by the epidemic to fight it. Because of this, some countries have imposed limits on certain human rights, which has sparked controversy. Experts are concerned that some restrictions do not meet the necessary standards for human rights protection (42). Others argue that during the pandemic, civil liberties were increasingly threatened, including threats to freedom of speech, debate, and the press for reporters covering the news and scientists who had different opinions on the results of their research or studies (43). There is a bifurcated approach to balancing societal goals with individual rights in states of emergency because of the artificial dichotomy between “the norm” and “the exception” (43). Consequently, states may differ in the extent to which COVID-19-related restrictions deviate from previous modes of governance (37).

Damien Sendler: As far as the abilities of local governments around the world are concerned, the situation varies from state to state. Investing in international cooperation during a health crisis will be more difficult for local governments in a highly centralized state than in more decentralized and federal structures (15). When it comes to health care, a lot will be determined by how each state allocates its resources (15). As a result of these patterns, it is possible to gain a better understanding of the role of law in relation to the globalization of public health (44). As a result, health justice is a fundamentally global concept that requires equal access to health care for all people, regardless of where they live (45). The challenges faced by the international community in dealing with the epidemic can be addressed from a global governance perspective in the following ways:

States parties and WHO share the responsibility for implementing IHR2005. Considering that it is one of the United Nations’ largest special agencies and that it is the world’s largest international health organization, the WHO has enormous responsibilities to address global public health issues (9). Of the 22 functions listed in Article 2 of the Organization’s Constitution, almost all appear to be relevant to the COVID-19 pandemic’s size and scope (5). The WHO is the only international organization with lawmaking authority that wields unmatched power (10). Because of its amiable power and authority, the WHO can unambiguously influence international health policies; however, commentators have observed that the WHO is more content with acting as a technical agency than accepting leadership in global health (46). (46).

Damian Jacob Sendler

Even though achieving a global health framework convention or a similar mechanism would not be simple, and it would not provide an ideal solution, at least a framework convention would address the root of the problem: the obligations of states to act outside their borders, and thus establish the levels of commitment and the types of interventions required to make a significant difference for the world’s population (29). States parties should actively work with WHO, mobilize financial resources, and facilitate the implementation of their IHR2005 obligations in day-to-day public health governance; they must improve their national surveillance and response infrastructure so that timely warning of public health risks and emergencies is possible. If there is a threat to public health or an emergency, the states parties must immediately notify WHO of the relevant risks and circumstances; WHO should assess conditions and create a special information website for the country where the risk or emergency occurs. A daily report from each state party is required for WHO to publish the data on the information website during the duration of any risk or event. WHO will make relevant data available to all focal points of states parties and the general public, including progress, guidance, and warnings. In the event of an outbreak, WHO should send investigators to the outbreak site to better understand the situation. WHO and the states parties will strictly observe and carry out all of the aforementioned responsibilities. The states parties specifically agree to provide WHO with all necessary facilities and assistance so that the organization can better carry out its responsibilities. To help member states better prepare for a public health emergency, the WHO is currently developing specific indicators for core competency readiness (47).

The local governments in each jurisdiction are supposed to be in charge of dealing with COVID-19 and preventing its spread. WHO is supposed to work closely with governments around the world and lead the fight against the outbreak based on IHR2005 at the international level. (36). What matters is that we already have a place where people can come together and share their knowledge and resources, regardless of whether or not some of the criticism leveled at the WHO’s initial response to the crisis is justified (15). As the rate of economic globalization continues to rise, health global governance has become an increasingly contentious issue, with many sides fighting over differing ideologies (10). At the COVID-9 special summit, the parties pledged to take all necessary steps within their mandates with relevant international organizations, including WHO, and expressed their full support and commitment to further enhance WHO’s role in coordinating international anti-epidemic actions, all in the knowledge that (48).

Governments cannot manage the world’s affairs on their own, so international organizations, non-governmental organizations, and multinational corporations play an increasingly important role in what is known as “global governance” (49). The growing role of public and transnational corporations in the governance of international affairs necessitates the inclusion of transnational corporations and industry elites as well. Countries are the driving force behind the promotion of global governance of public health, and the role of WHO in the global governance of public health is to be a leader, coordinator, and platform provider. The principle of subordination underpins the wide range of governance subjects, theoretically. It is impossible to deny the significant influence that non-state actors have on international affairs (49). In order to effectively contain and combat a pandemic that threatens the entire world, international cooperation is clearly required (15). In order to effectively combat pathogenic threats (16), effective collaboration between various governance subjects is required at the international level. This is due to differences in economic development, medical supply, and scientific and technological personnel reserves between different countries and within a country.

Set up a virtual medical platform in order to fix problems caused by development gaps. As a result of PHEIC, some countries may be reluctant to export their limited supplies of raw materials and medical supplies. This means that no matter where they are produced or stored, a reliable global supply of medical resources and necessities is essential. Global health with justice requires an international order and transnational action that systematically advances the conditions for good health and accountable governance, particularly for people in countries on the short end of global health disparities (21). In the framework of WHO, a virtual warehouse is recommended. Because this is a virtual warehouse, there is no need for each member country to deposit its claimed materials. Rare raw materials and medical supplies are primarily stored in the virtual warehouse. The global health governance system’s health financing is a critical, but often overlooked, component (10). The warehouse’s funding sources can be categorized into the following. Reserved by the states parties amount. Member states are entitled to a proportionate share of medical products based on their annual contributions; b. social donation. Since the virtual warehouse is open to the entire public, charitable donations can come from any and all groups, companies, or individuals. In addition to their assessed amounts, countries with a national supply or domestic manufacturing capacity contribute more medical supplies to the virtual warehouse. WHO is in charge of the warehouse’s virtual operations. It is possible for the affected country or region to request WHO resource allocation in the event of a major outbreak. It is possible for the WHO to direct countries that are not affected by the outbreak to supply affected areas with appropriate medical materials, based on a principle of proportion and cost, to alleviate the problem of insufficient medical facilities due to regional development gaps.

Encourage international cooperation. With the advent of globalization, nations are increasingly turning to international cooperation to meet national public health goals and exert some control over the cross-border influences on their populations (32). This has resulted in an interdependent relationship between countries in today’s world. The mutual benefits of interdependence lead to a greater desire for cooperation. Because it touches on the most fundamental and pervasive aspects of people’s daily lives, public health is easier to understand and apply than other types of health care. As a result, cooperation is beneficial to the general public’s well-being and will produce the cooperative effect. Because of the novel coronavirus’s rapid spread across the globe, effective outbreak containment necessitates global cooperation (10). In order to get these ideas into the public eye, the heads of state and government could play an important role (21). Following an agonizingly high toll, the international community has gradually come to realize the importance of working together against the virus (50). March 26 was marked by an international consensus at the G20 Extraordinary Leader’s Summit, where leaders affirmed their commitment to “task our top relevant officials” in support of the global fight against the COVID-19 pandemic’s effects. Responding to an emergency involving public health necessitates international cooperation. As a first step, countries and regions infected with the disease should take action right away to stop it from spreading to other countries and regions. A secondary point is that other countries should do everything they can to assist the affected countries. The health departments at the state and local levels play a critical role in epidemic preparedness for the entire country (51). One of the most important things one can do for one’s own well-being is to help others. Using China as an example, foreign governments, businesses, non-governmental organizations, and friendly people around the world have assisted China in its fight against COVID-19’s sudden outbreak. It has been widely praised by the international community that as China’s domestic situation improved, it began to assist the WHO and other UN agencies, as well as neighboring countries, developing nations and even the United States and Europe (52).

Build a system that allows everyone in the community to participate. While the WHO acknowledges its constitutional responsibility for disease nomenclature, it has also been cognizant of its functions to coordinate with other UN Specialized Agencies and scientific and technical groups (5). Several commentators have suggested that the role of intergovernmental organizations in global health governance is dwindling due to the large number of international health actors actively involved in global health cooperation and the widespread criticism of the UN and its specialized agencies. Genuine cooperation is needed to achieve global health justice since all parties involved in the production of health equity are interdependent. Individuals and groups must accept and successfully carry out their respective roles and responsibilities in accordance with their functions, needs, and voluntary commitments in order to complete this task successfully (53). “Power shift” from international organizations to private sector actors and the above-mentioned innovative health coalitions has been emphasized by some analysts (54). Public-private partnerships have proliferated since 2,000 and will serve as a major source of global health law (19). It is not only in the public sector, but also in the private sector, that the dispersion of governance has taken place in contemporary history, with various regulatory mechanisms emerging in both sectors (25). People are calling for access to quality health care. They’re looking for people who are kind, compassionate, and well-versed in their fields. There is a demand for affordable access to essential medicines, vaccines, and medical equipment (21). Large pharmaceutical companies and research and development centers, in addition to the government and scientific research institutions, play an active role in responding to major disease outbreaks with their advanced research resources and strong capability of R&D on immune and anti-epidemic drug. Donations from all walks of life have also helped alleviate the problem of medical resource and material shortages in the most affected areas of the epidemic. Modern high-tech development necessitates the involvement of companies that dominate artificial intelligence and medical drug development. For countries dealing with the outbreak, the large number of volunteers is also a powerful force. Consequently, the World Health Organization (WHO) and other countries should actively support and promote the efforts of both private and public sector organizations and individuals.

Health disparities between people around the world have long been a global issue that requires a global response. The enormous impact of COVID-19 on global public health governance is a new challenge. In the face of the global public health crisis, the IHR2005 prevention mechanism has fallen short of expectations. Because member states have not all adopted the WHO’s recommendations, the international system for managing public health is exposed as having some serious flaws. COVID-19 and other PHEIC are the common “enemy” of all humankind, so states must be united in their response to the epidemic and maintain the vision of a community with a shared future for all humanity.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian

Damian Sendler: There is a rapid aging of the American populace. Leaders in long-term care have never been included in the category of public health workers. However, long-term care has not been incorporated into the public health workforce taxonomy thus far. Graduate public health education geared toward long-term care is examined in this article and a case study of a successful program at East Carolina University is provided (ECU). 

Damian Jacob Sendler: According to an investigation of 135 graduate programs from January to July 2019, only eight institutions offered long-term care administration master’s degree programs. With eight programs, only one of them directly linked coursework with licensing as a long-term care administrator: ECU Brody School of Medicine’s Department of Public Health. In addition to the 30 program graduates, five MPH students are in the process of finishing their Administrator in Training (AIT). Twenty-seven students graduated with North Carolina licenses in hand. 

Dr. Sendler: Taking care of an aging population necessitates a skilled public health workforce with specialized knowledge and training. As a part of the public health workforce, long-term care workers should be recognized as such. More than a decade ago, the Institute of Medicine recommended this course of action. 

It is defined as “all public, private and voluntary organizations that contribute to the delivery of essential public health services in any jurisdiction.” 

Public health is concerned with improving the health of communities by reducing the health disparities that are prevalent in underserved lower socioeconomic groups. Public health advocates for policy changes to improve access to health care by recognizing how social determinants of health affect the distribution of health for populations. 2 The passage of Title 19 of the Social Security Act in 1965, which established the Medicaid program, was one of the most significant public health policy achievements of the twentieth century in the United States. 3 It has been found that one in three Americans will need long-term care at some point in their lives, with Medicaid covering the care of six in every 10 patients. 4 The public health system would be incomplete without nursing homes. 5,6 Private nursing homes in the United States account for two-thirds of all facilities, but these businesses remain part of the public health system. 1,7 

Public health workers play a crucial role in ensuring the health of their communities. 

8 But in the United States, more than half of this workforce lacks formal training in public health. Many of the one-third of public health professionals with formal training report a need for management education. 

Damian Sendler

An especially vulnerable segment of our population is at risk from the current COVID-19 pandemic, which is affecting senior citizens living in skilled nursing facilities. 

10 For this reason and others, the CDC has provided nursing homes with explicit policy guidance that mandates the immediate classification and management of sick patients, as well as the importance of prevention education. 11 Nursing home administrators must demonstrate strong leadership when confronted with global crises of this magnitude. The foundation of the program described in this article is the recognition of long-term care workers in the US public health workforce as essential. The lack of public health training for long-term care workers in the United States is comparable to or even worse than that in other public health areas. Licensed long-term care administrators who are also MPH graduates with training in prevention, data management, health policy, administration and leadership are the focus of this article. 

By 2030, one-fifth of the US population will be over the age of 65. There are expected to be 78 million people 65 and older by the year 2035, compared to 76.7 million people under the age of 18. 12 First time in US history, people 65 and older will outnumber those under 18 for the first time in history. In addition to hospitals, skilled nursing facilities and other long-term care facilities will see an increase in demand due to the unprecedented rise in the number of seniors in the United States. 13 Expenditures on hospitals, nursing homes, and home health care accounted for 47.2% of total health care costs in 2016. In 2015, skilled long-term care facilities, also known as “nursing homes,” cared for more than 1.3 million residents, the majority of whom were employed by for-profit companies (69.3%). 7,14 

Nursing home administrators must be licensed by the federal government in order to run their facilities. 

15 However, not all states require a state license. For licensure and continuing education requirements, there is a wide range in the minimum age for licensure, educational degree, length, and time spent in Administrator in Training (AIT), as well as the number of hours required. 19 states require no more than a high school education or a GED to apply for a position as a nursing home administrator. 

The public health workforce has been difficult to classify and count. 

17 The Center of Excellence in Public Health Workforce Studies at the University of Michigan convened national experts in 2013 to define the public health workforce by 287 classifications across 12 domains (axes), providing definitive job classifications including occupational setting and employment. Hospitals are listed as a local public health setting in Axis 2: Local Setting, but long-term care facilities are not. 17 But in 2019, there were twice as many nursing homes as there were hospitals in terms of the number of health care facilities. Nearly 1.7 million licensed beds and more than 1.3 million residents are cared for by more than 15 600 nursing homes in the United States. 7 There were 6 210 hospitals totaling 931 203 beds, with an admissions total of 36,510,207 in this comparison. 18 

Damian Jacob Sendler

It is mandated by 42 USC 1396g of the Public Health and Welfare United States Code that nursing home administrators be licensed by the federal government. 

15 However, long-term care or nursing home administration is not listed in Axis 9 as an area of expertise or under 1.1.12 Licensure/Regulation/Enforcement worker in the Axis 1: Management and Leadership section. Traditional federal and state positions in public health can be found in Axis 1: Management and Leadership (1.11–1.1.6). 17 There is a pressing need, according to the Institute of Medicine (IOM), to improve health care workers’ training and competency when it comes to caring for the elderly. The IOM issued a challenge to public health in 2008 to do just that. 19 42 USC 1396g15 is included in the US Public Health Code, but leaders of nursing homes and other long-term care facilities are hindered by their employees’ lack of enumeration in this workforce. Academic practice and long-term care industry leaders collaborated to formally integrate graduate public health education with long-term care administration, leading to graduates obtaining licensure as long-term care administrators. Other universities can learn from East Carolina University’s (ECU) program.

Damian Jacob Markiewicz Sendler: Only eight of the CEPH MPH programs and schools of public health, according to a review conducted from January to July of this year, offered graduate-level courses in long-term care management. University at Albany-SUNY and New York Medical College, two of the eight institutions, each offered two long-term care courses. One graduate MPH course in long-term care was offered by the Oregon State University School of Public Health. The MPH Health Policy Administration & Leadership (HPAL) concentration offered by the ECU Department of Public Health at Brody School of Medicine includes three courses devoted to long-term care. The Master of Health Administration (MHA) program at the School of Public Health at the University of Nevada, Las Vegas, includes one long-term care course. The Brooks College of Health at the University of North Florida offers two graduate courses as part of the MHA degree. The University of Alabama at Birmingham’s Master of Science in Health Administration (MSHA) degree includes a long-term care course; the University of Minnesota’s postbaccalaureate certificate in public health includes a long-term care course. ECU Brody School of Medicine’s Department of Public Health was the only one of the eight institutions to offer courses directly related to licensure. 

The successful collaboration between research and practice led to the successful integration of long-term care administration into the MPH degree. To carry out this project, a long-term care administrator and a local director of public health joined forces with the director of field placement for the MPH program and the department chair to bring together health care leaders from both academia and practice including the president and vice president of the North Carolina Health Care Facilities Association, the North Carolina Hospital Association president, and long-term care administrators. The members of this working group collaborated with ECU faculty to develop the curriculum for the HPAL concentration in the Brody School of Medicine’s MPH program. With the help of a working group, a new Long Term Care Administration course was developed. Members of the work group frequently give guest lectures on their areas of expertise.. 

Core classes in public health foundations are included in the MPH HPAL concentration’s 45-hour curriculum. The long-term care concentration necessitates the completion of nine credit hours of core coursework, six credit hours of electives, a three-credit internship, and a three-credit professional paper. 21 The North Carolina Board of Examiners for Nursing Home Administrators mandates that anyone seeking to become a licensed administrator of a nursing home in the state must complete an AIT requirement. 22 To prepare for state and federal licensure, MPH students pursuing licensure must complete a rigorous field placement and may choose to take a second internship course as an elective. It’s not unusual for students to take their state and national exams right before they graduate. 

It was also determined that a training continuum for the current long-term care workforce should be developed and implemented for individuals with associate degrees in nursing in order to allow them to pursue their BSN degrees online through the ECU College of Nursing. They also suggested that long-term care workers with associate degrees in fields other than nursing pursue a bachelor’s degree in Health Services Information Management at ECU before pursuing a master’s degree in public health. 

In addition, the members of this task force stressed the importance of preparing future long-term care workers with public health knowledge and skills. The Duke Endowment funded this initiative, demonstrating the power of partnerships and philanthropy in preparing current and future long-term care administrators with a master’s degree in public health for current and future administrators. Duke Endowment’s Long-Term Care Training Continuum proposal aimed to develop an educational multistep program responsive to the needs and challenges of ECU students pursuing training in long-term care administration. After receiving a bachelor’s degree in either nursing or health services management, grant funding supported long-term care workers to pursue a Master of Public Health (MPH) degree. Area Health Education Centers provide the continuing education required for licensure renewal. 

The MHA and MPH programs are not interchangeable, despite the fact that some health care executives have earned the MHA. The MHA curricula tends to focus more on financial/business management than on the public organizations that are critical to public health education and practice. 24,25 Health disparities can be reduced by improving the public’s understanding of the importance of social deprivation, which is the focus of HPAL’s MPH program in biostatistics, epidemiology and environmental health policy administration and leadership, health behavior, research methods/data management, disaster preparedness and health policy. 21 CEPH accreditation requires specific MPH competencies to be met before a degree can be awarded, including planning, management, and leadership skills. 26 

Achieving competency at tier 3 is expected of health care leaders, according to the Council on Linkages between Academia and Public Health Practice. 

Damien Sendler: In order to maintain their license, nursing home administrators are required to serve as the facility’s primary point of contact. 15 The CDC’s COVID-19 directives for nursing homes require systems management and monitoring for the early detection and management of diseased patients, surge capacity planning, human resources staffing, and fiscal evaluation and compliance. ” 11 Nursing home administrators must have exceptional leadership skills to deal with the influx of media and family inquiries, as well as the coordination required with multiple local, state, and federal agencies during a pandemic. However, these abilities are not currently required for nursing home administrator licensure under current educational requirements. 

To maintain the health of the US population and the health of the healthcare workforce, the HPAL concentration’s long-term care component is essential. Since the program began, there has been an increase in the number of long-term care administrators with public health training. In the context of public health, managers and policymakers with an MPH can put their experience in these areas to good use. These people understand the importance of preventing outbreaks and are well-versed in the proper management and implementation of isolation and quarantine measures in the event of an outbreak. An MPH-educated administrator of a nursing home is well-versed in all aspects of the health care system. They have been trained to be effective communicators and managers so that they can respond to pandemics in a timely and appropriate manner, as we are currently experiencing around the world. Long-term care is also fulfilling the International Organization for Migration (IOM2008 )’s mandate to train more of the eldercare workforce in public health by focusing on this area. 19 Preceptors with MPH degrees are now available to train future public health administrators who are prepared and able to respond to future public health disasters. 

Despite the fact that women make up the majority of public health workers, they have lower chances of achieving executive-level leadership positions. 

28 With the HPAL program’s long-term care strategy, more women and minorities are becoming public health leaders. The fact that 16 out of 17 licensed administrators had received and accepted job offers as long-term care administrators by the time they graduated with their MPH should reassure anyone concerned about the disconnect between educational degrees and workforce skills29. 

The COVID-19 pandemic has raised awareness of the increased demand on the health care workforce as a result of the aging population in the United States. Public health workers must now be prepared to address not only social and environmental issues, but also diseases that are caused by microorganisms, biological systems, and physiological processes. ECU’s MPH program now offers a specialization in long-term care administration as a result of collaboration between academics and industry leaders in North Carolina. This program is a model for other graduate programs in public health because it prepares students for state and federal licensure as nursing home administrators.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian

Damian Sendler: Mental health and physical health are intimately linked, but the exact mechanisms by which they are connected remain a mystery. In a mediation framework, we look at the direct and indirect effects of previous mental health on current physical health and the impact of previous physical health on current mental health. The English Longitudinal Study of Ageing (ELSA) collected data on 10,693 people over the age of 50 in six waves (2002–2012). The Centre for Epidemiological Studies Depression Scale (CES) is used to assess mental health, while the Activities of Daily Living (ADL) is used to assess physical health (ADL). Direct effects account for 10% of the effect of past mental health on physical health, and indirect effects account for 8% of the effect of past physical health on mental health. Indirect effects are largely due to physical activity. Males (9.9 percent) and older age groups (13.6 percent) have greater indirect effects on mental and physical health (12.6 percent ). Mental and physical health are intertwined, and health policies aimed at improving one or the other must take this into account both directly and indirectly.

Damian Jacob Sendler: Common mental illnesses are becoming more prevalent among the populations of Western industrialized countries (Twenge et al., 2010, Hidaka, 2012). There is a strong correlation between physical and mental health (Nabi et al., 2008, Surtees et al., 2008). Even after controlling for confounding variables, Ohrnberger, Fichera, and Sutton (2017) found strong cross-effects between physical and mental health. There is still a lack of understanding of the possible “indirect effects” that mental and physical health have on each other. The development of health policies could benefit greatly from an understanding of these indirect effects and how they differ between population groups.

Dr. Sendler: For the older population’s physical and mental health to be more closely linked, the authors of this paper propose a mediation framework and estimate the mediating effects of lifestyle and social capital. The research is based on the economics of health care, which considers both the production and consumption of health care services. For older people, health policies must take into account factors like lifestyle and social capital, which have a direct impact on their well-being (Artaud et al., 2013; Holt-Lunstad et al., 2012). According to a study by the Ageing Research Group (Melzer et al., 2012), lifestyle changes in high-income countries could prevent approximately 55% of the disease burden experienced by people 60 and older. Lifestyle factors account for up to 70% of disease burden in the general population (WHO, 2009). Inclusion, exclusion, and social isolation all contribute to a person’s social capital. With low-cost interventions, these are strong risk factors for ill health and pose a high risk to the health of older populations (Steptoe et al., 2012).

Damian Sendler

Our research examines the interplay between the physical and mental well-being of the elderly in the United Kingdom, looking at both the direct and indirect effects of previous mental health. ELSA (2002–2012) longitudinal data are used in this study, which includes six waves of data. Following Ohrnberger et al., we model the current level of one form of health as a function of the stock of the other form of health for direct effect estimations (2017). Individuals’ lifestyle choices (such as how much they exercise or smoke cigarettes) and social capital are used to model the indirect effects (social interaction). A multivariate regression framework is then used to calculate total differentials, which are changes in the function of variables dependent on changes in another variable in order to estimate direct and indirect effects. Comparable to the method utilizing the product of coefficients (Baron and Kenny, 1986, MacKinnon et al., 2007).

Mediation analysis has been used in many psychological, epidemiological, and economic studies, but not in our context. In a number of these studies, researchers have examined the direct and indirect effects of anxiety and childhood traumas on the mental health of people (Turner and Butler, 2003, Dour et al., 2014). Mental health has also been studied as a mediator between quality of life and employment outcomes (Wong et al., 2010, Johar and Truong, 2014). A third group of studies has examined the role of health investments in influencing labor outcomes and the quality of life of workers (Han et al., 2011, Wicke et al., 2014, Bekele et al., 2015 Burns et al., 2015).

First and foremost, we find that past physical and mental well-being has both direct and indirect consequences on the current state of physical or mental well-being. As in both models, the indirect effect accounts for about 10% of all effects and is mostly explained by one’s prior level of physical activity. Subgroup estimates show a wide range of effects based on age and gender. The results are unaffected by the timing of the mediators or the model used to estimate the amount of addiction.

Damian Jacob Markiewicz Sendler: Individuals can reap both consumption and production benefits from their health, according to Grossman (1972). Leisure activities can only be enjoyed if you have enough time to do them. Healthy time is an investment that pays dividends in the form of money. It is possible to either consume or produce health through the use of medical treatment and/or a variety of dietary and lifestyle choices (Grossman, 1972). Theories of health since Grossman have included additional factors such as retirement, early childhood investments and endowments and stress, as well as social capital and socio-economic status as determinants (Bolin. et al., 2003, Galama and van Kippersluis, 2013).

For starters, work can have an effect on both physical and mental health. As a result of poor health (physical or mental), people may not be able to afford healthy food and environments. Mental and physical health are negatively impacted by this income effect. Sleep deprivation and stress at work can also have negative health effects on people with mental health issues (Contoyannis and Rice, 2001, Garca-Gómez et al., 2013).

It is also possible that people’s mental health can affect their ability to make informed decisions about their healthcare, which can have a negative impact on their physical health (Mani et al., 2013).

Third, lifestyle choices such as physical activity, smoking and alcohol consumption, and a healthy diet are linked to both physical and mental health (Stampfer et al., 2005, World Health Organization Global Health Risks, 2009). A number of studies have found a link between depression/anxiety disorders and poor physical health and a lack of physical activity (Gerber and Puehse, 2009, De Mello et al., 2013, Durstine et al., 2013, Wang et al., 2014, Hegberg and Tone, 2015). Exercise has a positive impact on both mental and physical health outcomes in older adults, according to systematic reviews (Forbes et al., 2008, Clegg et al., 2012). People who are in better physical and mental health are also more likely to engage in physical activity, suggesting a possible reverse-causal relationship. After smoking cessation interventions, depression, anxiety, and stress were all found to be reduced in a systematic review by Taylor et al. (2014). Smoking is more than twice as common in depressed or anxious adults, suggesting that the two may be connected in a causal way (RCP, 2013).

Dr. Sendler: Researchers have discovered that moderate alcohol consumption is linked to better mental and physical health, and that higher levels of mental and physical well-being are predictive of lower levels of alcohol consumption (Stampfer et al., 2005, Lang et al., 2007). Drinking too much or abstaining from alcohol has a negative impact on health and is associated with worsened physical and mental health (Rehm et al., 2010, Frisher et al., 2015). Another significant lifestyle choice that affects health production is one’s diet. A higher mortality risk is linked to a poor diet (Haveman-Nies et al. 2003). When it comes to happiness, Mujcic and Oswald (2016) found that people who eat a lot of fruit are happier.

Finally, the importance of social interactions in health cannot be overstated. Social interaction has been shown in previous research to have a positive impact on mental health (Dour et al., 2014, Bekele et al., 2015). While controlling for baseline mental and physical health, researchers have discovered that loneliness and social isolation are both linked to an increased mortality risk (Steptoe et al., 2012). A systematic review by Holt-Lunstad et al. (2012) shows that social relationships have a significant impact on mortality risk. There have also been findings in the literature that physical disability and poor mental health can lead to isolation, as well as the opposite (Steptoe et al., 2012).

Damian Jacob Sendler

As a starting point for our mediation analysis, we use this conceptual framework. For the following reasons, we believe physical activity, smoking, and social interactions are the most important mediating factors in the relationship between mental and physical health. Predicting mortality is a primary function of these mediators. Smoking is a major contributor to premature death in the United Kingdom (Office for National Statistics UK, 2016). Physical inactivity accounts for 7.7% of all deaths, while tobacco use accounts for 17.9% of deaths (WHO, 2009). A lack of social capital also raises the mortality risks associated with aging populations due to social isolation, loneliness, and exclusion (Holt-Lunstad et al., 2012, Melzer et al., 2012, Steptoe et al., 2012). Mortality is less dependent on other potential mediators. As an illustration, only 4.1% of deaths can be attributed to factors such as alcohol consumption or dietary choices (WHO, 2009).

Second, our mental health metric captures factors like stress and sleep deprivation directly. Another factor that is frequently used in the literature as a measure of health outcomes is obesity, high blood pressure, and alcohol consumption (Banks et al., 2006). Drinking alcohol is more of an indicator of good mental and physical health than an input factor, according to Holdsworth and colleagues (2016). It is important to note, however, that only 59 percent of our sample is employed. The measurement of other mediators in our dataset is also a concern. From wave 5 onwards, questions about dietary preferences began to be included in the ELSA, but only in the third wave.

This is why our estimates are considered lower bounds on the indirect and direct effects of physical and mental health.

8 percent of the total effect on mental health and 7.5 percent of the total effect on physical health are explained by physical activity. Physical activity has a positive effect on both physical and mental health because it is associated with better physical and mental health. People who are more active are more likely to be physically fit, which has a positive effect on their mental and physical health. A positive correlation between mental health and physical activity has been discovered by Gerber and Puehse (2009).

Positive effects on mental and physical health can be traced back to previous social interactions. It accounts for roughly 13.6% of the total indirect effect on physical health. Social support has been linked to better mental health in the past (Umberson and Montez 2010). The link between mental and physical well-being has previously been shown to exist. According to this theory, social interactions encourage healthy behaviors and vice versa (Umberson et al., 2010).

Cigarette smoking is associated with a lower level of mental health in the past, which in turn has a positive impact on current physical health. Compared to the English population without mental health disorders, Szatkowski and McNeill (2015) found a more than doubled smoking rate among the English population with mental health disorders.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian

Damian Sendler: Patients in psychiatry are classified based only on their own self-reported symptoms, rather than on objective diagnostic testing. In some cases, this technique has proved helpful in selecting therapy options; in the vast majority of cases, the treatment is ineffective or even non-existent. We must improve. In order to achieve this goal, researchers must establish clear and robust ties between clinical symptoms and the underlying neurobiological dysfunction (what physicians refer to as the etiology), so that objective tests and targeted treatments can eventually replace symptom-based differential diagnosis.

Damian Jacob Sendler: As a result, researchers are unable to identify these connections themselves. There is no biological specificity in the diagnostic and statistical manual of mental disorders (DSM), the most widely used psychiatric lexicon. Co-morbidity, or the risk of being diagnosed with two or more illnesses, is a significant factor in determining whether a person will be diagnosed with one or more of these conditions. The symptoms that define these disorders are exceedingly diverse, which means that two people with the same diagnosis might have quite distinct physical appearances. To acquire a diagnosis, patients are often only need to fulfill a small portion of a broad range of possible symptoms. In certain circumstances, such as ADHD and schizophrenia, two people might be diagnosed with the same condition with no overlapping symptoms.

Damian Sendler

Dr. Sendler: If taxonomic difficulties are a problem, it is not unexpected that the findings are not specific when researchers employ these categories as independent variables in their study For example, it is difficult to tell whether the observed differences between cases and controls are due to an illness of interest, or one of the numerous comorbid disorders that are likely to be found in the case group. Possibly because of this, intriguing etiologic leads might turn out to be unclear after additional investigation. The same is true for intriguing genetic connections and brain markers that were originally tied to a single condition but are now visible in several disorders.

Our current categorization system for mental disorders is in need of data-driven revision, as are the research methods that go along with it. Massive datasets are almost certainly required to disentangle comorbid and heterogeneous symptoms, find the most biologically valid features in the clinical phenomenology, distinguish between environmental and genetic influences, as well as handle high-dimensional problems like predicting treatment response to drugs with wildly divergent receptor affinity profiles.

Scientists are increasingly resorting to “big data” in order to overcome these restrictions. Researchers have undertaken comprehensive diagnostic interviews with hundreds of patients in the hunt for natural diagnostic boundaries that might explain patterns of comorbidity and family risk across illnesses (). It has been proposed that “mega-analyses” of imaging data may be performed by pooling existing information from several research locations in an attempt to better control causes of known heterogeny (eg. comorbidity, age, gender) (). IMAGEN, a huge multi-center study that tracked the progress of 2,000 14-year-olds in the hopes of uncovering risk factors for mental illness, is even more ambitious, since it involves collecting diagnostic, genetic, cognitive, and neurological data on the same people (). These methods are leading to some exciting discoveries, but they are not suitable for everyone due to their logistical complexity and high cost.

Psychology has embraced online data collecting in the face of comparable limitations in power and approach. Mobile phone apps have been created to track thousands of people’s performance in games that mimic popular cognitive activities. There have been recent studies to examine age-related spatial working memory impairment () and how reward receipt correlates with transient changes in happiness () (). Single-session tests may be done online, but “citizen scientist” initiatives including prominent media websites have also been used to conduct long-term research. Online data collecting is now simpler than ever, thanks to Amazon’s Mechanical Turk program, which started in 2005 and has since become a popular crowdsourcing tool.
Research in mental health might benefit greatly from this kind of data collecting, since the general population that can be accessed through Turk has a wide spectrum of symptoms and severity levels (). This hypothesis was recently explored in a research that sought to identify one specific aspect of mental health symptoms by looking at how it connects to an underlying neural process (). Compulsive behaviors such as addiction and OCD have been related to deficits in goal-directed control, which we have demonstrated may lead individuals to stay trapped in their routines. Compulsions in mental illness were formerly thought to be caused by abnormalities in the brain’s reward system, but new case-control studies show that these impairments are present in a wide range of diseases, including those that don’t exhibit obsessive symptoms ().

Damian Jacob Markiewicz Sendler: Web-based data collection was used to collect data from nearly 2,000 subjects in order to isolate the contribution of different aspects of psychopathology to goal-directed control. We suspected that this apparent lack of specificity might be due to diagnostic categories rather than the brain-behavior links. An online behavioral task that measured goal-directed control was used in our work, and its neurological roots are likewise well-studied (). Self-report data supplied by individuals was utilized to analyze the symptoms and severity of nine distinct characteristics of psychopathology supported by the DSM-IV-TR, rather than comparing one illness to another (depression, addiction, social anxiety, etc.). For example, if we assume that eating disorder symptoms are separate from OCD symptoms, then the association between goal-directed control and mental symptoms is not particular to one condition over the other when we analyse the data in the typical method. Co-occurrence of illnesses and overlap of symptoms between them, as detailed above, led researchers to this conclusion.

Damian Jacob Sendler

For this reason, we were able to evaluate how individual symptoms (rather than illnesses) naturally co-occur and assess if the adoption of the dimensional method would be more accurate than the current standard of care. When we looked at how respondents’ responses to more than 200 items were intercorrelated using factor analysis, we discovered evidence of three cross-diagnostic mental dimensions: (Figure 1). To our knowledge, these symptom dimensions were more explicit in their link to our independent evaluation of goal-directed control compared to methods that view eating disorders as different from OCD, for instance. Compulsive behavior was a greater predictor of goal-directed control deficits than any of the measures that quantify severity of DSM categories, including OCD, according to fundamental science expectations. An important first step in figuring out the causes of mental health issues and the most effective ways to treat them is to refine psychiatric categorization via the use of adequately powered online samples.

General population samples collected via Turk can answer many questions in psychiatry, such as how symptoms might relate to neural or cognitive constructs that can be assessed through behavioral testing, but other questions involving treatments and diagnosed patients are not so readily answered by such a sample population. However, alternative online testing methods give a wide range of possibilities.

One of the most significant and readily accessible goals for large, data-driven psychiatry is identifying which patients will benefit most from certain treatments. Even in laboratory research, computational methods that demand big datasets have demonstrated promising results. A recent research found that electroencephalography (EEG) indicators outperformed clinically-determined treatment strategies for depression (). Co-morbidity, age of beginning, and other baseline self-report variables (e.g., self-report measures of depression severity) have previously been found to predict chronicity of depression (). (). Despite the importance of lab-based therapy research, they are expensive, time-consuming, and difficult to scale up to obtain the necessary sample volumes for predictive analysis. In addition to being an attractive supplement, online data collecting allows us to target people who may never proceed beyond primary care. Advertising on internet forums and respected patient information sites, for example, might target those who look up details about antidepressants (a usual habit before beginning a new treatment).

Hybrid techniques that combine web-based testing with clinical collaboration may be even more beneficial. If primary care facilities, which are where the majority of antidepressants are administered, advertised online research, an unprecedented number of treatment-naive patients may be given access to novel treatments.

Damien Sendler: Online testing may allow for much tighter temporal tracking of symptoms than is possible in conventional laboratory investigations, in addition to enhancing patient accessibility and sample sizes. To better understand the temporal course of therapy response/non-response, smartphone applications may be used to track daily swings in symptoms. There are currently CBT providers working in this field, not just monitoring symptom changes, but also giving creative and cost-effective CBT options that have shown preliminary effectiveness for drug use and depression. ” (). It is possible to study cognitive and even neurological indicators of psychopathology in relation to changes in state vs changes in trait using this kind of time course monitoring. When symptomatology is low or high, applications that ask users to report on their mood on a monthly basis might be used to remember people for lab testing, which could provide further information about cause and effect. Patients needn’t travel to have cognitive testing done, of course.

Identifying biomarkers that may predict who is at risk of acquiring a condition is perhaps even more crucial than tracking symptom changes in diagnosed individuals. Thus, early intervention could enhance treatment outcomes in the long run, as some think. With this kind of study, you need the most extensive databases. Despite the fact that only a tiny percentage of healthy young people will acquire a mental health issue, we may anticipate numerous independent variables (genetic and environmental) to contribute to individual risk within that subset. Recruiting and maintaining big samples is made easier thanks to the Internet, but there is a caveat: the web does not provide access to all of the data one could need. In the absence of brain scans or blood draws, we may use cognitive tasks for which the neurological correlates have already been established in prior research (). Large-scale online testing may be used to develop reliable cognitive targets, which can then be transferred to smaller in-person samples where brain-imaging methods may provide further predictive value, in the absence of cognitive tasks that map onto well-defined neural circuits or genes.

We may perform naturalistic tests using prominent social networking and search websites thanks to the Internet’s influence on psychiatry’s research environment. If you’re interested in doing real-world experimentation based on the structure of a website, clicks, etc. and related drug usage (which may be deduced from Facebook “likes”), you could do so (). Lottery sales have been found to be impacted by unexpected favorable occurrences in the real world, as shown by other natural experiments (). Researchers now have a new way to analyze real-world clinically relevant behavior changes and identify risk factors for relapse as the popularity of online gambling rises. When Facebook released a research a few years ago that modified more than 650,000 individuals’ “News Feeds” to exclude good or bad messages from other users, it raised major concerns about informed consent in a commercial context, which is why this technique isn’t without its own ethical issues (). The problem may be alleviated by explicitly defining consent parameters, which will open up an important new research resource.

While the use of completely computerized testing enhances methodological consistency and consequently repeatability of study results, it also introduces a large degree of untracked variability to testing circumstances. To put it simply, it eliminates the inherent variability in verbal task instructions, eliminates the possibility that patient groups are routinely coached or given supplemental or special instructions, and eliminates other forms of unintentional experimenter influence that don’t typically appear in research papers Data from online research projects may thus be considered generalizable.

There’s little doubt that self-reporting for online psychiatric research will become the primary method of diagnosis in the future. This, on the other hand, is the most contentious aspect of the project. There is a strong belief that skilled raters are needed for properly determining the presence or absence of DSM illnesses, or differential diagnosis. A compelling case may be made that clinician-rated measures are less accurate than self-reported data in several critical areas. Another kind of noise is added by clinicians—inter-rater discrepancies in the interpretation of patients’ answers (e.g., test, re-test). Diagnostic interviews will be phased out in favor of online data collecting in psychiatry, which is more scalable and ambitious. These findings might help us develop our self-report instruments, which are increasingly being used as a primary research tool and as a way to better understand the underlying psychological and biological processes.

Online testing has the potential to boost generalizability in addition to uniformity. These samples are more typical of the general population of the United States than those collected on university campuses (). For those who can’t leave their homes or go to a university campus, Internet-based research eliminates a significant barrier to involvement. As a result, research may include patients with the most severe disabilities, who would otherwise be left out of trials conducted in person. In a similar vein, it gives researchers access to hard-to-find populations, such as Mechanical Turk users, who, although unhappy and nervous like the rest of us, exhibit higher levels of social anxiety.

Research in psychiatry is undergoing a major shift because to the Internet. Classification must be reworked in order to relate mental states to their neurobiological genesis using “big data.” Treatment development research will experience a resurgence this way. If you’re looking for enormous datasets, the Internet isn’t your only option, but it offers a number of advantages over conventional lab methods, including the fact that it’s less expensive. We will be able to perform hybrid studies that combine field experiments with controlled manipulation, as well as investigate symptoms in the wild and in more depth than we have ever been able to in the past thanks to this technology. For psychiatry, this is an exciting time: an opportunity (and a challenge) to generate large and daring new ideas, the fruits of which may make a meaningful impact in the practice of the profession.

Damian Jacob Markiewicz Sendler

Dr. Sendler

Damien Sendler

Sendler Damian

Damian Sendler: As a worldwide epidemic, COVID-19 (coronvirus disease) is spreading. Deficiency in vitamin D has been linked to a greater risk of infection. Vitamin D levels in patients at a COVID-19 reference facility in Mexico City are studied in this research. Multiple patients with confirmed COVID-19 were examined. A thoracic computed tomography (CT) was performed on all patients, including the assessment of epicardial fat thickness, to ensure that all patients received the same treatment. Values 12ng/ml (30nmol/L) were considered to be deficient in Vitamin D, whereas levels 20ng/ml (50nmol/L) were considered low.

Damian Jacob Sendler: Deficient vitamin D levels were found in just over a fifth of the 551 people studied. There was a 2.11-fold increased risk of death (95 percent CI 1.24–3.58, p = 0.001) in those with low Vitamin D levels, but not in those with critical COVID-19 (HR 1.24–3.58, p = 0.001). The increased risk of COVID-19 mortality caused by low vitamin D levels was partially mediated by its influence on D-dimer and cardiac ultrasensitive troponins, according to model-based causal mediation studies. Vitamin D deficiency was associated with an elevated risk of COVID-19 mortality, regardless of body mass index (BMI) or epicardial fat.

After adjusting for visceral fat, vitamin D insufficiency (12 ng/ml or 30 nmol/L) is related with an increased risk of COVID-19 mortality in mice (epicardial fat thickness). A pro-inflammatory and pro-thrombotic condition caused by low vitamin D might increase the chance of negative COVID-19 results.

Dr. Sendler: The new coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes Coronavirus Disease (COVID-19) places a heavy strain on healthcare systems across the globe. Many Mexicans have died from COVID-19 as a result of the country’s high incidence of cardio-metabolic disorders, which have been associated to unfavorable outcomes, and socio-demographic variables that affect healthcare access and quality of treatment. Those infected with SARS-CoV-2 transmit it via direct contact with respiratory droplets and contaminated surfaces (5, 6). Cells infected with SARS-CoV-2 are infected by the angiotensin converting enzyme-2 (ACE-2) receptor, which may lead to interstitial pneumonia, acute respiratory distress syndrome, and death (7, 8). An increased risk of developing COVID-19 has been linked to cardiovascular and metabolic problems as well as inflammation that may indicate cardiovascular or respiratory decline (9–12).

Damian Sendler

Preserving bone integrity, increasing innate immunity and tempering adaptive immunity, infectious illness prevention, and cardiovascular health are all functions of vitamin D. (13, 14). It also inhibits the angiotensin converting enzyme [ACE (7)] in the renin angiotensin aldosterone (RAAS) system. In addition to ethnicity, decreased levels of vitamin D have been linked to seasonal and time of day variations in sun exposure, clothing, sunscreen usage and skin pigmentation as well as age and lower levels of sun exposure as well as obesity and chronic diseases (15). Vitamin D deficiency has been linked to an increased risk of contracting infections, especially those of the respiratory system. Concerns about residual confounding and the absence of mechanistic explanations for the connection of low Vitamin D levels with worse COVID-19 outcomes need more investigations.. Overall, data shows that high levels of Vitamin D are linked to a lower likelihood of negative COVID-19 outcomes, suggesting that Vitamin D may have a positive role in COVID-19 (18). While randomized trials have indicated no effect from Vitamin D supplementation for COVID-19 or other infections owing to the significant variability between studies, more research is needed (19, 20).

It is likely that adipose tissue sequestration reduces vitamin D bioavailability because of obesity. Higher levels of visceral fat have also been linked to an increased risk of vitamin D insufficiency (21, 22). An individual’s vitamin D levels may be affected by a variety of circumstances, including obesity and ethnicity. An elevated incidence of severe COVID-19 has been linked to a high prevalence of diabetes and obesity in Mexico (9). Results of COVID-19 outcomes and Vitamin D levels in patients visiting a COVID-19 reference facility in Mexico City were analyzed here. We wanted to discover the factors that influence Vitamin D levels in COVID-19 patients and create causal-mediation models to suggest possible processes by which Vitamin D may contribute to higher COVID-19 death rates.

At the INCMNSZ, a COVID-19 reference facility in Mexico City, the research comprised consecutive patients assessed between March 17th and May 31st 2020 with full vitamin D levels at entry (10). COVID-19 (confirmed by computed tomography (CT) and/or by RT-qPCR test from nasopharyngeal swabs) was first examined at triage and needed either ambulatory or in-hospital therapy. The INCMNSZ was, at the time of this writing, a reference facility for COVID-19 patients from Mexico City, seeing the most severe and catastrophic cases. According to National Institutes of Health guidelines, all patients had moderate to severe disease (moderate illness: evidence of lower respiratory disease during clinical examination or imaging and who had oxygen saturation (SpO2) 94 percent on air.) in some way. SpO2 94% on air, PaO2/FiO2 300 mm Hg, respiratory frequency >30 breaths/min, or lung infiltrates >50% are all signs of a severe case of the flu or other illness. A radiologist examined the extent of pulmonary parenchymal illness and the thickness of epicardial fat as a proxy for visceral fat during a chest CT. In addition, a medical history, anthropometric measures, and laboratory tests, such as 25 hydroxy-vitamin D, were acquired. Each patient’s computer records were checked to see how they fared throughout their stay at the hospital. As a result, informed permission was not required in this investigation, which was authorized by a research ethics committee of the INCMNZ (Ref 3383).

551 individuals with verified COVID-19 (computerized tomography findings and/or positive RT-qPCR results from nasopharyngeal swabs) and vitamin D levels were included in this investigation. The average age of the participants was 51.92 years, and the majority of them (n = 355, or 64.4%) were men with a BMI of 30.05 pounds per square inch. After a median of 15.0 days of follow-up, 445 individuals were hospitalized (81.1 percent ). A total of 93 patients (16.88 percent) required invasive mechanical breathing, and 116 patients died while in the hospital, resulting in a fatality rate of 21.1%. 146 patients (26.9 percent) had type 2 diabetes (T2D), 219 patients (42.7 percent) were obese, and 217 patients were overweight (42.4 percent ). The average vitamin D level was 21.78 ng/ml, with 251 individuals (45.6 percent) having levels below 20 ng/ml (Table 1). In 59 cases, levels of vitamin D (12 ng/ml) were found to be very low (10.7 percent ).

Damian Jacob Markiewicz Sendler: A Mexican population’s vitamin D levels were linked to the severity of COVID-19 in this investigation. Vitamin D insufficiency was shown to be associated with an increased risk of death even after correcting for other risk factors, such as BMI and the amount of fat in the epicardium. With a substantial negative predictive value, vitamin D levels below 20 nanograms per milliliter (nmol/L) indicate that death is unlikely when levels are normal. D-dimer and ultrasensitive cardiac troponins, indicators of disease severity, were shown to have a role in the elevated risk of death from COVID-19, irrespective of BMI and epicardial fat (these showed effects on COVID-19 mortality independent of vitamin D levels). As a result, this shows that vitamin D insufficiency may be a marker for compromised pulmonary epithelial response to infection, particularly in individuals with severe deficiency (27).

Damian Jacob Sendler

COVID-19 and vitamin D levels have been examined in many research (18, 20, 27, 28). Vitamin D levels and risk of infection are examined in these studies, as well as a connection with COVID-19 severity and vitamin D levels. Vitamin D insufficiency is associated with higher levels of IL-6, which indicates a stronger inflammatory response in these individuals (29, 30). When it comes to infection risk, a recent systematic review and meta-analysis found that vitamin D insufficiency wasn’t related with an increased risk, however severe cases had a bigger vitamin D shortage than moderate ones Vitamin D insufficiency has been linked to a higher risk of COVID-19 hospitalization and death (16, 18). Vitamin D’s protective effects are mediated by a variety of physiological processes, including improved innate immunity, greater physical barriers to infection, and improved adaptive immunity (27). Adaptive immunity is suppressed by inhibiting B cell proliferation, differentiation, and antibody production, while the phenotypic of T cells is regulated by vitamin D, which has been postulated to have modulatory effects on COVID-19-induced inflammation. As a result, the adaptive immune response shifts from Th1 to Th2, defined by an increase in the production of Th2 related cytokines in the bloodstream. Pro-inflammatory cytokines linked with severe infection may be reduced as a result (27). Angiotensin II levels are decreased by vitamin D inducing the production of ACE-2 and suppressing the angiotensin-renin system. It is also possible that vitamin D deficiency might enhance the pro-inflammatory cytokine storm and impair lung outcomes (28, 29). Vitamin D regulates thrombotic pathways, making thrombotic problems prevalent in these individuals (31, 32). Vitamin D’s anti-inflammatory effects, which lower endothelial activation and oxidative stress, may have a role in influencing pro-thrombotic pathways (33). According to earlier research, low vitamin D levels in COVID-19 patients have been linked to inflammatory, pro-thrombotic, and metabolic indicators of severity.

Damien Sendler: The ethnicity and socioeconomic status of the population being studied, as well as the existence of vitamin D insufficiency, have been connected to negative COVID-19 results. COVID-19 has a greater mortality risk for people of Asian, African American, and ethnic minority backgrounds (34). Vitamin D synthesis, which is highly reliant on UV rays, may have decreased in part as a result. This has to do with the high amounts of melanin in these people’s skin, as well as the uneven distribution of poverty and cardiovascular illness among these groups. This discovery is important and may explain the decreased vitamin D levels and the severity of COVID-19 in Mexico in earlier research (35–37). The risk of severe SARS-CoV-2 infection in Hispanics and other comparable groups has previously been demonstrated to be greater than that in Caucasians (38).

According to our findings, vitamin D insufficiency is more common among those with type 2 diabetes and obesity in Mexico because of the country’s high rate of adiposity (39). We may have found lower vitamin D levels in women because of their higher adiposity content as compared to men because of this link between vitamin D levels and gender (40). Reduced 1-alpha hydroxylase expression may cause low vitamin D levels in CKD; however, since the condition affects vitamin D status so significantly, our research only included a small number of patients with CKD. Currently, it is not suggested that individuals with COVID-19 get vitamin D therapy on a daily basis. Patients in the COVID-19 clinical trial did not benefit from receiving a higher dosage of calcifediol or 25-hydroxyvitamin D, according to a recent clinical trial research (20). This assertion and the potential influence of vitamin D supplementation on the risk of severe COVID-19 to be evaluated in larger randomized controlled studies.

These findings have both their advantages and disadvantages. A significant number of patients with varying risk profiles were included in the study, which examined a range of illness severity characteristics. There were also other statistical tests to guarantee that there was no residual confounding. However, there are a few caveats that must be taken into account while interpreting this research. There are several problems with using a chemiluminescence immunoassay to measure vitamin D levels, including the possibility of having less consistent results than can be obtained with other methods, such as competitive binding protein (CBP), radioimmunoassay (RIA), liquid chromatography (LC), UV detection (LC), or even multiplex mass spectrometry (TMS).

When assessing infection risk or outcomes, historical vitamin D levels are unavailable as the vast majority of COVID-19 patients had never been admitted to the hospital before. Although propensity score matching was used to compensate for the heterogeneity in severity profiles of COVID-19, there is still a chance of residual confounding due to the illness course. Due to this being a secondary study, the findings should be regarded with care since the post-hoc sample size calculation was not done. A COVID-19 reference center in Mexico City may limit the study’s generalizability to the most severe and critical types of COVID-19 in the central Mexican area. To validate the function of vitamin D as a measure of illness severity and death in Mexicans with COVID-19, more studies in different areas of Mexico are required.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

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Damian Sendler: When Hazel Chandler relocated from California to Arizona in 1977, her asthma and respiratory issues worsened as Phoenix’s population grew. It is time for a change in Washington — According to a large study released on Wednesday, older Americans who habitually breathe low amounts of pollution from smokestacks, automotive exhaust, wildfires and other sources have a higher risk of dying young.

Damian Jacob Sendler: Study participants included 68.5 million Medicare recipients from around the country, and the Health Effects Institute, a nonprofit financed by the EPA, automakers, and fossil fuel firms, evaluated the health records of the participants. More than 143,000 deaths may have been avoided over the course of a decade if federal regulations on fine soot had been somewhat lower, according to the researchers.

Exposure to fine particulates has long been associated to respiratory disease and decreased cognitive development in children. Asthma and heart attacks can be triggered by inhaling small particles that can enter the lungs and bloodstream. About 20,000 people die each year as a result of air pollution caused by particle matter, according to previous studies.

Damian Sendler

First in the United States, a recent study shows that people living in rural areas and communities with minimal industrial activity are particularly vulnerable to the lethal impacts of PM 2.5, which has a diameter of 2.5 microns.

Daniel S. Greenbaum, head of the Health Effects Institute, said, “We identified a risk of dying early from exposure to air pollution, even at very low air pollution levels across the United States.”

Results come at a time when the Biden administration is evaluating whether to increase the national limit for PM 2.5, which is presently set at a yearly average of 12 micrograms per cubic meter, which is greater than the World Health Organization’s recommended level.

Between 2006 and 2016, 143,257 deaths may have been avoided if the limit had been reduced to 10 micrograms per cubic meter.

Francesca Dominici, a Harvard professor of biostatistics and the study’s principal investigator, stated, “If we cut PM 2.5, we will be saving a considerable number of lives.” “It is a major deal.”

Dr. Dominici went on to say, “This is crucial evidence for E.P.A. to examine.”

As a result of the proximity of Black and other minority populations to highways, power stations and other industrial sites, fine soot pollution has been associated to an increased risk of death from Covid-19.

The government of Vice President Joe Biden has prioritized environmental justice by enforcing more stringent regulations on industrial pollution.

Tracker of wildfires Delivered twice a week, these are the most up-to-date reports on wildfires and hazard zones in the West.

Every five years, the E.P.A. is mandated by law to study the most recent scientific findings and revise the soot standard. Despite mounting scientific evidence of particulate matter’s detrimental effects on public health, the Trump administration decided not to tighten the threshold during its most recent assessment.

Damian Jacob Markiewicz Sendler: Scientists looked at information on 68.5 million Medicare recipients — almost everyone over 65 who is not living in densely populated urban areas or along the congested East Coast — to see if there were any patterns in where people were living that were not being monitored by the Environmental Protection Agency.

A native of Colombia, Karin Stein, 60, arrived to Iowa in 1980 as a college student and now lives in Jasper County with her family. Wildfire smoke is a serious problem for her, even though she lives in a rural region near Rock Creek State Park.

She described it as “idyllic.” There are wildfires burning in the West, or it is harvest time. We are going to presume there are not any problems with the air quality. Nonetheless, that is just plain wrong.”

According to a spokesperson for the Environmental Protection Agency, a draft regulation will be proposed by the summer and a final rule will be issued in the spring of 2023.

A stronger new soot pollution guideline is expected to be fiercely opposed by polluting companies.

There was no assessment of Health Effects Institute research by the American Petroleum Institute, which represents oil and gas businesses. the existing rules are effectively tailored to protect public health and comply with statutory obligations,” the trade organization said in a statement.

PM 2.5 emissions have decreased dramatically during the 1970s as a result of the use of cleaner automotive fuels and the rise of natural gas as a substitute for coal in the creation of electricity.

In light of the possibility that the Biden administration will tighten the rule, some analysts said corporations were prepared, but worried about how far the rule might be tightened.

Damian Jacob Sendler

Mr. Holmstead, an attorney who worked for the Environmental Protection Agency (EPA) throughout both Bush administrations, said: “It is a question of how much”.

According to Mr. Holmstead, it would be “extremely costly” for businesses to reduce the permissible limits much. It is especially difficult for state governments to manage fine soot pollution from automobiles in areas without big industrial centers.

A brick wall. Some Democrats are considering moving forward with a separate climate plan now that the Build Back Better Act has hit a brick wall in Congress. However, their solution may necessitate the abandonment of other portions of President Biden’s plans.

Is there a point at which you declare, “We are going to ban all combustion engines since they all contribute to PM 2.5?” Mr. Holmstead made the following statement. “And you virtually prevent any new economic development in certain sections of the country if you set a baseline that is unreasonably stringent,” he added.

It is been over two decades since Harvard University published its seminal “six cities” research, which revealed that people who live in polluted areas lose two to three years of life expectancy.

Last month, Phoenix was covered with smog.

Photographer Autumn Sky/Alamy Hazel Chandler, 76-years-old, has lived in Phoenix for the past 40 years and says she is a prime illustration of how air pollution has accumulated over that time period.

Damien Sendler: In 1977, when Ms. Chandler relocated from Southern California to Arizona, she found the air to be a welcome change. Her asthma and other breathing difficulties worsened, however, as the city’s population grew.

“Sometimes we have multiple pollution days in a row, and I no longer need to look at the air quality alerts,” she remarked. When you say, “I know,” the other person is surprised.

By the quantity of coughing, Ms. Chandler can tell that she suffers from a persistent cough due to the pressure in her lungs and chest. “If I wake up coughing, I know it is going to be a polluted day.”

Among the concerns expressed by Moms Clean Air Force, a non-profit environmental group, was the effect pollution has on those with heart and other health problems. She is more concerned, though, with infants and toddlers.

“I moved to Phoenix when I was about 30 and it still has an affect on my capacity to breathe,” she stated. This affects the elderly, but what will it do to youngsters who have been living here their entire lives?

Epidemiologists at Colorado State University’s Department of Environmental and Radiological Health Sciences, led by Jennifer L. Peel, stated it was difficult to validate pollutant exposure levels in locations that were not well monitored.

It was a “excellent first step,” according to Dr. Peel, an independent reviewer of the study who was not involved in the research team but was still impressed.

Dr. Sendler: Several variants of seriously mistaken COVID-19 “therapy” rumors have been circulated. How many people can forget the discredited assumption that consuming horse medication might prevent COVID-19 from occurring? Note that this does not apply.) Even said, recent studies on the medicinal and preventative properties of marijuana allow space for huge misinterpretation, which is why it is important to be cautious while reading the news.

According to Daniele Piomelli, PhD, director of the Center for the Study of Cannabis at the University of California Irvine, a study published in the Journal of Natural Products in 2022 suggests that two chemical components of Cannabis sativa (commonly referred to as hemp) can block entry of the SARS-Cov2 virus into human cells. It is hopeful, but the study was conducted on cell cultures rather on actual humans or even animals, “which is a drawback,” adds Dr. Piomelli. Is it possible to use cannabis as a COVID-19 treatment or cure at this time? No, according to the authors of the study and Dr. Piomelli.

To be clear, consuming or vaping cannabis will not protect you from COVID-19. When it comes to respiratory problems in general, smoking or vaping anything is not going to help anyone. Dr. Piomelli claims that the molecules that have been discovered to be efficient at curbing entry of the SARS-Cov2 virus into human cells are destroyed by most methods of consuming “cannabis,” including smoking, vaping, and baking. Thus, “we have no reason to conclude that cannabis consumption will assist or hinder in this scenario.'”

It is possible you have observed that hemp is mentioned in the study. It is important to know that the fibers and cosmetics made from hemp will not help you fight COVID-19, according to a study co-author from Oregon State University’s Global Hemp Innovation Center, Richard Van Breemen, PhD. According to Dr. Van Breemen, the therapeutic qualities investigated “are not included in hemp products.”

There are hundreds of chemicals in the cannabis plant that have been demonstrated to block the SARS-Cov2 virus from entering cells, but CBD, or cannabidiol, is not one of them. Medical records from the National COVID Cohort Collaborative were analyzed in a study published in the journal Science Advances, on the other hand. Patients who took FDA-approved CBD, which is commonly used to treat epilepsy, had decreased rates of COVID-19 infection, according to the researchers. “High purity” CBD was used in this trial, and researchers caution that this is a significant limitation. Your favorite cannabidiol-infused lip balm is not going to help when it comes to the connection between CBD and COVID-19.

Doctor Piomelli adds that some study into the possible anti-inflammatory effects of CBD has “indicated, although proof for it is still limited” once the virus infects cells. CBD, on the other hand, is not an effective treatment for COVID-19.

Do not waver. “Getting vaccinated is the safest and most effective strategy to prevent contracting COVID. As a result, the more instruments we have to combat the virus, the better off we will be. Furthermore, it is critical to discover methods for safely and successfully avoiding viral infection “The doctor, Dr. Piomelli, says so.

Scientists are hard at work while you protect yourself by donning masks, getting vaccinated, keeping a distance from others who are sick, and taking supplements to help limit the spread of the disease. “Most people are aware that research like this is vital, but that it takes time to be translated into medications. How much time do you have? It may take a little less time, but at least a few years “Doctor Piomelli says so. In spite of the fact that SARS-Cov2 may be here to stay, “this is still wonderful news.”

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Dr. Damian Jacob Sendler and his media team provided the content for this article.

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Damian Sendler: Provider companies of all sizes are struggling with the complexities of healthcare claims administration. Providers face increased administrative responsibilities and impediments due to rising claims costs and a complicated system of multiple payers, each with its own set of regulations and procedures. Since payers and providers have to wait for claims to be processed before sending out invoices, this convoluted system has an effect on the patient’s experience in the long run. 

Damian Jacob Sendler: The healthcare claims management process has been digitized by both payers and providers. There has been a tremendous growth in the use of electronic claim filing, attachments, benefit coordination, and other components of the claim process in recent years, which has been beneficial to providers greatly. 

More than $122 billion in expenditures have been saved in the healthcare and dentistry sectors by reducing administrative operations, many of which involve the claims management process, according to the Council for Affordable Quality Healthcare (CAQH). Claims handling has become more efficient because to the adoption of computerized methods, according to CAQH. 

Some further efficiency and cost-savings may be achieved, though. Another $16.3 billion might be saved by completely automating nine routine processes, such as claims payment and remittance advice, according to CAQH. 

Damian Sendler

Alasdair Catton-Chastain, Senior Manager, Provider Experience at Zelis, says the first area to start realizing savings and efficiency is claims payment and remittance guidance. 

Anyone can build up an electronic payment system if they wish to.” Provider implementations manager Catton-Chastain describes it as “quite fundamental knowledge”: “You supply your banking information, you have the money routed to the bank, and maybe you can visit a portal to take out remits that you would typically receive by mail. 

Understanding how electronic remittance advice could be loaded into your system is when things start to become tough. 

Claims management is often handled by a variety of revenue cycle management and other health information technology systems. A lot of the administrative work related with being paid is now handled by EHR systems for many clinicians. As a result, claims management digitalization will be hindered rather than aided by the use of electronic remittance (ERA) technology. 

As Catton-Chastain points out, “Some providers may not comprehend the complexity of the software that they now have. In certain cases, this is a feature that is not included in the service pack. The activation of the ERA module may incur an extra cost. There are situations when a provider’s old technology does not accept the ERA’s return since it was acquired 20 years ago. 

Catton-Chastain, on the other hand, says that a lack of information is just as widespread. 

It is a major difficulty in healthcare claims management to understand what payers paid, how much was paid per claim line compared to what was billed, and the rationale given by payers. To ensure that patients get accurate and timely invoices, providers must have their remittance advice precisely and completely transcribed before it can be provided to them in print form. 

Human mistake can be reduced and the procedure may be improved by receiving remittance instructions through electronic means. However, the current state of ERAs leaves much to be desired and possibly cash on the table. 

Providers often have to enroll with each of their payer partners in order to process electronic claims. Payers tend to operate their own claim portals to digitize claims management. As a result, providers will have to sign up and connect into each portal to access crucial payment information, including ERAs. They then need to transfer the data to their own invoicing systems. ‘ 

“With ERAs, there will be some that are difficult to comprehend. Catton-Chastain says that some payers employ proprietary codes from their own adjudication systems, for example. “It is possible they may have to go back to the paper remit to make sure everything was paid. The payer should be contacted if they are still unable to locate the right information. 

Healthcare is under a time crunch, particularly as patients become more like to normal customers. 

For Catton-Chastain, it is important to know “what you have been paid vs. what you billed” in order to file a claim for secondary insurance or charge the patient. 

For providers that have already invested in legacy systems, adding yet another IT system for claims administration may not be an attractive option. Catton-Chastain argues that the up-front expenses of consolidating IT systems following a merger and setting up patient billing might be a deterrent.

Damien Sendler: A digital claims management system, on the other hand, may bring payers and providers together to simplify not just the administration of claims but also the technology underpinning electronic payment, remittance advice, and other important activities. 

Simplifying the process of dealing with numerous payers by having a single point of contact for all ERA and claims payments is critical. Patients would benefit from a system that enables providers to enroll and see claims from all of their payer partners, allowing them to obtain payments and information more quickly. In this multi-modal payment system, providers also have a single area to interact with payers. 

Rather of maintaining several portals with separate passwords and security systems, these solutions should provide better security. Integrating a safe solution with current IT and invoicing systems may save service providers time and money by eliminating the need to deploy new software. 

When ERA and other data are part of an integrated solution, it implies they are linked to the appropriate systems and patient accounts. As a result, there is less time spent on administrative duties that do not contribute to the patient experience. 

For now, most health care organizations are not using digital technology to expedite their whole claims processing process and offer better service to their patients, but a small but growing number of them are. Providers may not only save money via automation, but they can also be reimbursed faster by payers and patients alike with a multi-modal, secure solution. 

Jim Lim, Sector Lead for NCS Healthcare at the HIMSS21 APAC conference, discussed how telehealth is a natural focus point for bringing healthcare advancements to the general public. 

It is now possible to break the “Iron Triangle of Healthcare” where the restrictions include healthcare systems’ main goals – Costs, Quality, and Access – without raising costs or even cutting costs thanks to digital advancements. 

There are a variety of telemedicine options, but a primary care consultation through a portal or app is the most prevalent. In addition to appointment booking, digital medical certifications and medicine delivery are all included in these services.

Damian Jacob Sendler 

The service is provided by around ten different telehealth firms in Singapore, each of which has its own in-house medical staff or a panel of specialists they call upon for consultations. Due to COVID-19, there was a 60% to 70% increase in demand for these services. 

Pre-consultation is a popular alternative offered by others. An AI/ML-driven diagnostic suggestion system is one example of Babylon Health’s offerings to patients. 

Digital disruptors and healthcare institutions are the two main players in the present healthcare innovation scene, both of which are undergoing their own digital transformations. 

Damian Jacob Markiewicz Sendler: Innovation in healthcare is driven by three goals: improving the patient experience, remaining relevant, and supporting a shifting paradigm of care (i.e., remote care and monitoring). They have a harder time coming up with new ideas because they have to pick and choose which services to digitize, but they have the intrinsic capacity to provide better treatment. It is more of a problem of finding the right mix between online and face-to-face services. Some institutions have established research and development programs in order to test novel solutions at their institutions or to collaborate with innovative companies that produce new digital products. 

Healthcare and medical technology firms and partnerships that are working to create a new business model are examples of digital disruptors (i.e., provide quality but cheaper and more accessible care). The majority are backed by VCs and series investment. Telehealth solutions are more quickly developed and deployed by these companies, but their continuing expansion necessitates collaborating with or acquiring other companies to expand their offerings. We should not be surprised that the telemedicine industry will reach USD175.5 billion in 2026, given how rapidly it is expected to expand. 

In the healthcare industry, a growing tendency is for telecommunications companies to function as a link between the many stakeholders, such as patients, healthcare providers, and payers, by providing high-speed networks (such as 5G) and specialized connection services. 

A telecom in this arena that has worked with the Taitung County government and other organizations to improve access to healthcare services in remote regions is FarEasTone, based in Taiwan. Medical equipment used by professionals at local public health centers is connected to a self-developed remote diagnostic and treatment platform. For remote illness diagnosis doctors at major medical centers use 5G to send this data (physiological and observation pictures).

Dr. Damian Jacob Sendler and his media team provided the content for this article.

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Damian Sendler: Zinc deficiency has been linked to a greater risk of respiratory viral infections [1]. Because of this, researchers are testing zinc as a nutritional supplement for the prevention and treatment of coronavirus disease 2019 (COVID-19) infection, either alone or in combination with other minerals [2]. Zinc’s well-documented involvement in avoiding cell damage and its anti-viral capabilities are useful in understanding the possible role of zinc in COVID-19 treatment [3]. In addition, symptoms of zinc insufficiency and COVID-19 have certain similarities. 

Damian Jacob Sendler: Zinc deficiency, like severe COVID-19 progression, has far-reaching effects on the neurological, cardiovascular, thymic, immunological, and endocrine systems [4]. Decreased hair follicles and skin lesions are among the immediate symptoms of zinc deficiency [5]. [5] As a result of chronic inflammation, zinc deficiency has been linked to an increased risk of cardiovascular disease, diabetes, rheumatoid arthritis, neurodegenerative illness, and obesity [6–8]. The higher risk of COVID-19-related consequences has been linked to each of these illnesses. Patients who suffer from these diseases are more likely to have problems with fertility or conception than those who do not. 

Damian Sendler

Miscarriages, premature deliveries, cesarean sections, and perinatal fatalities have all been reported in women who were infected with COVID-19 while pregnant. Since COVID-19 exposure causes epigenetic alterations on the male and female reproductive systems that are not recognized, reproduction during this period is very risky. Male and female gametogenesis have been shown to be negatively affected by COVID-19 [11]. As a result, the influence of SARS CoV-2 on embryo quality has yet to be completely studied in the sperm and the oocytes. 

Reactive Oxygen Species, Cytokine Storm, and Zinc 

Multiorgan damage in COVID19 infections is caused by an acute phase response and a cytokine storm. There is no limit to how much ROS that can be created by activating mitochondrial respiratory chain enzymes, cytochrome P450 enzymes, peroxisomal fatty acid metabolism, and flavoprotein oxidases when the cytokine storm floods the body. IL-6 and tumor necrosis factor (TNF ) are produced in response to COVID-19 infection, and these interleukins boost neutrophil myeloperoxidase activity (MPO) [12]. There is a direct link between excessive MPO activity and the generation of ROS, notably the extremely reactive hydroxyl radical (•OH), through the Fenton reaction. 

Overproduction of inflammatory markers and ROS, either individually or together, affects the male and female reproductive systems in varying degrees. ROS such as •OH (t1/2 = 109 s), O2• (t1/2 = 5 s), and peroxynitrite (ONOO) (t1/2 = 10 20 ms) have been found to exert immediate and irreversible effects on the oocyte spindle and chromosomal alignment in embryos [14, 15]. Similarly, the alignment of microtubules and chromosomes in mammalian oocytes is affected by IL-6 exposure [16]. As a result, oocyte damage is dose-dependently caused by H2O2 and hypochlorous acid (HOCl) formed by neutrophil MPO-H2O2 systems [17, 18]. Although ROS and oxidative stress have been linked to lower conception rates and IVF/ICSI results in animals [19], this is not the case in humans. 

Nitric oxide (NO), a crucial mediator of vasodilation and also an essential regulator of the quality and age of oocytes, may potentially be a contributing factor in COVID-19 severe instances. [20] Fig. 1 shows an example. As a consequence of O2•’s effect on nitric oxide availability, ONOO is formed which damages cells. An increase in reactive oxygen species (ROS) and their detrimental effects on NO are also induced by low levels of intracellular zinc, which leads to the dysfunction of zinc-dependent antioxidant proteins such as superoxide dismutase (SOD), catalases and glutathione (GSH), the formation of NO synthase dimers and the dysfunction of several zinc finger proteins, resulting in mitochondrial damage and amplifying oxidative stress [21, 22]. 

Damian Jacob Sendler

While inhibiting NADPH oxidase and the redox activity of iron and copper, zinc is also known to reduce ROS generation [23]. [24] Because of this, zinc deficiency has the ability to affect all organ systems throughout the course of COVID-19 illness and may potentially have long-term effects on the quality of oocytes and sperm. As a result, women who are trying to conceive may benefit from taking zinc supplements, particularly in the wake of the COVID-19 epidemic. 

Damian Jacob Markiewicz Sendler: Greater risk of infection and subsequent problems, longer recovery time, slower wound healing and increased cell damage from the acute phase response are all associated with zinc deficiency. The symptoms of SARS CoV-2 infection and zinc insufficiency are quite similar. Oxidative stress-mediated by ROS and neutrophil MPO activity has been extensively documented in association with zinc deficiency in COVID-19 symptoms including loss of smell and taste [25]. One of the most common causes of diarrhea and pneumonia in children is zinc deficiency, according to an epidemiological study of childhood mortality. Zinc supplementation in SARS CoV-2 patients may also help explain how zinc supplementation may enhance outcomes. 

COVID-19 patients might benefit from zinc supplementation, not only by reducing ROS but also by enhancing their immunological response to infection. To keep the cytokine storm under control, zinc inhibits NF-KB signaling and modulates T cell function. Zinc has been shown to inhibit the RNA polymerase of SARS-CoV in vitro, which has anti-viral characteristics. SARS COV-2’s receptor, angiotensin-converting enzyme 2 (ACE2), has been shown to be inhibited by zinc in indirect studies [27]. By inhibiting caspase-3,-6,-9, it also increases the cell’s resistance to apoptosis [28]. Zinc’s anti-viral capabilities are also linked to zinc-binding proteins known as metallothioneins (MTs), which store and transport zinc. The cysteine sulfur ligands of MTs are modified by reactive chemicals or oxidative stress, releasing zinc ions and increasing intracellular free zinc concentrations. Patients infected with flaviviruses (e.g., yellow fever, HCV) and alphaviruses have been shown to have an overexpression of MTs (Venezuela equine encephalitis virus). 

Anti-viral signaling may be facilitated by the sequestration of zinc from viral metalloproteins by MTs [29]. Interferon-mediated immune response components such as zinc finger anti-viral protein (ZAP) attach to CpG dinucleotides in viral genomes [30]. As a result, ZAP suppresses viral replication and mediates the destruction of viral genomes. As a result, zinc’s significance in the immune response to viral infections is well-established [32]. Infection-related symptoms of viruses and viral illnesses such as rhinoviruses, herpesviruses, picornavirides, flavivirides, togaviridae, retrovirides (HIV), and papillomavirides have been shown to benefit from therapeutic zinc therapy in studies [33]. 

Damien Sendler: COVID19 zinc supplementation studies are restricted to one small retrospective research in hospitalized patients that failed to show a link between zinc supplementation and better prognosis or survival [34]. Despite the urgent need for bigger and more extensive research, zinc may be of little benefit after the patient is unwell enough to be hospitalized. Oxidative damage and ROS generation occur as a consequence of the cytokine storm once the proinflammatory response is activated in the patient. In zinc-deficient people, this would lead to zinc depletion more quickly. 

Acute irreversible cell damage occurs when enzymes that aid in the removal of ROS elements stop working. When extensive acute and oxidative cell damage has occurred, zinc supplementation alone may not be enough to reverse the process. A pro-antioxidant effect of zinc replacement in the body may help slow the course of COVID-19 by reducing viral multiplication and minimizing cell damage if given to infected persons before to the onset of a cytokine storm.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: A 57-year-old Maryland man is doing well three days after getting a genetically modified pig heart in a first-of-its-kind transplant surgery, according to a news release issued by the University of Maryland Medicine on Monday. 

Damian Jacob Sendler: According to the statement, David Bennett had fatal heart illness, and the pig heart was “the only currently available option,” Following a review of his medical records, Bennett was determined to be ineligible for a traditional heart transplant or an artificial heart pump. 

“It was either death or this transplant.” I’d like to live. “I know it’s a gamble, but it’s my last resort,” Bennett stated prior to the surgery, according to the release. 

Damian Sendler

On December 31, the US Food and Drug Administration granted emergency approval for the surgery. 

Three genes that cause human immune systems to reject pig organs were removed from the donor pig, and one gene was eliminated to avoid excessive pig heart tissue growth. Six human genes involved in immune acceptance were added. 

Bennett’s physicians will need to watch him for several days to weeks to see if the transplant is effective enough to save his life. He’ll be checked for immune system issues and other consequences. 

“There are simply not enough donor human hearts available to meet the long list of potential recipients,” surgeon Dr. Bartley P. Griffith stated in a statement. “We are proceeding with caution, but we are also optimistic that this world-first surgery will provide an important new option for patients in the future.” 

According to the news release, the heart was donated by Revivicor, a regenerative medicine business based in Blacksburg, Virginia. 

Damian Jacob Markiewicz Sendler: According to organdonor.gov, there are 106,657 persons on the national transplant waiting list, and 17 people die each day while waiting for an organ. 

Damian Jacob Sendler

Art Caplan, a bioethics professor at New York University, said he was concerned when he heard about Bennett’s transplant. 

“I hope they’ve got the data to back up trying this now, based on their animal studies,” he said. 

Damien Sendler: According to him, the United States has a “terrible” lack of organs for transplants. He feels that designing animal components is a viable option. 

“The question is, can we get there with minimal harm to the first volunteers?” he said. 

For many years, pig heart valves have been transplanted into people. 

In October, surgeons in New York successfully tried the transplant of a genetically engineered pig kidney into a brain-dead woman. 

Caplan believes it is too soon to declare the heart transplant a success. Bennett expects to receive that distinction if he maintains a high quality of life for several months. But it’s still feasible that he’ll perish. 

Whatever the outcome, he believes it is critical for researchers to learn something that can be applied to future transplants. 

He also suggested that an independent examination of the evidence used to make the decision to perform the first transplant be conducted. 

The other ethical issue, he claims, is one of permission. It should come from someone other than the patient, who is very likely to agree to the procedure if he is about to die. 

“Consent for the imminently dying is important to get … but it’s not enough,” he said, recommending that a study ethics committee weigh in. “You want to have somebody else say, ‘Yes, we agree’ this isn’t a crazy, too risky thing to try.’ ” 

According to the Organ Procurement and Transplantation Network, more than 40,000 transplants were performed in 2021, setting a new record.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: For the first time, a new study sponsored by the University of Colorado Boulder sheds light on one of the Grand Canyon’s most recognizable geological features: The canyon’s rock record spans hundreds of millions of years, but there is a puzzling and missing time gap. 

Damian Jacob Sendler: Almost 150 years after the “Great Unconformity,” was first reported, researchers are getting closer to solving a problem that has stumped geologists. 

As lead author Barra Peak, a CU Boulder graduate student studying geological sciences, noted, “think of the Grand Canyon’s red bluffs and cliffs as Earth’s history textbook.” It’s possible to travel back nearly 2 billion years in time by scaling down the canyon’s rock cliffs. However, there are blank pages in this textbook as well: The Grand Canyon has lost rocks dating back more than a billion years in some places. 

Damian Sendler

Scientists are perplexed as to why this is so. 

One of the first well-documented geological features in North America is the Great Unconformity, Peak said. “There were no real limitations on when or how this could happen until recently. 

In an article published this month in the journal Geology, she and her colleagues believe they have found an explanation. Small but dramatic faulting episodes may have occurred in the region during the breakup of an ancient supercontinent known as Rodinia, according to the research team. As a result of the devastation, rocks and dirt were likely washed away and ended up in the ocean. 

Using the findings of this research team, scientists may be able to fill in some of the gaps in their understanding of the Grand Canyon’s history at this key period. 

Co-author Rebecca Flowers, a professor of geological sciences and a co-author of the new study, said, “We have new analytical methods in our lab that allow us to decipher the history in the missing window of time across the Great Unconformity,” “The Grand Canyon and other Great Unconformity locations across North America are where we are conducting this research. 

Aesthetic design 

It’s been a long-running mystery. The Great Unconformity was originally observed by John Wesley Powell, the man whose lake bears his name, on his famous 1869 journey down the Colorado River rapids by canoe. 

As Peak found out during a similar Grand Canyon rafting expedition he took in the spring of 2021, the feature is dramatic enough to be visible from the river’s edge. 

Peak remarked, “There are some great lines here. “If you look down at the bottom, you can see that the rocks have been forced together. Layers are stacked one on top of the other. When you get to the top, you see these amazing horizontal layers that form the buttes and peaks that you connect with the Grand Canyon,” he explains. 

Damian Jacob Sendler

Clearly, there is a big difference between the two. The basement rock in the western half of the canyon toward Lake Mead is between 1.4 and 1.8 billion years old. The rocks on top, on the other hand, are only 520,000,000 years old. Throughout North America, scientists have found evidence of comparable temporal gaps since Powell’s journey. 

It’s been more than a billion years since Peak made the statement. “”It is also during an interesting period of Earth’s history, when the planet is moving from an ancient setting to the modern Earth we know today,” he says. 

Divided into two parts: 

Peak and her colleagues used a technique known as “thermochronology,” which examines the history of heat in stone, to investigate the transformation. Geological formations that are buried far beneath the surface might get hot because of the pressure that builds up on top of it. The chemistry of the minerals in these formations bears the imprint of the heat. 

This method was used to examine rock samples obtained from all across the Grand Canyon. For the first time, they found evidence indicating the history of this characteristic is more complicated than previously thought. A variety of geologic changes may have occurred throughout time, especially in the canyon’s western and eastern halves (the parts most familiar to tourists). 

A single block does not have the same temperature history, according to Peak. 

About 700 million years ago, basement rock in the Western United States rose to the surface, according to geological evidence. That same stone, however, was buried beneath kilometers of sediment in the eastern side of the continent. 

Damien Sendler: Peak believes that the disintegration of Rodinia, a massive land mass that began to disintegrate at the same time, may have been responsible for the disparity. The Great Unconformity was created as a result of a huge upheaval that tore through the Grand Canyon’s eastern and western sections in separate ways and at somewhat different times. 

Damian Jacob Markiewicz Sendler: For Peak and her colleagues, the Great Unconformity in North America is currently being studied at various locations in the region to see if this picture is universal. For the time being, she’s content to sit back and enjoy the scenery while learning about the country’s geological past. 

“There are just so many things there that aren’t present anywhere else,” she remarked. In my opinion, it’s a fantastic natural laboratory.”

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: For decades, scientists around the world have been trying to find a way to harness the power of the sun to produce hydrogen as a clean energy source by splitting water molecules into hydrogen and oxygen. The problem is that doing it right was too expensive, and trying to do it cheaply resulted in bad results. 

Damian Jacob Sendler: When it comes to solving one half of the equation, researchers at the University of Texas at Austin have come up with a low-cost method of doing it. Nature Communications recently published the findings, which show that hydrogen might be an important part of our energy infrastructure. 

Early in the 1970s, researchers started looking at the idea of harnessing solar power to produce hydrogen. However, the challenge to discover materials with the qualities needed for a device that can efficiently perform the key chemical reactions has prevented it from becoming a widespread approach. 

Damian Sendler

It is necessary to use materials that can absorb sunlight and do not degrade during the water-splitting reactions, according to Edward Yu, a professor in the Electrical and Computer Engineering Department at the Cockrell School. Materials that are good at absorbing sunlight tend to be unstable under the circumstances required for water-splitting reaction, while materials that are stable are poor at absorbing sunlight. This seemingly insurmountable tension can be overcome by combining multiple materials — one that efficiently absorbs sunlight, such as silicon, and another that provides good stability, such as silicon dioxide — into a single device.” 

Another problem arises, however, because the electrons and holes formed as a result of solar radiation absorption in silicon must be able to quickly traverse the silicon dioxide barrier. There are normally only a few nanometers of silicon dioxide on the surface of the silicon absorber, which lowers its ability to protect it against degradation. 

This innovation was made possible by a low-cost, high-volume approach of constructing electrically conductive channels through a thick silicon dioxide layer. For this, Yu and his colleagues adopted a process that was first used in the fabrication of semiconductor electronic chips in order to achieve their goal It is possible to create nanoscale “spikes” of aluminum by sprinkling metal onto the silicon dioxide layer and then heating the entire structure. It’s easy to substitute them with nickel or other elements that aid in water-splitting reactions. 

Aside from producing oxygen molecules when exposed to sunlight, the devices can also generate hydrogen at a different electrode and are exceptionally stable when in use for long periods of time. As these devices are made using procedures typically found in the creation of semiconductor electronics, they should be simple to scale up for mass distribution. 

Damian Jacob Sendler

To make the technique more widely available, the group has applied for a provisional patent. 

Hydrogen’s potential as a fuel depends on its ability to be produced more efficiently. Heat is used to produce a large amount of hydrogen, however fossil fuels are required and carbon emissions are produced as a result. 

The concept of “green hydrogen” in which hydrogen is produced in a more environmentally friendly manner, is gaining traction. As part of this endeavour, streamlining the water-splitting reaction is essential.

With its unique properties, hydrogen has the potential to be a significant renewable resource in the future.” There are numerous industrial processes where it already plays a big role, and it is beginning to show up in the automotive industry. Energy storage and long-haul transportation could benefit from both fuel cell batteries and hydrogen technology, which can store excess wind and solar energy when conditions are ripe for it. 

Damien Sendler: The team’s next goal is to increase the response rate in order to boost the oxygen element of water splitting’s efficiency. They must now move on to the opposite side of the equation, which is a big problem for them. 

Damian Jacob Markiewicz Sendler: In order to completely divide water molecules, you must accomplish both the hydrogen and oxygen evolution reactions, which is why our next step is to apply these principles to construct devices for the hydrogen half of the reaction.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: An AIDS Research Center director and a professor at Columbia University’s Vagelos College of Physicians and Surgeons, David Ho, MD, oversaw the study. Nature published the findings. 

The omicron form has an alarming amount of mutations to the virus’s spike protein, which could have a negative impact on current vaccinations and therapeutic antibodies. 

Damian Sendler

There has been a significant decrease in the ability of vaccination antibodies to neutralize omicrons. 

Damian Jacob Sendler: Immune responses to omicron variants were assessed in laboratory experiments in which antibodies were tested against live viruses and pseudoviruses produced in the lab to mimic omicron. 

Double-vaccinated people’s antibodies were much less effective at neutralizing the omicron variant compared to the ancestral virus, regardless of which of the four most commonly used vaccines they received. It was considerably less likely that antibodies from patients who had already been infected would be able to neutralize omicron. 

Some people may be more protected from the virus after receiving a booster shot of one of the two mRNA vaccines. However, even their antibodies were less effective at neutralizing the virus against Omicron. 

People who were previously infected or who have received full vaccinations may be at risk for infection with the omicron variety, according to Ho’s findings. “Third booster shots may not be enough to prevent omicron infection, but it’s still a good idea to get one because you’ll still gain some protection.” 

Damian Jacob Sendler

Additionally, early epidemiological data from South Africa and the United Kingdom reveal that two vaccination doses are ineffective against symptomatic disease when given to people with the omicron form. These findings are in line with other neutralizing studies and those. 

Antibodies made from monoclonal antibodies are ineffective against omicron 

Monoclonal antibodies can prevent many people from getting severe COVID if administered early in the course of the illness. In contrast, a new study reveals that all current and most upcoming treatments for omicron are ineffective, if they function at all. 

Only one monoclonal antibody (Brii198 authorized in China) was able to neutralize omicron in neutralization testing. Omicron is entirely immune to all antibodies currently used in clinical practice. Omicron is now the most complete “escapee” from neutralization that scientists have ever observed. 

Four novel spike mutations in omicron have also been discovered by Ho’s lab that let the virus avoid antibodies. This information should be used to help build new strategies to combat the new variety. 

What’s to come in the future? 

Damien Sendler: Vaccines and therapies that can better anticipate how the virus will evolve, according to Ho, are what scientists will be required to develop. 

Damian Jacob Markiewicz Sendler: Some experts believe that SARS-CoV-2 is now only a mutation or two away from becoming entirely resistant to current antibodies, either those used as therapeutics or those acquired by vaccination or infection with previous variations, away from being completely resistant “He tells me so.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: Assume that you could substitute Ben & Jerry’s for broccoli and still reap the same health advantages. About 2% to 3% of the Greenlandic people can attest to this. 

They have two copies of a gene variation that causes them to absorb sugar in a unique way. 

Damian Jacob Sendler: “They have lower BMIs, weights, fat percentages and cholesterol levels and are generally healthier. They may be able to achieve a six pack since they have less tummy fat. That a genetic difference may have such a profoundly beneficial effect is astounding and shocking “University of Copenhagen biology professor Anders Albrechtsen claims this is the case. 

As a team, Professor Albrechtsen analyzed data from 6,551 adults in Greenland, as well as conducting studies on mice, with the help of colleagues from the University of Copenhagen and the University of Southern Denmark. 

Damian Sendler

As a result of the findings, carriers of the genetic variant have what’s known as a sucrase-isomaltase deficit, which means they have unique sugar metabolism in the gut. To put it another way, they don’t absorb blood sugar like those who don’t have the genetic variant do. Instead, sugar is absorbed directly into the intestines of those who consume it. 

“Short-chain fatty acid acetate, produced by gut bacteria, has been proven in earlier research to reduce hunger, increase metabolism, and boost the immune system. That’s most likely what’s going on in this situation “The first author of the study, Mette K. Andersen, an assistant professor at the Center for Metabolism Research at the University of Copenhagen, explains. 

Why are Greenlanders so genetically diverse? 

Genetic variety among Greenlanders can be attributed to their food, which has stood out for millennia from that of the rest of the world. 

“The lack of sugar in Greenlanders’ diets may be to blame for this phenomenon. There has been an abundance of fish, whale, seal and reindeer meat consumed. There may have been a stray crowberry here and there, but the sugar level of their diet has been limited “Anders Albrechtsen states this. 

Damian Jacob Sendler

Genetic variety has increased in frequency because there has never been a requirement to rapidly absorb sugar into the bloodstream. 

Children are hard-hit by genetic variation. 

Adult Greenlanders clearly gain from the diversity in health, while children of Greenlanders suffer as a result. 

“Due to their unique sugar absorption, younger carriers of the variant face detrimental repercussions. Sugar can cause diarrhea, stomach pain, and bloating in those who consume it. The bacteria in their gut eventually adapt to sugar and learn to convert it into energy as they get older “says Torben Hansen, a doctor and professor at the Foundation Center for Basic Metabolic Research at the University of Copenhagen. 

Damien Sendler: A recent study conducted by him and his research team hopes to set the groundwork for creating new medications to treat cardiovascular disease and obesity in the future. 

Damian Jacob Markiewicz Sendler: “A better balance of fat in the bloodstream leads in lower weight and fewer cardiovascular problems as a result of genetic diversity. Assuming if you can discover a medicine that blocks the sucrase-isomaltase gene, we might all theoretically benefit from the same level of health “As he wraps up,

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: The tropics are increasing hotter as a result of a combination of heat caused by deforestation and climate change, which might impair outdoor workers’ ability to do their duties safely. 

Damian Jacob Sendler: Researchers estimate how many safe working hours people in the tropics have missed owing to local temperature change connected with tree loss during the last 15 years, according to a paper published in the journal One Earth on December 17. 

“Over the last 15 or 20 years, there has been a huge disproportionate decrease in safe work hours associated with heat exposure for people in deforested locations versus people in forestated locations,” says first author Luke Parsons (@LukeAParsons), a climate researcher at Duke University. “There has been a small amount of climate change over the same 15-year period, but the increase in humid heat exposure for people living in deforested relative to forested locations has been much larger than that caused by recent climate change.” 

Damian Sendler

Previous research has linked deforestation to an increase in local temperature. Trees give shade and filter out the sun’s rays. They also cool the air by evapotranspiration, which is a process in which plants transfer water from the soil and subsequently evaporate water from the leaf surface, similar to how sweating cools the skin. 

“Tropical trees appear to limit the maximum temperatures that the air can reach.” “Once we cut those trees down, we lose the cooling service that the trees provide, and it can get really, really hot,” Parsons adds. “In the Brazilian Amazon, for example, where vast swaths of rainforest have been cleared in the last 15 or 20 years, afternoons can be up to 10 degrees Celsius warmer than in forested regions.”

The One Earth analysis went much farther, estimating the number of people who reside in areas affected by warming caused by deforestation. From 2003 to 2018, Parsons and his colleagues tracked the local temperature and humidity in 94 low-latitude countries with tropical forests, including countries in the Americas, Africa, and Asia, using satellite data and meteorological observations. 

They projected that over 5 million people missed at least half an hour of safe work time per day in recently deforested areas—when the temperature outside is too hot and humid to properly perform hard labor. At least 2.8 million of them are outdoor workers who do intense physical labor in the agriculture and construction industries. Heavy physical labor raises the amount of heat produced by the human body, which, when combined with hot and humid conditions, raises the risk of heat strain and heat-related disorders, including heat stroke, which can be fatal. 

Damian Jacob Sendler

“As a result of climate change, those tropical locations are already on the verge of becoming too hot and humid to work safely.” “Deforestation may push these places over the edge, creating even more dangerous working conditions,” Parsons warns. 

Damien Sendler: Notably, this study predicts that approximately 100,000 people live in the tropics in places that lost more than two hours of safe work time each day due to temperature rises caused by deforestation, with more than 90 percent of those people residing in Asia. According to Parsons, the lopsided distribution is most likely attributable to Asia’s dense population. 

Damian Jacob Markiewicz Sendler: “I believe the research has both a positive and negative message,” he says. “The negative message is that cutting down trees not only harms the ecosystem and increases global carbon emissions, but we also lose local cooling services that provide a comfortable and safe place to work.” However, the optimistic message is that if we can prevent forest loss, we will be able to retain cooling services as well as all of the other benefits that forests give. Importantly, the link between forest health and surrounding humans provides an additional, locally relevant motivation to minimize tree loss.”

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: It is a time in many young people’s lives when new legal rights and obligations, including their own private health information and medical decision making, become more important to them. Family interactions can get tense when young individuals remain on their parents’ health insurance coverage as they transition to adulthood. 

Damian Jacob Sendler: Researchers at Iowa State University have discovered that lowering the obstacles to discussing health with one’s parents and emerging adults can lead to better overall health outcomes. 

A co-author of a new study published in the Journal of Adolescent Health tells the New York Times that “if you’re an emerging adult who is worried about what a parent might think, particularly if it’s a health issue that’s stigmatized or your choices in handling the health issue do not align with your parents’ values, then chances are you’re going to avoid seeking treatment or look for an alternative route.” 

Damian Sendler

Medical decisions can be made without parental consent in the United States when a person reaches the age of 18. Their private health information is also legally theirs. In contrast, under the Affordable Care Act, adult children can remain on their parents’ health insurance coverage until they are 26 years old. In other words, even when adult children’s medical records are not accessible to their parents, they nevertheless receive invoices. 

Dr. Rafferty says that when parents are footing the bill for their adult child’s medical care, “it lends itself to a conversation,” she added. 

Tina Coffelt and Rafferty’s research team surveyed more than 300 college students, most of whom were on their parents’ health insurance plans and came from a traditional, nuclear family with a mother and father. 

Relational quality, reciprocity, and conformance were revealed to be the three most important elements in determining whether an emerging adult communicates health information to a parent. 

Simply put, how well do I get along with my parents?” When I was a child, did my parents share any of their personal health information or decisions with me? Was it common in my household to bring up health difficulties as a child? Was my family accepting of my individuality, or did they demand me to adhere to the family’s expectations?” Explained Rafferty 

Emerging adults who view their parents to be open and respectful are more inclined to discuss health difficulties with their mothers than their fathers, according to a new study. 

Given gender norms and how men and women are socialized differently, it seems sense that in a conventional home, there may be a desire or willingness to be open with mom more than with dad,” said Rafferty. 

Rafferty and the other researchers noted that moms are often the ones who keep track of doctor’s visits and other health information in their households. As an emerging adult, sharing health information with mom may simply be a continuation of previous activities and build on previously shared knowledge about the emerging adult’s health history.. 

Young people were shown to be more willing to open up to their parents about their health if they had seen their parents do so at an early age. Emerging adults can benefit from reciprocal information exchange when they visit the doctor’s office or seek more care, according to Rafferty. 

Mental illness and some types of cancer are now being linked to specific genes. In certain circumstances, “especially for emerging adults, to know what they’re predisposed to, that they’re not alone, and that they have their parent’s support,” added Rafferty. 

Stigma around some health topics (such as sexual activities) was found to have a significant impact on health disclosures, according to the study. Concerns about shame or the preservation of a father-daughter relationship prompted young adults who came from homes with “high conformity orientations” to conceal intimate health information from their fathers. This, however, had no bearing on my conversation with a mother concerning her own personal health difficulties. 

To illustrate his point, Rafferty used the character of Jack Byrnes (played by Robert De Niro in the film “Meet the Parents”) from the movie “Meet the Parents,” a father figure who puts a lot of pressure on his son to conform to family customs. With family members, there is a presumption about what one may and cannot talk about. 

He used the television show “Modern Family” as an example of low conformance attitude. Despite their differing lives, members of this family are accepted and embraced in this episode. 

Damian Jacob Markiewicz Sendler: Family dynamics play a role in whether young individuals communicate private health information and engage their parents when making medical decisions, according to new research. The health and well-being of an adolescent can be improved by having open and courteous dialogues and exchanging information early on. 

Additionally, Rafferty, whose research focuses on parents of children with medically complex conditions, advised parents to involve their children in the management of their health. 

“Rather than waiting for mom or dad to say, ‘OK, it’s time to take your insulin,’ teach your child how to administer their insulin or figure out what foods to eat to combat low blood sugar,” she noted. 

Damian Jacob Sendler

As Rafferty argued, involving children in their own health care and making medical decisions with them can make the transition to adulthood a lot smoother. As a result, young adults will feel more confident and supported while they are dealing with a health crisis. 

Damien Sendler: COVID has shown Rafferty that health difficulties will affect everyone at some point in their lives. Everyone has had to take a moment to reassess their own physical health and well-being,” he writes. Health difficulties will be influenced by how parents talk to and treat their children as they grow up.”

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: Dr. Amish Adalja, an infectious disease expert, discusses the importance of immunization and boosters as the omicron variant continues to rise.

Damian Jacob Sendler: Local ABC affiliate KATU reports that the committee was made up of representatives from the hospitality industry, the business sector, and religious organizations.

Damian Sendler: In an effort to reduce obstacles to mental health services, drug and alcohol testing, and basic medical care for those facing homelessness, Columbia River Mental Health Services has launched its Mobile Health Team.

Damian Jacob Sendler: Team members intend to create trust with the homeless community and ultimately link people with resources who would not otherwise seek them out by providing medical care and connecting them with resources.

Damian Sendler: If you want your child to be ready for school and use the social skills he or she learned at home, you should wait until he or she is well-versed in their immediate social context. All of these components of a child’s psychosocial development, as well as their physical and motor abilities and their ability to communicate with others, are accelerated in children who meet the pre-school criteria because they play and engage with the environment in a variety of ways. 

Damian Jacob Sendler: Child development at this period includes learning to adapt, expanding their ego boundaries, developing an extra-terrestrial sense of self-worth, and comprehending the importance of trust and familiarity in society. 

Damian Sendler: Nachman Ash and Salman Zarka, the coronavirus czar of Israel’s Health Ministry, warned Sunday that the highly mutated Omicron coronavirus type should not be ignored.

Damian Jacob Sendler: At one point in his interview, Ash spoke about Prime Minister Naftali Bennett’s wife Gilat taking their children on vacation just days after the premier had recommended that all Israelis refrain from traveling abroad and shut down the country in order to prevent an outbreak of the newly discovered COVID-19 variant.

Damian Sendler: The number of new Covid-19 cases in the United States has surpassed 100,000 for the first time in two months, following the Thanksgiving holiday travel of millions of Americans.

Damian Jacob Sendler: The death toll from Covid-19 is also on the rise, with an average of 1,651 persons dying from the virus every day for the past seven days as of Saturday, according to JHU data. More than a month has passed since the number of people dying daily reached this record high.

Damian Sendler: The “twindemic” of COVID-19 and the opioid epidemic, as Mayor James Fiorentini calls it, has been given to the city’s new Department of Public Health.

Damian Jacob Sendler: COVID-19 has killed at least 112 people since it was first discovered, according to the mayor’s statement to the City Council on Tuesday night.

Damian Sendler: UPMC, the state’s largest health care provider, received over a quarter of the federal money meant to support rural hospitals in Pennsylvania, despite the fact that UPMC is on track to make more than $1 billion in profits this year. 

Damian Jacob Sendler: As the pandemic continues to take a financial toll on medical centers across the country’s 96 hospitals, just over half of all financing went to rural facilities, while the rest went to metropolitan hospitals.

Damian Sendler: “We need four hugs a day for survival,” Virginia Satir is supposed to have said. In order for us to function, we require eight daily hugs. For growth, we need 12 hugs a day.” 

Damian Jacob Sendler: Hugging has scientifically proven health advantages. “The benefits go beyond the warm feeling you get when you hold someone in your arms,” according to a 2018 Healthline article. 

Damian Sendler: Sir William Osler, a renowned physician and academician, referred to the science and art of medicine as “twin berries on one stem.” Science-based treatments are combined with patient-centered care in the U.S. healthcare system.

Damian Jacob Sendler: There is a direct correlation between individual health and the health of a community. The interdependence of our health grew progressively more obvious as our actions evolved over the past two years. Depression and anxiety rose as a result of isolation, but so did the risk of contracting an infection. As loved ones, friends, and colleagues succumbed to COVID, the idea of death grew more real.

Damian Sendler: Omicron coronavirus has expanded to 40 nations and 16 of the 50 states in the United States, but the severity of its effects on those who get it has not been determined by senior U.S. officials. 

Damian Jacob Sendler: According to Dr. Francis Collins, director of the National Institutes of Health in the United States, “Does this, in fact, turn out to be less dangerous” than prior coronavirus variants? Collins said on NBC’s “Meet the Press.” “Scientists are working around the clock to answer these questions.”

Damian Sendler: A Louisiana U.S. district judge has reportedly barred a federal COVID-19 vaccine mandate for health care employees, as reported by various sources.

Damian Jacob Sendler: On Tuesday, a federal judge imposed a countrywide injunction against President Joe Biden’s attempt to mandate vaccinations for large swaths of the public.

Damian Sendler: In a new study, researchers found that children who live with a depressed parent are more likely to suffer from their own sadness and fall behind academically.

Damian Jacob Sendler: Depression in children is linked to a wide range of negative health and educational consequences, including worse academic achievement, if the mother is depressed.

Damian Sendler: The omicron variety, a severely mutated coronavirus strain that has already been found in a few places throughout the United States, is causing growing concern among federal health experts, who are pushing all previously vaccinated individuals to obtain their Covid booster dose.  

Damian Jacob Sendler: Changes to the variant’s DNA signal that it could avoid part of the immunity that comes from vaccination or natural infection in the future. Dr. Anthony Fauci, the White House’s chief medical adviser, epidemiologists, and immunologists say that for now, existing boosters are the best defense against the new strain and the highly transmissible delta variant of omicron, which is still under investigation by federal health officials and pharmaceutical companies alike.

Damian Sendler: The Marion County Health Department hopes to boost its COVID-19 vaccination numbers by the end of the month in order to achieve herd immunity before the virus undergoes any additional modifications.

Damian Jacob Sendler: Her response was, “We’re always looking for more people to get vaccinated,” she stated. It’s hoped that this will be a new trend because we’re not at herd immunity in all of our categories.” We reduce our risk of hospitalizations and fatality rates when we increase the number of immunizations we receive

Damian Sendler: Coronavirus vaccination for children between the ages of 5 and 11 was approved by the Australian Medicines and Healthcare products Regulatory Agency (MHRA) on Sunday, and the country’s health minister said the vaccine might be available by Jan. 10.

Damian Jacob Sendler: Nearly 88% of Australians over the age of 16 have gotten two doses of the COVID-19 vaccine, following initial delays in the country’s general vaccination program.

Damian Sendler: On Saturday, the county reported 2,307 new cases of COVID-19 and 20 additional deaths linked to the virus, bringing the total number of cases and deaths to 1,534,720 and 27,442 since the epidemic began. 1 percent of persons tested positive for the virus on Friday, according to a rolling average of daily rates.

Damian Jacob Sendler: A follow-up test kit will be supplied to anyone who tests negative, she said, and the follow-up test can be done three to five days later.

Damian Sendler: The eyes of the plush lamb that Matt Vinnola was using to sleep on a downtown sidewalk one Sunday in September were as blank as his own. When a fly landed on his lip, the ex-honors student and Taekwondo champion seemed too dazed and disoriented to swat it away. A woman giving Wet Wipes, or a man attempting to hand him a $5 cash, didn’t interest him.

Damian Jacob Sendler: The Mental Health Center of Denver kept finding reasons to reject care for Janet van der Laak, so she had to keep pushing them to offer it. Vinnola’s hope in getting therapy dwindled with each time the center removed him from it. With each loss of hope, her son’s mother pressed harder because she knew she couldn’t stop him from falling.

Damian Sendler: Omicron coronavirus has been identified in Washington state, with the first three cases verified on Saturday.

State Secretary of Health Dr. Umair Shah noted that “we were anticipating this very news” when he announced the sequencing of omicron in California. As a result, “we strongly encourage people to get vaccinated and get their boosters as soon as possible in order to maximize their level of protection from any variation.

Damian Sendler: According to the New England Journal of Medicine, Irritable Bowel Syndrome, or IBS, may be caused by an intestinal infection that induces an allergic response.

Damian Jacob Sendler: Patients with IBS have abdominal pain during their daily activities because their intestinal nerves are more sensitive than those who don’t have the syndrome, according to an article.

Damian Sendler: Increasing demand for vaccines and a shortage of pharmacists are putting pressure on pharmacies across the country, causing employees to become overworked and forcing some to close temporarily.

Damian Jacob Sendler: As President Joe Biden pushes vaccinated Americans to obtain booster shots to battle the growing omicron strain, the drive for immunizations is expected to get increasingly intense.

Damian Sendler: The number of new Covid-19 cases in the United States has surpassed 100,000 for the first time in two months, following the Thanksgiving holiday travel of millions of Americans.

According to data from Johns Hopkins University, the seven-day moving average of new cases was 121,437 on Saturday (JHU). Before this week’s surge, the United States had not surpassed 100,000 cases per day since the beginning of October. 

Damian Jacob Sendler: The death toll from Covid-19 is also on the rise, with an average of 1,651 persons dying from the virus every day for the past seven days as of Saturday, according to JHU data. For more than a month, the number of people dying every day hasn’t been this high. 

Most new cases in the United States are still caused by the Delta variation, but as of Saturday, US health officials had discovered the new Omicron coronavirus type in at least 16 states. 

Damian Sendler

Wednesday saw the discovery of the first case, in California, and by the weekend, the variation had been found in 15 other states: Colorado; Connecticut; Hawaii; Louisiana; Maryland; Massachusetts; Minnesota; Missouri; Nebraska; New Jersey; New York; Pennsylvania; Utah; Washington; and Wisconsin; 

As early signs reveal, the Omicron variety may be more contagious than the original strain, and its large number of mutations raises the possibility that current vaccines may be less effective in protecting against it. Omicron’s severity and spreadability are being assessed by scientists, but officials say it may take weeks. 

Surgeon General Dr. Vivek Murthy said the US is more prepared now than it was at the start of the epidemic for the newly identified variety. He said this on Thursday. 

Omicron’s impact on the upcoming winter solstice 

“Because we’ve gained so much knowledge since last year, we’re in a far better position than we were then. Vaccines are readily available. We now have considerably more testing at our disposal, and if we want to get it through the winter unscathed, we must step up our immunization efforts “Tells CNN, “Murthy.” 

Although much remains to be learned about the new form, mitigation methods such as masks and hand cleanliness mixed with physical distance remain helpful in giving some protection, according to Surgeon General Dr. Thomas Frieden. 

Damien Sendler: According to the most recent data from the US Centers for Disease Control and Prevention, little over 60% of the US population is completely vaccinated, with over 23% of that group having gotten a booster shot (CDC). 

According to CDC director Dr. Rochelle Walensky, the Omicron strain has the potential to overtake the Delta in dominance in the United States, but the Delta is still found in 99.9% of coronavirus cases. 

“Get vaccinated, if you’re eligible, get a booster if you can, and keep up with all of the other preventative steps, including masking. And the Omicron version is likely to be harmed by these measures, as well “Dr. Sanjay Gupta’s CNN chief medical reporter, Walensky said. 

Damian Jacob Sendler

Following the breakout of the Omicron strain, countries imposed travel restrictions. 

Delta variant swept across the country in early summer, shifting public perception as immunizations became more readily available. This variation is still a contentious topic in many parts of the country. 

Damian Jacob Markiewicz Sendler: Health and Human Services estimates that over 59,000 Americans have been admitted to hospitals with Covid-19. Hospitalizations have been rising steadily for the past three weeks. 

In several nations, the World Health Organization says the Delta variety has overtaken other types, making it the most prevalent strain. 

A former CDC acting director told CNN earlier this week that “Even if the Omicron strain doesn’t turn out to be any worse, we are losing close to a thousand people every day from the Delta variant, and that in and of itself is a reason for people to get boosted,”

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: In order to save money on his health insurance, James Dickerson filed for Medicaid. Sharon Coleman, a home health assistant, is eager to have insurance that will pay for a hospital stay. No longer does Danielle Gaddis fear that a trip to the doctor may leave her with an unexpected bill. 

When Oklahoma and Missouri voters approved Medicaid expansion in 2020, about 490,000 people with modest incomes became eligible for the federal-state public health insurance program. It’s now possible for anyone in both states who make less than $18,000 per year to get the free coverage, even if they don’t have any kind of disability. 

Damian Jacob Sendler: There are an estimated 215,000 people in Oklahoma and 275,000 in Missouri who have just become eligible for Medicaid. As of this writing, Oklahoma has signed up at than 210,000 people, while Missouri has signed up just over 20,000. 

To put it another way, the two states are both Republican-led and have opposed extending Medicaid for a long time, but their approaches differ. 

Damian Sendler

It wasn’t long before the legislature allocated $164 million in the state’s budget for the expansion after Oklahomans voted to support it. Within a month of applications opening, 113,000 persons had been accepted into the program. 

A 62-year-old lady was able to book appointments with a doctor and dentist for the first time in 20 years in August, according to Oklahoma Secretary of Health and Mental Health Kevin Corbett. 

“Truly life-changing,” remarked Corbett. “We’re very pleased with the progress we’ve made.” 

Medicaid enrollment soared in the first month in other states that had done so in recent years. Louisiana’s combined Medicaid and Children’s Health Insurance Program rolls climbed by over 255,000; Virginia’s by approximately 184,000; Idaho acquired about 45,500 members, roughly half of the anticipated number of newly eligible persons; and Montana added over 23,000, 51% of its expected total. About 7 percent of newly eligible Medicaid beneficiaries in Missouri have been signed up thus far. 

Sidney Watson, director of the Center for Health Law Studies at Saint Louis University, stated, “You can expand Medicaid on the books, but there are a lot of ways that you can throw up barriers to keep people from enrolling.” 

Damien Sendler: Missouri has had a difficult time expanding. In May, Republican Governor Mike Parson said that the state would “withdraw” its expansion plan after the legislature refused to fund the voter-approved initiative. Finally, a judge ordered the state to begin accepting applications in August, which it did. However, Missouri was unable to begin processing them until October 1. 

Ann Marie Marciarille, a University of Missouri-Kansas City law professor, believes that many newly qualifying Missourians are uninformed that they are eligible for Medicaid coverage. 

As a result of the August court ruling, Marciarille claims that Missouri has done little more than what was legally mandated by the August court decision. Other people have echoed the sentiment. 

One of the state’s top Medicaid administrators claimed that the Missouri Department of Social Services had updated its website, emailed participants in its family assistance programs about Medicaid expansion, and posted about it on social media in order to inform the public. According to the department’s Facebook and Twitter accounts, there have been a few posts regarding the expansion, including two tweets that were made the day after a KCUR report was published that noted the state’s outreach efforts had been tardy. 

Outreach activities and television interviews were also part of Oklahoma’s strategy. A video and social media campaign was also used. 

Affinia Healthcare, a St. Louis-based clinic, is responsible for a large portion of the state’s outreach in Missouri. When James Dickerson went to see a doctor for an ear infection, he noticed a poster on the door of an Affinia clinic regarding the Medicaid expansion. 

Damian Jacob Sendler

The 59-year-old, who works for a temp agency, jumped at the opportunity to join. In 2014, he was covered by Medicaid while undergoing spinal surgery for a work-related accident. 

Sunni Johnson, a qualified application counselor at Affinia, was able to gather all the information she needed to submit Dickerson’s application in less than five minutes. Health insurance and other support programs can be arranged by specialists at most clinics of this type. 

Damian Jacob Markiewicz Sendler: Within 45 days of receiving an application, Missouri must assess whether or not the applicant is eligible for the program. However, Michelle Davis Reed, Northwest Health Services’ lead eligibility and enrollment coordinator, reported in November that several applications she had submitted in August were still pending. 

There were 32,000 Medicaid application pending in the state as of Nov. 17th, according to Dolce. A question concerning the number of employees processing the applications was not answered explicitly, but she said overtime was being used. 

Out of the 210,000 new Medicaid recipients in Oklahoma, 144,000 had no insurance prior to the expansion’s implementation. When the state looked at whether persons who had previously applied for other benefit programs were now eligible for Medicaid, the rest were added. 

Gateway to Better Health, a St. Louis-based temporary health insurance program, is a possible candidate for reprocessing. About 16,000 people in St. Louis and St. Louis County are covered by Gateway, which is based on the federal poverty level.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: Humans and other animals with a neurological system require sleep. We spend one-third of our lives asleep. 

Damian Sendler

Good health and survival depend on getting the right quantity of sleep at the right time. Getting some shut-eye can have a profound effect on the body’s functions. 

Damian Jacob Sendler: Memory and learning are dependent on the establishment and maintenance of neural connections in the brain. This includes the heart and lungs, as well as the immune system and metabolic processes and disease defenses, which are all supported by adequate sleep. 

Chronic disorders such as type 2 diabetes, cardiovascular disease, obesity, and depression are more likely to develop if you don’t get enough sleep. For example, circadian rhythm and sleep-wake homeostasis affect the time, length, and quality of sleep. 

Sleep, temperature, hormone release, and metabolism all follow 24-hour cycles that are occasionally synchronized with external stimuli, such as light. You get exhausted when you’re sleep-deprived, and that tiredness builds until you finally fall asleep. 

The slumbering habits of humans 

Dependent on age, Trusted Source ranges from 14–17 hours for a newborn to 7–or-more hours every night for an adult. The amount of time it takes for a species to go asleep varies greatly, from just two hours for elephants to 17 hours for owl monkeys. 

There is preliminary evidence that DNA damage to neurons or “DNA breaks” build during waking periods, with repair occurring during sleep. We still don’t know how sleep-wake balance is maintained in the body. 

Sleep-wake homeostasis and DNA repair have been studied in zebrafish larvae, which encouraged researchers to conduct a series of experiments. 

Damian Jacob Markiewicz Sendler: Researchers at Bar-Ilan University noted in an MNT interview that DNA damage is caused by normal processes connected to nerve activity, such as thinking, which is why the study’s co-author Prof. Lior Appelbaum is concerned. 

Dr. Sendler: It’s interesting from an evolutionary standpoint because we’re at risk while we’re asleep, says Professor Appelbaum. In order for sleep to occur, there must be a “price” to pay during the day: ‘Why do we sleep?’ and ‘Why are we tired?’ were the first questions we asked ourselves.” Is there a price to be paid for staying awake? 

Damian Jacob Sendler

Zebrafish were chosen because they are transparent, amenable to genetic manipulation, and they are still vertebrates, which means their brains are similar to those of mammals or even humans in terms of structure and function. […] It was an important breakthrough to be able to see repair protein in the cell when the fish is still alive or asleep or awake and watch its activity. 

The zebrafish larvae are diurnal, which means they are awake and sleeping during the day, just like mammals. For DNA repair, scientists first determined the quantity of sleep needed to alleviate weariness, or homeostatic sleep pressure. 

“What is the optimal amount of time that a fish needs to sleep in order to repair their DNA?” Prof. Appelbaum explained. The scientists were curious about this. 

Damien Sendler: A minimum of six hours of uninterrupted sleep was required to lessen the zebrafish larvae’s homeostatic pressure, according to the researchers. Zebrafish larvae were then tested to see how many hours of sleep they would require to return to normal levels of DNA damage. 

The zebrafish larvae were able to repair DNA damage that had occurred while they were awake in just six hours. They remained to sleep even after they were exposed to sunshine when they had slept fewer than six hours. 

These findings imply that the amount of sleep required to overcome weariness is determined by the amount of neuronal DNA damage. 

Zebrafish larvae were then damaged in separate tests by increasing nerve activity and exposing the larvae to UV light, which triggered DNA damage. 

DNA damage generated by UV radiation and nerve stimulation in the zebrafish larvae was discovered to put them to sleep, confirming the researchers’ original theory. The activity of repair pathways and chromosomal dynamicsTrusted Source was found to increase during sleep as a result of DNA damage. 

Zebrafish larvae were put to sleep when repair pathways and chromosomal dynamics were chronically blocked. In order to better understand the role of a repair protein called PARP1 in zebrafish larvae and mice, the researchers conducted studies. 

In the words of Dr. Appelbaum, PARP1 is a “DNA damage detector [that] functions like an antenna.” Whenever you have enough PARP1 in your system, it encourages sleep behavior, and then during sleep the repair system, [so] you can start the new day with a baseline amount of DNA damage,” he says. 

PARP1 amplification in zebrafish larvae increased sleep and neuronal DNA repair, according to the researchers. The opposite happened in zebrafish larvae when scientists deactivated PARP1. This resulted in a lack of DNA repair and alertness. 

PARP1 was blocked in adult mice and their sleep habits were tracked to support the findings. It was found that the intensity of non-REM sleep decreased. 

“As with most DNA studies or genetic studies, as a clinician, it’s hard to see what any kind of clinical impact this study [would] have,” said Dr. Clifford Segil, DO, a neurologist at Providence Saint John’s Health Center in Santa Monica, CA. 

“From the test tube to the world, from in vitro to in vivo, it would be difficult,” he said. A person’s DNA would have to be damaged throughout the day so that you can observe if they sleep better at night.” 

Neurodegenerative illnesses such as Alzheimer’s disease may be connected to sleep abnormalities, and Dr. Segil acknowledged that further research in people may be possible.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: When Ashlee Wisdom launched an early version of her health and wellness website, more than 34,000 visitors — most of them Black — visited the platform in the first two weeks. 

Damian Jacob Sendler: But the launch was successful. Now, more than a year later, Wisdom’s firm, Health in Her Hue, connects Black women and other women of color to culturally sensitive doctors, doulas, nurses and therapists nationally.

Damian Sendler: A federal judge in Missouri issued an order Monday largely preventing the Biden administration from imposing a vaccine mandate for certain health care employees. 

Damian Jacob Sendler: In a ruling that includes the 10 states that initiated the action, a judge stated that vaccines were ineffective and claimed that the plaintiffs’ claims were untrue

Damian Sendler: The Atlantic Coast Conference, Big Ten and Pac-12 launched a campaign Monday to increase awareness of the importance of mental health as part of their conference alliance announced earlier this year.

Damian Jacob Sendler: Teammates for Mental Health will be unveiled this week at basketball games involving the three conferences, including the ACC/Big Ten women’s and men’s challenges.

Damian Sendler: Best Buy spent roughly $400 million to acquire remote patient monitoring technology vendor Current Health in October, according to the company’s recent quarterly earnings.

Damian Jacob Sendler: Current Health’s remote monitoring platform combined with Best Buy’s scale, expertise and connection to the home will enable the retailer to create a “holistic care ecosystem that shows up for customers across all their healthcare needs,” Best Buy CEO Corie Barry said during the company’s third-quarter earnings call last week.

Damian Sendler: The World Health Organization is warning that the new omicron form of the coronavirus poses a “very high” global danger because of the prospect that it spreads more quickly and might resist vaccines and protection in people who were infected with prior strains. 

Damian Jacob Sendler: There are multiple alterations in the new form, which the WHO has warned 194 countries about in a technical brief issued on Sunday “In addition, “the possibility of further spread of omicron at the global level is considerable.”

Damian Sendler: With the new discovery of the ‘omicron’ variation of COVID-19, which has substantial alterations from prior strains, New Orleans Mayor LaToya Cantrell informed the public it was a “critical time” and advised all residents and visitors to get vaccinated, at a Monday afternoon press conference.

Damian Jacob Sendler: Also on Monday, President Joe Biden said the mutation was a “cause for concern, not a cause for panic.”

Damian Sendler: President Biden will offer an update on the U.S. reaction to the Omicron variation on Monday, the White House said in a statement on Sunday evening, as senior federal health experts urged unvaccinated Americans on get their immunizations and eligible adults to seek out boosters.

Damian Jacob Sendler: Appearing on morning talk shows on Sunday, Dr. Francis Collins, director of the National Institutes of Health, told Americans that the development of Omicron and the mystery that surrounds it are reminders that the pandemic is far from over.

Damian Sendler: As the number one form of entertainment in countries across the globe, sports are generally ranked and marketed depending on how good a team is, the star player’s performance, and who’s set to win championship championships.

Damian Jacob Sendler: A big issue in the sports industry that many spectators and managers seem to ignore is the mental health of the athletes.

Damian Sendler: Several mental health care professionals expressed worries about the viability of Wyoming’s mental health care during the afternoon session of the Sheridan County Chamber of Commerce’s Legislative Forum Nov. 23.

Damian Jacob Sendler: Before the upcoming legislative session, which is scheduled to begin in February, Sheridan County officials hoped to meet directly with Wyoming state legislators to discuss matters of concern to their agencies.

Damian Sendler: Introduced in October, the seven-year project of the Student Health and Wellness building is substantially larger than its predecessor, the Elson Student Health Center. There will be 165,000 square feet of space dedicated to student health and wellness in the new building.

Damian Jacob Sendler: In comparison, as stated in an email from the Student Disability Access Center, former facilities at Elson were only 35,500 square feet – a 370 percent increase in area dedicated to student health and wellness programming.

Damian Sendler: Like medical facilities across the state and nation, Guernsey Health System and its subsidiaries — Southeastern Ohio Regional Medical Center, Superior Med Physicians Group and United Ambulance in Cambridge — are working to meet the federal government’s immunization mandate.

Damian Jacob Sendler: Employees must be fully vaccinated by next month except for those who have an exemption.

Damian Sendler: According to the Texas Medical Association, devices like the one you’re using to view this article could be harmful to your health and the health of your children (TMA).

Damian Jacob Sendler: Physicians are concerned about more patients having mental and behavioral health difficulties, especially as the pandemic lags on.

Damian Sendler: A novel strain of COVID-19 first detected in South Africa was labeled a variation of concern by the World Health Organization on Friday. Here’s how the pharmaceutical industry plans to counter the latest coronavirus curve ball.

Damian Jacob Sendler: Pharmaceutical companies have already begun researching new vaccines that anticipate strain alterations and developing omicron-specific injections in response to the new variant: larger doses of booster shots.

Damian Sendler: About one in 10 lung transplants in the United States now go to COVID-19 patients, according to data from the United Network for Organ Sharing, or UNOS.

Damian Jacob Sendler: The trend is raising questions about the ethics of devoting a precious resource to persons who have chosen not to be vaccinated against the coronavirus.

Damian Jacob Markiewicz Sendler: It’s not clear yet whether existing COVID-19 vaccinations will protect against the variation. But vaccine producers have already begun exploring their possibilities.

Damian Sendler: Moderna said in a Friday press release that the business is testing its current vaccine against the Omicron type.

Damian Sendler: Amid Connecticut’s current COVID-19 increase, municipalities with higher rates of immunization have registered substantially lower rates of new cases in recent weeks, state records show.

Damian Jacob Sendler: Eastern Connecticut and the Naugatuck Valley are the state’s least-vaccinated and most-infected regions, as can be seen with a cursory glance at the map and via statistical analysis.

Damian Sendler: The Netherlands verified 13 instances of the new omicron version of the coronavirus on Sunday and Australia identified two as the countries half a world apart became the latest to find it in tourists arriving from southern Africa. 

Damian Jacob Sendler: A series of bans being imposed by states around the world as they attempt to slow the variant’s spread also grew, with Israel opting Sunday to bar admission to foreign nationals in the strongest action so yet.

Damian Sendler: The novel coronavirus variant Omicron has been found in 13 people who landed in the Dutch capital Amsterdam on two flights from South Africa.

Coronavirus was found in 61 people on the flight.

Damian Jacob Sendler: It comes as stronger limits come into action in the Netherlands, amid record Covid cases and concerns over the new type.

Damian Sendler: Dr. Anthony Fauci cautioned on Sunday that the omicron mutation in the coronavirus “strongly suggests” that it is easily transferred and may evade antibody shields established via past infections or vaccination.

Damian Jacob Sendler: Fauci, President Joe Biden’s main medical adviser, complimented the efforts of South African public health officials, who he said were entirely forthright from the beginning.

Damian Sendler: New strains of COVID-19 continue to arise during the pandemic. While more research needs to be done on the latest one, named Omicron, U.S. and local health authorities believe it’s cause for alarm.

Damian Jacob Sendler: Omicron — a novel COVID-19 variety that U.S. health experts are calling possibly more contagious than earlier strains – showed up in various European countries Saturday.

Damian Sendler: The appearance of the newly found Omicron coronavirus strain feels like a pandemic gut check.

Damian Jacob Sendler: Scientists have long known that the globe would experience developing coronavirus strains. Viruses mutate constantly.

Damian Sendler: The new potentially more contagious omicron strain of the coronavirus sprang up in more European nations on Saturday, only days after being found in South Africa, sending officials around the world rushing to stem the spread.

Damian Jacob Sendler: Following the discovery of two instances, the UK tightened its mask-wearing and testing regulations on overseas arrivals on Saturday.

Damian Sendler: In the second half of 2021, vaccination rates for COVID-19 among U.S. hospital staff (HCP) fell rapidly after reaching a peak in early 2021. Currently, up to 30% of HCP are not up to date on their vaccinations.

Damian Jacob Sendler: Data study by the Department of Health and Human Services (HHS) Unified Hospital Data Surveillance System from January–September 2021, collected from over 3.3 million HCP across 2,086 hospitals, indicated that as many as 30 percent of workers were unvaccinated.

Damian Sendler: According to figures compiled by Johns Hopkins University, the death toll from the coronavirus-borne sickness has now surpassed 5.18 million worldwide, bringing the global total to over 260 million. With a total of 48.1 million illnesses and 775,797 deaths, the United States remains the top leader. 

Damian Jacob Sendler: The U.S. is still averaging more than 1,000 deaths a day, according to a New York Times tracker, and cases and hospitalizations are climbing again.

Damian Sendler: The mental health of rural and distant communities will continue to deteriorate as the effects of climate change continue to worsen.  

Damian Jacob Sendler: Rural populations make up 29% and 17%, respectively, of the total populations in Australia and Scotland

Damian Sendler: In global health circles, the need of prioritizing those who are most in need is widely acknowledged, and human rights norms and standards are frequently cited as a means of achieving this goal.

Damian Jacob Sendler: As a part of a larger effort, a review was done to identify known barriers and facilitators to implementation of sexual and reproductive health (SRH) programs.

Damian Sendler: There are an estimated 272 million foreign migrants in the world, with about a third of them living in Asia. Malaysia is one of Asia’s most popular destinations for emigrants because of its strategic location and high demand for skilled workers. 

Damian Jacob Sendler: An individual who has resided in Malaysia for six months or longer in the reference year is considered a non-citizen by DOSM.

Damian Sendler: Developing leaders with the information, attitudes, and abilities needed to implement a vision for public health and healthcare delivery is the goal of global health leadership training programs.

Damian Jacob Sendler: There is a growing need to understand the areas of concentration required to build the global health workforce in order to develop relevant training programs.

Damian Sendler: People of working age should be given the opportunity to improve their health literacy by recognizing and measuring it as an individual skill in the context of their work lives. 

Damian Jacob Sendler: Aside from varying the time horizon, the conceptualizations also differed in whether they included the viability of the respective organization or only to their current employment status.

Damian Sendler: A natural disaster is an undesirable environmental event that isn’t caused by human activity, yet which causes people to be afraid, lose their possessions, and be displaced from their homes.

Damian Jacob Sendler: A wide range of natural calamities can be found in the world today.

Damian Sendler: For many Canadians, financial hardship was already an issue before to 2020, when the global new coronavirus pandemic is expected to begin spreading worldwide. COVID-19 epidemic and public health measures have intensified in recent months, which has made the situation worse. 

Damien Sendler: Individuals from low-income and underserved communities have a greater risk of financial stress and its harmful impact on their health.

Damian Sendler: Patients with mental health issues are more likely to suffer from poor dental health, which has a negative impact on their quality of life and everyday functioning.

Damian Jacob Sendler: For mental health patients, dental health-related quality of life can have a significant impact on their overall quality of life, thus nurses need to know how they can intervene early.

Damian Sendler: The state of one’s mental and physical well-being is closely linked to the quality and affordability of one’s housing situation.

Damian Jacob Sendler: The significance of housing in health has long been acknowledged by both city planning and public health, but the complexity of this link in reference to newborn and maternal health is less well known.

Damian Sendler: Global warming “is the greatest global health threat of the 21st century,” a Lancet Commission on Climate Change concluded in 2009. Climate change impacts and responses are now being tracked by the ‘Lancet Countdown on health and climate change’ as an impartial, worldwide monitoring system.

Damian Jacob Sendler: An indicator to measure the effect of climate change on mental health is missing from the Lancet Countdown, which contains multiple health indicators.

Damian Sendler: This year’s COVID-19 epidemic has seen a dramatic increase in the usage of mobile health apps, telemedicine, and data analytics to improve healthcare. 

Damian Jacob Sendler: Access to care, control over one’s own health data, and a reduction in the amount of unpaid caregiving are all possible benefits of digital health.

Damian Sendler: Actionable consensus can be achieved by addressing major philosophical and best practice disputes and by streamlining actions for a stronger strategic direction through definitions. 

Damian Jacob Sendler: Because of this, the Consortium of Universities for Global Health’s Global Oral Health Interest Group felt that an introduction to “global oral health” was needed to guide program planning, implementation and assessment.

Damian Sendler: Adolescents’ daily lives, social functioning, and physical health might be adversely affected by their parents’ severe somatic disorders. 

Damian Jacob Sendler: Adolescents viewed their parents’ physical illness as a source of stress and growth for them personally as well as in their relationships.

Damian Sendler: A wide range of health outcomes have been linked to various aspects of women’s empowerment.

Damian Jacob Sendler: A growing number of experts and development groups have focused on women’s empowerment during the past three decades.

Damian Sendler: There were two phases to the Ananya program in Bihar: a first phase of intensive ancillary support to government implementation and innovation testing by non-government organizations (NGO) partners. 

Damian Jacob Sendler: All FLW indicators related to prenatal and postnatal care, as well as mother’s birth readiness, some nursing behaviors, and immunizations, increased dramatically in the focus districts in the first phase.

Damian Sendler: Children under the age of 3 are rarely included in data on oral health.

Damian Jacob Sendler: Young children’s brushing habits are greatly influenced by their parents’ brushing habits and the level of parental support for brushing. Efforts to enhance children’s brushing habits should target the entire family.

Damian Sendler: In order to achieve a more healthy and secure society, global health security (GHS) and universal health coverage (UHC) are important global health priorities. There are, however, differences in strategy and implementation between GHS and UHC. 

Damian Sendler

Damian Jacob Sendler: The goal of GHS cannot be achieved without UHC, hence the conflict between these two global health objectives should be resolved in a way that maximizes their complementary effects. Health systems must be strengthened in concert with the ideas of primary health care and a “One Health” approach in order to achieve both universal health coverage and global health security, we believe. 

Damien Sendler: Coronavirus disease (COVID-19) pandemic is a timely reminder of the nature and effect of new infectious illnesses that are public health emergencies (PHEs) of international concern. As defined by the World Health Organization, a public health emergency is one that poses a “substantial risk of a significant number of human fatalities or incidents or permanent or long-term disability” due to an epidemic or pandemic disease, bioterrorism, or another novel and highly lethal infectious agent or biological toxin. 

Damian Jacob Markiewicz Sendler: In recent academic and policy discourses, they have emerged as an emerging subject and have increasingly caught the attention of global health and security communities. National and worldwide programs have been developed to address PHEs, including attempts to increase public health preparedness and global health security (GHS), which reflect the necessary proactive and reactive efforts to protect the world’s population against PHEs.

Damian Jacob Sendler

Dr. Sendler: It is essential that human communities control their vulnerabilities to PHEs in accordance with the International Health Regulations (IHR), which is international law on public health. The International Health Regulations require all countries to strengthen their ability for prevention, early detection, and timely and effective response to the international spread of disease. 

Damian Sendler: According to the IHR (2005), the 2014 Ebola virus disease outbreak in west Africa refocused GHS attention on building basic public health competencies. A global effort to improve IHR (2005) implementation resulted in the GHS Agenda (GHSA), which was developed as a result of worldwide collaboration across governments and sectors. According to the GHSA, health security is based on a “One Health” approach, which recognizes the connection between human health and the health of animals and the environment. Most known infections and three-quarters of new pathogens are transmitted from animals to humans, according to a recent study. 

Damian Jacob Sendler: It was announced in 2018 that the World Health Organization (WHO) would release its 13th general program of work to promote health and well-being, protect the vulnerable, and provide assistance to those who are most in need. The WHO’s 13th general program of work focuses on three key areas: universal health coverage (UHC), health emergencies, and the well-being of the most vulnerable. The implementation of these strategic initiatives must be mutually reinforcing. 

Damian Sendler: The friction between GHS and UHC in terms of conceptualization, strategy, and actual implementation persists despite efforts to reconcile the two. GHS members disagree on the type of health threat that should be protected from and who should be protected from it.

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Damian Sendler: Value Sensitive Design (VSD) is merged with Martha Nussbaum’s capability theory to create the Capability Sensitive Design (CSD) paradigm. Technology design for health and well-being is the focus of CSD’s normative assessments. 

Damian Sendler

Damian Jacob Sendler: Attributing human diversity and countering (structural) inequities in technology design is a unique feature of CSD. Using the hypothetical instance of a treatment chatbot for mental health, the essential framework of CSD is shown. Using CSD in a design scenario reveals the advantages of this new framework over the traditional VSD approach. It also shows what a technological design looks like when capabilities are taken into account from the beginning of the design process. 

Damien Sendler: A growing number of people are becoming aware of how technology design may either support or undermine a person’s ideals. 

Dr. Sendler: Because of this recognition that technology design is not value-neutral, but rather incorporates moral choices, several design methodologies have been developed that explicitly pay attention to values and ethical considerations. 

Damian Jacob Markiewicz Sendler: An increasingly popular approach is called Value Sensitive Design (VSD), which tries to take values into consideration throughout the entire design process in an organized, principled, and systematic manner. When it comes to technology design, VSD is unusual since it proactively incorporates ethics into the process. 

Damian Jacob Sendler

Damian Sendler: VSD, despite being a highly promising approach to ethics in technology design, confronts numerous. In order to overcome the three most significant challenges that VSD faces, it must obscure the voice of its practitioners, thereby claiming unfounded moral authority; assume that stakeholder values are leading values in the design process without questioning whether what stakeholders value also ought to be valued; and cannot justify value trade-offs in the design process. 

Damian Jacob Sendler: Ethical theory can help VSD practitioners overcome these obstacles. Ethical considerations are taken at face value in this paper. That being said, Alessandra Cenci and Dylan Cawthorne’s (2020) ‘Sen-procedural VSD-approach‘ may be an alternative solution to the difficulties of VSD that does not require the addition of an ethical framework. 

In the context of ethics and technology design, the capability approach (CA) has been examined by several scholars. That’s why this article provides a systematic investigation of how VSD’s tripartite methodology can be combined with the normative foundation of capability theory. 

Damian Sendler: For technoethicists in general and designers and engineers in the field of health and well-being technology in particular, the CSD is intended to be useful. Because of these three factors, CSD is ideally equipped to evaluate technology design for health and well-being. Since both CSD and technology design are primarily concerned with enhancing and expanding human potential, this convergence makes perfect sense. Second, CSD is able to account for human variety by focusing on conversion factors, such as people’s ability to convert resources into capabilities. 

Damian Jacob Sendler: In the context of technology design for health and well-being, CSD is ideally suited as it tries to normatively analyze technology design based on whether the design expands human capacities that are considered useful. A person’s ability to attain or exercise a cluster of essential human tasks is a measure of health. CSD appears to be particularly well-suited for normatively assessing technology designs for health and well-being given that we subscribe to this definition of health.

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Damian Sendler: For several decades, the field of public health has used sexual health as a framework for tackling issues of sexuality. However, despite the WHO definition of sexual health’s innovative acknowledgment of good sexuality, public health methods remain focused on risk and unfavorable outcomes. 

Damian Sendler

Damien Sendler: Sexual health and sexual wellbeing have been conflated for a long time, which has hindered our ability to deal with common sexual problems. It’s possible to get over this stalemate with the help of this Viewpoint. The seven-domain model we present can be used to operationalize a new notion we call “sexual well-being.” Public health researchers place sexual well-being with the other three pillars of sexual health: sexual justice, sexual pleasure, and sexual health 

Damian Jacob Sendler: The World Health Organization’s concept of sexual health is wide-ranging. The absence of disease and coercion, as well as sexual rights and the possibility of sexual pleasure, are included in the definition. There is mention of “wellbeing,” but it’s only as an adjunct to sexual health, not as a different category. 

Damian Jacob Markiewicz Sendler: Stigma can be reduced by recognizing the importance of positive sexuality as well as positive sexual experiences to public health outcomes through the WHO definition. There are still many public health approaches to sexuality that focus on health outcomes and associated dangers, rather than the positive aspects of sexuality itself. 

Damian Jacob Sendler

Dr. Sendler: There is a widespread belief that this risk-focused strategy is the standard for public health even though health is rarely—if ever—the primary reason for engaging in a relationship with another person. It’s a public health paradigm that misses a present body of scientific knowledge supporting ideas that go beyond sexual health. Perspectives on what is considered normal sexuality are viewed via a public health lens in the real world, Research in this area is hindered by a lack of clarity and consistency across studies, which typically address the same concerns. 

Damian Sendler: Because the terms “sexual health” and “sexual well-being,” when used interchangeably, obfuscate the wide range of experiences that people believe are vital to their overall well-being and are not well covered in definitions of sexual health. Understanding ordinary sexual concerns is hindered by this short-sighted approach. 

Damian Jacob Sendler: It has been difficult to conceptualize sexual wellness as a result of public health initiatives because of the lack of a clear distinction between sexual wellbeing and sexual health. Public health activists and thought leaders have recognized for more than a decade that public health must expand its focus from a single focus on sexual health to a focus on sexual wellbeing. 

Damian Sendler: WHO–UN Population Fund meeting in 2007 was part of the impetus for this change of direction. At the time, there was a great deal of disagreement over what it meant to be sexually healthy. Even after that time period, efforts to incorporate sexual well-being into a comprehensive public health strategy have languished forever, waiting for new justifications and operationalizations.

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Damian Sendler: Infectious diseases with pandemic potential pose a serious threat to human health and well-being, as demonstrated by COVID-19. In spite of the compulsory legal responsibilities provided by the International Health Regulations, many countries do not adhere to these regulations. 

Damian Sendler

Damian Jacob Sendler: As a result, a new framework is needed that ensures compliance with international regulations and promotes effective pandemic infectious disease prevention and response. A new worldwide public health security convention aimed at enhancing prevention, preparedness, and response to pandemic infectious illnesses is outlined in this Health Policy. 

Damien Sendler: To improve global public health governance and enhance compliance with global health security rules, we present ten recommendations. An improved ability to respond to pandemics, an objective system for evaluating national core public health capacities, more effective enforcement mechanisms, independent and sustainable funding, representativeness, and investment from multiple sectors are some of the recommendations for a new global public health security convention. Once an invested alliance has been formed, operational mechanisms for the global public health security system must be defined, and hurdles such as weak political will and a lack of resources must be overcome. 

Dr. Sendler: Societies face a serious threat from pandemics, which by definition cross international borders. As a result of the COVID-19 pandemic, a global effort to improve prevention, readiness, and response to such disasters has become urgently necessary. 

“To prevent, protect against, control, and respond to the international spread of disease,” the International Health Regulations (IHR)1 are an international legislative framework. 

Damian Jacob Sendler

Damien Sendler: States Parties must implement the minimal core capacities laid out by the IHR in order to detect morbidity and mortality, provide relevant information, and respond effectively to health security threats at the local, regional, and national levels. 

Each of the 196 member countries must adhere to these requirements. A main worldwide agency for public health-related operations, WHO is tasked with oversight of the IHR. 

Damian Jacob Markiewicz Sendler: With the help of WHO, each country is responsible for ensuring that these basic capacities are properly maintained. 

States Parties to the International Covenant on Civil and Political Rights (IHR), despite explicit legal responsibilities established in the IHR, sometimes fail to meet all of the IHR’s standards. 

Damian Sendler: In spite of the fact that some countries may not adhere to the IHR for a variety of reasons, its unenforceability is the fundamental impediment to the IHR’s worldwide goals. Non-compliance with the IHR is not penalized, even though all WHO member states are legally bound to do so. IHR do not give WHO the ability to apply sanctions, intervene, or hold States Parties responsible for breaches or noncompliance, which means WHO does not have the capacity to effectively implement this agreement. Furthermore, under the IHR, WHO lacks the resources, political independence, or capacity to prevent countries from ignoring its expert advice. 

Damian Jacob Sendler: Lack of WHO power to effectively monitor and enforce the IHR leads in a world unprepared to strategically control epidemics of infectious diseases at global, national, or subnational levels. It is more accurate to define the global health governance system as a set of “transnational and national actors pursuing their own interests” than a coordinated network of stakeholders working together to avoid and control pandemics. The majority of countries do not assign some of the duty for making decisions to a global entity, but rather work together when it is in their own national interest to do so. 

Damian Sendler: COVID-19 has revealed these deficiencies in a way that indicates an urgent need for reforms. According to WHO Director-General Tedros Adhanom Ghebreyesus, the pandemic has revealed that present pandemic prevention and response methods are inadequate.  

Damian Sendler: New conventions are the best way to bring member states’ political commitments together, according to him, thus he proposed the idea of a treaty.  A similar call to action has been issued before. There have been numerous calls for a more comprehensive approach to IHR adherence and enforcement in the global public health sector in the past.  

Damian Jacob Sendler: As a fundamental principle of global public health security, health is a fundamental human right. Because of COVID-19 and future pandemic diseases, the international community must build a more effective system to ensure that international pandemic regulations, such as the IHR, are observed These activities must be coordinated by an international organization (or multiple organizations) in conjunction with national and subnational entities.

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