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May is is proair same as ventolin Mental how to buy ventolin in usa Health Awareness Month. Many people in modern society seem to have a perception that the world is divided into two categories when it comes to mental health conditions. Those who how to buy ventolin in usa have them and those who donât. This mentality leads to all sorts of problems, including stigma.
According to the American Psychiatric Association a stigma is a pervasive negative perception of people with mental health conditions. They identify three types of stigma how to buy ventolin in usa. Public stigma â the negative attitudes others have concerning mental health disordersSelf-stigma â the negative attitude one has about their own mental health, which can show up as internalized shameInstitutional stigma â includes government or organizational policies that limit opportunities for those with mental health conditions, either intentionally or unintentionally Humans have a tendency to divide the world into âusâ andâthem,â no matter what the topic is. People will put down âthemâ in some way,to perceive âthemâ as not as good as âus.â This is true for mental healthconditions as well as many other characteristics.
Mental health issues haveadditional complexities how to buy ventolin in usa involved with the perception. Often people are uncomfortable with mental illness becausethey donât understand it. Mental health conditions can result in behaviors thatlook bizarre or seem strange to some people. This is how to buy ventolin in usa especially true forpsychotic disorders.
But people are often uncomfortable even with symptoms relatedto depression or anxiety, which are very common disorders. This may be becausewhen people put all mental health conditions into one category and thatcategory is associated with bizarre behavior they are likely to want to avoidit how to buy ventolin in usa. When people divide the world into two categories and perceive the âother,â those with a mental illness, as somehow strange, they are not only perpetuating stigma and setting themselves up to treat others poorly, but they are also putting themselves at risk to feel shame when they, themselves, may struggle with a mental health condition, which they are likely to experience at some point. According to the World Health Organization, 46 percent of people will experience a mental health condition at some point in their life.
When how to buy ventolin in usa people feel ashamed of their mental health status or repeatedly hear messages that they should feel shame, itâs less likely theyâll seek the care they need. According to the Centers for Disease Control and Prevention, embarrassment is one of the many barriers that stop people from seeking treatment. In fact, only about 20 percent of adults with a mental health condition actually seek treatment. There how to buy ventolin in usa are many things people can do to reduce stigma.
It beginswith each person looking at how they think about mental health conditions.Instead of compartmentalizing the world, it is useful to recognize that everyperson is human and all humans have struggles at times. Sometimes thesestruggles interfere with functioning. When this disruption of functioning isgreat enough it may be how to buy ventolin in usa diagnosed and may benefit from treatment. People can also talk about it.
Being open and honest about your own mental health can help others how to buy ventolin in usa feel comfortable opening up about what they might be going through. People need to be careful with words. Using real mental health conditions as negative adjectives sends a message that those diagnoses arenât taken seriously and arenât worthy of seeking treatment for. People should educate how to buy ventolin in usa themselves.
Learning more about mentalhealth conditions and available treatments can help people to be betterprepared to help friends and family by recognizing symptoms of mental healthconditions, and recognizing and accepting in themselves. There is no shame in seeking help for a mental health issue.In fact, seeking treatment is a commitment to yourself and for everyone youlove. Recognizing that there is no shame in mental how to buy ventolin in usa health struggles will resultin reduced stigma and increased compassion for yourself and others. All humans have struggles.
Itâs part of the human condition.Recognizing this can help people to be honest and accept others, andthemselves, without shame. For those who are struggling, MidMichigan Health provides aPsychiatric Partial Hospitalization Program at MidMichigan Medical Center âGratiot. Those interested in more information about the PHP program may call(989) 466-3253. Those interested in more information on MidMichiganâscomprehensive behavioral health programs may visitwww.midmichigan.org/mentalhealth..
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They contain Health Canada authorization dates for all drugs dating back to 1994 ventolin hfa purchase that have received an NOC. All NOCs issued between 1991 and 1993 can be found in the NOC listings. Please note any Portable Document Format (PDF) files visible on the NOC database are not part of the data extracts. For more information, please go to the Read ventolin hfa purchase Me File.
Data Extracts - Last updated. September 4, 2020 Copyright For information on copyright and who to contact, please visit the Notice of Compliance Online Database Terms and Conditions.On this page BackgroundIn the summer of 2018, several medications containing the active ingredient Valsartan were recalled in Canada and elsewhere in the world. This was ventolin hfa purchase because the nitrosamine impurity, N-nitrosodimethylamine (NDMA), was found in the active pharmaceutical ingredient (API). APIs are the substances in pharmaceutical medications that are responsible for the beneficial health effects experienced by patients or consumers.
Since then, some other medications made by different manufacturers have been found to contain NDMA or other similar nitrosamine impurities, such as. N-nitrosodiethylamine (NDEA) N-nitrosodiisopropylamine (NDIPA) N-nitrosomethyl-n-butylamine (NMBA)About nitrosamine impuritiesBased primarily ventolin hfa purchase on animal studies, nitrosamine impurities are probable human carcinogens. This means that long-term exposure to a level above what is considered safe may increase the risk of cancer. There is no immediate health risk associated with the use of medications containing low levels of a nitrosamine impurity.
Foods such as meats, dairy products ventolin hfa purchase and vegetables as well as drinking water may also contain low levels of nitrosamines. We donât expect that a nitrosamine impurity will cause harm when exposure is at or below the acceptable level. For example, no increase in the risk of cancer is expected if exposure to the nitrosamine impurity below the acceptable level occurs every day for 70 years. The actual ventolin hfa purchase health risk varies from person to person.
The risk depends on several factors, such as. The daily dose of the medication how long the medication is taken the level of the nitrosamine impurity in the finished productPatients should always talk to their health care provider before stopping a prescribed medication. Not treating a condition may pose a greater health risk than the potential exposure ventolin hfa purchase to a nitrosamine impurity. What we're doing Health Canada recognizes that the nitrosamine impurity issue may cause concern for Canadians.
Your health and safety is our top priority and we will continue to take action to address risks and inform you of new safety information. We have created a list of all medications currently known ventolin hfa purchase to contain nitrosamine impurities. We will continue to update it, as needed, as more information becomes available. As we continue to hold companies accountable for determining the root causes, weâre learning more about how nitrosamine impurities may have formed or be present in medications.
In the meantime, ventolin hfa purchase we will continue to take action to address and prevent the presence of unacceptable levels of these impurities. These actions may include. Assess the manufacturing processes of companies determine the risk to Canadians and the impact on the Canadian market test samples of drug products on the market or soon to be released to the market for NDMA and other nitrosamine impurities ask companies to stop distribution as an interim precautionary measure while we gather more information make information available to health care professionals and to patients to enable informed decisions regarding the medications that we takeAs the federal regulator of health products in Canada, we also. Request, confirm and monitor the effectiveness of recalls by companies as necessary conduct our own laboratory tests, where necessary, and assess if the results present a health risk to humans conduct inspections of domestic and foreign sites and restrict certain products from being on the market when problems are identifiedWe share information on ventolin hfa purchase potential root causes of nitrosamines identified to date in medications with Canadian drug companies.
We also ask the companies to. Review their manufacturing processes and controls take action to avoid nitrosamine impurities in all medications, as necessary test any products that could potentially contain nitrosamine impurities report their findings to Health Canada To better understand this global issue, we are collaborating and sharing information with international regulators, such as. U.S ventolin hfa purchase. Food and Drug Administration European Medicines Agency Australiaâs Therapeutic Goods Administration Japanâs Ministry of Health, Labour and Welfare and Pharmaceuticals and Medical Devices Agency Switzerlandâs Swissmedic Singaporeâs Health Sciences AuthorityWe continue to work with companies and our international regulatory partners to.
Determine the root causes of the issue verify that appropriate actions are taken to minimize or avoid the presence of nitrosamine impurities We regularly communicate information on health risks, test results, recalls and other actions taken. Some of these key ventolin hfa purchase actions and communications include. Letter to all manufacturers (October 2, 2019). Health Canada issued a key communication to all companies marketing human prescription and non-prescription medications requesting them to conduct detailed evaluations of their manufacturing procedures and controls for the potential presence of nitrosamines.
The letter outlined ventolin hfa purchase examples of potential root causes for the presence of nitrosamines and included a request for a stepwise approach to conduct these risk assessments and expectations for any necessary subsequent actions. Nitrosamines Questions and Answers (Q&A) document (November 26, 2019). Health Canada issued a Q&A document on issues relating to the control of nitrosamines in medicines. This Q&A ventolin hfa purchase document will be updated periodically as new information becomes available.
Webinar on Nitrosamines (January 31, 2020). The purpose of this session was to provide an opportunity for a discussion of this issue with Health Canada and stakeholders. Health Canada provided overviews of the situation relating to nitrosamine impurities in pharmaceuticals and stakeholders had the opportunity to share their ventolin hfa purchase experiences, successes and challenges in addressing the issue of nitrosamine contamination. The on-line webinar was well intended by approximately 500 participants from over 18 countries and provided valuable information to respond to this global issue.We will continue to update Canadians if a product is being recalled.
Related linksOn this page Overview One of Health Canadaâs roles is to regulate and authorize health products that improve and maintain the health and well-being of Canadians. The asthma treatment ventolin has created an unprecedented demand on Canadaâs health care system ventolin hfa purchase and has led to an urgent need for access to health products. As part of the government's broad response to the ventolin, Health Canada introduced innovative and agile regulatory measures. These measures expedite the regulatory review of asthma treatment health products without compromising safety, efficacy and quality standards.
These measures are helping to make health products and ventolin hfa purchase medical supplies needed for asthma treatment available to Canadians and health care workers. Products include. testing devices, such as test kits and swabs personal protective equipment (PPE) for medical purposes, such as medical masks, N95 respirators, gowns and gloves disinfectants and hand sanitizers investigational drugs and treatments We support the safe and timely access to these critical products through. temporary legislative, regulatory and ventolin hfa purchase policy measures partnerships and networks with companies, provinces and territories, other government departments, international regulatory bodies and health care professionals easily accessed and available guidance and other priority information We have also taken immediate steps to protect consumers from unauthorized health products and illegal, false or misleading product advertisements that claim to mitigate, prevent, treat, diagnose or cure asthma treatment.
Medical devices Medical devices play an important role in diagnosing, treating, mitigating or preventing asthma treatment. We are expediting access to medical devices through an interim order for importing and selling medical devices. This interim order, which was introduced on March 18, 2020, covers medical ventolin hfa purchase devices such as. Since the release of the interim order, we have authorized hundreds of medical devices for use against asthma treatment.
We have also expedited the review and issuance of thousands of Medical Device Establishment Licences (MDELs). These have ventolin hfa purchase been issued for companies asking to manufacture (Class I), import or distribute medical devices in relation to asthma treatment. Testing devices Early diagnosis is critical to slowing and reducing the spread of asthma treatment in Canada. Our initial focus during the ventolin has been the scientific review and authorization of testing devices.
We made ventolin hfa purchase it a priority to review diagnostic tests using nucleic acid technology. This helped to increase the number of testing devices available in Canada to diagnose active and early-stage s of asthma treatment. We are also reviewing and authorizing serological tests that detect previous exposure to asthma treatment. In May ventolin hfa purchase 2020, we authorized the first serological testing device to help improve our understanding of the immune status of people infected.
We also provided guidance on serological tests. We continue to collaborate with the Public Health Agency of Canadaâs National Microbiology Laboratory (NML) and with provincial public health and laboratory partners as they. review and engage in their own studies of ventolin hfa purchase serological technologies develop tests assess commercial tests The NML is known around the world for its scientific evidence. It works with public health partners to prevent the spread of infectious diseases.
When making regulatory decisions, we consider the data provided by the NML and provincial public health and laboratory partners. This work will facilitate access to devices that will ventolin hfa purchase improve our testing capacity. It will also support research into understanding immunity against asthma treatment and the possibility of re-. Personal protective equipment Personal protective equipment (PPE) is key to protecting health care workers, patients and Canadians through prevention and control.
We play an important role in providing guidance to companies and manufacturers in Canada that want ventolin hfa purchase to supply PPE. We are increasing the range of products available without compromising safety and effectiveness. For example, we are. We have authorized hundreds of new PPE products and other devices, all while ensuring the safety and quality of PPE ventolin hfa purchase.
Hand sanitizers, disinfectants, cleaners and soaps The asthma treatment ventolin created an urgent need for disinfectants, hand sanitizers, cleaners and soaps. To increase supply and ensure Canadians have access to these products, we. We will continue our efforts to support ventolin hfa purchase supply and access to these essential products. Drugs and treatments We are closely tracking all potential drugs and treatments in development in Canada and abroad.
We are working with companies, academic research centres and investigators to help expedite the development and availability of drugs and treatments to prevent and treat asthma treatment. Clinical trials ventolin hfa purchase On May 23, 2020, the Minister of Health signed a clinical trials interim order. This temporary measure is designed to meet the urgent need to diagnose, treat, reduce or prevent asthma treatment. The interim order facilitates clinical trials in Canada to investigate and offer greater patient access to potential asthma treatment drugs and medical devices, while upholding strong patient safety requirements.
As well, ventolin hfa purchase to encourage the rapid development of drugs and treatments, we are. prioritizing asthma treatment clinical trial applications providing regulatory agility and guidance on how clinical trials are to be conducted this encourages and supports the launch of new trials and the continuation of existing ones, as well as broader patient participation across the country working with companies outside of Canada to bring clinical trials to our country working with researchers around the world to add Canadian sites to their research efforts On May 15, 2020, we authorized Canadaâs first treatment clinical trial. Addressing critical product shortages We have taken steps to address critical product shortages caused by the asthma treatment ventolin. One of ventolin hfa purchase these steps was an interim order to prevent or ease shortages of drugs, medical devices and foods for a special dietary purpose.
Introduced on March 30, 2020, this interim order temporarily. allows companies with an MDEL to import foreign devices that meet similar high quality and manufacturing standards as Canadian-approved devices makes it mandatory to report shortages of medical devices that are considered critical during the ventolin allows companies with Drug Establishment Licences to import foreign drugs that meet similar high quality and manufacturing standards as Canadian-approved drugs We also work with provinces and territories, companies and manufacturers, health care providers and patient groups to strengthen the drug supply chain. To identify, prevent and ease ventolin hfa purchase shortages for Canadians, we. stepped up monitoring and surveillance activities to identify potential shortages early on have introduced temporary regulatory agility so manufacturers can ramp up production for example, increased the batch sizes regularly engaged stakeholders to share information and look at how we can prevent tier 3 drug shortages, which have the greatest impact on Canadaâs drug supply and health care system helped to access extra supplies of.
Drugs, including muscle relaxants, inhalers and sedatives medical devices, such as PPE (medical masks and gowns) and ventilators Post-market surveillance activities We actively monitor the post-market safety and effectiveness of health products related to asthma treatment. For example, we work with industry members and health ventolin hfa purchase care workers to. monitor safety issues take the necessary steps to protect Canadians from the effects of harmful products To ensure the ongoing safety of marketed health products, we. take proactive steps to identify asthma treatment-related adverse events from drugs and medical devices being used in Canada for asthma treatment proactively monitor major online retailers to identify authorized/unauthorized products making false and misleading asthma treatment claims manage risk communications for asthma treatment public advisories, information updates, health care professional communications and shortages take a proactive approach to identifying false and misleading ads for health products related to asthma treatment take part in international discussions on the real-world safety and effectiveness of asthma treatments Engaging with partners and stakeholders To support access to health products for asthma treatment, we collaborate with a range of organizations and stakeholders.
These include other government departments, including the Public Health Agency of Canada, as well as provinces and territories, ventolin hfa purchase international partners, companies and health care professionals. Engaging with stakeholders We take a whole-of-government approach to address stakeholder issues by. collaborating with other government departments to ease challenges across the entire supply chain connecting companies with government decision makers who play important roles in delivering health products to Canadians These efforts create opportunities for new companies and researchers interested in helping in the fight against asthma treatment. For example, we have worked with other departments to help ventolin hfa purchase new companies supply PPE to Canadians and health care workers.
Some of these companies had only ever manufactured auto parts, clothing and sports equipment before the ventolin. We engage the health products sector in mobilizing to find asthma treatment solutions by. meeting with industry leaders to identify and track potential health products ensuring that the regulatory review of promising health products is done in a timely manner hosting information ventolin hfa purchase sessions on our regulatory response maintaining a centralized asthma treatment website with relevant information for industry and health professionals Engaging with domestic partners We work closely with provincial/territorial public health partners and health system partners. For example, we.
share information with our provincial/territorial health partners about regulatory guidance for reprocessing N95 respirators for health professionals continue to engage and share information with our health system partners, such as health technology assessment agencies, to support efficiencies and alignment inform health professional networks of our activities and seek their perspectives on health care system priorities and challenges Engaging with international partners We are working with our international partners on a coordinated and well-aligned approach to this global ventolin. This ensures that ventolin hfa purchase health products are effective and quickly available to Canadians. Collaboration also helps advance the development of diagnostics, treatments and treatments that will save lives and protect the health and safety of people everywhere. Specifically, our international engagement involves discussing, collaborating and leveraging resources on issues related to.
clinical trials and ventolin hfa purchase investigational testing drug and medical device market authorizations health product risk assessments potential drug and medical device shortages Notably, we are participating in the. Moving forward The asthma treatment ventolin has strengthened relationships with our diverse partners and stakeholders. We are proud to work with our partners across Canada and around the world, as well as with our stakeholders, in supporting Canadaâs response. Looking ahead, we will build on the temporary regulatory agilities put into place to inform future ventolin hfa purchase agile approaches to regulation that support innovation and safety.
We will communicate with stakeholders before shifting away from these temporary measures. We will also continue to work with our partners to. Provide products and information that Canadians need to keep safe and healthy respond to emerging priority areas, anticipate needs ventolin hfa purchase and regularly review our policy and regulatory priorities Related linksFunding will redirect people who use drugs from the criminal justice system August 26, 2020 - Peterborough, Ontario - Health Canada Problematic substance use has devastating impacts on people, families and communities across Canada. Tragically, the asthma treatment outbreak has worsened the situation for many Canadians struggling with substance use.
The Government of Canada continues to address this serious public health issue by focusing on increasing access to quality treatment and harm reduction services nationwide. Today, on behalf ventolin hfa purchase of the Honourable Patty Hajdu, Minister of Health, the Honourable Maryam Monsef, Minister for Women and Gender Equality and Rural Economic Development, announced more than $1.9 million in funding over the next three years to the Peterborough Police Service. Through this funding, people who use drugs and experience mental health issues will be connected to newly-created community-based outreach and support services. As part of this project, the Peterborough Police Service is working with local partners to create a community-based outreach team to increase the capacity for front-line community services to help people at risk who are referred by police.
With the help of this new team, people who use drugs or experience mental health issues will be redirected from the criminal justice system ventolin hfa purchase to harm reduction, peer support, health and social services. Additionally, this initiative will increase access to culturally appropriate services for Indigenous Peoples, LGBTQ2+ populations, youth, women, and those living with HIV through partnerships with other organizations such as Nogojiwanong Friendship Centre and Peterborough AIDS Research Network. The Government of Canada is committed to working with partners, peer workers, people with lived and living experience and other stakeholders to ensure Canadians receive the support they need to reduce the harms related to substance use.From. Health Canada Media advisory Government of Canada to announce funding for community-based, multi-sector outreach and support services in Peterborough PETERBOROUGH, August 25, 2020 â On behalf of the ventolin hfa purchase Federal Minister of Health, Patty Hajdu, the Honourable Maryam Monsef, Minister for Women and Gender Equality and Rural Economic Development, will announce federal funding to help connect people at risk of experiencing opioid-related overdoses to community-based outreach and support services in Peterborough.There will be a media availability immediately following the announcement.DateWednesday, August 26, 2020Time10:00 AM (EDT)LocationThe media availability will be held on Zoom.Zoom link.
Https://us02web.zoom.us/j/89698543218Meeting ID. 896 9854 3218 Contacts Media Inquiries:Cole DavidsonOffice of the Honourable Patty HajduMinister of Health613-957-0200Media RelationsHealth Canada613-957-2983hc.media.sc@canada.caDate published. August 26, ventolin hfa purchase 2020On this page Backgroundasthma treatment is an infectious disease caused by the asthma asthma. The World Health Organization declared a global ventolin in March 2020, and the Minister of Health signed the Interim Order Respecting the Importation and Sale of Medical Devices for Use in Relation to asthma treatment on March 18, 2020.
The Interim Order (IO) allows us to quickly address large-scale public health emergencies.This IO allows for faster authorization of Class I-IV medical devices for asthma treatment.This document presents the criteria for safety and effectiveness that apply to test swabs used for asthma treatment sampling. It also provides guidance on how ventolin hfa purchase to meet these criteria in an application under the IO pathway. Diagnostic testing is a key element in both. identifying cases of preventing the spread of the asthma A test swab may be used to collect a sample for either Polymerase Chain Reaction (PCR) laboratory testing or point-of-care testing.
Point-of-care testing can be done directly in a hospital or doctorâs office ventolin hfa purchase. Once the sample has been taken, the swab is either placed in a preserving liquid and sent to a laboratory for testing, or placed directly in a testing device (point-of-care).Swabs may be packaged in a variety of ventolin transport media (VTM). Specifications for individual VTMs are beyond the scope of this document. Swabs play a role in the accuracy ventolin hfa purchase of asthma treatment diagnostic testing.
For example, false negatives can occur in PCR tests if. the swab material inhibits the test reaction or the swab design doesnât provide enough surface area to obtain a sufficient sample Test swabs that are not safe and effective may cause or lead to harm. For example ventolin hfa purchase. A swab that breaks during sample collection can cause physical injury a non-sterile swab that produces an incorrect test result can lead to harmHealth Canada has published a guidance document to support the preparation of applications submitted under the IO.
It should be read in conjunction with this document. We are ventolin hfa purchase processing applications as quickly as possible. To avoid delays, please ensure you have completed your application properly.Medical Devices Regulations (MDR) classification In the Canadian regulatory framework, Class I devices present the lowest potential risk and Class IV the highest. Swabs are classified according to their labelling and intended use.
For example, if a swab is labelled for nasopharyngeal (NP) or oropharyngeal ventolin hfa purchase (OP) use only, it will be classified as a Class I medical device according to Classification Rule 2(2) of the MDR. If a swab is not exclusively for use in oral or nasal cavities, or its use is not explicitly stated, it will be classified as a Class II device by Rule 2(1). These swabs belong to a higher risk class because their use in other body orifices for the collection of tissue samples (for example, to test for chlamydia or ureaplasma) is associated with greater risk. Rule 2 Subject to subrules (2) to (4), all invasive devices that penetrate the body through a body orifice or that come into contact with the surface of the eye are classified as Class II.
A device described in subrule (1) that is intended to be placed in the oral or nasal cavities as far as the pharynx or in the ear canal up to the ear drum is classified as Class I.Regulatory pathways for asthma treatment devicesManufacturers of Class I ventolin hfa purchase swabs may seek authorization to import and sell their products under either. A Medical Device Establishment Licence (MDEL) MDEL is an establishment oversight framework that is not product-specific and not designed to assess safety and effectiveness an IO authorization information on safety and effectiveness are required as part of the application Health Canada is encouraging a sub-group of swab manufacturers to use the IO authorization pathway for Class I swabs, especially if they are. New to the manufacturing of swabs and manufacturing in Canada (such as a company that has re-tooled to manufacture), or using a new manufacturing process or design for swabs (such as 3D printing or honeycomb design)IO applications for swabs should include the following information.Device description The device description should include. A picture and/or engineering drawing ventolin hfa purchase identification of all materials used in the production of the swab the intended use(s) (for example, NP swabs)Quality manufacturingManufacturers must either.
demonstrate compliance with Quality Manufacturing Systems (for example, ISO 13485 certificate) applicable to the swab, or provide a clear description of the planned quality manufacturing systems that are consistent with similar existing manufacturing systemsDesign verificationProvide swab design verification (bench testing) data in a summary report. It should show that the essential minimum design characteristics are met. These data should be based on test samples representative of finished swabs that have undergone sterilization prior ventolin hfa purchase to bench testing.Dimensions Swabs should have minimum length specifications and minimum and maximum head diameter specifications in order to be safe and effective. Minimum length specification for example, adult NP swabs require â¥14 cm to reach the posterior nasopharynx minimum and maximum head diameter specification for example, adult NP swabs require 1â4 mm to pass into the mid-inferior portion of the inferior turbinate and maneuver well FlexibilitySwab flexibility is assessed through.
Durability for example, tolerate 20 rough repeated insertions into a 4 mm inner diameter clear plastic tube curved back on itself with a curve radius of 3 cm bendability for example, bend tip and neck 90º without breaking ability to maintain initial form for example, restore to initial form following 45º bending Manufacturers may describe the test performed, the number of samples, and a summary of the results.Strength/Breakpoint (failure) To limit the potential for patient harm, the minimum breakpoint distance should be approximately 8 to 9 cm from the nasopharynx. However, no ventolin hfa purchase breaks or fractures should occur following reasonable manipulation. Applicants should submit a rationale for the design of the breakpoint distance from the swab tip. It should demonstrate that the breakpoint length can be accommodated by commercially available swab/media tubes.Surface propertiesThe swab surface should be free of.
processing aids (such as disinfectants) foreign materials degreasers mold release agents For injection molded swabs, no burrs, flashing, or sharp ventolin hfa purchase edges should be present. Design validationProvide swab validation (performance) data in a summary report that demonstrates that the swab. can acquire samples comparable to a commercially available swab control, and will not inhibit the PCR reactionThese data should be based on test samples representative of finished swabs that have undergone sterilization prior to testing.Comparable sample acquisition to a control, and PCR compatibilityThe manufacturer should demonstrate test swab cycle threshold (Ct) recovery values (RT-PCR) that are statistically comparable to those obtained from a commercially available swab control using asthma (or a scientifically justified surrogate).Pass/Fail criteria. Values ⥠2Cts indicate significantly ventolin hfa purchase less efficient ribonucleic acid collection and/or elution.Clinical feasibility/suitability simulationManufacturers should submit either.
A clinical test report or previous clinical data Clinical test reportThe clinical test report should describe the use of the proposed finished swab (sterilized) in a sufficient number of individuals by trained healthcare professionals in a minimum of 30 patients that have tested positive for asthma, or a scientifically justified surrogate ventolin. Include comparisons of the proposed swab against a flocked swab commercially available in Canada with respect to. flexibility fit ability to navigate ventolin hfa purchase to the nasopharynx (or other areas specified in the indications) ability to collect a specimen/respiratory epithelial cells for example, using the RNase P housekeeping gene test results agreement for example, ⥠90% positive % agreement using a composite control (positive % agreement calculation that includes all positive findings from control and test swabs) Clinical testing considerations A scientifically justified surrogate ventolin may be used if asthma treatment-positive patients are not available. Positive % agreement should not be determined using high Ct samples.
One-half (1/2) to two-thirds (2/3) of asthma treatment-positive samples should have a high viral loads (Cts <. 30). Report agreement between control and test swabs in terms of quantitative (Ct) and qualitative (+/- test) values with appropriate descriptive statistics. Include patient symptomatology for samples.
For example, days from symptom onset, known vs. Suspected asthma treatment status. Use of different VTM/universal transport media (V/UTM) across asthma treatment-positive samples may contribute to Ct variability. Ensure consistency by using the same media/tubes for each specimen within a clinical evaluation.
Validate the chosen V/UTM media/tubes to show they will not interfere with the PCR test results. For example, allowing 7 days of swab positive specimen incubation with the chosen media/vial is considered a worst-case transportation scenario to evaluate maximal leaching/interaction potential). Use a single PCR test platform throughout each clinical evaluation. The platform should have been previously authorized by HC or another jurisdiction.
Location (for example, left vs right nostril) and order of sampling (for example, control vs. Test swab) can affect specimen quality and results variability. Location and swab sampling order should be randomized.For additional information on collecting, handling, and testing asthma treatment specimens, please refer to the Centers for Disease Control and Prevention (CDC) Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for asthma treatment.Previous clinical dataPreviously obtained clinical data may be submitted in lieu of clinical testing. Those data should demonstrate the safe and effective use of a swab of identical design and materials in human subjects.
The proposed swab should be compared against a flocked swab commercially available in Canada with respect to. flexibility fit ability to navigate to the nasopharynx (or other areas specified in the indications) ability to collect a specimen/respiratory epithelial cells for example, using the RNase P housekeeping gene test results agreement for example, ⥠90% positive % agreement) using a composite control (positive % agreement calculation that includes all positive findings from control and test swabs) Sterility Provide sterilization validation data in a summary report. It should demonstrate that the chosen sterilization method will achieve a minimum Sterility Assurance Level (SAL) of 10-6 for the proposed swab, using an appropriate biological indicator (BI) organism (see below). If the swab will be sterilized using an ethylene oxide (EtO) method, you should demonstrate that EtO and ethylene chlorohydrin (ECH) residuals meet the tolerable contact limits (TCL) specified in ISO 10993-7.
Commonly used swab materials, compatible sterilization methods, and appropriate biological indicators are described below. Sterilization Method Swab Materials EtO(for example, ISO 11135) Gamma Irradiation(ISO 11137) Polystyrene handle, polyester bicomponent fiber tipFootnote * X(for example, Puritan 25-3316-H/U) Not applicable Polystyrene handle, nylon flocked fiber tipFootnote * X(for example, Copan 503CS01) X(for example, BD 220252) Footnote * The CDC provides guidance on the types of swabs that should be used for optimal specimen collection for PCR testing. They include swabs that are made of polyester (for example, Dacron), rayon, or nylon-flocked. Cotton-tipped or calcium alginate swabs are not acceptable because residues present in those materials inhibit the PCR reaction.
Return to footnote * referrer Appropriate BIIf ionizing radiation will be used to sterilize the swab. Bacillus pumilus spores are recommended for doses of 25 kGy Bacillus cereus or Bacillus sphaericus spores are recommended for doses of >. 25 kGy (World Health Organization, The International Pharmacopoeia, 9th Ed., 2019) Sterilization Process Spore (Indicator Organism) Steam Geobacillus stearothermophilus(formerly Bacillus stearothermophilus) Dry Heat Bacillus atrophaeus (formerly Bacillus subtilis var. Niger) Ethlylene Oxide Bacillus atrophaeus (formerly Bacillus subtilis var.
Niger) Hydrogen Peroxide Geobacillus stearothermophilus(formerly Bacillus stearothermophilus) Source. US Food and Drug Administration, "Biological Indicator (BI) Premarket Notification [510(k)] Submissions," October 2007. [Online].Packaging validation Provide packaging validation data in a summary report. It should demonstrate that the swab packaging system will maintain a sterile environment across the labelled shelf life (for example, ASTM F1980).
without leakage (for example, ASTM D3078-02) with adequate seal strength (for example, ASTM F88/EN 868-5)Test packaging samples should be representative of finished swab packages that have undergone sterilization prior to testing.Biocompatibility Provide biocompatibility data in a summary report. It should demonstrate compliance with biocompatibility tests recommended for devices in limited contact (â¤24 hrs) with mucosal membranes, as per ISO 10993-1. These include. cytotoxicity sensitization irritation/intracutaneous reactivityThese data should be based on test samples representative of finished swabs that have undergone sterilization prior to testing.LabellingSwabs should be individually packaged and labelled.
The application must include the swab label, which must include. The name and model number of the device the term âsterileâ, along with the sterilization method (EtO = ethylene oxide. R = gamma irradiation), if the swab is intended to be sold in a sterile condition the name and address of the manufacturer manufacturing and expiry datesIf swabs are not sterile but must be sterilized at the user facility, then the sterilization parameters and method should be clearly described in accompanying instructions for use documentation.Post-market requirementsAs stated in Section 12 of the IO, within 10 days of becoming aware of an incident in Canada, all IO authorization holders must. report the incident specify the nature of the incident specify the circumstances surrounding the incidentOn this page About face shields Personal protective equipment (PPE) can help prevent potential exposure to infectious disease.
They are considered medical devices in Canada and therefore must follow the requirements outlined in the Medical Devices Regulations. Medical devices are classified into 4 groups (Class I, II, III and IV) based on their risk to health and safety. Class I devices, such as gauze bandages, pose the lowest potential risk, while Class IV devices, such as pacemakers, pose the greatest potential risk. In Canada, face shields are Class I medical devices.
A face shield has a transparent window or visor that shields the face and associated mucous membranes (eyes, nose and mouth). It protects the wearer against exposure from splashes and sprays of body fluids. Face shields are made of shatterproof plastic, fit over the face and are held in place by head straps or caps. They may be made of polycarbonate, propionate, acetate, polyvinyl chloride, or polyethylene terephthalate.
They are usually worn with other PPE, such as a medical mask, respirator or eyewear. Health Canada strongly advises against the use of plastic bags as an alternative to face shields. Standards and requirements for face shields Organizations that are manufacturing face shields are advised to consult some or all of the following standards throughout the design and testing stages. ANSI/ISEA Z.87.1 (2015), American National Standard for Occupational and Educational Personal Eye and Face Protection Devices CSA Z94.3 (2020), Eye and Face Protectors CSA Z94.3.1 (2016), Guideline for Selection, Use, and Care of Eye and Face Protectors BS EN 166 (2002), Personal Eye Protection.
Specifications. Minimum specifications must be incorporated into the design and verification stages to ensure safe and effective face shields. Provide adequate coverage (CSA Z94.3 Sections 0.2.1/10.2.2/10.3/10.4). The size of the face shield is important because it must protect the face and front part of the head.
This includes the eyes, forehead, cheeks, nose, mouth, and chin. Protection may also need to extend to the front of the neck in situations with flying particles and sprays of hazardous liquids. Fit snugly to afford a good seal to the forehead area and to prevent slippage of the device Footnote 1. Be made of optically clear, distortion-free, lightweight materials (CSA Z94.3.1-16 and Footnote 1).
Be free of visible defects or flaws that would impede vision (ANSI Z87.1 Section 9.4). Be comfortable and easy to assemble, use and remove by health care professionals. Provide adequate space between the wearerâs face and the inner surface of the visor to allow for the use of ancillary equipment (for example, medical mask, respirator, eyewear) Footnote 1. The characteristics and performance requirements of face shields must not be altered when attaching shields to other protective equipment, such as hats or caps.
Display anti-fog characteristics on inside and outside of shield (CSA Z94.3.1-16). For face shields that are not fog resistant, anti-fog spray must be provided. Provide user-contacting materials that have adequate material biocompatibility (skin sensitivity and cytotoxic testing) (ISO 10993-5, 10). Other items to take note of include.
Face shields used for protection in hospital settings do not have to be impact- or flame- resistant. If the device is specifically designed to withstand impact from sharp or fast projectiles, it must comply with set-out standards (ANSI Z87.1, sections 9.2 and 9.3, CSA Z94.3, section 10.1). For reuse, manufacturers must provide validated cleaning instructions. Sterilization procedures must not compromise the shield in any way, such as deformation or cracking.
Regulatory authorization Most PPE, including face shields, are Class I medical devices if they are manufactured, sold or represented for use for reducing the risk of or preventing the user from . This includes asthma treatment. Face shields may be authorized for sale or import into Canada through the following regulatory pathways. Pathway 1.
Interim order authorization to import and sell medical devices related to asthma treatment. Pathway 2. Expedited review and issuance of Medical Device Establishment Licences (MDEL) related to asthma treatment. MDEL holders that import and sell face shields should take measures to ensure they are safe and effective.
Pathway 3. Exceptional importation and sale of certain non-compliant medical devices related to asthma treatment. Note that a sale generally requires the transfer of ownership of a device from one party to another and does not necessitate any transfer of money. Applicants should carefully review the pathways and select the most appropriate authorization route for their product.
For more information, see Personal protective equipment (asthma treatment). How to get authorization. If you intend to manufacture 3D print face shields in response to the asthma treatment crisis, see. 3D printing and other manufacturing of personal protective equipment in response to asthma treatment Feedback If you have any questions or comments about this notice, contact the Medical Devices Directorate at hc.meddevices-instrumentsmed.sc@canada.ca R.
J. Roberge, "Face shields for control. A review," Journal of Occupational and Environmental Hygiene, pp. 235-242, 2016.
Related links FootnotesFootnote 1 R. J. Roberge, "Face shields for control. A review," Journal of Occupational and Environmental Hygiene, pp.
235-242, 2016.Return to footnote 1 referrerWhat is the Notice of Compliance (NOC) Data Extract?. The data extract is a series of compressed ASCII text files of the database. The uncompressed size of the files is approximately 19.0 MB. In order to utilize the data, the file must be loaded into an existing database or information system.
The typical user is most likely a third party claims adjudicator, provincial formulary, insurance company, etc. A casual user of this file must be familiar with database structure and capable of setting up queries. The "Read me" file contains the data structure required to download the zipped files. The NOC extract files have been updated.
They contain Health Canada authorization dates for all drugs dating back to 1994 that have received an NOC. All NOCs issued between 1991 and 1993 can be found in the NOC listings. Please note any Portable Document Format (PDF) files visible on the NOC database are not part of the data extracts. For more information, please go to the Read Me File.
Data Extracts - Last updated. September 4, 2020 Copyright For information on copyright and who to contact, please visit the Notice of Compliance Online Database Terms and Conditions.Before drug products are authorized for sale in Canada, Health Canada reviews them to assess their safety, efficacy and quality. Drug products include prescription and non-prescription pharmaceuticals, disinfectants and sanitizers with disinfectant claims.What information can you find here?. This section contains links to reports and publications related to drug products.
Drug Submission Performance ReportsThe Drug Submission Review Performance Reports provide detailed metrics about the timeliness of pre-market drug review process against performance service standards. The annual report compares five consecutive fiscal years (April 1 - March 31), while the quarterly report compares five quarters. The reports are broken down by operational areas. The Therapeutic Product Directorate (TPD) report summarises performance metrics for pharmaceuticals.
The Biologics and Genetic Therapies Directorate (BGTD) was renamed to the Biologic and Radiopharmaceutical Drugs Directorate (BRDD). The BRDD report summarises performance metrics for biologics and radiopharmaceutical drugs. The Natural and Non-Prescription Health Products Directorate (NNHPD) report summarises performance metrics for non-prescription (over-the-counter) and disinfectant drugs. Within each report, statistics are provided by submission type and show the number received, the number in workload, the number of decisions and the number of approvals and time to approval.Submissions Received are counts of submissions received during the year using the filing date.
Workload is reported as the number of submissions "under active review" on a given day. "Backlog" is the proportion of the workload that is over target.
N-nitrosodiethylamine (NDEA) N-nitrosodiisopropylamine (NDIPA) N-nitrosomethyl-n-butylamine (NMBA)About nitrosamine try here impuritiesBased primarily on animal studies, nitrosamine impurities how to buy ventolin in usa are probable human carcinogens. This means that long-term exposure to a level above what is considered safe may increase the risk of cancer. There is no immediate health risk associated with the use of medications containing low levels of a nitrosamine impurity. Foods such as meats, dairy products and vegetables as well as drinking water may also contain low levels of how to buy ventolin in usa nitrosamines. We donât expect that a nitrosamine impurity will cause harm when exposure is at or below the acceptable level.
For example, no increase in the risk of cancer is expected if exposure to the nitrosamine impurity below the acceptable level occurs every day for 70 years. The actual health risk varies how to buy ventolin in usa from person to person. The risk depends on several factors, such as. The daily dose of the medication how long the medication is taken the level of the nitrosamine impurity in the finished productPatients should always talk to their health care provider before stopping a prescribed medication. Not treating how to buy ventolin in usa a condition may pose a greater health risk than the potential exposure to a nitrosamine impurity.
What we're doing Health Canada recognizes that the nitrosamine impurity issue may cause concern for Canadians. Your health and safety is our top priority and we will continue to take action to address risks and inform you of new safety information. We have created a list of all medications how to buy ventolin in usa currently known to contain nitrosamine impurities. We will continue to update it, as needed, as more information becomes available. As we continue to hold companies accountable for determining the root causes, weâre learning more about how nitrosamine impurities may have formed or be present in medications.
In the meantime, we how to buy ventolin in usa will continue to take action to address and prevent the presence of unacceptable levels of these impurities. These actions may include. Assess the manufacturing processes of companies determine the risk to Canadians and the impact on the Canadian market test samples of drug products on the market or soon to be released to the market for NDMA and other nitrosamine impurities ask companies to stop distribution as an interim precautionary measure while we gather more information make information available to health care professionals and to patients to enable informed decisions regarding the medications that we takeAs the federal regulator of health products in Canada, we also. Request, confirm and monitor the effectiveness of recalls by companies as necessary conduct our own laboratory tests, where how to buy ventolin in usa necessary, and assess if the results present a health risk to humans conduct inspections of domestic and foreign sites and restrict certain products from being on the market when problems are identifiedWe share information on potential root causes of nitrosamines identified to date in medications with Canadian drug companies. We also ask the companies to.
Review their manufacturing processes and controls take action to avoid nitrosamine impurities in all medications, as necessary test any products that could potentially contain nitrosamine impurities report their findings to Health Canada To better understand this global issue, we are collaborating and sharing information with international regulators, such as. U.S how to buy ventolin in usa. Food and Drug Administration European Medicines Agency Australiaâs Therapeutic Goods Administration Japanâs Ministry of Health, Labour and Welfare and Pharmaceuticals and Medical Devices Agency Switzerlandâs Swissmedic Singaporeâs Health Sciences AuthorityWe continue to work with companies and our international regulatory partners to. Determine the root causes of the issue verify that appropriate actions are taken to minimize or avoid the presence of nitrosamine impurities We regularly communicate information on health risks, test results, recalls and other actions taken. Some of these key actions how to buy ventolin in usa and communications include.
Letter to all manufacturers (October 2, 2019). Health Canada issued a key communication to all companies marketing human prescription and non-prescription medications requesting them to conduct detailed evaluations of their manufacturing procedures and controls for the potential presence of nitrosamines. The letter outlined examples of potential root causes for the presence of nitrosamines and included a request for a stepwise approach to conduct these risk assessments and how to buy ventolin in usa expectations for any necessary subsequent actions. Nitrosamines Questions and Answers (Q&A) document (November 26, 2019). Health Canada issued a Q&A document on issues relating to the control of nitrosamines in medicines.
This Q&A document how to buy ventolin in usa will be updated periodically as new information becomes available. Webinar on Nitrosamines (January 31, 2020). The purpose of this session was to provide an opportunity for a discussion of this issue with Health Canada and stakeholders. Health Canada provided overviews of the situation relating to nitrosamine impurities in pharmaceuticals and stakeholders how to buy ventolin in usa had the opportunity to share their experiences, successes and challenges in addressing the issue of nitrosamine contamination. The on-line webinar was well intended by approximately 500 participants from over 18 countries and provided valuable information to respond to this global issue.We will continue to update Canadians if a product is being recalled.
Related linksOn this page Overview One of Health Canadaâs roles is to regulate and authorize health products that improve and maintain the health and well-being of Canadians. The asthma treatment how to buy ventolin in usa ventolin has created an unprecedented demand on Canadaâs health care system and has led to an urgent need for access to health products. As part of the government's broad response to the ventolin, Health Canada introduced innovative and agile regulatory measures. These measures expedite the regulatory review of asthma treatment health products without compromising safety, efficacy and quality standards. These measures are helping to make health products and medical supplies how to buy ventolin in usa needed for asthma treatment available to Canadians and health care workers.
Products include. testing devices, such as test kits and swabs personal protective equipment (PPE) for medical purposes, such as medical masks, N95 respirators, gowns and gloves disinfectants and hand sanitizers investigational drugs and treatments We support the safe and timely access to these critical products through. temporary legislative, regulatory and policy measures partnerships and networks with companies, provinces and territories, other government departments, international regulatory bodies and health care professionals easily accessed and available guidance and other priority information We have also taken immediate steps to protect consumers from unauthorized health products and illegal, false or misleading product advertisements that claim to mitigate, prevent, treat, diagnose or cure asthma treatment how to buy ventolin in usa. Medical devices Medical devices play an important role in diagnosing, treating, mitigating or preventing asthma treatment. We are expediting access to medical devices through an interim order for importing and selling medical devices.
This interim order, which was introduced how to buy ventolin in usa on March 18, 2020, covers medical devices such as. Since the release of the interim order, we have authorized hundreds of medical devices for use against asthma treatment. We have also expedited the review and issuance of thousands of Medical Device Establishment Licences (MDELs). These have been issued for companies asking how to buy ventolin in usa to manufacture (Class I), import or distribute medical devices in relation to asthma treatment. Testing devices Early diagnosis is critical to slowing and reducing the spread of asthma treatment in Canada.
Our initial focus during the ventolin has been the scientific review and authorization of testing devices. We made it a priority to review how to buy ventolin in usa diagnostic tests using nucleic acid technology. This helped to increase the number of testing devices available in Canada to diagnose active and early-stage s of asthma treatment. We are also reviewing and authorizing serological tests that detect previous exposure to asthma treatment. In May 2020, we authorized the first serological testing device to help improve our understanding of how to buy ventolin in usa the immune status of people infected.
We also provided guidance on serological tests. We continue to collaborate with the Public Health Agency of Canadaâs National Microbiology Laboratory (NML) and with provincial public health and laboratory partners as they. review and engage in their own studies of serological technologies develop tests assess commercial tests The NML is known around the world for its how to buy ventolin in usa scientific evidence. It works with public health partners to prevent the spread of infectious diseases. When making regulatory decisions, we consider the data provided by the NML and provincial public health and laboratory partners.
This work will facilitate access to devices that will improve our testing capacity how to buy ventolin in usa. It will also support research into understanding immunity against asthma treatment and the possibility of re-. Personal protective equipment Personal protective equipment (PPE) is key to protecting health care workers, patients and Canadians through prevention and control. We play an important role in providing guidance to companies and manufacturers in Canada that want to supply how to buy ventolin in usa PPE. We are increasing the range of products available without compromising safety and effectiveness.
For example, we are. We have how to buy ventolin in usa authorized hundreds of new PPE products and other devices, all while ensuring the safety and quality of PPE. Hand sanitizers, disinfectants, cleaners and soaps The asthma treatment ventolin created an urgent need for disinfectants, hand sanitizers, cleaners and soaps. To increase supply and ensure Canadians have access to these products, we. We will continue how to buy ventolin in usa our efforts to support supply and access to these essential products.
Drugs and treatments We are closely tracking all potential drugs and treatments in development in Canada and abroad. We are working with companies, academic research centres and investigators to help expedite the development and availability of drugs and treatments to prevent and treat asthma treatment. Clinical trials On May 23, 2020, the Minister of Health signed a clinical trials interim how to buy ventolin in usa order. This temporary measure is designed to meet the urgent need to diagnose, treat, reduce or prevent asthma treatment. The interim order facilitates clinical trials in Canada to investigate and offer greater patient access to potential asthma treatment drugs and medical devices, while upholding strong patient safety requirements.
As well, to encourage the how to buy ventolin in usa rapid development of drugs and treatments, we are. prioritizing asthma treatment clinical trial applications providing regulatory agility and guidance on how clinical trials are to be conducted this encourages and supports the launch of new trials and the continuation of existing ones, as well as broader patient participation across the country working with companies outside of Canada to bring clinical trials to our country working with researchers around the world to add Canadian sites to their research efforts On May 15, 2020, we authorized Canadaâs first treatment clinical trial. Addressing critical product shortages We have taken steps to address critical product shortages caused by the asthma treatment ventolin. One of these steps was an interim order to how to buy ventolin in usa prevent or ease shortages of drugs, medical devices and foods for a special dietary purpose. Introduced on March 30, 2020, this interim order temporarily.
allows companies with an MDEL to import foreign devices that meet similar high quality and manufacturing standards as Canadian-approved devices makes it mandatory to report shortages of medical devices that are considered critical during the ventolin allows companies with Drug Establishment Licences to import foreign drugs that meet similar high quality and manufacturing standards as Canadian-approved drugs We also work with provinces and territories, companies and manufacturers, health care providers and patient groups to strengthen the drug supply chain. To identify, prevent and ease shortages for Canadians, we how to buy ventolin in usa. stepped up monitoring and surveillance activities to identify potential shortages early on have introduced temporary regulatory agility so manufacturers can ramp up production for example, increased the batch sizes regularly engaged stakeholders to share information and look at how we can prevent tier 3 drug shortages, which have the greatest impact on Canadaâs drug supply and health care system helped to access extra supplies of. Drugs, including muscle relaxants, inhalers and sedatives medical devices, such as PPE (medical masks and gowns) and ventilators Post-market surveillance activities We actively monitor the post-market safety and effectiveness of health products related to asthma treatment. For example, we work with industry members and health care how to buy ventolin in usa workers to.
monitor safety issues take the necessary steps to protect Canadians from the effects of harmful products To ensure the ongoing safety of marketed health products, we. take proactive steps to identify asthma treatment-related adverse events from drugs and medical devices being used in Canada for asthma treatment proactively monitor major online retailers to identify authorized/unauthorized products making false and misleading asthma treatment claims manage risk communications for asthma treatment public advisories, information updates, health care professional communications and shortages take a proactive approach to identifying false and misleading ads for health products related to asthma treatment take part in international discussions on the real-world safety and effectiveness of asthma treatments Engaging with partners and stakeholders To support access to health products for asthma treatment, we collaborate with a range of organizations and stakeholders. These include other government departments, including the Public Health Agency of Canada, as well how to buy ventolin in usa as provinces and territories, international partners, companies and health care professionals. Engaging with stakeholders We take a whole-of-government approach to address stakeholder issues by. collaborating with other government departments to ease challenges across the entire supply chain connecting companies with government decision makers who play important roles in delivering health products to Canadians These efforts create opportunities for new companies and researchers interested in helping in the fight against asthma treatment.
For example, we have worked with other departments to help new companies supply PPE to Canadians and health care how to buy ventolin in usa workers. Some of these companies had only ever manufactured auto parts, clothing and sports equipment before the ventolin. We engage the health products sector in mobilizing to find asthma treatment solutions by. meeting with industry leaders to identify and track potential health products ensuring that the regulatory review of promising health products how to buy ventolin in usa is done in a timely manner hosting information sessions on our regulatory response maintaining a centralized asthma treatment website with relevant information for industry and health professionals Engaging with domestic partners We work closely with provincial/territorial public health partners and health system partners. For example, we.
share information with our provincial/territorial health partners about regulatory guidance for reprocessing N95 respirators for health professionals continue to engage and share information with our health system partners, such as health technology assessment agencies, to support efficiencies and alignment inform health professional networks of our activities and seek their perspectives on health care system priorities and challenges Engaging with international partners We are working with our international partners on a coordinated and well-aligned approach to this global ventolin. This ensures that health products are effective and how to buy ventolin in usa quickly available to Canadians. Collaboration also helps advance the development of diagnostics, treatments and treatments that will save lives and protect the health and safety of people everywhere. Specifically, our international engagement involves discussing, collaborating and leveraging resources on issues related to. clinical trials and investigational testing drug and how to buy ventolin in usa medical device market authorizations health product risk assessments potential drug and medical device shortages Notably, we are participating in the.
Moving forward The asthma treatment ventolin has strengthened relationships with our diverse partners and stakeholders. We are proud to work with our partners across Canada and around the world, as well as with our stakeholders, in supporting Canadaâs response. Looking ahead, we how to buy ventolin in usa will build on the temporary regulatory agilities put into place to inform future agile approaches to regulation that support innovation and safety. We will communicate with stakeholders before shifting away from these temporary measures. We will also continue to work with our partners to.
Provide products and information that Canadians need to keep safe and healthy respond to emerging priority areas, anticipate needs and regularly review our policy and regulatory priorities Related linksFunding will redirect people who use drugs from the criminal justice system August 26, 2020 - Peterborough, Ontario - Health Canada Problematic substance use how to buy ventolin in usa has devastating impacts on people, families and communities across Canada. Tragically, the asthma treatment outbreak has worsened the situation for many Canadians struggling with substance use. The Government of Canada continues to address this serious public health issue by focusing on increasing access to quality treatment and harm reduction services nationwide. Today, on behalf of the how to buy ventolin in usa Honourable Patty Hajdu, Minister of Health, the Honourable Maryam Monsef, Minister for Women and Gender Equality and Rural Economic Development, announced more than $1.9 million in funding over the next three years to the Peterborough Police Service. Through this funding, people who use drugs and experience mental health issues will be connected to newly-created community-based outreach and support services.
As part of this project, the Peterborough Police Service is working with local partners to create a community-based outreach team to increase the capacity for front-line community services to help people at risk who are referred by police. With the help of this new team, people who use drugs how to buy ventolin in usa or experience mental health issues will be redirected from the criminal justice system to harm reduction, peer support, health and social services. Additionally, this initiative will increase access to culturally appropriate services for Indigenous Peoples, LGBTQ2+ populations, youth, women, and those living with HIV through partnerships with other organizations such as Nogojiwanong Friendship Centre and Peterborough AIDS Research Network. The Government of Canada is committed to working with partners, peer workers, people with lived and living experience and other stakeholders to ensure Canadians receive the support they need to reduce the harms related to substance use.From. Health Canada Media advisory Government of Canada to announce funding for community-based, multi-sector outreach and support services in Peterborough PETERBOROUGH, August 25, 2020 â On how to buy ventolin in usa behalf of the Federal Minister of Health, Patty Hajdu, the Honourable Maryam Monsef, Minister for Women and Gender Equality and Rural Economic Development, will announce federal funding to help connect people at risk of experiencing opioid-related overdoses to community-based outreach and support services in Peterborough.There will be a media availability immediately following the announcement.DateWednesday, August 26, 2020Time10:00 AM (EDT)LocationThe media availability will be held on Zoom.Zoom link.
Https://us02web.zoom.us/j/89698543218Meeting ID. 896 9854 3218 Contacts Media Inquiries:Cole DavidsonOffice of the Honourable Patty HajduMinister of Health613-957-0200Media RelationsHealth Canada613-957-2983hc.media.sc@canada.caDate published. August 26, 2020On this page Backgroundasthma treatment how to buy ventolin in usa is an infectious disease caused by the asthma asthma. The World Health Organization declared a global ventolin in March 2020, and the Minister of Health signed the Interim Order Respecting the Importation and Sale of Medical Devices for Use in Relation to asthma treatment on March 18, 2020. The Interim Order (IO) allows us to quickly address large-scale public health emergencies.This IO allows for faster authorization of Class I-IV medical devices for asthma treatment.This document presents the criteria for safety and effectiveness that apply to test swabs used for asthma treatment sampling.
It also provides guidance on how to buy ventolin in usa how to meet these criteria in an application under the IO pathway. Diagnostic testing is a key element in both. identifying cases of preventing the spread of the asthma A test swab may be used to collect a sample for either Polymerase Chain Reaction (PCR) laboratory testing or point-of-care testing. Point-of-care testing can be done how to buy ventolin in usa directly in a hospital or doctorâs office. Once the sample has been taken, the swab is either placed in a preserving liquid and sent to a laboratory for testing, or placed directly in a testing device (point-of-care).Swabs may be packaged in a variety of ventolin transport media (VTM).
Specifications for individual VTMs are beyond the scope of this document. Swabs play a role in the accuracy of asthma treatment diagnostic testing how to buy ventolin in usa. For example, false negatives can occur in PCR tests if. the swab material inhibits the test reaction or the swab design doesnât provide enough surface area to obtain a sufficient sample Test swabs that are not safe and effective may cause or lead to harm. For example how to buy ventolin in usa.
A swab that breaks during sample collection can cause physical injury a non-sterile swab that produces an incorrect test result can lead to harmHealth Canada has published a guidance document to support the preparation of applications submitted under the IO. It should be read in conjunction with this document. We are processing applications as quickly how to buy ventolin in usa as possible. To avoid delays, please ensure you have completed your application properly.Medical Devices Regulations (MDR) classification In the Canadian regulatory framework, Class I devices present the lowest potential risk and Class IV the highest. Swabs are classified according to their labelling and intended use.
For example, if a swab is labelled for nasopharyngeal (NP) or oropharyngeal (OP) use only, it will be classified as a Class I medical device according to Classification Rule 2(2) of how to buy ventolin in usa the MDR. If a swab is not exclusively for use in oral or nasal cavities, or its use is not explicitly stated, it will be classified as a Class II device by Rule 2(1). These swabs belong to a higher risk class because their use in other body orifices for the collection of tissue samples (for example, to test for chlamydia or ureaplasma) is associated with greater risk. Rule 2 Subject to subrules (2) to (4), all invasive devices that penetrate the body through a body orifice or how to buy ventolin in usa that come into contact with the surface of the eye are classified as Class II. A device described in subrule (1) that is intended to be placed in the oral or nasal cavities as far as the pharynx or in the ear canal up to the ear drum is classified as Class I.Regulatory pathways for asthma treatment devicesManufacturers of Class I swabs may seek authorization to import and sell their products under either.
A Medical Device Establishment Licence (MDEL) MDEL is an establishment oversight framework that is not product-specific and not designed to assess safety and effectiveness an IO authorization information on safety and effectiveness are required as part of the application Health Canada is encouraging a sub-group of swab manufacturers to use the IO authorization pathway for Class I swabs, especially if they are. New to how to buy ventolin in usa the manufacturing of swabs and manufacturing in Canada (such as a company that has re-tooled to manufacture), or using a new manufacturing process or design for swabs (such as 3D printing or honeycomb design)IO applications for swabs should include the following information.Device description The device description should include. A picture and/or engineering drawing identification of all materials used in the production of the swab the intended use(s) (for example, NP swabs)Quality manufacturingManufacturers must either. demonstrate compliance with Quality Manufacturing Systems (for example, ISO 13485 certificate) applicable to the swab, or provide a clear description of the planned quality manufacturing systems that are consistent with similar existing manufacturing systemsDesign verificationProvide swab design verification (bench testing) data in a summary report. It should show that the essential how to buy ventolin in usa minimum design characteristics are met.
These data should be based on test samples representative of finished swabs that have undergone sterilization prior to bench testing.Dimensions Swabs should have minimum length specifications and minimum and maximum head diameter specifications in order to be safe and effective. Minimum length specification for example, adult NP swabs require â¥14 cm to reach the posterior nasopharynx minimum and maximum head diameter specification for example, adult NP swabs require 1â4 mm to pass into the mid-inferior portion of the inferior turbinate and maneuver well FlexibilitySwab flexibility is assessed through. Durability for example, tolerate 20 rough repeated insertions into a 4 mm inner diameter clear plastic tube curved back on itself with a curve radius of 3 cm bendability for example, bend tip and neck 90º without breaking ability to maintain initial form for example, restore to initial form following 45º bending Manufacturers may describe the test performed, the number of samples, and a summary of the results.Strength/Breakpoint (failure) To limit the potential for patient harm, the minimum breakpoint distance should be approximately 8 to 9 cm from the nasopharynx. However, no breaks how to buy ventolin in usa or fractures should occur following reasonable manipulation. Applicants should submit a rationale for the design of the breakpoint distance from the swab tip.
It should demonstrate that the breakpoint length can be accommodated by commercially available swab/media tubes.Surface propertiesThe swab surface should be free of. processing aids (such as disinfectants) foreign materials degreasers mold release agents For injection molded swabs, no burrs, flashing, or sharp edges should be how to buy ventolin in usa present. Design validationProvide swab validation (performance) data in a summary report that demonstrates that the swab. can acquire samples comparable to a commercially available swab control, and will not inhibit the PCR reactionThese data should be based on test samples representative of finished swabs that have undergone sterilization prior to testing.Comparable sample acquisition to a control, and PCR compatibilityThe manufacturer should demonstrate test swab cycle threshold (Ct) recovery values (RT-PCR) that are statistically comparable to those obtained from a commercially available swab control using asthma (or a scientifically justified surrogate).Pass/Fail criteria. Values ⥠2Cts indicate significantly less efficient ribonucleic how to buy ventolin in usa acid collection and/or elution.Clinical feasibility/suitability simulationManufacturers should submit either.
A clinical test report or previous clinical data Clinical test reportThe clinical test report should describe the use of the proposed finished swab (sterilized) in a sufficient number of individuals by trained healthcare professionals in a minimum of 30 patients that have tested positive for asthma, or a scientifically justified surrogate ventolin. Include comparisons of the proposed swab against a flocked swab commercially available in Canada with respect to. flexibility fit ability to navigate to the nasopharynx (or other areas how to buy ventolin in usa specified in the indications) ability to collect a specimen/respiratory epithelial cells for example, using the RNase P housekeeping gene test results agreement for example, ⥠90% positive % agreement using a composite control (positive % agreement calculation that includes all positive findings from control and test swabs) Clinical testing considerations A scientifically justified surrogate ventolin may be used if asthma treatment-positive patients are not available. Positive % agreement should not be determined using high Ct samples. One-half (1/2) to two-thirds (2/3) of asthma treatment-positive samples should have a high viral loads (Cts <.
30). Report agreement between control and test swabs in terms of quantitative (Ct) and qualitative (+/- test) values with appropriate descriptive statistics. Include patient symptomatology for samples. For example, days from symptom onset, known vs. Suspected asthma treatment status.
Use of different VTM/universal transport media (V/UTM) across asthma treatment-positive samples may contribute to Ct variability. Ensure consistency by using the same media/tubes for each specimen within a clinical evaluation. Validate the chosen V/UTM media/tubes to show they will not interfere with the PCR test results. For example, allowing 7 days of swab positive specimen incubation with the chosen media/vial is considered a worst-case transportation scenario to evaluate maximal leaching/interaction potential). Use a single PCR test platform throughout each clinical evaluation.
The platform should have been previously authorized by HC or another jurisdiction. Location (for example, left vs right nostril) and order of sampling (for example, control vs. Test swab) can affect specimen quality and results variability. Location and swab sampling order should be randomized.For additional information on collecting, handling, and testing asthma treatment specimens, please refer to the Centers for Disease Control and Prevention (CDC) Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for asthma treatment.Previous clinical dataPreviously obtained clinical data may be submitted in lieu of clinical testing. Those data should demonstrate the safe and effective use of a swab of identical design and materials in human subjects.
The proposed swab should be compared against a flocked swab commercially available in Canada with respect to. flexibility fit ability to navigate to the nasopharynx (or other areas specified in the indications) ability to collect a specimen/respiratory epithelial cells for example, using the RNase P housekeeping gene test results agreement for example, ⥠90% positive % agreement) using a composite control (positive % agreement calculation that includes all positive findings from control and test swabs) Sterility Provide sterilization validation data in a summary report. It should demonstrate that the chosen sterilization method will achieve a minimum Sterility Assurance Level (SAL) of 10-6 for the proposed swab, using an appropriate biological indicator (BI) organism (see below). If the swab will be sterilized using an ethylene oxide (EtO) method, you should demonstrate that EtO and ethylene chlorohydrin (ECH) residuals meet the tolerable contact limits (TCL) specified in ISO 10993-7. Commonly used swab materials, compatible sterilization methods, and appropriate biological indicators are described below.
Sterilization Method Swab Materials EtO(for example, ISO 11135) Gamma Irradiation(ISO 11137) Polystyrene handle, polyester bicomponent fiber tipFootnote * X(for example, Puritan 25-3316-H/U) Not applicable Polystyrene handle, nylon flocked fiber tipFootnote * X(for example, Copan 503CS01) X(for example, BD 220252) Footnote * The CDC provides guidance on the types of swabs that should be used for optimal specimen collection for PCR testing. They include swabs that are made of polyester (for example, Dacron), rayon, or nylon-flocked. Cotton-tipped or calcium alginate swabs are not acceptable because residues present in those materials inhibit the PCR reaction. Return to footnote * referrer Appropriate BIIf ionizing radiation will be used to sterilize the swab. Bacillus pumilus spores are recommended for doses of 25 kGy Bacillus cereus or Bacillus sphaericus spores are recommended for doses of >.
25 kGy (World Health Organization, The International Pharmacopoeia, 9th Ed., 2019) Sterilization Process Spore (Indicator Organism) Steam Geobacillus stearothermophilus(formerly Bacillus stearothermophilus) Dry Heat Bacillus atrophaeus (formerly Bacillus subtilis var. Niger) Ethlylene Oxide Bacillus atrophaeus (formerly Bacillus subtilis var. Niger) Hydrogen Peroxide Geobacillus stearothermophilus(formerly Bacillus stearothermophilus) Source. US Food and Drug Administration, "Biological Indicator (BI) Premarket Notification [510(k)] Submissions," October 2007. [Online].Packaging validation Provide packaging validation data in a summary report.
It should demonstrate that the swab packaging system will maintain a sterile environment across the labelled shelf life (for example, ASTM F1980). without leakage (for example, ASTM D3078-02) with adequate seal strength (for example, ASTM F88/EN 868-5)Test packaging samples should be representative of finished swab packages that have undergone sterilization prior to testing.Biocompatibility Provide biocompatibility data in a summary report. It should demonstrate compliance with biocompatibility tests recommended for devices in limited contact (â¤24 hrs) with mucosal membranes, as per ISO 10993-1. These include. cytotoxicity sensitization irritation/intracutaneous reactivityThese data should be based on test samples representative of finished swabs that have undergone sterilization prior to testing.LabellingSwabs should be individually packaged and labelled.
The application must include the swab label, which must include. The name and model number of the device the term âsterileâ, along with the sterilization method (EtO = ethylene oxide. R = gamma irradiation), if the swab is intended to be sold in a sterile condition the name and address of the manufacturer manufacturing and expiry datesIf swabs are not sterile but must be sterilized at the user facility, then the sterilization parameters and method should be clearly described in accompanying instructions for use documentation.Post-market requirementsAs stated in Section 12 of the IO, within 10 days of becoming aware of an incident in Canada, all IO authorization holders must. report the incident specify the nature of the incident specify the circumstances surrounding the incidentOn this page About face shields Personal protective equipment (PPE) can help prevent potential exposure to infectious disease. They are considered medical devices in Canada and therefore must follow the requirements outlined in the Medical Devices Regulations.
Medical devices are classified into 4 groups (Class I, II, III and IV) based on their risk to health and safety. Class I devices, such as gauze bandages, pose the lowest potential risk, while Class IV devices, such as pacemakers, pose the greatest potential risk. In Canada, face shields are Class I medical devices. A face shield has a transparent window or visor that shields the face and associated mucous membranes (eyes, nose and mouth). It protects the wearer against exposure from splashes and sprays of body fluids.
Face shields are made of shatterproof plastic, fit over the face and are held in place by head straps or caps. They may be made of polycarbonate, propionate, acetate, polyvinyl chloride, or polyethylene terephthalate. They are usually worn with other PPE, such as a medical mask, respirator or eyewear. Health Canada strongly advises against the use of plastic bags as an alternative to face shields. Standards and requirements for face shields Organizations that are manufacturing face shields are advised to consult some or all of the following standards throughout the design and testing stages.
ANSI/ISEA Z.87.1 (2015), American National Standard for Occupational and Educational Personal Eye and Face Protection Devices CSA Z94.3 (2020), Eye and Face Protectors CSA Z94.3.1 (2016), Guideline for Selection, Use, and Care of Eye and Face Protectors BS EN 166 (2002), Personal Eye Protection. Specifications. Minimum specifications must be incorporated into the design and verification stages to ensure safe and effective face shields. Provide adequate coverage (CSA Z94.3 Sections 0.2.1/10.2.2/10.3/10.4). The size of the face shield is important because it must protect the face and front part of the head.
This includes the eyes, forehead, cheeks, nose, mouth, and chin. Protection may also need to extend to the front of the neck in situations with flying particles and sprays of hazardous liquids. Fit snugly to afford a good seal to the forehead area and to prevent slippage of the device Footnote 1. Be made of optically clear, distortion-free, lightweight materials (CSA Z94.3.1-16 and Footnote 1). Be free of visible defects or flaws that would impede vision (ANSI Z87.1 Section 9.4).
Be comfortable and easy to assemble, use and remove by health care professionals. Provide adequate space between the wearerâs face and the inner surface of the visor to allow for the use of ancillary equipment (for example, medical mask, respirator, eyewear) Footnote 1. The characteristics and performance requirements of face shields must not be altered when attaching shields to other protective equipment, such as hats or caps. Display anti-fog characteristics on inside and outside of shield (CSA Z94.3.1-16). For face shields that are not fog resistant, anti-fog spray must be provided.
Provide user-contacting materials that have adequate material biocompatibility (skin sensitivity and cytotoxic testing) (ISO 10993-5, 10). Other items to take note of include. Face shields used for protection in hospital settings do not have to be impact- or flame- resistant. If the device is specifically designed to withstand impact from sharp or fast projectiles, it must comply with set-out standards (ANSI Z87.1, sections 9.2 and 9.3, CSA Z94.3, section 10.1). For reuse, manufacturers must provide validated cleaning instructions.
Sterilization procedures must not compromise the shield in any way, such as deformation or cracking. Regulatory authorization Most PPE, including face shields, are Class I medical devices if they are manufactured, sold or represented for use for reducing the risk of or preventing the user from . This includes asthma treatment. Face shields may be authorized for sale or import into Canada through the following regulatory pathways. Pathway 1.
Interim order authorization to import and sell medical devices related to asthma treatment. Pathway 2. Expedited review and issuance of Medical Device Establishment Licences (MDEL) related to asthma treatment. MDEL holders that import and sell face shields should take measures to ensure they are safe and effective. Pathway 3.
Exceptional importation and sale of certain non-compliant medical devices related to asthma treatment. Note that a sale generally requires the transfer of ownership of a device from one party to another and does not necessitate any transfer of money. Applicants should carefully review the pathways and select the most appropriate authorization route for their product. For more information, see Personal protective equipment (asthma treatment). How to get authorization.
If you intend to manufacture 3D print face shields in response to the asthma treatment crisis, see. 3D printing and other manufacturing of personal protective equipment in response to asthma treatment Feedback If you have any questions or comments about this notice, contact the Medical Devices Directorate at hc.meddevices-instrumentsmed.sc@canada.ca R. J. Roberge, "Face shields for control. A review," Journal of Occupational and Environmental Hygiene, pp.
235-242, 2016. Related links FootnotesFootnote 1 R. J. Roberge, "Face shields for control. A review," Journal of Occupational and Environmental Hygiene, pp.
235-242, 2016.Return to footnote 1 referrerWhat is the Notice of Compliance (NOC) Data Extract?. The data extract is a series of compressed ASCII text files of the database. The uncompressed size of the files is approximately 19.0 MB. In order to utilize the data, the file must be loaded into an existing database or information system. The typical user is most likely a third party claims adjudicator, provincial formulary, insurance company, etc.
A casual user of this file must be familiar with database structure and capable of setting up queries. The "Read me" file contains the data structure required to download the zipped files. The NOC extract files have been updated. They contain Health Canada authorization dates for all drugs dating back to 1994 that have received an NOC. All NOCs issued between 1991 and 1993 can be found in the NOC listings.
Please note any Portable Document Format (PDF) files visible on the NOC database are not part of the data extracts. For more information, please go to the Read Me File. Data Extracts - Last updated. September 4, 2020 Copyright For information on copyright and who to contact, please visit the Notice of Compliance Online Database Terms and Conditions.Before drug products are authorized for sale in Canada, Health Canada reviews them to assess their safety, efficacy and quality. Drug products include prescription and non-prescription pharmaceuticals, disinfectants and sanitizers with disinfectant claims.What information can you find here?.
This section contains links to reports and publications related to drug products. Drug Submission Performance ReportsThe Drug Submission Review Performance Reports provide detailed metrics about the timeliness of pre-market drug review process against performance service standards. The annual report compares five consecutive fiscal years (April 1 - March 31), while the quarterly report compares five quarters. The reports are broken down by operational areas. The Therapeutic Product Directorate (TPD) report summarises performance metrics for pharmaceuticals.
The Biologics and Genetic Therapies Directorate (BGTD) was renamed to the Biologic and Radiopharmaceutical Drugs Directorate (BRDD). The BRDD report summarises performance metrics for biologics and radiopharmaceutical drugs. The Natural and Non-Prescription Health Products Directorate (NNHPD) report summarises performance metrics for non-prescription (over-the-counter) and disinfectant drugs. Within each report, statistics are provided by submission type and show the number received, the number in workload, the number of decisions and the number of approvals and time to approval.Submissions Received are counts of submissions received during the year using the filing date. Workload is reported as the number of submissions "under active review" on a given day.
"Backlog" is the proportion of the workload that is over target. "Approvals" are Notice of Compliances (NOC) issued or issuable. An issuable NOC arises when a submission NOC is placed "on hold" awaiting authorization to market, due to requirements in the Patented Medicines (Notice of Compliance) Regulations, or due to a conversion of status from prescription to Over the Counter.Drug Submission Performance Reports are available by request only. Please see contact information below.Annual ReportsTPD. BRDD.
NNHPD. Quarterly ReportsTPD. BRDD. NNHPD. Reports.
What should I watch for while using Ventolin?
Tell your doctor or health care professional if your symptoms do not improve. Do not take extra doses. If your asthma or bronchitis gets worse while you are using Ventolin, call your doctor right away. If your mouth gets dry try chewing sugarless gum or sucking hard candy. Drink water as directed.
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WASHINGTON â President Trump on Thursday pledged to send $200 prescription drug coupons to 33 million Medicare beneficiaries âin the coming weeks,â a political ploy to curry favor with seniors who view drug prices as a priority.Trumpâs promise comes less than six weeks before Election Day, and represents the lek ventolin latest step in his administrationâs (and his campaignâs) click over here now efforts to amass health care talking points, even if their actions do little to save Americans money.The administration is getting its authority to ship the coupons from a Medicare demonstration program, a White House spokesman told STAT in a statement. The nearly $7 billion required to send the coupons, he said, would come from savings from Trumpâs âmost favored nationsâ drug pricing proposal. That regulation has also not yet been implemented â meaning the Trump administration is effectively pledging to spend $6.6 billion in savings lek ventolin that do not currently exist. The cards, he said, would be âactual discount cards for prescription drug copays.âadvertisement Trump also bragged about a new regulation allowing states and pharmacies to import prescription drugs from Canada. While the administration did publish a Food and Drug Administration regulation on importation Thursday, states would still need to apply to participate and then would have to set up new programs to actually begin importing drugs.Health secretary Alex Azar also sent a letter to congressional leadership lek ventolin formally âcertifyingâ that importation can be done safely and that it would save the U.S.
Money. Thatâs a major step in green-lighting lek ventolin widespread drug importation. Current law requires that importation can only happen if the secretary formally certifies it first. Azar is the first Department of Health and lek ventolin Human Services secretary in history to formally certify that importation is safe.advertisement Trumpâs remarks came during a careening North Carolina speech address on Trumpâs âAmerica First Health Care Plan,â which he had pledged to unveil for months.During the event, Trump attacked Democrats and his election opponent, Joe Biden, and insisted that heâd done more to reform U.S. Health care than any past administration.
(The health care law championed and signed by former president Barack Obama lek ventolin helped reduce the rate of Americans without insurance from 16% of the population in 2010 to 9% in 2016, and made other sweeping changes to the delivery of health care in the U.S.)It is unclear whether Trumpâs promises on $200 credits for prescription drug coupons will come to fruition. Under the Constitution, it is Congress, not the White House, that is empowered to spend taxpayer money, and it is unclear where the roughly $6.6 billion for the program would come from. The idea has never lek ventolin been formally proposed or sketched out by health officials, though the New York Times reported this week that Trump officials had tried to convince the pharmaceutical industry to pay for similar cards worth $100. The drug industry refused.A spokesperson for PhRMA, the drug industry trade group, said that âone-time savings cards will neither provide lasting help, nor advance the fundamental reforms necessary to help seniors better afford their medicines.â Trumpâs remarks followed a similarly puzzling press briefing orchestrated by two top administration health advisers. During a Thursday afternoon call with reporters, the administration teased a âhistoricâ health care plan likely to kickstart lek ventolin âthe most consequential health care reform in American history.âThe actual policies they announced, however, are simple, superficial, and non-binding executive orders.
Neither will improve the quality of Americansâ health care or lower its cost.The first, Azar said, is a declaration. ÂIt is the policy of the United States that people who suffer from pre-existing conditions will be protectedâ from discrimination by health lek ventolin insurers. He acknowledged the order was redundant. It mirrors protections enshrined lek ventolin in the Affordable Care Act, the landmark health law that the Trump administration has asked a federal court to invalidate. The second order, Azar said, was a directive that he work with Congress to ban âsurpriseâ out-of-network medical bills by Jan.
1. If Congress remains gridlocked on the issue then, he added, Trump would direct him to pursue other actions or regulations.âI donât have details for you at this point on that,â he said.Throughout a 30-minute press call, Azar and Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, struggled to provide any further detail. But they continually cast the actions as historic, the latest in a series of Trump administration attempts to play up health care actions in the final run-up to Election Day. On Sept. 13, Trump rolled out a series of actions on drug pricing that will be all but impossible to implement by Nov.
3, including a controversial plan to cap Medicareâs drug payment levels based on prices that pharmaceutical companies charge in other countries.The actions were widely viewed as motivated by election politics, not policy â Trump has sparred with drug manufacturers for years, but his administration has struggled to enact its own agenda on drug pricing thanks to a federal court setback, a series of internal conflicts, and steadfast industry opposition. Trumpâs health care electioneering has even extended to his governmentâs widely criticized asthma treatment response. Often, Trumpâs misstatements have taken a markedly political tone and generated controversy regarding the role of high-ranking government scientists. In particular, Stephen Hahn, the commissioner of the Food and Drug Administration, was criticized in August for dramatically overstating the impact of blood plasma from recovered asthma treatment patients as a asthma treatment.The two executive actions fall dramatically short of the âfull and completeâ health care planâ Trump promised in July. During Thursdayâs press call, both Azar and Verma officials struggled to provide detail or cast the actions as a comprehensive plan.
Azar was, at times, candid in acknowledging that the executive orders carried little force. The surprise billing order, he said, would require private-sector players like hospitals and insurance companies negotiate among themselves.âAll the relevant players â hospitals, doctors, insurance companies â had better get their act together and get legislation passed through Congress that protects patients against surprise medical bills from anybody. Hospitals or doctors, doesnât matter,â he said. ÂThose special interest groups need to sort it out and figure out how that would work.âThe protections for patients with pre-existing conditions have been in force since 2014, and are among the most popular elements of the Affordable Care Act. The administrationâs announcement on the stated protections is likely empty rhetoric.
Many legal experts believe it is unlikely that the White House could enact similar protections without help from Congress. The announcement comes in the face of intense criticism surrounding the Trump administrationâs support for a lawsuit that would overturn the ACA in its entirety. The Supreme Courtâs decision in the case this term could ultimately end the ACAâs expansion of state Medicaid programs, its protections for patients with pre-existing conditions, and, ironically, the very federal program that has allowed the Trump administration to attempt such drastic action to regulate lower drug prices.Azar and Verma also attempted to cast past health care actions, including a measure on hospital price transparency, as part of Trumpâs new plan, perhaps in recognition of Trumpâs precarious Election Day position on most health care issues.Trump trails his Democratic challenger, Joe Biden, on most health care issues, according to polls. Americans disapprove of the administrationâs chaotic asthma treatment response by wide margins. And one recent Kaiser Family Foundation survey found a majority of voters trust Biden over Trump on protecting patients with pre-existing conditions, ensuring access to insurance, and protecting the Affordable Care Act, though Trump held a slight advantage on plans to tackle high drug prices..
WASHINGTON â President how to buy ventolin in usa Trump on Thursday pledged to send $200 prescription drug coupons to 33 million Medicare beneficiaries âin the coming weeks,â a political ploy to curry favor with seniors who view drug prices as a priority.Trumpâs promise comes less than six weeks before Election Day, and represents the latest step in his administrationâs (and his campaignâs) efforts to amass health care talking points, even if their actions do little to save Americans money.The administration is getting its authority to ship the coupons from a Medicare Extra resources demonstration program, a White House spokesman told STAT in a statement. The nearly $7 billion required to send the coupons, he said, would come from savings from Trumpâs âmost favored nationsâ drug pricing proposal. That regulation has also not yet been implemented â meaning how to buy ventolin in usa the Trump administration is effectively pledging to spend $6.6 billion in savings that do not currently exist.
The cards, he said, would be âactual discount cards for prescription drug copays.âadvertisement Trump also bragged about a new regulation allowing states and pharmacies to import prescription drugs from Canada. While the administration did publish a Food and Drug Administration regulation on importation Thursday, states would still how to buy ventolin in usa need to apply to participate and then would have to set up new programs to actually begin importing drugs.Health secretary Alex Azar also sent a letter to congressional leadership formally âcertifyingâ that importation can be done safely and that it would save the U.S. Money.
Thatâs a how to buy ventolin in usa major step in green-lighting widespread drug importation. Current law requires that importation can only happen if the secretary formally certifies it first. Azar is the first Department of Health and Human Services secretary in history to formally certify that importation is safe.advertisement Trumpâs remarks came during a careening North Carolina speech address on Trumpâs âAmerica First Health Care Plan,â which he had pledged to unveil for months.During the event, Trump attacked Democrats and his election opponent, Joe Biden, and insisted that heâd done more to how to buy ventolin in usa reform U.S.
Health care than any past administration. (The health care law championed and signed by former president Barack Obama helped reduce the rate of Americans without insurance from 16% of the population in 2010 to 9% in 2016, and made other sweeping changes to the delivery of health care in the U.S.)It is unclear whether Trumpâs promises on $200 credits for prescription drug coupons will come to fruition how to buy ventolin in usa. Under the Constitution, it is Congress, not the White House, that is empowered to spend taxpayer money, and it is unclear where the roughly $6.6 billion for the program would come from.
The idea has never been formally proposed or sketched out by health officials, though the New York Times reported this week that Trump officials had tried to convince the pharmaceutical how to buy ventolin in usa industry to pay for similar cards worth $100. The drug industry refused.A spokesperson for PhRMA, the drug industry trade group, said that âone-time savings cards will neither provide lasting help, nor advance the fundamental reforms necessary to help seniors better afford their medicines.â Trumpâs remarks followed a similarly puzzling press briefing orchestrated by two top administration health advisers. During a Thursday afternoon call with reporters, the how to buy ventolin in usa administration teased a âhistoricâ health care plan likely to kickstart âthe most consequential health care reform in American history.âThe actual policies they announced, however, are simple, superficial, and non-binding executive orders.
Neither will improve the quality of Americansâ health care or lower its cost.The first, Azar said, is a declaration. ÂIt is the policy of the United States that people who suffer from how to buy ventolin in usa pre-existing conditions will be protectedâ from discrimination by health insurers. He acknowledged the order was redundant.
It mirrors how to buy ventolin in usa protections enshrined in the Affordable Care Act, the landmark health law that the Trump administration has asked a federal court to invalidate. The second order, Azar said, was a directive that he work with Congress to ban âsurpriseâ out-of-network medical bills by Jan. 1.
If Congress remains gridlocked on the issue then, he added, Trump would direct him to pursue other actions or regulations.âI donât have details for you at this point on that,â he said.Throughout a 30-minute press call, Azar and Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, struggled to provide any further detail. But they continually cast the actions as historic, the latest in a series of Trump administration attempts to play up health care actions in the final run-up to Election Day. On Sept.
13, Trump rolled out a series of actions on drug pricing that will be all but impossible to implement by Nov. 3, including a controversial plan to cap Medicareâs drug payment levels based on prices that pharmaceutical companies charge in other countries.The actions were widely viewed as motivated by election politics, not policy â Trump has sparred with drug manufacturers for years, but his administration has struggled to enact its own agenda on drug pricing thanks to a federal court setback, a series of internal conflicts, and steadfast industry opposition. Trumpâs health care electioneering has even extended to his governmentâs widely criticized asthma treatment response.
Often, Trumpâs misstatements have taken a markedly political tone and generated controversy regarding the role of high-ranking government scientists. In particular, Stephen Hahn, the commissioner of the Food and Drug Administration, was criticized in August for dramatically overstating the impact of blood plasma from recovered asthma treatment patients as a asthma treatment.The two executive actions fall dramatically short of the âfull and completeâ health care planâ Trump promised in July. During Thursdayâs press call, both Azar and Verma officials struggled to provide detail or cast the actions as a comprehensive plan.
Azar was, at times, candid in acknowledging that the executive orders carried little force. The surprise billing order, he said, would require private-sector players like hospitals and insurance companies negotiate among themselves.âAll the relevant players â hospitals, doctors, insurance companies â had better get their act together and get legislation passed through Congress that protects patients against surprise medical bills from anybody. Hospitals or doctors, doesnât matter,â he said.
ÂThose special interest groups need to sort it out and figure out how that would work.âThe protections for patients with pre-existing conditions have been in force since 2014, and are among the most popular elements of the Affordable Care Act. The administrationâs announcement on the stated protections is likely empty rhetoric. Many legal experts believe it is unlikely that the White House could enact similar protections without help from Congress.
The announcement comes in the face of intense criticism surrounding the Trump administrationâs support for a lawsuit that would overturn the ACA in its entirety. The Supreme Courtâs decision in the case this term could ultimately end the ACAâs expansion of state Medicaid programs, its protections for patients with pre-existing conditions, and, ironically, the very federal program that has allowed the Trump administration to attempt such drastic action to regulate lower drug prices.Azar and Verma also attempted to cast past health care actions, including a measure on hospital price transparency, as part of Trumpâs new plan, perhaps in recognition of Trumpâs precarious Election Day position on most health care issues.Trump trails his Democratic challenger, Joe Biden, on most health care issues, according to polls. Americans disapprove of the administrationâs chaotic asthma treatment response by wide margins.
And one recent Kaiser Family Foundation survey found a majority of voters trust Biden over Trump on protecting patients with pre-existing conditions, ensuring access to insurance, and protecting the Affordable Care Act, though Trump held a slight advantage on plans to tackle high drug prices..
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IntroductionLa Peste (Camus 1947) has served as a basis for several critical works, including ventolin evohaler canada some in the field of medical humanities (Bozzaro http://www.katzenfreund.ch/eine-dosis-katzenwissen/ 2018. Deudon 1988. Tuffuor and Payne ventolin evohaler canada 2017). Frequently interpreted as an allegory of Nazism (with the plague as a symbol of the German occupation of France) (Finel-Honigman 1978. Haroutunian 1964), it has also received philosophical readings beyond the sociopolitical context in which it was written (Lengers 1994).
Other scholars, on the other hand, have centred their analyses on its literary aspects (Steel 2016).The asthma treatment ventolin has increased general interest about historical and fictional epidemics ventolin evohaler canada. La Peste, as one of the most famous literary works about this topic, has been revisited by many readers during recent months, leading to an unexpected growth in sales in certain countries (Wilsher 2020. Zaretsky 2020). Apart from that, commentaries about the novel, especially among health sciences scholars, have emerged with a renewed interest (Banerjee et ventolin evohaler canada al. 2020.
Bate 2020. Vandekerckhove 2020 ventolin evohaler canada. Wigand, Becker, and Steger 2020). This sudden curiosity is easy to understand if we consider both La Pesteâs literary value, and peopleâs desire to discover real or fictional situations similar to theirs. Indeed, Oran inhabitantsâ experiences are not quite far from our own, even if geographical, chronological and, specially, scientific factors (two different diseases occurring at two different stages in the history of medical development) prevent us from establishing too close resemblances between both situations.Furthermore, it will not be strange if asthma treatment serves as a frame for fictional works in the near future ventolin evohaler canada.
Other narrative plays were based on historical epidemics, such as Daniel Defoeâs A Journal of the Plague Year or Giovanni Boccaccioâs Decameron (Wigand, Becker, and Steger 2020. Withington 2020). The biggest ventolin in the last century, the so-called âSpanish Influenzaâ, has been described as not very fruitful in this sense, even if it produced famous novels such as Katherine A ventolin evohaler canada Porterâs Pale Horse, Pale Rider or John OâHaraâs The Doctor Son (Honigsbaum 2018. Hovanec 2011). The overlapping with another disaster like World War I has been argued as one of the reasons explaining this scarce production of fictional works (Honigsbaum 2018).
By contrast, we may think that asthma treatment is having a global impact hardly overshadowed by other events, and that it will leave a significant mark on the collective memory.Drawing on the reading of La Peste, we point out in ventolin evohaler canada this essay different aspects of living under an epidemic that can be identified both in Camusâs work and in our current situation. We propose a trip throughout the novel, from its early beginning in Part I, when the Oranians are not aware of the threat to come, to its end in Part V, when they are relieved of the epidemic after several months of ravaging disasters.We think this journey along La Peste may be interesting both to health professionals and to the lay person, since all of them will be able to see themselves reflected in the characters from the novel. We do not skip critique of some aspects related to the authoritiesâ management of asthma treatment, as Camus does concerning Oranâs rulers. However, what we want to foreground is La Pesteâs intrinsic value, its suitability ventolin evohaler canada to be read now and after asthma treatment has passed, when Camusâs novel endures as a solid art work and asthma treatment remains only as a defeated plight.MethodsWe confronted our own experiences about asthma treatment with a conventional reading of La Peste. A first reading of the novel was used to establish associations between those aspects which more saliently reminded us of asthma treatment.
In a second reading, we searched for some examples to illustrate those aspects and tried to detect new associations. Subsequent readings of certain parts were done to ventolin evohaler canada integrate the information collected. Neither specific methods of literary analysis, nor systematic searches in the novel were applied. Selected paragraphs and ideas from Part I to Part V were prepared in a draft copy, and this manuscript was written afterwards.Part ISome phrases in the novel could be transposed word by word to our situation. This one pertaining to its start, for instance, may make us remember the first months of 2020:By now, it will be easy to accept that nothing could lead the people of our town to expect the events that took place ventolin evohaler canada in the spring of that year and which, as we later understood, were like the forerunners of the series of grave happenings that this history intends to describe.
(Camus 2002, Part I)By referring from the beginning to âthe people of our townâ, Camus is already suggesting an idea which is repeated all along the novel, and which may be well understood by us as asthma treatmentâs witnesses. Epidemics affect the community as a whole, they are present in everybodyâs mind and their joys and sorrows are not individual, but collective. For example (and we are anticipating Part II), the narrator says:But, once the gates were ventolin evohaler canada closed, they all noticed that they were in the same boat, including the narrator himself, and that they had to adjust to the fact. (Camus 2002, Part II)Later, he will insist in this opposition between the concepts of âindividualâ, which used to prevail before the epidemic, and âcollectiveâ:One might say that the first effect of this sudden and brutal attack of the disease was to force the citizens of our town to act as though they had no individual feelings. (Camus 2002, Part II)There were no longer any individual destinies, but a collective history that was the plague, and feelings shared by all.
(Camus 2002, Part III)This distinction is not trivial, since the story will display a strong confrontation between those who get involved and help their neighbours ventolin evohaler canada and those who remain behaving selfishly. Related to this, Claudia Bozzaro has pointed out that the main topic in La Peste is solidarity and auistic love (Bozzaro 2018). We may add that the disease is so attached to peopleâs lives that the epidemic becomes the new everyday life:In the morning, they would return to the pestilence, that is to say, to routine. (Camus 2002, ventolin evohaler canada Part III)Being collective issues does not mean that epidemics always enhance auism and solidarity. As said by Wigand et al, they frequently produce ambivalent reactions, and one of them is the opposition between auism and maximised profit (Wigand, Becker, and Steger 2020).
Therefore, the dichotomy between individualism and collectivism, a central point in the characterisation of national cultures (Hofstede 2015), could play a role in epidemics. In fact, concerning asthma treatment, some authors ventolin evohaler canada have described a greater impact of the ventolin in those countries with higher levels of individualism (Maaravi et al. 2021. Ozkan et al. 2021).
However, this finding should be complemented with other national culturesâ aspects before concluding that collectivism itself exerts a protective role against epidemics. Concerning this, it has been shown how âpower distanceâ frequently intersects with collectivism, being only a few countries in which the last one coexists with a small distance to power, namely with a capacity to disobey the power authority (Gupta, Shoja, and Mikalef 2021). Moreover, those countries classically classified as âcollectivistâ (China, Japan, South Korea, India, Vietnam, etc.) are also characterised by high levels of power distance, and their citizens have been quite often forced to adhere to asthma treatment restrictions and punished if not (Gupta, Shoja, and Mikalef 2021). Thus, it is important to consider that individualism is not always opposed to âlook after each otherâ (Ozkan et al. 2021, 9).
For instance, the European region, seen as a whole as highly âindividualisticâ, holds some of the most advanced welfare protection systems worldwide. It is worth considering too that collectivism may hide sometimes a hard institutional authority or a lack in civil freedoms.Coming back to La Peste, we may think that Camusâs Oranians are not particularly âcollectivistâ. Their initial description highlights that they are mainly interested in their own businesses and affairs:Our fellow-citizens work a good deal, but always in order to make money. They are especially interested in trade and first of all, as they say, they are engaged in doing business. (Camus 2002, Part I)And later, we see some of them trying selfishly to leave the city by illegal methods.
By contrast, we observe in the novel some examples of more âcollectivisticâ attitudes, such as the discipline of those quarantined at the football pitch, and, over all, the main charactersâ behaviour, which is generally driven by auism and common goals.Turning to another topic, the plague in Oran and asthma treatment are similar regarding their animal origin. This is not rare since many infectious diseases pass to humans through contact with animal vectors, being rodents, especially rats (through rat fleas), the most common carriers of plague bacteria (CDC. N.d.a, ECDC. N.d, Pollitzer 1954). Concerning asthma, even if further research about its origin is needed, the most recent investigations conducted in China by the WHO establish a zoonotic transmission as the most probable pathway (Joint WHO-China Study Team 2021).
In Camusâs novel, the animalâs link to the epidemic seemed very clear since the beginning:Things got to the point where Infodoc (the agency for information and documentation, â all you need to know on any subjectâ) announced in its free radio news programme that 6,231 rats had been collected and burned in a single day, the 25th. This figure, which gave a clear meaning to the daily spectacle that everyone in town had in front of their eyes, disconcerted them even more. (Camus 2002, Part I)This accuracy in figures is familiar to us. People nowadays have become very used to the statistical aspects of the ventolin, due to the continuous updates in epidemiological parameters launched by the media and the authorities. Camus was aware about the relevance of figures in epidemics, which always entail:â¦required registration and statistical tasks.
(Camus 2002, Part II)Because of this, the novel is scattered with numbers, most of them concerning the daily death toll, but others mentioning the number of rats picked up, as we have seen, or combining the number of deaths with the time passed since the start of the epidemic:â Will there be an autumn of plague?. Professor B answers. Â Noâ â, â One hundred and twenty-four dead. The total for the ninety-fourth day of the plague.â (Camus 2002, Part II)We permit ourselves to introduce here a list of recurring topics in La Peste, since the salience of statistical information is one of them. These topics, some of which will be treated later, appear several times in the novel, in various contexts and stages in the evolution of the epidemic.
We synthesise them in Table 1, coupled with a asthma treatment parallel example extracted from online press. This ease to find a current example for each topic suggests that they are not exclusive of plague or of Camusâs mindset, but shared by most epidemics.View this table:Table 1 Recurring topics in La Peste. Each topic is accompanied by two examples from the novel and one concerning asthma treatment, extracted from online press.Talking about journalism and the media (one of the topics above), we might say that asthma treatmentâs coverage is frequently too optimistic when managing good news and too alarming when approaching the bad. Mediaâs âexaggeratedâ approach to health issues is not new. It was already a concern for medical journalsâ editors a century ago (Reiling 2013) and it continues to be it for these professionals in recent times (Barbour et al.
2008). It is well known that media tries to attract spectatorsâ attention by making the news more appealing. However, they deal with the risk of expanding unreliable information, which may be pernicious for the public opinion. Related to the intention of âgarnishingâ the news, Aslam et al. (2020) have described that 82% of more than 100â000 pieces of information about asthma treatment appearing in media from different countries carried an emotional, either negative (52%) or positive (30%) component, with only 18% of them considered as âneutralâ (Aslam et al.
2020). Some evidence about this tendency to make news more emotional was described in former epidemics. For instance, a study conducted in Singapore in 2009 during the H1N1 crisis showed how press releases by the Ministry of Health were substantially transformed when passed to the media, by increasing their emotional appeal and by changing their dominant frame or their tone (Lee and Basnyat 2013). In La Peste, this superficial way of managing information by the media is also observed:The newspapers followed the order that they had been given, to be optimistic at any cost. (Camus 2002, Part IV)At the first stages of the epidemic in Oran, journalists proclaim the end of the dead ratsâ invasion as something to be celebrated.
Dr Rieux, the character through which Camus symbolises caution (and comparable nowadays to trustful scientists, well-informed journalists or sensible authorities), exposes then his own angle, quite far from suggesting optimism:The vendors of the evening papers were shouting that the invasion of rats had ended. But Rieux found his patient lying half out of bed, one hand on his belly and the other around his neck, convulsively vomiting reddish bile into a rubbish bin. (Camus 2002, Part I)Camus, who worked as a journalist for many years, insists afterwards on this cursory interest that some media devote to the epidemic, more eager to grab the noise than the relevant issues beneath it:The press, which had had so much to say about the business of the rats, fell silent. This is because rats die in the street and people in their bedrooms. And newspapers are only concerned with the street.
(Camus 2002, Part I)By then, Oranians continue rejecting the epidemic as an actual threat, completely immersed in that phase that dominates the beginning of all epidemics and is characterised by âdenial and disbeliefâ (Wigand, Becker, and Steger 2020, 443):A pestilence does not have human dimensions, so people tell themselves that it is unreal, that it is a bad dream which will end. [â¦] The people of our town were no more guilty than anyone else, they merely forgot to be modest and thought that everything was still possible for them, which implied that pestilence was impossible. They continued with business, with making arrangements for travel and holding opinions. Why should they have thought about the plague, which negates the future, negates journeys and debate?. They considered themselves free and no one will ever be free as long as there is plague, pestilence and famine.
(Camus 2002, Part I)Probably to avoid citizens' disapproval, among other reasons, the Oranian Prefecture (health authority in Camus' novel) does not want to go too far when judging the relevance of the epidemic. While not directly exposed, we can guess in this fragment the tone of the Prefectâs message, his intention to convey confidence despite his own doubts:These cases were not specific enough to be really disturbing and there was no doubt that the population would remain calm. None the less, for reasons of caution which everyone could understand, the Prefect was taking some preventive measures. If they were interpreted and applied in the proper way, these measures were such that they would put a definite stop to any threat of epidemic. As a result, the Prefect did not for a moment doubt that the citizens under his charge would co-operate in the most zealous manner with what he was doing.
(Camus 2002, Part I)The relevant role acquired by health authorities during epidemics is another topic listed in our table. Language use, on the other hand, is an issue linkable both with the media topic and with this one. As in La Peste, during asthma treatment we have seen some public figures using words not always truthfully, carrying out a careful selection of words that serves to the goal of conveying certain interests in each moment. Dr Rieux refers in Part I to this language manipulation by the authorities:The measures that had been taken were insufficient, that was quite clear. As for the â specially equipped wardsâ, he knew what they were.
Two outbuildings hastily cleared of other patients, their windows sealed up and the whole surrounded by a cordon sanitaire. (Camus 2002, Part I)He illustrates the need of frankness, the preference for clarity in language, which is often the clarity in thinking:No. I phoned Richard to say we needed comprehensive measures, not fine words, and that either we must set up a real barrier to the epidemic, or nothing at all. (Camus 2002, Part I)At the end of this part, his fears about the inadequacy of not taking strict measures are confirmed. Oranian hospitals become overwhelmed, as they are now in many places worldwide due to asthma treatment.Part IILeft behind the phases of âdenial and disbeliefâ and of âfear and panicâ, it appears among the Oranians the âacceptance paired with resignationâ (Wigand, Becker, and Steger 2020, 443):Then we knew that our separation was going to last, and that we ought to try to come to terms with time.
[â¦] In particular, all of the people in our town very soon gave up, even in public, whatever habit they may have acquired of estimating the length of their separation. (Camus 2002, Part II)In asthma treatment as well, even if border closure has not been so immovable as in Oran, many people have seen themselves separated from their loved ones and some of them have not yet had the possibility of reunion. This is why, in the actual ventolin, the idea of temporal horizons has emerged like it appeared in Camusâs epidemic. In Spain, the general lockdown in March and April 2020 made people establish the summer as their temporal horizon, a time in which they could resume their former habits and see their relatives again. This became partially true, and people were allowed in summer to travel inside the country and to some other countries nearby.
However, there existed some reluctance to visit ill or aged relatives, due to the fear of infecting them, and some families living in distant countries were not able to get together. Moreover, autumn brought an increase in the number of cases (âthe second waveâ) and countries returned to limit their internal and external movements.Bringing all this together, many people nowadays have opted to discard temporal horizons. As Oranians, they have noted that the epidemic follows its own rhythm and it is useless to fight against it. Nonetheless, it is in human nature not to resign, so abandoning temporal horizons does not mean to give up longing for the recovery of normal life. This vision, neither maintaining vain hopes nor resigning, is in line with Camusâs philosophy, an author who wrote that âhope, contrary to what it is usually thought, is the same to resignation.â (Camus 1939, 83.
Cited by Haroutunian 1964, 312 (translation is ours)), and that âthere is not love to human life but with despair about human life.â (Camus 1958, 112â5. Cited by Haroutunian 1964, 312â3 (translation is ours)).People nowadays deal with resignation relying on daily life pleasures (being not allowed to make further plans or trips) and in company from the nearest ones (as they cannot gather with relatives living far away). Second, they observe the beginning of vaccination campaigns as a first step of the final stage, and summer 2021, reflecting what happened with summer 2020, has been fixed as a temporal horizon. This preference for summers has an unavoidable metaphorical nuance, and their linking to joy, long trips and life in the streets may be the reason for which we choose them to be opposed to the lockdown and restrictions of the ventolin.We alluded previously to the manipulation of language, and figures, as relevant as they are, they are not free from manipulation either. Tarrou, a close friend to Dr Rieux, points out in this part of the novel how this occurred:Once more, Tarrou was the person who gave the most accurate picture of our life as it was then.
Naturally he was following the course of the plague in general, accurately observing that a turning point in the epidemic was marked by the radio no longer announcing some hundreds of deaths per week, but 92, 107 and 120 deaths a day. ÂThe newspapers and the authorities are engaged in a battle of wits with the plague. They think that they are scoring points against it, because 130 is a lower figure than 910.â (Camus 2002, Part II)Tarrou collaborates with the health teams formed to tackle the plague. Regarding these volunteers and workers, Camus refuses to consider them as heroes, as many essential workers during asthma treatment have rejected to be named as that. The writer thinks their actions are the natural behaviour of good people, not heroism but âa logical consequenceâ:The whole question was to prevent the largest possible number of people from dying and suffering a definitive separation.
There was only one way to do this, which was to fight the plague. There was nothing admirable about this truth, it simply followed as a logical consequence. (Camus 2002, Part II)We consider suitable to talk here about two issues which represent, nowadays, a great part of asthma treatment fears and hopes, respectively. New genetic variants and treatments. Medical achievements are another recurrent issue included in table 1, and we write about them here because it is in Part II where Camus writes for the first time about treatments, and where it insists on an idea aforementioned in Part I.
That the plague bacillus affecting Oran is different from previous variants:â¦the microbe differed very slightly from the bacillus of plague as traditionally defined. (Camus 2002, Part II)Related to asthma treatment new variants, they represent a challenge because of two main reasons. Their higher transmissibility and/or severity and their higher propensity to skip the effect of natural or treatment-induced immunity. Public health professionals are determining which is the actual threat of all the new variants discovered, such as those first characterised in the UK (Public Health England 2020), South Africa (Tegally et al. 2021) or Brazil (Fujino et al.
2021). In La Peste, Dr Rieux is always suspecting that the current bacteria they are dealing with is different from the one in previous epidemics of plague. Since several genetic variations for the bacillus Yersinia pestis have been characterised (Cui et al. 2012), it could be possible that the epidemic in Oran originated from a new one. However, we should not forget that we are analysing a literary work, and that scientific accuracy is not a necessary goal in it.
In fact, Rieuxâs reluctances have to do more with clinical aspects than with microbiological ones. He doubts since the beginning, relying exclusively on the symptoms observed, and continues doing it after the laboratory analysis:I was able to have an analysis made in which the laboratory thinks it can detect the plague bacillus. However, to be precise, we must say that certain specific modifications of the microbe do not coincide with the classic description of plague. (Camus 2002, Part II)Camus is consistent with this idea and many times he mentions the bacillus to highlight its oddity. Insisting on the literary condition of the work, and among other possible explanations, he is maybe declaring that that in the novel is not a common (biological, natural) bacteria, but the Nazism bacteria.Turning to treatments, they constitute the principal resource that the global community has to defeat the asthma treatment ventolin.
Vaccination campaigns have started all over the world, and three types of asthma treatments are being applied in the European Union, after their respective statements of efficacy and security (Baden et al. 2021. Polack et al. 2020. Voysey et al.
2021), while a fourth treatment has just recently been approved (EMA 2021a). Although some concerns regarding the safety of two of these treatments have been raised recently (EMA 2021b. EMA 2021c), vaccination plans are going ahead, being adapted according to the state of knowledge at each moment. Some of these treatments are mRNA-based (Baden et al. 2021.
Polack et al. 2020), while others use a viral vector (Bos et al. 2020. Voysey et al. 2021).
They are mainly two-shot treatments, with one exception (Bos et al. 2020), and complete immunity is thought to be acquired 2âweeks after the last shot (CDC. N.d.b, Voysey et al. 2021). Other countries such as China or Russia, on the other hand, were extremely early in starting their vaccination campaigns, and are distributing among their citizens different treatments than the aforementioned (Logunov et al.
2021. Zhang et al. 2021).Even if at least three types of plague treatments had been created by the time the novel takes place (Sun 2016), treatments do not play an important role in La Peste, in which therapeutic measures (the serum) are more important than prophylactic ones. Few times in the novel the narrator refers to prophylactic inoculations:There was still no possibility of vaccinating with preventive serum except in families already affected by the disease. (Camus 2002, Part II)Deudon has pointed out that Camus mixes up therapeutic serum and treatment (Deudon 1988), and in fact there exists a certain amount of confusion.
All along the novel, the narrator focuses on the prophylactic goals of the serum, which is applied to people already infected (Othonâs son, Tarrou, Grandâ¦). However, both in the example above (which can be understood as vaccinating household contacts or already affected individuals) and in others, the differences between treating and vaccinating are not clear:After the morning admissions which he was in charge of himself, the patients were vaccinated and the swellings lanced. (Camus 2002, Part II)In any case, this is another situation in which Camus stands aside from scientific matters, which are to him less relevant in his novel than philosophical or literary ones. The distance existing between the relevance of treatments in asthma treatment and the superficial manner with which Camus treats the topic in La Peste exemplifies this.Part IIIIn part III, the plagueâs ravages become tougher. The narrator turns his focus to burials and their disturbance, a frequent topic in epidemicsâ narrative (table 1).
Camus knew how acutely increasing demands and hygienic requirements affect funeral habits during epidemics:Everything really happened with the greatest speed and the minimum of risk. (Camus 2002, Part III)Like many other processes during epidemics, the burial process becomes a protocol. When protocolised, everything seems to work well and rapidly. But this perfect mechanism is the Prefectureâs goal, not Rieuxâs. He reveals in this moment an aspect in his character barely shown before.
Irony.The whole thing was well organized and the Prefect expressed his satisfaction. He even told Rieux that, when all was said and done, this was preferable to hearses driven by black slaves which one read about in the chronicles of earlier plagues. Â Yes,â Rieux said. Â The burial is the same, but we keep a card index. No one can deny that we have made progress.â (Camus 2002, Part III)Even if this characteristic may seem new in Dr Rieux, we must bear in mind that he is the story narrator, and the narration is ironic from time to time.
For instance, speaking precisely about the burials:The relatives were invited to sign a register âwhich just showed the difference that there may be between men and, for example, dogs. You can keep check of human beings-. (Camus 2002, Part III)In Camusâs philosophy, the absurd is a core issue. According to Lengers, Rieux is ironic because he is a kind of Sisyphus who has understood the absurdity of plague (Lengers 1994). The response to the absurd is to rebel (Camus 2013), and Rieux does it by helping his fellow humans without questioning anything.
He does not pursue any other goal than doing his duty, thus humour (as a response to dire situations) stands out from him when he observes others celebrating irrelevant achievements, such as the Prefect with his burial protocol. In the field of medical ethics, Lengers has highlighted the importance of Camusâs perspective when considering âthe immediacy of life rather than abstract valuesâ (Lengers 1994, 250). Rieux himself is quite sure that his solid commitment is not âabstractâ, and, even if he falls into abstraction, the importance relies on protecting human lives and not in the name given to that task:Was it truly an abstraction, spending his days in the hospital where the plague was working overtime, bringing the number of victims up to five hundred on average per week?. Yes, there was an element of abstraction and unreality in misfortune. But when an abstraction starts to kill you, you have to get to work on it.
(Camus 2002, Part II)Farewells during asthma treatment may have not been particularly pleasant for some families. Neither those dying at nursing homes nor in hospitals could be accompanied by their families as previously, due to corpses management protocols, restrictions of external visitors and hygienic measures in general. However, as weeks passed by, certain efforts were made to ease this issue, allowing people to visit their dying beloved sticking to strict preventive measures. On the other hand, the number of people attending funeral masses and cemeteries was also limited, which affected the conventional development of ceremonies as well. Hospitals had to deal with daily tolls of deaths never seen before, and the overcrowding of mortuaries made us see rows of coffins placed in unusual spaces, such as ice rinks (transformation of facilities is another topic in table 1).We turn now to two other points which asthma treatment has not evaded.
s among essential workers and epidemicsâ economic consequences. The author links burials with s among essential workers because gravediggers constitute one of the most affected professions, and connects this fact with the economic recession because unemployment is behind the large availability of workers to replace the dead gravediggers:Many of the male nurses and the gravediggers, who were at first official, then casual, died of the plague. [â¦] The most surprising thing was that there was never a shortage of men to do the job, for as long as the epidemic lasted. [â¦] When the plague really took hold of the town, its very immoderation had one quite convenient outcome, because it disrupted the whole of economic life and so created quite a large number of unemployed. [â¦] Poverty always triumphed over fear, to the extent that work was always paid according to the risk involved.
(Camus 2002, Part III)The effects of the plague over the economic system are one of our recurrent topics (table 1). The plague in Oran, as it forces to close the city, impacts all trading exchanges. In addition, it forbids travellers from arriving to the city, with the economic influence that that entails:This plague was the ruination of tourism. (Camus 2002, Part II)Oranians, who, as we saw, were very worried about making money, are especially affected by an event which jeopardises it. In asthma treatment, for one reason or for another, most of the countries are suffering economic consequences, since the impact on normal life from the epidemic (another recurrent topic) means also an impact on the normal development of trading activities.Part IVIn Part IV we witness the first signals of a stabilisation of the epidemic:It seemed that the plague had settled comfortably into its peak and was carrying out its daily murders with the precision and regularity of a good civil servant.
In theory, in the opinion of experts, this was a good sign. The graph of the progress of the plague, starting with its constant rise, followed by this long plateau, seemed quite reassuring. (Camus 2002, Part IV)At this time, we consider interesting to expand the topic about the transformation of facilities. We mentioned the case of ice rinks during asthma treatment, and we bring up now the use of a football pitch as a quarantine camp in Camusâs novel, a scene which has reminded some scholars of the metaphor of Nazism and concentration camps (Finel-Honigman 1978). In Spain, among other measures, a fairground was enabled as a field hospital during the first wave, and it is plausible that many devices created with other purposes were used in tasks attached to healthcare provision during those weeks, as occurred in Oranâs pitch with the loudspeakers:Then the loudspeakers, which in better times had served to introduce the teams or to declare the results of games, announced in a tinny voice that the internees should go back to their tents so that the evening meal could be distributed.
(Camus 2002, Part IV)Related to this episode, we can also highlight the opposition between science and humanism that Camus does. The author alerts us about the dangers of a dehumanised science, of choosing procedures perfectly efficient regardless of their lack in human dignity:The men held out their hands, two ladles were plunged into two of the pots and emerged to unload their contents onto two tin plates. The car drove on and the process was repeated at the next tent.â Itâs scientific,â Tarrou told the administrator.â Yes,â he replied with satisfaction, as they shook hands. Â Itâs scientific.â (Camus 2002, Part IV)Several cases with favourable outcomes mark Part IV final moments and prepare the reader for the end of the epidemic. To describe these signs of recovering, the narrator turns back to two elements with a main role in the novel.
Rats and figures. In this moment, the first ones reappear and the second ones seem to be declining:He had seen two live rats come into his house through the street door. Neighbours had informed him that the creatures were also reappearing in their houses. Behind the walls of other houses there was a hustle and bustle that had not been heard for months. Rieux waited for the general statistics to be published, as they were at the start of each week.
They showed a decline in the disease. (Camus 2002, Part IV)Part VGiven that we continue facing asthma treatment, and that forecasts about its end are not easy, we cannot compare ourselves with the Oranians once they have reached the end of the epidemic, what occurs in this part. However, we can analyse our current situation, characterised by a widespread, though cautious, confidence motivated by the beginning of vaccination campaigns, referring it to the events narrated in Part V.Even more than the Oranians, since we feel further than them from the end of the problem, we are cautious about not to anticipate celebrations. From time to time, however, we lend ourselves to dream relying on what the narrator calls âa great, unadmitted hopeâ. asthma treatment took us by surprise and everyone wants to âreorganiseâ their life, as Oranians do, but patience is an indispensable component to succeed, as fictional and historical epidemics show us.Although this sudden decline in the disease was unexpected, the towns-people were in no hurry to celebrate.
The preceding months, though they had increased the desire for liberation, had also taught them prudence and accustomed them to count less and less on a rapid end to the epidemic. However, this new development was the subject of every conversation and, in the depths of peopleâs hearts, there was a great, unadmitted hope. [â¦] One of the signs that a return to a time of good health was secretly expected (though no one admitted the fact) was that from this moment on people readily spoke, with apparent indifference, about how life would be reorganized after the plague. (Camus 2002, Part V)We put our hope on vaccination. Social distancing and other hygienic measures have proved to be effective, but treatments would bring us a more durable solution without compromising so hardly many economic activities and social habits.
As we said, a more important role of scientific aspects is observed in asthma treatment if compared with La Peste (an expected fact if considered that Camusâs story is an artistic work, that he skips sometimes the most complex scientific issues of the plague and that health sciences have evolved substantially during last decades). Oranians, in fact, achieve the end of the epidemic not through clearly identified scientific responses but with certain randomness:All one could do was to observe that the sickness seemed to be going as it had arrived. The strategy being used against it had not changed. It had been ineffective yesterday, and now it was apparently successful. One merely had the feeling that the disease had exhausted itself, or perhaps that it was retiring after achieving all its objectives.
In a sense, its role was completed. (Camus 2002, Part V)They receive the announcement made by the Prefecture of reopening the townâs gates in 2âweeks time with enthusiasm. Dealing with concrete dates gives them certainty, helps them fix the temporal horizons we wrote about. This is also the case when they are told that preventive measures would be lifted in 1âmonth. Camus shows us then how the main characters are touched as well by this positive atmosphere:That evening Tarrou and Rieux, Rambert and the rest, walked in the midst of the crowd, and they too felt they were treading on air.
Long after leaving the boulevards Tarrou and Rieux could still hear the sounds of happiness following them⦠(Camus 2002, Part V)Then, Tarrou points out a sign of recovery coming from the animal world. In a direct zoological chain, infected fleas have vanished from rats, which have been able again to multiply across the city, making the cats abandon their hiding places and to go hunting after them again. At the final step of this chain, Tarrou sees the human being. He remembers the old man who used to spit to the cats beneath his window:At a time when the noise grew louder and more joyful, Tarrou stopped. A shape was running lightly across the dark street.
It was a cat, the first that had been seen since the spring. It stopped for a moment in the middle of the road, hesitated, licked its paw, quickly passed it across its right ear, then carried on its silent way and vanished into the night. Tarrou smiled. The little old man, too, would be happy. (Camus 2002, Part V)Unpleasant things as a town with rats running across its streets, or a man spending his time spitting on a group of cats, constitute normality as much as the reopening of gates or the reboot of commerce.
However, when Camus speaks directly about normality, he highlights more appealing habits. He proposes common leisure activities (restaurants, theatres) as symbols of human life, since he opposes them to Cottardâs life, which has become that of a âwild animalâ:At least in appearance he [ Cottard ] retired from the world and from one day to the next started to live like a wild animal. He no longer appeared in restaurants, at the theatre or in his favourite cafés. (Camus 2002, Part V)We do not disclose why Cottardâs reaction to the end of the epidemic is different from most of the Oraniansâ. In any case, the narrator insists later on the assimilation between common pleasures and normality:â Perhaps,â Cottard said, â Perhaps so.
But what do you call a return to normal life?. Â â New films in the cinema,â said Tarrou with a smile. (Camus 2002, Part V)Cinema, as well as theatre, live music and many other cultural events have been cancelled or obliged to modify their activities due to asthma treatment. Several bars and restaurants have closed, and spending time in those who remain open has become an activity which many people tend to avoid, fearing contagion. Thus, normality in our understanding is linked as well to these simple and pleasant habits, and the complete achievement of them will probably signify for us the desired defeat of the ventolin.In La Peste, love is also seen as a simple good to be fully recovered after the plague.
While Rieux goes through the ârebornâ Oran, it is loversâ gatherings what he highlights. Unlike them, everyone who, during the epidemic, sought for goals different from love (such as faith or money, for instance) remain lost when the epidemic has ended:For all the people who, on the contrary, had looked beyond man to something that they could not even imagine, there had been no reply. (Camus 2002, Part V)And this is because lovers, as the narrator says:If they had found that they wanted, it was because they had asked for the only thing that depended on them. (Camus 2002, Part V)We have spoken before about language manipulation, hypocrisy and public figuresâ roles during epidemics. Camus, during Dr Rieuxâs last visit to the old asthmatic man, makes this frank and humble character criticise, with a point of irony, the authoritiesâ attitude concerning tributes to the dead:â Tell me, doctor, is it true that theyâre going to put up a monument to the victims of the plague?.
Ââ So the papers say. A pillar or a plaque.ââ I knew it!. And thereâll be speeches.âThe old man gave a strangled laugh.â I can hear them already.  Our deadâ¦â Then theyâll go and have dinner.â (Camus 2002, Part V)The old man illustrates wisely the authoritiesâ propensity for making speeches. He knows that most of them usually prefer grandiloquence rather than common words, and seizes perfectly their tone when he imitates them (âOur deadâ¦â).
We have also got used, during asthma treatment, to these types of messages. We have also heard about âour old peopleâ, âour youthâ, âour essential workersâ and even âour deadâ. Behind this tone, however, there could be an intention to hide errors, or to falsely convey carefulness. Honest rulers do not usually need nice words. They just want them to be accurate.We have seen as well some tributes to the victims during asthma treatment, some of which we can doubt whether they serve to victimsâ relief or to authoritiesâ promotion.
We want rulers to be less aware of their own image and to stress truthfulness as a goal, even if this is a hard requirement not only for them, but for every single person. Language is essential in this issue, we think, since it is prone to be twisted and to become untrue. The old asthmatic man illustrates it with his âThereâll be speechesâ and his âOur deadâ¦â, but this is not the only time in the novel in which Camus brings out the topic. For instance, he does so when he equates silence (nothing can be thought as further from wordiness) with truth:It is at the moment of misfortune that one becomes accustomed to truth, that is to say to silence. (Camus 2002, Part II)or when he makes a solid statement against false words:â¦I understood that all the misfortunes of mankind came from not stating things in clear terms.
(Camus 2002, Part IV)The old asthmatic, in fact, while praising the deceased Tarrou, remarks that he used to admire him because âhe didnât talk just for the sake of it.â (Camus 2002, Part V).Related to this topic, what the old asthmatic says about political authorities may be transposed in our case to other public figures, such as scholars and researchers, media leaders, businessmen and women, health professionals⦠and, if we extend the scope, to every single citizen. Because hypocrisy, language manipulation and the fact of putting individual interests ahead of collective welfare fit badly with collective issues such as epidemics. Hopefully, also examples to the contrary have been observed during asthma treatment.The story ends with the fireworks in Oran and the depiction of Dr Rieuxâs last feelings. While he is satisfied because of his medical performance and his activity as a witness of the plague, he is concerned about future disasters to come. When asthma treatment will have passed, it will be time for us as well to review our life during these months.
For now, we are just looking forward to achieving our particular âpart Vâ.AbstractThis study addresses the existing gap in literature that ethnographically examines the experiences of Spanish-speaking patients with limited English proficiency in clinical spaces. All of the participants in this study presented to the emergency department (ED) for evaluation of non-urgent health conditions. Patient shadowing was employed to explore the challenges that this population face in unique clinical settings like the ED. This relatively new methodology facilitates obtaining nuanced understandings of clinical contexts under study in ways that quantitative approaches and survey research do not. Drawing from the field of medical anthropology and approach of narrative medicine, the collected data are presented through the use of clinical ethnographic vignettes and thick description.
The conceptual framework of health-related deservingness guided the analysis undertaken in this study. Structural stigma was used as a complementary framework in analysing the emergent themes in the data collected. The results and analysis from this study were used to develop an argument for the consideration of language as a distinct social determinant of health.emergency medicinemedical anthropologymedical humanitiesData availability statementData sharing not applicable as no datasets were generated and/or analysed for this study..
IntroductionLa Peste (Camus 1947) has served as a basis for several how to buy ventolin in usa critical works, including some in the field of medical humanities (Bozzaro 2018. Deudon 1988. Tuffuor and Payne 2017) how to buy ventolin in usa. Frequently interpreted as an allegory of Nazism (with the plague as a symbol of the German occupation of France) (Finel-Honigman 1978. Haroutunian 1964), it has also received philosophical readings beyond the sociopolitical context in which it was written (Lengers 1994).
Other scholars, on the other hand, have centred their analyses on its literary aspects (Steel 2016).The asthma treatment ventolin how to buy ventolin in usa has increased general interest about historical and fictional epidemics. La Peste, as one of the most famous literary works about this topic, has been revisited by many readers during recent months, leading to an unexpected growth in sales in certain countries (Wilsher 2020. Zaretsky 2020). Apart from that, commentaries about the novel, especially among health sciences how to buy ventolin in usa scholars, have emerged with a renewed interest (Banerjee et al. 2020.
Bate 2020. Vandekerckhove 2020 how to buy ventolin in usa. Wigand, Becker, and Steger 2020). This sudden curiosity is easy to understand if we consider both La Pesteâs literary value, and peopleâs desire to discover real or fictional situations similar to theirs. Indeed, Oran inhabitantsâ experiences are not quite far from our own, even if geographical, chronological and, specially, scientific factors (two different diseases occurring at two how to buy ventolin in usa different stages in the history of medical development) prevent us from establishing too close resemblances between both situations.Furthermore, it will not be strange if asthma treatment serves as a frame for fictional works in the near future.
Other narrative plays were based on historical epidemics, such as Daniel Defoeâs A Journal of the Plague Year or Giovanni Boccaccioâs Decameron (Wigand, Becker, and Steger 2020. Withington 2020). The biggest ventolin in the last century, the how to buy ventolin in usa so-called âSpanish Influenzaâ, has been described as not very fruitful in this sense, even if it produced famous novels such as Katherine A Porterâs Pale Horse, Pale Rider or John OâHaraâs The Doctor Son (Honigsbaum 2018. Hovanec 2011). The overlapping with another disaster like World War I has been argued as one of the reasons explaining this scarce production of fictional works (Honigsbaum 2018).
By contrast, we may think that asthma treatment is having a global impact hardly overshadowed by other events, and that it will leave a significant mark on the collective memory.Drawing on the reading of La Peste, we point out in this essay different aspects of living under an epidemic that can be identified both how to buy ventolin in usa in Camusâs work and in our current situation. We propose a trip throughout the novel, from its early beginning in Part I, when the Oranians are not aware of the threat to come, to its end in Part V, when they are relieved of the epidemic after several months of ravaging disasters.We think this journey along La Peste may be interesting both to health professionals and to the lay person, since all of them will be able to see themselves reflected in the characters from the novel. We do not skip critique of some aspects related to the authoritiesâ management of asthma treatment, as Camus does concerning Oranâs rulers. However, what we want to foreground is La Pesteâs intrinsic value, its suitability to be how to buy ventolin in usa read now and after asthma treatment has passed, when Camusâs novel endures as a solid art work and asthma treatment remains only as a defeated plight.MethodsWe confronted our own experiences about asthma treatment with a conventional reading of La Peste. A first reading of the novel was used to establish associations between those aspects which more saliently reminded us of asthma treatment.
In a second reading, we searched for some examples to illustrate those aspects and tried to detect new associations. Subsequent readings of certain parts were done to how to buy ventolin in usa integrate the information collected. Neither specific methods of literary analysis, nor systematic searches in the novel were applied. Selected paragraphs and ideas from Part I to Part V were prepared in a draft copy, and this manuscript was written afterwards.Part ISome phrases in the novel could be transposed word by word to our situation. This one pertaining to its start, for instance, may make us remember the first months of 2020:By now, it will be easy to accept that nothing could lead the people of our town to expect the events that took place in the spring of how to buy ventolin in usa that year and which, as we later understood, were like the forerunners of the series of grave happenings that this history intends to describe.
(Camus 2002, Part I)By referring from the beginning to âthe people of our townâ, Camus is already suggesting an idea which is repeated all along the novel, and which may be well understood by us as asthma treatmentâs witnesses. Epidemics affect the community as a whole, they are present in everybodyâs mind and their joys and sorrows are not individual, but collective. For example (and we are anticipating Part II), the narrator says:But, once the gates were closed, they all noticed that they were in the same boat, including the narrator himself, and that they had to adjust to the fact how to buy ventolin in usa. (Camus 2002, Part II)Later, he will insist in this opposition between the concepts of âindividualâ, which used to prevail before the epidemic, and âcollectiveâ:One might say that the first effect of this sudden and brutal attack of the disease was to force the citizens of our town to act as though they had no individual feelings. (Camus 2002, Part II)There were no longer any individual destinies, but a collective history that was the plague, and feelings shared by all.
(Camus 2002, how to buy ventolin in usa Part III)This distinction is not trivial, since the story will display a strong confrontation between those who get involved and help their neighbours and those who remain behaving selfishly. Related to this, Claudia Bozzaro has pointed out that the main topic in La Peste is solidarity and auistic love (Bozzaro 2018). We may add that the disease is so attached to peopleâs lives that the epidemic becomes the new everyday life:In the morning, they would return to the pestilence, that is to say, to routine. (Camus 2002, Part III)Being collective issues does not mean that epidemics always enhance how to buy ventolin in usa auism and solidarity. As said by Wigand et al, they frequently produce ambivalent reactions, and one of them is the opposition between auism and maximised profit (Wigand, Becker, and Steger 2020).
Therefore, the dichotomy between individualism and collectivism, a central point in the characterisation of national cultures (Hofstede 2015), could play a role in epidemics. In fact, concerning asthma treatment, some authors have described a greater impact of the ventolin in those countries with higher how to buy ventolin in usa levels of individualism (Maaravi et al. 2021. Ozkan et al. 2021).
However, this finding should be complemented with other national culturesâ aspects before concluding that collectivism itself exerts a protective role against epidemics. Concerning this, it has been shown how âpower distanceâ frequently intersects with collectivism, being only a few countries in which the last one coexists with a small distance to power, namely with a capacity to disobey the power authority (Gupta, Shoja, and Mikalef 2021). Moreover, those countries classically classified as âcollectivistâ (China, Japan, South Korea, India, Vietnam, etc.) are also characterised by high levels of power distance, and their citizens have been quite often forced to adhere to asthma treatment restrictions and punished if not (Gupta, Shoja, and Mikalef 2021). Thus, it is important to consider that individualism is not always opposed to âlook after each otherâ (Ozkan et al. 2021, 9).
For instance, the European region, seen as a whole as highly âindividualisticâ, holds some of the most advanced welfare protection systems worldwide. It is worth considering too that collectivism may hide sometimes a hard institutional authority or a lack in civil freedoms.Coming back to La Peste, we may think that Camusâs Oranians are not particularly âcollectivistâ. Their initial description highlights that they are mainly interested in their own businesses and affairs:Our fellow-citizens work a good deal, but always in order to make money. They are especially interested in trade and first of all, as they say, they are engaged in doing business. (Camus 2002, Part I)And later, we see some of them trying selfishly to leave the city by illegal methods.
By contrast, we observe in the novel some examples of more âcollectivisticâ attitudes, such as the discipline of those quarantined at the football pitch, and, over all, the main charactersâ behaviour, which is generally driven by auism and common goals.Turning to another topic, the plague in Oran and asthma treatment are similar regarding their animal origin. This is not rare since many infectious diseases pass to humans through contact with animal vectors, being rodents, especially rats (through rat fleas), the most common carriers of plague bacteria (CDC. N.d.a, ECDC. N.d, Pollitzer 1954). Concerning asthma, even if further research about its origin is needed, the most recent investigations conducted in China by the WHO establish a zoonotic transmission as the most probable pathway (Joint WHO-China Study Team 2021).
In Camusâs novel, the animalâs link to the epidemic seemed very clear since the beginning:Things got to the point where Infodoc (the agency for information and documentation, â all you need to know on any subjectâ) announced in its free radio news programme that 6,231 rats had been collected and burned in a single day, the 25th. This figure, which gave a clear meaning to the daily spectacle that everyone in town had in front of their eyes, disconcerted them even more. (Camus 2002, Part I)This accuracy in figures is familiar to us. People nowadays have become very used to the statistical aspects of the ventolin, due to the continuous updates in epidemiological parameters launched by the media and the authorities. Camus was aware about the relevance of figures in epidemics, which always entail:â¦required registration and statistical tasks.
(Camus 2002, Part II)Because of this, the novel is scattered with numbers, most of them concerning the daily death toll, but others mentioning the number of rats picked up, as we have seen, or combining the number of deaths with the time passed since the start of the epidemic:â Will there be an autumn of plague?. Professor B answers. Â Noâ â, â One hundred and twenty-four dead. The total for the ninety-fourth day of the plague.â (Camus 2002, Part II)We permit ourselves to introduce here a list of recurring topics in La Peste, since the salience of statistical information is one of them. These topics, some of which will be treated later, appear several times in the novel, in various contexts and stages in the evolution of the epidemic.
We synthesise them in Table 1, coupled with a asthma treatment parallel example extracted from online press. This ease to find a current example for each topic suggests that they are not exclusive of plague or of Camusâs mindset, but shared by most epidemics.View this table:Table 1 Recurring topics in La Peste. Each topic is accompanied by two examples from the novel and one concerning asthma treatment, extracted from online press.Talking about journalism and the media (one of the topics above), we might say that asthma treatmentâs coverage is frequently too optimistic when managing good news and too alarming when approaching the bad. Mediaâs âexaggeratedâ approach to health issues is not new. It was already a concern for medical journalsâ editors a century ago (Reiling 2013) and it continues to be it for these professionals in recent times (Barbour et al.
2008). It is well known that media tries to attract spectatorsâ attention by making the news more appealing. However, they deal with the risk of expanding unreliable information, which may be pernicious for the public opinion. Related to the intention of âgarnishingâ the news, Aslam et al. (2020) have described that 82% of more than 100â000 pieces of information about asthma treatment appearing in media from different countries carried an emotional, either negative (52%) or positive (30%) component, with only 18% of them considered as âneutralâ (Aslam et al.
2020). Some evidence about this tendency to make news more emotional was described in former epidemics. For instance, a study conducted in Singapore in 2009 during the H1N1 crisis showed how press releases by the Ministry of Health were substantially transformed when passed to the media, by increasing their emotional appeal and by changing their dominant frame or their tone (Lee and Basnyat 2013). In La Peste, this superficial way of managing information by the media is also observed:The newspapers followed the order that they had been given, to be optimistic at any cost. (Camus 2002, Part IV)At the first stages of the epidemic in Oran, journalists proclaim the end of the dead ratsâ invasion as something to be celebrated.
Dr Rieux, the character through which Camus symbolises caution (and comparable nowadays to trustful scientists, well-informed journalists or sensible authorities), exposes then his own angle, quite far from suggesting optimism:The vendors of the evening papers were shouting that the invasion of rats had ended. But Rieux found his patient lying half out of bed, one hand on his belly and the other around his neck, convulsively vomiting reddish bile into a rubbish bin. (Camus 2002, Part I)Camus, who worked as a journalist for many years, insists afterwards on this cursory interest that some media devote to the epidemic, more eager to grab the noise than the relevant issues beneath it:The press, which had had so much to say about the business of the rats, fell silent. This is because rats die in the street and people in their bedrooms. And newspapers are only concerned with the street.
(Camus 2002, Part I)By then, Oranians continue rejecting the epidemic as an actual threat, completely immersed in that phase that dominates the beginning of all epidemics and is characterised by âdenial and disbeliefâ (Wigand, Becker, and Steger 2020, 443):A pestilence does not have human dimensions, so people tell themselves that it is unreal, that it is a bad dream which will end. [â¦] The people of our town were no more guilty than anyone else, they merely forgot to be modest and thought that everything was still possible for them, which implied that pestilence was impossible. They continued with business, with making arrangements for travel and holding opinions. Why should they have thought about the plague, which negates the future, negates journeys and debate?. They considered themselves free and no one will ever be free as long as there is plague, pestilence and famine.
(Camus 2002, Part I)Probably to avoid citizens' disapproval, among other reasons, the Oranian Prefecture (health authority in Camus' novel) does not want to go too far when judging the relevance of the epidemic. While not directly exposed, we can guess in this fragment the tone of the Prefectâs message, his intention to convey confidence despite his own doubts:These cases were not specific enough to be really disturbing and there was no doubt that the population would remain calm. None the less, for reasons of caution which everyone could understand, the Prefect was taking some preventive measures. If they were interpreted and applied in the proper way, these measures were such that they would put a definite stop to any threat of epidemic. As a result, the Prefect did not for a moment doubt that the citizens under his charge would co-operate in the most zealous manner with what he was doing.
(Camus 2002, Part I)The relevant role acquired by health authorities during epidemics is another topic listed in our table. Language use, on the other hand, is an issue linkable both with the media topic and with this one. As in La Peste, during asthma treatment we have seen some public figures using words not always truthfully, carrying out a careful selection of words that serves to the goal of conveying certain interests in each moment. Dr Rieux refers in Part I to this language manipulation by the authorities:The measures that had been taken were insufficient, that was quite clear. As for the â specially equipped wardsâ, he knew what they were.
Two outbuildings hastily cleared of other patients, their windows sealed up and the whole surrounded by a cordon sanitaire. (Camus 2002, Part I)He illustrates the need of frankness, the preference for clarity in language, which is often the clarity in thinking:No. I phoned Richard to say we needed comprehensive measures, not fine words, and that either we must set up a real barrier to the epidemic, or nothing at all. (Camus 2002, Part I)At the end of this part, his fears about the inadequacy of not taking strict measures are confirmed. Oranian hospitals become overwhelmed, as they are now in many places worldwide due to asthma treatment.Part IILeft behind the phases of âdenial and disbeliefâ and of âfear and panicâ, it appears among the Oranians the âacceptance paired with resignationâ (Wigand, Becker, and Steger 2020, 443):Then we knew that our separation was going to last, and that we ought to try to come to terms with time.
[â¦] In particular, all of the people in our town very soon gave up, even in public, whatever habit they may have acquired of estimating the length of their separation. (Camus 2002, Part II)In asthma treatment as well, even if border closure has not been so immovable as in Oran, many people have seen themselves separated from their loved ones and some of them have not yet had the possibility of reunion. This is why, in the actual ventolin, the idea of temporal horizons has emerged like it appeared in Camusâs epidemic. In Spain, the general lockdown in March and April 2020 made people establish the summer as their temporal horizon, a time in which they could resume their former habits and see their relatives again. This became partially true, and people were allowed in summer to travel inside the country and to some other countries nearby.
However, there existed some reluctance to visit ill or aged relatives, due to the fear of infecting them, and some families living in distant countries were not able to get together. Moreover, autumn brought an increase in the number of cases (âthe second waveâ) and countries returned to limit their internal and external movements.Bringing all this together, many people nowadays have opted to discard temporal horizons. As Oranians, they have noted that the epidemic follows its own rhythm and it is useless to fight against it. Nonetheless, it is in human nature not to resign, so abandoning temporal horizons does not mean to give up longing for the recovery of normal life. This vision, neither maintaining vain hopes nor resigning, is in line with Camusâs philosophy, an author who wrote that âhope, contrary to what it is usually thought, is the same to resignation.â (Camus 1939, 83.
Cited by Haroutunian 1964, 312 (translation is ours)), and that âthere is not love to human life but with despair about human life.â (Camus 1958, 112â5. Cited by Haroutunian 1964, 312â3 (translation is ours)).People nowadays deal with resignation relying on daily life pleasures (being not allowed to make further plans or trips) and in company from the nearest ones (as they cannot gather with relatives living far away). Second, they observe the beginning of vaccination campaigns as a first step of the final stage, and summer 2021, reflecting what happened with summer 2020, has been fixed as a temporal horizon. This preference for summers has an unavoidable metaphorical nuance, and their linking to joy, long trips and life in the streets may be the reason for which we choose them to be opposed to the lockdown and restrictions of the ventolin.We alluded previously to the manipulation of language, and figures, as relevant as they are, they are not free from manipulation either. Tarrou, a close friend to Dr Rieux, points out in this part of the novel how this occurred:Once more, Tarrou was the person who gave the most accurate picture of our life as it was then.
Naturally he was following the course of the plague in general, accurately observing that a turning point in the epidemic was marked by the radio no longer announcing some hundreds of deaths per week, but 92, 107 and 120 deaths a day. ÂThe newspapers and the authorities are engaged in a battle of wits with the plague. They think that they are scoring points against it, because 130 is a lower figure than 910.â (Camus 2002, Part II)Tarrou collaborates with the health teams formed to tackle the plague. Regarding these volunteers and workers, Camus refuses to consider them as heroes, as many essential workers during asthma treatment have rejected to be named as that. The writer thinks their actions are the natural behaviour of good people, not heroism but âa logical consequenceâ:The whole question was to prevent the largest possible number of people from dying and suffering a definitive separation.
There was only one way to do this, which was to fight the plague. There was nothing admirable about this truth, it simply followed as a logical consequence. (Camus 2002, Part II)We consider suitable to talk here about two issues which represent, nowadays, a great part of asthma treatment fears and hopes, respectively. New genetic variants and treatments. Medical achievements are another recurrent issue included in table 1, and we write about them here because it is in Part II where Camus writes for the first time about treatments, and where it insists on an idea aforementioned in Part I.
That the plague bacillus affecting Oran is different from previous variants:â¦the microbe differed very slightly from the bacillus of plague as traditionally defined. (Camus 2002, Part II)Related to asthma treatment new variants, they represent a challenge because of two main reasons. Their higher transmissibility and/or severity and their higher propensity to skip the effect of natural or treatment-induced immunity. Public health professionals are determining which is the actual threat of all the new variants discovered, such as those first characterised in the UK (Public Health England 2020), South Africa (Tegally et al. 2021) or Brazil (Fujino et al.
2021). In La Peste, Dr Rieux is always suspecting that the current bacteria they are dealing with is different from the one in previous epidemics of plague. Since several genetic variations for the bacillus Yersinia pestis have been characterised (Cui et al. 2012), it could be possible that the epidemic in Oran originated from a new one. However, we should not forget that we are analysing a literary work, and that scientific accuracy is not a necessary goal in it.
In fact, Rieuxâs reluctances have to do more with clinical aspects than with microbiological ones. He doubts since the beginning, relying exclusively on the symptoms observed, and continues doing it after the laboratory analysis:I was able to have an analysis made in which the laboratory thinks it can detect the plague bacillus. However, to be precise, we must say that certain specific modifications of the microbe do not coincide with the classic description of plague. (Camus 2002, Part II)Camus is consistent with this idea and many times he mentions the bacillus to highlight its oddity. Insisting on the literary condition of the work, and among other possible explanations, he is maybe declaring that that in the novel is not a common (biological, natural) bacteria, but the Nazism bacteria.Turning to treatments, they constitute the principal resource that the global community has to defeat the asthma treatment ventolin.
Vaccination campaigns have started all over the world, and three types of asthma treatments are being applied in the European Union, after their respective statements of efficacy and security (Baden et al. 2021. Polack et al. 2020. Voysey et al.
2021), while a fourth treatment has just recently been approved (EMA 2021a). Although some concerns regarding the safety of two of these treatments have been raised recently (EMA 2021b. EMA 2021c), vaccination plans are going ahead, being adapted according to the state of knowledge at each moment. Some of these treatments are mRNA-based (Baden et al. 2021.
Polack et al. 2020), while others use a viral vector (Bos et al. 2020. Voysey et al. 2021).
They are mainly two-shot treatments, with one exception (Bos et al. 2020), and complete immunity is thought to be acquired 2âweeks after the last shot (CDC. N.d.b, Voysey et al. 2021). Other countries such as China or Russia, on the other hand, were extremely early in starting their vaccination campaigns, and are distributing among their citizens different treatments than the aforementioned (Logunov et al.
2021. Zhang et al. 2021).Even if at least three types of plague treatments had been created by the time the novel takes place (Sun 2016), treatments do not play an important role in La Peste, in which therapeutic measures (the serum) are more important than prophylactic ones. Few times in the novel the narrator refers to prophylactic inoculations:There was still no possibility of vaccinating with preventive serum except in families already affected by the disease. (Camus 2002, Part II)Deudon has pointed out that Camus mixes up therapeutic serum and treatment (Deudon 1988), and in fact there exists a certain amount of confusion.
All along the novel, the narrator focuses on the prophylactic goals of the serum, which is applied to people already infected (Othonâs son, Tarrou, Grandâ¦). However, both in the example above (which can be understood as vaccinating household contacts or already affected individuals) and in others, the differences between treating and vaccinating are not clear:After the morning admissions which he was in charge of himself, the patients were vaccinated and the swellings lanced. (Camus 2002, Part II)In any case, this is another situation in which Camus stands aside from scientific matters, which are to him less relevant in his novel than philosophical or literary ones. The distance existing between the relevance of treatments in asthma treatment and the superficial manner with which Camus treats the topic in La Peste exemplifies this.Part IIIIn part III, the plagueâs ravages become tougher. The narrator turns his focus to burials and their disturbance, a frequent topic in epidemicsâ narrative (table 1).
Camus knew how acutely increasing demands and hygienic requirements affect funeral habits during epidemics:Everything really happened with the greatest speed and the minimum of risk. (Camus 2002, Part III)Like many other processes during epidemics, the burial process becomes a protocol. When protocolised, everything seems to work well and rapidly. But this perfect mechanism is the Prefectureâs goal, not Rieuxâs. He reveals in this moment an aspect in his character barely shown before.
Irony.The whole thing was well organized and the Prefect expressed his satisfaction. He even told Rieux that, when all was said and done, this was preferable to hearses driven by black slaves which one read about in the chronicles of earlier plagues. Â Yes,â Rieux said. Â The burial is the same, but we keep a card index. No one can deny that we have made progress.â (Camus 2002, Part III)Even if this characteristic may seem new in Dr Rieux, we must bear in mind that he is the story narrator, and the narration is ironic from time to time.
For instance, speaking precisely about the burials:The relatives were invited to sign a register âwhich just showed the difference that there may be between men and, for example, dogs. You can keep check of human beings-. (Camus 2002, Part III)In Camusâs philosophy, the absurd is a core issue. According to Lengers, Rieux is ironic because he is a kind of Sisyphus who has understood the absurdity of plague (Lengers 1994). The response to the absurd is to rebel (Camus 2013), and Rieux does it by helping his fellow humans without questioning anything.
He does not pursue any other goal than doing his duty, thus humour (as a response to dire situations) stands out from him when he observes others celebrating irrelevant achievements, such as the Prefect with his burial protocol. In the field of medical ethics, Lengers has highlighted the importance of Camusâs perspective when considering âthe immediacy of life rather than abstract valuesâ (Lengers 1994, 250). Rieux himself is quite sure that his solid commitment is not âabstractâ, and, even if he falls into abstraction, the importance relies on protecting human lives and not in the name given to that task:Was it truly an abstraction, spending his days in the hospital where the plague was working overtime, bringing the number of victims up to five hundred on average per week?. Yes, there was an element of abstraction and unreality in misfortune. But when an abstraction starts to kill you, you have to get to work on it.
(Camus 2002, Part II)Farewells during asthma treatment may have not been particularly pleasant for some families. Neither those dying at nursing homes nor in hospitals could be accompanied by their families as previously, due to corpses management protocols, restrictions of external visitors and hygienic measures in general. However, as weeks passed by, certain efforts were made to ease this issue, allowing people to visit their dying beloved sticking to strict preventive measures. On the other hand, the number of people attending funeral masses and cemeteries was also limited, which affected the conventional development of ceremonies as well. Hospitals had to deal with daily tolls of deaths never seen before, and the overcrowding of mortuaries made us see rows of coffins placed in unusual spaces, such as ice rinks (transformation of facilities is another topic in table 1).We turn now to two other points which asthma treatment has not evaded.
s among essential workers and epidemicsâ economic consequences. The author links burials with s among essential workers because gravediggers constitute one of the most affected professions, and connects this fact with the economic recession because unemployment is behind the large availability of workers to replace the dead gravediggers:Many of the male nurses and the gravediggers, who were at first official, then casual, died of the plague. [â¦] The most surprising thing was that there was never a shortage of men to do the job, for as long as the epidemic lasted. [â¦] When the plague really took hold of the town, its very immoderation had one quite convenient outcome, because it disrupted the whole of economic life and so created quite a large number of unemployed. [â¦] Poverty always triumphed over fear, to the extent that work was always paid according to the risk involved.
(Camus 2002, Part III)The effects of the plague over the economic system are one of our recurrent topics (table 1). The plague in Oran, as it forces to close the city, impacts all trading exchanges. In addition, it forbids travellers from arriving to the city, with the economic influence that that entails:This plague was the ruination of tourism. (Camus 2002, Part II)Oranians, who, as we saw, were very worried about making money, are especially affected by an event which jeopardises it. In asthma treatment, for one reason or for another, most of the countries are suffering economic consequences, since the impact on normal life from the epidemic (another recurrent topic) means also an impact on the normal development of trading activities.Part IVIn Part IV we witness the first signals of a stabilisation of the epidemic:It seemed that the plague had settled comfortably into its peak and was carrying out its daily murders with the precision and regularity of a good civil servant.
In theory, in the opinion of experts, this was a good sign. The graph of the progress of the plague, starting with its constant rise, followed by this long plateau, seemed quite reassuring. (Camus 2002, Part IV)At this time, we consider interesting to expand the topic about the transformation of facilities. We mentioned the case of ice rinks during asthma treatment, and we bring up now the use of a football pitch as a quarantine camp in Camusâs novel, a scene which has reminded some scholars of the metaphor of Nazism and concentration camps (Finel-Honigman 1978). In Spain, among other measures, a fairground was enabled as a field hospital during the first wave, and it is plausible that many devices created with other purposes were used in tasks attached to healthcare provision during those weeks, as occurred in Oranâs pitch with the loudspeakers:Then the loudspeakers, which in better times had served to introduce the teams or to declare the results of games, announced in a tinny voice that the internees should go back to their tents so that the evening meal could be distributed.
(Camus 2002, Part IV)Related to this episode, we can also highlight the opposition between science and humanism that Camus does. The author alerts us about the dangers of a dehumanised science, of choosing procedures perfectly efficient regardless of their lack in human dignity:The men held out their hands, two ladles were plunged into two of the pots and emerged to unload their contents onto two tin plates. The car drove on and the process was repeated at the next tent.â Itâs scientific,â Tarrou told the administrator.â Yes,â he replied with satisfaction, as they shook hands. Â Itâs scientific.â (Camus 2002, Part IV)Several cases with favourable outcomes mark Part IV final moments and prepare the reader for the end of the epidemic. To describe these signs of recovering, the narrator turns back to two elements with a main role in the novel.
Rats and figures. In this moment, the first ones reappear and the second ones seem to be declining:He had seen two live rats come into his house through the street door. Neighbours had informed him that the creatures were also reappearing in their houses. Behind the walls of other houses there was a hustle and bustle that had not been heard for months. Rieux waited for the general statistics to be published, as they were at the start of each week.
They showed a decline in the disease. (Camus 2002, Part IV)Part VGiven that we continue facing asthma treatment, and that forecasts about its end are not easy, we cannot compare ourselves with the Oranians once they have reached the end of the epidemic, what occurs in this part. However, we can analyse our current situation, characterised by a widespread, though cautious, confidence motivated by the beginning of vaccination campaigns, referring it to the events narrated in Part V.Even more than the Oranians, since we feel further than them from the end of the problem, we are cautious about not to anticipate celebrations. From time to time, however, we lend ourselves to dream relying on what the narrator calls âa great, unadmitted hopeâ. asthma treatment took us by surprise and everyone wants to âreorganiseâ their life, as Oranians do, but patience is an indispensable component to succeed, as fictional and historical epidemics show us.Although this sudden decline in the disease was unexpected, the towns-people were in no hurry to celebrate.
The preceding months, though they had increased the desire for liberation, had also taught them prudence and accustomed them to count less and less on a rapid end to the epidemic. However, this new development was the subject of every conversation and, in the depths of peopleâs hearts, there was a great, unadmitted hope. [â¦] One of the signs that a return to a time of good health was secretly expected (though no one admitted the fact) was that from this moment on people readily spoke, with apparent indifference, about how life would be reorganized after the plague. (Camus 2002, Part V)We put our hope on vaccination. Social distancing and other hygienic measures have proved to be effective, but treatments would bring us a more durable solution without compromising so hardly many economic activities and social habits.
As we said, a more important role of scientific aspects is observed in asthma treatment if compared with La Peste (an expected fact if considered that Camusâs story is an artistic work, that he skips sometimes the most complex scientific issues of the plague and that health sciences have evolved substantially during last decades). Oranians, in fact, achieve the end of the epidemic not through clearly identified scientific responses but with certain randomness:All one could do was to observe that the sickness seemed to be going as it had arrived. The strategy being used against it had not changed. It had been ineffective yesterday, and now it was apparently successful. One merely had the feeling that the disease had exhausted itself, or perhaps that it was retiring after achieving all its objectives.
In a sense, its role was completed. (Camus 2002, Part V)They receive the announcement made by the Prefecture of reopening the townâs gates in 2âweeks time with enthusiasm. Dealing with concrete dates gives them certainty, helps them fix the temporal horizons we wrote about. This is also the case when they are told that preventive measures would be lifted in 1âmonth. Camus shows us then how the main characters are touched as well by this positive atmosphere:That evening Tarrou and Rieux, Rambert and the rest, walked in the midst of the crowd, and they too felt they were treading on air.
Long after leaving the boulevards Tarrou and Rieux could still hear the sounds of happiness following them⦠(Camus 2002, Part V)Then, Tarrou points out a sign of recovery coming from the animal world. In a direct zoological chain, infected fleas have vanished from rats, which have been able again to multiply across the city, making the cats abandon their hiding places and to go hunting after them again. At the final step of this chain, Tarrou sees the human being. He remembers the old man who used to spit to the cats beneath his window:At a time when the noise grew louder and more joyful, Tarrou stopped. A shape was running lightly across the dark street.
It was a cat, the first that had been seen since the spring. It stopped for a moment in the middle of the road, hesitated, licked its paw, quickly passed it across its right ear, then carried on its silent way and vanished into the night. Tarrou smiled. The little old man, too, would be happy. (Camus 2002, Part V)Unpleasant things as a town with rats running across its streets, or a man spending his time spitting on a group of cats, constitute normality as much as the reopening of gates or the reboot of commerce.
However, when Camus speaks directly about normality, he highlights more appealing habits. He proposes common leisure activities (restaurants, theatres) as symbols of human life, since he opposes them to Cottardâs life, which has become that of a âwild animalâ:At least in appearance he [ Cottard ] retired from the world and from one day to the next started to live like a wild animal. He no longer appeared in restaurants, at the theatre or in his favourite cafés. (Camus 2002, Part V)We do not disclose why Cottardâs reaction to the end of the epidemic is different from most of the Oraniansâ. In any case, the narrator insists later on the assimilation between common pleasures and normality:â Perhaps,â Cottard said, â Perhaps so.
But what do you call a return to normal life?. Â â New films in the cinema,â said Tarrou with a smile. (Camus 2002, Part V)Cinema, as well as theatre, live music and many other cultural events have been cancelled or obliged to modify their activities due to asthma treatment. Several bars and restaurants have closed, and spending time in those who remain open has become an activity which many people tend to avoid, fearing contagion. Thus, normality in our understanding is linked as well to these simple and pleasant habits, and the complete achievement of them will probably signify for us the desired defeat of the ventolin.In La Peste, love is also seen as a simple good to be fully recovered after the plague.
While Rieux goes through the ârebornâ Oran, it is loversâ gatherings what he highlights. Unlike them, everyone who, during the epidemic, sought for goals different from love (such as faith or money, for instance) remain lost when the epidemic has ended:For all the people who, on the contrary, had looked beyond man to something that they could not even imagine, there had been no reply. (Camus 2002, Part V)And this is because lovers, as the narrator says:If they had found that they wanted, it was because they had asked for the only thing that depended on them. (Camus 2002, Part V)We have spoken before about language manipulation, hypocrisy and public figuresâ roles during epidemics. Camus, during Dr Rieuxâs last visit to the old asthmatic man, makes this frank and humble character criticise, with a point of irony, the authoritiesâ attitude concerning tributes to the dead:â Tell me, doctor, is it true that theyâre going to put up a monument to the victims of the plague?.
Ââ So the papers say. A pillar or a plaque.ââ I knew it!. And thereâll be speeches.âThe old man gave a strangled laugh.â I can hear them already.  Our deadâ¦â Then theyâll go and have dinner.â (Camus 2002, Part V)The old man illustrates wisely the authoritiesâ propensity for making speeches. He knows that most of them usually prefer grandiloquence rather than common words, and seizes perfectly their tone when he imitates them (âOur deadâ¦â).
We have also got used, during asthma treatment, to these types of messages. We have also heard about âour old peopleâ, âour youthâ, âour essential workersâ and even âour deadâ. Behind this tone, however, there could be an intention to hide errors, or to falsely convey carefulness. Honest rulers do not usually need nice words. They just want them to be accurate.We have seen as well some tributes to the victims during asthma treatment, some of which we can doubt whether they serve to victimsâ relief or to authoritiesâ promotion.
We want rulers to be less aware of their own image and to stress truthfulness as a goal, even if this is a hard requirement not only for them, but for every single person. Language is essential in this issue, we think, since it is prone to be twisted and to become untrue. The old asthmatic man illustrates it with his âThereâll be speechesâ and his âOur deadâ¦â, but this is not the only time in the novel in which Camus brings out the topic. For instance, he does so when he equates silence (nothing can be thought as further from wordiness) with truth:It is at the moment of misfortune that one becomes accustomed to truth, that is to say to silence. (Camus 2002, Part II)or when he makes a solid statement against false words:â¦I understood that all the misfortunes of mankind came from not stating things in clear terms.
(Camus 2002, Part IV)The old asthmatic, in fact, while praising the deceased Tarrou, remarks that he used to admire him because âhe didnât talk just for the sake of it.â (Camus 2002, Part V).Related to this topic, what the old asthmatic says about political authorities may be transposed in our case to other public figures, such as scholars and researchers, media leaders, businessmen and women, health professionals⦠and, if we extend the scope, to every single citizen. Because hypocrisy, language manipulation and the fact of putting individual interests ahead of collective welfare fit badly with collective issues such as epidemics. Hopefully, also examples to the contrary have been observed during asthma treatment.The story ends with the fireworks in Oran and the depiction of Dr Rieuxâs last feelings. While he is satisfied because of his medical performance and his activity as a witness of the plague, he is concerned about future disasters to come. When asthma treatment will have passed, it will be time for us as well to review our life during these months.
For now, we are just looking forward to achieving our particular âpart Vâ.AbstractThis study addresses the existing gap in literature that ethnographically examines the experiences of Spanish-speaking patients with limited English proficiency in clinical spaces. All of the participants in this study presented to the emergency department (ED) for evaluation of non-urgent health conditions. Patient shadowing was employed to explore the challenges that this population face in unique clinical settings like the ED. This relatively new methodology facilitates obtaining nuanced understandings of clinical contexts under study in ways that quantitative approaches and survey research do not. Drawing from the field of medical anthropology and approach of narrative medicine, the collected data are presented through the use of clinical ethnographic vignettes and thick description.
The conceptual framework of health-related deservingness guided the analysis undertaken in this study. Structural stigma was used as a complementary framework in analysing the emergent themes in the data collected. The results and analysis from this study were used to develop an argument for the consideration of language as a distinct social determinant of health.emergency medicinemedical anthropologymedical humanitiesData availability statementData sharing not applicable as no datasets were generated and/or analysed for this study..
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Hundreds of medical and social-services organizations have advocated for the passage of the Social Determinants Accelerator Act of 2021, a bipartisan House bill that would establish an interagency council on hop over to this web-site SDOH, among other ventolin hfa 90 mcg provisions. As outlined in a letter sent this week by the Aligning for Health association to members of the House Energy and Commerce Committee, the legislation would empower communities across the country to share data across sectors, foster partnerships, make use of available resources and coordinate care â all with the aim of improving outcomes."Taken together, these elements will address the complexity that often stymies innovative cross-sector efforts or limits the scope and scalability of initiatives at the state and local level," read the letter. WHY IT MATTERS As Aligning for Health pointed out, health and wellness are affected by ventolin hfa 90 mcg more than medical care alone. Factors such as housing, transportation, pollution and access to healthy food can all contribute to health outcomes."These challenges have only become more serious in the wake of the asthma treatment ventolin, which disproportionately impacted vulnerable and underserved communities," noted the Aligning for Health letter.
To begin addressing those needs, HR ventolin hfa 90 mcg 2503 would. Provide planning grants and targeted technical assistance to communities to develop and design innovative, evidence-based approaches to coordinate health and social services.Encourage improvements in cross-sector information exchange, allowing for greater coordination and accountability.Create a federal inter-agency technical advisory council to identify key learnings and best practices, and to facilitate a national dialogue around barriers to success. Rep ventolin hfa 90 mcg. Cheri Bustos, D-Ill., who introduced the act, took to the House floor last week to encourage her colleagues to join the 35 members of Congress who have cosponsored the bill.
The act, she said, is intended "to empower our local communities to address the day-to-day factors that affect their lives."Aligning for Health â itself composed of multiple healthcare member organizations â enclosed a list of groups supporting the bill, including the American Medical Association, the American Hospital Association, eHealth Initiative, Uber Health, Aunt Bertha ventolin hfa 90 mcg and the Blue Cross Blue Shield Association. "We believe that the Social Determinants Accelerator Act of 2021 is a critical step to overcome ... Challenges and move the ball forward," wrote Aligning for Health in its ventolin hfa 90 mcg letter. THE LARGER TREND Perhaps energized in part by the asthma treatment crisis, many elected officials have pushed forward policies aimed at addressing social determinants of health.
In February, a bipartisan group of senators introduced the LINC to Address Social Needs Act, with the ventolin hfa 90 mcg goal of building more robust technology networks for statewide and regional collaboration. That bill is currently in committee. Meanwhile, President Joe Biden has also signaled his support for SDOH-focused digital ventolin hfa 90 mcg health initiatives. His health IT wish list in April included millions of dollars allocated toward the Centers for Disease Control and Prevention's Social Determinants of Health Program.ON THE RECORD The bill, wrote Aligning for Health in its letter, "will provide state, local and tribal governments with additional capacity and support to incubate innovative strategies â and the entire nation will benefit from the results of their effort." Kat Jercich is senior editor of Healthcare IT News.Twitter.
@kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication..
Hundreds of how to buy ventolin in usa medical and social-services organizations have advocated for the passage of the Social Determinants Accelerator Act of 2021, a bipartisan House bill that would establish an interagency council on SDOH, among other provisions. As outlined in a letter sent this week by the Aligning for Health association to members of the House Energy and Commerce Committee, the legislation would empower communities across the country to share data across sectors, foster partnerships, make use of available resources and coordinate care â all with the aim of improving outcomes."Taken together, these elements will address the complexity that often stymies innovative cross-sector efforts or limits the scope and scalability of initiatives at the state and local level," read the letter. WHY IT MATTERS how to buy ventolin in usa As Aligning for Health pointed out, health and wellness are affected by more than medical care alone.
Factors such as housing, transportation, pollution and access to healthy food can all contribute to health outcomes."These challenges have only become more serious in the wake of the asthma treatment ventolin, which disproportionately impacted vulnerable and underserved communities," noted the Aligning for Health letter. To begin addressing those needs, HR how to buy ventolin in usa 2503 would. Provide planning grants and targeted technical assistance to communities to develop and design innovative, evidence-based approaches to coordinate health and social services.Encourage improvements in cross-sector information exchange, allowing for greater coordination and accountability.Create a federal inter-agency technical advisory council to identify key learnings and best practices, and to facilitate a national dialogue around barriers to success.
Rep how to buy ventolin in usa. Cheri Bustos, D-Ill., who introduced the act, took to the House floor last week to encourage her colleagues to join the 35 members of Congress who have cosponsored the bill. The act, she said, is intended "to empower our local communities to address the day-to-day factors that affect their lives."Aligning for Health â itself composed of multiple healthcare member organizations â enclosed a list of groups supporting the bill, including the American Medical Association, how to buy ventolin in usa the American Hospital Association, eHealth Initiative, Uber Health, Aunt Bertha and the Blue Cross Blue Shield Association.
"We believe that the Social Determinants Accelerator Act of 2021 is a critical step to overcome ... Challenges and move the ball forward," how to buy ventolin in usa wrote Aligning for Health in its letter. THE LARGER TREND Perhaps energized in part by the asthma treatment crisis, many elected officials have pushed forward policies aimed at addressing social determinants of health.
In February, a bipartisan group of senators introduced the LINC to Address Social Needs Act, with the goal of how to buy ventolin in usa building more robust technology networks for statewide and regional collaboration. That bill is currently in committee. Meanwhile, President Joe Biden has also signaled his support for SDOH-focused digital health initiatives.
His health IT wish list in April included millions of dollars allocated toward the Centers for Disease Control and Prevention's Social Determinants of Health Program.ON THE RECORD The bill, wrote Aligning for Health in its letter, "will provide state, local and tribal governments with additional capacity and support to incubate innovative strategies â and the entire nation will benefit from the results of their effort." Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication..
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Sex differences in clinical management and outcomes of patients with cardiovascular disease sometimes how much does ventolin cost are due to healthcare inequities (which should be eliminated) but also might be due to sex-related differences in aetiology and pathophysiology best site. For example, the optimal medical dose for management of heart failure with reduced ejection fraction (HFrEF) may be lower in women compared with men. In a study of 561âwomen and 615 men with a new diagnosis of either HRrEF or heart failure with preserved ejection fraction (HFpEF), Bots and colleagues1 found that although 79% of women and 86% of men with HFrEF were prescribed an ACE inhibitor how much does ventolin cost (ACEI) or angiotensin receptor blocker (ARB), the average dose was only about 50% of the recommended target dose for both sexes. A lower ACEI/ARB dose was associated with higher survival outcomes in women, but not men, with HFrEF. In patients of both sexes with HFpEF, there was no relationship between medication dose and survival (figure 1).Central figure summarising the design and main findings of this study." how much does ventolin cost data-icon-position data-hide-link-title="0">Figure 1 Central figure summarising the design and main findings of this study.In the accompanying editorial, Hassan and Ahmed 2 comment that.
ÂSex differences in HF outcomes may be further exacerbated by differences in medication pharmacokinetics and pharmacodynamics, with female-specific physiological factors including lower body mass, as well as decreased renal excretion and gastrointestinal enzymatic activity, leading to higher medication bioavailability. As a result, the administration of sex-neutral how much does ventolin cost medication doses leads to greater drug exposure in female patients, which may subsequently lead to a higher incidence of adverse drug reactions. This raises the possibility of sex-based HF treatments to improve clinical outcomes. However, current guidelines adopt a âone size fits allâ approach, with how much does ventolin cost an emphasis on target-dosed therapy. In this era of precision medicine, is it time to redefine optimal HF therapy based on the sex of the patient?.
ÂOn the other hand, adverse outcomes in women with infective endocarditis likely are how much does ventolin cost related to bias and healthcare inequities. In a multicentric Spanish cohort of 3541 patients3 diagnosed with endocarditis between 2008 and 2018, women underwent surgical intervention less often than men (38.3% vs 50%) despite the increasing recognition that earlier surgical intervention often is beneficial as recommended in current guidelines (figure 2). The lower likelihood of surgery in women persisted how much does ventolin cost after propensity matching for age and surgical risk (OR 0.74. 95%âCI 0.59 to 0.91. P=0.05).
In addition, women had a higher in-hospital mortality compared with men, even after adjusting for possible confounders (OR 1.41. 95%âCI 1.21 to 1.65. P<0.001).Stratification of the GAMES (âGrupo de Apoyo al Manejo de la Endocarditis Infecciosa en Españaâ or âSpanish Collaboration on Endocarditisâ) cohort according to surgical recommendation between sexes. Overall and stratified mortality is displayed in each group." data-icon-position data-hide-link-title="0">Figure 2 Stratification of the GAMES (âGrupo de Apoyo al Manejo de la Endocarditis Infecciosa en Españaâ or âSpanish Collaboration on Endocarditisâ) cohort according to surgical recommendation between sexes. Overall and stratified mortality is displayed in each group.Van Spall, Jaffer and Mamas4 remind us of the many factors to be considered in the decision to recommend surgical intervention in a patient with endocarditis (figure 3).
However, as they conclude. ÂDisparities in referral and receipt of surgical intervention, along with differences in aetiology, microbiology and comorbidities, may be responsible for the higher risk of mortality in women than in men with IE. Ultimately, awareness of these issues should prompt a self-evaluation of biases on the part of clinicians such that objective, timely surgical referrals are made and interventions are offered regardless of demographic group. While the biology is not modifiable, the biases and care disparities are.âFactors associated with infective endocarditis outcomes." data-icon-position data-hide-link-title="0">Figure 3 Factors associated with infective endocarditis outcomes.Another interesting paper in this issue is the study by Sung and colleagues5 showing a positive, graded association between higher levels of physical activity and a higher prevalence, with more rapid progression, of coronary artery calcification (CAC). These findings were based on a cohort of 25â485 Korean men and women with a median interval between CAC measurements of 3 years.
In discussing these seeming paradoxical findings, Gulsin and Moss6 point out that although CAC is a surrogate marker for calcified atherosclerosis and is associated with a higher risk of myocardial infarction, treatment with a statin also accelerates deposition of calcified plaque, similar to the effects of physical activity in the current study. They also remind us that. (1) the severity of CAC at baseline is a key predictor of progression rates, (2) an increase in CAC score is not the same an accelerated rate of total atherosclerotic plaque progression, and (3) the risk of plaque rupture and clinical events is greatest within the necrotic core of noncalcified plaques. Thus, it is possible that an increase in CAC scores reflects a protective response and a transition to a more stable plaque morphology rather than more extensive atherosclerosis. They conclude.
ÂSung and colleagues5 have produced a timely manuscript that highlights the complexity of interpreting coronary artery calcium scores in patients who have implemented recommendations on physical activity or commenced on statin therapy. While proponents would argue that it is an effective tool to screen for subclinical atherosclerosis in asymptomatic individuals, clinicians should be cautious regarding the overuse of this test in otherwise healthy individuals. The coronary artery calcium paradox should not result in paradoxical care for our patients.âThe Education in Heart article7 in this issue provides an overview for clinicians to detect and manage mental issues in their patients with cardiovascular disease (CVD). There is a reciprocal relationship between mental disorders and CVD. Patients with mental disorders have a 1.5- to 3.0-fold higher risk of developing CVD and, conversely, the onset of CVD increases the risk of a developing a mental disorder by 2.2-fold.The Cardiology in-Focus topic in this issue is a step-by-step guide to writing a Image Challenge question, authored by our Image Challenge Editor.8 We encourage both cardiology trainees and clinicians to submit Image Challenge questions to Heart, using this basic guide, because this type of question accelerates learning for both the author and the reader (table 1).View this table:Table 1 Key components of an image challenge questionEthics statementsPatient consent for publicationNot applicable.Reducing the risk of plaque rupture events in individuals without a prior myocardial infarction is an imprecise science.
To help clarify whether there is evidence of coronary artery disease and avoid âmedicalisationâ of otherwise healthy individuals, international guidelines recommend incorporating the measurement of coronary artery calcium alongside risk prediction models.1 Coronary artery calcium serves as a surrogate marker of advanced calcified atherosclerosis and can be calculated from a non-contrast ECG-gated CT scan where a score of 1â99 Agatston units represents subclinical atherosclerosis, and a score of 100 or more Agatston units is considered an appropriate threshold for initiating medical therapy.1 At â¥100 Agatston units, the burden of advanced calcified atherosclerosis justifies statin implementation and this has been validated in a real-world cohort study of 16â996 subjects with a 10-year number needed to treat to prevent one cardiovascular event of 12.2 Many clinicians have advocated the benefits of coronary artery calcium in redefining the cardiovascular risk assessment of healthy individuals, as there is a strong link between high burdens of coronary artery calcium, accelerated progression of calcified plaque and the risk of future myocardial infarction. However, if the burden of calcified plaque is an accurate barometer of cardiovascular risk, one would expect an intervention which reduces an individualâs cardiovascular risk to attenuate progression of calcified plaque. And herein lies the coronary artery calcium paradox. Both invasive and non-invasive imaging studies have â¦.
Sex differences in clinical management and outcomes of patients with cardiovascular disease sometimes are due to healthcare inequities how to buy ventolin in usa (which should be eliminated) but also might be due to sex-related differences in aetiology and pathophysiology. For example, the optimal medical dose for management of heart failure with reduced ejection fraction (HFrEF) may be lower in women compared with men. In a study of 561âwomen and 615 men with a new diagnosis of either HRrEF or heart failure with preserved ejection fraction (HFpEF), Bots and colleagues1 found that although 79% of women and 86% of men with HFrEF were prescribed an ACE inhibitor (ACEI) or angiotensin receptor blocker (ARB), the average dose was only about how to buy ventolin in usa 50% of the recommended target dose for both sexes. A lower ACEI/ARB dose was associated with higher survival outcomes in women, but not men, with HFrEF.
In patients of both sexes with HFpEF, there was no relationship between medication dose and survival (figure 1).Central figure summarising the design and main findings of this study." data-icon-position data-hide-link-title="0">Figure 1 Central figure summarising the design and main findings of this how to buy ventolin in usa study.In the accompanying editorial, Hassan and Ahmed 2 comment that. ÂSex differences in HF outcomes may be further exacerbated by differences in medication pharmacokinetics and pharmacodynamics, with female-specific physiological factors including lower body mass, as well as decreased renal excretion and gastrointestinal enzymatic activity, leading to higher medication bioavailability. As a result, the administration of sex-neutral medication doses leads to greater drug exposure in female patients, which may how to buy ventolin in usa subsequently lead to a higher incidence of adverse drug reactions. This raises the possibility of sex-based HF treatments to improve clinical outcomes.
However, current guidelines adopt a âone size fits allâ approach, with an emphasis on target-dosed therapy how to buy ventolin in usa. In this era of precision medicine, is it time to redefine optimal HF therapy based on the sex of the patient?. ÂOn the other hand, adverse outcomes in women with infective endocarditis likely are related to bias and healthcare inequities how to buy ventolin in usa. In a multicentric Spanish cohort of 3541 patients3 diagnosed with endocarditis between 2008 and 2018, women underwent surgical intervention less often than men (38.3% vs 50%) despite the increasing recognition that earlier surgical intervention often is beneficial as recommended in current guidelines (figure 2).
The lower likelihood of surgery in how to buy ventolin in usa women persisted after propensity matching for age and surgical risk (OR 0.74. 95%âCI 0.59 to 0.91. P=0.05). In addition, women had a higher in-hospital mortality compared with men, even after adjusting for possible confounders (OR 1.41.
95%âCI 1.21 to 1.65. P<0.001).Stratification of the GAMES (âGrupo de Apoyo al Manejo de la Endocarditis Infecciosa en Españaâ or âSpanish Collaboration on Endocarditisâ) cohort according to surgical recommendation between sexes. Overall and stratified mortality is displayed in each group." data-icon-position data-hide-link-title="0">Figure 2 Stratification of the GAMES (âGrupo de Apoyo al Manejo de la Endocarditis Infecciosa en Españaâ or âSpanish Collaboration on Endocarditisâ) cohort according to surgical recommendation between sexes. Overall and stratified mortality is displayed in each group.Van Spall, Jaffer and Mamas4 remind us of the many factors to be considered in the decision to recommend surgical intervention in a patient with endocarditis (figure 3).
However, as they conclude. ÂDisparities in referral and receipt of surgical intervention, along with differences in aetiology, microbiology and comorbidities, may be responsible for the higher risk of mortality in women than in men with IE. Ultimately, awareness of these issues should prompt a self-evaluation of biases on the part of clinicians such that objective, timely surgical referrals are made and interventions are offered regardless of demographic group. While the biology is not modifiable, the biases and care disparities are.âFactors associated with infective endocarditis outcomes." data-icon-position data-hide-link-title="0">Figure 3 Factors associated with infective endocarditis outcomes.Another interesting paper in this issue is the study by Sung and colleagues5 showing a positive, graded association between higher levels of physical activity and a higher prevalence, with more rapid progression, of coronary artery calcification (CAC).
These findings were based on a cohort of 25â485 Korean men and women with a median interval between CAC measurements of 3 years. In discussing these seeming paradoxical findings, Gulsin and Moss6 point out that although CAC is a surrogate marker for calcified atherosclerosis and is associated with a higher risk of myocardial infarction, treatment with a statin also accelerates deposition of calcified plaque, similar to the effects of physical activity in the current study. They also remind us that. (1) the severity of CAC at baseline is a key predictor of progression rates, (2) an increase in CAC score is not the same an accelerated rate of total atherosclerotic plaque progression, and (3) the risk of plaque rupture and clinical events is greatest within the necrotic core of noncalcified plaques.
Thus, it is possible that an increase in CAC scores reflects a protective response and a transition to a more stable plaque morphology rather than more extensive atherosclerosis. They conclude. ÂSung and colleagues5 have produced a timely manuscript that highlights the complexity of interpreting coronary artery calcium scores in patients who have implemented recommendations on physical activity or commenced on statin therapy. While proponents would argue that it is an effective tool to screen for subclinical atherosclerosis in asymptomatic individuals, clinicians should be cautious regarding the overuse of this test in otherwise healthy individuals.
The coronary artery calcium paradox should not result in paradoxical care for our patients.âThe Education in Heart article7 in this issue provides an overview for clinicians to detect and manage mental issues in their patients with cardiovascular disease (CVD). There is a reciprocal relationship between mental disorders and CVD. Patients with mental disorders have a 1.5- to 3.0-fold higher risk of developing CVD and, conversely, the onset of CVD increases the risk of a developing a mental disorder by 2.2-fold.The Cardiology in-Focus topic in this issue is a step-by-step guide to writing a Image Challenge question, authored by our Image Challenge Editor.8 We encourage both cardiology trainees and clinicians to submit Image Challenge questions to Heart, using this basic guide, because this type of question accelerates learning for both the author and the reader (table 1).View this table:Table 1 Key components of an image challenge questionEthics statementsPatient consent for publicationNot applicable.Reducing the risk of plaque rupture events in individuals without a prior myocardial infarction is an imprecise science. To help clarify whether there is evidence of coronary artery disease and avoid âmedicalisationâ of otherwise healthy individuals, international guidelines recommend incorporating the measurement of coronary artery calcium alongside risk prediction models.1 Coronary artery calcium serves as a surrogate marker of advanced calcified atherosclerosis and can be calculated from a non-contrast ECG-gated CT scan where a score of 1â99 Agatston units represents subclinical atherosclerosis, and a score of 100 or more Agatston units is considered an appropriate threshold for initiating medical therapy.1 At â¥100 Agatston units, the burden of advanced calcified atherosclerosis justifies statin implementation and this has been validated in a real-world cohort study of 16â996 subjects with a 10-year number needed to treat to prevent one cardiovascular event of 12.2 Many clinicians have advocated the benefits of coronary artery calcium in redefining the cardiovascular risk assessment of healthy individuals, as there is a strong link between high burdens of coronary artery calcium, accelerated progression of calcified plaque and the risk of future myocardial infarction.
However, if the burden of calcified plaque is an accurate barometer of cardiovascular risk, one would expect an intervention which reduces an individualâs cardiovascular risk to attenuate progression of calcified plaque. And herein lies the coronary artery calcium paradox. Both invasive and non-invasive imaging studies have â¦.
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