Epidemiology of Placebo Effect. Distribution, Frequency and Determining Factors

Jose Luis Turabian

Citation: Turabian JL. Epidemiology of Placebo Effect. Distribution, Frequency and Determining Factors. Medp Public Health Epidemiol. 2022; 1(1): mpphe-202210003.

Abstract 

  Background: Although there is disagreement about the definition and clinical relevance of the placebo effect, the use of inert or non-indicated medication has been common throughout the history of medicine. There is increasing evidence that placebos are effective in clinical practice. However, knowledge of the epidemiology of the placebo effect is poorly developed. 

  Aim: To explore, describe and discuss the topic of epidemiology of placebo effect, in a broad way, considering multiple factors from a theoretical and contextual point of view and its impact on epidemiology. Methods: This article should be considered as a personal point of view, based on the author’s experience, plus an non-systematic or opportunistic search for information. 

  Results: Scientific evidence has shown that the placebo effect exists: it is a true biopsychosocial phenomenon produced by the context in which an intervention is carried out. The placebo is viewed from a different perspective in clinical trials or in clinical practice: 1. the placebo effect occurs in 100% of treatments in clinical practice; placebo effect is a part of all regular treatment. It’s not drug or placebo; it’s drug and placebo. On the other hand, many doctors admit to regularly prescribing placebos, but there are marked differences on the frequency of their use, because of the different definition criteria, but with a high prevalence that is greater than 50% in the treatment courses; 2. Numerous clinical trials have calculated the magnitude or rate of the placebo effect in different clinical conditions. The magnitude of the placebo effect ranges from an average rate of 35% in classic reviews, 62% in neuropathic pain, 40% in fibromyalgia and restless legs syndrome, 25% in patients with schizophrenia and 68% in unipolar depression. 

  Conclusion: It can be said that the placebo response is a complex phenomenon that has many variables; there is no single placebo effect, but rather many effects with different mechanisms, in different medical conditions, and different therapeutic interventions. 

  Key Words: Placebo Effect; Specific and Non-Specific Treatment Effects; Clinical Research; Controlled Clinical Trials; Epidemiology

 

Incidence Rates and Risk Factors for Covid-19 Booster Adverse Reactions in General Medicine

Jose Luis Turabian*  

Citation: Turabian JL. Incidence Rates and Risk Factors for Covid-19 Booster Adverse Reactions in General Medicine. Medp Public Health Epidemiol. 2022; 1(1): mpphe-202210007.

Abstract

   Background: Data on the incidence rate and risk factors of covid-19 booster adverse reactions are critical to success vaccination programs. 

  

   Objective: To describing the incidence rates and risk factors for covid-19 booster adverse reactions in general medicine. 

   Methodology: An observational, longitudinal and prospective study of patients who self report covid-19 booster adverse reactions as a reason for visiting in a general medicine office in Toledo (Spain) was carried out from December 1, 2021-September, 1 2022. 

   Results: Statistically significant factors found for the covid-19 booster adverse reactions were: 1) Protective factors: age > = 65 years, complex family, chronic diseases of circulatory system, and vaccine booster with Comirnaty, Pfizer / BioNTech); And 2) Risk factors: age 14- 64 years, presence of chronic diseases, chronic diseases of genitourinary, and vaccine booster with Moderna mRNA-1273. The incidence rates of covid-19 booster adverse reactions were: 2% >=14 years, 0.3% >= 65 years, 3% in women, 1.5% in men, 1% in Comirnaty (Pfizer / BioNTech), and 3 % in Moderna mRNA-1273. 

   Conclusions: In the context of general medicine in Toledo (Spain), for the period December 1, 2021-September, 1 2022, the incidence rates of covid-19 booster adverse reactions was low, especially in >= 65 years and men. Risk factors focus on women aged 16-64 years, with chronic diseases, and vaccine booster with Moderna mRNA-1273. The risk estimates clearly favour vaccination. However, the small number of cases limits the conclusions that can be drawn. 

   Key Words: COVID-19; SARS-CoV-2; Post-Vaccination Reactions; COVID-19 vaccines; Adverse Events Reaction; Booster Vaccination; General Practice; Risk Factors

The Biopsychosocial Approach Gives Relevance to General Medicine as a Tool of Public Health

Jose Luis Turabian*

Citation: Turabian JL. The Biopsychosocial Approach Gives Relevance to General Medicine as a Tool of Public Health. Medp Public Health Epidemiol. 2022; 1(1): mpphe-202210006

Abstract

   Public Health is the care and promotion of health applied to the entire population. But public health should not be considered as something apart from the health of each individual and general medical care. Numerous social factors have a powerful influence on public health, which is why it is necessary to consider it from a comprehensive perspective. However, comprehensiveness is a principle that is difficult to implement in its dimensions and the role of the relational, community, and social is forgotten. Furthermore, Public health and general medicine are often conceived as two entities providing different services within the health system, and appear as separate disciplines, which are conceptualized, organized and financed as two distinct entities. Thus, it is important to reflect on the conceptual links between individual health and community health; that is, between public health and general medicine. General medicine is a public health tool, and the working instrument of general medicine is the biopsychosocial model. The concepts of comprehensiveness and biopsychosocial approach are those that give importance to general medicine as a basic tool of Public Health. The incorporation of a biopsychosocial perspective in general medicine results in a strengthening of the public health of the population. It is suggested to give more importance to the role of the general practitioner as a public health doctor, emphasizing the comprehensiveness of their work that allows the construction of scenarios for the health and life of communities. 

   Key Words: Public Health; General Practice; Biopsychosocial; Comprehensiveness; Theoretical Framework

Adverse Reactions with Covid-19 Vaccine Booster are of Milder Gravity than with First and Second Dose

 Jose Luis Turabian*

Citation: Turabian JL. Adverse Reactions with Covid-19 Vaccine Booster are of Milder Gravity than with First and Second Dose. Medp Public Health Epidemiol. 2022; 1(1): mpphe–202210005.

Abstract

   Background: It is not clearly known whether the third doses (booster) of the covid-19 vaccine present more or fewer adverse reactions than those of the first and second doses. 

   Objective: Comparison of self-reported adverse reactions, with first and second versus third (booster) doses of covid-19 vaccine. 

   Emplacement: The population attended in a general medicine consultation in Toledo, Spain. 

   Methodology: Analysis of secondary data from two observational, longitudinal, and prospective studies: 1) Adverse covid-19 vaccines reactions from February to July 2021; And 2) Adverse covid-19 vaccines booster reactions from November 2021 to August 2022. 

   Results: We included 21 cases of adverse covid-19 vaccines booster reactions and 109 cases of adverse covid-19 vaccines reactions (1 and 2 doses). Cases of adverse covid-19 vaccines booster reactions versus cases of adverse covid-19 vaccines reactions (1 and 2 doses) differed only statistically significantly in presenting more mild and less severe adverse reactions. 

   Conclusions: In the context of general medicine in Toledo (Spain), there is a tendency for adverse reactions to be significantly lighter with the booster than with the first or second dose of the covid-19 vaccine. 

   Key Words: COVID-19; SARS-CoV-2; Adverse Drug Events; Post-Vaccination Reactions; Booster; COVID-19 vaccine; General Practice; Secondary Analysis

Epidemiology of Placebo Effect. Distribution, Frequency and Determining Factors-Corrected

Jose Luis Turabian* 

Citation: Turabian JL. Epidemiology of Placebo Effect. Distribution, Frequency and Determining Factors-Corrected. Medp Public Health Epidemiol. 2022; 1(1): mpphe-202210003.

Abstract

   Background: Although there is disagreement about the definition and clinical relevance of the placebo effect, the use of inert or non-indicated medication has been common throughout the history of medicine. There is increasing evidence that placebos are effective in clinical practice. However, knowledge of the epidemiology of the placebo effect is poorly developed. 

   Aim: To explore, describe and discuss the topic of epidemiology of placebo effect, in a broad way, considering multiple factors from a theoretical and contextual point of view and its impact on epidemiology. 

  

   Methods: This article should be considered as a personal point of view, based on the author’s experience, plus an non-systematic or opportunistic search for information. 

   Results: Scientific evidence has shown that the placebo effect exists: it is a true biopsychosocial phenomenon produced by the context in which an intervention is carried out. The placebo is viewed from a different perspective in clinical trials or in clinical practice: 1. the placebo effect occurs in 100% of treatments in clinical practice; placebo effect is a part of all regular treatment. It’s not drug or placebo; it’s drug and placebo. On the other hand, many doctors admit to regularly prescribing placebos, but there are marked differences on the frequency of their use, because of the different definition criteria, but with a high prevalence that is greater than 50% in the treatment courses; 2. Numerous clinical trials have calculated the magnitude or rate of the placebo effect in different clinical conditions. The magnitude of the placebo effect ranges from an average rate of 35% in classic reviews, 62% in neuropathic pain, 40% in fibromyalgia and restless legs syndrome, 25% in patients with schizophrenia and 68% in unipolar depression. 

   Conclusion: It can be said that the placebo response is a complex phenomenon that has many variables; there is no single placebo effect, but rather many effects with different mechanisms, in different medical conditions, and different therapeutic interventions. 

   Key Words: Placebo Effect; Specific and Non-Specific Treatment Effects; Clinical Research; Controlled Clinical Trials; Epidemiology 

Biliary Atresia-Challenges of Liver Transplantation

 Suresh Krishnarao*

Citation: Suresh K. Biliary Atresia-Challenges of Liver Transplantation. Medp Public Health Epidemiol. 2022; 1(1): mpphe-202210002.

Abstract

   Objective: Biliary Atresia is a rare condition in early infancy in India, as nearly 2500-5000 such children are born each year. Liver transplantation is a highly successful treatment for biliary atresia, as survival after surgery has increased dramatically in recent years. However, the poor awareness about needs and urgency for liver transplantation for young infants born with Biliary Atresia, availability of donors and lack of facilities for transplantation surgeries, and socioeconomic inequities in accessing the service across the world including advanced countries like USA and UK lead to children experiencing long waiting times for procedure. The objective of this publication of clinical cases is to describe epidemiological risk factor; ordeals of liver transplantation in India and raising an alert for better preparedness of the health system and other stakeholders. 

   Location: Case reports of two liver transplants in Mumbai and Bengaluru in August 2022. 

   Participants: In this review 2 liver transplant surgeries one each in Mumbai and Bengaluru, India in August 2022 are discussed to drive the need for a comprehensive effort from the Government, families and the health insurance companies. The first case was of an infant of 9 months old boy, who underwent within two weeks of birth a corrective surgery (Kasai procedure) to allow for bile drainage, but the surgery failed and resulted in decompensated chronic liver disease with jaundice and other complications needing liver transplantation. He had to undergo an incompatible liver transplant with an aunt’s donated liver as parents were unsuitable. The second case was of a 11-month-old boy needing primary liver transplant due delayed manifestation (at 6 months), diagnosis and mobilizing resources. 

   Measurements: The operating procedures and the outcome in the first month. The financing mechanism for the procedure and limitation of country’s health assurance scheme. 

   Results: The immediate outcome of both the liver transplants were encouraging. 

   Conclusion: liver transplantation for Infants with Biliary Atresia is an urgency, but as of now must wait for long. families, government, insurance companies and even the facilities and surgeons need to join hands for this arduous process. Unless exceptional attention is granted it is difficult to save the children. 

   Materials & Methods: Reports on the ordeals of two cases of Liver transplants one in Bengaluru and another in Mumbai, India in August 2022. 

   Key Words: Bile Duct; Biliary Atresia; Liver Transplantation; Porto-Enterostomy; Ayushman Bharat; State Health Assurance Schemes.

 Jose Luis Turabian*

Citation: Turabian JL. Adverse Covid-19 Vaccines Booster Reactions Case Series, From November 2021 TO September 2022, In a General Medicine Office in Toledo, Spain. Medp Public Health Epidemiol. 2022; 1(1): mpphe–202210001.

Abstract

   Background: There is lack of clinical outcome data on the safety of covid-19 vaccines booster. 

   Objective: To study, in general medicine, clinical-epidemiological characteristics of patients who consulted for self-reported adverse reactions to covid-19 vaccines booster. 

   Methodology: An observational, longitudinal and prospective case series study of patients with adverse reactions to covid-19 vaccines booster, based on a cohort of patients in a family medicine office in Toledo (Spain) was carried out from November 1, 2021 to September 1, 2022. 

   Results: Twenty-one cases of adverse reactions to covid-19 vaccines booster were included. The mean age of the patients was 45 years. 67% were women. According to the criteria of causality, 42% were probable. According to the time of appearance, the majority (76%) occurred between 1-72 hours after shot. 52% were moderate (with interference with normal activities); there was no severe adverse reaction. 81% of adverse reactions to covid-19 vaccines booster occurred with Moderna mRNA-1273. Only 1 case had also presented an adverse reaction with a previous dose of the vaccine. 71% had chronic diseases, being 21% from the genitourinary group and 17% mental. 64% of the symptoms were from the group of symptoms, signs not elsewhere classified (Injection site pain, throat pain, fever, chills, dizziness, headache, asthenia, lymphadenopathy). 

   Conclusion: In the context of general medicine in Toledo (Spain), during the 10 months following the start of the covid-19 vaccination booster, no serious adverse effects were found, which were mostly symptoms and signs not otherwise specified in middle aged women with chronic diseases of genitourinary and mental system. 

   Key Words: COVID-19; Adverse Drug Events; Post-vaccination Reactions; Booster; COVID-19 vaccine; General Practice; Case Series

Magnitude of the Problem & Management of Tropical Fevers-in Smaller Settings (Primary Care Providers to get Ready for the Rainy Season)

 Suresh Krishnarao*

Citation: Suresh K. Magnitude of the Problem & Management of Tropical Fevers-in Smaller Settings (Primary Care Providers to get Ready for the Rainy Season). Medp Public Health Epidemiol. 2022; 1(1): mpphe-202208007.

Abstract

   Pyrexial illness is a presentation associated with tropical environments, include many common infections, like influenza and tuberculosis that occur across the countries. Tropical fevers are defined as infections prevalent in or are unique to tropical & subtropical regions. Some of these occur throughout the year and some especially in rainy and post-rainy season. Febrile patients may also have chronic or recurrent medical problems unrelated to tropical exposure, non-infectious disease e.g., autoimmune, or malignant conditions. Infection of the upper airways is the most common acute illness encountered in the outpatient of smaller settings. The infection is usually caused by viruses including rhinoviruses, influenza viruses, parainfluenza, and respiratory syncytial viruses occurring predominately during annual winter epidemics. Bacterial infection such as acute rhinopharyngitis is uncommon and usually presents with either persistent symptoms of an URTI lasting over a week or worsening course after initial improvement or acute onset with high fever and inflammatory changes confined to the pharynx. Currently India is battling outbreaks of multiple viral and bacterial fevers like Covid 19, Dengue, Chikungunya, Swine Flu (H1N1), Enteric fevers, Monkeypox, tomato fever, Nipah and Zika virus fevers, Chicken pox, Measles, Scrub Typhus, Leptospirosis, West Nile fever, Brucellosis etc. across cities and states. While Public Health approach looks at Tropical Fevers as diseases classified based on Incubation Period, Types of exposure and transmission methods for Control & eradication goals. Clinicians in smaller settings at sub-state capital towns and villages, with limited diagnostic facilities must depend upon Syndromic approach for management. With about 50 outbreaks and more than thousands of cases, currently common febrile conditions in India demand, more clinical acumen though supplementation by diagnostics in most urban areas. This review is based on the clinician’s approach to manage Tropical fevers. 

   

   Materials and Methods: This review is based on the clinical syndromic approach and empirical treatment followed in smaller setting in India. It uses the burden of different fever cases, based on data available from multiple sources, challenges in real time data collection, lack of transparency and availability in public domain and outbreaks data of last 3 years from Integrated Disease surveillance Program for which author had worked in 2006-2013. 

   

   Key Words: Fevers; Tropical Fevers; Viral Fevers; Fever Panel of Diagnostics

Depressed Women and Household Food Security Status

 Zahra Mirzadehahari, Fatemeh Khorramrouz, Morteza Gohari, Mohammad Amin Senobari, Gity Sotoudeh, Maryam Khosravi*.

• Citation: Khosravi M. Depressed Women and Household Food Security Status. Medp Nutr and Food Sci. 2022; 1(1): mpnfs-202210001.

Abstract

   Introduction: Household food insecurity (HFI) has become a major public health concern throughout the world. In addition, depression, as one of the main causes of disability, affects 350 million people worldwide. Given that both problems have a high prevalence, we investigated the relationship between depression and household food insecurity in this study. 

  

   Methods: In this case-control study, the status of food insecurity was compared between adult women with newly diagnosed major depression and healthy women in a 1-to-2 ratio. Major depression was diagnosed by a psychiatrist through a structured interview by diagnostic instrument DSM (Diagnostic and Statistical Manual of Mental Disorder), food insecurity was evaluated using HFIAS (Household Food Insecurity Access Scale) and other general data were gathered by a researcher-made questionnaire. We used SPSS, version18 to analyze data. The differences between quantitative and qualitative variables were examined by the t-test, ANOVA, and χ2 tests, and determining the odds ratio for depression between different degrees of food insecurity was performed by logistic regression.                

   Results: We observed a positive significant relationship between major depression and food insecurity so that the risk of major depression was 3.34 times higher in the severe food insecurity group than in the food security group (P=0.029). This relationship remained significant after adjusting for the confounding factors, including physical activity, number of children, and marital status. 

   

   Conclusion: It was observed a high prevalence of food insecurity in major depressed Iranian women.   

   Keywords: Household Food Insecurity (HFI); Depression; Major Depression Disorder (MDD); Women, Food Security