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The affective statements that caused this reduction were related to emphasizing being there for the person – the sense of a physician’s duty of care – providing reassurance of continuing medical support. Thus, the over-the- counter sale of antibiotics both encourages self-medication and the storage of leftover antimicrobials, creating a vicious circle that increases the consumption of antimicrobials (Figure 1). Llor C., Hernández S., Bayona C., Moragas A., Sierra N., Hernández M., et al. Multidrug- resistant and extensively drug-resistant tubercu- losis: a threat to global control of tuberculosis. for monitoring chronic conditions such as high blood pressure or diabetes [1, 2] and improving adherence to therapies. A few verbal affective remarks can be ef- fective and this is not necessarily time con- suming [12]: In one study it took only 38 seconds to make a difference! These two professions are comple- mentary and synergistic, and ideally, if they re-forge old ties, they will make great new discoveries that will benefit the health of all species as the twenty-first century progresses. found that the main reason for self-medication was a previous medical prescription of the same medication [15]. Part of this stems from the fact that economists as well as politi- cians have come to realize that mobile de- vices along with the (public) health related apps running on them offer great potential for the medical field, not only by improv- ing the quality of care for patients, but also from an economic point of view. For example, they are regarded as invaluable for prevention, e.g. Microbes do not necessarily recognize the differences between species and could infect across them if given the right conditions. (1999)”Narrative based medicine: Why study narrative” BMJ 318,:48–50)De Salvo L. (1996) Patient-centered medicine: a professional evolution. For instance, in our study carried out in 2007, fluoroquinolones, which are consid- ered as critically important antimicrobials by the World Health Organization as also are third- and fourth-generation cephalo- sporins and macrolides) [19], accounted for 40% of the antibiotics sold for urinary tract infections [7]. At the same time apps have already proven to be effective tools for boosting adherence to therapies (for example, via text messag- ing reminders) or for disease management [5]. Zoonotic disease risks from wildlife, livestock, and pets cannot be ad- equately addressed without meaningful collaboration and cooperation between vet- erinarians and physicians. Over-the-counter sale of antimicrobials of- ten leads to a wrong choice of these drugs. Also, they believe that being well informed may also serve to mitigate potential risks. Agenda setting is a teachable and learnable skill that deserves emphasis and reinforcement. International Journal of Person Centered medicine 11, 39-42 10. Informa- tion was shared, and collegial relationships formed. “Risk Factors for Human Disease Emergence.” Philos Trans R Soc Lond B Biol Sci July 29, 2001. Riedel S.“Edward Jenner and the history of small- pox and vaccination.” BUMC Proceedings. In a population survey con- ducted in 19 ­European countries, covering 15,548 respondents, Grigoryan et al. EAHP is now working with counterpart healthcare professional and patient organ- isations at the European level to promote this much needed policy agenda [11] and hope that in time a positive European ex- ample of response to the shortages prob- lem may yet be provided to our colleagues elsewhere in the world. A new European Commission settling into its 5 year term of office could provide the opportunity re- quired [12]. At first gaining great popularity with busi- nesspeople as well as private users who feel they can rarely do without their constant mobile companions, the devices have also become accepted in other sectors, including the medical field. Using a simple opening empathic enquiry, such as “What concerns do you have? ”repeatedly until a complete agenda has been identified appears to take 6 seconds longer than interviews in which the patient’s agenda is interrupted. (2011) Conceptual appraisal of the person centered Integrative Di- agnostic Model. Recently, the World Medical Association and the World Veterinary Association held a joint global conference on One Health. This in-home antibiotic storage might also increase the risk of self-prescription of antibiotics to families and friends. Drawing inspiration, EAHP’s 2014 report on medicines shortages in European hospi- tals ends with a set of policy calls to political decision makers: • Improved collection and sharing of in- formation about medicines shortages in Europe, by both national medicines agencies and the European Medicines Agency; • Clarification and enforcement of legal re- sponsibilities on manufacturers of medi- cines to report disruptions to supply; • An inquiry at the European level into the primary factors causing medicines short- ages; • Criteria for a fair distribution of supply in cases of shortage, based on primary con- sideration of patient need. Empty Shelves, Full of Frustration: Consequences of Drug Shortages and the Need for Action. smart watches, perform their duties in an unobtrusive way but still provide users with impressive functional- ities that would have been unthinkable of only a few years ago: the sensor technology included in most of these devices can record data relating to many different aspects of the user’s life and these data can easily be stored and evaluated either on the devices themselves or be sent to some remote loca- tion for further processing and storage.

There is then a tendency to move to gather more specific information to exclude other possibilities and confirm the presumptive diagnosis. Studying disease similarities and differences between species could shed important new information on disease progression, treat- ment,and control. Southern Euro- pean countries usually rank at the top in Carl Llor Pros and Cons of the Over-the-counter Sales of Antimicrobials Ana Moragas Table 1. Ef- fort, energy and awareness must be drawn to potential solutions. n=418 Approximately how often does your hospital pharmacy experience shortages?

As rapport is established elements of the patient’s tem- perament and personality become more apparent and the patient’s reaction to each question can be noted. Reducing patients’ anxiety and uncertainty, and improving recall in bad news consultations. Beyond zoonoses, comparative medicine is the study of disease processes such as asth- ma, diabetes, and cancer across species. In a nice study carried out in a Finnish community living in Spain, Väänänen et al. Here again, EAHP’s 2014 report provides some addi- tional insight. The areas in which shortages of medicines are most commonly reported are: • antimicrobial agents • oncology medicines • emergency medicines • cardiovascular medicines • anaesthetic agents It is interesting to note that at least 19 (4.5%) reports were received for the lowest affected category: transplant medicines.

It is only through this open style interactive conversation and questioning the physician sorts, extracts, subtracts and adds informa- tion into a meaningful format. Physicians rarely ask their patients about pet ownership or animal exposures,yet pet-associated infec- tions are common and can be deadly [9]. “Theobald Smith— the discoverer of ticks as vectors of disease.” Wien Klin Wochenschr. By contrast with Northern Europe and North America, non-prescription access to antimicrobials is common in the rest of the world [5], as shown in Table 1. The most telling and pressing impact is for patients. N=427 In which area of medicine does your hospital experience shortage most commonly?

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

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

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