BGH manual 2022-2023 Part 2

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Bridging Gaps in Health

Manual 2022-2023

Causes of climate change Impacts of climate change Impacts of climate change on physical health Impacts of Climate Change on Mental Health Relation between Climate change and food safety Climate change in Egypt IFMSA actions in climate change Our role as a public health advocates

▪AMR What is AMR Why is AMR a global concern How is AMR related to the SDGs World Antimicrobial Awareness Week (WAAW) Global Action Plan for Antimicrobial Resistance (GAP) How can we Prevent and control AMR phenomena

▪Immunization Difference between immunity, vaccines, vaccinations and immunization?

History of vaccination How do vaccines play a role in AMR? Our role as public health advocates?

Recommendations regarding BGH Focus Area

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Table of Content

▪Climate Change

Third Piece

CLIMATE CHANGE -Causes of climate change.

-Impacts of climate change -Impacts of climate change on physical health -Impacts of Climate Change on Mental Health -Relation between Climate change and food safety -Climate change in Egypt -IFMSA actions in climate change -Our role as a public health advocates

Climate Change What is climate change?

“It’s a myth” “it’s a conspiracy theory from the government.” “it’s a problem for developed countries, we’re already going through more serious issues!”. These are common misconceptions about climate change and its effects. Simply put, it is the long-term shifts in temperatures and weather patterns. These shifts are expected, however, due to human activity and industrialization, they’re happening quicker than expected.

What are causes of climate change?

Generating power: producing heat and electricity results in the majority of gas emissions.

Manufacturing goods: Manufacturing and industry produce emissions, mostly from burning fossil fuels to produce energy for making things like cement, iron, steel, electronics, plastics, clothes, and other goods.

Cutting down forests: Each year approximately 12 million hectares of forest are destroyed. Since forests absorb carbon dioxide, destroying them also limits nature’s ability to keep emissions out of the atmosphere.

Consuming too much: the power usage in the household, electricity, heating, and water contribute to the production of gas emissions. The wealthiest bear the greatest responsibility: the richest 1 percent of the global population combined account for more greenhouse gas emissions than the poorest 50 percent.

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Overview of the impacts of climate change Climate change is the single biggest threat facing humanity; we should take it very seriously. Earth is a big ship and we humans are the crew who’re keeping it afloat. The health impacts of climate change will be further discussed in detail throughout this manual.

When talking about climate change, the temperature rise is only the beginning of the story. The consequences of climate change are never-ending from intense droughts, catastrophic storms, and declining biodiversity. All of these have detrimental effects on us and the environment around us.

The impacts on health are mainly in two ways; By creating new or unanticipated health problems in people or places where they have not been before and by changing the seriousness or frequency of health problems people already suffer from.

Between 2030 and 2050, climate change is expected to cause approximately 250 000 additional deaths per year, from malnutrition, malaria, diarrhea, and heat stress.

Impacts of climate change on physical health When talking about climate change, not many think about it affecting our health directly, but they’re a myriad of ways it can cause health issues! But before diving into details into those diseases, we have to answer an important question; what determines a person’s vulnerability to these health impacts?

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Exposure: People will encounter climate hazards differently.

Exposure will depend on where and how long people spend time exposed to the impact of climate change. For example, a builder working most hours in the sun will experience the effects of extreme heat.

Sensitivity: Some people are more sensitive than others to climate hazards due to factors like age and pre-existing health conditions. For example, children and adults with asthma are particularly sensitive to air pollutants and wildfire smoke.

Adaptive capacity: People can adjust to, take advantage of, or respond to climate change hazards. A person’s ability to adapt may depend upon income, age, living situation, access to health care, and many other factors.

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Impact of air pollution and allergens Due to climate change, pollen seasons have grown longer and people with allergies have been suffering due to it, needing stronger medications and longer treatment courses. Additionally, as the climate changes conditions become dry and warmer resulting in an increased frequency of wildfires, putting the danger of wildfires aside, the smoke released results in the exacerbation of attacks in asthmatic patients. In 2019 alone, fine particulate matter (produced due to wildfires) in the atmosphere resulted in at least 1.8 million deaths globally.

For additional resources on this topic: Tap Here.

Extreme temperatures Being exposed to extreme heat causes the body to lose the ability to regulate our internal body temperature (which is important for our vital processes to occur), this loss results in various illnesses such as heat cramps, heat exhaustion, heatstroke, and hyperthermia. Research has concluded that most of us can adapt to the changing temperatures, however, that is not the case for certain groups such as the elderly, pregnant women, and children. Additionally, those who work outdoors, outdoor athletes, and the homeless are more at risk.

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Climate change also results in extremely cold temperatures, especially in areas which were not usually cold, therefore, people are not adapted to it. The cold puts stress on the cardiovascular system as the body struggles to retain heat and in extreme cases, may result in hypothermia.

To learn more: Tap Here, Here or Here.

Vector-borne diseases A vector is any organism – such as fleas, ticks, or mosquitoes – that can transmit a pathogen, or infectious agent, from one host to another. Because warmer average temperatures can mean longer warm seasons, earlier spring seasons, shorter and Milder conditions might become more favorable for many carriers of vector-borne diseases.

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Moreover, due to the change in the usual temperatures of some areas, vectors and pathogens that were not normally present or endemic in a certain area may begin appearing and cause diseases.

To learn about vector-borne diseases and climate change: Follow Here.

Access to healthcare How can something environmental like climate change lower the healthcare quality or make healthcare less accessible? This occurs as climate change affects multiple aspects of healthcare such as: Increasing costs: As climate change and air pollution worsen the health of millions more people each year, it also pushes up healthcare costs on the hospital. On an individual level, the development of new cardiovascular or respiratory diseases acts as a financial burden.

Health equity: Climate change does not affect everyone equally.

The greatest toll is on the ones already at risk when it comes to exposure, sensitivity, and the person’s ability to adapt. These people already have issues getting the healthcare they need, they include: low-income people, workers in certain hazardous occupations, such as construction workers, people living in environmentally fragile areas, and people with preexisting health conditions.

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Access: Extreme climate events lead to health system disruption.

Hospitals may need to be evacuated, facilities may be damaged or closed, power outages may disrupt care, and damaged roads may prevent people from getting to health facilities. When Hurricane Sandy struck New York City in 2012, Bellevue Hospital, which serves more than 500,000 patients annually, was forced to close temporarily and move patients elsewhere.

Quality: Climate disasters such as storms or hurricanes can lead to overcrowding in hospitals and many people needing urgent care puta a load on the healthcare workforce (especially if the area is already experiencing a shortage in the medical staff).

Additional resources on the topic: Tap Here.

What are the Impacts of Climate Change on Mental Health?

It seems very farfetched to link climate change and mental health; how can they intersect? Firstly, climate disasters such as storms or hurricanes cause people to lose their homes, loved ones and basically their life all in one moment. This may cause high levels of anxiety and post-traumatic stress disorder. Being exposed to extreme heat, can alter a person’s mood, cause violence and in some cases progress to suicide.

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What is the relation between Climate change and food safety?

Firstly, food security is affected due to the changes in temperatures and water moisture in the soil, contributing to the food shortage issue. Secondly, it affects our food safety as the high temperatures can predispose and allow bacteria that contaminate foods (especially those stored) to flourish, leading to more food-borne illnesses.

To know more: Tap Here, Here or Here.

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Climate change in Egypt When talking about climate change with any Egyptian, their reply would be “we have more pressing issues than this!” And they’d proceed to talk about every other issue going on. However, climate change is not an issue that we can choose to believe in or not; it’s currently happening, and the entire planet is contributing and getting affected by it and Egypt is no exception. Stronger warming has been documented over the past 30 years, with average annual temperatures increasing by 0.53 degree Celsius per decade. This number may not mean much to us; but it’s affecting Egyptian more than one way. The main effect is on our water sources that are already threatened. The great Nile, our primary water source, that we depend on for 97% of our agriculture, is vulnerable to climate change.

Another aspect that is affected is food security. Climate change leads to a decrease in the productivity of the main agricultural crops in Egypt, such as wheat by 18%, rice by 11%, and soybean by 28%.

The food we eat and the water we drink, is seriously at risk. So, what’s stopping us from taking action towards stopping this disaster? The country’s climate risks are and will impact the younger generations of today. Our single mission as public health advocates and youth of this generation is: to protect the planet with all our ability, try to undo what can be undone and hand it on to the next generation.

To learn more about how Egypt is affected by climate change: Tap Here.

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What are IFMSA actions in climate change?

Workshop or training on climate change and health or advocacy effort to influence a certain community to decrease their ecological footprint.

Education and awareness raising event on the effect of air pollution on people’s health.

Fossil free investment campaigns that target individuals, NGOs, universities and/or hospitals.

Activities that encourage and promote environmental sustainability and go green initiatives.

What is Our role as a public health advocates (Solutions)?

Health professionals can take many different actions, such as advocating for implementation in the health sector and generally; being vocal in framing climate change as a public health issue; pushing for rapid attainment of the United Nations Sustainable Development goals, and speaking out to reduce poverty and inequity related to climate change; advocating for political leadership at the local, national and international levels to reduce the risks of dangerous climate change; promoting the available solutions (eg, renewable energy streams, improved energy efficiency and technology transfer from high-income to middle-income and low-income countries) in the health sector and beyond.

Increasingly, due to the climate change commitment from prior emissions, health professionals must also advocate strongly for adaptation measures in the health sector and other areas of the economy that affect health, such as water and agriculture.

The 2016 ‘WHO conference on climate change and health’ concluded with a loud and clear call to the international health community: ‘it is imperative that health professionals worldwide show strong leadership in tackling climate change’.

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Forth Piece

ANTI-MICROBIAL RESISTANCE

--What is AMR -Why is AMR a global concern -How is AMR related to the SDGs -World Antimicrobial Awareness Week (WAAW) -Global Action Plan for Antimicrobial Resistance (GAP) -How can we Prevent and control AMR phenomena

AMR What are antimicrobials?

Antimicrobials are medicines used to prevent and treat infections in humans, animals and plants. including antibiotics, antivirals, antifungals and antiparasitic‫ز‬

What is AMR? The World Health Organization defines antimicrobial resistance (AMR) as the ability of microorganisms (such as bacteria, fungi, viruses, and parasites) to become resistant to antimicrobial drugs (such as antibiotics, antifungals, antivirals, and antimalarials) , it is currently one of the greatest global threats. It results in millions of deaths, long-lasting disabilities and increased health care costs.

What is the history of AMR? The discovery of antibiotics and their widespread revolutionized healthcare was after the Second World War. But bacteria and pathogens have attained resistance to even the newest drugs that scientists invent to combat them.

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Resistance has increasingly become a problem in recent years and because discovering new antibiotics isn't easy and a slow process therefore resistance is rising as well as deaths .

And you can see the whole timeline from this photo:

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Why is AMR a global concern?

The emergence and wild spread of drug-resistant pathogens that have acquired new resistance mechanisms, leading to antimicrobial resistance, the resistance continues to pose a threat to our ability to treat common and mild infections. What is alarming is the rapid global spread of multi- and pan-resistant bacteria -also known as “superbugs” that cause infections that are not treatable with existing antimicrobials such as antibiotics.

Antibiotics are becoming increasingly ineffective as AMR spreads globally leading to more difficulty in treating infections and more deaths.

AMR problem occur naturally over time, usually through genetic changes. Antimicrobial resistant organisms are found in people, animals, food, plants , in water, soil and air. They can spread from person to person or between people and animals, including food of animal origin or from environment to person. The main causes of antimicrobial resistance is the misuse and overuse of antimicrobials in addition to lack of access to clean water, sanitation and hygiene

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How is AMR related to the SDGs? AMR hinders and slows down the progress in many of the Sustainable Development Goals; it could have significant effects on a range of SDGs, according to guidelines published by the World Health Organization.

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HOW AMR IMPEDES PROGRESS ON THE SDG People living in poverty are more prone to infectious diseases, and resistant infections are more likely to spread in poor living conditions.

The poor are less able to access effective treatment.

High costs of treatment and chronic infections will impoverish millions of people . An additional 28.3 million people could be pushed into extreme poverty by 2050

HOW PROGRESS ON THE SDG HELPS TO ADDRESS AMR

Financial and social protection strategies will allow poor people to receive high-quality services and also lessen the effect of AMR.

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HOW AMR IMPEDES PROGRESS ON THE SDG

AMR affecting animals increases costs of animal health and medications , infections become untreatable,animal products decrease and working animals cannot carry out their tasks, affecting the livelihood of farmers and food security.

Livestock production in low-income countries would decline the most, with a possibility of high-AMR spread 23

HOW PROGRESS ON THE SDG HELPS TO ADDRESS AMR Developing sustainable food production systems with less reliance on antimicrobials and with the phasing out of useing antibiotic in livestock for growth promotion will be essential for long-term AMR control.

Increased professional advice and vaccination of food animals can reduce the emergence and spread of drugresistant infections

HOW AMR IMPEDES PROGRESS ON THE SDG

Globally, drug-resistant diseases currently cause at least 700 000 deaths a year.

AMR will increase treatment costs, making effective care unaffordable for many, and UHC unattainable.

Reducing child and infant mortality relies on effective antibiotics.

HOW PROGRESS ON THE SDG HELPS TO ADDRESS AMR Strategies to reduce the risks of AMR must be linked to improving care and ensuring access to effective care needed.

Central to addressing AMR is ensuring that health systems are accessible and have a trained workforce providing evidence-based high-quality care in a hygienic setting .

Increased vaccine coverage reduces the incidence of disease from resistant pathogens and limits the need for antibiotics; in turn, this prevents the development of AMR. Reliance on out-of-pocket payment for health care correlates with AMR.

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HOW AMR IMPEDES PROGRESS ON THE SDG Globally, 1 in 4 health care facilities have no access to basic water services, 1 in 10 have no availablesanitation services, 1 in 3 do not have adequate facilities to clean hands at the point of care, and 1 in 3 don't segregate waste safely. Lack of the availability of basic WASH services is greatest in least developed countries, where 50% of health care facilities lack access to water services and 60% have no sanitation services at all.

Lack of access to adequate WASH services is giving rise to the spread of infectious diseases; in turn, this increases antibiotic use and thus drives the emergence and spread of AMR.

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HOW PROGRESS ON THE SDG HELPS TO ADDRESS AMR

Each year, hundreds of millions of cases of diarrhea in humans are treated with antimicrobials. Universal access to WASH could reduce such cases by 60%.

Improved WASH services are critical to reducing the spread of infection.

HOW AMR IMPEDES PROGRESS ON THE SDG

Antimicrobial compounds and their metabolites can be found in the wastewaters from manufacturing sites for medicines and APIs. In extreme cases, antimicrobial compounds have been found in water downstream from manufacturing sites in concentrations higher than those found in the blood of patients taking medicines

HOW PROGRESS ON THE SDG HELPS TO ADDRESS AMR

Effective pollution controls on pharmaceutical production, health facilities and agricultural production will substantially decrease the risk of AMR emergence and spread in the environment.

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HOW AMR IMPEDES PROGRESS ON THE SDG

HOW PROGRESS ON THE SDG HELPS TO ADDRESS AMR

To effectively manage AMR, collaboration and partnerships needed across all relevant health sectors human, animal, plants and the environment and at all levels national, regional and global levels.

Working in partnership and taking a step closer to the One Health approach to addressing AMR.

Related SDGs to AMR

This pattern show some SDGS that AMR is related to:

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What is the World Antimicrobial Awareness Week (WAAW) and how do we celebrate it?

WAAW is a global campaign held every year that aims to increase awareness of antimicrobial resistance worldwide and to encourage best practices among the general public, health workers and policy makers to avoid the further emergence , spread of drug-resistant infections and slow AMR development. in IFMSA-Egypt we celebrate WAAW every year with different , creative and impactful ways as in our local committees we establish campaigns ; online and physical to advocate and empower medical students and the public about what is AMR ,our situation and prevention Antimicrobials are critical tools in helping to fight diseases in humans, animals and plants. WAAW was previously called World Antibiotic Awareness Week. Since 2020, it has been called World Antimicrobial Awareness Week. This reflects the broadened scope of WAAW to include all antimicrobials including antibiotics, antifungals, antiparasitics and antivirals. Held annually since 2015,

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What is the Global Action Plan for Antimicrobial Resistance (GAP) ?and what are the objectives ?

As a response to the global crisis of the AMR the during world health assembly GAP was adopted on May 2015 The goal of the global action plan is to ensure, for as long as possible the continuity of successful treatment and prevention of infectious diseases to have effective and safe medicines that are quality-assured .

To achieve this goal, the global action plan sets out 5 main objectives : 1. to improve awareness and understanding of antimicrobial resistance through effective communication, education and trainings 2. to strengthen the knowledge and evidence-base through surveillance and research.

3. to reduce the incidence of infections through effective sanitation, hygiene and infection prevention measures.

4. to optimize the use of antimicrobial medicines in human and animal health.

5. to develop the economic case for sustainable investment that takes account of the needs of all countries and to increase investment in new medicines, diagnostic tools, vaccines and other interventions.

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How can we Prevent and control AMR phenomena?

1.As Individuals To prevent and control the spread of antibiotic resistance, individuals can:

Do

-Follow health professionals ’s advice when using antibiotics.

-Only use antibiotics when prescribed by a certified health professional.

-Use safe clean water and raw materials.

-Avoiding close contact with sick people, infections, and keeping your vaccinations up to date.

-Regularly wash hands when preparing food hygienically following the WHO Five Keys to Safer Food (keep clean, separate raw and cooked, cook thoroughly, keep food at safe temperatures,)

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Don't

-Demand antibiotics if your health worker says you don’t need them.

-Share or use leftover antibiotics without being prescribed.

-Choose foods that have been produced with the use of antibiotics for growth promotion or disease prevention in healthy animals.

-Dispose of unused antimicrobials in the toilet or sink.

2. As Health Professionals To prevent and control the spread of antibiotic resistance, health professionals can:

Do -Ensuring your hands, instruments, and environment are clean.

-Report antibioticresistant infections and drugs to surveillance teams.

Don't -Over prescribe antibiotics.

-Ignore preventative measures.

-Talk to your patients about preventing infections (for example, vaccination, hand washing, safer sex, and covering nose and mouth when sneezing) -Prescribe and dispense antibiotics when they are only needed, according to current guidelines published.

3. In Healthcare industry To prevent and control the spread of antibiotic resistance, the health industry can: Invest in research and development of new antibiotics, vaccines, diagnostics and other tools.

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4. As Policy makers To prevent and control the spread of antibiotic resistance, policy makers can:

Do

Don't

-Ensure an intensive national action plan to tackle antimicrobial resistance is in place.

-Sale of over-the-counter prescriptions.

-Regulate and promote the appropriate use and disposal of quality medicines.

-Strengthen policies, programs, and implementation of infection prevention and control measures.

-Improve surveillance of antibiotic resistant infections.

-Make information available on the impact and effects of antibiotic resistance.

-Develop a publicly accessible database for all antimicrobials used in human medicine and animal medicine.

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To Know more about How can we Prevent and control AMR phenomena: Tap Here or Here.

Fifth Piece

IMMUNIZATION

-Difference between immunity, vaccines, vaccinations and immunization?

-History of vaccination -How do vaccines play a role in AMR? -Our role as public health advocates?

Immunization Immunization is a crucial part of primary healthcare and unquestionably a human right; it resembles a success story in global health and development. It's also among the finest investments in health that money can buy. Infectious illness outbreaks can be prevented and controlled with the use of vaccines. They support the security of the world's health and will be a crucial weapon in the fight against antibiotic resistance.

What is the difference between vaccinations and immunization?

immunity,

vaccines,

Immunity: The ability of our immune system to defend against an infectious disease.

If you are immune to a disease, you can be exposed to it without becoming infected or without complications.

Vaccine: A preparation that is used to stimulate the body’s immune response against diseases.it is a substance that boosts the immune system's defenses against disease. Vaccines are typically given via needle injection, however it can be administered by mouth or sprayed into the nose or subcutaneously.

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Vaccination: The act of introducing a vaccine into the body to produce protection from a specific disease.

Immunization: is a process through which a person acquires immunity to a disease by immunization or prior exposure .vaccination or previous infection. This term can be often used interchangeably with vaccination.

Humans have been attempting to defend one another against both deadly and non-lethal diseases for many centuries. From experiments and taking chances to a global vaccine roll-out in the midst of an unprecedented pandemic, immunization has a long history.

What is the history of vaccination?

Vaccines have saved more human lives than any other medical invention in history.

In May 1796, the English physician Edward Jenner expanded on this discovery and inoculated 8-year-old James Phipps with matter collected from a cowpox sore on the hand of a milkmaid.

Despite suffering a local reaction and feeling unwell for several days, Phipps made a full recovery, and this was the first vaccine discovered. It was smallpox vaccine that saved many lives from his disease after that and was the first step in discovery and invention of vaccines.

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How do vaccines play a role in AMR? Vaccines are an important tool in the fight against antimicrobial resistance and can help to prevent it in multiple ways by minimizing the occurrence of secondary infections, it is less probable for the pathogen to mutate from a drug-sensitive to a drug-resistant form, preventing it from spreading within communities and resulting in disease-related consequences. And complications.

Importantly, people protected by vaccines take less antibiotics because they don’t get sick as often and this further reduces the likelihood of a pathogen becoming resistant and spreading within the community.

What is our role as public health advocates?

1. Make awareness campaigns about hygiene and sanitation to prevent infections.

2. Illustrate to the public the importance of vaccination.

3. Conduct campaigns to the public to rationalize consumption of antimicrobials.

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All Piec

Recommendations regarding BGH FA Activities you can open under BGH FA, Climate Change, UHC, Global Health and Digital Health Also you can work conjoint with other focus areas and Projects like NCDs, Mental Health, Health Equity, Medical Education and social accountability. ex, Gaps in Cancer health system Every topic in SCOPH can be from a BGH prospective ex, Mental health issues and their relation to SDGs and SDOH You can search in every topic in BGH using this Tips and Tricks: 1. Search in English 2. Search on websites that end with .gov or .edu and Avoid websites that end with .com or .org 3.Check date of the paper and name of the authors 4. Also you can find scientific data in WHO, NIH, UNICEF, FAO, Myo clinic and PubMed.

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