Pharmacist experiences and perspectives with Oregon's Death with Dignity Act.

BACKGROUND: Medical aid-in-dying (AID) is increasingly available in the United States. Despite their substantial role in the medication use process, pharmacists' involvement in medical AID has been overlooked. OBJECTIVE: To describe pharmacist attitudes toward medical AID and experiences with Oregon's Death with Dignity Act (DWDA). METHODS: Qualitative analysis of Oregon-licensed pharmacists with professional interactions involving Oregon's DWDA. Data were collected through semistructured focus groups and analyzed with immersion-crystallization methods. RESULTS: Sixteen Oregon pharmacists participated in this study. The participants were almost evenly divided between males and females, who varied in age, years of pharmacy experience, and the number of DWDA encounters. Of these, 14 pharmacists agreed to participate in the DWDA process while 2 declined. Three themes emerged. First, pharmacists identified logistical challenges that negatively affected their ability to assist patients seeking medical AID. Second, pharmacists described the content and other patient counseling considerations for DWDA prescriptions. Third, pharmacists discussed how values and preferences informed their decisions related to medical AID requests. CONCLUSION: Pharmacists' involvement in medical AID has been largely focused on medication dispensing and patient counseling, and medical AID prescriptions raise unique challenges. Their decisions to participate were frequently tied to support for patient autonomy, although more research is needed to capture the diversity of attitudes, perspectives, and experiences related to their involvement with medical AID, particularly for those who decline to participate. There is a need to develop educational materials and other resources to assist pharmacists in navigating medical AID requests.

Pharmacy density in rural and urban communities in the state of Oregon and the association with hospital readmission rates.

OBJECTIVES: To characterize the pharmacy density in rural and urban communities with hospitals and to examine its association with readmission rates. DESIGN: Ecologic study. SETTING: Forty-eight rural and urban primary care service areas (PCSAs) in the state of Oregon. PARTICIPANTS: All hospitals in the state of Oregon. INTERVENTION: Pharmacy data were obtained from the Oregon Board of Pharmacy based on active licensure. Pharmacy density was calculated by determining the cumulative number of outpatient pharmacy hours in a PCSA. MAIN OUTCOME MEASURES: Oregon hospital 30-day all-cause readmission rates were obtained from the Centers for Medicare and Medicaid Services and were determined with the use of claims data of patients 65 years of age or older who were readmitted to the hospital within 30 days from July 2012 to June 2013. RESULTS: Readmission rates for Oregon hospitals ranged from 13.5% to 16.5%. The cumulative number of pharmacy hours in PCSAs containing a hospital ranged from 54 to 3821 hours. As pharmacy density increased, the readmission rates decreased, asymptotically approaching a predicted 14.7% readmission rate for areas with high pharmacy density. CONCLUSION: Urban hospitals were in communities likely to have more pharmacy access compared with rural hospitals. Future research should determine if increasing pharmacy access affects readmission rates, especially in rural communities.

Introduction - The Prevention of Sexual Violence in Sport: A Real Game Changer.

This Special Issue focuses on the prevention of sexual violence in sport. It begins with an examination of the role of theory in the prevention of sport related sexual violence, identifies critical gaps in the literature, features a number of cutting-edge sexual violence prevention studies, and provides a practically oriented investigation that demonstrates the importance of incorporating a socioecological framework and policy structures in the prevention of sexual violence in sport. This Special Issue was designed to encourage greater development and study of empirically based approaches to prevent sexual violence in sport in response to the paucity of available strategies to enhance athlete safety and well-being.

The Role of Theory in the Prevention of Sexual Violence in Sport.

Sexual violence (SV) remains at epidemic proportions in the U.S. and growing evidence demonstrates that youth and adults engaged in sport are at increased risk of victimization and perpetration of SV. Unfortunately, sport SV prevention strategies are rarely built on theory or theoretically grounded evidence, despite demonstrated effectiveness of such approaches. This study aimed to answer to questions: 1) Which theories are relevant to the development of effective SV prevention strategies in sport?; and 2) How has theory been incorporated into existing SV prevention literature on sport safety? A scoping review of the literature plus expert input identified 29 theories pertinent to SV prevention in sport. A systemized review of the literature regarding SV prevention in sport resulted in the identification and characterization of 41 published articles. Authors then examined theory's role in prevention literature. This study identified 29 theories pertinent to SV prevention in sports and applicable across the behavioral spectrum. Most theories were rooted in the Behavioral (41%), Situational (24%) or Social/Attitudinal (21%) areas. Less common were theories grounded in Feminist (14%) domains. Theories were predominantly focused at the individual (42%), organizational (29%), and interpersonal (18%) ecological levels. Of the 41 sport prevention articles, 33 (83%) referred to a theory either explicitly or implicitly. Though most theories have been incorporated into prevention efforts, closer examination indicates that the majority were descriptive, unlikely to use a sophisticated methodology (10%; e.g., experimental, quasi-experimental), and rarely intended to assess a specific prevention program/strategy or policy (21%). Strong theoretical foundations are available for SV prevention research focused on sports, and their application appears to show value across the developmental spectrum of athletes. There remains a need for greater focus on theory-driven research intended to develop prevention strategies and policies designed to enhance athlete safety.

Prevention of Sexual Violence in sport: A Socioecological Review.

Sexual violence in sport is prevalent and represents a serious public health concern. The social-ecological model for health promotion has been used successfully as a framework to identify individual-to-policy level factors aimed at health promotion or disease prevention. The purpose of this review was to examine both published and non-published (publicly available) SVP efforts conducted within the context of sport and make recommendations for future practice. Grey literature search methods were utilized to conduct a review of publicly available documents. This included (a) a comprehensive Google search using unique search terms that would identify SVP efforts within sport settings and (b) a review of the publicly accessible websites identified in the previous step. Following the grey literature search, and using the SVP practices identified in step one, we conducted a supplementary literature search using scientific publication search engines to identify whether the SVP practices identified in step one had associated peer-reviewed publications. Finally, we assessed various characteristics of each SVP practice including the target population, age range of intended participants, and whether the SVP had associated peer review publications. This led to the identification of 35 unique SVP practices: 25 (71%) SVP practices were assigned to the Intrapersonal level, 6 (17%) were assigned to the Interpersonal level, 9 (26%) were assigned to the Organizational level, 3 (9%) were assigned to the Community, and 2 (6%) were assigned to the Policy level. This review uncovered several important findings including a lack of multi-level SVP practices within sport, a lack of SVP practices that target children, minimal programming aimed at specifically preventing perpetration, the need to elevate policy level action, and a lack of peer-reviewed literature. Ultimately findings suggest that sport organizations ought to prioritize sexual violence prevention using national organizations for guidance.

Implications of Zoonoses From Hunting and Use of Wildlife in North American Arctic and Boreal Biomes: Pandemic Potential, Monitoring, and Mitigation.

The COVID-19 pandemic has re-focused attention on mechanisms that lead to zoonotic disease spillover and spread. Commercial wildlife trade, and associated markets, are recognized mechanisms for zoonotic disease emergence, resulting in a growing global conversation around reducing human disease risks from spillover associated with hunting, trade, and consumption of wild animals. These discussions are especially relevant to people who rely on harvesting wildlife to meet nutritional, and cultural needs, including those in Arctic and boreal regions. Global policies around wildlife use and trade can impact food sovereignty and security, especially of Indigenous Peoples. We reviewed known zoonotic pathogens and current risks of transmission from wildlife (including fish) to humans in North American Arctic and boreal biomes, and evaluated the epidemic and pandemic potential of these zoonoses. We discuss future concerns, and consider monitoring and mitigation measures in these changing socio-ecological systems. While multiple zoonotic pathogens circulate in these systems, risks to humans are mostly limited to individual illness or local community outbreaks. These regions are relatively remote, subject to very cold temperatures, have relatively low wildlife, domestic animal, and pathogen diversity, and in many cases low density, including of humans. Hence, favorable conditions for emergence of novel diseases or major amplification of a spillover event are currently not present. The greatest risk to northern communities from pathogens of pandemic potential is via introduction with humans visiting from other areas. However, Arctic and boreal ecosystems are undergoing rapid changes through climate warming, habitat encroachment, and development; all of which can change host and pathogen relationships, thereby affecting the probability of the emergence of new (and re-emergence of old) zoonoses. Indigenous leadership and engagement in disease monitoring, prevention and response, is vital from the outset, and would increase the success of such efforts, as well as ensure the protection of Indigenous rights as outlined in the United Nations Declaration on the Rights of Indigenous Peoples. Partnering with northern communities and including Indigenous Knowledge Systems would improve the timeliness, and likelihood, of detecting emerging zoonotic risks, and contextualize risk assessments to the unique human-wildlife relationships present in northern biomes.

Mothers' "liquid gold": a quality improvement initiative to support early colostrum delivery via oral immune therapy (OIT) to premature and critically ill newborns.

Early breast milk, known as colostrum ("liquid gold") provides immune benefits to infants, offering potential risk reduction for nosocomial infection (NI) and necrotizing enterocolitis (NEC), a serious gastrointestinal emergency. Provision of colostrum is recognized as oral immune therapy (OIT) and is valuable to all NICU infants unable to feed orally. A quality improvement project was initiated by the multidisciplinary NICU Quality Care Council at London Health Sciences Centres-Victoria (LHSC-VH) to obtain mothers' colostrum for early OIT. The initiative was driven by the Canadian EPIQ (Evidence-based Practice for Improving Quality) group as a means of reducing the rates of NEC and NI, two major morbidities in the NICU. The overall aim was to facilitate the availability of OIT to preterm and critically ill neonates as soon as possible after birth.