Community pharmacists as antimicrobial resistance stewards: a narrative review on their contributions and challenges in low- and middle-income countries.

Antimicrobial resistance (AMR) is a global public health crisis that impedes the therapeutic effectiveness of available antimicrobial agents. Due to the high burden of infectious diseases and limited resources, especially trained healthcare professionals, low- and middle-income countries (LMICs) are particularly susceptible to the detrimental effects of AMR. Sometimes, as the first and last point of contact for patients seeking treatment for infections, community pharmacists can play a pivotal role in the stewardship required for AMR. This review aims to highlight the contributions made by community pharmacists in LMICs as AMR stewards. The review considers the challenges from the perspectives of limited resources, inadequate training, a lack of policies and regulations, and issues related to patient behavior. Community pharmacists in LMICs could optimize their advocacy contributions by focusing on One Health AMR stewardship. Transformational and actionable patient and population-centric antimicrobial stewardship (AMS) is feasible with the synergy of policymakers and other healthcare providers in the implementation of AMS policies and programs that support community pharmacists in their efforts to promote rational antimicrobial use.

Angina in primary care in Goa, India: sex differences and associated risk factors.

BACKGROUND: Little is known about the prevalence of angina in people seen in Indian general practices. The authors assessed the prevalence of angina and its associated risk factors in Goan general practices. METHODS: Cross-sectional study on consecutive attendees in nine private general practices in Goa, India. All participants completed the Rose Angina Questionnaire, to ascertain the presence of angina. Other demographic, clinical and biochemical data were also collected. RESULTS: 1556 (626 men and 930 women) consecutive attendees aged 30 to 75 years. Angina was detected in 37 (5.9%, 95% CI 2.4 to 9.4%) men and 99 (10.6%, 95% CI=7.4 to 11.2%) women. The prevalence of angina increased with age in both sexes but was greater in women between aged 46-60 (OR=4.3 (95% CI 2.0 to 9.2)) when compared with men. When compared with men, the odds of angina in women of all ages was 2.03 (95% CI 1.10 to 3.75) after controlling for confounders. Angina was associated with depressive and/or anxiety symptoms in both sexes (men OR=5.65, 95% CI=2.25 to 14.16; women OR=2.18, 95% CI=1.01 to 4.69) and with hypertension in men (OR=3.82, 95% CI=1.57 to 9.30) and family history of coronary heart disease (OR=1.53, 95% CI 1.05 to 2.24) in women. Borderline/high total cholesterol levels (OR=0.5, 95% CI 0.28 to 0.89) in women were associated with a reduced risk of angina. CONCLUSION: Women attending general practices in Goa, India are at greater risk of angina than men. Depression/anxiety is strongly associated with angina. Greater awareness of the general practitioners to the disparity in angina between the sexes and its association with psychological distress is required.

Harmful alcohol use in Goa, India, and its associations with violence: a study in primary care.

AIMS: To determine (i) the prevalence and characteristics of harmful alcohol consumption in general practice attendees; (ii) social and psychological associations with harmful drinking and (iii) recognition of harmful drinking by GPs. METHODS: A cross-sectional study of ten general practices in Goa, India. A total of 1567 general practice attendees were recruited. RESULTS: A total of 338 men (41%) and 597 women (81%) reported that they never consumed alcohol. One hundred and twenty-eight people or 8.2% scored >or=8 on the AUDIT [123 (15%) men and five (0.7%) women] and were classified as harmful or dependent drinkers. The population attributable fraction of harmful drinking in the perpetration of any physical violence by men over 12 months was 0.36. The population attributable fraction of moderate drinking (vs abstention) in the perpetration of any physical violence by women over 12 months was 0.27. Doctors identified almost 60% of problem drinkers but misidentified approximately 5% of moderate drinkers as problem drinkers. CONCLUSIONS: The male pattern of drinking in Goa is one of the high rates of abstention coupled with relatively high rates of harmful and dependent drinking in those who consume alcohol. Most women are abstainers. These data provide the first evidence in India on (i) the role of the GP in identification of harmful alcohol use and (ii) the contribution of harmful drinking to the perpetration of physical violence from the perspective of the alcohol user.