Knowledge and beliefs, behaviors, and adherence among Latino parents or legal guardians related to antibiotic use for upper respiratory tract infections in children under 6 years of age.

OBJECTIVE: Evaluate parents or legal guardians' knowledge and beliefs, behaviors, and adherence regarding antibiotic use for upper respiratory tract infection (URTI) in their children who are younger than 6 years. DESIGN: A cross-sectional study from September 2016 to February 2017. SETTING: Emergency department with a pediatric unit. PARTICIPANTS: One hundred and one parents or legal guardians who visited one of the selected emergency departments during the study period. INTERVENTION: Administration of a validated questionnaire to assess knowledge and beliefs, behaviors, and adherence regarding antibiotic use for URTI. MAIN OUTCOME MEASURES: Knowledge and beliefs, behaviors, and adherence regarding antibiotic use for URTI. RESULTS: Items with the least desired scores were seen in the "knowledge and beliefs" domain. Higher number of antibiotics used for URTI during the last year (P < 0.01) and lower education level (P = 0.03) were associated with least desired knowledge and beliefs scores. The "behaviors" domain contained the items with the best scores: higher education level (P = 0.05), fewer antibiotics used for URTI during the last year (P = 0.05), and older age (P = 0.02) were the only variables associated with better behaviors. For the "adherence" domain, lower education level (P < 0.01) was associated with poor indicators of adherence. The Cronbach alpha for the "knowledge and beliefs" items was 0.875, the "behaviors" items 0.569, and the "adherence" items 0.798. CONCLUSION: Findings of our study support the need for proper antibiotic education among parents, especially in those with an increased risk of antibiotic misuse and overuse. Pharmacists and physicians need to establish a dialogue with parents or legal guardians to discuss how antibiotics work, what types of infection they treat, and how to prevent antibiotic resistance. Sociodemographic variables can be used to identify at-risk groups and to develop successful interventions.

Readiness to provide pharmaceutical care to transgender patients: Perspectives from pharmacists and transgender individuals.

OBJECTIVES: The objectives of this study were (1) to assess pharmacist readiness to provide pharmaceutical care for transgender patients through measuring both pharmacists' knowledge and attitudes towards transgender patients, (2) to assess transgender patients' perception of pharmacist readiness to provide them pharmaceutical care through measuring both pharmacists' knowledge and attitudes toward them, and (3) to compare pharmacist readiness to provide pharmaceutical care for transgender patients and patient perception of this readiness. DESIGN: The study used a descriptive, cross-sectional design. The pharmacist's readiness and the transgender patient's perception of their readiness, defined as a combination of knowledge and attitude, were evaluated. Two separate, validated questionnaires with dichotomous, multiple choice, and open-ended questions were used to measure both constructs among both populations. SETTING: Community-based research. PARTICIPANTS: Pharmacists practicing in Puerto Rico were provided the questionnaire by e-mail or in person. Transgender participants in Puerto Rico were recruited through health clinics and community partners and were surveyed in person. The analysis included responses from 96 pharmacists and 31 transgender participants. RESULTS: The majority of the pharmacists' knowledge scores (90%) were found in the low (0-5) and moderate (6-10) ranges, with a mean score of 7.23 out of a total possible score of 16 (SD ±2.36). For the attitude construct, most of the scores (81%) were found in the high (18-26) range, with a mean score of 19.63 out of a total possible score of 26 (SD ±3.65). For both constructs, transgender patient perceptions echoed the results of the pharmacists, indicating several perceived knowledge deficits in combination with mostly positive attitudes. CONCLUSION: The majority of pharmacists demonstrated positive attitudes toward caring for transgender patients, and transgender patients also perceived these positive attitudes from pharmacists. However, the measured and perceived knowledge deficits observed in this study suggest the need for educational interventions to improve pharmacist readiness to provide care for transgender patients.

Lessons Learned From Hurricane Maria: Pharmacists' Perspective.

The destruction in Puerto Rico following Hurricane Maria brought an increased demand for health care services while severely limiting the health care system's ability to provide patient care. Immediately following the hurricane, countless patients found themselves in a situation without their medications for both acute and chronic conditions. Many of these patients turned first to community pharmacies for access to their medications. In this letter, we describe the response of pharmacists to the needs of their communities following the natural disaster, Hurricane Maria, and summarize some lessons learned from the experience that may be useful in future disaster planning.

Knowledge and Perceptions of E-cigarettes and the Motivations for their Use: Talking to Smokers (E-cigarettes and/or Conventional Cigarettes) and Non-smokers in Puerto Rico.

OBJECTIVE: The awareness and use of e-cigarettes have been increasing in recent years. The World Health Organization recently reported that regulations are needed to impede the promotion of e-cigarettes to young people, prohibit unproven health claims about them (including those regarding smoking-cessation efficacy), minimize potential health risks to e-cigarette users and non-users, and protect existing tobacco controls. The study described herein explored e-cigarette knowledge, perceptions, and usage motivations among a group of adults in Puerto Rico. METHODS: This research study used a validated questionnaire with closed-ended questions to gather data. Non-inferential and inferential statistics were used to characterize smokers (of e-cigarettes, of conventional cigarettes, and of both) and non-smokers. RESULTS: A total of 415 respondents took part; they were evenly distributed by gender, age, and socioeconomic status; all were residents of Puerto Rico at the time of the survey. The overall awareness of e-cigarettes was high, but knowledge of nicotine content and regulations was limited. Asked whether e-cigarettes contain nicotine (they do not), approximately two thirds stated either that they do or that they didn't know; asked whether e-cigarettes are regulated as a tobacco product (they are in Puerto Rico), 84% stated either that they are not or that they didn't know. Common perceptions of e-cigarettes are that they are harmful to health and that they are no less harmful than cigarettes are. However, a significant portion of the respondents perceived e-cigarettes to be less addictive than conventional cigarettes are. Overall, the respondents were divided on the efficacy of e-cigarettes for smoking cessation. Nonetheless, the most common motivation for their use, according to both current users and potential future users, is to aid in smoking cessation or reduction. CONCLUSION: The majority of individuals surveyed were aware of e-cigarettes but had limited knowledge of their contents or regulation. As an aid in smoking cessation was the most commonly mentioned motivation for e-cigarette use.

Impact of a Pharmacist Conducted Educational Program on Human Papilloma Virus Vaccination Rates in a Low Socioeconomic Population in the City of Lares, PR.

OBJECTIVE: To observe whether local vaccination rates are improved by a patient and physician education program on the human papillomavirus (HPV) vaccine in Farmacia San José, Lares. According to the Puerto Rico Immunization Registry, the HPV vaccine is currently underutilized. METHODS: Patients within the ages of 18 and 26 years who are current patients of Farmacia San José were contacted by phone and approached in person at the pharmacy. Once contacted, patients were provided with educational materials and counseling regarding the risks and benefits of HPV vaccination. The primary outcome for this study is HPV vaccination rates at 4 months after starting the educational program. RESULTS: Only 79 of the 200 attempted patients who were candidates to receive the HPV vaccine were able to be reached by phone. Out of 79 patients, 24 reported they had previously been vaccinated against HPV. After all educational efforts, 4 patients (all insured by government) received vaccination against HPV at the pharmacy. In addition, 16 physicians near the pharmacy were contacted and visited by the pharmacist resident. The physicians agreed to receive educational information regarding the ACIP recommendations for their patients. CONCLUSION: Although the total number of HPV vaccination administered at the pharmacy during the study period was low, we found an individual patient counseling approach to be much more successful than attempting to coordinate group educational interventions.

Experiences of Latinx sexual and gender minorities with access to healthcare during COVID-19 stay-at-home orders.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic affected all social systems, but healthcare services were particularly disrupted. The pandemic also had a disproportionate impact on populations made socially vulnerable. In this study, we documented the experiences of Latinx sexual and gender minority (SGM) individuals with access to care during COVID-19 stay-at-home orders. METHODS: Semistructured qualitative interviews assessing experiences during the stay-at-home orders in response to the COVID-19 pandemic and patients' experiences accessing healthcare during this period were conducted with 21 Latinx SGM individuals from the Washington, DC, area. Data were analyzed using rapid qualitative analysis (RQA), and salient themes were identified. RESULTS: The RQA revealed 3 themes reflecting participants' experiences with pharmaceutical care during COVID-19 stay-at-home orders: (1) challenges in accessing HIV services; (2) community engagement; and (3) providers supporting access to care. Participants experienced problems with adherence to medication, transportation, and technology, as well as delays in care and miscommunication with providers. Latinx SGM individuals demonstrated engagement in response to this emergency as a community and valued their providers and their efforts to facilitate access to care. CONCLUSION: The COVID-19 pandemic strained healthcare services. Findings from this study show that the impact of the pandemic on the provision of care increased the vulnerability of Latinx SGM people. Future research should explore the impact of public health emergencies on the health of populations historically made socially vulnerable, and innovative solutions should be identified to eliminate these barriers to health equity.

Implementing a pharmacogenomic-driven algorithm to guide antiplatelet therapy among Caribbean Hispanics: a non-randomised clinical trial.

OBJECTIVES: To assess whether genotype-guided selection of oral antiplatelet drugs using a clinical decision support (CDS) algorithm reduces the rate of major adverse cardiovascular and cerebrovascular events (MACCEs) among Caribbean Hispanic patients, after 6 months. DESIGN: An open-label, multicentre, non-randomised clinical trial. SETTING: Eight secondary and tertiary care hospitals (public and private) in Puerto Rico. PARTICIPANTS: 300 Caribbean Hispanic patients on clopidogrel, both genders, underwent percutaneous coronary intervention (PCI) for acute coronary syndromes, stable ischaemic heart disease and documented extracardiac vascular diseases. INTERVENTIONS: Patients were separated into standard-of-care (SoC) and genotype-guided (pharmacogenetic (PGx)-CDS) groups (150 each) and stratified by risk scores. Risk scores were calculated based on a previously developed CDS risk prediction algorithm designed to make actionable treatment recommendations for each patient. Individual platelet function, genotypes, clinical and demographic data were included. Ticagrelor was recommended for patients with a high-risk score ≥2 in the PGx-CDS group only, the rest were kept or de-escalated to clopidogrel. The intervention took place within 3-5 days after PCI. Adherence medication score was also measured. PRIMARY AND SECONDARY OUTCOMES: The occurrence rate of MACCEs (primary) and bleeding episodes (secondary). Statistical associations between patient time free of events and predictor variables (ie, treatment groups, risk scores) were tested using Kaplan-Meier survival analyses and Cox proportional-hazards regression models. RESULTS: The genotype-guided group had a clinically lower but not significantly different risk of MACCEs compared with the SoC group (8.7% vs 10.7%, p=0.56; HR=0.56). Among high-risk score patients, genotype-driven guidance of antiplatelet therapy showed superiority over SoC in reducing MACCE incidence 6 months postcoronary stenting (adjusted HR=0.104; p< 0.0001). CONCLUSIONS: The potential benefit of implementing our PGx-CDS algorithm to significantly reduce the incidence rate of MACCEs in post-PCI Caribbean Hispanic patients on clopidogrel was observed exclusively among high-risk patients, with apparently no evident effect in other patient groups. TRIAL REGISTRATION NUMBER: NCT03419325.

Association Between Concurrent Use of Benzodiazepines and Opioids and Health Care Utilization Among Patients With Cancer in Puerto Rico.

PURPOSE: To evaluate the association between concurrent use of opioids and benzodiazepines (BZDs) and emergency room (ER) visits and hospital admissions in patients with cancer. METHODS: Data were obtained from the Puerto Rico Central Cancer Registry-Health Insurance Linkage. Odds ratios (ORs) with 95% CIs and incidence rate ratio (IRR) were estimated using logistic and negative binomial regression analyses to assess the association between concurrent use of opioids and BZDs (overlap of at least 7 days) and ER visits and hospital admissions. RESULTS: A total of 9,259 patients were included in the main analysis. The logistic regression results showed a significant association between concurrent use of opioids and BZDs and at least one ER visit (OR, 1.28 [95% CI, 1.07 to 1.54]) or hospital admission (OR, 1.42 [95% CI, 1.18 to 1.71]) compared with individuals with BZDs alone, after adjusting for age, sex, comorbidity index, cancer stage, health insurance, and health region. Compared with individuals with opioid use alone, the association did not reach significance. In the negative binomial regression, a significant association was observed for ER visits (IRR, 1.52 [95% CI, 1.31 to 1.76]) and hospitalizations (IRR, 1.34 [95% CI, 1.20 to 1.50]) when compared with individuals with BZDs alone. Compared with individuals with opioids alone, it only reached significance for ER visits (IRR, 1.39 [95% CI, 1.20 to 1.61]). CONCLUSION: Careful evaluation must be done before prescribing concurrent opioids and BZDs in patients with cancer, as the results suggest that coprescribing may increase the odds of ER visits and hospitalizations.

Discovery of Ancestry-specific Variants Associated with Clopidogrel Response among Caribbean Hispanics.

Background: High on-treatment platelet reactivity (HTPR) with clopidogrel is predictive of ischemic events in adults with coronary artery disease. Despite strong data suggesting HTPR varies with ethnicity, including clinical and genetic variables, no genome-wide association study (GWAS) of clopidogrel response has been performed among Caribbean Hispanics. This study aimed to identify genetic predictors of HTPR in a cohort of Caribbean Hispanic cardiovascular patients from Puerto Rico. Methods: Local Ancestry inference (LAI) and traditional GWASs were performed on a cohort of 511 clopidogrel-treated patients, stratified based on their P2Y12 reaction units (PRU) into responders and non-responders (HTPR). Results: The LAI GWAS identified variants within the CYP2C19 region associated with HTPR, predominantly driven by individuals of European ancestry and absent in those with native ancestry. Incorporating local ancestry adjustment notably enhanced our ability to detect associations. While no loci reached traditional GWAS significance, three variants showed suggestive significance at chromosomes 3, 14 and 22 (OSBPL10 rs1376606, DERL3 rs5030613, and RGS6 rs9323567). In addition, a variant in the UNC5C gene on chromosome 4 was associated with an increased risk of HTPR. These findings were not identified in other cohorts, highlighting the unique genetic landscape of Caribbean Hispanics. Conclusion: This is the first GWAS of clopidogrel response in Hispanics, confirming the relevance of the CYP2C19 cluster, particularly among those with European ancestry, and also identifying novel markers in a diverse patient population. Further studies are warranted to replicate our findings in other diverse cohorts and meta-analyses.