LexCHI: A quick lexical test for estimating language proficiency in Chinese.

A prominent methodological issue in cognitive research on bilingualism is the lack of consistency in measuring second language (L2) proficiency. To reduce the inconsistency in L2 proficiency measurements, brief and valid vocabulary tests have been developed as an objective measure of proficiency in a variety of languages (e.g., English, French, Spanish). Here, we present LexCHI, a valid lexical test to measure Chinese proficiency. This freely available short test consists of 60 two-character items presented in simplified Chinese. Although it only takes a few minutes to complete LexCHI, the LexCHI scores in two studies correlated significantly with L2 participants' performance in a translation task and a cloze test. We believe that LexCHI is a useful tool for researchers who need to objectively measure Chinese proficiency as part of their investigations.

The harm hypothesis: How perceived harm to women shapes reactions to research on sex differences.

Past research suggests that reactions to research on sex differences are often less positive when the findings put men in a better light than women, especially when the lead researcher is a man. The factors underlying this effect, however, are not yet fully understood. The present study aimed to provide the first experimental test of the hypothesis that the key variable is perceived harm to women. Participants (214 men and 219 women) evaluated a bogus popular-science article reporting fictional research finding either a female- or a male-favouring sex difference in intelligence, attributed to either a female or a male lead researcher. To examine the effects of perceived harm, the introduction to the task highlighted either the potential benefits or potential drawbacks of sex-differences research in general. Consistent with past research, participants reacted less positively to the male-favouring difference, especially for male-led research. Consistent with the harm hypothesis, the effect was stronger after highlighting the potential drawbacks of sex-differences research than after highlighting the potential benefits. Our findings suggest that perceptions of harm to women underpin the aversion to male-favouring findings.

Adherence to Psychotropic Medication Before and During COVID-19: A Population-Wide Retrospective Observational Study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic and associated public health measures have shifted the way people access health care. We aimed to study the effects of the COVID-19 pandemic on psychotropic medication adherence. METHODS: A retrospective cohort study using administrative data from the Manitoba Centre for Health Policy Manitoba Population Research Data Repository was conducted. Outpatients who received at least 1 prescription for an antidepressant, antipsychotic, anxiolytic/sedative-hypnotic, cannabinoid, lithium, or stimulants from 2015 to 2020 in Manitoba, Canada, were included. Adherence was measured using the proportion of individuals with a mean possession ratio of ≥0.8 over each quarter. Each quarter of 2020 after COVID-19-related health measures were implemented was compared with the expected trend using autoregression models for time series data plus indicator variables. Odds ratio of drug discontinuation among those previously adherent in 2020 was compared with each respective quarter of 2019. RESULTS: There were 1,394,885 individuals in the study population in the first quarter of 2020 (mean [SD] age, 38.9 [23.4] years; 50.3% female), with 36.1% having a psychiatric diagnosis in the preceding 5 years. Compared with the expected trend, increases in the proportions of individuals adherent to antidepressants and stimulants were observed in the fourth quarter (October-December) of 2020 (both P < 0.001). Increases in the proportions of individuals with anxiolytic and cannabinoid adherence were observed in the third quarter (July-September) of 2020 (both P < 0.05), whereas a decrease was seen with stimulants in the same quarter ( P < 0.0001). No significant changes were observed for antipsychotics. All drug classes except lithium had decreases in drug discontinuation in previously adherent patients during the pandemic compared with 2019. CONCLUSIONS: Improved adherence to most psychotropic medications in the 9 months after public health restrictions were enacted was observed. Patients who were already adherent to their psychotropic medications were less likely to discontinue them during the pandemic.

Translation norms for Malay and English words: The effects of word class, semantic variability, lexical characteristics, and language proficiency on translation.

Translation equivalents are widely used in bilingual research concerning word processing (e.g., Eddington & Tokowicz, 2013; Jouravlev & Jared, 2020) and second-language vocabulary learning (e.g., Bracken et al., 2017; Degani et al., 2014). Although translation norms exist in several languages, to date there are no Malay-English translation norms. This study presents the first Malay-English translation norms collected with highly proficient Malay-English bilinguals. Furthermore, the study investigates the impact of lexical characteristics on translation ambiguity. The forward translation (FT) task (N = 30) collected English translations for 1004 Malay words selected from the Malay Lexicon Project (Yap et al., 2010), and subsequently the backward translation (BT) task (N = 30) gathered Malay translations for 845 English words obtained from the FT phase. The data revealed a high prevalence of translation ambiguity in both translation directions. Specifically, verbs, adjectives, and class-ambiguous words were more translation-ambiguous than nouns. Furthermore, within-language semantic variability and word length were positively correlated with translation ambiguity, whereas word frequency only correlated with translation ambiguity in FT. Word length and word frequency of the source words and their translations were positively correlated. Intriguingly, only in FT were bilinguals with higher Malay proficiency more likely to provide accurate and dominant translations for the Malay words. These findings contrast with those reported in translation norming studies involving other language pairs. The translation norms provide a useful resource for bilingual language studies involving Malay-English bilinguals.

LexMAL: A quick and reliable lexical test for Malay speakers.

Objective language proficiency measures have been found to provide better and more consistent estimates of bilinguals' language processing than self-rated proficiency (e.g., Tomoschuk et al., 2019; Wen & van Heuven, 2017a). However, objectively measuring language proficiency is often not possible because of a lack of quick and freely available language proficiency tests (Park et al., 2022). Therefore, quick valid vocabulary tests, such as LexTALE (Lemhöfer & Broersma, 2012) and its extensions (e.g., LexITA: Amenta et al., 2020; LEXTALE-FR: Brysbaert, 2013; LexPT: Zhou & Li, 2022) have been developed to reliably assess language proficiency of speakers of various languages. The present study introduces a Lexical Test for Malay Speakers (LexMAL), which estimates language proficiency for Malay first language (L1) and second language (L2) speakers. An initial 180-item LexMAL prototype was evaluated using 60 Malay L1 and 60 L2 speakers in Experiment 1. Sixty words and 30 nonwords with the highest discriminative power that span across the full difficulty range were selected for the final LexMAL based on point-biserial correlations and an item response theory analysis. The validity of LexMAL was demonstrated through a reliable discrimination between L1 and L2 speakers, significant correlations between LexMAL scores and performance on other Malay language tasks (i.e., translation accuracy and cloze test scores), and LexMAL outperforming self-rated proficiency. A validation study (Experiment 2) with the 90-item final LexMAL tested with a different group of Malay L1 (N = 61) and L2 speakers (N = 61) replicated the findings of Experiment 1. LexMAL is freely available for researchers at www.lexmal.org .

Physical assessment in pharmacy practice: Perspectives from pharmacists, nonpharmacist health care providers and the public.

BACKGROUND: Physical assessment in pharmacy practice is not a new concept, yet the idea is still unfamiliar to many people. Canadian pharmacy graduates are expected to be trained in physical examination as it relates to drug therapy. However, standard delivery of course content in this area has not been clearly established, and previous publications have reported low uptake of this practice despite formal training. To aid the future development of a physical assessment course for pharmacists that is relevant to practice and will contribute to patient care, it is important to gather insight from practising pharmacists, health care providers and the public. OBJECTIVE: To determine the type of physical assessment skills that would be of value to pharmacy practice and the benefits and barriers of these skills in practice from the perspectives of pharmacists, health care providers and the public. METHODS: This was a cross-sectional online survey of pharmacists, nonpharmacist health care providers and the public. Descriptive statistics and thematic analysis were used to describe data. RESULTS: A total of 348 respondents (98 pharmacists, 154 nonpharmacist health care providers, 96 public) completed the survey. Most (64%) nonpharmacist providers were physiotherapists or occupational therapists (only 6.5% physicians). Most respondents felt that performing basic vital signs was relevant to pharmacy practice (79% pharmacists, 69% other providers, 79% public) and felt confident and comfortable about pharmacists using these skills. Palpation, percussion and auscultation were rated less favourably (<50% for most respondents). Nonpharmacist providers tended to be less favourable than pharmacist and public respondents. Seven themes related to benefits and 13 themes related to disadvantages of pharmacists performing physical assessment were identified. CONCLUSION: These findings provide insight into opinions about the value of pharmacists performing physical assessments. Consensus recommendations on performance expectations to improve recognition of pharmacists in this area is needed in the future. Can Pharm J (Ott) 2021;154:xx-xx.

Trends in the Use of Long-Acting Injectable Antipsychotics in the Province of Manitoba, Canada.

BACKGROUND: Long-acting injectable antipsychotics (LAIAs) have advantages over oral antipsychotics but are not widely used. We aimed to evaluate the impact of market entry of second-generation LAIAs on prescribing trends. METHODS: We used administrative health databases to describe trends in LAIA use from 1995 to 2015 in the Canadian province of Manitoba. Age- and sex-specific incident and prevalent use were determined using prescription dispensation records for the entire population. We used interrupted time series analysis with Poisson regression to estimate change in LAIA use attributable to the market entry of the second-generation LAIA risperidone. RESULTS: We observed 3380 prevalent LAIA users and 2375 incident users in our cohort. Long-acting injectable antipsychotic use was higher in males. Incidence proportions declined from 21.5 users per 100,000 in 1996 to 4.8 in 2004 and then climbed to 14.7 by 2015. First-generation LAIA use peaked at 94.6 prevalent users per 100,000 in 1998 but fell to 40.9 in 2015. Long-acting injectable antipsychotic use increased 1.4% per quarter after the market entry of risperidone long-acting injectable. CONCLUSIONS: Risperidone risperidone long-acting injectable market entry had a positive impact on LAIA prescribing.

Cerebrovascular, Cardiovascular, and Mortality Events in New Users of Selective Serotonin Reuptake Inhibitors and Serotonin Norepinephrine Reuptake Inhibitors: A Propensity Score-Matched Population-Based Study.

BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are widely prescribed for mood and anxiety disorders. However, it is not clear whether SNRIs are more strongly associated with cardiovascular and cerebrovascular events than SSRIs. METHODS: This was a propensity score-matched, population-based, cohort study of Manitobans who started an SSRI or SNRI between April 1, 1998, and March 31, 2014. The primary outcome was a composite of acute myocardial infarction (AMI), stroke, or cardiovascular-related hospitalization within 1 year of drug initiation. Each component of the primary outcome and death were analyzed separately in secondary analyses. RESULTS: A total of 225,504 and 54,635 patients initiated treatment on an SSRI and SNRI, respectively. After propensity score matching, a higher risk was observed for the primary outcome among SNRI users (weighted hazards ratio [HR], 1.13; 95% confidence interval [CI], 1.06-1.21). Secondary analyses showed that the risk of nonfatal stroke was higher among SNRI users (weighted HR, 1.20; 95% CI, 1.08-1.33). The risk of death was higher among SNRI users without mood and/or anxiety disorders (weighted HR, 1.17; 95% CI; 1.03-1.32). No differences were observed in the risk of AMI or fatal stroke between SSRI and SNRI use. CONCLUSIONS: New SNRI use was associated with a higher risk of nonfatal stroke relative to SSRI use. Further investigation is warranted regarding the higher risk of death observed in our subgroup analysis among incident SNRI users without mood and/or anxiety disorders.

Validity of the days supply field in pharmacy administrative claims data for the identification of blister packaging of medications.

PURPOSE: Pharmacy claims data is often used in pharmacoepidemiology studies, but no studies to date have examined whether it was possible to identify the use of blister packs in these databases. We aimed to determine whether medications dispensed in days divisible by 7 are more likely to be blister packed than medications dispensed in other quantities. METHODS: Community pharmacies in Manitoba were invited to participate in a mail-out survey to identify the use of blister packaging for up to 25 patients who had a solid oral medication dispensed from April 1, 2012 to March 31, 2014. Eligible medications were identified using the population-based province-wide retail pharmacy network. Algorithms for identifying the use of blister packaging were determined by comparing the proportion of fills that confirmed blister pack use between different days supply quantities. RESULTS: Twenty-seven out of 32 pharmacies that agreed to participate completed the survey. The total number of prescriptions in the analysis was 2045 of which 131 (6.4%) were dispensed in blister packaging. Overall, prescriptions dispensed in days divisible by 7 yielded a 72.5% sensitivity, 86.6% specificity, 30.3% PPV, and 97.9% NPV compared with prescriptions dispensed in other quantities. A 28-day to 30-day comparison yielded an 87.9% sensitivity, 96.1% specificity, 64.6% PPV, and 99.0% NPV. CONCLUSION: While the NPV was high, the PPV for identifying blister packaging using the days supply field in pharmacy claims data was modest given the low prevalence in blister pack use. The best predictor occurred when 28 days was compared with 30 days. KEY POINTS Blister packs are arranged in 4 × 7 compartments and are often used to improve adherence, but no studies have examined whether it was possible to identify the use of blister packs using the days supply field in pharmacy claims data. Findings show that a 28-day supply yielded a high sensitivity and specificity for identifying the use of blister packaging compared with a 30-day supply, but there is potential for misclassification. Future studies directed at examining subgroups that are more likely to use blister packs and replication of findings using other data sources in other jurisdictions are encouraged.

Psychotropic Drug Use before, during, and after Pregnancy: A Population-Based Study in a Canadian Cohort (2001-2013).

OBJECTIVE: To describe the extent of increase in use and the rate of continuation versus discontinuation of psychotropic agents before, during, and after pregnancy. METHODS: Rates of psychotropic use (antidepressants, anxiolytic/sedative-hypnotics, antiepileptics, antipsychotics, lithium, stimulants) among women with a hospital-recorded pregnancy outcome were assessed using databases at the Manitoba Centre for Health Policy. Rate of use was defined as ≥1 prescription over the total number of pregnancies in the 3-12 months before pregnancy, 0-3 months before pregnancy, during pregnancy, or 3 months after pregnancy. Continued use was defined as ≥2 prescriptions with gap ≤14 days. Poisson regression was used to analyze trends. RESULTS: Over the study period, a psychotropic drug was used before, during, or after pregnancy in 41,923 of 224,762 pregnancies. From 2001 to 2013, psychotropic use increased 1.5-fold from 11.1% to 16.2% ( p < 0.0001) in the 3-12 months before pregnancy, 1.6-fold from 6.4% to 10.5% ( p < 0.0001) in the 3 months before pregnancy, 1.8-fold from 3.3% to 6.0% ( p < 0.0001) during pregnancy, and 1.5-fold from 6.2% to 9.5% ( p < 0.0001) in the 3 months postpartum. Among the 13,579 women who received at least 1 psychotropic agent in the 3 months prior to pregnancy, 38.5% stopped the agent prior to pregnancy and only 10.3% continued use throughout pregnancy. Continued use throughout pregnancy was higher (56.9%) among the 6693 women who received at least 2 prescriptions for a psychotropic agent and were at least 80% adherent in the 3 months prior to pregnancy. CONCLUSION: The use of psychotropic agents increased over 12 years. The safety of continuing versus discontinuing these agents during pregnancy remains uncertain, but we observed a decrease in psychotropic drug use during the pregnancy period.

New antidepressant use in older adults: a Canadian population-based study (1997-2013).

OBJECTIVE: There has been much attention on appropriate prescribing in older adults in recent years. Recent guidelines favor the use of newer antidepressants over older agents based on their safety profile in this population. This study aimed to examine whether there has been a decline in older antidepressants and an increase in newer antidepressants used by older adults. METHOD: A retrospective cross-sectional study using administrative databases examined the annual incidence of antidepressant use (per 1000) of community-dwelling adults ≥60 years old between 1997/1998 and 2012/2013 in Manitoba, Canada. RESULTS: The population of Manitoba ≥60 years increased by 25.6% from 188,296 to 236,569 from 1997/1998 to 2012/2013. New antidepressant use peaked to 45.9 per 1000 in 1999/2000, and then decreased steadily to 30.5 per 1000 in 2012/2013 (p < 0.0001). Incident amitriptyline use was high but declined from 15.5 to 7.4 per 1000 (p < 0.001). An increase in incident trazodone, mirtazapine, and venlafaxine use was observed (p < 0.001). CONCLUSIONS: There has been an overall decrease in the annual incidence of antidepressant users in older adults over the last 16 years, with a marked decline in new amitriptyline use and an increase in the incidence of newer agents.

Community Pharmacists' Perspectives on Dispensing Medications With the Potential for Misuse, Diversion, and Intentional Overdose: Results of a Province-Wide Survey of Community Pharmacists in Canada.

BACKGROUND: Community pharmacists frequently encounter patients at risk of medication misuse, diversion, and intentional overdose. However, few studies have examined the perspective of the pharmacist on the identification and management of these patients. OBJECTIVE: To understand the perspective of community pharmacists on the dispensing of select medications commonly associated with misuse, diversion, and overdose. METHODS: An online survey was disseminated by electronic mail to community pharmacists listed in the College of Pharmacists of Manitoba directory. The survey was open from July to September 2014. Descriptive statistics were used to describe demographic information of the pharmacist and practice setting, and pharmacists' perceptions on the dispensing of select medications. RESULTS: A total of 82 community pharmacists completed the survey. Most pharmacists considered a one-month supply appropriate for a psychotropic agent; but a 7-10 day-supply was considered appropriate for an opioid for acute pain. Factors that aid pharmacist decisions on providing select medications to patients include familiarity with the patient, ease of access to medical history information, and ease of access to the prescribing physician. Only 10.3%, 16.2%, and 32.4% felt they have received adequate training on the management of patients at risk for suicide, drug diversion, and medication misuse, respectively. CONCLUSION: Findings from this study demonstrated a need for improved systems for managing patients at risk for medication misuse, diversion, and overdose. Strategies that warrant further attention for limiting the means of medication misuse include increased access to electronic medical records and providing additional continuing education support for community pharmacists.

Student perspectives of an online module for teaching physical assessment skills for dentistry, dental hygiene, and pharmacy students.

The integration of web-based learning into the curriculum of healthcare education has significantly increased over the past decade. This article aims to describe the student perspectives of an online module to teach physical assessment skills for pharmacy, dentistry, and dental hygiene students. A total of 103 students completed the online module: 48 third-year pharmacy students, 29 first-year dentistry students, and 26 first-year dental hygiene students. Students were asked to rate a list of 10 statements on a 5-point Likert scale on the relevance, impact, and overall satisfaction of the online module. Eighty-four of the 103 students (81.6% response rate) completed the questionnaire. While most students responded positively to the online content, pharmacy students responded more favorably compared with students from Dentistry and Dental Hygiene. These findings provide useful information to identify areas in which the web-based module can be improved for teaching skills in physical assessment across multiple healthcare programs.

Treating recurrent postmenopausal vasomotor symptoms in a patient with a positive family history for breast cancer.

OBJECTIVE: To report a case of recurrent hot flashes unresponsive to gabapentin in a postmenopausal patient with a positive family history of breast cancer. CASE SUMMARY: A 69-year-old Caucasian female experienced a recurrence of debilitating hot flashes for the past eight months. More recently, she failed a two-month trial of gabapentin 600 mg by mouth at bedtime after she previously received effective hormone replacement therapy (HRT) seven years ago with near-complete resolution of her symptoms. The patient had a sister and a niece who developed breast cancer in their 40s. DISCUSSION: The treatment of postmenopausal hot flashes in a patient with a positive family history of breast cancer represents a clinical challenge for many clinicians. This case is an example in which gabapentin was ineffective in the treatment of severe hot flashes in a postmenopausal woman. The risks and benefits of HRT compared with nonhormonal alternatives were assessed. CONCLUSION: In this case, a two-month trial of gabapentin 600 mg/day failed to demonstrate efficacy in reducing the severity, frequency, and duration of hot flashes. Controlled trials are necessary to evaluate the safety and efficacy of other therapeutic alternatives.

Community Pharmacy Practice Barriers in Preventing Drug Misuse, Divergence and Overdose: A Focus Group Study.

Community pharmacists frequently encounter patients suspected to be at risk of medication misuse, divergence and overdose; yet, little research exists in describing how pharmacists effectively identify and intervene during these encounters. This study aimed to understand the barriers and facilitators in community pharmacy practice using a focus group design to help inform policymakers in the development of effective and feasible strategies for limiting the means of medication misuse. Findings revealed three themes: (1) patient-level barriers (deciphering signs of misuse); (2) pharmacist-level barriers (type of practice experience); and (3) system-level barriers (prescriber, third-party payer). Insight into pharmacy practice provided a foundation for future study to explore strategies for improving care for at-risk patients.

Knowledge and perceptions of pharmacogenomics among pharmacists in Manitoba, Canada.

Objective: This work was designed to describe the knowledge and perceptions of pharmacogenomics (PGx) among pharmacists in the Canadian province of Manitoba. Methods: A 40-item, web-based survey was distributed to pharmacists in Manitoba. Results: Of 74 participants, one third had some education or training in PGx, and 12.2% had used PGx test results in their practice. Participants' self-rated knowledge of PGx testing and common PGx resources (e.g., Pharmacogenomics Knowledge Base, Clinical Pharmacogenetics Implementation Consortium) was low. Most pharmacists surveyed believe that PGx can improve medication efficacy (82.4%) or prevent adverse drug reactions (81.1%). Most (91%) desired more education on PGx. Conclusion: Manitoba pharmacists reported positive perceptions toward PGx. However, they are currently underprepared to implement PGx into practice.

Evaluating the impact of COVID-19 on medication adherence and health care utilization among individuals with psychotic disorders who are prescribed long-acting injectables (LAIs) or clozapine: A population-based study in Manitoba, Canada.

BACKGROUND: Ongoing psychiatric follow-up and medication adherence improve outcomes for patients with psychotic disorders. Due to COVID-19, outpatient care may have been disrupted, impacting healthcare utilization. METHODS: A retrospective population-wide study was conducted for adults in Manitoba, Canada. Medication adherence and healthcare utilization were examined from 2019 to 2021. The presence of a diagnosed psychotic disorder was identified in the five years before the index date in each year. The LAI and clozapine cohorts consisted of those who received at least two prescriptions in each year 180 days before the March 20th index date. The change in adherence was measured using the average Medication Possession Ratio. Healthcare utilization rates were compared using Generalized Estimating Equation models. RESULTS: There were no significant differences between LAI and clozapine discontinuation rates before and during the pandemic. In the LAI cohort, general practitioner visits decreased significantly (-3.5 %, p = 0.039) across four quarters of 2021 versus 2019. All-cause hospitalizations decreased by 16.8 % in 2020 versus 2019 (p = 0.0055), while psychiatric hospitalizations decreased by 18.7 % across four quarters in 2020 (p = 0.0052) and 13.7 % in 2021 (p = 0.0425), versus 2019 in the LAI cohort. There was a significant transition to virtual care during the first wave of COVID-19 (71 % in clozapine, 51 % in LAI cohorts). Trends in total outpatient visits and non-psychiatric hospitalizations remained stable. CONCLUSION: COVID-19 had no substantial impact on LAI and clozapine discontinuation rates for patients previously adherent. Outpatient care remained stable, with a significant proportion of visits being done virtually at the outset of the pandemic.

Knowledge, perceptions, and attitudes toward pharmacogenomics among pharmacists and pharmacy students: A systematic review.

Background and Aims: Pharmacists have been recognized as one of the most qualified healthcare professionals in the clinical implementation of pharmacogenomics, yet its widespread implementation in clinical pharmacy practice has remained limited. The review aims to systematically investigate knowledge, perceptions, and attitudes toward pharmacogenomics among pharmacists and pharmacy students to inform the future delivery of pharmacogenomics education programs. Methods: PubMed, MEDLINE, Embase, Scopus, and the International Pharmaceutical Abstracts were searched up to May 17, 2022. Studies were selected if they included data on pharmacists' or pharmacy students' knowledge, perception, or attitude about pharmacogenomics and were published in a peer-reviewed, English-language journal with full-text availability. Any published study not deemed original research was excluded. All included studies were critically appraised using the Center for Evidence-Based Management's critical appraisal tools. The data were descriptively analyzed and presented based on pharmacists' and pharmacy students' knowledge/awareness, perception/attitudes toward pharmacogenomic (PGx), confidence in using or interpreting PGx testing results, and their desire to get further PGx education or their most preferred method of further education. Results: A combined total of 12,430 pharmacists and pharmacy students from 26 countries are represented in the 52 included studies. Despite overwhelmingly positive attitudes and perceptions toward pharmacogenomics among pharmacists and pharmacy students, an overall lack of adequate knowledge and confidence was found. The review also found a strong desire for further pharmacogenomics education among pharmacists and pharmacy students. Conclusion: Pharmacists and pharmacy students have positive perceptions and attitudes toward pharmacogenomics, which is hindered by a lack of knowledge and confidence. However, inadequate control for confounders, limited representativeness of the studied population or region, and small sample sizes diminish the generalizability of the review results. Knowledge and confidence could be improved through enhanced delivery of pharmacogenomic courses within the pharmacy curriculum and continuing education programs.

Trend in Prescription Medication Utilization for Opioid Use Disorder and Alcohol Use Disorder From 2015 to 2021: A Population-wide Study in a Canadian Province.

OBJECTIVE: To examine the quarterly incidence and prevalence of medications for opioid use disorder (OUD) and alcohol use disorder (AUD) from 2015 to 2021. METHODS: A retrospective population-wide observational study in Manitoba, Canada, was conducted using administrative claims data from the Manitoba Centre for Health Policy to examine the incidence and prevalence of OUD (methadone, buprenorphine-naloxone, buprenorphine) or AUD medications (naltrexone, acamprosate, disulfiram) per 10,000 individuals in each quarter between January 1, 2015, and December 31, 2021. RESULTS: There were 1179 and 451 individuals who received at least one prescription for OUD and AUD, respectively, in the first quarter of 2020. The prevalence of OUD medications more than doubled from 6.3 to 14.3 per 10,000 from January 1, 2015, to December 31, 2021. Likewise, AUD medication prevalence increased almost 10-fold from 0.68 to 6.5 per 10,000 from January 1, 2015, to December 31, 2021, primarily due to naltrexone. The incidence of AUD prescription use increased 8.6-fold from 0.29 to 2.51 per 10,000 during the study period. In contrast, the incidence of opioid agonist therapy declined from 2.1 per 10,000 in the first quarter of 2015 to 0.53 per 10,000 the first quarter of 2016, primarily due to methadone. Whereas methadone incidence declined, buprenorphine-naloxone incidence increased almost 15-fold during the study period. CONCLUSION: An increase in both AUD medication prevalence and incidence in addition to an increase in buprenorphine-naloxone incidence was observed. These findings reflect an increase in the uptake of medications for treating AUD and OUD following changes to improve coverage and access to these medications.

The use of prescription medications and non-prescription medications during lactation in a prospective Canadian cohort study.

BACKGROUND: A lack of safety data on postpartum medication use presents a potential barrier to breastfeeding and may result in infant exposure to medications in breastmilk. The type and extent of medication use by lactating women requires investigation. METHODS: Data were collected from the CHILD Cohort Study which enrolled pregnant women across Canada between 2008 and 2012. Participants completed questionnaires regarding medications and non-prescription medications used and breastfeeding status at 3, 6 and 12 months postpartum. Medications, along with self-reported reasons for medication use, were categorized by ontologies [hierarchical controlled vocabulary] as part of a large-scale curation effort to enable more robust investigations of reasons for medication use. RESULTS: A total of 3542 mother-infant dyads were recruited to the CHILD study. Breastfeeding rates were 87.4%, 75.3%, 45.5% at 3, 6 and 12 months respectively. About 40% of women who were breastfeeding at 3 months used at least one prescription medication during the first three months postpartum; this proportion decreased over time to 29.5% % at 6 months and 32.8% at 12 months. The most commonly used prescription medication by breastfeeding women was domperidone at 3 months (9.0%, n = 229/2540) and 6 months (5.6%, n = 109/1948), and norethisterone at 12 months (4.1%, n = 48/1180). The vast majority of domperidone use by breastfeeding women (97.3%) was for lactation purposes which is off-label (signifying unapproved use of an approved medication). Non-prescription medications were more often used among breastfeeding than non-breastfeeding women (67.6% versus 48.9% at 3 months, p < 0.0001), The most commonly used non-prescription medications were multivitamins and Vitamin D at 3, 6 and 12 months postpartum. CONCLUSIONS: In Canada, medication use is common postpartum; 40% of breastfeeding women use prescription medications in the first 3 months postpartum. A diverse range of medications were used, with many women taking more than one prescription and non-prescription medicines. The most commonly used prescription medication by breastfeeding women were domperidone for off-label lactation support, signalling a need for more data on the efficacy of domperidone for this indication. This data should inform research priorities and communication strategies developed to optimize care during lactation.