Acute Migraine Treatment with Timolol 0.5% Nasal Spray - Compounding Pharmacists Have an Important Role.

For the foreseeable future, timolol 0.5% nasal spray prepared by compounding pharmacists will be the only source for a potentially dramatic new paradigm in the treatment of acute migraine.1 It is also likely other medical conditions can be treated with the compounded timolol nasal spray that need extremely rapid therapeutic beta blocker blood levels when IV infusion is not possible or practical. This manuscript will review the research and development of compounded timolol medication over the past dozen years and reference previous articles in IJPC detailing how the pharmaceutical compounded product is prepared.2 A final goal is to engage physicians in a beneficial working relationship with compounding pharmacies to make immediately available to patients a nasal spray formulation of the beta blocker timolol 0.5% in solution. It has recently been demonstrated for the first time to benefit acute migraine treatment.

Healthcare Professionals' Knowledge, Attitudes, and Practices in the Assessment, and Management of Sickle-Cell Disease: A Meta-Aggregative Review.

BACKGROUND: Sickle Cell Disease (SCD) presents significant health challenges globally. Despite its prevalence in diverse geographical regions, there is a paucity of literature synthesizing evidence on healthcare professionals' knowledge, attitudes, and practices (KAP) toward SCD assessment and management. This meta-aggregative review systematically examined and synthesized existing qualitative research to elucidate healthcare professionals' KAP regarding SCD assessment and management. METHODS: This meta-aggregative review followed Aromataris and Pearson's guidelines and the PRISMA framework for systematic review reporting. The search was conducted in Scopus, PubMed, Embase, CINAHL Web of Science, Google Scholar, Dimensions AI, and HINARI. Quality appraisal was performed using the Joanna Briggs Institute tool. RESULTS: Healthcare professionals (HCPs) demonstrate varying levels of KAP toward SCD assessment and management. Studies reveal low-to-moderate levels of general knowledge among HCPs, with nurses often exhibiting poorer understanding than physicians. Deficiencies in awareness of specific interventions, such as chemoprophylaxis and prenatal diagnosis, are noted, along with gaps in SCD assessment and diagnosis, particularly in pain management and premarital screening. Attitudes toward SCD patients vary, and practices reveal inconsistencies and deficiencies, including inadequate nutritional counseling and barriers in emergency departments. However, interventions aimed at improving HCPs' KAP show promise in enhancing understanding and attitudes toward SCD, suggesting potential avenues for improvement. CONCLUSIONS: Educational initiatives targeted at both student nurses and practicing healthcare providers, coupled with the implementation of standardized protocols and guidelines, can enhance knowledge acquisition and promote consistent, high-quality care delivery. Future studies should improve the quality of their methods in this area of study.

Stress-related experiences and intentions to quit studies among female married postgraduate distance education students in Ghana.

BACKGROUND: Although postgraduate studies have been shown to be associated with stressful experiences, students reading programmes through the distance and e-learning mode experience greater levels of stress due to several reasons. These stressful encounters might be heightened in female married postgraduates on distance education programmes due to other family-work-related engagements. This study investigated the stress-related experiences and intentions to quit studies among female married students on a distance education programme in Ghana. METHODS: Using a sequential explanatory mixed-methods design, 164 married postgraduate distance education students were sampled to participate by responding to a questionnaire. Follow-up interviews were conducted with 10 participants to offer insight into the quantitative findings. Quantitative data were analysed using descriptive statistics, including frequency and percentages, while the qualitative data were thematically analysed. RESULTS: Stress was prevalent among the female married distance education students, with the majority having intentions of quitting their studies. The stressors identified ranged from personal (i.e., work and family demands) to institutional ones (i.e., academic load, unresolved complaints and high financial demands from the programme). CONCLUSIONS: Key findings suggest that female married postgraduate distance education students perform multiple roles as full-time employees with family and academic demands that can negatively impact their health and academic work. Implications and recommendations of the findings are discussed.

Gender Differences in Academic Resilience and Well-Being among Senior High School Students in Ghana: A Cross-Sectional Analysis.

Senior high school (SHS) students are at risk of stress and other adverse exposures that may negatively affect their well-being and possibly cause attrition. The concepts of academic resilience and well-being share commonality as psychological attributes linked to positive functioning among students. Despite this connection, there seems to be limited research exploring these concepts across genders among SHS students in developing regions. This study examined the gender difference in academic resilience and well-being among SHS students in Ghana. Using a cross-sectional survey design, 190 SHS students in three schools from Kwahu North and South district (i.e., Afram Plains) of Ghana's Eastern Region completed the Academic Resilience Scale (ARS-30) and College Student Subjective Wellbeing Questionnaire (CSSWQ). The sample consists of 102 males and 88 females, with a mean age of 17.83 years. The data were analyzed using independent samples t-tests and hierarchical regression. The study established that students have a moderate level of academic resilience and a higher level of well-being, with no statistically significant variation in students' academic resilience (t = 0.718; p = 0.474) or well-being (t = -1.596; p = 0.112) across gender. Further, the study discovered that resilience significantly predicted academic well-being (B = 0.425; SE = 0.050; t = 8.50; p < 0.001). This study highlights the importance of promoting gender-sensitive intervention strategies that enhance the academic resilience and well-being of SHS students and help boost their educational attainment.

Female genital mutilation and safer sex negotiation among women in sexual unions in sub-Saharan Africa: Analysis of demographic and health survey data.

BACKGROUND: The practice of female genital mutilation is associated with harmful social norms promoting violence against girls and women. Various studies have been conducted to examine the prevalence of female genital mutilation and its associated factors. However, there has been limited studies conducted to assess the association between female genital mutilation and markers of women's autonomy, such as their ability to negotiate for safer sex. In this study, we examined the association between female genital mutilation and women's ability to negotiate for safer sex in sub-Saharan Africa (SSA). METHODS: We pooled data from the most recent Demographic and Health Surveys (DHS) conducted from 2010 to 2020. Data from a sample of 50,337 currently married and cohabiting women from eleven sub-Saharan African countries were included in the study. A multilevel binary logistic regression analysis was used to examine the association between female genital mutilation and women's ability to refuse sex and ask their partners to use condom. Adjusted odds ratios (aORs) with a 95% confidence interval (CI) were used to present the findings of the logistic regression analysis. Statistical significance was set at p<0.05. RESULTS: Female genital mutilation was performed on 56.1% of women included in our study. The highest and lowest prevalence of female genital mutilation were found among women from Guinea (96.3%) and Togo (6.9%), respectively. We found that women who had undergone female genital mutilation were less likely to refuse sex from their partners (aOR = 0.91, 95% CI = 0.86, 0.96) and ask their partners to use condoms (aOR = 0.82, 95% CI = 0.78, 0.86) compared to those who had not undergone female genital mutilation. CONCLUSION: Female genital mutilation hinders women's ability to negotiate for safer sex. It is necessary to implement health education and promotion interventions (e.g., decision making skills) that assist women who have experienced female genital mutilation to negotiate for safer sex. These interventions are crucial to enhance sexual health outcomes for these women. Further, strict enforcement of policies and laws aimed at eradicating the practice of female genital mutilation are encouraged to help contribute to the improvement of women's reproductive health.

Moderated moderation modelling of subjective social status, pocket money and depressive symptoms of university students in Ghana.

Introduction: Although the relationship between subjective social status and depression in university students has been well-established, this association could be seen as a spurious one. Previous studies have shown that key variables like financial resources and age could play key roles in explaining the variances in social status and mental health outcomes. In this research, we assessed the complex interrelationships between subjective social status, financial resources at their disposal and depressive symptoms among university students within their young and middle adulthood stages. Methods: A cross-sectional survey was conducted in a university in Ghana to sample 1134 university students through accidental sampling. The McArthur Scale and WHO-5 Well-being measure were used for the data collection. Results: The results revealed that higher levels of subjective social status were associated with lower levels of depression. It was further found that the interaction between students' pocket money and age played unique roles in the relationship between subjective social status and depression. Conclusion: The study findings call on stakeholders in education to explore funding opportunities and to examine ways of empowering parents (financially) to adequately support the students. Health educationists and promoters, including psychologists, school counsellors and parents could compliment these efforts by helping to train and empower students through self-regulation or management skills to help improve their well-being. Continuous efforts are required to improve the financial status and mental health of students.

Risk Factors of Malnutrition among In-School Children and Adolescents in Developing Countries: A Scoping Review.

Malnutrition among in-school children is a complex issue influenced by socio-economic, environmental, and health-related factors, posing significant challenges to their well-being and educational trajectories in developing countries. This review synthesized evidence on the multifaceted aspects of child malnutrition within the educational setting in developing countries. This review followed the six steps outlined by Arksey and O'Malley's framework. Four main databases (PubMed, CENTRAL, JSTOR, and Scopus) were searched. Additional searches were conducted in WHO Library, ProQuest, HINARI, Google Scholar, and Google. Reference lists of eligible papers were checked. This review found that low family income, varying family sizes, parental employment status, and educational levels significantly impact malnutrition among in-school children and adolescents. Environmental elements, including rural/urban residence, household sanitation, and living conditions, also influence malnutrition. In addition, nutrition knowledge, dietary habits, nutrient deficiencies, physical activity, and prevalent health conditions compound the risk of malnutrition. This study underscores the extensive health impact of malnutrition on general health, specific nutrient deficiencies, fetal/maternal health concerns, and overall morbidity. Also, malnutrition affects school performance and attendance, impacting cognitive abilities, and academic achievements. Addressing these challenges requires comprehensive policy actions aligned with Sustainable Development Goals, emphasizing poverty alleviation, health literacy, and gender equity.

Neutrophils and Neutrophil Extracellular Traps Cause Vascular Occlusion and Delayed Cerebral Ischemia After Subarachnoid Hemorrhage in Mice.

BACKGROUND: After subarachnoid hemorrhage (SAH), neutrophils are deleterious and contribute to poor outcomes. Neutrophils can produce neutrophil extracellular traps (NETs) after ischemic stroke. Our hypothesis was that, after SAH, neutrophils contribute to delayed cerebral ischemia (DCI) and worse outcomes via cerebrovascular occlusion by NETs. METHODS: SAH was induced via endovascular perforation, and SAH mice were given either a neutrophil-depleting antibody, a PAD4 (peptidylarginine deiminase 4) inhibitor (to prevent NETosis), DNAse-I (to degrade NETs), or a vehicle control. Mice underwent daily neurological assessment until day 7 and then euthanized for quantification of intravascular brain NETs (iNETs). Subsets of mice were used to quantify neutrophil infiltration, NETosis potential, iNETs, cerebral perfusion, and infarction. In addition, NET markers were assessed in the blood of aneurysmal SAH patients. RESULTS: In mice, SAH led to brain neutrophil infiltration within 24 hours, induced a pro-NETosis phenotype selectively in skull neutrophils, and caused a significant increase in iNETs by day 1, which persisted until at least day 7. Neutrophil depletion significantly reduced iNETs, improving cerebral perfusion, leading to less neurological deficits and less incidence of DCI (16% versus 51.9%). Similarly, PAD4 inhibition reduced iNETs, improved neurological outcome, and reduced incidence of DCI (5% versus 30%), whereas degrading NETs marginally improved outcomes. Patients with aneurysmal SAH who developed DCI had elevated markers of NETs compared with non-DCI patients. CONCLUSIONS: After SAH, skull-derived neutrophils are primed for NETosis, and there are persistent brain iNETs, which correlated with delayed deficits. The findings from this study suggest that, after SAH, neutrophils and NETosis are therapeutic targets, which can prevent vascular occlusion by NETs in the brain, thereby lessening the risk of DCI. Finally, NET markers may be biomarkers, which can predict which patients with aneurysmal SAH are at risk for developing DCI.

ICNIRP Statement on Short Wavelength Light Exposure from Indoor Artificial Sources and Human Health.

ABSTRACT: Concerns have been raised about the possibility of effects from exposure to short wavelength light (SWL), defined here as 380-550 nm, on human health. The spectral sensitivity of the human circadian timing system peaks at around 480 nm, much shorter than the peak sensitivity of daytime vision (i.e., 555 nm). Some experimental studies have demonstrated effects on the circadian timing system and on sleep from SWL exposure, especially when SWL exposure occurs in the evening or at night. The International Commission on Non-Ionizing Radiation Protection (ICNIRP) has identified a lack of consensus among public health officials regarding whether SWL from artificial sources disrupts circadian rhythm, and if so, whether SWL-disrupted circadian rhythm is associated with adverse health outcomes. Systematic reviews of studies designed to examine the effects of SWL on sleep and human health have shown conflicting results. There are many variables that can affect the outcome of these experimental studies. One of the main problems in earlier studies was the use of photometric quantities as a surrogate for SWL exposure. Additionally, the measurement of ambient light may not be an accurate measure of the amount of light impinging on the intrinsically photosensitive retinal ganglion cells, which are now known to play a major role in the human circadian timing system. Furthermore, epidemiological studies of long-term effects of chronic SWL exposure per se on human health are lacking. ICNIRP recommends that an analysis of data gaps be performed to delineate the types of studies needed, the parameters that should be addressed, and the methodology that should be applied in future studies so that a decision about the need for exposure guidelines can be made. In the meantime, ICNIRP supports some recommendations for how the quality of future studies might be improved.

Nasally Delivered 0.5% Timolol Beta Blocker Successfully Treats Acute Migraines in a Referral Headache Clinic: A Case Series.

This is the first reported case series of nasally delivered beta blocker (timolol 0.5%) for the treatment of acute migraine. In a retrospective chart review, 16 patients were found who had received intranasal timolol for sub-optimally treated acute migraines. Of these, 10 (62.5%) reported to their provider that the medication was helpful. Encouragingly, the treatment was beneficial even for patients previously refractory to other medications. Intranasal timolol was well tolerated, with only one patient reporting mild nasal congestion and no other side effects reported. These findings suggest the need for a prospective pilot study followed by a larger double-blind randomized placebo-controlled trial to determine the overall efficacy and safety of nasally delivered beta blockers for acute migraine treatment.

Acute Adverse Events After Iodinated Contrast Agent Administration of 359,977 Injections: A Single-Center Retrospective Study.

OBJECTIVE: To assess the effects of patient variables, examination variables, and seasonality on allergic-like and physiologic reactions to iodinated contrast material (ICM). PATIENTS AND METHODS: All ICM-enhanced computed tomography (CT) examinations performed from June 1, 2009, to May 9, 2017, at our institution were included. Reactions were identified and categorized as allergic-like or physiologic and mild, moderate, or severe. The effect of patient and examination variables on reactions was evaluated by logistic regression models. RESULTS: A total of 359,977 CT examinations performed on 176,886 unique patients were included. A total of 1150 allergic-like reactions (0.32%; 19 severe [0.005%]) and 679 physiologic reactions (0.19%; 3 severe [0.0008%]) occurred. On multivariable analysis, iopromide had higher rates of reactions compared with iohexol (allergic-like reactions: odds ratio [OR], 3.07 [95% CI, 2.37 to 3.98], P<.0001; physiologic reactions: OR, 2.60 [1.92 to 3.52], P<.0001). Non-White patients had higher rates of reactions compared with White patients (allergic-like reactions: OR, 1.77 [1.36-2.30], P<.0001; physiologic reactions: OR, 1.76 [1.27-2.42], P=.0006). Patient age, sex, prior ICM reaction, ICM dose, CT location, and CT type were also significantly associated with reactions. No significant seasonality trend was observed (P=.07 and .80). CONCLUSION: Non-White patients and patients administered iopromide had higher rates of acute reactions compared with White patients and patients administered iohexol. Younger patients (<50 years vs 51 to 60 years), female sex, history of ICM allergy or other allergies, ICM dose, and contrast-enhanced CT location and type also correlated with higher acute reaction rates.

Modelling the associations between academic engagement, study process and grit on academic achievement of physical education and sport university students.

OBJECTIVE: The present study examined the impact of academic engagement, study processes, and grit on the academic achievement of physical education and sport university students. METHODS: An internet-based survey recruited 459 university students aged 19-25 years (M = 21 ± 1.3) in physical education and sports (PES) to fill out questionnaires on Physical Education-Study Process Questionnaire (PE-SPQ), Physical Education-Grit (PE-Grit), academic engagement (A-USEI), and Grade Point Average (GPA). A path analysis was carried out to understand variable relationships. RESULTS: Data from each variable exhibited symmetrical and normal distribution, as indicated by the skewness and kurtosis values. The model's fit indices showed sufficient Comparative Fit Index (CFI = 0.92), Tucker-Lewis Index (TLI = 0.90), Goodness of Fit Index (GFI = 0.99) and Normed Fit Index (NFI = 0.90) and showed acceptable levels. The results indicated a statistically significant positive impact of engagement (ß = 0.299, p < 0.001) and study processes (ß = 0.397, p < 0.001) on academic achievement. However, the effect of grit on achievement was non-significant. CONCLUSIONS: Academic engagement as well as study processes are two important factors predicting academic achievement while grit seems to be not a major predictor. Hence, physical education and sport faculty and university administrators should prioritize student engagement as a determinant of academic outcomes by reforming or redesigning physical education and sport curriculum modules that can facilitate engagement.

In-school adolescents' sociodemographic correlates of serious unintentional injuries in Saint Vincent and the Grenadines: A cross-sectional study.

Background: As a public health concern, serious adolescent injuries constitute considerable global morbidity and mortality. Despite the proliferation of literature on this problem, the evidence on the determinants of injuries among in-school adolescents in Saint Vincent and the Grenadines (SVG) is insufficient. Method: The study analyzed data from the 2018 Global School-based Student Health Survey to examine the prevalence and determinants of serious injuries in a nationwide adolescent sample in SVG. χ 2 And binomial logistic regression analyses were carried out, along with an adjusted odds ratio and a 95% confidence interval. Results: Serious injuries among this population were estimated at 50.5%. Student grades, gender, truancy, amphetamine or methamphetamine use, marijuana or alcohol use, cigarette smoking, physical assault, physical fight, cyberbullying, suicidal behavior (ideation, plan, and attempt), parental or guardian tobacco use, and multiple sexual partners were significantly associated with serious injuries. After adjusting for other variables, being a male, having experienced a physical attack, fighting physically, attempting suicide, and having multiple sexual partners predicted serious injuries among in-school adolescents in SVG. Conclusion: The use of integrative health promotion and injury prevention programmes (e.g., antiviolence campaigns) and educational measures could help minimize or eradicate this menace in SVG.

Development of a machine learning algorithm based on administrative claims data for identification of ED anaphylaxis patient visits.

Background: Epidemiologic studies of anaphylaxis commonly rely on International Classification of Diseases (ICD) codes to identify anaphylaxis cases, which may lead to suboptimal epidemiologic classification. Objective: We sought to develop and assess the accuracy of a machine learning algorithm using ICD codes and other administrative data compared with ICD code-only algorithms to identify emergency department (ED) anaphylaxis visits. Methods: We conducted a retrospective review of ED visits from January 2013 to September 2017. Potential ED anaphylaxis visits were identified using 3 methods: anaphylaxis ICD diagnostic codes (method 1), ICD symptom-based codes with or without a code indicating an allergic trigger (method 2), and ICD codes indicating a potential allergic reaction only (method 3). A machine learning algorithm was developed from administrative data, and test characteristics were compared with ICD code-only algorithms. Results: A total of 699 of 2191 (31.9%) potential ED anaphylaxis visits were classified as anaphylaxis. The sensitivity and specificity of method 1 were 49.1% and 87.5%, respectively. Method 1 used in combination with method 2 resulted in a sensitivity of 53.9% and a specificity of 68.7%. Method 1 used in combination with method 3 resulted in a sensitivity of 98.4% and a specificity of 15.1%. The sensitivity and specificity of the machine learning algorithm were 87.3% and 79.1%, respectively. Conclusions: ICD coding alone demonstrated poor sensitivity in identifying cases of anaphylaxis, with venom-related anaphylaxis missing 96% of cases. The machine learning algorithm resulted in a better balance of sensitivity and specificity and improves upon previous strategies to identify ED anaphylaxis visits.

Investigating sedentariness and health status of primary school teachers in Ghana.

OBJECTIVE: Physical inactivity is linked to chronic illnesses and disabilities among workers, especially those in high demanding jobs like teachers. Despite the global prominence of sedentary behavior research, studies drawing the relationships between physical inactivity and multimorbidity among working teacher populations in low-and middle-countries remain untapped. This study assessed the sedentariness and health status of primary school teachers in Cape Coast Metropolis in Ghana. METHOD: This cross-sectional survey employed 1109 primary school teachers from the Cape Coast Metropolis in the Central Region of Ghana, targeting the entire population. RESULTS: Generally, the teachers were highly sedentary and reported poor health status. Other results showed no difference in sedentariness across gender, (n = 1107, t= -0.32, p > 0.05). However, female teachers suffer more pain and discomfort, (n = 1103.51), t = - 3.07, p < 0.05), anxiety and depression, (n = 1099.56), t = - 2.85, p < 0.000), and poor health status (n = 1107), t = 2.14, p < 0.05), than their male counterparts. Also, pain and discomfort, anxiety and depression, health status and years of work significantly predicted sedentariness among the teachers, F (4, 1104) = 5.966, p = 0.00, R = 0.145, R2 = 0.029, adjusted R2 = 0.018. CONCLUSION: The findings suggest that individualized or personalized interventions are urgently needed to promote regular physical activity to improve the health status and reduce associated complications on the health and well-being, especially among the female primary school teachers. Given the health risks of sedentary lifestyle, behavioral interventions at the person-level (i.e., individualized- routine weekly physical activity programs) and built environmental restructuring (e.g., creation of walkways to encourage regular walking) could be done to improve physical activity behavior among teachers within the Cape Coast Metropolis, and perhaps beyond.