Toxics source reduction and sewage upgrades eliminated winter flounder liver neoplasia (1984-2017) from Boston Harbor, MA, USA.

Chemical carcinogen biomarkers can validate public investment in environmental remediation. A major factor driving the clean-up of Boston Harbor, MA, USA, induced by the federal Clean Water Act legislation of 1972, was the high prevalence of petroleum and halogenated aromatic hydrocarbon contaminant-associated liver neoplasia in winter flounder Pseudopleuronectes americanus in the harbor in the 1980s. In the present study, we examined the spatial and temporal relationships between the suspended solids and contaminants in the municipal sewage discharge, and liver neoplasia and histopathology in flounder, from 1987 to 2017. Toxics source reduction, sewage treatment, and sludge removal in the 1990s and outfall relocation offshore in 2000 enabled a decreasing prevalence of persistent toxic chemicals in flounder, effluent, and sediment, and consequent disappearance of liver neoplasia and reduction of neoplasm-associated, hydropically vacuolated biliary epithelial cells to background levels. This supports long-term investment in elimination and treatment of anthropogenic waste streams and the value of federal regulatory mandates to maintain and improve regional environmental quality.

Home medication management practices and associated factors among patients with selected chronic diseases in a community pharmacy in Uganda.

BACKGROUND: Chronic diseases are rapidly increasing and are currently the major cause of death and disability worldwide. Patients with chronic diseases experience many challenges including medicine-related problems. However, there is limited information about the home management of medicines among these patients. This study therefore was to determine home medication management practices and associated factors among patients with chronic diseases seeking care in a community pharmacy in Uganda. METHODS: A cross-sectional study was conducted in a community pharmacy in Kampala from June to July 2010. A total of 207 consenting chronic disease patients or caregivers of children with chronic disease were consecutively sampled. The patients were visited at home to evaluate their drug management practices and to check their medical forms for disease types and drugs prescribed. An interviewer-administered questionnaire and an observation checklist were used to collect the data. RESULTS: Overall home medication management was inappropriate for 70% (n = 145) of the participants (95% CI = 63.3-76.2) and was associated with perceived severity of disease (not severe OR =0.40, moderately severe OR = 0.35), duration of disease >5 years (OR = 2.15), and health worker not assessing for response to treatment (OR = 2.53). About 52% (n = 107) had inappropriate storage which was associated with inadequate information about the disease (OR = 2.39) and distance to the health facility >5 kilometres (OR = 2.82). Fifteen percent (n = 31) had no drug administration schedule and this was associated with increasing age (OR = 0.97), inadequate information about the disease (OR = 2.96), and missing last appointment for medical review (OR = 6.55). About 9% (n = 18) had actual medication duplication; 1.4% (n = 3) had expired medicines; while 18.4% (n = 38) had drug hoarding associated with increasing number of prescribers (OR = 1.34) and duration of disease (OR = 2.06). About 51% (n = 105) had multiple prescribers associated with perceiving the disease to be non severe (OR = 0.27), and having more than one chronic disease (OR = 2.37). CONCLUSIONS: Patients with chronic disease have poor home management of medicines. In order to limit the occurrence of poor outcomes of treatment or drug toxicity, health providers need to strengthen the education of patients with chronic disease on how to handle their medicines at home.

The Resilience of Final-Year Pharmacy Students and Aspects of the Course They Found to Be Resilience-Building.

Background: This work aimed to investigate final year pharmacy students' resilience (as determined by the CD-RISC-25 tool), whether students considered certain aspects of the course to be resilience-building, and the role of the university in developing this attribute. Methods: Following ethical approval and an invitation to participate, data were collected from consenting students at Queen's University Belfast via a pre-piloted paper-based questionnaire. Descriptive statistics were performed. To ascertain significant differences (p < 0.05) by gender, the Welch Two Sample t-test was used for the CD-RISC-25 mean scores and the Mann-Whitney U Test and Chi-squared test for Section B data. Results: The response rate was 80.61% (79/98). The mean CD-RISC-25 score for males was higher (not significantly) than the female mean score (70.39 versus 67.18, p = 0.2355, possible score range 0−100). While 93.67% (74/79) considered the School has a responsibility to develop resilience, <20.00% availed of the free resilience building events. Activities deemed to help build resilience included being able to make mistakes in a safe environment and needing to achieve a high grade to pass assessments. Conclusions: Resilience levels among future pharmacists at Queen's University Belfast should be improved going forward. A strategy, developed in light of conducting this research (from one institution), will now be implemented to enhance the curriculum with regard to resilience building opportunities.

Veganism: Are future pharmacists ready to provide advice?

INTRODUCTION: In addition to advising about diets, nutritional deficiencies, and supplements, pharmacists should be confident discussing medicine-related issues that may arise from people adopting veganism, including checking about animal-derived pharmaceutical product excipients, formulation processes, and determining whether vegan-friendly alternatives exist. Thus, this study aimed to investigate pharmacy students' knowledge and views about veganism. METHODS: Given veganism's increasing popularity and relevance to pharmacy practice, students enrolled in their last year of the undergraduate master of pharmacy degree program at Queen's University Belfast participated in this voluntary study. The questionnaire was given out at an obligatory workshop (only non-identifiable data were requested). Students were scored on veganism knowledge (22 true/false statements) with other analysis about views being largely descriptive in nature. RESULTS: Ninety-two out of 101 (91.1%) completed the questionnaire. Only one reporting being vegan. Mean knowledge score (possible range of 0-22) was 16.59 (±2.43). Only 37% (34/92) reported feeling confident discussing veganism with patients or other healthcare professionals and 40.2% (37/92) deemed they could establish whether a medical product is vegan-friendly. A minority (4.3%) considered they had received adequate training on veganism. A greater proportion of males than females considered that vegans are too forceful with their beliefs (74.2% vs. 51.7%). CONCLUSIONS: This study presents the first description of pharmacy students' knowledge and opinions on veganism (from a single institution only). The reported gap in educational provision and lack of confidence needs to be investigated and addressed to enhance patient-centered care.

Future Pharmacists' Opinions on the Facilitation of Self-Care with Over-the-Counter Products and Whether This Should Remain a Core Role.

BACKGROUND: The aim was to investigate pharmacy students' views on the role of the pharmacist in facilitating self-care with over-the-counter (OTC) medicines, particularly in light of new roles, and establish personal practice. METHODS: Final year pharmacy students at Queen's University Belfast were invited to participate. Data were collected via a pre-piloted questionnaire, distributed at a compulsory class (only non-identifiable data were requested). Descriptive statistics were performed, and non-parametric tests were employed for inferential statistical analysis (responses by gender). RESULTS: The response rate was 87.6% (78/89); 34.6% (27/78) males and 65.4% (51/78) females. Over a third [34.6% (27/78)] reported using OTC medicines about once a month. All appreciated the importance of an evidence-based approach to optimize patient care. Most [(96.2% (75/78)] deemed OTC consultations should remain a fundamental responsibility of pharmacists and 69.2% (54/78) thought OTC consultations have the potential to be as complex as independent pharmacist prescribing. Females felt more confident recommending OTC emergency contraception than males (p = 0.002 for levonorgestrel and p = 0.011 for ulipristal acetate). Many [61.5% (48/78)] considered more medicines should not be deregulated from prescription-only status. CONCLUSIONS: Data from this single institution suggests that enabling self-medication is an important part of practice but there were confidence issues around deregulations.

UK Pharmacy Students' Opinions on Mental Health Conditions.

Objective. To determine future pharmacists' opinions on mental health conditions and investigate the influence of gender. Methods. Final-year Master of Pharmacy students at Queen's University Belfast completed a paper-based questionnaire. Section A of the questionnaire was adapted from a United Kingdom public opinion questionnaire on mental health. Section B gathered non-identifiable demographic data. Descriptive statistics were undertaken. Mann-Whitney U and Chi-square tests were used for gender comparisons. Results. An 89% (97/109) response rate was obtained. Most survey respondents considered that pharmacological and non-pharmacological measures were beneficial in the management of mental health conditions (89% and 96%, respectively) and that people with mental illness had the same rights to jobs as anyone else (82%). However, only 57% of the respondents felt confident discussing mental health issues with patients and 36% deemed university training to be satisfactory. Males were more likely than females to "agree strongly" or "agree slightly" that they would not want to live next door to someone who has been mentally ill. Conclusion. While some positive opinions were evident, more work is needed to prepare future pharmacists for roles within mental health care teams.

A Questionnaire Study to Investigate Stress among Future Pharmacists by Gender and Year Group.

BACKGROUND: This work aimed to ascertain future pharmacists' stressors and stress-coping practices. METHODS: Queens' University Belfast Year 2 and 4 pharmacy students were invited to participate in an ethically approved, pre-piloted questionnaire study. Section A was the 10-item Perceived Stress Scale, Sections B and C related to stressors and stress-coping mechanisms, and Section D gathered non-identifiable demographic information. Data analysis largely took the form of descriptive statistics. RESULTS: A response rate of 94.2% (213/226) was obtained. The mean Perceived Stress Scale score was 19.94 [standard deviation (SD) 6.37], with females having a higher mean score than males (20.55 SD 5.67 versus 18.16 SD 7.42). Common general stressors were career choice, employment opportunities, and finance. Common degree-specific stressors were particular assessments (objective structured clinical examinations and one-off written examinations) and the amount of course material. Popular stress-coping practices included getting emotional support from friends and family and using self-distractions. CONCLUSION: Stress appears to be an issue among these future pharmacists, and potentially more so for females. While the main stressors are unsurprising, this UK data enables comparisons to be made and helps inform support mechanisms within the university.

An investigation of final year pharmacy students' moral reasoning ability, and their views on professionalism and fitness to practice panel determinations: A questionnaire study.

BACKGROUND AND PURPOSE: The aim was to establish pharmacy students' moral reasoning ability and obtain their views on professionalism and fitness to practice (FtP) determinations involving pharmacists. EDUCATIONAL ACTIVITY AND SETTING: Following ethical approval and piloting, final year pharmacy students at Queen's University Belfast (QUB) (n=119) were invited to participate in a questionnaire study. Section A was a validated moral reasoning assessment tool [Defining Issues Test (DIT2); five moral dilemmas], Section B was FtP cases and professionalism. Distribution occurred at a compulsory class. DIT2 data were scored by the University of Alabama. Descriptive statistics and non-parametric tests were used with significance level set at 0.05 a priori. FINDINGS: The response rate was 94.1% (112/119) and the 'DIT2 P score mean' (postconventional schema) was 25.21±14.10. Almost all [(98.2% (110/112)] fully understood the term "professionalism" and 83.9% (94/112) considered it reasonable for a professional code to apply always (within university and out socializing). Differences in opinions existed depending on what the FtP case related to. Students were significantly more likely to consider a 12-month suspension 'very lenient' or 'lenient' for a pharmacist's personal use of illicit drugs compared with theft of money/cosmetics (42.0% versus 64.3%; p=0.031). There were no significant differences between male and female responses/scores and no strong correlations between DIT2 scores and FtP/professionalism responses. DISCUSSION AND SUMMARY: Pharmacy students appeared to understand professionalism and accepted being bound by a code. A level of discrimination between the FtP cases was evident. Moral reasoning ability was lower than expected for future healthcare professionals (see manuscript) requiring attention.

First-Year Pharmacy Students' Views on Their Chosen Professional Career.

Objective. To investigate what factors influenced students to study pharmacy and determine in which sector they hoped to gain employment, both in the short and longer term. Methods. First-year pharmacy students (n=124) were invited to complete a paper-based, self-administered questionnaire consisting of 4 sections. Descriptive statistics and nonparametric tests were conducted. Results. One hundred (96.8% response rate) students completed the questionnaire (22.5% male; 77.5% female). Key influential factors for choosing pharmacy included: enjoyment of science at school, a desire to improve people's health and wellbeing, and to work in health care. Career aspirations were to work in a hospital or in community practice rather than in industry or academia. Conclusions. Students choose pharmacy as a career primarily for altruistic and clinical reasons. This research provides information for pharmacy schools about the career aspirations of students and data from future pharmacists is potentially helpful to pharmacy professional organizations and potential employers.

Pharmacy students' use and views on over-the-counter (OTC) medicines: a questionnaire study.

INTRODUCTION: The role of the pharmacist centers on ensuring the safe and effective use of medicines, including over-the-counter (OTC) medicines. It is important to ascertain pharmacy students׳ use and opinions on OTC medicines, given that they are the pharmacists of the future and that this market continues to expand. This study aimed to investigate Queen׳s University Belfast (QUB) final-year pharmacy students׳ use and views on OTC medicines. Scarce work has been conducted in this area to date. METHODS: Following ethical approval and a pilot study, all students (n = 155) were invited to participate in a self-completed questionnaire (n = 20 questions), distributed at a mandatory class. Descriptive statistics and non-parametric tests (Chi-squared and Mann-Whitney U test) were used for data analyses. RESULTS: The response rate was 99.4% (154/155). The majority (153/155) reported using OTC medicines; the key consideration during personal product selection was effectiveness. Most [96.1% (147/153)] were in agreement that safety was the over-riding concern during OTC consultations. While 96.1% (149/155) considered that using an evidence-based approach improved the quality-of-patient care, 68.0% (104/153) would be prepared to sell a product that lacks evidence of effectiveness, provided it would not cause harm. CONCLUSIONS: The importance of evidence of effectiveness was acknowledged, yet many students in this study were prepared to recommend unproven products. Further strategies are required at QUB to ensure this routine consideration alongside safety in practice.

Associations between Achievement Goal Orientations and Academic Performance Among Students at a U.K. Pharmacy School.

OBJECTIVE: To ascertain goal orientations of pharmacy students and establish whether associations exist between academic performance, gender, or year of study. METHODS: Goal orientations were assessed using a validated questionnaire. Respondents were categorized as high or low performers based on university grades. Associations and statistical significance were ascertained using parametric and nonparametric tests and linear regression, as appropriate. RESULTS: A response rate of 60.7% was obtained. High performers were more likely to be female than male. The highest mean score was for mastery approach; the lowest for work avoidance. The mean score for work avoidance was significantly greater for low performers than for high performers and for males than for females. First-year students were most likely to have top scores in mastery and performance approaches. CONCLUSION: It is encouraging that the highest mean score was for mastery approach orientation, as goal orientation may play a role in academic performance of pharmacy students.

Appointment keeping for medical review among patients with selected chronic diseases in an urban area of Uganda.

INTRODUCTION: Proper management of chronic diseases is important for prevention of disease complications and yet some patients miss appointments for medical review thereby missing the opportunity for proper monitoring of their disease conditions. There is limited information on missed appointments among chronic disease patients in resource limited settings. This study aimed to determine the prevalence of missed appointments for medical review and associated factors among chronic disease patients in an urban area of Uganda. METHODS: Patients or caregivers of children with chronic diseases were identified as they bought medicines from a community pharmacy. They were visited at home to access their medical documents and those whose chronic disease status was ascertained were enrolled. The data was collected using: questionnaires, review of medical documents, and in-depth interviews with chronic disease patients. RESULTS: The prevalence of missed appointments was 42% (95%CI = 35-49%). The factors associated with missed appointments were: monthly income ≤30US Dollars (OR = 2.56, CI = 1.25-5.26), affording less than half of prescribed drugs (OR = 3.92, CI = 1.64-9.40), not experiencing adverse events (OR = 2.66, CI = 1.26-5.61), not sure if treatment helps (OR = 2.84, CI = 1.047.77), not having a medicines administration schedule (OR = 6.77, CI = 2.11-21.68), and increasing number of drugs (OR = 0.72, CI = 0.53-0.98). CONCLUSION: Patients missed appointments mainly due to: financial and health system barriers, conflicting commitments with appointments, and perceptions of the disease condition. Patients should be supported with accessible and affordable health services.

Use and views on social networking sites of pharmacy students in the United kingdom.

Objective. To investigate students' use and views on social networking sites and assess differences in attitudes between genders and years in the program.Methods. All pharmacy undergraduate students were invited via e-mail to complete an electronic questionnaire consisting of 21 questions relating to social networking.Results. Most (91.8%) of the 377 respondents reported using social networking Web sites, with 98.6% using Facebook and 33.7% using Twitter. Female students were more likely than male students to agree that they had been made sufficiently aware of the professional behavior expected of them when using social networking sites (76.6% vs 58.1% p=0.002) and to agree that students should have the same professional standards whether on placement or using social networking sites (76.3% vs 61.6%; p<0.001).Conclusions. A high level of social networking use and potentially inappropriate attitudes towards professionalism were found among pharmacy students. Further training may be useful to ensure pharmacy students are aware of how to apply codes of conduct when using social networking sites.

Pharmacy students' views of faculty feedback on academic performance.

OBJECTIVE: To investigate students' views on and satisfaction with faculty feedback on their academic performance. METHODS: A 41-item survey instrument was developed based on a literature review relating to effective feedback. All pharmacy undergraduate students were invited via e-mail to complete the self-administered electronic questionnaire relating to their views on feedback, including faculty feedback received to date regarding their academic performance. RESULTS: A response rate of 61% (343/561) was obtained. Only 32.3% of students (107/331) agreed that they were satisfied with the feedback they received; dissatisfaction with examination feedback was particularly high. The provision of faculty feedback was perceived to be variable in terms of quality and quantity. CONCLUSIONS: There are some inconsistencies relating to provision of feedback within the MPharm degree program at Queen's University Belfast. Further work is needed to close the gap between student expectations and the faculty's delivery of feedback on academic performance.