Meningococcal Disease in Persons With HIV Reported Through Active Surveillance in the United States, 2009-2019.

Persons with HIV (PWH) are at increased risk for bacterial infections, and previous publications document an increased risk for invasive meningococcal disease (IMD) in particular. This analysis provides evidence that PWH face a 6-fold increase in risk for IMD based on Active Bacterial Core surveillance data collected during 2009-2019.

Development and Validation of an Eating-Related Eco-Concern Questionnaire.

Eco-concern, the distress experienced relating to climate change, is associated with mental health, yet no study has examined disordered eating related to eco-concern. This study developed and validated a 10-item scale assessing Eating-Related Eco-Concern (EREC). Participants (n = 224) completed the EREC, Climate Change Worry Scale (CCWS), and Eating Disorder Examination-Questionnaire (EDE-Q). Construct validity, convergent validity, and internal consistency were evaluated. Sex differences in EREC were evaluated using t-tests. Associations among the EREC, CCWS, and EDE-Q were evaluated using linear regression models. Sensitivity analyses were conducted in individuals below EDE-Q global score clinical cut-offs. Factor analysis suggested that all items loaded adequately onto one factor. Pearson's correlation and Bland-Altman analyses suggested strong correlation and acceptable agreement between the EREC and CCWS (r = 0.57), but weak correlation and low agreement with the EDE-Q global score (r = 0.14). The EREC had acceptable internal consistency (α = 0.88). No sex difference was observed in the EREC in the full sample; females had a significantly higher mean score than males in sensitivity analysis. The EREC was significantly positively associated with the CCWS and EDE-Q global and shape concern scores, but not in sensitivity analysis. The EREC is a brief, validated scale that can be useful to screen for eating-related eco-concern.

The burden of COVID-19 on pharmacists.

The unprecedented changes brought about by the global coronavirus disease 2019 (COVID-19) pandemic have had important impacts on society. The pandemic has provided an opportunity to highlight the crucial role pharmacists play in the provision of health care. The critical and unique role of pharmacists in pandemics and other disasters has been highlighted in the past (severe acute respiratory syndrome and Ebola outbreaks) and more recently with reports of the contributions of pharmacists during the global COVID-19 pandemic. Many reports have documented that health care professionals are experiencing significant psychological morbidity as a result of providing essential care and services during the global COVID-19 pandemic. In these reports, pharmacists are not well represented, and, therefore, it is essential to understand the impact of COVID-19 on pharmacists across multiple practice settings. This is particularly true as the experiences of pharmacists working through previous pandemics and disasters, and the associated psychological burden, are likely to offer insights and be useful in supporting the psychological well-being of pharmacists during the global COVID-19 pandemic. Research into the effect of the global COVID-19 pandemic on pharmacists should improve the understanding of the impact and the psychological morbidity associated with their role as frontline health care professionals.

Benign or not benign? Deep phenotyping of liver Glycogen Storage Disease IX.

INTRODUCTION: Liver Glycogen Storage Disease Type IX (GSD IX) is one of the most common forms of GSD. It is caused by a deficiency in enzyme phosphorylase kinase (PhK), a complex, hetero-tetrameric enzyme comprised of four subunits - α, ß, γ, and δ - each with tissue specific isoforms encoded by different genes. Until the recent availability of gene panels and exome sequencing, the diagnosis of liver GSD IX did not allow for differentiation of these subtypes. This study presents the first comprehensive literature review for liver GSD IX subtypes - GSD IX α2, ß, and γ2. We aim to better characterize the natural history of liver GSD IX and further investigate if there are subtype-specific differences in clinical presentation. METHODS: A comprehensive literature review was performed with the help of a medical librarian at Duke University Medical Center to gather all published patients of liver GSD IX. Our refined search yielded 74 articles total. Available patient data were compiled into an excel spreadsheet. Data were analyzed via descriptive statistics. The number of patients with specific symptoms were individually summed and reported as a percentage of the total number of patients for which data were available or were averaged and reported as a mean numerical value. Published pathology reports were scored using the International Association of the Study of the Liver Scale. RESULTS: There were a total of 183 GSD IX α2 patients, 17 GSD IX ß patients, and 30 GSD IX γ2 patients. Average age at diagnosis was 4 years for GSD IX α2 patients, 2.34 years for GSD IX ß patients, and 1.81 years for GSD IX γ2 patients. Hepatomegaly was reported in 164/176 (93.2%) of GSD IX α2 patients, 16/17 (94.1%) of GSD IX ß patients, and 30/30 (100%) of GSD IX γ2 patients. Fasting hypoglycemia was reported in 53/121 (43.8%) of GSD IX α2 patients, 8/16 (50%) of GSD IX ß patients, and 18/19 (94.7%) of GSD IX γ2 patients. Liver biopsy pathology reports were available and interpreted for 46 GSD IX α2 patients, 3 GSD IX ß patients, and 24 GSD IX γ2 patients. 22/46 (47.8%) GSD IX α2 patients, 1/3 (33.3%) GSD IX ß patients, and 23/24 (95.8%) GSD IX γ2 patients with available pathology reports documented either some degree of fibrosis or cirrhosis. CONCLUSION: Our comprehensive review demonstrates quantitatively that the clinical presentation of GSD IX γ2 patients is more severe than that of GSD IX α2 or ß patients. However, our study also shows the existence of a severe phenotype in GSD IX α2, evidenced by early onset liver pathology in conjunction with clinical symptoms. There is need for a more robust natural history study to better understand the variability in liver pathophysiology within liver GSD IX; in addition, further study of mutations and gene mapping could bring a better understanding of the relationship between genotype and clinical presentation.

Effect of acute modafinil ingestion on cognitive and physical performance following mental exertion.

OBJECTIVE: Modafinil is a psychostimulant that has been shown to enhance cognitive and physical performance. Given its long half-life, it may provide operational advantages if it can improve tolerance to the deleterious effects of prolonged mental exertion. METHODS: Physically active males (n = 13, 23 ± 4 years, peak oxygen consumption 45.3 ± 3.2 ml kg-1  min-1 ) took part in a placebo controlled, double-blind randomised crossover study to investigate if modafinil could improve cognitive and physical performance following a prolonged period of mental exertion. RESULTS: Overall modafinil improved performance on a task of executive function over time (p = .023; η2  = 0.376) but did not improve subsequent physical endurance performance (mean difference 2.3 ± 11.5%, p = .50), despite improvement in 10 out of the 13 participants. Task demand was reported as lower with modafinil, although perceptual measures of fatigue and motivation did not consistently improve. Heart rate during submaximal exercise was higher (134 ± 11 vs. 119 ± 14 bpm, p < .001), and sleep was reduced (5.5 ± 1.4 vs. 7.5 ± 1.4 hr, p < .001) and less efficient (64 ± 13 vs. 83 ± 9%, p < .001) compared with placebo. CONCLUSIONS: Operationally, modafinil may offer advantages given the established longer half-life than other psychostimulants, despite the variable response. The impact of higher heart rates and disrupted sleep on performance must also be considered.

A wake-up call for physical activity promotion in Australia: results from a survey of Australian nursing and allied health professionals.

Objective Nursing and allied health professionals (AHPs) are in an ideal position to promote physical activity (PA) as part of their health care provision. The aim of this study was to investigate current promotion and knowledge of PA among people in these disciplines. Methods A cross-sectional online survey of practicing Australian physiotherapists, nurses, exercise physiologists, occupational therapists, dietitians and pharmacists was conducted in 2016. Results A total of 433 nurses and AHPs completed the survey. All disciplines agreed that providing PA advice was part of their role, although nurses were less likely to agree. All disciplines felt they had the skills to promote PA but nurses were more likely to report a lack of time as a barrier. Physiotherapists and exercise physiologists were more confident giving PA advice to patients. Most health professionals (68%) were aware of the PA guidelines, although only 16% were accurately able to describe all relevant components. In logistic regression modelling, women and those working in public hospitals were less likely to encourage PA. Awareness of the PA guidelines doubled the odds of encouraging PA in patients (odds ratio 2.01, 95% confidence interval 1.18-3.43). Conclusions Australian nurses and AHPs perceive that PA promotion is part of their role, however few have specific knowledge of the PA guidelines. To increase PA promotion by nurses and AHPs awareness of the PA guidelines appears to be essential. What is known about the topic? Nurses and AHPs are in an ideal position to promote PA, although there is limited evidence of their PA promotion and knowledge. What does the paper add? Australian nurses and AHPs are confident and think it is feasible to promote PA to patients in several healthcare settings but many lack sufficient PA knowledge, limiting their PA promotion. What are the implications for practitioners? Increasing PA knowledge of nurses and AHPs could generate increased levels of PA in the Australian population and improve national health and wellbeing.

What can pharmacists do in general practice? A pilot trial.

BACKGROUND AND OBJECTIVES: Non-dispensing pharmacists are being suggested as a useful addition to the workforce in general practice. The aim of this study was to describe the activities of three general practice pharmacists over six months in a pilot trial. METHOD: Three general practices integrated a part-time (15.2-16 hours per week) non-dispensing pharmacist to be employed according to their individual skillset and local workplace needs. Each general practice pharmacist maintained a daily activity diary, which was subsequently analysed. RESULTS: The general practice pharmacists' activities were categorised as quality of practice (37%), administration (34%), medication review (19%) and patient education (11%). Within the quality of practice category, most time was spent conducting clinical audits (47%). Over the course of the six months, time spent on administration decreased, while time communicating with general practitioners (GPs) on clinical issues increased. DISCUSSION: The general practice pharmacists conducted a range of predominantly clinically related activities involving their expertise in the quality use of medications. Involvement in clinical activities to support GPs increased with time working in the practice. Randomised controlled trials are required to collect clinical outcomes and determine which activities conducted by pharmacists are most beneficial to Australian patients and GPs.

Stakeholder perspectives about general practice pharmacists in the Australian Capital Territory: a qualitative pilot study.

Previous studies have found that integrating non-dispensing pharmacists in general practice may improve patient safety, improve patient outcomes, deliver health system efficiencies and generate savings. However, the employment of pharmacists in general practice is not common in Australia. A naturalistic study was conducted in the Australian Capital Territory with three general practices, each employing a part-time pharmacist for 12 months. This study reports on stakeholder perspectives of the benefits, barriers and enablers for integrating pharmacists into general practice. Patients, practice staff and community pharmacists that had interacted with a practice pharmacist were asked to complete a self-administered questionnaire. Patient questionnaire respondents (n=44) reported that a practice pharmacist was beneficial and wanted to see this continue. Practice pharmacists were also perceived beneficial by primary healthcare employees surveyed (n=42). Opinions were further explored by individual semi-structured interviews (n=20). The qualitative data explored five themes: perception of the practice pharmacist, collaboration with doctors, pharmacist roles, sustainability and community pharmacy aspects. Patients welcomed improved understanding about their medication, whereas general practice staff appreciated pharmaceutical advice about patients with chronic conditions. Participants discussed options to fund practice pharmacists longer term, which was identified as the main barrier to widespread roll out.

Australian pharmacists' knowledge of the efficacy and safety of complementary medicines.

Global usage and expenditure on complementary medicines is increasing. Over 50% of consumers purchase these products from pharmacies and expect pharmacists to provide them with appropriate information regarding efficacy and safety of these products. Internationally, pharmacists have identified their lack of detailed knowledge of the efficacy and safety of these products as a barrier to recommending these products. Currently, little is known about the actual knowledge Australian pharmacists have of these products. This research seeks to determine Australian pharmacists' knowledge of the efficacy and safety of complementary medicines. An online survey was validated and distributed by three professional pharmacy bodies in Australia and online social media to survey Australian pharmacists' knowledge of a selection of complementary medicines that are defined as having therapeutic benefits as per the Australian Therapeutic Guidelines. In total, 535 complete surveys were returned and included in the final analysis. Surveys were predominantly completed by community pharmacists. The mean knowledge score obtained was 62%. There were no statistically significantly different results from pharmacists with a nutritional qualification. Australian pharmacists appear to have a basic knowledge of complementary medicines with a defined clinical effect. Specialised and targeted education focussing on relevant and efficacious complementary medicines with strong clinical evidence base is required.

An empirical review of antimalarial quality field surveys: the importance of characterising outcomes.

For decades, thousands of people have been dying from malaria infections because of poor-quality medicines (PQMs). While numerous efforts have been initiated to reduce their presence, PQMs are still risking the lives of those seeking treatment. This review addresses the importance of characterising results of antimalarial medicine field surveys based upon the agreement of clearly defined definitions. Medicines found to be of poor quality can be falsified or counterfeit, substandard or degraded. The distinction between these categories is important as each category requires a different countermeasure. To observe the current trends in the reporting of field surveys, a systematic literature search of six academic databases resulted in the quantitative analysis of 61 full-text journal articles. Information including sample size, sampling method, geographical regions, analytical techniques, and characterisation conclusions was observed for each. The lack of an accepted uniform reporting system has resulted in varying, incomplete reports, which may not include important information that helps form effective countermeasures. The programmes influencing medicine quality such as prequalification, procurement services, awareness and education can be supported with the information derived from characterised results. The implementation of checklists such as the Medicine Quality Assessment Reporting Guidelines will further strengthen the battle against poor-quality antimalarials.

Why does the need for medication become a barrier to breastfeeding? A narrative review.

PROBLEM: The need for medication during lactation can contribute to the early cessation of breastfeeding. BACKGROUND: Breastfeeding women may require medication for acute or chronic health conditions. For some women this need for medication can become a barrier to breastfeeding; this is despite the fact that the majority of medications are considered to be compatible with lactation. AIM: This narrative review aims to investigate factors relating to medicines safety that could contribute to medication unnecessarily becoming a barrier to breastfeeding. METHODS: A selective literature search using PubMed, Scopus and Google Scholar was conducted over a 6-month period using the search terms "breastfeeding", "lactation", "medication" and "information". Articles were assessed to identify whether they addressed the impact of medication use on the decision to breastfeed. FINDINGS: Fifty six articles were identified as having appropriate discussion about decision making for the safe use of medication during lactation. Themes identified included variable and conflicting safety advice for medicines; difficulty interpreting risks associated with medicine use; societal pressures faced by the breastfeeding woman; and the varied knowledge and training of health professionals involved in the care of breastfeeding women. CONCLUSION: Poor quality of information about medicine safety during lactation can contribute to confusion in giving recommendations. This confusion can result in early cessation of breastfeeding or insufficient health care for the breastfeeding woman.

Move it or Lose it. Is it Reasonable for Older Adults with Osteoarthritis to Continue to Use Paracetamol in Order to Maintain Physical Activity?

Osteoarthritis is a common progressive disease in older adults, and those affected often have impaired physical function, co-existing disease states, and reduced quality of life. In patients with osteoarthritis, pain is reported as a primary cause of mobility limitation, and guidelines recommend a mix of pharmacologic and non-pharmacologic strategies for pain management. The benefits of exercise in the management of osteoarthritis are well established; however, pain appears to be the biggest barrier to patients engaging in, and adhering to, physical activity programs. Attitudes towards the use of pain medications differ widely, and lack of efficacy or fear of side effects may lead to sub-therapeutic dosing. Furthermore, a recent review suggesting that short-term paracetamol use is ineffective for osteoarthritis has added to the confusion. This narrative review investigates limitations of current medications, summarizes patient attitudes toward the use of analgesics for osteoarthritis pain (with a focus on paracetamol), and explores the uptake of physical activity for osteoarthritis management. Evidence suggests that, despite clear guidelines, symptoms of osteoarthritis generally remain poorly managed. More research is required to investigate clinical outcomes in patients with osteoarthritis through optimized medication plans to better understand whether longer-term analgesic use in conjunction with physical activity can assist patients to overcome mobility limitations.

Therapeutic Potential of Tea Tree Oil for Scabies.

Globally, scabies affects more than 130 million people at any time. In the developed world, outbreaks in health institutions and vulnerable communities result in a significant economic burden. A review of the literature demonstrates the emergence of resistance toward classical scabicidal treatments and the lack of effectiveness of currently available scabicides in reducing the inflammatory skin reactions and pyodermal progression that occurs in predisposed patient cohorts. Tea tree oil (TTO) has demonstrated promising acaricidal effects against scabies mites in vitro and has also been successfully used as an adjuvant topical medication for the treatment of crusted scabies, including cases that did not respond to standard treatments. Emerging acaricide resistance threatens the future usefulness of currently used gold standard treatments (oral ivermectin and topical permethrin) for scabies. The imminent development of new chemical entities is doubtful. The cumulative acaricidal, antibacterial, antipruritic, anti-inflammatory, and wound healing effects of TTO may have the potential to successfully reduce the burden of scabies infection and the associated bacterial complications. This review summarizes current knowledge on the use of TTO for the treatment of scabies. On the strength of existing data for TTO, larger scale, randomized controlled clinical trials are warranted.

Dementia, medication and transitions of care.

BACKGROUND: Persons with dementia (PWD) often have complex medication regimens and are at risk of medication problems during the multiple transitions of care experienced as the condition progresses. OBJECTIVES: To explore medication processes in acute care episodes and care transitions for PWD and to make recommendations to improve practice. METHOD: Semi-structured interviews were conducted by two pharmacy researchers from a focused purposive sample of fifty-one participants (carers, health professionals, Alzheimer's Australia staff) from urban and rural Australia. After written consent, the interviews were audio-recorded then transcribed verbatim for face-to-face interviews, or notes were taken during the interview if conducted by telephone. The transcripts were checked for accuracy by the pharmacy researchers. Thematic analysis of the data was undertaken independently by the two researchers to reduce bias and any disagreements were resolved by discussion. RESULTS: Themes identified were: medication reconciliation; no modified planning for care transitions; underutilization of information technology; multiple prescribers; residential aged care facilities; and medication reviews by pharmacists. Sub themes were: access to appropriate staff; identification of dementia; dose administration aids; and staff training. CONCLUSIONS: Medication management is sub-optimal for PWD during care transitions and may compromise safety. Suggested improvements included: increased involvement of pharmacists in care transitions; outreach or transitional health care professionals; modified planning for care transitions for individuals over 80 years; co-ordinated electronic records; structured communication; and staff training.

A systematic review of community pharmacist therapeutic knowledge of dietary supplements.

BACKGROUND: Internationally, the use of dietary supplements has been growing rapidly. Patient support for pharmacist sales of nutritional and dietary supplements is also strong. The increase in demand for nutritional and dietary supplements and subsequent advice about these products, however, makes it necessary that pharmacists maintain a contemporary knowledge of the area. AIM OF REVIEW: This systematic review was conducted to examine the current evidence regarding the level of the nutritional and dietary supplement knowledge of community pharmacists and their understanding of their therapeutic effects. METHOD: Electronic databases including Medline, Scopus, Embase, CINAHL, Scifinder and the Cochrane Controlled Trials Register were searched. Studies assessing nutritional knowledge of pharmacists in community pharmacies were eligible for inclusion. All languages and study designs were considered. Study results were analysed and pharmacist knowledge scores were given out of 100 %. Results From 5594 studies identified, nine met the inclusion criteria. Each study tested pharmacist knowledge with predetermined questions calculating results as the number of questions answered correctly. These knowledge scores were converted to a percentage score for the purpose of this paper. The median knowledge score across all papers was 64 %. A lack of studies assessing community pharmacists' knowledge of commonly sold vitamins and minerals was observed. CONCLUSIONS: Global community pharmacist knowledge of dietary supplements appears to be poor. Community pharmacists have an professional responsibility to provide accurate health information about dietary supplements as they do for any other therapies they provide to patients. Further research including that which assesses pharmacists' therapeutic knowledge of commonly sold vitamins and minerals is suggested.

'Catching chlamydia': combining cash incentives and community pharmacy access for increased chlamydia screening, the view of young people.

In Australia and elsewhere, chlamydia screening rates for those aged between 16 and 30 years continue to be low. Innovative, age-appropriate approaches are necessary to increase chlamydia screening among this target group to prevent short- and long-term consequences of the infection such as pelvic inflammatory disease, chronic pelvic pain, ectopic pregnancy and infertility. Studies have demonstrated that offering chlamydia screening in community pharmacies may be a useful adjunct to current screening services. Approximately 90% of Australians visit a pharmacy at least once a year. Chlamydia screening and education in community pharmacies with remuneration may provide another option for opportunistic testing as part of a national chlamydia screening scheme. Compensation is an accepted practice in the field of research and has been demonstrated to improve adherence to health promotion activities. In 2011, a cross-sectional study of community pharmacy-based chlamydia screening offered in conjunction with an A$10 cash incentive to participate was conducted in the Australian Capital Territory. As part of this study young people were asked about their experience of, and views about, pharmacy-based chlamydia screening. The views of consented participants were collected using the one-page questionnaire consisting of 10 closed questions and one open-ended question. Participants completed the questionnaire when they returned their urine sample and before being given the cash incentive. Overall participants were highly satisfied with the pharmacy-based chlamydia screening service. Over 60% of questionnaire respondents felt that the payment did affect their decision to have the chlamydia test, and 23% stated that it made no difference. Young people reported that pharmacy-based screening is acceptable and convenient. Accessibility and the small cash incentive played significant roles in increasing participation.

Can pharmacy assistants play a greater role in public health programs in community pharmacies? Lessons from a chlamydia screening study in Canberra, Australia.

BACKGROUND: Little is known about the engagement of pharmacy assistants (PA) in public health service provision. OBJECTIVE: To explore the experiences of PA participating in a study to determine whether a cash reward, offered to consumers and pharmacy businesses, increased participation in community pharmacy-based chlamydia screening. METHODS: PA experience of the study education and training package, participant recruitment and conducting screening (providing information about chlamydia, specimen collection and handling urine samples) were evaluated using knowledge assessment, a questionnaire and focus groups. RESULTS: Twenty PA participated in the study: 15 (75%) completed all education and training components, 20 (100%) completed the questionnaire and 10 (50%) attended a focus group. PA rated all education and training components as effective (mean visual analog scale scores >8.5). Most PA (13/18, 72.2%) did not support/were unsure about continuing the program, citing the 25% repeat testing rate (presumed to relate to the cash reward) and privacy/confidentiality issues as reasons. Qualitative analysis suggested that minimizing repeat testing, improved workload management and recognition of, and remuneration for, education and training would make this model more acceptable to PA. CONCLUSION: Findings from this study support the assertion that PA can play a significant role in public health initiatives.

Factors affecting learning and teaching for medicines supply management training in Pacific Island Countries--a realist review.

INTRODUCTION: Limited human resources are a major impediment to achieving the UN health-related Millennium Development Goals in a number of Pacific Island Countries (PICs). Lack of education capacity to support competency development in medicine supply management is one of the main issues affecting workforce development in this region, which is characterised by disparate service delivery due to the range of environments in which supply occurs (ie urban, rural and remote), geographical challenges and cultural practices associated with teaching and learning. The supply of medicines, and an adequate pharmacy workforce with appropriate competencies is crucial to ensuring a well-functioning pharmaceutical system. In this region approximately 80% of patients access healthcare in rural areas without a pharmacist, thus local health personnel must be competent in pharmaceutical management relevant to the local context and culture. A new approach involves a partnership between the UN Population Fund Suva Sub-Regional Office, University of Canberra, Ministry of Health officials and the heath personnel within identified PICs, starting with the need to understand local culture and its impact on learning and teaching, and the mapping of competency requirements and an understanding of currently available information and materials. This information will be used to develop and trial new pedagogical approaches to training health personnel involved in essential medicines supply management, to improve medicines availability for patients in their own environment. The focus of this review was to determine what cultural and learning factors need to be considered when developing a curriculum for South Pacific pharmaceutical health personnel who work across a range of practice environments. METHODS: A 'realist methodology' consisting of a systematic investigation of the published literature and a targeted review of the 'grey' literature was used. All relevant literature was retrieved and coded manually using broad thematic analysis. RESULTS: The combined bibliographic and 'grey' literature search strategy resulted in the inclusion of 17 full text articles, 44 documents and 10 books. The five themes identified as key to optimising the cultural and learning approaches for the study population included recognition of: (1) past regional experiences of health related training; (2) the impact of South Pacific culture on learning styles; (3) the impact of external influences on curriculum; (4) the challenges of open and distance education in the Pacific; and (5) a distinct South Pacific student learning approach. CONCLUSIONS: The results of this 'realist methodology' review provide insights into learning approaches and cultural influences on student learning within PICs. The themes generated will be used to develop a set of principles to inform educators and health personnel involved in pharmaceutical training within PICs.