Abstract Introduction: Fragility fractures (low-energy, minimal-trauma fractures) are common in the aging population and can lead to decreased function, increased mortality, and long-lasting pain. Although opioids are helpful in reducing acute postoperative pain, they present risks that may lead to increased morbidity and mortality. Materials and Methods: This was a retrospective review of medical records of all Alaska Native and American Indian people older than 50 years, who received surgery for hip fracture repair between January 2018 and June 2019 (n = 128). Results: We found that receipt of a peripheral nerve block (PNB) is a predictor for decreased length of hospital stay. However, receipt of PNB did not predict a reduction in postoperative morphine milligram equivalents opioid doses. Discussion: Further study is required to determine whether one PNB method is superior to others based on individual-level characteristics.
Purpose. Respiratory syncytial virus (RSV) infection is most common in infants and young children, with almost all children experiencing at least one infection by their second birthday. Summary. RSV is the leading cause of upper and lower respiratory tract infections in infants and young children, and is the most common cause of bronchiolitis and pneumonia in children younger than one year of age. Since infection with RSV does not result in permanent immunity, repeat infections are common, often occurring during the same RSV season. RSV bronchiolitis is the leading cause of hospitalization in children younger than age one, and this virus is associated with approximately 75,000 to 125,000 hospitalizations annually in the United States. Children hospitalized for RSV bronchiolitis during the first year of life are at an increased risk of respiratory problems, such as wheezing and allergic asthma, throughout childhood and into adolescence. RSV-related mortality has decreased over the last 20 years; however, RSV is still the leading cause of viral deaths in infants. Conclusion. RSV infection is associated with significant disease burden in infants and young children in terms of hospitalization, related complications, and even mortality. The economic burden resulting from RSV disease is also substantial, with significantly higher costs seen in children with risk factors for severe disease and RSV-related complications.
Background: Over the past decade, the number of natural disasters, health care emergencies, and epidemics has increased significantly.These unpredictable and sometimes devastating events tax already stretched health care systems.The goal of this process paper is to share the experience of a pharmacy school in the development and implementation of a sustainable emergency preparedness and response support network (EPRSN) using an established student government infrastructure to support information sharing among community pharmacies, state emergency response teams, and community members.Observations: There are more than 140 accredited pharmacy schools/colleges across the United States, employing more than 6,500 pharmacy faculty members and teaching more than 63,000 student pharmacists.The majority of schools/colleges provide free and volunteer-based health care services and collaborate with local, regional, and national entities, such as state boards of pharmacy and national and state profes-sional pharmacy organizations.Student pharmacists are positioned across the country with reach to rural and underserved communities and have student organizational structures in place to manage student volunteers and support health care service opportunities.To address gaps in emergency and preparedness response, pharmacy students assessed and operationalized steps to develop the EPRSN.Pharmacies were identified and contacted by student pharmacists.Student leaders created student organization flowcharts and call charts with up-to-date pharmacist contact information.Organizational structure for collecting, capturing, updating, and sharing pharmacy data with state emergency response teams was developed and trialed.Conclusions: Student pharmacists represent a sustainable resource, uniquely positioned to identify community needs, support emergency efforts, coordinate with local pharmacies, and work with pharmacists and others to ensure that patients receive the care they need during pandemics and other emergencies.
BACKGROUND Depression and anxiety are common mental health disorders. Untreated or unmanaged depression and anxiety can lead to physical and/or behavioral health concerns. Many people suffering from depression and/or anxiety have inadequate access to health care and supports. Evidence supports that mobile health (mHealth) applications (apps) can be beneficial in the management of chronic conditions. OBJECTIVE Compare consumer-directed mobile-health applications (mHealth apps) available for self-management of depression and/or anxiety. METHODS A systematic review of 93,849 consumer-apps was conducted using a 3-step inclusion-criteria. Step-one: available in English, downloadable, and aligned with established self-management program components. Step-two: defined depression/anxiety, described symptoms, and discussed greater than 2-management techniques. Step-three: screened for user-friendliness and self-management components (n=10). Apps were assessed for readability and validity. RESULTS Seventy-percent of mHealth apps incorporated 4-major self-management components. Eighty-percent of apps described at least three DSM-5 symptoms. Thirty- three percent of apps were 5-grade-levels higher than general US comprehension estimates. Only 40% of reviewed apps provided evidence-based self-management support and only 20% were affiliated with an accredited organization. CONCLUSIONS mHealth apps have the potential to reduce barriers to access to mental health treatment. Further research is necessary to understand how pharmacists can better support patient self-management of depression/anxiety with mHealth apps.
As the world tries to cope with the devastating effects of the COVID-19 pandemic and emerging variants of the virus, COVID-19 vaccination has become an even more critical tool toward normalcy. The effectiveness of the vaccination program and specifically vaccine uptake and coverage, however, is a function of an individual’s knowledge and individual opinion about the disease and available vaccines. This study investigated the knowledge, attitudes, and resulting community practice(s) associated with the new COVID-19 variants and vaccines in Bangladesh, Colombia, India, Malaysia, Zimbabwe, and the USA. A cross-sectional web-based Knowledge, Attitudes, and Practices (KAP) survey was administered to respondents living in six different countries using a structured and multi-item questionnaire. Survey questions were translated into English, Spanish, and Malay to accommodate the local language in each country. Associations between KAP and a range of explanatory variables were assessed using univariate and multiple logistic regression. A total of 781 responses were included in the final analysis. The Knowledge score mean was 24 (out of 46), Attitude score 28.9 (out of 55), and Practice score 7.3 (out of 11). Almost 65% of the respondents reported being knowledgeable about COVID-19 variants and vaccination, 55% reported a positive attitude toward available COVID-19 vaccines, and 85% reported engaging in practices that supported COVID-19 vaccination. From the multiple logistic models, we found post-graduate education (AOR = 1.83, 95% CI: 1.23–2.74) and an age range 45–54 years (AOR = 5.81, 95% CI: 2.30–14.69) to be significantly associated with reported COVID-19 knowledge. In addition, positive Attitude scores were associated with respondents living in Zimbabwe (AOR = 4.49, 95% CI: 2.04–9.90) and positive Practice scores were found to be associated with people from India (AOR = 3.68, 95% CI: 1.15–11.74) and high school education (AOR = 2.16, 95% CI: 1.07–4.38). This study contributes to the identification of socio-demographic factors associated with poor knowledge, attitudes, and practices relating to COVID-19 variants and vaccines. It presents an opportunity for collaboration with diverse communities to address COVID-19 misinformation and common sources of vaccine hesitancy (i.e., knowledge, attitudes, and practices).
Pharmacogenetic research and clinical testing raise important concerns for individuals and communities, especially where past medical research and practice has perpetrated harm and cultivated distrust of health care systems and clinicians. We investigated perceptions of pharmacogenetics among Alaska Native (AN) people.We held four focus groups for 32 ANs in south central Alaska to elicit views about pharmacogenetics in general and for treatment of cardiovascular disease, breast cancer, depression, and nicotine addiction. We analyzed data for perceived risks and rewards of pharmacogenetics.Potential risks of pharmacogenetics included health care rationing, misuse of information, and stigma to individuals and the AN community. Potential rewards included decreased care costs, improved outcomes, and community development. Participants also discussed 8 contingent conditions that could mitigate risks and increase pharmacogenetic acceptability.Alaska Natives perceive pharmacogenetics as potentially benefitting and harming individuals, communities, and health systems, depending on methods and oversight. Researchers, clinicians, and administrators, especially in community-based clinic and health care systems serving minority populations, must address this "double-edged sword" to effectively conduct pharmacogenetics.
Indigenous North American populations, including American Indian and Alaska Native peoples in the United States, the First Nations, Métis and Inuit peoples in Canada and Amerindians in Mexico, are historically under-represented in biomedical research, including genomic research on drug disposition and response. Without adequate representation in pharmacogenetic studies establishing genotype-phenotype relationships, Indigenous populations may not benefit fully from new innovations in precision medicine testing to tailor and improve the safety and efficacy of drug treatment, resulting in health care disparities. The purpose of this review is to summarize and evaluate what is currently known about cytochrome P450 genetic variation in Indigenous populations in North America and to highlight the importance of including these groups in future pharmacogenetic studies for implementation of personalized drug therapy.
Vaccine hesitancy (VH), delay in acceptance, and/or refusal to vaccinate is influenced by complacency, confidence, unmet safety, and efficacy concerns. A survey was conducted among U.S. healthcare students to identify factors contributing to COVID-19 vaccine hesitancy.The World Health Organization 2014 vaccine hesitancy guidelines informed development of a 37-item survey. This cross-sectional survey was distributed to students in 10 randomly selected nursing, pharmacy, and medical programs. Descriptive statistics and logistic regression were used to identify factors contributing to COVID-19 vaccine hesitancy.Of the 902 participants who started the survey, 398 completed all COVID-19 questions. Survey respondents were primarily from private schools (84%) and consisted of medical students (49%), female (71%), and millennials (57%). Students believed COVID-19 vaccine was important and protection of vulnerable communities more important than individual protection. Students in general agreed getting the vaccine was necessary to protect others (school and healthcare facilities) (77.4%); only one-third (33.7%) disagreed that they planned to wait and want to see how vaccine affected others before receiving it. Logistic regression results suggest significant differences based on program and political affiliation.Engagement of healthcare students may help reach student peers who are vaccine hesitant and help reduce the spread of COVID-19.
