Predicting pharmacy naloxone stocking and dispensing following a statewide standing order, Indiana 2016

BACKGROUND: While naloxone, the overdose reversal medication, has been available for decades, factors associated with its availability through pharmacies remain unclear. Studies suggest that policy and pharmacist beliefs may impact availability. Indiana passed a standing order law for naloxone in 2015 to increase access to naloxone. OBJECTIVE: To identify factors associated with community pharmacy naloxone stocking and dispensing following the enactment of a statewide naloxone standing order. METHODS: A 2016 cross-sectional census of Indiana community pharmacists was conducted following a naloxone standing order. Community, pharmacy, and pharmacist characteristics, and pharmacist attitudes about naloxone dispensing, access, and perceptions of the standing order were measured. Modified Poisson and binary logistic regression models attempted to predict naloxone stocking and dispensing, respectively. RESULTS: Over half (58.1%) of pharmacies stocked naloxone, yet 23.6% of pharmacists dispensed it. Most (72.5%) pharmacists believed the standing order would increase naloxone stocking, and 66.5% believed it would increase dispensing. Chain pharmacies were 3.2 times as likely to stock naloxone. Naloxone stocking was 1.6 times as likely in pharmacies with more than one full-time pharmacist. Pharmacies where pharmacists received naloxone continuing education in the past two years were 1.3 times as likely to stock naloxone. The attempted dispensing model yielded no improvement over the constant-only model. CONCLUSIONS: Pharmacies with larger capacity took advantage of the naloxone standing order. Predictors of pharmacist naloxone dispensing should continue to be explored to maximize naloxone access

Feeding Patterns and Milk Production of Small-Scale Dairy Farmers under Semi-Intensive and Extensive Cattle Management Systems in Sri Lanka

The main objective of the present study was to determine the feeding pattern and milk production of small-scale dairy farmers under semi-intensive and extensive management systems in the intermediate zone of Sri Lanka. This region is sandwiched between the Wet and Dry Zones, receives a mean annual rainfall of 1750-2500 mm, and covers an area of about 1.2 million ha. A survey was conducted with 60 farmers and data on their herd size, herd composition and breeds, management system, breeding method, milk production, feeding costs and returns of raising animals were collected. The results indicated that the majority of farmers conducted dairying as a part-time business in both semi-intensive (80%) and extensive (66%) management systems in the study area. The highest (P \u3c 0.05) average herd size was observed under semi-intensive systems (3.7 animal units (AU)), compared to extensive systems (2.7 AU). The farmers under the semi-intensive system maintained better feeding levels compared with the extensive system. The majority of farmers in the area depended on tethering and stall feeding as their main source of animal feed. Grasses grown on roadsides, paddy fields, neighbours’ land, government estates and tree leaves were the main feed resources available for both management systems. Rice (Oriza sativa) bran and coconut (Cocos nucifera) poonac were the main concentrate feed ingredients in the study area. Jersey crosses were the most popular dairy animals among semi-intensively managed farms, whereas Sahiwal crosses were most popular in extensive management systems. The average milk production under extensive systems was significantly lower (P \u3c 0.01) at 3.9 l/AU/day, compared to 5.4 l/AU/day under semi-intensive systems. Semi-intensive management systems also had the highest average monthly return per AU

QUANTIFICATION OF TOTAL CHROMIUM AND HEXAVALENT CHROMIUM IN WATER BY ELECTROTHERMAL ATOMIC ABSORPTION SPECTROMETRY

The two primary oxidation states of chromium in natural waters, Cr(Ill) and Cr(VI), differsignificantly in biological, geochemical and toxicological properties. Whereas Cr(Ill) isconsidered essential for human in glucose, lipid and protein metabolism, Cr(VI) is toxicbecause of its ability to oxidize other species and its adverse effects on the lung, liver andkidney. Because of the different toxicities and bioavailability of Cr(Ill) and Cr(VI),determination of the total chromium content does not give full information about possiblehealth hazard. Hence monitoring of the concentration of the separate chromium species isof great importance. Many different techniques have been in use for Cr containing samplespreparation and metal ions speciation: ion chromatography, flow injection analysis, andatomic absorption spectrometry (AAS).Procedures for the quantification of total chromium and hexavalent chromium in watersamples arc presented. For the quantification of total chromium and hexavalent chromiumin water Chrornabond NH2 columns (arninopropyl phase with a 3ml volume and 500mg ofsorbent) obtained from Machery- Nagel (Duren, Germany) were used.The pH value of the water sample was adjusted to 5.5 using acetic acid or sodium acetateand sample was aspirated through the previously conditioned column. The column contentswere dried under vacuum and the hexavalent chromium selectively linked was eluted withnitric acid and quantification was performed by Electrothermal Atomic AbsorptionSpectrometry (ET AAS). For the detection of total chromium, Cr(Ill) was transformed intoCr(VI) by oxidizing the sample with 1% K2S20S solution and AgNOJ at 100°C for 15 min.Oxidized solution was eluted through a Chromabond column and total Cr level wasquantified by ET AAS using the same instrumental conditions as for hexavalent chromium.Total chromium was also quantified directly in the water samples using ET AAS. Thetemperature programme of the graphite furnace, the use of chemical modifiers, the atomictechnique employed and the effectiveness of deuterium background correction wereinvestigated. Chromium was reliably determined by without chemical modifiers orbackground correction.The detection limits were 0.4 and 0.5~gll for total chromium and hexavalent chromiumrespectively. The linearity changed under the optimized conditions was 0.4 - 50j.lgll and0.5-50j.lgll and the relative standard deviation was less than 3.5%. The validation of bothprocedures was performed by the standard addition method and the recoveries were higherthan 96% in all cases. It is proved that the method can be successfully employed as analternative to the commonly used preconcentration and speciation analytical techniques.The direct procedure was adopted for the estimation of total chromium in water samples becauseboth procedures applied for total chromium gave similar results. The methods were applied to thedetermination of total chromium and hexavalent chromium in 40 water samples.

Mindfulness in schools: a health promotion approach to improving adolescent mental health.

Between 10 and 20% of adolescents worldwide experience a mental health problem within a given 12-month period. Mental health problems impact on an adolescent’s potential to live a fulfilling and productive life and lead to challenges such as stigma, isolation and discrimination. To address this need, in recent years, there has been growing interest into broad-based school-integrated health promotion interventions that seek to build resilience and augment protective factors in adolescents. Mindfulness-based interventions (MBIs) reflect one such approach that have been administered to adolescent populations in both resilience building and treatment contexts. This paper discusses the utility of school-based MBIs as an adolescent health promotion approach and makes recommendations for intervention design, delivery and evaluation. Emerging evidence indicates that school-integrated MBIs may be a cost-effective means of not only meeting government objectives relating to adolescent mental health, but also for improving the wellbeing of teachers and parents. Furthermore, there is growing evidence indicating that mindfulness can elicit improvements in student learning performance and general classroom behaviour. However, notwithstanding these beneficial properties, there remains a need to conduct large-scale empirical investigations that seek to evaluate the effectiveness of school-integrated MBIs at a regional or national level. A further challenge is the need to ensure that mindfulness instructors are able to impart to adolescents an experiential understanding of this ancient contemplative technique.N

Malaria knowledge and agricultural practices that promote mosquito breeding in two rural farming communities in Oyo State, Nigeria

<p>Abstract</p> <p>Background</p> <p>Agricultural practices such as the use of irrigation during rice cultivation, the use of ponds for fish farming and the storage of water in tanks for livestock provide suitable breeding grounds for anthropophylic mosquitoes. The most common anthropophylic mosquito in Nigeria which causes much of the morbidity and mortality associated with malaria is the anopheles mosquito. Farmers are therefore at high risk of malaria - a disease which seriously impacts on agricultural productivity. Unfortunately information relating to agricultural practices and farmers' behavioural antecedent factors that could assist malaria programmers plan and implement interventions to reduce risk of infections among farmers is scanty. Farmers' knowledge about malaria and agricultural practices which favour the breeding of mosquitoes in Fashola and Soku, two rural farming communities in Oyo State were therefore assessed in two rural farming communities in Oyo State.</p> <p>Methods</p> <p>This descriptive cross-sectional study involved the collection of data through the use of eight Focus Group Discussions (FGDs) and the interview of 403 randomly selected farmers using semi-structured questionnaires. These sets of information were supplemented with observations of agricultural practices made in 40 randomly selected farms. The FGD data were recorded on audio-tapes, transcribed and subjected to content analysis while the quantitative data were analyzed using descriptive and inferential statistics.</p> <p>Results</p> <p>Most respondents in the two communities had low level of knowledge of malaria causation as only 12.4% stated that mosquito bite could transmit the disease. Less than half (46.7%) correctly mentioned the signs and symptoms of malaria as high body temperature, body pains, headache, body weakness and cold/fever. The reported main methods for preventing mosquito bites in the farming communities included removal of heaps of cassava tuber peelings (62.3%), bush burning/clearing (54.6%) and clearing of ditches (33.7%). The dumping of cassava tuber peelings which allows the collection of pools of water in the farms storage of peeled cassava tubers soaked in water in uncovered plastic containers, digging of trenches, irrigation of farms and the presence of fish ponds were the observed major agricultural practices that favoured mosquito breeding on the farms. A significant association was observed between respondents' knowledge about malaria and agricultural practices which promote mosquito breeding. Respondents' wealth quintile level was also seen to be associated with respondents' knowledge about malaria and agricultural practices which promote mosquito breeding.</p> <p>Conclusion</p> <p>Farmers' knowledge of malaria causation and signs and symptoms was low, while agricultural practices which favour mosquito breeding in the farming communities were common. There is an urgent need to engage farmers in meaningful dialogue on malaria reduction initiatives including the modification of agricultural practices which favour mosquito breeding. Multiple intervention strategies are needed to tackle the factors related to malaria prevalence and mosquito abundance in the communities.</p

Childhood obesity intervention studies: A narrative review and guide for investigators, authors, editors, reviewers, journalists, and readers to guard against exaggerated effectiveness claims

Being able to draw accurate conclusions from childhood obesity trials is important to make advances in reversing the obesity epidemic. However, obesity research sometimes is not conducted or reported to appropriate scientific standards. To constructively draw attention to this issue, we present 10 errors that are commonly committed, illustrate each error with examples from the childhood obesity literature, and follow with suggestions on how to avoid these errors. These errors are as follows: using self-reported outcomes and teaching to the test; foregoing control groups and risking regression to the mean creating differences over time; changing the goal posts; ignoring clustering in studies that randomize groups of children; following the forking paths, subsetting, p-hacking, and data dredging; basing conclusions on tests for significant differences from baseline; equating “no statistically significant difference” with “equally effective”; ignoring intervention study results in favor of observational analyses; using one-sided testing for statistical significance; and stating that effects are clinically significant even though they are not statistically significant. We hope that compiling these errors in one article will serve as the beginning of a checklist to support fidelity in conducting, analyzing, and reporting childhood obesity research

Arterial stiffness is a predictor for acute kidney injury following coronary artery bypass graft surgery

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a serious postoperative complication of cardiac surgery, an episode of which impacts on patient morbidity and mortality. Pulse wave velocity (PWV; a non-invasive measurement tool to assess arterial stiffness) has been shown to predict kidney disease progression, and cardiovascular and all-cause mortality in patients with chronic kidney disease. We hypothesised that PWV would also predict acute kidney injury in subjects who have undergone non-valve repair elective coronary artery bypass graft (CABG) surgery

Associations of iron metabolism genes with blood manganese levels: a population-based study with validation data from animal models

<p>Abstract</p> <p>Background</p> <p>Given mounting evidence for adverse effects from excess manganese exposure, it is critical to understand host factors, such as genetics, that affect manganese metabolism.</p> <p>Methods</p> <p>Archived blood samples, collected from 332 Mexican women at delivery, were analyzed for manganese. We evaluated associations of manganese with functional variants in three candidate iron metabolism genes: <it>HFE </it>[hemochromatosis], <it>TF </it>[transferrin], and <it>ALAD </it>[δ-aminolevulinic acid dehydratase]. We used a knockout mouse model to parallel our significant results as a novel method of validating the observed associations between genotype and blood manganese in our epidemiologic data.</p> <p>Results</p> <p>Percentage of participants carrying at least one copy of <it>HFE C282Y</it>, <it>HFE H63D</it>, <it>TF P570S</it>, and <it>ALAD K59N </it>variant alleles was 2.4%, 17.7%, 20.1%, and 6.4%, respectively. Percentage carrying at least one copy of either <it>C282Y </it>or <it>H63D </it>allele in <it>HFE </it>gene was 19.6%. Geometric mean (geometric standard deviation) manganese concentrations were 17.0 (1.5) μg/l. Women with any <it>HFE </it>variant allele had 12% lower blood manganese concentrations than women with no variant alleles (β = -0.12 [95% CI = -0.23 to -0.01]). <it>TF </it>and <it>ALAD </it>variants were not significant predictors of blood manganese. In animal models, <it>Hfe</it>^-/-mice displayed a significant reduction in blood manganese compared with <it>Hfe</it>^+/+mice, replicating the altered manganese metabolism found in our human research.</p> <p>Conclusions</p> <p>Our study suggests that genetic variants in iron metabolism genes may contribute to variability in manganese exposure by affecting manganese absorption, distribution, or excretion. Genetic background may be critical to consider in studies that rely on environmental manganese measurements.</p

Cross-sectional and longitudinal associations between different exercise types and food cravings in free-living healthy young adults

Introduction: An increase in energy intake due to alterations in hedonic appetite sensations may, at least in part, contribute to lower-than-expected weight loss in exercise interventions. The aim of this study was to examine cross-sectional and longitudinal associations between habitual exercise participation and food cravings in free-living young adults. Methods: A total of 417 adults (49% male, 28 ± 4 years) reported frequency and duration of walking, aerobic exercise, resistance exercise and other exercise at baseline and every 3 months over a 12-month period. Food cravings were assessed via the Control of Eating Questionnaire at baseline and 12-month follow-up. Results: Cross-sectional analyses revealed more frequent cravings for chocolate and a greater difficulty to resist food cravings in women compared to men (p < 0.01). Only with resistance exercise significant sex by exercise interaction effects were observed with favorable responses in men but not in women. Significant main effects were shown for walking and aerobic exercise with exercisers reporting more frequent food cravings for chocolate and fruits and greater difficulty to resist eating compared to non-exercisers (p < 0.05). Longitudinal analyses revealed significant interaction effects for other exercise (p < 0.05) with favorable results in men but not women. Furthermore, significant main effects were observed for aerobic exercise, resistance exercise and total exercise with an increase in exercise being associated with a reduced difficulty to resist food cravings (p < 0.05). Discussion: The association between exercise participation and hedonic appetite sensations varies by exercise type and sex. Even though exercise was associated with more frequent and greater difficulty to food cravings in the cross-sectional analyses, which may be attributed to greater energy demands, longitudinal results indicate beneficial effects of increased exercise on appetite control, particularly in men