Evaluation Of Pharmacist'S Educational Intervention In Improving Treatment Outcomes Of Patients With Rheumatoid Arthritis

Pharmacist’s role in Pakistan’s healthcare system has traditionally been limited to dispensing of medications. Healthcare stakeholders and policy makers have repeatedly called for enhancing this role and involving pharmacists in direct patient care. Therefore, this study was aimed to evaluate pharmacist led educational intervention in improving treatment outcomes of patients with rheumatoid arthritis. A two arm-randomized single-blind controlled trial was designed. One arm was labeled as, ‘control’ group (CG), while other was, ‘intervention’ group (IG). The pharmacist provided an educational intervention in IG and usual care in CG. This study was conducted in rheumatology clinics of 7 hospitals in Karachi, Pakistan. A total of 714 patients were randomly enrolled, 354 in the IG and 360 in the CG

Which aspects of job determine satisfaction among pharmacists working in Saudi pharmacy settings?

Objective The aim of this study was to evaluate the impact of several employment-related aspects on overall job satisfaction among pharmacists working in Saudi pharmacy settings. Methods A cross-sectional survey was conducted for a period of 1-month (December 2020) among pharmacists working in community pharmacies located in 3 cities of Saudi Arabia. Convenience sampling was employed, and the data was collected using the English version of Job Satisfaction Survey (JSS) questionnaire. The data was analyzed using IBM SPSS version 23. Descriptive statistics such as mean (x̄) and 95% confidence interval range were used to report continuous data; frequency (%) and sample counts (N) were used to report categorical data. Bivariate analyses were conducted using chi square (χ2) test. A multiple linear regression model was formulated to report the employment aspects that determined overall job satisfaction of pharmacists. The study was approved by an ethics committee. Results A total of 241 samples were analyzed. Less than a quarter of pharmacists (N = 54, 22.4%) were satisfied with their job. The overall job satisfaction score was 130.74 out of 199. The sub-scales for co-workers and communication had scores > 15.8 out of 24; subscale for operating conditions had score > 12.5 out of 20. The subscales for promotion and rewards had scores < 14 out of 24. The aspects of communication, fringe benefits and nature of work had the highest contribution towards overall job satisfaction. For a unit increase in score for communication, fringe benefits, and nature of work, the overall job satisfaction score increased by 0.204, 0.2, and 0.199, respectively. Conclusion A very small number of pharmacists seemed satisfied with their job. Satisfaction with communication, nature of work and fringe benefits contributed the most toward overall job satisfaction. Results of this study could provide the means for human resource managers and organizational policy makers to delve into the determinants of satisfaction among pharmacists working in community settings

Determinants of academic stress and stress-related selfmedication practice among undergraduate male pharmacy and medical students of a tertiary educational institution in Saudi Arabia

Purpose: To identify factors that promote academic stress and stress-related self-medication practice among undergraduate male students of pharmacy and medical colleges at Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Methods: A cross-sectional survey was conducted among undergraduate students of pharmacy and medical colleges of the university. The study used Perceived Stress Scale (PSS) to document academic stress. The responses of the students were analyzed using SPSS version 22. Results: As many as 51.6 % of students’ perceived moderate stress. The majority of students (55.9 %) highlighted examination as a stressor followed by course load (43.2 %) and cGPA (40.4 %). Prevalence of self-medication was 31.58 and 29.20 % among pharmacy and medical students, respectively. Most of the students consumed caffeine (63.8 %) and nicotine (17.8 %) as a drug. Students blamed heavy course load (23.9 %), followed by assignment load (23 %) and examination (21.1 %) for indulging in self-medication. Conclusion: Academic stress in undergraduate students in health disciplines is perceived to be high by the students. Examinations, course load and lack of time for leisure are major determinants of stress. Caffeine and nicotine are most frequently used by a majority of the students for self-medication. Keywords: Stress, Self-medication, Stressor, Caffeine, Nicotine, Student

Development and validation of a novel general medication adherence scale (GMAS) for chronic illness patients in Pakistan

Objective: This study aimed to develop and validate a self-reporting adherence tool termed as General Medication Adherence Scale (GMAS) in Urdu language for measuring adherence toward medication use among Pakistani patients with a chronic disease. Methods: A month-long study (December 2017) was conducted in three tertiary health care settings of Karachi, Pakistan. The tool underwent content and face validity as well as factor analyses, i.e., exploratory, partial confirmatory and confirmatory factor analyses. Random sampling was conducted, and sample size was calculated using item response theory. The item-to-respondent ratio was 1:15. Fit indices namely normed fit index (NFI), Tucker Lewis index (TLI), comparative fit index (CFI), goodness of fit index (GFI), absolute goodness of fit (AGFI), parsimony goodness of fit index (PGFI), root mean square error of approximation (RMSEA), and standard root mean square residual (SRMR) were calculated. Additionally, estimation of the convergent, discriminant and known group validities, was conducted. Internal consistency was analyzed by testretest reliability, McDonald’s and Pearson correlation coefficient. The factor analyses were conducted using IBM SPSS version 22 and IBM SPSS AMOS version 25. Results: Content validity index (CVI) was reported at 0.8 (SD 0.147) and the tool was content validated with three hypothetical constructs. Factor analyses highlighted a 3- factor structure. The fit indices were calculated with satisfactory results, i.e., PGFI, GFI, AGFI, NFI, TLI, and CFI were greater than 0.9 and PGFI > 0.5. The values of RMSEA and SRMR were less than 0.07. A Cronbach’s alpha value of 0.84 was obtained in reliability analysis. The test-retest Pearson’s correlation coefficient value was reported at 0.996 (p-value < 0.01). Convergent and discriminant validities for all constructs and, known group validity for two constructs, were established. A high response rate of 91% was achieved in respondents. Patients without insurance coverage appeared to be low adherent compared to those with insurance coverage (p-value < 0.05). Non-comorbid patients were more likely to be highly adherent as compared to comorbid patients (pvalue < 0.01). Conclusion: A novel tool GMAS was developed in Urdu language and was subsequently validated in patients with chronic diseases

DIRECT COST OF TREATMENT OF DIABETES MELLITUS TYPE 2 IN PAKISTAN

Objective: Diabetes is a serious illness. It is a key and growing threat to the health of the global world. The prime concern of this research was to estimate the cost-of-illness of type 2 diabetes in Karachi, a major metropolitan city of Pakistan. This study was performed on the basis a community perspective to calculate the economic burden of diabetes mellitus type 2 in Pakistan. Methods: This study was conducted in all districts of Karachi, the patients were taken from all economic segment of society from low income group, average revenue and high revenue group. A preliminary test questionnaire was used to collect the data directly from patients and in some locations conducted interviews with patients due to lack of understanding and un-educated patients. The total of 885diabetes patients was selected with convenient random sampling. Results: The average direct cost of all these expense bear by diabetic patient in Pakistan is Pak Rupees Rs.5542 per month. The cost range starts from Rs. 650/month to 20000 per month on the basis of patient economic condition and disease state. The average appointment fee of a physician, laboratory test and medicines came to Rs. 700/visit, 400/test, and 1100/visit precisely. The average travel and food spent was Rs.200/visit and 1000/month. Medicine accounted for largest cost followed by consultation with the physician. Conclusion: This is clearly indicated by this study that considerable cost is amounted by diabetes, it is suggested that a huge amount of resources could be prevented by taking care, initial understanding of the disease and a decrease in diabetes co-morbidities and complications through better diabetes mellitus treatment. Very extensive and cost-effective programs should be started to maximize health benefits and to diminish the prevalence of this epidemic

Knowledge and perceptions towards cardiovascular disease prevention among patients with type 2 diabetes mellitus: A review of current assessments and recommendations

Introduction: Patients with type 2 diabetes mellitus (T2DM) are at significantly higher risk of developing cardiovascular disease (CVD). There is scarcity of literature reviews that describes and summarises T2DM patients' knowledge and perception about CVD prevention. Objectives: To describe and summarise the assessment of knowledge and perceptions about CVD risk and preventive approaches among patients with T2DM. Methods: A scoping review methodology was adopted, and three scientific databases, Google Scholar, Science Direct and PubMed were searched using predefined search terms. A multistage screening process that considered relevancy, publication year (2009-2019), English language, and article type (original research) was followed. We formulated research questions focused on the assessment of levels of knowledge and perceptions of the illness relevant to CVD prevention and the identification of associated patients' characteristics. Results: A total of 16 studies were included. Patients were not confident to identify CVD risk and other clinical consequences that may occur in the prognostic pathway of T2DM. Furthermore, patients were less likely to identify all CV risk factors indicating a lack of understanding of the multi-factorial contribution of CVD risk. Patients' beliefs about medications were correlated with their level of adherence to medications for CVD prevention. Many knowledge gaps were identified, including the basic disease expectations at the time of diagnosis, identification of individuals' CVD risk factors and management aspects. Knowledge and perceptions were affected by patients' demographic characteristics, e.g., educational level, race, age, and area of residence. Conclusion: There are knowledge gaps concerning the understanding of CVD risk among patients with T2DM. The findings necessitate educational initiatives to boost CVD prevention among patients with T2DM. Furthermore, these should be individualised based on patients' characteristics and knowledge gaps, disease duration and estimated CVD risk

Development and Validation of a Novel General Medication Adherence Scale (GMAS) for Chronic Illness Patients in Pakistan

Objective: This study aimed to develop and validate a self-reporting adherence tool termed as General Medication Adherence Scale (GMAS) in Urdu language for measuring adherence toward medication use among Pakistani patients with a chronic disease.Methods: A month-long study (December 2017) was conducted in three tertiary health care settings of Karachi, Pakistan. The tool underwent content and face validity as well as factor analyses, i.e., exploratory, partial confirmatory and confirmatory factor analyses. Random sampling was conducted, and sample size was calculated using item response theory. The item-to-respondent ratio was 1:15. Fit indices namely normed fit index (NFI), Tucker Lewis index (TLI), comparative fit index (CFI), goodness of fit index (GFI), absolute goodness of fit (AGFI), parsimony goodness of fit index (PGFI), root mean square error of approximation (RMSEA), and standard root mean square residual (SRMR) were calculated. Additionally, estimation of the convergent, discriminant and known group validities, was conducted. Internal consistency was analyzed by test-retest reliability, McDonald’s and Pearson correlation coefficient. The factor analyses were conducted using IBM SPSS version 22 and IBM SPSS AMOS version 25.Results: Content validity index (CVI) was reported at 0.8 (SD 0.147) and the tool was content validated with three hypothetical constructs. Factor analyses highlighted a 3-factor structure. The fit indices were calculated with satisfactory results, i.e., PGFI, GFI, AGFI, NFI, TLI, and CFI were greater than 0.9 and PGFI &gt; 0.5. The values of RMSEA and SRMR were less than 0.07. A Cronbach’s alpha value of 0.84 was obtained in reliability analysis. The test-retest Pearson’s correlation coefficient value was reported at 0.996 (p-value &lt; 0.01). Convergent and discriminant validities for all constructs and, known group validity for two constructs, were established. A high response rate of 91% was achieved in respondents. Patients without insurance coverage appeared to be low adherent compared to those with insurance coverage (p-value &lt; 0.05). Non-comorbid patients were more likely to be highly adherent as compared to comorbid patients (p-value &lt; 0.01).Conclusion: A novel tool GMAS was developed in Urdu language and was subsequently validated in patients with chronic diseases

Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990-2019 : a systematic analysis from the Global Burden of Disease Study 2019

Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Findings In 2019, 273 center dot 9 million (95% uncertainty interval 258 center dot 5 to 290 center dot 9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 center dot 72% (4 center dot 46 to 5 center dot 01). 228 center dot 2 million (213 center dot 6 to 244 center dot 7; 83 center dot 29% [82 center dot 15 to 84 center dot 42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global agestandardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 center dot 21% [-1 center dot 26 to -1 center dot 16]), similar progress was not observed for chewing tobacco (0 center dot 46% [0 center dot 13 to 0 center dot 79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 center dot 94% [-1 center dot 72 to -0 center dot 14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Summary Background Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control. Methods We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period. Findings In 2019, 273 & middot;9 million (95% uncertainty interval 258 & middot;5 to 290 & middot;9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 & middot;72% (4 & middot;46 to 5 & middot;01). 228 & middot;2 million (213 & middot;6 to 244 & middot;7; 83 & middot;29% [82 & middot;15 to 84 & middot;42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global age standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 & middot;21% [-1 & middot;26 to -1 & middot;16]), similar progress was not observed for chewing tobacco (0 & middot;46% [0 & middot;13 to 0 & middot;79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 & middot;94% [-1 & middot;72 to -0 & middot;14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Copyright (c) 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe