Pharmacists’ “full scope of practice”: knowledge, attitudes and practices of rural and remote Australian pharmacists

Purpose: Poor health outcomes for patients living in rural and remote areas of Australia are often attributed to the lack of a range of accessible health professionals delivering health services. Community pharmacists are already an integral part of these communities and as such are often the most frequently consulted health professionals. The aim of this study was to explore rural pharmacist knowledge and experiences of expanded pharmacy and to identify the barriers and enablers to remote pharmacists providing expanded pharmacy services (EPS), which can be described as services outside of usual medication management tasks. Methods: Rural and remote pharmacists (Modified Monash Model (MMM) categories 2– 7) participated in an online survey. Descriptive statistics and chi-squared tests were performed and data from open-ended questions were analyzed, categorized into themes and quantitized. Results: Two-thirds (n=13, 68%) of rural pharmacists surveyed (n=19) had knowledge of EPS in rural pharmacies and the majority (n=17, 89%) agreed that these services would benefit rural communities. Mental health service referral was considered very/extremely important by the majority (n=16, 84%) of respondents; however, no pharmacists were currently providing mental health screening services while (n=15, 79%) were willing to provide these services. While staff shortages, costs, time and training were indicated to be the main barriers to the provision of EPS, enablers included accessibility of rural pharmacies and a perceived need. Conclusion: This study indicated that pharmacists are already providing some EPS and see value in their implementation; however, what constitutes an expanded service was unclear to some participants. Mental health services were highlighted as most important demonstrating a recognized burden of mental illness in rural and remote locations. Findings from this pilot study will provide further understanding for future development of the pharmacist’s scope of practice and implementation of EPS

Developing and Assessing the Validity of a Scale to Assess Pet Dog Quality of Life: Lincoln P-QoL

There has been little investment in exploring the impact of the child-dog relationship on the dog. Since child-dog interactions can pose potentially serious threats to a dog’s physical and psychological health, as well as the wider satisfaction of the owner with their dog, we describe the development and validation of an owner-completed pet dog quality of life scale (Lincoln P-QOL), to enable professionals and families to monitor dog wellbeing and employ suitable interventions as required. Four-hundred and two dog-owners (194 lived with a neuro-typically developing child; 208 lived with a child with a neuro-developmental disorder) responded to an online survey. Respondents recorded whether they had observed their dog displaying any of the 22 behavioural responses which have been identified as being common in 11 child-dog interactions. These behavioural responses appeared to group into three categories of behaviours (i.e. behavioural constructs), representing Excitability, Calmness and Fearfulness in the dog. To assess convergent validity of the quality of life scale respondents completed additional measures including, dog body condition score, health issues (incorporating psychological factors such as anxiety and physical proxies of wellbeing, such as skin irritations) and dog-owner relationship satisfaction. Excitability and Fearfulness constructs were associated with a negative impact on dog health and the owner-dog relationship. Calmness was associated with a positive impact on the dog-owner relationship. A range of interactions, including carefully expressed child-dog physical affection and spending quiet time together appear to had a beneficial impact on dog quality of life, whereas rough contact, child meltdowns and grooming/bathing had a negative effect. We found little evidence to support a difference in the overall quality of life of dogs living with neuro-typically developing children compared to those with a neuro-developmental disorder. However, parents and practitioners need to be aware of the potential increased risk to dog wellbeing when meltdowns, grooming/bathing and quiet time involve a child with a neuro-developmental disorder. This is the first validated scale for the assessment of dog wellbeing around children, additionally, the behavioural constructs identified may form the rational basis of a more general dog behaviour/stress assessment tool in social situations

Deconstructing wall turbulence -visualization of resolvent modes

This article accompanies a fluid dynamics video entered into the Gallery of Fluid Motion of the 66th Annual Meeting of the APS Division of Fluid Dynamics.Comment: High and low resolution videos associated with this manuscript can be found as ancillary file

Use of Leishmania major parasites expressing a recombinant Trypanosoma cruzi antigen as live vaccines against Chagas disease

INTRODUCTION: METHODS: We generated recombinant RESULTS: We demonstrate that mice inoculated with these recombinant TS-expressing DISCUSSION: Altogether, these data indicate tha

Screening Practices for Infectious Diseases among Burmese Refugees in Australia

Helicobacter pylori and Strongyloides spp. infections were the most common conditions found

The Effectiveness and Cost-Effectiveness of Screening for and Vaccination Against Hepatitis B Virus among Migrants in the EU/EEA: A Systematic Review

: Migrants from hepatitis B virus (HBV) endemic countries to the European Union/European Economic Area (EU/EEA) comprise 5.1% of the total EU/EEA population but account for 25% of total chronic Hepatitis B (CHB) infection. Migrants from high HBV prevalence regions are at the highest risk for CHB morbidity. These migrants are at risk of late detection of CHB complications; mortality and onwards transmission. The aim of this systematic review is to evaluate the effectiveness and cost-effectiveness of CHB screening and vaccination programs among migrants to the EU/EEA. We found no RCTs or direct evidence evaluating the effectiveness of CHB screening on morbidity and mortality of migrants. We therefore used a systematic evidence chain approach to identify studies relevant to screening and prevention programs; testing, treatment, and vaccination. We identified four systematic reviews and five additional studies and guidelines that reported on screening and vaccination effectiveness. Studies reported that vaccination programs were highly effective at reducing the prevalence of CHB in children (RR 0.07 95% CI 0.04 to 0.13) following vaccination. Two meta-analyses of therapy for chronic HBV infection found improvement in clinical outcomes and intermediate markers of disease. We identified nine studies examining the cost-effectiveness of screening for CHB: a strategy of screening and treating CHB compared to no screening. The median acceptance of HB screening was 87.4% (range 32.3–100%). Multiple studies highlighted barriers to and the absence of effective strategies to ensure linkage of treatment and care for migrants with CHB. In conclusion, screening of high-risk children and adults and vaccination of susceptible children, combined with treatment of CHB infection in migrants, are promising and cost-effective interventions,but linkage to treatment requires more attention

Reduction of inequalities in health: assessing evidence-based tools

BACKGROUND: The reduction of health inequalities is a focus of many national and international health organisations. The need for pragmatic evidence-based approaches has led to the development of a number of evidence-based equity initiatives. This paper describes a new program that focuses upon evidence- based tools, which are useful for policy initiatives that reduce inequities. METHODS: This paper is based on a presentation that was given at the "Regional Consultation on Policy Tools: Equity in Population Health Reports," held in Toronto, Canada in June 2002. RESULTS: Five assessment tools were presented. 1. A database of systematic reviews on the effects of educational, legal, social, and health interventions to reduce unfair inequalities is being established through the Cochrane and Campbell Collaborations. 2 Decision aids and shared decision making can be facilitated in disadvantaged groups by 'health coaches' to help people become better decision makers, negotiators, and navigators of the health system; a pilot study in Chile has provided proof of this concept. 3. The CIET Cycle: Combining adapted cluster survey techniques with qualitative methods, CIET's population based applications support evidence-based decision making at local and national levels. The CIET map generates maps directly from survey or routine institutional data, to be used as evidence-based decisions aids. Complex data can be displayed attractively, providing an important tool for studying and comparing health indicators among and between different populations. 4. The Ottawa Equity Gauge is applying the Global Equity Gauge Alliance framework to an industrialised country setting. 5 The Needs-Based Health Assessment Toolkit, established to assemble information on which clinical and health policy decisions can be based, is being expanded to ensure a focus on distribution and average health indicators. CONCLUSION: Evidence-based planning tools have much to offer the goal of equitable health development

Attitudes and tolerance of private landowners shape the African wild dog conservation landscape in the greater Kruger National Park

The survival of wildlife ultimately relies on its acceptability to humans. The African wild dog Lycaon pictus is an endangered species that often comes into conflict with humans. Currently, the only viable population in South Africa resides in the Kruger National Park (KNP). To begin to understand the acceptability of wild dogs outside this important wild dog stronghold, we interviewed private landowners (n = 186) along the KNP western and southern boundaries. Respondents generally held positive attitudes towards wild dogs and had a good knowledge of them. Attitudes were also more positive when the property was part of a conservancy, indicating that the conservation landscape for wild dogs on private land outside the KNP is promising. However, the impact of edge effects such as disease transmission should not be ignored in future research, and creative solutions for mitigating these effects must be sought to ensure the future conservation of wild dogs.Jaguar Land Rover South Africa, Vaughan de la Harpe and his Climb for Kruger Wild Dogs Expedition, Richard Bosman and GCCL2 Management Services, and Rhodes University for the Henderson Prestigious Masters Postgraduate Scholarship.http://www.int-res.com/journals/esr/esr-homeam2018Mammal Research InstituteZoology and Entomolog

The factors affecting household transmission dynamics and community compliance with Ebola control measures: a mixed-methods study in a rural village in Sierra Leone.

BACKGROUND: Little is understood of Ebola virus disease (EVD) transmission dynamics and community compliance with control measures over time. Understanding these interactions is essential if interventions are to be effective in future outbreaks. We conducted a mixed-methods study to explore these factors in a rural village that experienced sustained EVD transmission in Kailahun District, Sierra Leone. METHODS: We reconstructed transmission dynamics using a cross-sectional survey conducted in April 2015, and cross-referenced our results with surveillance, burial, and Ebola Management Centre (EMC) data. Factors associated with EVD transmission were assessed with Cox proportional hazards regression. Following the survey, qualitative semi-structured interviews explored views of community informants and households. RESULTS: All households (n = 240; 1161 individuals) participated in the survey. 29 of 31 EVD probable/confirmed cases died (93·5% case fatality rate); six deaths (20·6%) had been missed by other surveillance systems. Transmission over five generations lasted 16 weeks. Although most households had ≤5 members there was a significant increase in risk of Ebola in households with > 5 members. Risk of EVD was also associated with older age. Cases were spatially clustered; all occurred in 15 households. EVD transmission was better understood when the community experience started to concord with public health messages being given. Perceptions of contact tracing changed from invading privacy and selling people to ensuring community safety. Burials in plastic bags, without female attendants or prayer, were perceived as dishonourable. Further reasons for low compliance were low EMC survival rates, family perceptions of a moral duty to provide care to relatives, poor communication with the EMC, and loss of livelihoods due to quarantine. Compliance with response measures increased only after the second generation, coinciding with the implementation of restrictive by-laws, return of the first survivor, reduced contact with dead bodies, and admission of patients to the EMC. CONCLUSIONS: Transmission occurred primarily in a few large households, with prolonged transmission and a high death toll. Return of a survivor to the village and more effective implementation of control strategies coincided with increased compliance to control measures, with few subsequent cases. We propose key recommendations for management of EVD outbreaks based on this experience