An international survey of health literacy education within schools of pharmacy

Background: Health literacy (HL) influences patients’ health status, use of the healthcare system and medication-related behaviours. However, the concept is relatively new to pharmacy and its incorporation in academic curricula has not been examined. Aims: To explore HL training in pharmacy schools internationally, and academics’ opinions in regards to how it should be taught and assessed. Methods: An anonymous, online survey was administered to academics who teach within pharmacy degree courses from countries where English is the main language. Results: Responses were received from 21 pharmacy schools in seven countries; 20 stated that HL was taught within their pharmacy degree, in four as a stand-alone topic. Small-group tutorials were thought to be the most beneficial form of teaching health literacy, best assessed using oral and objective structured clinical examinations. Conclusion: The majority of pharmacy schools taught health literacy and had similar opinions regarding best practice teaching and assessment

Predictive and prognostic properties of TB-LAM among HIV-positive patients initiating ART in Johannesburg, South Africa

While the diagnostic properties of the TB LAM urine assay (LAM) have been well-described, little is known about its predictive and prognostic properties at ART initiation in a routine clinic setting. We describe the predictive and prognostic properties of LAM in HIV-positive patients initiating ART at an urban hospital in Johannesburg, South Africa. Retrospective study of HIV-positive adults (>18 years) who initiated  standard first-line ART between February 2012 and April 2013 and had a LAM test at initiation. In  HIV-positive patients with no known TB at ART initiation, we assessed the sensitivity, specificity and positive/negative likelihood ratios of LAM to predict incident TB within 6 months of ART initiation. In addition, in patients with a TB diagnosis and on TB treatment <3 months at ART initiation, we measured the CD4 response at 6 months on ART. Of the 274 patients without TB at ART initiation, 65% were female with median CD4 count of 213 cells/mm3. Among the 14 (5.1%) patients who developed active TB, none were urine LAM +ve at baseline. LAM had poor sensitivity (0.0 % 95 % CI 0.00-23.2) to predict incident TB within 6 months of initiation. We analyzed 22 patients with a confirmed TB diagnosis at initiation separately. Of these, LAM +ve patients (27%) showed lower CD4 gains compared to LAM negative patients (median increase 103 vs 199 cells/mm3; p=0.08). LAM has limited value for accurately predicting incident TB in patients with higher CD4 counts after ART initiation. LAM may help identify TB/HIV co-infected patients at ART initiation who respond more slowly to treatment and require targeted interventions to improve treatment outcomes. Larger studies with longer patient follow-up are needed.Key words: Antiretroviral therapy, HIV, lipoarabinomannan, Mycobacterium, TB LAM, South Afric

An international survey of health literacy education within schools of pharmacy

Background: Health literacy (HL) influences patients’ health status, use of the healthcare system and medication-relatedbehaviours. However, the concept is relatively new to pharmacy and its incorporation in academic curricula has notbeen examined.Aims: To explore HL training in pharmacy schools internationally, and academics’ opinions in regards to how it shouldbe taught and assessed.Methods: An anonymous, online survey was administered to academics who teach within pharmacy degree coursesfrom countries where English is the main language.Results: Responses were received from 21 pharmacy schools in seven countries; 20 stated that HL was taught withintheir pharmacy degree, in four as a stand-alone topic. Small-group tutorials were thought to be the most beneficial formof teaching health literacy, best assessed using oral and objective structured clinical examinations.Conclusion: The majority of pharmacy schools taught health literacy and had similar opinions regarding best practiceteaching and assessment

Gender Differences in Mortality and CD4 Count Response Among Virally Suppressed HIV-Positive Patients

Treatment outcomes for antiretroviral therapy (ART) patients may vary by gender, but estimates from current evidence may be confounded by disease stage and adherence. We investigated the gender differences in treatment response among HIV-positive patients virally suppressed within 6 months of treatment initiation

A method to determine spatial access to specialized palliative care services using GIS

Background: Providing palliative care is a growing priority for health service administratorsworldwide as the populations of many nations continue to age rapidly. In many countries, palliativecare services are presently inadequate and this problem will be exacerbated in the coming years.The provision of palliative care, moreover, has been piecemeal in many jurisdictions and there islittle distinction made at present between levels of service provision. There is a pressing need todetermine which populations do not enjoy access to specialized palliative care services in particular.Methods: Catchments around existing specialized palliative care services in the Canadian provinceof British Columbia were calculated based on real road travel time. Census block face populationcounts were linked to postal codes associated with road segments in order to determine thepercentage of the total population more than one hour road travel time from specialized palliativecare.Results: Whilst 81% of the province\u27s population resides within one hour from at least onespecialized palliative care service, spatial access varies greatly by regional health authority. Based onthe definition of specialized palliative care adopted for the study, the Northern Health Authorityhas, for instance, just two such service locations, and well over half of its population do not havereasonable spatial access to such care.Conclusion: Strategic location analysis methods must be developed and used to accurately locatefuture palliative services in order to provide spatial access to the greatest number of people, andto ensure that limited health resources are allocated wisely. Improved spatial access has thepotential to reduce travel-times for patients, for palliative care workers making home visits, and fortravelling practitioners. These methods are particularly useful for health service planners – andprovide a means to rationalize their decision-making. Moreover, they are extendable to a numberof health service allocation problems

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

The congruency between home and school literacy practices in a South African primary school

South Africa has undergone widespread changes in the educationni system and previously racially segregated schools have been opened to all races unce the early 1990's. The new multi-cultural composition of many suburban schools has raised the question of the extent of congruence between school literacy practices and those in households originating in different cultural contexts. Accordingly, this study examined the congruence between home and school literacy practices and values and its impact on scholastic achievement. A broad literature survey was conducted which distinguished three streams of research and theory, namely the cognitive stream, the educational stream and the socio-cultural stream. The socio-cultural paradigm was adopted to examine the literacy practices of diverse cultural groups. Reference was also made to interactive information-processing models and schema theory. An appropriate multi-cultural school was identified for observation of dominant sociocultural values, specific school literacy practices, discourse patterns and expectations of parental involvement in the children's education. Ten children in two classes were selected for further study on the basis of geographical, racial, cultural and economic diversity, school achievement and parental interest in schooling. Children from both the suburbs and the townships were included, together with a mixed category comprising township families who had recently moved into the suburbs, the child of a domestic servant and a black child who lived with a white suburban family. A number of themes were explored in the home context and related to school performance, namely socio-cultural identity and values, parental role and support in schooling, discourse patterns, literacy practices and availability of resources. The main findings of the research were firstly that socio-cultural values provided a broad context for achievement, although the lack of value congruence affected only a few children. Secondly, middle-class family literacy practices were congruent with school literacy practices and the children of these families all performed well at school. However, certain students could perform scholastically in spite of a lack of congruence in literacy practices, provided they had parental support. Thirdly, children from a variety of socio-economic and cultural contexts who received direct curricular assistance with homework achieved average or above average results at school. However, the direct help which they received may only have short-term positive effects on school achievement because the children did not acquire the background schemas to enable generalization and integration. Finally, in middle-class households where a broad literate orientation was adopted, and where the parents provided extended, decontextualised support beyond the curriculum, more generalized changes in thinking were likely to occur, with these children more likely to deal effectively with new learning situations and incorporate new information. In conclusion, it is argued that congruency needs to go beyond literacy practices and values to embrace broader school and home values. Suggestions are made for achieving greater congruency by effecting changes in practices and values in the classroom and the home

Tissue viability imaging of skin microcirculation following exposure to whole body cryotherapy (-110-degress-C) and cold water immersion (8-degrees-C)

Cryotherapy is currently used in various clinical, rehabilitative, and sporting settings. However, very little is known regarding the impact of cooling on the microcirculatory response. Objectives: The present study sought to examine the influence of two commonly employed modalities of cryotherapy, whole body cryotherapy (WBC; -110°C) and cold water immersion(CWI; 8±1°C), on skin microcirculation in the mid- thigh region. Methods: The skin area examined was a 3 × 3 cm located between the most anterior aspect of the inguinal fold and the patella. Following 10 minutes of rest, 5 healthy, active males were exposed to either WBC for 3 minutes or CWI for 5 minutes in a randomised order. Volunteers lay supine for five minutes after treatment, in order to monitor the variation of red blood cell (RBC) concentration in the region of interest for a duration of 40 minutes. Microcirculation response was assessed using a non-invasive, portable instrument known as a Tissue Viability imaging system. After a minimum of seven days, the protocol was repeated. Subjective assessment of the volunteer’s thermal comfort and thermal sensation was also recorded. Results: RBC was altered following exposure to both WBC and CWI but appeared to stabilise approximately 35 minutes after treatments. Both WBC and CWI affected thermal sensation (p 0.05). Conclusions: As both WBC and CWI altered RBC, further study is necessary to examine the mechanism for this alteration during whole body cooling

“The way all foster care should be”: the experience of therapeutic foster carers in the Victorian Circle Program

Central to the success of therapeutic foster care (TFC) is the quality and stability of the relationship between the child and carer. This key relationship may, from a therapeutic perspective, facilitate healing by addressing the impact of complex developmental trauma experienced by the child who has been placed in care. Stability of the carer–child relationship is critical in this context. Therapeutic carers have been shown to be significantly more likely to remain in the role of carer than their counterparts in mainstream foster care. The research reported on in this paper draws upon findings from an evaluation of a TFC programme and gives voice to the Circle Carers, presenting the components of TFC which are important to them. The paper commences with the story of Ruby in TFC as told by a carer. The focus then becomes a detailed exploration of the experience of carers and their capacity to care. Implications for practice are identified