A systematic review of the outcome data supporting the Healthy Living Pharmacy concept and lessons from its implementation

Background The Healthy Living Pharmacy (HLP) project, launched in England, UK in 2009 was a novel approach of introducing public health services within community pharmacy to tackle local health inequalities. A national roll-out followed a reported successful pilot; subsequent local evaluations ensued. Objectives To summarise reported outcomes and investigate contextual factors that indicate the presence, absence and maturity of implementation determinants, thus offering useful lessons to stakeholders in implementing future initiatives to achieve successful outcomes. Methods A systematic review was conducted to identify all publications reporting on the HLP project. All HLP articles and conference abstracts were considered for inclusion and were assessed for methodological quality. The Consolidated Framework for Implementation Research (CFIR) was utilised to identify potential implementation determinants reported. Each article was then analysed to identify reported economic, humanistic or clinical outcomes. Results The review included six peer-reviewed journal articles and 12 conference abstracts. Joanna Briggs Institute Qualitative Assessment and Review Instrument indicated deficiencies in methodological quality. Through adoption of the CFIR framework, the implementation determinants relevant to the implementation of HLP into community pharmacy were identified. A resonating issue emerged in that the absence of adopting an evidence-based implementation process limited the ability to capture meaningful outcome data. This resulted in a lack of evidence to support sustainability and the failure to address many of the well cited barriers, e.g. lack of awareness amongst patients, public and other healthcare professionals, and weak support for future investment in resource for training and dissemination. Conclusions Healthcare systems are increasingly called on to adopt evidence-based interventions that improve quality, control costs, and maximize value, thus offering opportunity to accelerate the implementation of clinical pharmacy services and programs aimed at improving patient care. Interventions, such as the HLP project require focused efforts on implementation and evaluation of those implementation efforts to produce effective and lasting changes in complex health care systems

Expansion of health facilities in Iraq a decade after the US-led invasion, 2003–2012

Background: In the last few decades, Iraq’s health care capacity has been severely undermined by the effects of different wars, international sanctions, sectarian violence and political instability. In the aftermath of the 2003 US-led invasion, the Ministry of Health has set plans to expand health service delivery, by reorienting the public sector towards primary health care and attributing a larger role to the private sector for hospital care. Quantitative assessments of the post-2003 health policy outcomes have remained scant. This paper addresses this gap focusing on a key outcome indicator that is the expansion of health facilities. Methods: The analysis is based on data on health facilities provided by the World Health Organisation and Iraq’s Ministry of Health. For each governorate, we calculated the change in the absolute number of facilities by type from early 2003 to the end of 2012. To account for population growth, we computed the change in the number of facilities per 100,000 population. We compared trends in the autonomous northern Kurdistan region, which has been relatively stable from 2003 onwards, and in the rest of Iraq (centre/south), where fragile institutions and persistent sectarian strife have posed major challenges to health system recovery. Results: The countrywide number of primary health care centres per 100,000 population rose from 5.5 in 2003 to 7.4 in 2012. The extent of improvement varied significantly within the country, with an average increase of 4.3 primary health care centres per 100,000 population in the Kurdistan region versus an average increase of only 1.4 in central/southern Iraq. The average number of public hospitals per 100,000 population rose from 1.3 to 1.5 in Kurdistan, whereas it remained at 0.6 in centre/south. The average number of private hospitals per 100,000 population rose from 0.2 to 0.6 in Kurdistan, whereas it declined from 0.3 to 0.2 in centre/south. Conclusions: The expansion of both public and private health facilities in the Kurdistan region appears encouraging, but still much should be done to reach the standards of neighbouring countries. The slow pace of improvement in the rest of Iraq is largely attributable to the dire security situation and should be a cause for major concern

Short-term Weight Loss Outcomes of 104 Mini Gastric Bypass or One Anastomosis Gastric Bypass Operations: Retrospective study

Objectives: This study aimed to examine the short-term effects of Mini gastric bypass (MGB) or one anastomosis gastric bypass (OAGB) procedures on weight loss in individuals with obesity. Methods: This retrospective study was conducted in Iraq from January 2019 to May 2020.  104 patients with obesity underwent MGB or OAGB surgery in a single center in Iraq. Preoperative body mass index (BMI), age, height, and preoperative weight were recorded as baseline measures. Weight-related changes were evaluated during a follow-up phase of 48 weeks. Results: The mean baseline parameters of the subjects before surgery included 1.64 meters for height, 122.9 kg for weight, and 45.6 kg/m² for BMI. During the 48-week follow-up period, there was a substantial reduction in mean weight, which dropped from 122.9 kg at baseline to 75.5 kg at week 48. The weight change (in percentage) gradually increased from -11.8% at week 12 to -37.9% at week 48, without statistically significant association with demographic factors or chronic diseases. From week 12 to week 48, the percentage of excess weight loss (%EWL) increased substantially from 26.8% to 86.1%. The results of the subgroup analysis indicated that the %EWL was considerably higher among those aged 30 or older at week 36 and singles at week 48. Conclusion: The results of this study illustrate the efficacy of MGB or OAGB procedures in significantly reducing weight in the short term. The %EWL increased with the follow up time and it was significantly associated with age and marital status

Association of Breakfast Intake with Obesity, Dietary and Physical Activity Behavior Among Urban School-Aged Adolescents in Delhi, India: Results of a Cross-Sectional Study

In developed countries, regular breakfast consumption is inversely associated with excess weight and directly associated with better dietary and improved physical activity behaviors. Our objective was to describe the frequency of breakfast consumption among school-going adolescents in Delhi and evaluate its association with overweight and obesity as well as other dietary, physical activity, and sedentary behaviors. Methods: Design: Cross-sectional study. Setting: Eight schools (Private and Government) of Delhi in the year 2006. Participants: 1814 students from 8th and 10th grades; response rate was 87.2%; 55% were 8th graders, 60% were boys and 52% attended Private schools. Main outcome measures: Body mass index, self-reported breakfast consumption, diet and physical activity related behaviors, and psychosocial factors. Data analysis: Mixed effects regression models were employed, adjusting for age, gender, grade level and school type (SES). Results: Significantly more Government school (lower SES) students consumed breakfast daily as compared to Private school (higher SES) students (73.8% vs. 66.3%; p<0.01). More 8th graders consumed breakfast daily vs. 10th graders (72.3% vs. 67.0%; p<0.05). A dose-response relationship was observed such that overall prevalence of overweight and obesity among adolescents who consumed breakfast daily (14.6%) was significantly lower vs. those who only sometimes (15.2%) or never (22.9%) consumed breakfast (p<0.05 for trend). This relationship was statistically significant for boys (15.4 % vs. 16.5% vs. 26.0; p<0.05 for trend) but not for girls. Intake of dairy products, fruits and vegetables was 5.5 (95% CI 2.4-12.5), 1.7 (95% CI 1.1-2.5) and 2.2 (95% CI 1.3-3.5) times higher among those who consumed breakfast daily vs. those who never consumed breakfast. Breakfast consumption was associated with greater physical activity vs. those who never consumed breakfast. Positive values and beliefs about healthy eating; body image satisfaction; and positive peer and parental influence were positively associated with daily breakfast consumption, while depression was negatively associated. Conclusion: Daily breakfast consumption is associated with less overweight and obesity and with healthier dietary-and physical activity-related behaviors among urban Indian students. Although prospective studies should confirm the present results, intervention programs to prevent or treat childhood obesity in India should consider emphasizing regular breakfast consumption.Obesity Prevention Center, University of MinnesotaPRIME program of the University of Texas, School of Public Health (Stigler, PI)Center for Health Promotion and Disease Prevention Research in Underserved Population

Undergraduate pharmacy students\u27 perceptions and experiences of a student-led clinic providing preventative services

\ua9 2024 The Author(s). Published by Oxford University Press on behalf of the Royal Pharmaceutical Society.Objectives: Authentic work-based learning is crucial to facilitate the development and preparedness for training healthcare professionals. Such experiences are challenging to design and secure within the clinical environment. One School of Pharmacy established a student-led clinic to provide undergraduate pharmacy students the opportunity to practise physical assessment and communication skills with members of the public. The aim of this study was to explore students\u27 thoughts and perspectives on this experience. Methods: Undergraduate students were invited to participate in a semi-structured interview after their clinic experience. Transcriptions of the interviews were analysed by reflexive thematic analysis. Results: Twelve students agreed to an interview that took place between October and December 2022. Three themes were identified from the qualitative data which related to external factors that influenced student experience of the clinic, for example, organizational issues and impact of the physical environment; interactions within the clinic environment; and internalized learning for example, professional growth and development, and the appreciating the learning opportunity. Conclusions: In the current climate, where securing valuable work-based learning opportunity is challenging, student-led clinics offer an environment that is well-received by students and appears to facilitate student professional development. Student clinics are receiving more attention and investment across undergraduate healthcare programmes around the world given advantages such as these. However, they need to be well integrated and structured into the existing training and education and students need appropriate induction to prepare them for the experience and manage expectations

Patient and public perception and experience of community pharmacy services post-discharge in the UK: a rapid review and qualitative study

OBJECTIVES: To investigate the perception and experience of patients and the public (PP) about community pharmacy (CP) services and other primary care services after hospital discharge back home. DESIGN AND SETTING: A rapid review and qualitative study exploring PP perceptions of primary care, focusing on CP services in the UK. METHODS: A mixed-methods approach was adopted including a rapid review undertaken between 24 April and 8 May 2019 across four databases (MEDLINE, EMBASE, PsycINFO and CINAHL). Semistructured interviews were then conducted investigating for shifts in current PP perception, but also nuanced opinion pertaining to CP services. A convenience sampling technique was used through two online PP groups for recruitment. Thematic framework analysis was applied to interview transcripts. PARTICIPANTS: Any consenting adults ≥18 years old were invited regardless of their medical condition, and whether they had used post-discharge services or not. RESULTS: Twenty-five studies met the inclusion criteria. Patients were generally supportive and satisfied with primary care services. However, some barriers to the use of these services included: resource limitations; poor communication between healthcare providers or between patient and healthcare providers; and patients' lack of awareness of available services. From the 11 interviewees, there was a lack of awareness of CP post-discharge services. Nevertheless, there was general appreciation of the benefit of CP services to patients, professionals and wider healthcare system. Potential barriers to uptake and use included: accessibility, resource availability, lack of awareness, and privacy and confidentiality issues related to information-sharing. Several participants felt the uptake of such services should be improved. CONCLUSION: There was alignment between the review and qualitative study about high patient acceptance, appreciation and satisfaction with primary care services post-discharge. Barriers to the use of CP post-discharge services identified from interviews resonated with the existing literature; this is despite developments in pharmacy practice in recent times towards clinical and public health services

Socioeconomic Inequalities in Secondhand Smoke Exposure at Home and at Work in 15 Low- and Middle-Income Countries.

INTRODUCTION: In high-income countries, secondhand smoke (SHS) exposure is higher among disadvantaged groups. We examine socioeconomic inequalities in SHS exposure at home and at workplace in 15 low- and middle-income countries (LMICs). METHODS: Secondary analyses of cross-sectional data from 15 LMICs participating in Global Adult Tobacco Survey (participants ≥ 15 years; 2008-2011) were used. Country-specific analyses using regression-based methods were used to estimate the magnitude of socioeconomic inequalities in SHS exposure: (1) Relative Index of Inequality and (2) Slope Index of Inequality. RESULTS: SHS exposure at home ranged from 17.4% in Mexico to 73.1% in Vietnam; exposure at workplace ranged from 16.9% in Uruguay to 65.8% in Bangladesh. In India, Bangladesh, Thailand, Malaysia, Philippines, Vietnam, Uruguay, Poland, Turkey, Ukraine, and Egypt, SHS exposure at home reduced with increasing wealth (Relative Index of Inequality range: 1.13 [95% confidence interval [CI] 1.04-1.22] in Turkey to 3.31 [95% CI 2.91-3.77] in Thailand; Slope Index of Inequality range: 0.06 [95% CI 0.02-0.11] in Turkey to 0.43 [95% CI 0.38-0.48] in Philippines). In these 11 countries, and in China, SHS exposure at home reduced with increasing education. In India, Bangladesh, Thailand, and Philippines, SHS exposure at workplace reduced with increasing wealth. In India, Bangladesh, Thailand, Philippines, Vietnam, Poland, Russian Federation, Turkey, Ukraine, and Egypt, SHS exposure at workplace reduced with increasing education. CONCLUSION: SHS exposure at homes is higher among the socioeconomically disadvantaged in the majority of LMICs studied; at workplaces, exposure is higher among the less educated. Pro-equity tobacco control interventions alongside targeted efforts in these groups are recommended to reduce inequalities in SHS exposure. IMPLICATIONS: SHS exposure is higher among the socioeconomically disadvantaged groups in high-income countries. Comprehensive smoke-free policies are pro-equity for certain health outcomes that are strongly influenced by SHS exposure. Using nationally representative Global Adult Tobacco Survey (2008-2011) data from 15 LMICs, we studied socioeconomic inequalities in SHS exposure at homes and at workplaces. The study showed that in most LMICs, SHS exposure at homes is higher among the poor and the less educated. At workplaces, SHS exposure is higher among the less educated groups. Accelerating implementation of pro-equity tobacco control interventions and strengthening of efforts targeted at the socioeconomically disadvantaged groups are needed to reduce inequalities in SHS exposure in LMICs

Funkcja endoprotezy onkologicznej w nawrotowym mięsaku kostno pochodnym dalszego końca kości udowej .

Endoprothesis is the commonly used method of segmental reconstruction after bone tumor resection around knee. To achieve stability after extensive removal of knee structures, hinged endoprostheses are usually being preferred as a limb salvage procedure. Despite advances in diagnostics and preoperative tumor chemotherapy and radiotherapy, as well as meticulous intraoperative preparation, local tumor recurrence is still possible. We analyzed 22 patients with osteosarcoma in distal femur who underwent the knee arthroplasty with modular replacement system between 2002 and 2007. Three of them (two females aged 33 and 44 and one male aged 29) developed local recurrence 7, 9 and 12 months after operation. All of them were offered the amputation or metastatectomy, as well as further chemotherapy, and all refused. Reasons for refusal included disseminated disease, uncertain prognosis of amputation treatment and still good functional outcome despite existing tumor around the prosthesis. Two of the above mentioned patients deceased from disseminated disease 7 and 11 months later, one patient is still being followed 10 months long. Clinical examinations have shown the effective and satisfactory prosthesis functions in reported patients during the whole observation period. We have concluded that limb salvage surgery with implantation of hinged knee endoprosthesis in tumors in distal femur provide satisfactory functional outcome even when local tumor recurrence is found.Endoproteza jest powszechnie używaną metodą segmentalnej rekonstrukcji po resekcji guzów kości w okolicy stawu kolanowego. Dla uzyskania stabilności po rozległym usunięciu struktur stawu kolanowego, protezy zawiasowe są zazwyczaj preferowane jako procedury oszczędzające kończynę. Pomimo zaawansowanej diagnostyki i przedoperacyjnej chemioterapii i radioterapii guza, jak również drobiazgowego śródoperacyjnego preparowania, miejscowa wznowa guza nadal jest możliwa. Przeanalizowaliśmy 22 pacjentów z mięsakiem kostnopochodnym dalszego końca kości udowej, którzy zostali poddani endoprotezoplastyce poresekcyjnej stawu kolanowego z użyciem modularnego systemu pomiędzy 2002r. a 2007r. U trzech z nich (dwie kobiety w wieku 33 i 44 lata i jeden mężczyzna w wieku 29 lat) rozwinęła się miejscowa wznowa 7, 9 i 12 miesięcy po operacji. Zaproponowano im amputację lub resekcję wznowy, jak również dalszą chemioterapię. Wszyscy odmówili. Przyczynami odmowy były: rozsiana choroba nowotworowa, niepewne rokowanie po amputacji i wciąż dobry czynnościowy wynik pomimo istniejącego guza wokół endoprotezy. Dwóch z tych pacjentów zmarło z powodu rozsianego procesu nowotworowego 7 i 11 miesięcy później, a trzeci chory był jeszcze obserwowany przez kolejnych 10 miesięcy. Kliniczna ocena pokazała wydolną i zadawalającą funkcję endoprotezy u opisywanych chorych podczas całego okresu obserwacji. Stwierdziliśmy, że operacje oszczędzające kończynę z wszczepieniem endoprotezy poresekcyjnej, zawiasowej stawu kolanowego w guzach dalszego końca kości udowej przynosi zadawalający wynik czynnościowy nawet kiedy występuje miejscowa wznowa guza

Economic analysis of farming and wild collection of seaweeds in Ramanathapuram District, Tamil Nadu

The commercially important red alga Kappaphycus alvarezii is widely cultivated along Tamil Nadu coast. Apart from farming, wild collection of seaweed is also being practiced by fishers for their livelihoods. The present study on economics and constraints of farming and wild collection of seaweeds was undertaken in the Ramanathapuram District of Tamil Nadu, employing an expost-facto research design. The study found that the total cost of production for fabricating one bamboo raft (12 x 12 feet) was `1,050/-. The crop duration was 45 days and four to six crops were harvested in a year. The average yield was 200-260 kg per raft per crop. The price of harvested kappaphycus on wet and dry weight basis were `4 and `37.50 per kg respectively. Majority of seaweed farmers earned around `50,000/- to 1,00,000/- annually and the profit margin was 60%. The average gross revenue per trip per group of five members for wild collection of seaweed worked out to `6,700/- and the capital productivity was 0.30. It is interesting to note that about 20% of the respondents were those who left fishing and switched to farming and wild collection of seaweeds