Patient medication knowledge and adherence to asthma pharmacotherapy: a pilot study in rural Australia

Asthma is a chronic disease with both inflammatory and bronchoconstrictive elements and often requires multiple medications. Most asthma regimens include medications with different therapeutic modes of action and a number of different medication delivery devices. To effectively participate in their asthma management, patients need to recognize each of their medication types, understand their purpose, adhere to their treatment regimen, and be proficient in using the required delivery devices. This study evaluated patient knowledge of asthma pharmacotherapy and adherence. An interview study was undertaken in two rural locations, in Australia, to elicit participants' knowledge, use, and inhalation device technique. Of participants, 75.9% used preventer medication and the remaining 24.1% used reliever medication only. Of those using preventer medication, 82.5% could distinguish their preventer from a range of asthma medicines. Metered dose inhalers (MDIs) were used by 80% of participants; 23% used a Turbuhaler®; 24% used an Accuhaler®; and 5% used an MDI with a spacer device. The study established poor medication knowledge, suboptimal device technique, and disturbing levels of adherence with management recommendations. Asthma education strategies need to be modified to engage patients with low asthma knowledge to achieve improved patient outcomes. Further, strategies need to motivate patients to use preventer medication during times when they feel well

Qualitative Interviews of Romanian Key Informants Guiding a Preliminary Health Needs Assessment of Romanian Immigrants in Southern California

Background: Current literature suggests that immigrant populations face greater challenges in regards to health and healthcare which are caused by a variety of factors, including language, socioeconomic status, acculturation, and health beliefs. The scope of this research was to conduct a preliminary health needs assessment of the Romanian-American population as a first step towards creating culturally tailored health programs to meet their needs. Methods and Results: Qualitative data was acquired through semistructured interviews with key stakeholders (n= 5) in the Romanian health care system, in Romania, revealing a total of 5 themes. The data was compiled and analyzed to discover the main health beliefs that contribute to the health behaviors present in this population. Conclusion: These data begin to identify important health beliefs and risk factors unique to this population and clarify priorities for future research in the U.S

A Comparison of Network Sampling Designs for a Hidden Population of Drug Users: Random Walk vs. Respondent-Driven Sampling

Both random walk and respondent-driven sampling (RDS) exploit social networks and may reduce biases introduced by earlier methods for sampling from hidden populations. Although RDS has become much more widely used by social researchers than random walk (RW), there has been little discussion of the tradeoffs in choosing RDS over RW. This paper compares experiences of implementing RW and RDS to recruit drug users to a network-based study in Houston, Texas. Both recruitment methods were implemented over comparable periods of time, with the same population, by the same research staff. RDS methods recruited more participants with less strain on staff. However, participants recruited through RW were more forthcoming than RDS participants in helping to recruit members of their social networks. Findings indicate that, dependent upon study goals, researchers' choice of design may influence participant recruitment, participant commitment, and impact on staff, factors that may in turn affect overall study success

Intertester reliability of brachial artery flow-mediated vasodilation using upper and lower arm occlusion in healthy subjects

The assessment of endothelial function as brachial artery flow-mediated vasodilatation is a widely used technique that determines the effect of risk factor intervention and may have the potential to predict the clinical benefit of antiatherogenic therapy. Previous studies suggest that flow-mediated dilation is greater using the upper-arm occlusion technique, but no data are available to compare intertester reliability between technicians. This study was undertaken to compare the amount of hyperemia between upper and lower occlusion techniques and to determine reproducibility between testers. Nineteen healthy adults, ages 25 to 50, were included in the study. Brachial artery vasodilatation was measured 1 and 3 minutes post cuff deflation and was compared with the baseline and expressed as a percent change. There was a tester effect in the percent change in diameter across all measurements. The results of this study reveal inconsistencies between testers when using a blood pressure cuff to induce hyperemia for the assessment of endothelial function through brachial artery flow-mediated vasodilation. However, upper arm as compared to lower arm blood pressure cuff occlusion results in significantly greater hyperemia and vasodilatation, even though there was a difference in measurements between testers

Research that Drives Change : Conceptualizing and Conducting Nationally Led Violence Prevention Research. Synthesis Report of the “Multi-Country Study on the Drivers of Violence Affecting Children” in Italy, Peru, Viet Nam and Zimbabwe

Globally, studies have demonstrated that children in every society are affected by physical, sexual and emotional violence. The drive to both quantify and qualify violence through data and research has been powerful: discourse among policy makers is shifting from “this does not happen here” to “what is driving this?” and “how can we address it?” To help answer these questions, the MultiCountry Study on the Drivers of Violence Affecting Children – conducted in Italy, Viet Nam, Peru and Zimbabwe – sought to disentangle the complex and often interrelated underlying causes of violence affecting children (VAC) in these four countries. Led by the UNICEF Office of Research – Innocenti with its academic partner, the University of Edinburgh, the Study was conducted by national research teams comprised of government, practitioners and academic researchers in each of the four countries. Drawing on human-centred principles, the Study used an iterative approach which put national ownership and co-creation at its core. Government partners were actively engaged as co-researchers and all data analysis was conducted in-country by government statisticians. Facilitating and prioritizing national meaningmaking through dialogue and joint analysis and synthesis of findings was also a key part of the Study design. Each national team used a common process involving three separate components, all of which build on existing data and research: a systematic literature review of academic and ‘grey’ literature (such as research reports) including both quality quantitative and qualitative research, secondary analyses of nationally representative data sets and an initial mapping of the interventions landscape. Analysed together, these sources of information helped build initial hypotheses around what drives violence in each country. Two key frameworks were applied to the analysis in this Study: 1) a version of the socio-ecological model, which helps to understand the dynamic relationships between factors at the micro-, mesoand macro-levels, and 2) an age and gender framework, which recognizes that a child’s vulnerability and ability to protect herself from violence changes over time with her evolving capacities. Through these lenses, common themes emerged across contexts. Guided by findings from the four countries highlighting the dynamic and constantly changing and/or overlapping domains that shape violence in children’s lives, this Study moved beyond understanding the risk and protective factors for violence affecting children, which are often measured at the individual, interpersonal and community level. In doing so, it demonstrated how patterns of interpersonal violence are intimately connected to larger structural and institutional factors—or the drivers of violence. The structural drivers of violence identified across the four country sites, representing high (Italy), upper middle (Peru), lower middle (Viet Nam) and low income (Zimbabwe) settings, include: rapid socio-economic transformations accompanied by economic growth but also instability; poverty; migration; and gender inequality. The institutional drivers of violence, such as legal structures, ineffective child protection systems, weak school governance and harmful social and cultural norms, often serve to reinforce children’s vulnerabilities. Drivers are rarely isolated factors and tend to work in potent combination with other factors within a single level as well as between levels of the social ecology that shapes children’s lives. While some drivers can lead to positive change for children, in this study, these factors or combinations of factors are most often invisible forms of harm in and of themselves. While VAC is present in every country, the analyses also show how violence conspires unevenly to create and maintain inequalities between and within countries. The institutions and communities upon which children and their families depend are changing social entities with many interdependent parts. The type of violence in any one or multiple settings may vary depending on a variety of risk or protective factors and/or by age and gender. One of the most important findings is that violence is a fluid and shifting phenomenon in children’s lives as they move between the places where they live, play, sleep and learn. Identifying and addressing unequal power dynamics – wherever they may occur in the home, school or community – is of central importance to effective violence prevention. The research also shows how behaviours around violence are passed through generations, suggesting that the social tolerance of these behaviours is learned in childhood. Data across countries also shows how violence is intimately connected to how relationships are structured and defined by power dynamics within and among families, peers and communities. These findings, along with learning from the study process, led to the development of a new childcentred and integrated framework, which proposes a process by which interdisciplinary coalitions of researchers, practitioners and policymakers can understand violence affecting children and what can be done to prevent it. Using data to drive change, our proposed Child-Centred and Integrated Framework for Violence Prevention serves to situate national findings according to a child’s social ecology, making clear how institutional and structural drivers and risk/protective factors together shape the many risks and opportunities of childhood around the world

A pharmacovigilance study of anti-depressant agents in psychiatric patients at a tertiary care teaching hospital

Background: Anti-depressant drugs have great benefit in treating a many psychiatric disorders, including schizophrenia and bipolar disorder, although all these drugs are associated with many potential adverse effects. In this study, the occurrence of adverse effects like weight gain, sleep disturbances, dry mouth were assessed and reported in drug naïve patients Anti-depressant drugs.Methods: It is a prospective observational study of patients attending Psychiatry department in NRI General Hospital of age 10 to 80 years who were prescribed with anti-depressant drugs. The study was conducted for a period of 8 months from June 2018 to February 2018.Results: Among 86 patients prescribed with antidepressants, the occurrence of adverse drug reactions due to antidepressants was 60.78% with Selective serotonin reuptake inhibitors being the most common class of drugs implicated for adverse drug reactions followed by 24.49% with Tricyclic antidepressants. A total of 51 adverse drug reactions were noted of which weight gain was most common, closely followed by sleep disturbances and drowsiness. Out of 52 adverse drug reactions assessed for causality, 88.2% of the adverse drug reactions cases were probable, while 11.7% were possible. According to Hartwig and Siegel’s Scale 84.3% of the cases are found to be mild, 15.68% moderate.Conclusions: The study allows knowing information about the occurrence and pattern of adverse drug reactions associated with Anti-depressant drugs in the population thus reducing its incidence and protecting the user population from available harm

The experience of antenatal hospitalization among high-risk pregnant women

Pregnancy is a multi-dimensional experience that affects a woman physically, psychologically, and socially, in which hopes and expectations for the pregnancy and becoming a mother are developed. However, when women experience a high-risk pregnancy, the hopes of a rewarding experience are shattered. These women could have difficulty with the mothering role after birth and their mental health or parenting ability could be impacted. If there are major discrepancies between maternal expectations and actual experiences, taking on the maternal role could be negatively impacted (Rubin, 1984). The purpose of the study was to describe the high-risk pregnant woman’s experience of antepartum hospitalization. Specific aims for the study were to discover how the hospitalized high-risk pregnant woman felt about her unborn baby and to describe how the hospitalized high-risk pregnant woman cognitively constructed her transition to becoming a mother. The study was conducted using a hermeneutic, phenomenological approach. Rubin’s (1984) work on maternal identity was used to guide the study. Additionally, the philosophy of Merleau-Ponty (1945/2012) was used to understand the unique lived experiences of hospitalized high-risk pregnant women. Thirteen hospitalized, high-risk pregnant women, with an average age of 27.5 years (range: 20-38), were interviewed for the study. The average number of weeks gestation of the participants was 28.19 (range: 22 6/7-33 5/7 weeks gestation). Thematic analysis of high-risk pregnant women’s hospital experiences yielded the overarching theme, Doing Whatever It Takes, and four additional themes: Flooding Emotions from Hospitalization, Struggling with Uncertainty and Changing Expectations, Dealing with Hospitalization, and Anticipating Motherhood. Doing Whatever It Takes was expressed as a prominent way of dealing with the hospitalization and the unanticipated changes in their pregnancies, with many expressing the will to fight for their babies no matter the difficulties they faced. The initial response to the hospitalization caused a wide range of negative emotions, with some women grieving the loss of the idealized pregnancy, while others grieved missing out on the events of pregnancy (e.g., baby showers and preparing the nursery). Despite these difficulties, all women considered the hospital as a safe place for them, knowing they and their babies were close to care, if needed. Various ways of Dealing with the Hospitalization included holding on to hope, keeping a positive attitude, relying upon God, and feeling supported. Overall, most women expressed excitement for their babies and becoming a mother, with some already seeing themselves as mothers. Many women described their babies in the present tense and expressed their thoughts of what their babies would be like in the future (e.g., size and personality). However, not all women saw themselves as mothers “until the baby was born” or “hoping it would develop (being mother) after the baby was born.” Some women described the relationship with their babies as close already, while a few stated they did not have a relationship with the baby yet, but expected it to form once the baby arrived. Three new findings emerged from this study. First, the developing relationship between a mother and baby was described as growing stronger as the pregnancy continued. Second, the use of technology to stay connected to family and friends during hospitalization was reported as being helpful. Finally, previous studies reported deleterious physical effects of bed rest; whereas in this study, women described emotional effects, rather than physical effects

Identification of folate receptor α (FRα) binding oligopeptides and their evaluation for targeted virotherapy applications

Oncolytic virotherapies (OV) based on human adenoviral (HAdV) vectors hold significant promise for the treatment of advanced ovarian cancers where local, intraperitoneal delivery to tumour metastases is feasible, bypassing many complexities associated with intravascular delivery. The efficacy of HAdV-C5-based OV is hampered by a lack of tumour selectivity, where the primary receptor, hCAR, is commonly downregulated during malignant transformation. Conversely, folate receptor alpha (FRα) is highly expressed on ovarian cancer cells, providing a compelling target for tumour selective delivery of virotherapies. Here, we identify high-affinity FRα-binding oligopeptides for genetic incorporation into HAdV-C5 vectors. Biopanning identified a 12-mer linear peptide, DWSSWVYRDPQT, and two 7-mer cysteine-constrained peptides, CIGNSNTLC and CTVRTSAEC that bound FRα in the context of the phage particle. Synthesised lead peptide, CTVRTSAEC, bound specifically to FRα and could be competitively inhibited with folic acid. To assess the capacity of the elucidated FRα-binding oligopeptides to target OV to FRα, we genetically incorporated the peptides into the HAdV-C5 fiber-knob HI loop including in vectors genetically ablated for hCAR interactions. Unfortunately, the recombinant vectors failed to efficiently target transduction via FRα due to defective intracellular trafficking following entry via FRα, indicating that whilst the peptides identified may have potential for applications for targeted drug delivery, they require additional refinement for targeted virotherapy applications