Pharmacy staff perceptions and self-reported behaviors related to providing contraceptive information and counseling

Pharmacy staff perspectives during a 2-year intervention that had a goal of reducing unintended pregnancy in 18-30 year old women were evaluated and studied in this article. Each pharmacy staff member completed a paper survey. The self-reported behaviors of the pharmacy staff members included displaying posters, brochures,  and shelf takers in their pharmacy. They also provided contraceptive information and counseling to patients that were coming into the pharmacy. Only 44% of the 192 pharmacy staff members that responded consistently provided contraceptive information and counseling. 90% felt that talking with the patient’s was easy showing that the staff was willing to work and make this topic a priority. This study showed that community pharmacy staff can make a big change in the adult women community about contraceptives and pregnancy planning. It showed that the staff are comfortable providing these services and talking to their patients as long as the patients also reciprocate.

I was surprised with the amount of pharmacy staff members that were counseling patients on this topic. I didn’t think that the percentage was that high but the study was pretty small. But regardless, counseling on unplanned pregnancy is fairly simple and doesn’t need too much personal information and medical background knowledge from the patient. It doesn’t have to take long and can make a big difference in the patients lives. I always wonder to what degree can the pharmacy field make counseling for some prescription mandatory? Should there be guidelines to when the counseling is mandatory given a certain risk factor or side effects of a given drug?

http://www.japha.org/article/S1544-3191(15)30107-2/abstractJ Am Pharm Assoc. 2015;55(5):481-487

Relationship between Nonmedical Prescription-Opioid Use and Heroin Use

Prescription opioid abuse has become a major public health issue in the United States and even locally here in Pittsburgh. In 2013, 10.3 million persons reported that they were using opioids for a nonmedical reason. Emergency room visits that involved misuse or abuse of opioids gotten from a prescription in the ED has increased 153% from 2004-2011. Death rates from these overdoses as quadrupled in 14 years.

Some people use heroin when they are unable to get prescription opioids. With the preventative measures put in place to decrease prescription opioid use there has been an increase in heroin use and deaths of heroin overdose. Heroin is pharmacologically similar to opioids. There has been evidence showing the substantial decrease in the cost of heroin in the last 30 years. The purity of the heroin on the streets has also increased which could be a factor in the increase in the rate of heroin.

In conclusion, data has indicated that nonmedical opioid use has a high risk factor for heroin use. A majority of current heroin users report having prescriptions opioids nonmedically before they use heroin. But, heroin use among people who use prescription opioids for nonmedically reasons is rare and the transition to heroin use is low. The article goes to talk about the best way to minimize overall opioid-related deaths is to help people that are already addicted and efforts to help prevent addiction. I definitely agree with this statement. I think that opioid prescriptions need to be better monitored similarly to the way certain cold medicines require scanning the customer’s ID before they can buy the product to keep track of the amount of them purchased. I think this is the first step in preventing opioid abuse.

Citation:

N Engl J Med. 2016; 374:154-163.

http://www.nejm.org/doi/full/10.1056/NEJMra1508490

 

Does thyroxine treatment improve emotional well being among women with subclinical hypothyroidism?

The main goal of this study was to determine if treatment of subclinical hypothyroidism during pregnancy improves the maternal emotional well being of the patient. Subclinical hypothyroidism is usually referred to as milk thyroid failure. It is diagnosed when the patient’s peripheral thyroid hormones are normal but their serum thyroid-stimulating hormones are mildly elevated. Only about 3-5% of the general population experiences this.

Women carrying health, normal, single pregnancies and that were diagnosed with SCH were randomized in the trial. The women could not have already been taking antidepressants or be diagnosed with depression. During the study, each patient was assessed for depressive symptoms using the CES-D scale for grading depression. The test was done prior to the third trimester of their pregnancy and then one year after giving birth.

Treatment with thyroxine or the placebo gave similar positive scores that were at baseline during the first testing. Treatment was not associated with improvements in median CES-D scores during the first testing before the third trimester. At one year postpartum, the frequency of positive screenings was higher for the placebo group but the difference was not significant. Treatment was overall not associated with improved emotional states in pregnant women. This treatment study is interesting because of the amount of women that experience post-partum depression. I have read about different homeopathic preventative measures that some women have tried but never knew if drugs were studied. I think it’s important to continue studying this disease state in pregnant women post birth because it has a big impact on the infants health and care. Should more money in the antidepressant field be going to preventative measures of post-birth depression in women?

Am J Obstet Gynecol. 2016;214(1):201-202.

https://www-clinicalkey-com.pitt.idm.oclc.org/#!/content/journal/1-s2.0-S0002937815017044

 

Familial Risk and Heritability of Cancer Among Twins in Nordic Countries

Cancer prevention has turned a new leaf since the use of genomics and hereditary studies to determine if a patient is at a greater risk for developing cancer. A study was conducted to estimate the family risk and heritability of certain cancers. This was done using a large group of twins. Over 80,000 monozygotic and 120,000 same-sex dizygotic twins were used from Denmark, Finland, Norway and Sweden.

Each set of twins were said to share environmental and heritable risk factors in the study. The incidents of cancer in the twins was what was measured and analyzed. Of the 32% of individuals that were diagnosed with cancer during the study, 38% of monozygotic and 26% of dizygotic pairs had the same type of cancer. There was an increase risk for one twin being diagnosed with cancer if their twin was just diagnosed also. Familial and cumulative risks were also higher in monozygotic twins. Skin melanoma was the largest heritability risk cancer from the ones studied that the twins were diagnosed with. Following this type were prostate, breast, and ovarian cancer.

If we know that these cancer types have an associated hereditary risk carried with them, is there any way that we can sequence more of these patient’s genomes to see if there is a gene associated with more cancer types? Decreasing our risks of cancer and knowing what risk we are at can make a big difference in the treatment plans if diagnosed. I believe that more work should be done in the field of prevention and early risk diagnosis and prevention in the cancer field.

Citation:

JAMA. 2016;315(1):68-76.

A National Profile of Family and Unpaid Caregivers Who Assist Older Adults With Health Care Activities.

Often times in the elderly community, family members and unpaid caregivers provide care for patients with poor mobility and those who can not take care of themselves anymore. Families sometimes steer away from nursing homes and other establishments because they want their family members to reside at their homes and remain as comfortable as possible. A research study was published to JAMA Internal Medicine that investigated the responsibilities and effects of the health care provided to the patients on the caregivers. Effects were categorized as emotional, financial, and physical difficulties due to taking care of their family members.

The results showed that from the large pool of caregivers and older adults, 44.1% of caregivers provided substantial help to their family members and almost half of those caregivers were providing help to patients with dementia. Only 26.1% of caregivers provided no health care. The caregivers that were providing substantial help assisted patients for 28.1 hours a week and experienced more physical, emotional, and financial difficulties than the caregivers that provided no help. They were also five times more likely to not participate in events and activities that they wanted to personally because of work responsibilities.

This article really showed how much family members and unpaid caregivers sacrifice everyday to help their loved ones. It made me wonder if the government or insurance companies should financial help unpaid caregivers because they are keeping the patients out of the hospitals and nursing facilities and ultimately saving the insurance companies money. Do you think there should be government or insurance financial sponsorship and support for unpaid caregivers?

Citation:

AMA Intern Med. 2015;175(10):1640-1641.

http://archinte.jamanetwork.com/article.aspx?articleid=2491683

Metabolic Syndrome Among Marijuana Users in the United States: An Analysis of National Health and Nutrition Examination Survey Data

The National Institute of Health and Drug Abuse sponsored a research study the relationship between marijuana use and a person’s overall metabolism and health. Medical marijuana has been legalized and THC-based medications are used to decrease pain, inflammation, and control muscle spasms and epileptic seizures.

In this study, 20-59 year olds completed surveys from 2005-2010 and categorized their marijuana use as never used, past used (not within the last 30 days) or current use. The age groups were split and analyzed for metabolic syndrome. The research study defined metabolic syndrome as having 3 or more of the following diagnostic states: elevated fasting glucose, high triglycerides, low HDL, elevated hypertension, and increased waist circumference.

The results of the study showed that 13.8% of current marijuana users and 17.5% of past marijuana users presented metabolic syndrome. 19.5% of never users had the syndrome. Adults ages 20-30 who were current users were 54% less likely to present metabolic syndrome than adults in that same age range that never used marijuana. The study concluded that marijuana use was linked to lower odds of metabolic syndrome but there is no researched reason for these outcomes yet.

I thought this article was very interesting seeing that marijuana is slowly being legalized in more and more cities. Its important to note that thought this article seems to show benefits of marijuana use, there are definitely consequences of it also. I wonder if there is any way that the drug can be compounded differently to only exhibit the positive effects of it and not the CNS effects that coincide with marijuana use. Could this be a new preventative obesity pill in the future?

Citation:

Am J Med. 2016;129(2):173-179.

http://www.amjmed.com/article/S0002-9343(15)01024-4/pdf

Congress Seeks FDA Documents About Generic Drug Approvals

The use of generic drugs has been rising since drug costs have increased exponentially. As the article reports, about 86% of prescriptions filled in the United States are for generic drugs. Knowing that generic and brand name drugs are supposed to have the similar efficacy, treatment, and mechanism of action, these drugs need to start being held to a higher standard because of their popular use. The chair of the House of Committee on Oversight and Government reform and many other members are asking the FDA for more information on which standards and processes generic drugs go through to be approved.

The committee is also investigating the fine line between generic drug costs and the ever changing development and innovation of new drugs. Obviously generic drugs costs should be kept to a minimum so that the patient can afford them. Therefore, should drug developers stop their projects when they see that they are in a deficit and have to increase the generic drugs costs to pay for their new innovations? In recent years, there has also been a drop in the generic drug companies and the committee is investigating if these drug companies are reducing competition amongst each other to monopolize their drug or drugs that they produce.

If the cost of a generic drug is 80-80% less than its brand-name counterpart, there needs to be closer monitoring at the production and efficacy of these drugs. The FDA needs to be able to release the research information that says that these generic drugs can stand on their own as therapeutic treatments to the common disease states that they are being used. There has to be some substantial difference in the production of these drugs that keeps them low and if this difference greatly hinders therapeutic goals of the drug then we should all be informed.

Citation:

JAMA. 2016;315(6):549

http://jama.jamanetwork.com/article.aspx?articleid=2488288

 

The Obesity Epidemic- Understanding the Disease and the Treatment

Childhood obesity has been a hot topic in recent years. From Michelle Obama’s program to reconstruct school lunches to the many childhood fitness centers opening up, the health of our future has been on everyone’s mind. The prevalence of childhood obesity has risen from 4% to 6% from 1999-2004 to during 2011-2012 as stated in the article. Our children’s chances for more serious diseased states in their later years is increasing with every incidence of severe childhood obesity.

In this editorial, there is good evidence showing that obesity can be considered a disease that is initiated by interactions of genetics and the environment. Around 90% of children with severe obesity will become obese adults. The disease may start off as a lifestyle problem, but it can rapidly lead to energy-balance imbalances. In a way, the body sets a new body-weight set point and continues to try to maintain that.

It’s most important to note that none of the medications that have recently been approved and studied in adults to lower body weight have been studied in children. These drugs such as phentermine, lorcaserin, liraglutide have no evidence backing their use in the younger obese population. This puts a damper on the treatment of childhood obesity and the prevention of what disease states await these children. Bariatric surgery has been used on some adolescents as a means of sustained weight loss. But, the risks and benefits have yet to be closely analyzed in this population. There are social benefits to the patient but longitudinal studies of these patients still has to be done to establish if there are any long term risks. The main point of the article is that obesity is difficult to manage and prevention is one of the best and only ways that we can safely target our adolescent and child population against this disease. Lifestyle interventions should be closely instituted in children and followed through during their learning ages to best equip them to make the healthiest and safest decisions in their lives.

Knowing that lifestyle is one of the biggest preceptors to childhood obesity, should the parents of obese children be instructed to take parental guidance classes to help themselves and their children make healthier lifestyle changes?

 

 

Citation:

N Engl J Med. 2016; 374:177-179

http://www.nejm.org/doi/full/10.1056/NEJMe1514957