Pharmacists' Perceptions of Mental Well-Being and Immunization Safety During COVID-19

Purpose: To assess pharmacists' mental well-being, perceptions of safety, and willingness to administer vaccines before and during the COVID-19 pandemic. Methods: An electronic survey was administered to a convenient sample of practicing pharmacists working in Alabama, Tennessee and Texas. The 33-item survey examined pharmacists' beliefs about the pandemic's impact on their mental well-being, their perceptions of safety in vaccine administration, and their willingness to vaccinate. Responses were assessed on a 5-point Likert scale, ranging from strongly disagree (1) to strongly agree (5). A recruitment email with the survey link was sent to pharmacists, with periodic reminders over a 4-week period. Descriptive statistics and bivariate analyses were utilized to evaluate survey responses. Results: A total of 387 responses were analyzed, with an estimated response rate of 3.93%. Most respondents were women (65%) and had at least 6 to 10 years of practice experience (28%). Overall, participants felt that the pandemic worsened their mental well-being, with women reporting a more negative mental well-being compared with men (P < .001). They reported having less time during workflow to apply personal protective equipment (PPE) (P = .0074) compared to before the pandemic. They also reported a decrease in willingness to vaccinate adult patients during the pandemic (P < .0001), and that concern about contracting COVID-19 prevented them from giving vaccinations (P < .0001). Conclusions: Pharmacists felt their mental well-being and willingness to vaccinate patients suffered as a result of the COVID-19 pandemic. Future research and initiatives that focus on improving vaccination rates should also consider pharmacists' concerns and well-being.

Development of a comprehensive genome-wide cardiovascular disease genetic risk assessment test

BACKGROUND

Despite monogenic and polygenic contributions to cardiovascular disease (CVD), genetic testing is not widely adopted, and current tests are limited by the breadth of surveyed conditions and interpretation burden.

METHODS

We developed a comprehensive clinical genome CVD test with semi-automated interpretation. Monogenic conditions and risk alleles were selected based on systematic assessment of the strength of disease association and evidence for increased disease risk, respectively. Non-CVD secondary finding genes, pharmacogenomic (PGx) variants and CVD polygenic risk scores (PRS) were also assessed for inclusion. Test performance was modeled using 2,594 genomes from the 1000 Genomes Project, and further investigated in 20 previously tested individuals.

RESULTS

The CVD genome test is composed of a panel of 215 CVD gene-disease pairs, 35 non-CVD secondary findings genes, 4 risk alleles or genotypes, 10 PGx genes and a PRS for coronary artery disease. Modeling of test performance from samples in the 1000 Genomes Project revealed ~6% of individuals with a monogenic finding in a CVD-associated gene, 6% with a risk allele finding, 0.9% with a non-CVD secondary finding, and 93% with CVD-associated PGx variants. Assessment of blinded clinical samples showed complete concordance with prior testing. An average of 4 variants were reviewed per case, with interpretation and reporting time ranging from 9-96 min.

CONCLUSIONS

A genome sequencing based CVD genetic risk assessment can provide comprehensive genetic disease and genetic risk information to patients with CVD. The semi-automated and limited interpretation burden suggest that this testing approach could be scaled to support population-level initiatives.

Provider perceptions of barriers to biosimilar utilization in community oncology practices

BACKGROUND

Biosimilars reduce the burden of cost on patients and payers, and so doing, increase access to life-saving care. However, biosimilar uptake in the US has been inconsistent.

OBJECTIVES

This study assessed provider perceptions of barriers to biosimilar use and their relationships to utilization rates in a large, national oncology network and examined if perceptions differed by demographic and practice characteristics.

METHODS

A 28-item survey was administered to 400 network physicians, pharmacists, nurses, and administrators, spanning 25 provider groups, and measured 1) barriers to use categorized into 4 subscales-payer-related, provider-related, operational, and patient-related, using a Likert scale ranging from Never (1) to Always (5); and 2) demographic and practice characteristics. Utilization rates were assessed using aggregated patient-level drug administration data found in the electronic health record system. Descriptive and inferential statistics were used to describe responses and assess relationships between variables.

RESULTS

A total of 46 responses were analyzed, with a response rate of 11.5%. Most respondents were female (55.6%), physicians (52.2%), with over 6 years of experience (67%). A majority worked in practices participating in the Oncology Care Model (86.7%) and received continuing education on biosimilars (84.8%). Overall scale score was moderately low (mean=2.31), indicating low levels of perceived barriers. The lowest subscale score was operational barriers (mean=2.21), while payer-related barriers was the highest (mean=2.78). Perceptions of barriers did not differ based on demographic and practice characteristics. The average biosimilar utilization rate was 66.2%, with practices in the West administering biosimilars most frequently (71.8%). Utilization was not impacted by perceptions of barriers.

CONCLUSION

Perceived barriers to biosimilar utilization were not common and not associated with utilization. Infrequent impediments to utilization may be associated with network-wide emphasis on continuing education and a value-based care environment. Future research should consider other practice- and patient-level factors that may impact biosimilar utilization.

A framework for the evaluation and reporting of incidental findings in clinical genomic testing

Currently, there are no widely accepted recommendations in the genomics field guiding the return of incidental findings (IFs), defined here as unexpected results that are unrelated to the indication for testing. Consequently, reporting policies for IFs among laboratories offering genomic testing are variable and may lack transparency. Herein we describe a framework developed to guide the evaluation and return of IFs encountered in probands undergoing clinical genome sequencing (cGS). The framework prioritizes clinical significance and actionability of IFs and follows a stepwise approach with stopping points at which IFs may be recommended for return or not. Over 18 months, implementation of the framework in a clinical laboratory facilitated the return of actionable IFs in 37 of 720 (5.1%) individuals referred for cGS, which is reduced to 3.1% if glucose-6-phosphate dehydrogenase (G6PD) deficiency is excluded. This framework can serve as a model to standardize reporting of IFs identified during genomic testing.

Determinants of Human Papillomavirus (HPV) vaccination intentions among young adult college students using the theory of planned behavior

Purpose: To determine college students' intentions to be Human Papillomavirus (HPV) vaccinated. Methods: The study was comprised of college students aged 18-45 years. A survey was developed based on the Theory of Planned Behavior (TPB). The significance of the TPB constructs-attitude, subjective norms, and perceived behavioral control-and an additional construct-knowledge-in predicting intention were assessed. Results: The regression model containing attitude, subjective norms and perceived behavioral control accounted for 40% of the variance in intention. Attitude and subjective norms were significant predictors, while perceived behavioral control was not. Provider recommendation was the only significant covariate. Knowledge did not significantly contribute to the model. Discussion: The TPB was useful in predicting HPV vaccination intentions. A focus on attitude, subjective norms and provider recommendation may be useful in creating new or enhancing existing interventions.

A narrative review of the well-being and burnout of U.S. community pharmacists

OBJECTIVES

The purpose of this narrative review is to summarize the literature on well-being and burnout among community pharmacists in the U.S. and provide recommendations for future research.

METHODS

Relevant literature was identified by searching PubMed for combinations of keywords such as "burnout" and "well-being" combined with "pharmacists." Titles and abstracts were reviewed for relevancy, and full text articles were reviewed when applicable.

RESULTS

While burnout is defined by its 3 core symptoms of emotional exhaustion, depersonalization, and low personal accomplishment, well-being is more challenging to define and measure, which has led to it being less studied. Community pharmacists faced high rates of burnout, low quality of life (QOL), and extreme fatigue prior to the COVID-19 pandemic, a situation that has likely only worsened. Factors such as workload, the type of community pharmacy, the level of education or training of the pharmacist, and stress may be some of the contributors to high rates of burnout. Clinician burnout may be related to high rates of mental health disorders seen in pharmacists, may impact patient safety and satisfaction, and may affect productivity and costs to employers and the healthcare system overall. There has been no research into interventions or strategies to support well-being and reduce burnout among community pharmacists, but having a workplace that is perceived as supporting well-being may have some impact. Recommendations for future research include the following: (1) define well-being, (2) explore why various factors support well-being or contribute to burnout, (3) determine the impact of community pharmacists experiencing well-being or burnout, and (4) develop strategies to support well-being and reduce burnout that are specific to community pharmacy.

CONCLUSION

There is a sparsity of evidence regarding community pharmacist well-being and burnout. Further research is needed to generate the evidence needed to support interventions that are specific to the unique work setting of community pharmacists.

Pregnancy-related risk factors and receipt of postpartum care among Texas Medicaid pregnant enrollees: Opportunities for pharmacist services

BACKGROUND

The United States (US) experiences the highest rate of maternal mortality of similar countries. Postpartum care (PPC) focused on chronic disease management is potentially lifesaving, especially among pregnancies complicated by risk factors such as diabetes, hypertension, and mental health conditions (MHCs), which are conditions in which pharmacists can have an impact.

OBJECTIVE

To evaluate the prevalence of maternal mortality risk factors and their relationships with receipt of PPC among Texas Medicaid enrollees.

METHODS

A retrospective study included women with a delivery between 3/25/2014-11/1/2019 who were continuously enrolled in Texas Medicaid during the study period from 84 days pre-delivery to 60 days post-delivery. PPC was defined as ≥1 visit associated with postpartum follow-up services. Maternal mortality risk factors (diabetes, hypertension, and MHCs) during and after pregnancy were identified using diagnoses and medication utilization. Age, race/ethnicity, cesarean delivery, and preterm birth served as covariates. Multivariable logistic regression was used to address the study objective.

RESULTS

The sample (N = 617,010) was 26.5±5.7 years, primarily (52.8%) Hispanic, and 33.0% had cesarean deliveries and 9.3% had preterm births. Risk factor prevalence included: diabetes (14.0%), hypertension (14.3%), and MHCs during (6.3%) and after (9.1%) pregnancy. A majority (77.9%) had a PPC visit within 60 days of delivery. The odds of receiving PPC were 1.2 times higher for patients with diabetes (OR = 1.183; 95% CI = 1.161-1.206; P < 0.0001), 1.1 times higher for patients with hypertension (OR = 1.109; 95% CI= 1.089-1.130; P < 0.0001), and 1.1 times higher for patients with MHCs (OR=1.138; 95% CI = 1.108-1.170; P < 0.0001) than patients without, respectively.

CONCLUSION

Over three-quarters of Texas Medicaid pregnant enrollees received PPC within 60 days of delivery and risk factors were prevalent and predictive of receipt of PPC. Pharmacists can have a positive impact on maternal health by addressing hypertension, diabetes, and MHC risk factors.

The smallest likely pathogenic duplication of a SOX9 enhancer identified to date in a family with 46,XX testicular differences of sex development

Copy number variants that duplicate distal upstream enhancer elements of the SOX9 gene cause 46,XX testicular differences of sex development (DSD) which is characterized by a 46,XX karyotype in an individual presenting with either ambiguous genitalia or genitalia with varying degrees of virilization, including those resembling typical male genitalia. Reported duplications in this region range in size from 24 to 780 kilobases (kb). Here we report a family with two affected individuals, the proband and his maternal uncle, harboring a 3.7 kb duplication of a SOX9 enhancer identified by clinical genome sequencing. Prior fluorescence in situ hybridization (FISH) for SRY and a multi-gene panel for ambiguous genitalia were non-diagnostic. The unaffected mother also carries this duplication, consistent with previously described incomplete penetrance. To our knowledge, this is the smallest duplication identified to-date, most of which resides in a 5.2 kb region that has been previously shown to possess enhancer activity that promotes the expression of SOX9. The duplication was confirmed by quantitative-PCR and shown to be in tandem by bidirectional Sanger sequencing breakpoint analysis. This finding highlights the importance of non-coding variant interrogation in suspected genetic disorders.

Evaluating the relationship between patient activation and health-related quality of life (HRQOL) in patients with pancreatic cancer (PwPC)

PURPOSE

Advanced pancreatic cancer is synonymous with a high mortality rate, debilitating symptom profile, and minimal prolongation in overall survival. Therefore, health-related quality of life (HRQOL) is important in patients with pancreatic cancer (PwPC). In chronic conditions, patient activation is positively associated and higher HRQOL. However, no known study has evaluated patient activation, HRQOL, and their association in PwPC.

METHODS

A 43-item cross-sectional survey assessed patient activation and HRQOL of patients with locally advanced and metastatic pancreatic cancer undergoing chemotherapy. Variables were analyzed descriptively, and relationships were assessed using bivariate statistics (sig p < 0.05).

RESULTS

Fifty-six patients participating in the study had an average age of 69.5 ± 11.1 years, and the majority were females (51.8%), Caucasians (61.8%), married/partnered (64.3%), and had at least a college degree (59%). Almost half were at stage 4 (48.2%), and most were newly diagnosed (66.1%). Mean patient activation score was 63.5 ± 17.2 (scale range: 0-100), with most at higher activation levels of 3 or 4 (66.7%). Mean HRQOL score of 41.0 ± 12.7 (scale range: 0-72) was low. Patient activation levels, age, education level, and gender explained 21% of variation in overall HRQOL scores. Patients at activation level 4 had significantly higher overall HRQOL versus those at lower activation (level 1 or 2). Higher patient activation was significantly associated with having either private insurance only or multiple insurances and being partnered.

CONCLUSION

Patient activation significantly predicted HRQOL in PwPC despite the low sample size. Initiatives to increase patient activation should focus on patients of low socioeconomic status and those without partner support.

Perceived Discrimination in the Community Pharmacy: A Cross-Sectional, National Survey of Adults

BACKGROUND

Discrimination experiences have been documented in various health care settings; little is known about discrimination experiences in the community pharmacy setting.

OBJECTIVES

This study aimed to (1) describe perceived everyday discrimination, including racial discrimination, in community pharmacies, (2) examine factors associated with perceived everyday discrimination, (3) examine the relationship between perceived racial discrimination and delays in picking up prescriptions, and (4) examine the relationship between perceived racial discrimination and forgoing prescriptions.

METHODS

A cross-sectional survey was conducted in 2021 with a U.S. Qualtrics research panel. The 9-item Everyday Discrimination Scale (EDS) was used to assess perceived discrimination (range 9-45, higher scores indicate higher perceived discrimination). One question asked whether respondents perceived racial discrimination. Two questions asked whether respondents delayed or forwent getting a prescription(s) in the past year. Descriptive statistics were calculated for all variables. A generalized linear model examined factors associated with perceived discrimination; logistic regression examined the relationships between perceived racial discrimination and delays in getting or forgoing prescription(s).

RESULTS

Participants (n = 578) were 40.2 (±16.5) years old. Most were white (55.5%), 24.4% were black, and 29.4% were Hispanic or Latino. The mean EDS score was 16.5 (±8.8); 18.7% perceived racial discrimination. Overall, 36.3% and 33.0% reported a delay in getting and forgoing their prescriptions, respectively. Age (P < 0.0001), sexual identity or orientation (P = 0.010), ethnicity (P = 0.049), annual income (P = 0.012), and prescription insurance (P = 0.008) were associated with perceived discrimination. Those with perceived racial discrimination had significantly higher odds of a delay in getting their prescription(s) than those without perceived racial discrimination (odds ratio 2.6 [95% CI 1.3-5.3]).

CONCLUSIONS

Study findings elucidate discrimination experiences in the community pharmacy and the impact of racial discrimination on individuals' decision in obtaining their medications in a timely manner. Community pharmacy staff need to recognize their implicit biases and obtain training on best practices that promote equitable treatment of diverse patients.

Opioid harm reduction: A scoping review of physician and system-level gaps in knowledge, education, and practice

Background: Harm reduction includes treatment and prevention approaches rather than abstinence, as a public health strategy for mitigating the opioid epidemic. Harm reduction is a new strategy for many healthcare professionals, and gaps in knowledge and practices may lead to barriers to optimal treatment. Our objective was to identify and describe gaps in physicians' knowledge, education, and practice in harm reduction strategies related to opioid overdose. Methods: We searched the PubMed, CINAHL, and Web of Science databases for articles published between 2015 and 2021, published in English, containing empirical evidence, addressing opioid harm reduction, and identifying gaps in physicians' knowledge, education, or practice. Results: Thirty-seven studies were included. Studies examined how physicians' perceptions or stigma influenced harm reduction efforts and addressed clinical knowledge gaps in overdose treatment and prevention and OUD treatment. Less than half of the studies addressed access issues at the system level, above the individual healthcare professional. Conclusion: Individual-level interventions should be addressed with professional continuing education and curricular-based changes through experiential and interprofessional education. System-level gaps can be remedied by increasing patient access to care, creating policies favorable to harm reduction, and extending resources to provide harm reduction strategies.

General versus disease-specific health literacy in patients with breast cancer: a cross-sectional study

Health literacy is recognized as a critical factor affecting communication across the continuum of cancer care and plays a key role in patients' ability to meaningfully discuss their condition with healthcare providers. However, there is no consensus on the best approach to measure health literacy in clinical practice. The aims of this study were to compare general and disease-specific measurements of health literacy in patients with breast cancer as well as examine their relationships with patient-provider communication. During office visits, patients with HER-2 + breast cancer who received care at oncology clinics with value-based models of care completed a survey including the 6-item cancer health literacy tool (CHLT-6), 6-item newest vital sign (NVS), 2 items measuring difficulty of patient-provider communication, and 11 demographic/clinical items. The mean age of 146 participants was 57.1 ± 10.8 years. Most participants had adequate general health literacy as measured by the NVS (79%) and a high probability of adequate cancer health literacy (≥ 0.7) as measured by the CHLT-6 (92%). Most patients easily communicated with healthcare providers (90.2%) and understood information they provided (83.5%). However, there was no significant relationship between patient-provider communication and health literacy. Both the CHLT-6 and NVS may be useful tools to assess the health literacy of patients with cancer in clinical practice. Study findings of adequate health literacy and ease of communication might have been influenced by the value-based care models adopted by participating clinics. Further research in more diverse samples of patients with cancer and different types of oncology practice settings is warranted.

Exploring access to care from the perspective of patients with breast cancer: A qualitative study

Objectives

Patients face a myriad of personal and system‐based challenges in accessing breast cancer care, but less is known about access as expressed and experienced by patients themselves. The objective of this qualitative study was to further explore the breadth of issues related to access from the perspective of patients with breast cancer across their care journey.

Methods

Twelve women participated in 1‐h semi‐structured interviews and 48 women participated in 2‐h focus groups at six oncology practices in 2018. Grounded theory was used to analyze the data.

Results

Six primary themes emerged concerning access to care: information, psychosocial support, health insurance, financial resources, timeliness, and emotions.

Conclusions

This study identified six core dimensions of access to care. Access encompassed not only gaining entrée to care services—in the traditional sense of access—but also the continuing support needed to effectively use those services throughout the cancer care journey. Future strategies aimed at improving access to breast cancer care should attend to these ongoing patient‐centric and system‐based issues which are mostly amenable to change.

A clinical laboratory's experience using GeneMatcher - building stronger gene-disease relationships

The use of whole-genome sequencing (WGS) has accelerated the pace of gene discovery and highlighted the need for open and collaborative data sharing in the search for novel disease genes and variants. GeneMatcher (GM) is designed to facilitate connections between researchers, clinicians, health-care providers and others to help in the identification of additional patients with variants in the same candidate disease genes. The Illumina Clinical Services Laboratory offers a WGS test for patients with suspected rare and undiagnosed genetic disease and regularly submits potential candidate genes to GM to strengthen gene-disease relationships. We describe our experience with GM, including criteria for evaluation of candidate genes, and our workflow for the submission and review process. We have made 69 submissions, 36 of which are currently active. Ten per cent of submissions have resulted in publications, with an additional 14 submissions part of ongoing collaborations and expected to result in a publication. This article is protected by copyright. All rights reserved.

Are Health Literacy and Patient Activation Related to Health Outcomes in Breast Cancer Patients?

Background:

Assessing health literacy and patient activation at the beginning of care could facilitate the provision of appropriate information to patients with breast cancer and increase the effectiveness of interventions geared toward improving patient involvement in self-managing their health and, consequently, their quality of life.

Objective:

The aim of this study was to evaluate cancer health literacy and patient activation in patients with breast cancer as well as examine their relationships to health-related quality of life (HRQoL) and resource use.

Methods:

Patients with breast cancer positive for human epidermal growth factor receptor 2 (HER2+) receiving care at 12 oncology clinics in Texas were offered participation in the study via convenience sampling. The survey consisted of the 6-item Cancer Health Literacy Tool, the 13-item Patient Activation Measure, the 27-item Functional Assessment of Cancer Therapy – General (version 4), and single-item measures for number of emergency department visits and hospitalizations as well as clinical and demographic characteristics.

Key Results:

The mean age of the 146 study participants was 57.1 ± 10.8 years; 92% (n = 134) had a high probability (≥0.7) of adequate cancer health literacy whereas 68% percent (n = 99) had high patient activation (level 3 or 4). Cancer health literacy had significant positive relationships with education and household income. Patient activation, education, and number of treatment types received explained 23% of the variation in HRQoL, and all except cancer health literacy were positive and significant predictors. No bivariate/multivariate analysis was conducted for emergency department visits and hospitalizations because there were few reported incidents.

Conclusions:

Interventions that aim to improve HRQoL in patients with breast cancer could target modifiable factors like patient activation. The homogeneity of cancer health literacy among study participants might have influenced its nonsignificant relationship with HRQoL and patient activation. Further assessments of health literacy and patient activation in larger and more diverse populations of patients with breast cancer are warranted. [HLRP: Health Literacy Research and Practice. 2021;5(3):e171–e178.]

Plain Language Summary:

In this study, the majority of patients with breast cancer were found to have high levels of cancer health literacy, patient activation, and health-related quality of life (HRQoL). The significant relationship between patient activation and HRQoL implies that patients with breast cancer who are able to actively participate in managing their health and health care are more likely to have higher HRQoL. Interventions that aim to improve HRQoL in patients with breast cancer could target modifiable factors like patient activation.

Impact of a G-CSF Policy to Reduce Low-Value Care on Guideline Adherence and Mortality

PURPOSE

Practice guidelines recommend the prophylactic use of granulocyte colony-stimulating factors (G-CSFs) in patients with high risk of febrile neutropenia, but evidence suggests that G-CSFs are frequently overused. The objectives of this study were (1) to determine the prevalence and prescribing patterns of G-CSF and (2) to evaluate the impact of a program initiative on G-CSF prescribing patterns, adherence to guidelines, and mortality.

METHODS

In this retrospective cohort study, data were used from the electronic health records of patients with metastatic colorectal cancer who received care at a multicenter oncology practice network during two time periods: July 01, 2013, to December 31, 2014, and July 01, 2017, to December 31, 2017. Beginning 2016, a site-wide program initiative that involved educational materials, appropriate nonuse recommendations, and prior authorization was introduced in the oncology practice network with an aim of reducing G-CSF overutilization. Descriptive statistics, t tests, and chi-squared tests were employed to analyze program impact.

RESULTS

There were 3,426 chemotherapy regimens corresponding to 2,968 patients. There were a total of 387 (11.3%) G-CSF-treated patients and 3,095 G-CSF administrations during the study period. G-CSF use was significantly lower in the postperiod, compared with the preperiod (P < .0001). Adherence to guidelines was significantly higher in the postperiod, compared with the preperiod (P < .0001). Mortality rates did not significantly differ between the two time periods.

CONCLUSION

This study demonstrates that policy initiatives have the potential to positively affect G-CSF prescription patterns and promote guideline adherence. These findings could help prescribers adopt a cost-effective approach in patients with metastatic colorectal cancer, leading to enhanced clinical practice and value-based care.

Health Behaviors and Health-Related Quality of Life Among U.S. Adults Aged 18-64 Years

INTRODUCTION

This study aims to (1) describe the prevalence and clustering of 3 health behaviors, (2) examine the association between individual health behaviors and health-related quality of life, and (3) explore the association between the clustering of the health behaviors and health-related quality of life.

METHODS

Investigators analyzed a sample of U.S. adults aged 18-64 years using data from the 2016-2018 Behavioral Risk Factor Surveillance System survey in March 2020. Logistic regression models examined the associations among 3 healthy behaviors (currently not smoking, physical activity, and nonheavy alcohol consumption) and 4 indicators of health-related quality of life (general health, physical health, mental health, and activity limitation). Alpha was set at 0.01.

RESULTS

A total of 450,870 individuals were included in the analysis (weighted n=100,102,329). Of these, 82.0% were current nonsmokers, 92.8% were nonheavy drinkers, and 77.6% reported physical activity. The prevalence of having none, 1, 2, and 3 of the health behaviors was 0.7%, 7.7%, 30.1%, and 61.5%, respectively. Smoking status and physical activity status were significantly associated with all the 4 health-related quality of life indicators. Alcohol status was significantly associated with mental health and activity limitation. The associations demonstrated a higher health-related quality of life among individuals who reported healthy behaviors than among those who did not engage in healthy behaviors. Compared with respondents who reported none of the health behaviors, people with all 3 health behaviors were more likely to report higher health-related quality of life.

CONCLUSIONS

Health behaviors were significantly associated with health-related quality of life among U.S. adults. Healthy behaviors should be encouraged because adopting these behaviors may contribute to a higher health-related quality of life.

Evaluation of access to care issues in patients with breast cancer

AIMS

System-level efforts have been deployed to improve oncology care and access while reducing utilization and costs. Understanding the nature of access to care from the perspective of patients themselves is an unmet need. This study examined access to care in a population of women with breast cancer and its relationship to overall patient satisfaction.

MATERIALS AND METHODS

Patients with breast cancer from six oncology clinics in five states completed a survey during routine office visits. Access to care (higher scores indicated increasing access barriers), overall patient satisfaction, and patient demographic/clinical characteristics were measured. The relationships between access (composite and factor scores) and satisfaction were assessed using multivariable analyses controlling for age (the only significant characteristic from bivariate analyses).

RESULTS

A total of 180 patients completed the survey. Factor analysis of access to care items revealed an 8-factor measure - Insurance, Health System, Emotional, Holistic Treatment, Family Support, Knowledge/Understanding, Information Quality, and Financial Support - with high reliability (Composite: Cronbach alpha = 0.93; Factors: Cronbach alpha range = 0.85-0.91). Access composite score was moderately low (mean = 1.90), indicating an overall low level of access barriers, and overall patient satisfaction was high (mean = 4.59). The composite score (p < .001) and the Health System and Knowledge/Understanding factors (p < .01) were significant and negative predictors of overall satisfaction.

LIMITATIONS

Study sites were high functioning clinics and all, but one, are Oncology Care Model practices. Thus, the scope of access to care issues for patients of under-resourced clinics might not be well addressed.

CONCLUSIONS

Access to care overall and by factor was significantly predictive of patient satisfaction with care. In addition, access to care factors varied across several demographic and clinical characteristics. Future strategies that address access to care challenges should consider these modifiable, patient-centric, and system-based issues.

Factors that Influence Mammography Use for Breast Cancer Screening among African American Women

OBJECTIVES

The purpose of this study was to assess factors that influence use of mammography screening among African American women, with a focus on social and cultural influences using Andersen's behavioral model (ABM), and to assess the methodological quality of the included studies.

METHODS

A literature review was conducted using PubMed, CINAHL, PSYCINFO, and Web of Science. Search terms included a combination of the following words using Boolean operators: breast cancer screening, mammography, repeat mammography, and African American. Studies that met the following criteria were included in the review: 1) examined factors associated with mammography screening, 2) included African American women as a majority, 3) published in a peer-reviewed English language journal between 2005 and 2017, and 4) conducted in the United States. Literature reviews, commentaries and non-research studies were excluded. Cited references from identified studies were examined for additional, relevant articles. Associated factors were grouped into predisposing, enabling, and need factor domains of ABM. The reviewed studies were rated using a methodological quality score (MQS) ranging from 0 to 20, with higher scores indicating higher methodological quality.

RESULTS

Twenty-four studies met the inclusion criteria. Fifteen factors that affect breast cancer screening in African American women were identified: predisposing (age, education, knowledge, beliefs, mistrust, religiosity, fears and fatalism), enabling (health insurance, access to care, income, health utilization), and need (physician recommendation, family/personal history, pain/discomfort, family responsibilities) factors. The most common factor was insurance status, although cultural issues (e.g., mistrust) were evident. Most of the identified factors are modifiable. The mean MQS was 12.2, indicating that the studies were slightly above average in quality.

CONCLUSIONS

Financial and cultural issues were important hindrances to breast cancer screening in African American women. These findings highlight the importance of affordable health care for preventive health services as well as the relevance of culturally embedded issues to health, while the MQS accentuates the need for more rigorous research articles. Breast cancer screening interventions in this population should attend to barriers identified in this review.

Willingness to Seek Help for Depression in Young African American Adults: Study Protocol

Background

In the United States, among those living with mental illness, 81% of African American (AA) young adults do not seek treatment compared with 66% of their white counterparts. Although the literature has identified unique culturally related factors that impact help seeking among AAs, limited information exists regarding the development and evaluation of interventions that incorporate these unique factors.

Objective

This study aims to describe a study protocol designed to develop a culturally relevant, theory-based, psychoeducational intervention for AA young adults; to determine if exposure to the intervention impacts AA young adults’ willingness to seek help; and to determine whether cultural factors and stigma add to the prediction of willingness to seek help.

Methods

The Theory of Planned Behavior (TPB) and Barrera and Castro’s framework for cultural adaptation of interventions were used as guiding frameworks. In stage 1 (information gathering), a literature review and three focus groups were conducted to identify salient cultural beliefs. Using stage 1 results, the intervention was designed in stage 2 (preliminary adaptation design), and in stage 3 (preliminary adaptation tests), the intervention was tested using pretest, posttest, and 3-month follow-up surveys. An experimental, mixed methods, prospective one-group intervention design was employed, and the primary outcomes were participants’ willingness and intention to seek help for depression and actual help-seeking behavior.

Results

This study was funded in May 2016 and approved by the University of Texas at Austin institutional review board. Data were collected from November 2016 to March 2016. Of the 103 students who signed up to participate in the study, 70 (67.9%) completed the pre- and posttest surveys. The findings are expected to be submitted for publication in 2020.

Conclusions

The findings from this research are expected to improve clinical practice by providing empirical evidence as to whether a culturally relevant psychoeducational intervention is useful for improving help seeking among young AAs. It will also inform future research and intervention development involving the TPB and willingness to seek help by identifying the important factors related to willingness to seek help. Advancing this field of research may facilitate improvements in help-seeking behavior among AA young people and reduce the associated mental health disparities that apparently manifest early on.

International Registered Report Identifier (IRRID)

DERR1-10.2196/16267

Guideline adherence and the strategy of chemotherapy dose reduction in metastatic colorectal cancer: A multicenter oncology practice experience

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Background: Current American Society of Clinical Oncology (ASCO) guidelines recommend prophylactic use of colony stimulating factors (CSF) for prevention of febrile neutropenia among cancer patients. ASCO also recommends chemotherapy dose reduction as a viable alternative to CSF administration, which may result in cost savings to patients and payers, but adherence to these guidelines has been less than ideal. The objectives of this study were i.) to determine the prevalence and prescribing patterns of CSF and dose reduction in metastatic colorectal cancer patients and ii.) to evaluate the impact of a program initiative on CSF prescribing patterns and on compliance to ASCO guidelines. Methods: In this retrospective study, we utilized data from the electronic health records of metastatic colorectal cancer patients who received care at a multi-center oncology practice network during two time periods: July 2013 to December 2014 and July to December 2017. In 2016, a site-wide program initiative that involved educational materials, appropriate non-use recommendations and prior authorization was introduced in the oncology practice network with an aim of reducing CSF overutilization. Descriptive statistics and chi squared tests were employed to explore CSF utilization across patient age, gender, disease, year of diagnosis, febrile neutropenia risk, line of therapy and duration of treatment. Results: There were 3426 chemotherapy regimens corresponding to 2968 patients. There was a total of 3095 CSF administrations and the CSF administered was pegfilgrastim. There were 343 (10%) CSF users. Among subjects who had data on dose reduction (N = 508), 58.7% received dose reduction. CSF use was significantly lower in the post-period, compared to the pre-period (p < 0.0001). Compliance to guidelines was significantly higher in the post-period, compared to the pre-period (p < 0.0001). Conclusions: Our results demonstrate that program initiatives have the potential to positively impact CSF prescription patterns. These findings could help prescribers adopt a cost-effective approach for this population, leading to enhanced clinical practice and value-based care.

The cerebral angiome: High resolution MicroCT imaging of the whole brain cerebrovasculature in female and male mice

The cerebrovascular system provides crucial functions that maintain metabolic and homeostatic states of the brain. Despite its integral role of supporting cerebral viability, the topological organization of these networks remains largely uncharacterized. This void in our knowledge surmises entirely from current technological limitations that prevent the capturing of data through the entire depth of the brain. We report high-resolution reconstruction and analysis of the complete vascular network of the entire brain at the capillary level in adult female and male mice using a vascular corrosion cast procedure. Vascular network analysis of the whole brain revealed sex-related differences of vessel hierarchy. In addition, region-specific network analysis demonstrated different patterns of angioarchitecture between brain subregions and sex. Furthermore, our group is the first to provide a three-dimensional analysis of the angioarchitecture and network organization in a single reconstructed tomographic data set that encompasses all hierarchy of vessels in the brain of the adult mouse.

Variations in competencies needed to complete surgical training

Background

This study aimed to analyse the degree of relative variation in specialty-specific competencies required for certification of completion of training (CCT) by the UK Joint Committee on Surgical Training.

Methods

Regulatory body guidance relating to operative and non-operative surgical skill competencies required for CCT were analysed and compared.

Results

Wide interspecialty variation was demonstrated in the required minimum number of logbook cases (median 1201 (range 60-2100)), indexed operations (13 (5-55)), procedure-based assessments (18 (7-60)), publications (2 (0-4)), communications to learned associations (0 (0-6)) and audits (4 (1-6)). Mandatory courses across multiple specialties included: Training the Trainers (10 of 10 specialties), Advanced Trauma Life Support (6 of 10), Good Clinical Practice (9 of 10) and Research Methodologies (8 of 10), although no common accord was evident.

Discussion

Certification guidelines for completion of surgical training were inconsistent, with metrics related to minimum operative caseload and academic reach having wide variation.

Examination of Barriers to Medication Adherence, Asthma Management, and Control Among Community Pharmacy Patients With Asthma

OBJECTIVE

To describe the prevalence of common barriers to asthma medication adherence and examine associations between patient-reported asthma controller adherence and asthma control, therapy adherence barriers, and asthma management characteristics.

METHODS

Previously developed asthma-specific tool was pilot tested on a convenience sample of adult patients with persistent asthma. The following data were collected via patient survey: demographic characteristics and comorbidities, adherence, asthma control, and asthma management characteristics. Descriptive and inferential statistics were used to address the study objective.

RESULTS

The patients (N = 93) were 45.4 (17.2) years of age, and 66.7% were female. The majority had poor (68.8%) adherence, with 61.3% of patients having controlled asthma. There was no significant association between adherence and asthma control. The mean number of barriers for good and poor adherence groups differed significantly: 2.0 ± 1.1 and 5.4 ± 2.4, respectively (P < .0001). Having an asthma action plan (AAP) was the only asthma management characteristic significantly related to adherence. The majority of patients with poor adherence did not have an AAP (76.6%), whereas 81.5% of patients with good adherence did have an AAP (P < 0.0001).

CONCLUSIONS

The use of this survey tool confirmed presence of asthma-specific barriers, thus using this specialized approach may lead to more effective, targeted counseling in community pharmacy settings.

Influence of Maternal Obesity on Labor Induction: A Systematic Review and Meta-Analysis

INTRODUCTION

Studies have shown that women with obesity have longer labors. The purpose of this systematic review and meta-analysis is to examine existing evidence regarding labor induction in women with obesity, including processes and outcomes. The primary outcome was cesarean birth following labor induction. Secondary outcomes were the timing and dosage of prostaglandins, the success of mechanical cervical ripening methods, and synthetic oxytocin dose and timing.

METHODS

Searches were performed in PubMed, MEDLINE, Embase, CINAHL, EBSCO, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Effects, Google Scholar, and ClinicalTrials.gov. Searches were limited to studies published in English after 1990. Ten studies published between 2009 and 2017 were included in this review. All were observational studies comparing processes and outcomes of induction of labor in relation to maternal body mass index. The primary outcome was cesarean birth following labor induction. We assessed heterogeneity using Cochran's Q test and tau-squared and I² statistics. We also calculated fixed-effect models to estimate pooled relative risks and weighted mean differences.

RESULTS

Ten cohort studies met inclusion criteria; 8 studies had data available for a meta-analysis of the primary outcome. Cesarean birth was more common among women with obesity compared with women of normal weight following labor induction (Mantel-Haenszel fixed-effect odds ratio, 1.82; 95% CI, 1.55-2.12; P < .001). Maternal obesity was associated with a longer time to birth, higher doses of prostaglandins, less frequent success of cervical ripening methods, and higher dose of synthetic oxytocin, as well as a longer time to birth after oxytocin use.

DISCUSSION

Women with obesity are more likely than women with a normal weight to end labor induction with cesarean birth. Additionally, women with obesity require longer labor inductions involving larger, more frequent applications of both cervical ripening methods and synthetic oxytocin.

Common acoustic phonon lifetimes in inorganic and hybrid lead halide perovskites

The acoustic phonons in the organic-inorganic lead halide perovskites have been reported to have anomalously short lifetimes over a large part of the Brillouin zone. The resulting shortened mean free paths of the phonons have been implicated as the origin of the low thermal conductivity. We apply neutron spectroscopy to show that the same acoustic phonon energy linewidth broadening (corresponding to shortened lifetimes) occurs in the fully inorganic CsPbBr3 by comparing the results on the organic-inorganic CH3NH3PbCl3. We investigate the critical dynamics near the three zone boundaries of the cubic P m 3 ¯ m Brillouin zone of CsPbBr3 and find energy and momentum broadened dynamics at momentum points where the Cs-site (A-site) motions contribute to the cross section. Neutron diffraction is used to confirm that both the Cs and Br sites have unusually large thermal displacements with an anisotropy that mirrors the low temperature structural distortions. The presence of an organic molecule is not necessary to disrupt the low-energy acoustic phonons at momentum transfers located away from the zone center in the lead halide perovskites and such damping may be driven by the large displacements or possibly disorder on the A site.

Utilizing the common sense model to explore African Americans' perception of type 2 diabetes: A qualitative study

Illness perceptions, which are likely influenced by patients' cultural contexts, are associated with disease self-management and adherence. African American patients perceptions of type 2 diabetes is not well understood and no known studies has used a comprehensive evidence-based theoretical framework to explore what AAs with type 2 diabetes know, believe, and think about type 2 diabetes. Understanding perceptions of an illness shared by a group of people will be useful in developing culturally-appropriate interventions targeted to the needs of the community. The purpose of this study is to explore African Americans' perceptions of type 2 diabetes based on the common sense model of illness and self-regulation. Using a phenomenology qualitative approach and purposive sampling, 40 African American men and women, age 45-60 years old with diagnosed type 2 diabetes at least one year prior, and who took at least one prescription diabetes medication, participated in six semi-structured 90-minute focus groups conducted in a private space. Qualitative content analysis was conducted to explore African Americans beliefs about type 2 diabetes. Participants expressed that historical issues, e.g., slavery, healthcare providers, the government, and God influenced how they developed diabetes. Participants reported a loss of autonomy, a change of their identity as an employee, a social individual and sexual person, as well as anger and frustration due to having diabetes. Diabetes made the African American family bonding experience of eating difficult, and the disease diminished their cultural experiences. Concerns about diabetes ranged from fear of death and amputations to the inability to prevent the disease among their children/grandchildren. Participants perceived that medications, faith in God, and positive thinking about survival helped control diabetes. Conclusions: Improved diabetes self-management and medication adherence may depend on the meaning African Americans attach to diabetes, available psychosocial support for managing diabetes, and African Americans experience with diabetes.

Associations Between Treatment Satisfaction, Medication Beliefs, and Adherence to Disease-Modifying Therapies in Patients with Multiple Sclerosis

Background

Adherence to disease-modifying therapy (DMT) remains problematic for many patients with multiple sclerosis (MS). An improved understanding of factors affecting DMT adherence may inform effective interventions. This study examined associations between treatment satisfaction, medication beliefs, and DMT adherence.

Methods

A survey was mailed in 2016 to 600 adult patients with relapsing-remitting MS taking an injectable or oral DMT. Patients were sampled from the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. The survey measured self-reported DMT adherence (doses taken divided by doses prescribed during previous 2-week period-adherence ≥0.80), DMT satisfaction using the Treatment Satisfaction Questionnaire for Medication version II, medication beliefs using the Beliefs About Medicines Questionnaire, and demographic and clinical covariates. Relationships between variables were examined using multivariate logistic regression.

Results

Final analyses included 489 usable surveys. Mean ± SD participant age was 60.5 ± 8.3 years. Most respondents were white (93.8%), female (86.6%), taking an injectable DMT (66.9%), and adherent to DMT (92.8%). Significant predictors of DMT adherence were age (odds ratio [OR], 1.086; 95% CI, 1.020-1.158; P = .011), type of DMT (oral vs. injectable; OR, 23.350; 95% CI, 2.254-241.892; P = .008), and DMT experience (naive vs. experienced; OR, 2.831; 95% CI, 1.018-7.878; P = .046).

Conclusions

In patients with MS sampled from a patient registry, treatment satisfaction and medication beliefs were not significantly associated with DMT adherence. Based on significant predictors, younger patients, patients taking injectable DMTs, and patients with previous experience with another DMT(s) are at higher risk for nonadherence. Future research is warranted to assess relationships between variables in more diverse MS populations.

Understanding the disease burden and unmet needs among patients with cutaneous lupus erythematosus: A qualitative study

Background

Cutaneous lupus erythematosus (CLE) is a rare dermatologic autoimmune disease marked by photosensitive lesions that can vary in appearance depending on the subtype. The extent to which CLE affects a patient’s quality of life (QoL) has not been fully characterized. Focus groups were conducted to explore patients’ perspectives of how CLE has affected their lives and to understand the unmet needs in regards to CLE treatment and care.

Methods

This qualitative study involved three focus groups with a total of 19 patients with CLE. A moderator guide containing open-ended questions was used to assess how CLE affects overall QoL. The focus groups were audio-recorded with notetaking. Data were content-analyzed to identify emergent themes.

Results

Four themes emerged as important to patients with CLE: disease sequelae, social interactions, functioning, and unmet needs. Most patients reported decreased QoL due to signs and symptoms such as dyspigmentation and scarring. Having CLE negatively affected patients’ mental health and personal relationships and led to negative coping strategies, such as recreational drug use. Issues related to body image were also elicited by patients. Patients cited unmet needs including lack of treatments to improve chronic skin lesions of CLE and inadequate patient education on living with CLE.

Conclusions

Providers can look for signs of QoL impairment in patients with CLE by asking questions related to body image, mental health, social isolation, and coping mechanisms. Future QoL measures can include the effect of CLE-specific attributes such as scarring and dyspigmentation to empower patients’ voices in determining therapeutic efficacy in future clinical trials. Findings from our study have added a new understanding of daily experiences that were elicited directly from patients with CLE.

Incremental health care services and expenditures associated with depression among individuals with cutaneous lupus erythematosus (CLE)

Objectives

The objective of this paper is to describe the annual direct medical expenditures for cutaneous lupus erythematosus (CLE) patients, and to estimate the incremental health care expenditures and utilization associated with depression among adults with CLE, while controlling for covariates.

Methods

Using the 2014 Medical Expenditure Panel Survey (MEPS), we compared CLE patients with and without depression to determine differences in: (a) health care utilization—inpatient, outpatient, office-based and emergency room (ER) visits, and prescriptions filled; and (b) expenditures—total costs, inpatient, outpatient, office-based, ER, and prescription medication costs, and other costs using demography-adjusted and comorbidity-adjusted multivariate models (age, gender, race/ethnicity, marital status, education, perception of health status, poverty category, smoking status, and Charlson Comorbidity Index).

Results

The total direct medical expenditure associated with CLE is estimated at approximately $29.7 billion in 2014 US dollars. After adjusting for covariates, adults with CLE and depression had more hospital discharges (utilization ratio (UR) = 1.13, 95% confidence interval (CI) (1.00–1.28)), ER visits (UR = 1.17, 95% CI (1.09–1.37)), and prescribed medicines (UR = 2.15, 95% CI (1.51–3.05)) than those without depression. Adults with CLE and depression had significantly higher average annual total expenditure that those without depression ($19,854 vs. $9735).

Conclusions

High health care expenditures are significant for patients with CLE, especially among those with depression. Prescription drugs, inpatient visits, and ER visits contributed most to the total expenditures in CLE patients with depression. Early diagnosis and treatment of depression in CLE patients may reduce total health care expenditures and utilization in this population.

"I did not want to take that medicine": African-Americans' reasons for diabetes medication nonadherence and perceived solutions for enhancing adherence

BACKGROUND

Diabetes is disproportionally burdensome among African-Americans (AAs) and medication adherence is important for optimal outcomes. Limited studies have qualitatively examined reasons for nonadherence among AAs with type 2 diabetes, though AAs are less adherent to prescribed medications compared to whites. This study explored the reasons for medication nonadherence and adherence among AAs with type 2 diabetes and examined AAs' perceived solutions for enhancing adherence.

METHODS

Forty AAs, age 45-60 years with type 2 diabetes for at least 1 year prior, taking at least one prescribed diabetes medication, participated in six semistructured 90-minute focus groups. Using a phenomenology qualitative approach, reasons for nonadherence and adherence, as well as participants' perceived solutions for increasing adherence were explored. Qualitative content analysis was conducted.

RESULTS

AAs' reasons for intentional nonadherence were associated with 1) their perception of medicines including concerns about medication side effects, as well as fear and frustration associated with taking medicines; 2) their perception of illness (disbelief of diabetes diagnosis); and 3) access to medicines and information resources. Participants reported taking their medicines because they valued being alive to perform their social and family roles, and their belief in the doctor's recommendation and medication helpfulness. Participants provided solutions for enhancing adherence by focusing on the roles of health care providers, patients, and the church. AAs wanted provider counseling on the necessity of taking medicines and the consequences of not taking them, indicating the need for the AA community to support and teach self-advocacy in diabetes self-management, and the church to act as an advocate in ensuring medication use.

CONCLUSION

Intentional reasons of AAs with type 2 diabetes for not taking their medicines were related to their perception of medicines and illness. Solutions for enhancing diabetes medication adherence among AAs should focus on the roles of providers, patients, and the church.

Estrogens as neuroprotectants: Estrogenic actions in the context of cognitive aging and brain injury

There is ample empirical evidence to support the notion that the biological impacts of estrogen extend beyond the gonads to other bodily systems, including the brain and behavior. Converging preclinical findings have indicated a neuroprotective role for estrogen in a variety of experimental models of cognitive function and brain insult. However, the surprising null or even detrimental findings of several large clinical trials evaluating the ability of estrogen-containing hormone treatments to protect against age-related brain changes and insults, including cognitive aging and brain injury, led to hesitation by both clinicians and patients in the use of exogenous estrogenic treatments for nervous system outcomes. That estrogen-containing therapies are used by tens of millions of women for a variety of health-related applications across the lifespan has made identifying conditions under which benefits with estrogen treatment will be realized an important public health issue. Here we provide a summary of the biological actions of estrogen and estrogen-containing formulations in the context of aging, cognition, stroke, and traumatic brain injury. We have devoted special attention to highlighting the notion that estrogen appears to be a conditional neuroprotectant whose efficacy is modulated by several interacting factors. By developing criteria standards for desired beneficial peripheral and neuroprotective outcomes among unique patient populations, we can optimize estrogen treatments for attenuating the consequences of, and perhaps even preventing, cognitive aging and brain injury.

Abstract P1-10-14: Early results of toxicity for high-risk patients treated with hypofractionated regional nodal irradiation

This abstract was withdrawn by the authors.

Knowledge of Prostate Cancer and Screening Among Young Multiethnic Black Men

The purpose of this study was to assess the knowledge of prostate cancer and screening and its associated factors in young Black men aged 18 to 40 years. This was a cross-sectional study conducted in a convenience sample of 267 young Black men in Austin, Texas. Knowledge about prostate cancer and screening was operationalized through 14 items, including 12 items from the Knowledge about Prostate Cancer Screening Questionnaire (PC knowledge), and two items assessing dietary knowledge and prostate cancer screening controversy. PC knowledge scores were regressed on age, cues to action, health screening experience, and demographic/personal factors. Most participants were African American men of American origin (65.3%) and were college freshmen (18.9%). PC knowledge scores were low, with mean correct responses of 28.5%, mean knowledge score of 5.25 ± 3.81 (possible score range of 0 to 14, with higher scores indicating higher PC knowledge) and a median score of 5.00. On average, 47% of the respondents replied “Don’t Know” to the questions. Overall, PC knowledge scores were low among these young Black men, especially in domains related to risk factors, screening age guidelines, limitations, and diet. It is thus important that these men be educated more on these important domains of prostate cancer and screening so that the decision to screen or not will be an informed one. Health screening experience, residence area, major field of study, and academic classification were significant predictors of knowledge.

Determinants of Prostate Cancer Screening Intentions of Young Black Men Aged 18 to 40 Years

INTRODUCTION

Black men are more likely to be diagnosed with prostate cancer, with higher stage and higher grade at presentation. Evidence suggests that for education in health promotion behaviors (such as screenings) in early adult years, young Black men can be better equipped to make informed decisions in later years.

OBJECTIVE

Using the theory of reasoned action (TRA), we assessed the intention of young Black men to screen for prostate cancer when it is recommended and determined its correlates.

METHODS

This was a cross-sectional study of 267 Black men aged 18 to 40 years. A 47-item questionnaire collected information on demographics/personal factors, attitudes toward prostate cancer screening, social influence, comfortability with prostate examinations, cues to action, health screening experiences, knowledge of prostate cancer and screening, and intention. Descriptive statistics were calculated for all variables and hierarchical logistic regression was employed to determine significant predictors of prostate cancer screening intentions.

RESULTS

The regression model accounted for 46% of the variance in intention (p < 0.01), with excellent perception of health, having private or public health insurance, longer regular source of care, positive attitude, positive social influence, positive cues to action, and higher knowledge levels being significant predictors of intentions.

CONCLUSION

This study provides support for the use of TRA in predicting prostate cancer screening intentions among young Black men when it is recommended by a physician. Findings may inform the development of empirical-based interventions to educate and inform at-risk young Black men about the pros and cons of prostate cancer screening so that they can make informed decision on screening when recommended later in life.

Predictors of prostate cancer screening using Andersen's Behavioral Model of Health Services Use

PURPOSE

The purposes of the study were to examine the prevalence of prostate cancer screening (PCS) in the United States and to identify predictors of PCS guided by Andersen's Behavioral Model of Health Services Use (ABM).

METHODS

PCS rates were analyzed in men (aged ≥40y) using 2014 data from the Behavioral Risk Factor Surveillance System. Descriptive analysis was conducted using sampling weights to determine the prevalence of PCS (i.e., had a prostate-specific antigen test). Multiple logistic regression within the framework of ABM was used to identify predictors of PCS. The ABM variables of predisposing (e.g., age), enabling (e.g., health insurance), and need (e.g., comorbidities) comprised the independent variables.

RESULTS

Among the 131,415 men, 62.4% (N = 82,014) reported that they had a prostate-specific antigen test in the last 2 years. Among predisposing factors, age, education, income, and employment status were significantly associated with undergoing PCS. Informed decision-making process, health care coverage, regular health care provider, and length of time since last routine checkup were significant enabling factors. Health care provider recommendation and previous cancer diagnosis were significant need factors.

CONCLUSIONS

Most older men in the United States had previously engaged in PCS. Several ABM variables were predictive of PCS and should be considered when developing future strategies to encourage PCS in at-risk men with the recommended life expectancies. Such strategies should also ensure that the decision to undergo PCS is an informed process between patients and their health care providers.

Beliefs Regarding Prostate Cancer Screening Among Black Males Aged 18 to 40 Years

This study was conducted to identify the salient behavioral beliefs of young Black men toward prostate cancer screening, and to identify the issues surrounding their comfortability with prostate examinations. A total of 20 Black men, aged between 18 and 40 years, participated in three focus group sessions between June 2013 and July 2013 in Austin, Texas. Participants were asked open-ended questions about: (a) the advantages and disadvantages of screening to identify salient behavioral beliefs about screening and (b) issues that would make prostate examinations comfortable or uncomfortable to identify comfortability factors. Focus group discussions were tape-recorded, transcribed, and content analyzed to identify emerging themes of salient beliefs and comfortability. Also, nine salient behavioral beliefs toward prostate cancer screening were identified, and eight factors were linked to comfortability with prostate examinations. Given the increase of prostate cancer disparity as a public health issue, understanding the beliefs of Black men of prescreening age (18-40 years) may be crucial to the effectiveness of future interventions to improve screening when recommended at later ages.

Perceptions and Practices of Mass Bat Exposure Events in the Setting of Rabies Among U.S. Public Health Agencies

Current guidelines in the setting of exposures to potentially rabid bats established by the Advisory Committee on Immunization Practices (ACIP) address post-exposure prophylaxis (PEP) administration in situations where a person may not be aware that a bite or direct contact has occurred and the bat is not available for diagnostic testing. These include instances when a bat is discovered in a room where a person awakens from sleep, is a child without an adult witness, has a mental disability or is intoxicated. The current ACIP guidelines, however, do not address PEP in the setting of multiple persons exposed to a bat or a bat colony, otherwise known as mass bat exposure (MBE) events. Due to a dearth of recommendations for response to these events, the reported reactions by public health agencies have varied widely. To address this perceived limitation, a survey of 45 state public health agencies was conducted to characterize prior experiences with MBE and practices to mitigate the public health risks. In general, most states (69% of the respondents) felt current ACIP guidelines were unclear in MBE scenarios. Thirty-three of the 45 states reported prior experience with MBE, receiving an average of 16.9 MBE calls per year and an investment of 106.7 person-hours annually on MBE investigations. PEP criteria, investigation methods and the experts recruited in MBE investigations varied between states. These dissimilarities could reflect differences in experience, scenario and resources. The lack of consistency in state responses to potential mass exposures to a highly fatal disease along with the large contingent of states dissatisfied with current ACIP guidance warrants the development of national guidelines in MBE settings.

Consumer perceptions about a community pharmacy-based medication take back program

The stockpiling and improper disposal of unused or expired medications has the potential to harm the environment and humans. Community-based medication take-back programs have been established to ensure proper disposal of unused drugs; however, few of these programs present consumers' perceptions about the program. Therefore, the main aims of this pilot study are 1) to assess the users' and non-users' perceptions about a medication take-back program and 2) to determine if perceptions differ between users and non-users. The results are based on a survey administered to 35 users and 20 non-users of a medication take-back program located at a community pharmacy in Texas. The majority of users were participating in a take-back service for the first time. Though most non-users had never participated in a take-back program, they would consider participating in the future. All users viewed the medication take-back program as a valuable service, while nearly all (90%) non-users viewed the program as a potentially valuable service. The primary reason for participating in the service was to protect the environment. Most respondents (users and non-users) were likely to choose a pharmacy that provides the take-back service more than a pharmacy that does not. More than half of respondents positively viewed paying for the service on a per weight basis. In comparison to non-users, users were significantly older, had more favorable perceptions about paying for the service, and were more likely to choose a pharmacy that provides the service. This pilot study presents overall favorable user perceptions toward medication-take back services and supports the need to establish more community-based take back programs to meet the needs of consumers.

Factors associated with hospices' provision of complementary and alternative medicine

There is limited research about the provision of complementary and alternative (CAM) in US hospices. The purpose of this study was to assess the factors that influence hospices' likelihood of providing CAM therapies. Mail surveys were sent to 369 hospices in Texas; 61 were returned undelivered, yielding a total usable response rate of 35.7% (n = 110) after an initial and one follow-up mail out. Binary logistic regression was used to assess whether the likelihood of offering CAM is related to hospice's age, geographic location, agency type, profit orientation, Medicare certification, and number of patients served annually. Results showed that profit orientation and the number of patients served by hospices were significantly related to the probability that hospices will offer CAM. Specifically, the odds of offering CAM in not-for-profit hospices were approximately 4 times higher than that in for-profit hospices (odds ratio [OR] = 3.77, P = .022, 95% confidence interval [CI] = 1.2, 11.8). In addition, for every 100 patients served by the hospices, the odds of offering CAM increases by 13% (OR = 1.13, P = .015, 95% CI = 1.02, 1.25). In conclusion, CAM offering by hospices is related to hospices' profit orientation status and number of patients served but is not related to other measured characteristics of hospices.

Complementary and alternative medicine utilization in Texas hospices: prevalence, importance, and challenges

The purpose of this study was to describe the prevalence, importance, and challenges of complementary and alternative medicine (CAM) utilization in Texas hospices. Mail surveys were sent to 369 hospices in Texas, and 110 useful surveys were returned. Results showed that a majority (n = 62, 56.4%) of hospices offer CAM to their clients, with the most popularly offered CAMs being massage, music, and relaxation therapies. Despite the availability of CAM services in most hospices, and that the utilization of CAM has the potential to improve overall quality of life of patients, our results showed that a sizeable proportion of patients in these hospices are not utilizing the provided CAMs. Funding and personnel constraints were substantial obstacles to offering CAM.

Pharmacist reporting of serious adverse drug events to the Food and Drug Administration

OBJECTIVE

To identify barriers to and facilitators of pharmacist reporting of serious adverse drug events (ADEs) to the Food and Drug Administration (FDA).

METHOD

Two focus groups consisting of practicing pharmacists were held in Austin, TX, in 2009. The following open-ended questions were used in the focus groups: (1) What do you think would make it easier to report serious ADEs to the FDA? (2) What do you think would make it more difficult to report serious ADEs to the FDA? A content analysis was performed on the generated transcripts.

RESULTS

13 pharmacists practicing in hospital and community settings in Texas participated. Pharmacists identified 27 barriers to and facilitators of reporting serious ADEs to FDA. Lack of patients' complete medical histories and lack of time were the barriers most frequently cited. Knowledge and awareness of ADEs and ADE reporting emerged as important factors that would facilitate reporting serious ADEs to FDA.

CONCLUSION

These findings highlight the factors that facilitate and/or inhibit pharmacist reporting of serious ADEs to FDA. Improved knowledge of ADEs and ADE reporting would facilitate reporting behaviors, while lack of time, lack of complete patient medical histories, and lack of compensation issues serve as important barriers to reporting. Interventions are needed to address these factors.