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Alzahrani F, Waite N, Beazely M, Cooke M. Estimating implicit and explicit racial and ethnic bias among community pharmacists in Canada. Saudi Pharm J 2024; 32:102024. [PMID: 38525267 PMCID: PMC10960120 DOI: 10.1016/j.jsps.2024.102024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/09/2024] [Indexed: 03/26/2024] Open
Abstract
Background Bias, whether implicit (unconscious) or explicit (conscious), can lead to preferential treatment of specific social groups and antipathy towards others. When healthcare professionals (HCPs), including pharmacists, act on these biases, patient care and health outcomes can be adversely affected. This study aims to estimate implicit and explicit racial/ethnic bias towards Black and Arab people among community pharmacists in Ontario, Canada. Methods Community pharmacists participated in a secure, web-based survey using a cross-sectional design that included Harvard's Race and Arab Implicit Association Tests (IATs) to examine bias towards Black and Arab people. Explicit (stated) preferences were measured by self-report. Data were analyzed using descriptive and inferential statistics. Results The study surveyed 407 community pharmacists, 56.1 % of whom were women with an average age of 46.9. Implicit Association Test (IAT) results showed a statistically significant moderate preference for white people over both Black (mean IAT = 0.41) and Arab people (mean IAT = 0.35). However, most pharmacists explicitly stated that they had no racial/ethnic preference, with 75.7 % expressing a neutral preference between Black and white and 66.6 % neutral between Arab and white. However, a slight preference for white individuals was observed. Demographic factors such as age, place of birth, race/ethnicity, and experience significantly impacted IAT scores. For example, older, Canadian-born, white pharmacists with more experience displayed higher implicit bias scores. A mild correlation was found between implicit and explicit bias, indicating as implicit bias increases, explicit bias tends to become more negative. Conclusions This study is the first to explore the issue of pharmacist bias in Canada and concentrate on anti-Arab bias. Our findings reveal that Ontario community pharmacists tend to have an unconscious inclination towards white people, which calls for further understanding of this matter. Additionally, we discovered a moderate degree of anti-Arab bias, indicating that studies on other HCPs should consider bias against this social group. Educational interventions are needed to address the implicit biases among community pharmacists in Ontario, Canada. These findings should aim to raise self-awareness of biases, educate about the potential implications of these biases on patient care, and provide strategies to reduce bias.
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Affiliation(s)
- Fahad Alzahrani
- Department of Pharmacy Practice, College of Pharmacy, Taibah University, Madinah, Saudi Arabia
| | - Nancy Waite
- School of Pharmacy, University of Waterloo, Kitchener, Canada
| | - Michael Beazely
- School of Pharmacy, University of Waterloo, Kitchener, Canada
| | - Martin Cooke
- Department of Sociology and Legal Studies & School of Public Health Sciences, University of Waterloo, Waterloo, Canada
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2
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Cid A, Mahajan N, Wong WWL, Beazely M, Grindrod KA. An economic evaluation of community pharmacy-dispensed naloxone in Canada. Can Pharm J (Ott) 2024; 157:84-94. [PMID: 38463179 PMCID: PMC10924576 DOI: 10.1177/17151635241228241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 03/12/2024]
Abstract
Aims To determine the cost-effectiveness of pharmacy-based intranasal (IN) and intramuscular (IM) naloxone distribution in Canada. Methods We developed a state-transition model for pharmacy-based naloxone distribution, every 3 years, to illicit, prescription, opioid-agonist therapy and nonopioid use populations compared to no naloxone distribution. We used a monthly cycle length, lifetime horizon and a Canadian provincial Ministry of Health perspective. Transition probabilities, cost and utility data were retrieved from the literature. Costs (2020) and quality-adjusted life years (QALY) were discounted 1.5% annually. Microsimulation, 1-way and probabilistic sensitivity analyses were conducted. Results Distribution of naloxone to all Canadians compared to no distribution prevented 151 additional overdose deaths per 10,000 persons, with an incremental cost-effectiveness ratio (ICER) of $50,984 per QALY for IM naloxone and an ICER of $126,060 per QALY for IN naloxone. Distribution of any naloxone to only illicit opioid users was the most cost-effective. One-way sensitivity analysis showed that survival rates for illicit opioid users were most influenced by the availability of either emergency medical services or naloxone. Conclusion Distribution of IM and IN naloxone to all Canadians every 3 years is likely cost-effective at a willingness-to-pay threshold of $140,000 Canadian dollars/QALY (~3 × gross domestic product from the World Health Organization). Distribution to people who use illicit opioids was most cost-effective and prevented the most deaths. This is important, as more overdose deaths could be prevented through nationwide public funding of IN naloxone kits through pharmacies, since individuals report a preference for IN naloxone and these formulations are easier to use, save lives and are cost-effective. Can Pharm J (Ott) 2024;157:xx-xx.
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Affiliation(s)
- Ashley Cid
- From the School of Pharmacy, University of Waterloo, Kitchener, Ontario
| | - Nikita Mahajan
- From the School of Pharmacy, University of Waterloo, Kitchener, Ontario
| | - William W L Wong
- From the School of Pharmacy, University of Waterloo, Kitchener, Ontario
| | - Michael Beazely
- From the School of Pharmacy, University of Waterloo, Kitchener, Ontario
| | - Kelly A Grindrod
- From the School of Pharmacy, University of Waterloo, Kitchener, Ontario
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3
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Deline ML, Straub J, Patel M, Subba P, Grashei M, van Heijster FHA, Pirkwieser P, Somoza V, Livingstone JD, Beazely M, Kendall B, Gingras MJP, Leonenko Z, Höschen C, Harrington G, Kuellmer K, Bian W, Schilling F, Fisher MPA, Helgeson ME, Fromme T. Lithium isotopes differentially modify mitochondrial amorphous calcium phosphate cluster size distribution and calcium capacity. Front Physiol 2023; 14:1200119. [PMID: 37781224 PMCID: PMC10540846 DOI: 10.3389/fphys.2023.1200119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/21/2023] [Indexed: 10/03/2023] Open
Abstract
Lithium is commonly prescribed as a mood stabilizer in a variety of mental health conditions, yet its molecular mode of action is incompletely understood. Many cellular events associated with lithium appear tied to mitochondrial function. Further, recent evidence suggests that lithium bioactivities are isotope specific. Here we focus on lithium effects related to mitochondrial calcium handling. Lithium protected against calcium-induced permeability transition and decreased the calcium capacity of liver mitochondria at a clinically relevant concentration. In contrast, brain mitochondrial calcium capacity was increased by lithium. Surprisingly, 7Li acted more potently than 6Li on calcium capacity, yet 6Li was more effective at delaying permeability transition. The size distribution of amorphous calcium phosphate colloids formed in vitro was differentially affected by lithium isotopes, providing a mechanistic basis for the observed isotope specific effects on mitochondrial calcium handling. This work highlights a need to better understand how mitochondrial calcium stores are structurally regulated and provides key considerations for future formulations of lithium-based therapeutics.
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Affiliation(s)
- Marshall L. Deline
- Chair of Molecular Nutritional Medicine, TUM School of Life Sciences, Technical University of Munich, Freising, Germany
| | - Joshua Straub
- Department of Physics, University of California, Santa Barbara, CA, United States
| | - Manisha Patel
- Department of Physics, University of California, Santa Barbara, CA, United States
| | - Pratigya Subba
- Chair of Molecular Nutritional Medicine, TUM School of Life Sciences, Technical University of Munich, Freising, Germany
| | - Martin Grashei
- Department of Nuclear Medicine, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Frits H. A. van Heijster
- Department of Nuclear Medicine, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Philip Pirkwieser
- Leibniz Institute for Food Systems Biology at the Technical University of Munich, Freising, Germany
| | - Veronika Somoza
- Leibniz Institute for Food Systems Biology at the Technical University of Munich, Freising, Germany
- Chair of Nutritional Systems Biology, TUM School of Life Sciences, Technical University of Munich, Munich, Germany
| | | | - Michael Beazely
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Brian Kendall
- Department of Earth and Environmental Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Michel J. P. Gingras
- Department of Physics and Astronomy, University of Waterloo, Waterloo, ON, Canada
- CIFAR, MaRS Centre, Toronto, ON, Canada
| | - Zoya Leonenko
- Department of Physics and Astronomy, University of Waterloo, Waterloo, ON, Canada
- Department of Biology, University of Waterloo, Waterloo, ON, Canada
| | - Carmen Höschen
- Chair of Soil Science, TUM School of Life Sciences, Technical University of Munich, Munich, Germany
| | - Gertraud Harrington
- Chair of Soil Science, TUM School of Life Sciences, Technical University of Munich, Munich, Germany
| | - Katharina Kuellmer
- Chair of Molecular Nutritional Medicine, TUM School of Life Sciences, Technical University of Munich, Freising, Germany
| | - Wangqing Bian
- Chair of Molecular Nutritional Medicine, TUM School of Life Sciences, Technical University of Munich, Freising, Germany
| | - Franz Schilling
- Department of Nuclear Medicine, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthew P. A. Fisher
- Department of Physics, University of California, Santa Barbara, CA, United States
| | - Matthew E. Helgeson
- Department of Chemical Engineering, University of California, Santa Barbara, CA, United States
| | - Tobias Fromme
- Chair of Molecular Nutritional Medicine, TUM School of Life Sciences, Technical University of Munich, Freising, Germany
- EKFZ—Else Kröner-Fresenius Center for Nutritional Medicine, Technical University of Munich, Freising, Germany
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Cid A, Patten A, Beazely M, Grindrod K, Yessis J, Chang F. Protocol for the Optimizing Naloxone Dispensing in Pharmacies (ONDP) Online Continuing Education Program: A Randomized Controlled Trial. Pharmacy 2022; 10:pharmacy10010024. [PMID: 35202073 PMCID: PMC8875968 DOI: 10.3390/pharmacy10010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 12/10/2022] Open
Abstract
The number of opioid-related deaths in Canada has steadily increased since 2016 and the COVID-19 pandemic has worsened this trend. Naloxone has been pivotal for reducing opioid-related harms and death, and pharmacists play a crucial role in ensuring the supply of naloxone to Canadians through community pharmacies. However, naloxone dispensing by pharmacists is not optimal; in fact, in Ontario, only 50% of pharmacists offer naloxone, despite national guidelines that pharmacists should offer naloxone to everyone with an opioid prescription. When asked why pharmacists do not proactively offer naloxone, recent research has identified that pharmacists need continuing education to boost confidence and knowledge on how to start conversations with patients. The study involves a delayed start, double-blind randomized controlled trial, for Canadian licensed pharmacists and pharmacy technicians. The goals of the program are to increase Canadian pharmacy professional’s knowledge, confidence, and motivation to proactively offer naloxone, as well as to decrease stigma associated with naloxone. The program incorporates behaviour change techniques from the Theoretical Domains Framework and the Theory of Planned Behaviour. The intervention program includes three modules that focus on improving pharmacists’ communication skills by teaching them how to proactively offer naloxone, while the control group will complete a reading assignment on the naloxone consensus guidelines. The program will involve a process and outcome evaluation in addition to a contribution analysis. This program is important for breaking down previously identified barriers and knowledge gaps for why pharmacists currently do not proactively offer naloxone. This study will provide important new information about what behaviour change techniques are successful in improving confidence and motivation in the pharmacy profession and in an online environment. Findings from this study can be used to produce a national naloxone education program that can also be implemented into current pharmacy school curriculum.
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Affiliation(s)
- Ashley Cid
- School of Pharmacy, University of Waterloo, 10 Victoria St. S A, Kitchener, ON N2G 1C5, Canada; (A.C.); (A.P.); (M.B.); (F.C.)
| | - Alec Patten
- School of Pharmacy, University of Waterloo, 10 Victoria St. S A, Kitchener, ON N2G 1C5, Canada; (A.C.); (A.P.); (M.B.); (F.C.)
| | - Michael Beazely
- School of Pharmacy, University of Waterloo, 10 Victoria St. S A, Kitchener, ON N2G 1C5, Canada; (A.C.); (A.P.); (M.B.); (F.C.)
| | - Kelly Grindrod
- School of Pharmacy, University of Waterloo, 10 Victoria St. S A, Kitchener, ON N2G 1C5, Canada; (A.C.); (A.P.); (M.B.); (F.C.)
- Correspondence:
| | - Jennifer Yessis
- School of Public Health Sciences, University of Waterloo, 200 University Ave. W, Waterloo, ON N2L 3G1, Canada;
| | - Feng Chang
- School of Pharmacy, University of Waterloo, 10 Victoria St. S A, Kitchener, ON N2G 1C5, Canada; (A.C.); (A.P.); (M.B.); (F.C.)
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Affiliation(s)
- Kelly Grindrod
- University of Waterloo School of Pharmacy, Kitchener, Ontario
| | - Michael Beazely
- University of Waterloo School of Pharmacy, Kitchener, Ontario
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Peng F, Yao H, Bai X, Zhu X, Reiner BC, Beazely M, Funa K, Xiong H, Buch S. Platelet-derived growth factor-mediated induction of the synaptic plasticity gene Arc/Arg3.1. J Biol Chem 2010; 285:21615-24. [PMID: 20452974 DOI: 10.1074/jbc.m110.107003] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Platelet-derived growth factor (PDGF) is a pleiotropic protein with critical roles in both developmental as well as pathogenic processes. In the central nervous system specifically, PDGF is critical for neuronal proliferation and differentiation and has also been implicated as a neuroprotective agent. Whether PDGF also plays a role in synaptic plasticity, however, remains poorly understood. In the present study we demonstrated that in the rat hippocampal neurons PDGF regulated the expression of Arc/Arg3.1 gene that has been implicated in both synapse plasticity and long term potentiation. Relevance of these findings was further confirmed in vivo by injecting mice with intracerebral inoculations of PDGF, which resulted in a rapid induction of Arc in the hippocampus of the injected mice. PDGF induced long term potentiation in rat hippocampal slices, which was abolished by PDGF receptor-tyrosine kinase inhibitor STI-571. We also present evidence that PDGF-mediated induction of Arc/Arg3.1 involved activation of the MAPK/ERK (MEK) pathway. Additionally, induction of Arc/Arg3.1 also involved the upstream release of intracellular calcium stores, an effect that could be blocked by thapsigargin but not by EGTA. Pharmacological approach using inhibitors specific for either MAPK/ERK phosphorylation or calcium release demonstrated that the two pathways converged downstream at a common point involving activation of the immediate early gene Egr-1. Chromatin immunoprecipitation assays demonstrated the binding of Egr-1, but not Egr-3, to the Arc promoter. These findings for the first time, thus, suggest an additional role of PDGF, that of induction of Arc.
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Affiliation(s)
- Fuwang Peng
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, Nebraska 68198-5880, USA
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