Factors affecting sense of belonging and academic achievement in MPharm students

Introduction

Academic achievement in higher education has been linked to academic ability and a student’s experiences at university. Factors affecting the student experience include demographics (age, gender, ethnicity), and contextual factors (living arrangements, sense of belonging (SOB)).1 Whether SOB is relevant to understanding pharmacy students’ academic achievement has not been investigated.

Aim

This study aims to investigate SOB in students on one MPharm programme and its associations with demographic / contextual factors and academic achievement.

Method

A questionnaire was distributed to all MPharm students at one university (n=601). It included a SOB instrument2 measuring five domains (perceived peer support, faculty support, classroom comfort, isolation, empathetic faculty understanding), demographic and contextual factors, and consent to link responses to end of year marks. Mean marks, % rank, one-way ANOVA with Tukey HST post hoc tests, independent samples t-tests and Pearson’s correlation co-efficient were calculated in SPSS v25 to investigate associations between SOB and demographic / contextual factors and academic achievement. Results: Four-hundred-and-forty-seven students responded (74.4%), of whom 80.1% consented to data linkage with assessment marks. Of the respondents, 317 (71.9%) were female, 408 (91.9%) were younger than 21 when commencing their MPharm, and 275 (61.5%) lived with other students. Respondents’ ethnicity was: 128 (32.8%) white, 158 (40.5%) asian, 53 (13.6%) black, 51 (13.1%) chinese. Analysis suggests SOB domains varied significantly in relation to demographic and contextual factors, with perceived peer support and perceived isolation in particular associated with multiple factors investigated (see Table 1).

Analysis of mean % rank (f=8.601, p=0.001) revealed that white students achieved significantly higher (64.6) than asian (51.5, p= 0.002), black (50.4, p=0.006), and chinese (41.9, p=0.014) students. Students who lived with other students achieved a significantly higher mean % rank (58.3), than those who did not (48.3, t=3.251, p=0.001). A positive correlation was identified between perceived peer support (r=0.211, p=0.001) and % rank. Perceived isolation was negatively correlated to % rank (r= -0.192, p=0.001).

Conclusion

Although limited to one UK school of pharmacy, yet with a good mix of student ethnicity, findings suggest important differences in the student experience, and that for some subgroups this may be associated with their academic achievement. This study offers valuable understanding of factors potentially impacting academic achievement, and provides insights to inform targeted interventions aimed at improving the student experience with a view to addressing SOB and achievement gaps. Further research is required to quantify the effect of the factors and their interdependence.

References

1. Mountford-Zimdars A, Sabri D, Moore J, Sanders J, Jones S, & Higham L. (2015). Causes of differences in student outcomes. Report for HEFCE by Kings College London, ARC Network and the University of Manchester. Available at: https://dera.ioe.ac.uk/23653/1/HEFCE2015_diffout.pdf accessed October 2020.

2. Hoffman M, Richmond J, Morrow J, & Salomone K. (2002). Investigating “Sense of Belonging” in First-Year College Students. Journal of College Student Retention: Research, Theory & Practice, 4(3), pp. 227–256.

Portuguese recommendations for the prevention, diagnosis and management of primary osteoporosis - 2018 update

BACKGROUND

Advances in osteoporosis (OP)case definition, treatment options, optimal therapy duration and pharmacoeconomic evidence in the national context motivated the Portuguese Society of Rheumatology (SPR) to update the Portuguese recommendations for the diagnosis and management of osteoporosis published in 2007.

METHODS

SPR bone diseases' working group organized meetings involving 55 participants (rheumatologists, rheumatology fellows and one OP specialist nurse) to debate and develop the document. First, the working group selected 11 pertinent clinical questions for the diagnosis and management of osteoporosis in standard clinical practice. Then, each question was investigated through literature review and draft recommendations were built through consensus. When insufficient evidence was available, recommendations were based on experts' opinion and on good clinical practice. At two national meetings, the recommendations were discussed and updated. A draft of the recommendations full text was submitted to critical review among the working group and suggestions were incorporated. A final version was circulated among all Portuguese rheumatologists before publication and the level of agreement was anonymously assessed using an online survey.

RESULTS

The 2018 SPR recommendations provide comprehensive guidance on osteoporosis prevention, diagnosis, fracture risk assessment, pharmacological treatment initiation, therapy options and duration of treatment, based on the best available evidence. They attained desirable agreement among Portuguese rheumatologists. As more evidence becomes available, periodic revisions will be performed. Target audience and patient population: The target audience for these guidelines includes all clinicians. The target patient population includes adult Portuguese people. Intended use: These recommendations provide general guidance for typical cases. They may not be appropriate in all situations - clinicians are encouraged to consider this information together with updated evidence and their best clinical judgment in individual cases.

Granulomatosis with polyangiitis initially misdiagnosed as lung cancer

Granulomatosis with Polyangiitis (GPA), which was formerly named Wegener's Granulomatosis (WG) is a systemic disease characterized by necrotizing granulomatous inflammation and vasculitis that primarily involves upper and lower respiratory tract, as well as kidneys. Diagnosing GPA on the basis of transthoracic fine needle aspiration (TFNA) may be problematic, as it can be misdiagnosed as cancer. We describe a patient with a probable GPA which was originally diagnosed as malignancy, but who responded to lung cancer chemotherapy.

[Myalgia of the girdle in the elderly: an uncommon etiology]

We describe the clinical case of 80 years, caucasian woman, with personal history of osteoporosis and chronic normochromic normocytic anemia (NN). She had a three month history of myalgias of the girdle, stiffness in the morning, exceeding 1 hour, associated with inflammatory arthralgia of the small joints of hands and feet. Complementary exams showed normocytic normochromic anemia with Hg 9.8 g/dL; ESR 44 mm/h; CRP 7 mg/dL. Given the profile suggestive of Polymyalgia Rheumatica started prednisolone 10 mg/day with favorable clinical response. Four months after treatment she started paresthesias of right hand and foot, polaquiuria, petequial lesions in lower limbs and inability to walk; there was worsening of anemia and elevation of the biological parameters of inflammation, beginning of renal insufficiency with creatinine clearance 22 ml/min, proteinuria and eritrocituria. Renal biopsy was compatible with Wegener's granulomatosis/microscopic poliangeite. Vasculitis is a rare disease of the elderly and its clinical presentation is varied. The arteritis of giant cells and Polymyalgia Rheumatica are more common in the elderly. It is not often Polymyalgia-like presentation in cases of Wegener's granulomatosis/microscopic polyangitis.

Determination of dimenhydrinate in human plasma by liquid chromatography–electrospray tandem mass spectrometry: Application to a relative bioavailability study

Here we present a sensitive and specific liquid chromatography-tandem mass spectrometric method for the quantification of dimenhydrinate (I) in human plasma. Sample preparation is conducted using citalopram (II) addition as an internal standard (IS), liquid-liquid extraction with basified plasma using a mixture hexane/acetate (1:1, v/v) as the extracting solvent, and the final extract reconstituted in the mobile phase. I and II (IS) were injected in a C8 column with the mobile phase composed of methanol:isopropanol:water:formic acid (78.00:19.92:2.00:0.08, v/v/v/v) and monitored using a positive electrospray source with tandem mass spectrometry analyses. The selected reaction monitoring (SRM) was set using precursor ion and product ion combinations of m/z 256.0>167.0 and m/z 325.0>109.0 for I and II, respectively. The limit of quantification (LOQ) was 0.4 ng/mL, the dynamic range being 0.4-200 ng/mL. Validation results on linearity, specificity, accuracy, precision and stability, as well as on application to the analysis of plasma samples taken up to 24 h after oral administration of 100 mg of dimenhydrinate in healthy volunteers demonstrated its applicability to bioavailability studies.

Association between Pro12Ala polymorphism of the PPAR-gamma2 gene and insulin sensitivity in Brazilian patients with type-2 diabetes mellitus

AIM

Peroxisome-proliferator-activated receptor-gamma2 (PPAR-gamma2) is a nuclear receptor that plays an important role in lipid metabolism and insulin sensitivity. The purpose of this study is to investigate the association of Pro12Ala polymorphism at the PPAR-gamma2 gene in Brazilian patients with type-2 diabetes mellitus (T2Dm) and controls (CG).

METHODS

Genomic DNA was obtained from 207 unrelated white people presenting with T2Dm and from 170 controls. Anthropometric data included body mass index and waist to hip ratio. Biochemical parameters included fasting plasma glucose, total cholesterol, high- and low-density lipoprotein cholesterol, triglycerides, glycated haemoglobin and insulin. Systolic and diastolic blood pressures were also measured. Screening for mutations in the entire coding region of the PPAR-gamma gene was performed by means of polymerase chain reaction (PCR), single-strand conformational polymorphism and sequencing. Pro12Ala polymorphism was analysed by using PCR-RFLP (restriction fragment-length polymorphism).

RESULTS

One base substitution was identified - a C to G substitution in exon B of the PPAR-gamma2 gene. The frequency of the Ala12 allele in T2Dm (0.09) was similar to that found in CG (0.06, p = 0.185). In the T2Dm group, Ala12 allele was associated with lower fasting plasma insulin levels (p = 0.036) and higher insulin sensitivity (p = 0.049) by means of homeostasis model assessment. Among obese people, there was no association between any of the T2Dm or obesity-related traits and the Pro12Ala polymorphism.

CONCLUSIONS

The results of our study suggest that people with the Ala12 allele of the PPAR-gamma2 gene could be more sensitive to insulin than those carriers of the Pro12 allele among Brazilian Caucasians.

Effect of the peroxisome proliferator-activated receptor-gamma C161T polymorphism on lipid profile in Brazilian patients with Type 2 diabetes mellitus

AIM

The aim of the present study was to examine the effects of the C161T polymorphism of the peroxisome proliferator-activated receptor gamma (PPARgamma) gene in Brazilian subjects with Type 2 diabetes mellitus (T2DM) and controls residing in Sao Paulo City, Brazil.

METHODS

Genomic DNA was obtained from 207 patients with T2DM and 170 unrelated normoglycemic individuals (CG). Anthropometric data included: body mass index, waist, hip, waist-to-hip ratio; biochemical parameters: fasting plasma glucose, total cholesterol, HDL- and LDL-cholesterol, triglycerides, glycated hemoglobin and insulin. Systolic and diastolic blood pressure was also measured. Screening for mutations in the entire coding region of the PPARgamma gene was carried out by PCR, single strand conformational polymorphism analysis (SSCP) and sequencing. C161T polymorphism was analyzed by PCR-RFLP.

RESULTS

The C161T polymorphism was the only variant found in exon 6 of the PPARgamma gene. The frequency of the 161T allele in T2DM (0.10) was similar to that found in CG (0.07, p=0.210). Serum triglycerides (p=0.040), VLDL-cholesterol (p=0.040) and Atherogenic Index of Plasma (AIP; p=0.003) were significantly lower in 161T allele carriers than non-carriers in women of the T2DM group.

CONCLUSIONS

Our results show that the C161T polymorphism in the PPARgamma gene is not associated with variables related to T2DM or insulin resistance in the Brazilian population. However, a reduction of serum triglycerides and AIP was observed in women with 161T allele of the C161T polymorphism of the PPARgamma gene.

Guidelines for clinical studies assessing the efficacy of drugs for the management of acute low back pain

In this paper we propose guidelines for clinical trials aimed at assessing the efficacy of drugs for acute non-specific low back pain (LBP) with or without radicular pain, preliminary to their approval and registration. To this end, consensus statements were obtained from a group of experts in the fields of rheumatology, clinical medicine, public health and epidemiology. EBM resources were systematically used as references. Four diagnostic categories were defined: type 1--LBP with no radiation; type 2--LBP radiating no further than the knee; type 3--LBP radiating beyond the knee, but with no neurologic signs; and type 4--LBP radiating to a specific and entire leg dermatome, with or without neurologic signs. Studies should be designed on the basis of the claimed indications for the drug, but must be double-blinded whatever the indication. The duration of the study may be shorter for LBP type 1 or 2 (one week) than for LBP types 3 and 4 (up to one month), depending on the aim of the study and the indications for the drug. The comparator may be inactive (placebo) or active (for a superiority trial, e.g., versus paracetamol). Specific inclusion and exclusion criteria have been defined here for each category. An appropriate wash-out period for any drugs that could affect the pain status should be planned. Paracetamol may be allowed as rescue medication. The primary endpoint should be based on a validated pain assessment tool that may be either generic (type 1 or 2) or oriented (back and knee for types 3 and 4). Secondary endpoints could include the assessment of functional performance; the duration of any period of bed-rest; work limitation; a global assessment comprising pain at rest, standing and walking; the time elapsed before epidural injection, the prescription of other therapeutic agents, or surgery; and the use of rescue medication. Adverse events (AE) should be monitored systematically using a methodology that reflects the mode of action of the tested drug. With the application of these guidelines, LBP could serve as an appropriate disease for testing analgesic drugs. Rigorous evaluation may also help to improve the management of acute LBP.

Fibrodysplasia ossificans progressiva: report of two cases

Fibrodysplasia Ossificans Progressiva (FOP) is a rare hereditary connective tissue disease, genetically inherited as an autosomal dominant trait with complete penetrance but variable expressivity. Onset is typically in childhood and progressive involvement of the spine and proximal extremities leads to immobility and articular dysfunction. We present two cases with the typical features of FOP and a review of the pathogenesis, clinical manifestations and treatment options of this rare disease.

[Viral infection and fibromyalgia]

Fibromyalgia (FM) is a very frequent syndrome of unknown cause, characterized by generalized pain, fatigue and a number of tender points to palpation. Among the several etiopathogenic hypotheses discussed, the association of FM with some viral infections has been the object of multiple studies due to its relation and similarity with the chronic fatigue syndrome, acknowledges as being related, although not exclusively, with the chronic infection by the Epstein-Barr virus. Many individual descriptions of association between infection with the human parvovirus B19 and FM led us to carry out this study, comparing the serology for that virus in 52 patients with FM and 39 healthy controls. The titers of specific IgG anti-parvovirus B19 antibodies, indicating previous infection with that virus, were determined in all 91 individuals through ELISA method and at the same laboratory. Results revealed, though not significantly, a greater prevalence of positive titers, of which the mean was also higher, in patients than in controls. When comparing the women from both groups, this tendency was even less perceptible. These data imply that there is no etiologic association between infection with the human parvovirus B19 and FM.