Medicine burden experiences of people living with HIV and association with stigma

The medicine burden of people living with HIV (PLWH) is unknown. Between 2018 and 2020, participants completed a survey comprising outcome measures for medicine burden (LMQ-3) and stigma experiences (SSCI-8). Participants were HIV+ adults (≥18 years), using antiretrovirals (ARV) with or without non-ARV medicines, recruited via two outpatient clinics in southeast England and online via HIV charities across the UK. Spearman's correlations between medicine burden levels and stigma scores were calculated. Participants were mostly males (72%, 101/141) of mean (SD) age 48.6 (±12.31) years. Total number of medicines ranged from 1-20. High medicine burden was self-reported by 21.3% (30) and was associated with polypharmacy (≥ 5 medicines) (101.52 Vs 85.08, p = 0.006); multiple doses versus once daily regimes (109.31 Vs 85.65, p = 0.001); unemployment (98.23 Vs 84.46, p = 0.004); and ethnicity (97 Vs 86.85, p = 0.041 for non-White versus White participants). A correlation between medicine burden and stigma was observed (r = 0.576, p < 0.001). The LMQ-3 demonstrated adequate construct validity and reliability (domain loadings ranging 0.617-0.933 and Cronbach's α of 0.714-0.932). Assessment of medicine burden and psychosocial stigma in PLWH could enable identification of those needing additional support in future research and practice.

Role of cosyntropin in the management of postpartum post-dural puncture headache: a two-center retrospective cohort study

BACKGROUND

Research suggests that postpartum post-dural puncture headache (PDPH) might be prevented or treated by administering intravenous cosyntropin.

METHODS

In this retrospective cohort study, we questioned whether prophylactic (1 mg) and therapeutic (7 µg/kg) intravenous cosyntropin following unintentional dural puncture (UDP) was effective in decreasing the incidence of PDPH and therapeutic epidural blood patch (EBP) after birth. Two tertiary-care American university hospitals collected data from November 1999 to May 2017. Two hundred and fifty-three postpartum patients who experienced an UDP were analyzed. In one institution 32 patients were exposed to and 32 patients were not given prophylactic cosyntropin; in the other institution, once PDPH developed, 36 patients were given and 153 patients were not given therapeutic cosyntropin. The primary outcome for the prophylactic cosyntropin analysis was the incidence of PDPH and for the therapeutic cosyntropin analysis in exposed vs. unexposed patients, the receipt of an EBP. The secondary outcome for the prophylactic cosyntropin groups was the receipt of an EBP.

RESULTS

In the prophylactic cosyntropin analysis no significant difference was found in the risk of PDPH between those exposed to cosyntropin (19/32, 59%) and unexposed patients (17/32, 53%; odds ratio (OR) 1.37, 95% CI 0.48 to 3.98, P = 0.56), or in the incidence of EBP between exposed (12/32, 38%) and unexposed patients (6/32, 19%; OR 2.6, 95% CI 0.83 to 8.13, P = 0.095). In the therapeutic cosyntropin analysis, in patients exposed to cosyntropin the incidence of EBP was significantly higher (20/36, 56% vs. 43/153, 28%; OR 3.20, 95% CI 1.52 to 6.74, P = 0.002).

CONCLUSIONS

Our data show no benefits from the use of cosyntropin for preventing or treating postpartum PDPH.

The spatial and temporal dynamics of sediment phosphorus attenuation and release in impacted stream catchments

Sediments can attenuate phosphorus (P) from overlying water and reduce trophic status in zero and first order ditches and streams. These features can be considered as intermediate mitigation features between P mobilised from land, and onward delivery to river systems, if the risk of chemical P release from sediments is minimal. However, risk assessments are rarely based on temporal scale dynamics and especially at fine scale in both sediment and water column environments. In this study, in eutrophic stream catchments, bed sediments were tested fortnightly and spatially over one year for EPC0 (to derive phosphate exchange potential-PEP) and for P across a spectrum from labile to recalcitrant fractions. At the same time stream discharge and P concentrations were measured synchronously at high frequency and resolved to 1-hour intervals and indicated high water quality pressures at all flow rates. PEP indicated spatial and temporal changes most likely caused by periods of source disconnection/reconnection and sediment mobilisation during storm events, moving from periods of high attenuation potential to near saturation. Despite these spatial and temporal changes, PEP did not indicate much potential for chemical P release from the sediments (distributing mostly below or close to zero). However, this may be a misleading risk assessment by itself as physical P release, especially of the labile bicarbonate-dithionite (B-D) P fraction of sediments, was a more dominant process mobilised during storm events reducing by up to 84 % during a succession of summer storm events. The total P and total reactive P loads monitored leaving the catchments were coincident with these changes. The specific downstream trophic effects of this episodic P release will need to be assessed in terms of its bioavailability, in combination with other more noted diffuse and point P source processes.

My HIV Care – Preferences of people living with HIV for medicine-related support from community pharmacists

Introduction

HIV is now a long-term condition, presenting new challenges for primary care providers. Hospital-based specialists have traditionally provided medicine-related support to people living with HIV (PLWH) within secondary care clinics,1 but with an aging population and rising polypharmacy2 other forms of support will be needed. Although community pharmacists (CPs) are already involved in sexual and reproductive health service delivery to varying magnitudes,3 it is unknown whether PLWH want them to be involved in their HIV treatment and medicine support.

Aim

To understand the pReferences and perceptions of PLWH towards CP involvement in their care.

Methods

An online survey, promoted to UK HIV charities and activists via social media (November 2021–July 2022), asked about pReferences for medicine-related support and the involvement of CPs in PLWH’s care. Questions explored factors that would influence use of CPs for all services. Views on sharing HIV diagnoses with CPs during medicine-related consultations were also obtained. Descriptive analysis was used. Institutional ethics approval was obtained.

Results

Approximately half (73/144) of those who accessed the survey fully completed it: 57.5% male; age 22-80 years. Of those who provided demographic data: 88.9%(n=48/54) were white; gay/lesbian (64.8%, n=35); University-level education (57.4%, n=31) and employed (55.6%, n=30). CPs were rated among the least helpful health professionals in terms of medicine support (2.7%, n=2) compared to general practitioners (13.7%, n=10), HIV clinic-based nurses (35.6%, n=26), specialist pharmacists (42.5%, n=31) or consultants (56.2%, n=41). Over half (56.1%, n=41) were unsure or did not want their CP to be involved in their HIV care. Patient autonomy/self-efficacy, mistrust, concerns around stigma and privacy/confidentiality of information shared in community pharmacy settings, and perceived lack of HIV-related knowledge among CPs influenced participants’ pReferences: “they don’t need to know or don’t have the understanding of HIV and HIV meds to correctly use this information. I check drug and treatment interactions or complications before procedures myself.” Many participants wanted more information on HIV-related drug interactions and less judgemental attitudes: "if they could be less racist and homophobic and normalise conversations about HIV.” Some participants wanted holistic supply of all their antiretroviral and non-HIV medicines from their community pharmacies. There was equal resistance from other participants: “I certainly wouldn’t want my HIV care to be done by a chemist...” Expectedly, more participants were willing to share information about their HIV status and antiretroviral drug history during private (39.7%, n= 29) compared to over-the-counter consultations (28.8%, n= 21). Reasons for sharing information with CPs were positive: “so that they fully understand my medical circumstances and help me accordingly” and “in case of interactions”.

Discussion/Conclusion

Whereas some PLWH want more involvement of CPs in their care, others are sceptical of their role in HIV, similar to other primary care providers.1 This study was limited to online respondents. Future research is needed to explore how to build confidence of PLWH in CPs with regards to their changing medicine support needs. Understanding training needs of CPs and promoting HIV-friendly community pharmacies will be key in supporting medicine needs of PLWH.

References

1. Rai T et al. Experience of primary care for people with HIV: a mixed-method analysis. BJGP Open, 2019;3(4):1-14

2. Baylis A et al. The future of HIV services in England -shaping the response to changing needs. Kings Fund Report. 2017;1-100

3. Public Health England (The UK Health Security Agency). The pharmacy offer for sexual health, reproductive health and HIV - a resource for commissioners and providers, 2019;1-25

Associations Between Nicotine Knowledge and Smoking Cessation Behaviors among U.S. Adults Who Smoke

INTRODUCTION

Misperceptions about nicotine's contribution to smoking-related health harms could complicate efforts to reduce the public health burden of smoking. Study goals were to describe nicotine knowledge among adults who smoke and investigate whether misperceiving nicotine as a source of health harm was associated with beneficial health behaviors, or lower uptake of using less harmful sources of nicotine to support smoking cessation attempts.

METHOD

This study used longitudinal data from 9,140 adults who participated in four waves of the Population Assessment of Tobacco and Health Study and were current smokers during the first wave. Logistic regressions estimated odds ratios for correct responses across six aspects of nicotine knowledge assessed in Wave 4. Longitudinal models estimated associations between misperceptions and cigarette consumption, and odds of making a quit attempt; self-reported cessation; e-cigarette use; and use of NRT or e-cigarettes to support quit attempts.

RESULTS

Participants who were non-White, older, and had lower educational attainment or income tended to be least knowledgeable about nicotine. Misperceiving nicotine as harmful to health was associated with increased odds of quit attempts (AOR: 1.12, 95% CI: 1.03, 1.23), lower odds of cessation success (AOR: 0.84, 95% CI: 0.73, 0.98) and e-cigarette use (AOR: 0.79, 95% CI: 0.72, 0.86), and lower odds of using NRT (AOR: 0.84, 95% CI: 0.71, 0.99) or e-cigarettes to support quit attempts (AOR: 0.59, 95% CI: 0.49, 0.71).

CONCLUSION

Harm reduction efforts may be impeded by misperceptions about nicotine. Further work should evaluate the effects of correcting such misperceptions through public education.

IMPLICATIONS

This study provides longitudinal evidence that among adult smokers, misperceiving nicotine as a primary cause of smoking-related diseases may be associated with reduced cessation success and lower likelihood of using less harmful nicotine products. These misperceptions may therefore impede efforts to encourage smokers ready to quit to use evidence-based cessation support such as nicotine replacement during quit attempts and limit the success of policies designed to shift smokers to less harmful sources of nicotine. Further work should evaluate the longitudinal effects of correcting nicotine misperceptions through public education targeted toward adults who smoke.

Relationship between postpartum mood disorder and birth experience: a prospective observational study

BACKGROUND

This study aims to investigate the relationship between the birth experience and the risk of developing postpartum depression or post-traumatic stress disorder.

METHODS

In this prospective, longitudinal, observational study, women were assessed at different time points for depression and post-traumatic stress disorder. The risk of depression or post-traumatic stress disorder based on patient characteristics and specific birth events was assessed within three months postpartum.

RESULTS

We enrolled 600 women; 426 were eligible for postpartum assessment. At six weeks and three months postpartum, 15.9% and 12.7% screened positive for depression respectively. Positive post-traumatic stress disorder screenings at six weeks and three months postpartum were 6.2% and 5.1% respectively. Twenty-seven women (8.3%) with a negative screening at six weeks converted to a positive depression or post-traumatic stress disorder screening at three months. A pre-existing history of anxiety or depression was associated with an increased risk of developing depression (aOR 2.12, 95% CI 1.30 to 3.47) and post-traumatic stress (aOR 3.15, 95% CI 1.42 to 7.02) within three months postpartum. The risk of developing post-traumatic stress disorder within three months postpartum was also increased among patients experiencing their first delivery (aOR 2.55, 95% CI 1.10 to 5.88) or operative management of postpartum hemorrhage (aOR 4.44, 95% CI 1.16 to 17.02).

CONCLUSION

Depression and post-traumatic stress symptoms either persisted or had new onset at three months postpartum. Mental health screening and postpartum follow-up after six weeks should be considered in high-risk patients who have a history of psychopathology, nulliparity, or undergo operative management of postpartum hemorrhage.

Cyclic voltammetric detection in capillary electrophoresis with application to metal ions

Fast cyclic voltammetry (CV) was evaluated over sweep rates of 20-1000 V/s at Au disk electrodes (25 and 10 μm) for end-capillary detection in capillary electrophoresis with metal ions as test analytes; some studies were also done with 25-μm Pt disk electrodes. The waveform applied to the electrode consisted of a preconcentration period (55-330 ms) followed by cyclic voltammetry (2-100 ms). Maximum signal-to-noise was obtained with the integrated CV current as the analytical signal, and this was linearly proportional to sweep rate; maximum response was obtained at sweep rates of >100 V/s for 10-μm electrodes and >200 V/s for 25-μm electrodes; sweep rates of >400 V/s caused peak tailing due to trapping of the analyte at the electrode. With this CV detection approach, comigrating analytes could be identified and determined. Reproducibilities for six analytes over the range 1.0 × 10(-)(7)-1.0 × 10(-)(5) mol/L were 2%-5%, and calibration curves were linear, with response factors in the range of 2%-6%. Detection limits (2 × peak-to-peak baseline noise) were in the range of 5 × 10(-)(9)-4 × 10(-)(8) mol/L, which are 1-2 orders of magnitude better than results obtained previously with square-wave pulsed amperometric detection of metal ions.

Thoroughbred racehorse mitochondrial DNA demonstrates closer than expected links between maternal genetic history and pedigree records

The potential future earnings and therefore value of Thoroughbred foals untested in the racing arena are calculated based on the performance of their forebears. Thus, lineage is of key importance. However, previous research indicates that maternally inherited mitochondrial DNA (mtDNA) does not correspond to maternal lineage according to recorded pedigree, casting doubt on the voracity of historic pedigrees. We analysed mtDNA of 296 Thoroughbred horses from 33 maternal lineages and identified an interesting trend. Subsequent to the founding of the Thoroughbred breed in the 16th century, well-populated maternal lineages were divided into sub-lineages. Only six in 10 of the Thoroughbreds sampled shared mitochondrial haplotype with other members of their maternal lineage, despite having a common maternal ancestor according to pedigree records. However, nine in 10 Thoroughbreds from the 103 sub-lineages sampled shared mtDNA with horses of their maternal pedigree sub-lineage. Thus, Thoroughbred maternal sub-lineage pedigree represents a more accurate breeding record than previously thought. Errors in pedigrees must have occurred largely, though, not exclusively, at sub-lineage foundation events, probably due to incomplete understanding of modes of inheritance in the past, where maternal sub-lineages were founded from individuals, related, but not by female descent.

Low flow water quality in rivers; septic tank systems and high-resolution phosphorus signals

Rural point sources of phosphorus (P), including septic tank systems, provide a small part of the overall phosphorus budget to surface waters in agricultural catchments but can have a disproportionate impact on the low flow P concentration of receiving rivers. This has particular importance as the discharges are approximately constant into receiving waters and these have restricted dilution capacity during ecologically sensitive summer periods. In this study, a number of identified high impact septic systems were replaced with modern sequential batch reactors in three rural catchments during a monitoring period of 4 years. Sub-hourly P monitoring was conducted using bankside-analysers. Results show that strategic replacement of defective septic tank systems with modern systems and polishing filters decreased the low flow P concentration of one catchment stream by 0.032 mg TPL(-1) (0.018 mg TRPL(-1)) over the 4 years. However two of the catchment mitigation efforts were offset by continued new-builds that increased the density of septic systems from 3.4 km(-2) to 4.6 km(-2) and 13.8 km(-2) to 17.2 km(-2) and subsequently increased low flow P concentrations. Future considerations for septic system mitigation should include catchment carrying capacity as well as technology changes.

The cosmopolitan maternal heritage of the Thoroughbred racehorse breed shows a significant contribution from British and Irish native mares

The paternal origins of Thoroughbred racehorses trace back to a handful of Middle Eastern stallions, imported to the British Isles during the seventeenth century. Yet, few details of the foundation mares were recorded, in many cases not even their names (several different maternal lineages trace back to ‘A Royal Mare’). This has fuelled intense speculation over their origins. We examined mitochondrial DNA from 1929 horses to determine the origin of Thoroughbred foundation mares. There is no evidence to support exclusive Arab maternal origins as some historical records have suggested, or a significant importation of Oriental mares (the term used in historic records to refer to Middle East and western Asian breeds including Arab, Akhal-Teke, Barb and Caspian). Instead, we show that Thoroughbred foundation mares had a cosmopolitan European heritage with a far greater contribution from British and Irish Native mares than previously recognized.

Separation and determination of the macrolide antibiotics (erythromycin, spiramycin and oleandomycin) by capillary electrophoresis coupled with fast reductive voltammetric detection

Separation and determination of erythromycin, spiramycin and oleandomycin by capillary zone electrophoresis coupled with fast reductive voltammetric detection using an Hg-film electrode was investigated in a simple aqueous phosphate buffer system. The influence of pH, concentration of phosphate, applied voltage, capillary length and dimension on the separation was examined and optimized. The entire separation of erythromycin, spiramycin, and oleandomycin was achieved in a 0.2 mol/L phosphate buffer system without organic modifiers. The electrochemical detection parameters, such as electrode material, applied waveform, scan rate, preconcentration potentials and preconcentration times, were investigated and discussed. This approach provides high separation efficiency and high sensitivity for all compounds, with detection limits (3 x peak-to-peak baseline noise) of 7.5 x 10(-8) mol/L for spiramycin, and 3 x 10(-7) mol/ L for erythromycin and oleandomycin. The calibration plot of peak areas for each separated peak vs. concentration of analyte was found to be linear over three orders of magnitude.

Nurse-managed wound clinic. A case study in success

The wound Care Clinic at Naval Hospital Charleston is a nurse-managed ambulatory clinic that has demonstrated the successful application of nursing case management in caring for patients with chronic and complex wounds. Nursing case management is an outcomes-based system of assessment, planning, provision of nursing services, coordination of interdisciplinary efforts, education, and referral. Nursing case management has been shown, in the literature and at Naval Hospital Charleston, to be an extension of role of professional nursing practice and results in decreased costs, improved quality of care, faster wound healing times, decreased complications, and greater coordination of care between specialty disciplines. These positive results are illustrated in several case studies. Nursing case management has many implications for the successful implementation of any healthcare delivery system where decreased costs and improved quality of care are valued, and it has special benefit in the complex management of chronically ill patients.

Capillary electrophoresis of some tetracycline antibiotics coupled with reductive fast cyclic voltammetric detection

The separation and quantitative performance parameters for tetracycline, chlortetracycline and oxytetracycline antibiotics were investigated by capillary zone electrophoresis coupled with fast cyclic voltammetric detection. Optimization of pH and complexation with a boric acid-sodium tetraborate buffer provided good resolution of all compounds. Detection by electrochemical reduction using fast on-line cyclic voltammetric detection with a Hg-film-microm electrode gave detection limits (2 x peak-to-peak baseline noise) of 7 x 10(-7) mol/l for tetracycline and chlortetracycline, and 1.5 x 10(-6) mol/l for oxytetracycline. The influence of electrode material, potential range and scan rate was examined and discussed. Optimal electrochemical detection was obtained at a Hg-film electrode with a waveform that consisted of an initial constant potential of -0.6 V for 200 ms followed by a cyclic voltammetry (CV) scan at 300 V/s from - 0.6 V to a vertex potential of 1.7 V. The analytical signal was obtained by plotting the integrated values of the CV current from each applied waveform as a function of time. The calibration plot (peak areas) for each separated peak was found to be linear over three-orders of magnitude.

Determination of trimethoprim and sulphadoxine residues in porcine tissues and plasma

Healthy gilts and market-ready hogs were administered a single intramuscular (IM) injection of Borgal, a commercial formulation of trimethoprim-sulfadoxine (TMP-SDX), once or twice daily. The objectives were to determine if a newly-developed high-performance liquid chromatographic (HPLC) method would be suitable for measuring the residual concentrations of TMP in the plasma of these live animals, and to determine if the administration of this veterinary drug would leave measurable residues in their plasma and tissues at slaughter. Plasma and tissue concentrations of SDX and TMP from these animals were determined over a period of 14 d using thin-layer chromatography/densitometry (TLCD), and the newly-developed HPLC method, respectively. The lowest detectable limit (LDL) for SDX in plasma and tissue was 20 ppb by TLCD. The HPLC method had a LDL of 5 ppb for TMP in plasma and tissue. Both methods were then used to provide baseline data on the absorption and depletion of TMP and SDX from these healthy animals. It was observed that both TMP and SDX were readily absorbed into the blood and tissues, but TMP was eliminated much faster than SDX. No TMP residues were detected in the plasma of any of the gilts at and beyond 21 h after drug administration. Also, no TMP residues were detected in the plasma of any of the market-ready hogs 24 h after drug administration at either the label dose or twice the label dose. Sulfadoxine residues at concentrations above the maximum residue limit (MRL) of 100 ppb were, however, detected in the plasma, muscle, kidney, liver, and injection sites of hogs slaughtered 1 and 3 d after a single IM administration at the label dose. Although SDX residues were still detectable in the lungs, kidney, liver and plasma of some hogs 10 d after administration of the label dose and twice the label dose, these were below the MRL. Postmortem examination revealed necrosis and inflammation at the injection sites, but no visible deposits of the injected drug.

Should all pregnant women be screened for hepatitis B?

To assess the sensitivity of historical risk factors for identification for hepatitis B surface antigen (HBsAg)-positive parturients, 4399 pregnant women were consecutively screened for HBsAg. Information regarding risk for hepatitis B infection was obtained from each HBsAg-positive parturient. Twenty-three HBsAg-positive subjects were identified (5.2/1000 deliveries). The HBsAg carrier rate (18/2231, or 8.1/1000 deliveries) was significantly higher in women of black, Asian, or Hispanic origin than in the remaining ethnic groups (non-Hispanic whites plus all others, 5/2168, or 2.3/1000 deliveries) (chi square, 5.95; p = 0.016). Risk factors for identification of HBsAg-positive women were present in 10 of 22 asymptomatic subjects (sensitivity, 45%; 95% confidence interval, 24% to 68%). Much of the information required to assess one of these risk factors, previous infection, involved detailed questioning and is unlikely to be obtained in the context of conventional obstetrical care. Routine maternal HBsAg screening programs may be needed if transmission of hepatitis B from mother to infant is to be prevented.

Eosinophilic granuloma of the proximal tibial epiphysis

This is a 3-year follow-up report of an eosinophilic granuloma of bone occurring in a growing epiphysis. The lesion occurred in a 6-year-old boy and is only the third such case reported in the literature. Eosinophilic granuloma should be considered in the differential diagnosis of lytic lesions of the epiphysis in childhood.