Race and gender disparities in preventive health activity engagement of older adults in the southeastern United States.

A cross-sectional study was conducted to determine preventive-health-activity engagement in community-dwelling older adults participating in student-led health screenings in east Alabama. From 2017-2019, health professions students conducted health screenings at 23 community and independent living sites to assess medical and social needs of adults. Clients' responses to questions regarding vaccinations (flu/pneumonia/shingles), cancer screenings (colon/sex-specific), and other (dental/vision) screenings were aggregated to create a preventive health behavior (prevmed) score. Chi-square, t-tests, and regression analyses were conducted. Data from 464 adults ages 50-99 (72.9±10.1) years old were analyzed. The sample was 71.3% female, 63.1% Black/African American (BA), and 33.4% rural. Linear regression indicated BA race (p=0.001), currently unmarried (p=0.030), no primary care provider (p<0.001) or insurance (p=0.010), age <65 years (p=0.042) and assessment at a residential site (p=0.037) predicted lower prevmed scores. Social factors predict preventive health activity engagement in community-dwelling adults in east Alabama, indicating several opportunities to improve health outcomes.

Ten Lessons Learned in the Implementation of Mobile, Community-Based Interprofessional Clinics.

ABSTRACT: Incorporation of interprofessional activities within health profession programs is critical to prepare students for practice. Faculty at our institution saw a need to incorporate interprofessional education in the nursing, pharmacy, social work, and dietetics program curricula. We collaborated with a medical school in the area to develop a mobile, community-based interprofessional clinic to deliver care and education and address the needs of older adults while also providing unique, meaningful learning opportunities for students. We describe several lessons learned from our experience of developing and implementing this interprofessional clinic.

Identifying future pharmacists: Development and implementation of a pharmacy camp experience.

INTRODUCTION: Hands-on learning continues to serve as a positive mechanism for gaining interest and increasing recruitment in the health professions. This paper explores the Harrison School of Pharmacy's (HSOP) development and implementation of a week-long pharmacy camp designed to engage learners through active learning experiences to provide early exposure to the pharmacy profession. METHODS: The planning committee was formed in fall 2016, with the inaugural camp occurring summer 2017. A partnership with Auburn University Youth Programs allowed the committee to utilize existing university infrastructure and resources. Designed to expose campers to a variety of practice settings, the curriculum immersed participants in active learning experiences that allowed them to learn more about the clinical skills and knowledge needed for practice. To create diverse and learner-centric experiences, the planning committee recruited current second- and third-year student pharmacists to serve as counselors and peer instructors for all camp activities. RESULTS: Over two years, the camp hosted 40 campers representing nine states. Campers were predominantly female (65.3%), an average age of 16.8 years, and 16% were from diverse backgrounds. Camper feedback found overall satisfaction with the camp was high, with most indicating they attended camp to learn more about the pharmacy profession, specifically the school. As of spring 2019, 20% of total campers had applied and been accepted into the HSOP's Early Assurance Program. CONCLUSIONS: While early findings are good, the true value of the camp will be found over time as the committee explores if more students are choosing pharmacy as a career.

Exploring the Impact of Participating as Pharmacy Camp Counselors on Student Pharmacists' Professional Identity.

Objective. To explore how participation as a pharmacy camp counselor impacted pharmacy students' professional identity and views on professionalism. Methods. A pharmacy camp was developed to introduce rising high school juniors and seniors to the pharmacy profession. First- and second-year student pharmacists were invited to serve as counselors and, afterward, to participate in a focus group to share their experiences. Researchers used the focus group data to explore the impact of the camp experience on the student pharmacists. A direct interpretation approach was used to examine data as it allowed the research team to assess this single instance and draw meaning from focus group findings. Categories/themes were constructed through the interpretations of patterns and relationships discovered within the deconstructed results. Results. Ten student pharmacists participated in the focus group. The students provided their perspectives on the camp experience, including their role as camp counselors, the campers attending the camp, and the differences observed between student pharmacists and non-pharmacy camp counselors. Student pharmacists' comments gravitated toward the topic of professionalism. Student pharmacist counselors recognized positive and negative models of professionalism and made personal judgments concerning these concepts. Conclusion. Inclusion of student pharmacists in leadership roles such as this proved to be an effective means for further developing professional attributes. The focus group feedback provided novel insights into the professional mindset of student pharmacists. After serving as camp counselors, student pharmacists described their new perspectives on the importance of professionalism in their individual journeys, among their peers, and as future student pharmacists.

Evolution and expansion of a resident teaching and learning program sponsored by a school of pharmacy.

PURPOSE: The evolution and expansion of a school of pharmacy-sponsored resident teaching and learning program (RTLP) are described. SUMMARY: Since its establishment in 2012, Auburn University Harrison School of Pharmacy's RTLP has grown to include up to 12 residency programs in Alabama and on the Gulf Coast of Mississippi and Florida. Program requirements include seminar attendance, teaching experiences and observations, and development of an electronic teaching portfolio. Residents are provided support and guidance from an assigned faculty mentor and from chosen teaching mentors in each teaching activity. A program satisfaction survey was developed to assess residents' reasons for RTLP participation and their views on the manageability of program requirements, the level of residency program support received, the usefulness of seminar content, and other aspects of the program. Resident feedback has been used by RTLP coordinators to modify and refine program requirements. Major changes have included a switch to alternative information delivery mechanisms, clarification of mentor roles and responsibilities, and a transition from longitudinal seminars to intensive workshop days. At the end of the 2016-17 residency year, the RTLP had hosted a total of 66 residents from 12 different residency programs, with a 93.9% retention rate and a more than 3-fold increase in total resident enrollment. CONCLUSION: Evolution of a school of pharmacy-sponsored RTLP was essential to meet the growing needs of affiliated residency programs while optimizing faculty resources.

Practical Team-Based Learning from Planning to Implementation.

Team-based learning (TBL) helps instructors develop an active teaching approach for the classroom through group work. The TBL infrastructure engages students in the learning process through the Readiness Assessment Process, problem-solving through team discussions, and peer feedback to ensure accountability. This manuscript describes the benefits and barriers of TBL, and the tools necessary for developing, implementing, and critically evaluating the technique within coursework in a user-friendly method. Specifically, the manuscript describes the processes underpinning effective TBL development, preparation, implementation, assessment, and evaluation, as well as practical techniques and advice from authors' classroom experiences. The paper also highlights published articles in the area of TBL in education, with a focus on pharmacy education.

Assessing the validity and reliability of three indicators self-reported on the pregnancy risk assessment monitoring system survey.

OBJECTIVES: We investigated the reliability and validity of three self-reported indicators from the Pregnancy Risk Assessment Monitoring System (PRAMS) survey. METHODS: We used 2008 PRAMS (n=15,646) data from 12 states that had implemented the 2003 revised U.S. Certificate of Live Birth. We estimated reliability by kappa coefficient and validity by sensitivity and specificity using the birth certificate data as the reference for the following: prenatal participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); Medicaid payment for delivery; and breastfeeding initiation. These indicators were examined across several demographic subgroups. RESULTS: The reliability was high for all three measures: 0.81 for WIC participation, 0.67 for Medicaid payment of delivery, and 0.72 for breastfeeding initiation. The validity of PRAMS indicators was also high: WIC participation (sensitivity = 90.8%, specificity = 90.6%), Medicaid payment for delivery (sensitivity = 82.4%, specificity = 85.6%), and breastfeeding initiation (sensitivity = 94.3%, specificity = 76.0%). The prevalence estimates were higher on PRAMS than the birth certificate for each of the indicators except Medicaid-paid delivery among non-Hispanic black women. Kappa values within most subgroups remained in the moderate range (0.40-0.80). Sensitivity and specificity values were lower for Hispanic women who responded to the PRAMS survey in Spanish and for breastfeeding initiation among women who delivered very low birthweight and very preterm infants. CONCLUSION: The validity and reliability of the PRAMS data for measures assessed were high. Our findings support the use of PRAMS data for epidemiological surveillance, research, and planning.

Racial differences in trends and predictors of infant sleep positioning in South Carolina, 1996-2007.

This paper examines racial differences in trends and predictors of prone and lateral infant sleep positioning among South Carolina mothers and infants. Pregnancy Risk Assessment Monitoring System data were used to analyze linear trends in prone, lateral, and supine infant sleep positioning among 14,648 mother-infant pairs from 1996 to 2007. Logistic regression models were used to examine the predictors of prone and lateral positioning among 9,015 mother-infant pairs from 2000 to 2007. From 1996 to 2007, white infants experienced a reduction in both prone and lateral positioning and an increase in supine positioning (28.2-66.7%), while black infants had smaller decreases in prone and lateral positioning and a smaller increase in supine positioning (22.6-47.1%) than white infants. Compared to births in 2000-2005, births after the explicit recommendation that infants not be placed in the lateral sleep position (2006-2007) were associated with decreased odds of lateral positioning among white infants (odds ratio [OR]: 0.66; 95% confidence interval [CI]: 0.51, 0.87) but not among black infants. The significant predictors of white infants being placed in the prone position were different from the predictors for black infants. Additionally, with regard to lateral sleep positioning, more significant predictors were observed among white infants than black infants. These findings suggest that efforts are warranted to increase the prevalence of supine sleep positioning, especially among black infants. Race-specific programs may efficiently reduce non-supine sleep positioning to help narrow racial gaps in sudden infant death syndrome.

Birth outcomes of intended pregnancies among women who used assisted reproductive technology, ovulation stimulation, or no treatment.

OBJECTIVE: To study birth outcomes among live born infants conceived by women who used infertility treatment. DESIGN: Population-based surveillance of women who recently delivered a live infant. SETTING: The birth outcomes among infants whose mothers used assisted reproductive technology (ART) or ovulation stimulation medications alone were compared with the outcomes of infants conceived without treatment. PATIENT(S): Stratified random sample of women who were attempting conception and gave birth to a live infant in six US states (n = 16,748). INTERVENTION(S): Assisted reproductive technology and ovulation stimulation. MAIN OUTCOME MEASURE(S): Adjusted odds ratios for perinatal outcomes. RESULT(S): The prevalence of infertility treatment use overall among women attempting conception was 10.9% (5.4% ART procedures, 5.5% ovulation stimulation medications). Singletons of mothers who received ART procedures were more likely to be born with low birthweight, preterm, and small for gestational age (SGA) than singleton infants conceived without treatment. Singleton infants of mothers who used ovulation stimulation medications alone were more likely to be SGA than singleton infants conceived without treatment. No differences were found between ART and no treatment twin infants. CONCLUSION(S): Among singleton infants, ART is associated with decreased fetal growth, decreased gestational length, and SGA; ovulation stimulation alone is associated with SGA.

Racial and ethnic differences in preterm delivery among low-risk women.

BACKGROUND: Preterm delivery is the leading cause of infant mortality in the United States. The risk of preterm delivery and the prevalence of factors associated with preterm delivery differ by racial and ethnic groups. OBJECTIVE: To examine racial and ethnic differences in preterm delivery among women without the common risk factors for preterm delivery. METHODS: We used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) for singleton births occurring in selected US states between 1988 and 2002. PRAMS is a cross-sectional study of state residents who delivered a live birth within the state. We defined risk status using maternal age, education, marital status at delivery, parity, interpregnancy interval, tobacco or alcohol use, source and amount of income, and pre-pregnancy body mass index. RESULTS: Only 9.6% (18,815) of women were low risk. Between 2.4% (Native Americans) and 12.4% (Asian-Pacific Islanders) were low risk. Low-risk women were 29.0% (95% CI: 23.0%, 34.0%) less likely to deliver preterm than non-low-risk women. Among low-risk women, African American women had more preterm births than White women (PR: 1.3, 95% CI: 1.0, 1.6), but only among multiparous women whose most recent prior birth was neither low birth weight nor preterm. CONCLUSIONS: Traditional risk factors explain about half of the excess prevalence of preterm births among African Americans and explain all of the excess among other racial and ethnic groups. The remaining excess among African American appears to be due to risk factors among multiparous women that occur between pregnancies.

Factors influencing pharmacy students' attendance decisions in large lectures.

OBJECTIVES: To identify reasons for pharmacy student attendance and absenteeism in large lectures and to determine whether certain student characteristics affect student absenteeism. METHODS: Pharmacy students' reasons to attend and not attend 3 large lecture courses were identified. Using a Web-based survey instrument, second-year pharmacy students were asked to rate to what degree various reasons affected their decision to attend or not attend classes for 3 courses. Bivariate analyses were used to assess the relationships between student characteristics and degree of absenteeism. RESULTS: Ninety-eight students (75%) completed the survey instrument. The degree of student absenteeism differed among the 3 courses. Most student demographic characteristics examined were not related to the degree of absenteeism. Different reasons to attend and not to attend class were identified for each of the 3 courses, suggesting that attendance decisions were complex. CONCLUSIONS: Respondents wanted to take their own notes and the instructor highlighted what was important to know were the top 2 common reasons for pharmacy students to attend classes. Better understanding of factors influencing student absenteeism may help pharmacy educators design effective interventions to facilitate student attendance.

Insulin glulisine: an evaluation of its pharmacodynamic properties and clinical application.

OBJECTIVE: To evaluate the pharmacodynamic properties, efficacy, safety, and clinical application of insulin glulisine, a rapid-acting insulin analog, in the treatment of diabetes mellitus in ambulatory and hospitalized patients. DATA SOURCES: Searches were performed with the headings glulisine, insulin analog, [LysB3, GluB29] insulin, insulin glulisine, rDNA insulin, rapid-acting insulin, SoloStar, safety, efficacy, pharmacodynamics, and cost analysis within MEDLINE and PubMed, American Diabetes Association (ADA), the Food and Drug Administration (FDA), and Sanofi-aventis Pharmaceuticals (1990-August 2008). STUDY SELECTION AND DATA EXTRACTION: Phase 1, Phase 2, Phase 3, and postmarketing trials examining the efficacy and safety of glulisine in type 1 or type 2 diabetes were reviewed. Studies published as abstracts and the manufacturer's product information supplemented data absent from clinical trials. DATA SYNTHESIS: Insulin glulisine is a rapid-acting insulin with relative equivalence in efficacy and safety to other short- and rapid-acting insulins. Glulisine's onset of action of 20 minutes and 4-hour duration of action allow for bolus administration 15-20 minutes prior to or up to 20 minutes after meals. Clinical trials have demonstrated the safety and efficacy in adults with type 1 or type 2 diabetes. Several studies indicated a statistically significant decrease of hemoglobin A1C (A1C) with glulisine compared with regular insulin (0.10 decrease); however, no difference in A1C control was found compared with insulin aspart or lispro. Significant adverse effects appear to be limited to localized and systemic allergic reactions and hypoglycemia. CONCLUSIONS: Insulin glulisine is a safe and effective rapid-acting insulin analog for the treatment of adults with diabetes. Clinical benefit over other short- and rapid-acting insulin products is not established. Addition of insulin glulisine to a formulary should be based on institution-specific availability and cost differences between glulisine, lispro, and aspart in the absence of superiority of clinical efficacy or safety and data beyond 26 weeks.

Devices for home evaluation of women's health concerns.

PURPOSE: Devices used for home evaluation of fertility, pregnancy, menopause, colon cancer, breast cancer, and urinary-tract and vaginal yeast infections are discussed. SUMMARY: Ovulation-prediction devices monitor natural changes in a woman's body during the menstrual cycle, including changes in basal body temperature, urinary luteinizing hormone, and urinary estrone-3-glucuronide concentrations. Also available are devices that identify changes in the content of sodium chloride and other electrolytes in saliva and cervical-vaginal mucus. Home pregnancy tests are designed to detect human chorionic gonadotropin in the urine. Both urine and saliva tests are available for home evaluation of menopause; the most common devices use urine to measure follicle-stimulating hormone. The saliva tests measure estradiol, progesterone, and testosterone. Devices for home screening for colon cancer use either the guaiac test or the fecal immunochemical test. For aid in breast self-examination, patients may use a simulated-breast product designed to train them to detect lumps or a thin, silicone-containing pad intended to increase the sensitivity of the fingers to abnormalities. Urine-dipstick tests can be used to screen for urinary-tract infection, and a swab or panty liner can be used to detect vaginal pH changes indicative of vaginal yeast infection. Home-based tests may be convenient and economical but also have limitations; pharmacists can help educate patients and clinicians. CONCLUSION: Many devices are available to help evaluate women's health concerns at home.

The role of vildagliptin in the management of type 2 diabetes mellitus.

OBJECTIVE: To highlight the role of incretin hormones in the management of type 2 diabetes mellitus with a focus on vildagliptin, a dipeptidyl peptidase IV (DPP IV) inhibitor currently in development. DATA SOURCES: Searches were conducted in MEDLINE (1950-April 2007) and International Pharmaceutical Abstracts (1970-April 2007) using the key words vildagliptin, LAF237, and dipeptidyl peptidase IV inhibitor. Additional data were obtained from abstracts presented at the American Diabetes Association Scientific Sessions (2003-2006) and from the manufacturer. STUDY SELECTION AND DATA EXTRACTION: Articles pertaining to the pharmacology, pharmacokinetics, safety, and efficacy of vildagliptin for the treatment of type 2 diabetes were reviewed for inclusion. When available, human trials were included over animal studies. DATA SYNTHESIS: Reduced incretin effect is thought to be associated with type 2 diabetes. Glucagon-like peptide-1 (GLP-1), an incretin hormone, stimulates postprandial insulin release; however, it is rapidly degraded by DPP IV. Studies evaluating the use of vildagliptin in patients with type 2 diabetes found significant decreases in DPP IV and increased GLP-1 activity 45 minutes after dosing. Glucagon levels were reduced, with little to no change in insulin levels. With vildagliptin doses ranging from 25 mg daily to 100 mg twice daily, researchers observed consistent reductions in fasting plasma glucose, 4 hour postprandial glucose, and hemoglobin A1c. Similar benefits were seen when vildagliptin was used in combination with metformin. Vildagliptin was well tolerated after 12 weeks; however, incidences of hypoglycemia increased with longer study duration. Optimal results with minimal adverse effects were achieved with 25 mg twice daily and 50 mg once daily doses. CONCLUSIONS: Vildagliptin represents a safe and effective new approach to targeting GLP-1 deficiencies in patients with type 2 diabetes by inhibiting DPP IV.

Surveillance for selected maternal behaviors and experiences before, during, and after pregnancy. Pregnancy Risk Assessment Monitoring System (PRAMS), 2000.

PROBLEM/CONDITION: Various maternal behaviors and experiences are associated with adverse health outcomes for both the mother and the infant. These behaviors and experiences can occur before pregnancy (e.g., insufficient intake of folic acid), during pregnancy (e.g., complications requiring hospitalization, such as high blood pressure), and after pregnancy (e.g., inadequate follow-up of infants who were discharged early). Information regarding maternal behaviors and experiences is needed to monitor trends, to enhance the understanding of the relations between behaviors and health outcomes, to plan and evaluate programs, to direct policy decisions, and to monitor progress toward Healthy People 2010 objectives (US Department of Health and Human Services. Healthy People 2010. 2nd. ed. With understanding and improving health and objectives for improving health [2 vols.]. Washington DC: US Department of Health and Human Services, 2000). REPORTING PERIOD COVERED: This report covers data for 2000. DESCRIPTION OF SYSTEM: The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, state- and population-based surveillance system designed to monitor selected self-reported maternal behaviors and experiences that occur before, during, and after pregnancy among women who deliver a live-born infant in 31 states and New York City. PRAMS employs a mixed-mode data collection methodology; as many as three self-administered surveys are mailed to a sample of mothers, and nonresponders are followed up with a telephone interview. Self-reported survey data are linked to selected birth certificate data and weighted for sample design, nonresponse, and noncoverage to create annual PRAMS analysis data sets. PRAMS data can be used to produce statewide estimates of various perinatal health behaviors and experiences among women delivering a live infant. Four indicators for the year 2000 (multivitamin use, pregnancy-related complications, infant checkup, and postpartum contraceptive use) from 19 states are examined in this report. RESULTS: In 2000, the prevalence of multivitamin use > or =4 times per week in the month before pregnancy ranged from 25.0% to 40.7% across the 19 states. Prevalence of pregnancy-related complications requiring hospitalization ranged from 8.8% to 16.3%. Prevalence of infant checkups within 1 week of early (< or =48 hours) hospital discharge ranged from 51.5% to 88.6%. Prevalence of postpartum contraceptive use ranged from 77.9% to 89.9%. INTERPRETATION: PRAMS data indicate that 19 states are well below the Healthy People 2010 objective for folic acid consumption, as measured by multivitamin use. Data for infant checkups indicate that guidelines for care are not being followed for as many as half of those discharged early. However, data for additional years are needed to assess trends in these four indicators. PUBLIC HEALTH ACTION: State maternal and child health programs can use these population-based data to monitor progress toward Healthy People 2010 objectives, evaluate adherence to guidelines for care, and assess changes in prevalence of other health behaviors. The data can be shared with policy makers to direct policy decisions that might affect the health of mothers and infants. By providing data on maternal behaviors and experiences that are associated with adverse outcomes, PRAMS supports the activities of two CDC initiatives-to promote safe motherhood and to reduce infant mortality and low birthweight.