Lesbian, gay, bisexual, and transgender inclusion: Survey of campus climate in colleges and schools of pharmacy.

BACKGROUND AND PURPOSE: To quantify the implementation of inclusive policies and benefits as well as institutional commitment to support LGBT faculty, staff, and students in pharmacy schools nationwide. EDUCATIONAL ACTIVITY AND SETTING: An anonymous, electronic survey was sent to administrators at 130 pharmacy schools. Forty-four survey responses were received, indicating a 34% response rate. The survey included questions relating to campus climate, inclusive policies and benefits, and institutional commitments to the LGBT community. FINDINGS: Approximately half of the survey respondents reported that their school has public written statements about diversity and multiculturalism that include sexual orientation and/or gender identity. About one-fifth of the respondents indicated that their school has inclusive materials for faculty, staff, and student information regarding sexual orientation and gender identity. Nearly one-fourth of schools of pharmacy had participated in a voluntary LGBT training program, such as Safe Zone, Safe Space, or Ally Program. Over half of the respondents reported having access to LGBT organizations on campus, with two schools reporting having pharmacy organizations that specifically focus on LGBT student pharmacists and allies. Less than one-tenth of schools reported offering gender-neutral/single-occupancy restrooms and no schools reported knowledge of LGBT-related scholarships. SUMMARY: Room for improvement exists regarding the implementation of inclusive practices to improve campus climate for LGBT students, faculty, and staff. Areas with the largest room for improvement include accessible gender-neutral restrooms and availability of LGBT trainings, scholarships, and events.

High frequency of gastrointestinal manifestations in myotonic dystrophy type 1 and type 2.

OBJECTIVE: To analyze gastrointestinal (GI) manifestations, their progression over time, and medications being used to treat GI symptoms in a large cohort of patients with myotonic dystrophy types 1 (DM1) and 2 (DM2). METHODS: We analyzed patient-reported data and medical records in a national registry cohort at baseline and 5 years. RESULTS: At baseline, the majority of patients reported trouble swallowing in DM1 (55%; n = 499 of 913) and constipation in DM2 (53%; n = 96 of 180). Cholecystectomy occurred in 16.5% of patients with DM1 and 12.8% of patients with DM2, on average before 45 years of age. The use of medications indicated for gastroesophageal reflux disease was reported by 22.5% of DM1 and 18.9% of patients with DM2. Greater risk of a GI manifestation was associated with higher body mass index and longer disease duration in DM1 and female sex in DM2. At the 5-year follow-up, the most common new manifestations were trouble swallowing in patients with DM1 and constipation in patients with DM2. CONCLUSIONS: GI manifestations were common in both DM1 and DM2, with a relatively high frequency of gallbladder removal in DM1 and DM2 occurring at a younger age compared to normative data in the literature. Studies are needed to determine the pathomechanism of how sex, weight gain, and duration of disease contribute to GI manifestations and how these manifestations affect quality of life and clinical care for patients with DM1 and DM2.

Medication adherence in patients with myotonic dystrophy and facioscapulohumeral muscular dystrophy.

Myotonic dystrophy (DM) and facioscapulohumeral muscular dystrophy (FSHD) are the two most common adult muscular dystrophies and have progressive and often disabling manifestations. Higher levels of medication adherence lead to better health outcomes, especially important to patients with DM and FSHD because of their multisystem manifestations and complexity of care. However, medication adherence has not previously been studied in a large cohort of DM type 1 (DM1), DM type 2 (DM2), and FSHD patients. The purpose of our study was to survey medication adherence and disease manifestations in patients enrolled in the NIH-supported National DM and FSHD Registry. The study was completed by 110 DM1, 49 DM2, and 193 FSHD patients. Notable comorbidities were hypertension in FSHD (44 %) and DM2 (37 %), gastroesophageal reflux disease in DM1 (24 %) and DM2 (31 %) and arrhythmias (29 %) and thyroid disease (20 %) in DM1. Each group reported high levels of adherence based on regimen complexity, medication costs, health literacy, side effect profile, and their beliefs about treatment. Only dysphagia in DM1 was reported to significantly impact medication adherence. Approximately 35 % of study patients reported polypharmacy (taking 6 or more medications). Of the patients with polypharmacy, the DM1 cohort was significantly younger (mean 55.0 years) compared to DM2 (59.0 years) and FSHD (63.2 years), and had shorter disease duration (mean 26 years) compared to FSHD (26.8 years) and DM2 (34.8 years). Future research is needed to assess techniques to ease pill swallowing in DM1 and to monitor polypharmacy and potential drug interactions in DM and FSHD.

A transgender health care panel discussion in a required diversity course.

OBJECTIVES: To examine the impact of a panel discussion on transgender health care on first-year (P1) pharmacy students' knowledge and understanding of transgender experiences in an Introduction to Diversity course. DESIGN: The panel consisted of both transgender males and females. After panelists shared their healthcare experiences, students asked them questions in a moderated setting. Students completed evaluations on the presentation and learning outcomes. They also wrote a self-reflection paper on the experience. ASSESSMENT: Ninety-one percent of students agreed that they could describe methods for showing respect to a transgender patient and 91.0% evaluated the usefulness of the presentation to be very good or excellent. Qualitative analysis (phenomenological study) was conducted on the self-reflection papers and revealed 7 major themes. CONCLUSION: First-year students reported that they found the panel discussion to be eye opening and relevant to their pharmacy career. Our panel may serve as model for other pharmacy schools to implement.

Role-reversal exercise with Deaf Strong Hospital to teach communication competency and cultural awareness.

OBJECTIVE: To implement a role-reversal exercise to increase first-year pharmacy students' awareness of communication barriers in the health care setting, especially for deaf and hard-of-hearing patients. DESIGN: Volunteers from the local deaf community conducted Deaf Strong Hospital, a role-reversal exercise in which students were the "patients." Students navigated through a reception area, encounter with a physician, and having a prescription filled at a pharmacy without receiving or using any spoken language. ASSESSMENT: A debriefing session was held in which small groups of students had the opportunity to ask questions of a panel of deaf and hard-of-hearing volunteers. On a survey administered to assess students' learning, 97% agreed or strongly agreed that the experience would likely impact their attitudes and behavior in future interactions with patients who did not speak English. CONCLUSIONS: The role-reversal exercise was an effective method of teaching students that the delivery of health care is dependent on adequate communication between health care providers and the patient.

Redefining the structure-activity relationships of 2,6-methano-3-benzazocines. 4. Opioid receptor binding properties of 8-[N-(4'-phenyl)-phenethyl)carboxamido] analogues of cyclazocine and ethylketocycalzocine.

The synthesis and evaluation of a series of aryl-containing N-monosubstituted analogues of the lead compound 8-carboxamidocyclazocine were performed to probe a putative hydrophobic binding pocket of opioid receptors. High binding affinity to mu, kappa, and delta opioid receptors was observed for the 8-[N-(4'-phenyl)-phenethyl)carboxamido] analogue.

Reduction of lipopolysaccharide-induced interleukin-6 production by the kappa opioid U50,488 in a mouse monocyte-like cell line.

Several studies demonstrate that opioids modulate the immune response via opioid receptors expressed directly on the immune cells themselves. Recently, it has been suggested that the kappa opioid system has a modulatory role in various inflammatory diseases including rheumatoid arthritis. This modulation may occur via changes in cytokine secretion by monocyte-derived cells. To further study this opioid-immune relationship, we stimulated P388D1 cells, a mouse monocyte-like cell line, with lipopolysaccharide (LPS) in the presence or absence of the kappa opioid-selective ligand, U50,488. Pretreatment with U50,488 significantly reduced LPS-stimulated interleukin-6 (IL-6) production as measured by ELISA. This effect was mediated by the kappa opioid receptor, because nor-binaltorphimine (nor-BNI), a kappa-selective antagonist, blocked this inhibition. It is likely that this reduction of IL-6 protein by U50,488 treatment is attributed to decreases in IL-6 mRNA. RT-PCR experiments demonstrated that U50,488 treatment significantly reduced the LPS-mediated increase in IL-6 mRNA and that this effect was also blocked by nor-BNI. Understanding the mechanism behind the reduction of proinflammatory cytokine production by opioids may lead to the development of more effective therapeutics for inflammatory diseases.

Opioid receptors and signaling on cells from the immune system.

This review discusses the criteria for determining whether a binding site or functional response is directly mediated by either the mu, delta, or kappa opioid receptors. In 1988, Sibinga and Goldstein published the first review that addressed whether cells from the immune system express opioid receptors. The criteria that they used, namely, structure-activity relationships, stereoselectivity, dose- and concentration-dependence, and saturability are still relevant criteria today for determining if an immunological response is mediated by either the mu, delta or kappa opioid receptors. Radioligand receptor binding studies and functional studies that clearly show the presence of an opioid receptor on immunocytes are presented. Selective agonists and antagonists for the mu, delta, and kappa opioid receptors are discussed, and the need for their use in experiments is emphasized. Conditions used in functional assays are very important. Receptor desensitization and downregulation occur within minutes after the application of an agonist. However, many immunological assays are applying an agonist for days before measuring an immunological effect. The results obtained may reflect changes that are results of receptor desensitization and/or downregulation instead of changes that are observed with acute activation of the receptor. The future of receptor pharmacology lies in the crosstalk and dimerization of G protein-coupled receptors. In transfected systems, opioid receptors have been shown to dimerize with chemokine and cannabinoid receptors, resulting in crosstalk between different types of receptors.

Assay of G protein-coupled receptor activation of G proteins in native cell membranes using [35S]GTP gamma S binding.

The interaction of a G protein-coupled receptor (GPCR) with the G protein is the first step in the transduction of receptor binding to the activation of second-messenger systems mediated by G proteins. Binding of the poorly hydroylzable GTP analog guanosine-5'-O-(3-[35S]thio)triphosphate ([35S]-GTP gamma S) to the alpha subunit of a G protein has been used as a biochemical assay to measure the efficacy of a compound. The maximal percent stimulation of [35S]GTP gamma S binding, induced by an agonist, correlates well with the efficacy of an agonist in an in vivo system. The concentration of agonist necessary to achieve 50% of the maximal stimulation is indicative of the affinity of the agonist for the receptor, under the assay conditions. The [35S]GTP gamma S binding assay, which uses membranes from either myeloma cells or endogenous tissues, is a biochemical assay to determine the efficacies of agonists for receptors that are expressed endogenously. Novel compounds that have been shown to have high affinity in radioligand receptor-binding assays are screened in the [35S]GTP gamma S binding assay to determine if they are agonists, antagonists, or partial agonists at a particular receptor.

Several delta-opioid receptor ligands display no subtype selectivity to the human delta-opioid receptor.

Pharmacological studies performed in vivo suggested that the delta-opioid receptor could exist as two distinct subtypes, delta(1) and delta(2), while in vitro studies are inconclusive. Therefore, we measured the binding and functional selectivity of several putative delta(1)- and delta(2)-opioid receptor-selective compounds in membranes from Chinese hamster ovary cells stably expressing the human delta-opioid receptor. The compounds characterized were the agonists [D-Pen(2),D-Pen(5)]enkephalin (DPDPE, delta(1)) and deltorphin II (delta(2)), and the antagonists 7-benzylidenenaltrexone (BNTX, delta(1)), naltriben (delta(2)), naltrindole 5'-isothiocyanate (delta(2)), and naltrindole (delta(1) and delta(2)). In competition binding assays, all compounds tested showed no preference for the [3H]DPDPE, [3H]deltorphin II, or [3H]naltrindole binding sites. BNTX also showed no selectivity for the delta-opioid receptor over the mu-opioid receptor. In functional assays, the stimulation of [35S]GTPgammaS binding induced by either DPDPE or deltorphin II was potently inhibited by both delta(1)- and delta(2)-opioid receptor-selective antagonists. Together, these results indicate that these compounds are not selective for either the delta(1)- or delta(2)-opioid receptor binding sites in binding or functional assays.