Sadness, hopelessness and suicide attempts in bullying: Data from the 2018 Iowa youth survey.

BACKGROUND: Bullying in schools is a common problem that can have significant consequences on the mental health of both bullies and victims of bullying. Some estimates suggest that 30% of American youth are bullied. Self-reported incidence of depression, anxiety, and suicide attempts has been correlated with bullying. Victims may also suffer from a variety of somatic complaints such as headache, sleep disorders, and others. Youth surveys undertaken by Education or Public Health Departments in most US states are an underutilized resource in evaluating the problem and any consequences. OBJECTIVE: The objective of this study was to explore the association of being involved in bullying either as a victim and/or a bully on mental health and suicide ideation by analyzing data from the 2018 Iowa Youth Survey. The results will then be applied to the published anti-bullying literature to make suggestions for how anti-bullying programs may be designed. METHODS: Data were obtained from the 2018 Iowa Youth Survey (IYS), which is a cross-sectional survey of 6th, 8th and 11th grade students. We chose two mental health questions as dependent variables and used a multivariable logistic regression analysis to evaluate the correlation between the two dependent variables and ten types of bullying included in the IYS. Since some respondents in the IYS were prescribed psychotropic medications to help with feeling angry, anxious, nervous, or sad, we adjusted for the use of psychotropic medication in our analysis. Similarly, the literature suggests that some students are both bullies and victims (bully-victims). Accordingly, we also adjusted for bully-victims. RESULTS: Unadjusted Odds Ratios (ORs) showed that not all forms of bullying were correlated with a significant risk of mental distress. Physical bullying had comparatively little association (ORs < 1 or overlapped 1), while identity bullying on sexual orientation or gender identity or sexual joking was consistently correlated with significant ORs for feeling sad or hopeless and attempting suicide (ORs 1.40-2.84). Cyberbullying (ORs 1.32-1.70) and social bullying (ORs < 1-2.21) were correlated with mental distress with ORs generally between physical and identity bullying. When adjusting for medication use or bully-victim status, adjusted ORs (aORs) were generally lower than unadjusted ORs. CONCLUSIONS: Not all types of bullying were significantly correlated with feeling sad or hopeless or attempting suicide. Being able to evaluate the specific associations of different types of bullying may have implications for teachers or policy makers hoping to implement bullying mitigation strategies in their schools.

A model for a drug distribution system in remote Australia as a social determinant of health using event structure analysis.

BACKGROUND: The social determinants of health include the health systems under which people live and utilize health services. One social determinant, for which pharmacists are responsible, is designing drug distribution systems that ensure patients have safe and convenient access to medications. This is critical for settings with poor access to health care. Rural and remote Australia is one example of a setting where the pharmacy profession, schools of pharmacy, and regulatory agencies require pharmacists to assure medication access. Studies of drug distribution systems in such settings are uncommon. This study describes a model for a drug distribution system in an Aboriginal Health Service in remote Australia. The results may be useful for policy setting, pharmacy system design, health professions education, benchmarking, or quality assurance efforts for health system managers in similarly remote locations. The results also suggest that pharmacists can promote access to medications as a social determinant of health. The primary objective of this study was to propose a model for a drug procurement, storage, and distribution system in a remote region of Australia. The secondary objective was to learn the opinions and experiences of healthcare workers under the model. METHODS: Qualitative research methods were used. Semi-structured interviews were performed with a convenience sample of 11 individuals employed by an Aboriginal health service. Transcripts were analyzed using Event Structure Analysis (ESA) to develop the model. Transcripts were also analyzed to determine the opinions and experiences of health care workers. RESULTS: The model was comprised of 24 unique steps with seven distinct components: choosing a supplier; creating a list of preferred medications; budgeting and ordering; supply and shipping; receipt and storage in the clinic; prescribing process; dispensing and patient counseling. Interviewees described opportunities for quality improvement in choosing suppliers, legal issues and staffing, cold chain integrity, medication shortages and wastage, and adherence to policies. CONCLUSION: The model illustrates how pharmacists address medication access as a social determinant of health, and may be helpful for policy setting, system design, benchmarking, and quality assurance by health system designers. ESA is an effective and novel method of developing such models.

Effect of a personal automated dose-dispensing system on adherence: a case series.

OBJECTIVE: To evaluate the effect of the MD.2 Personal Medication System (MD.2) on patient medication adherence and refill persistence. DESIGN: Open noncontrolled case series. SETTING: Community pharmacy. PATIENTS: Three patients with a documented history of poor medication adherence and persistence. INTERVENTION: MD.2 placed in patients' homes for 3 months. MAIN OUTCOME MEASURES: Medication adherence (doses taken at prescribed times) and persistence (refills obtained at correct times) assessed before and after installation of MD.2. RESULTS: Installation of MD.2 resulted in medication adherence rates of greater than 99% in all three patients. Refill persistence rates improved in both patients who needed refills during the study period. Missed doses and other problems were mostly due to caregiver error in filling or programming MD.2. CONCLUSION: The MD.2 Personal Medication System had a positive effect on medication adherence and persistence in these three patients. Training and selection of caregivers may be especially important for effective use of the machine. Larger studies will be needed to validate these results.

Patient satisfaction with pharmaceutical care: update of a validated instrument.

OBJECTIVE: To develop a questionnaire for measuring patient satisfaction with pharmaceutical care and to establish its factorial composition. DESIGN: Single intervention, noncomparative, 20-item self-administered questionnaire. SETTING: Iowa. PARTICIPANTS: Seven hundred seventy-five prescription patrons of eight community pharmacies whose pharmacists had received training in pharmaceutical care but who had not yet implemented it. INTERVENTIONS: An instrument originally developed to measure patient satisfaction with traditional community pharmacy services was modified to focus on the elements of pharmaceutical care. This revised questionnaire was mailed to participants. MAIN OUTCOME MEASURES: Participant responses to items in the questionnaire. RESULTS: The survey response rate was 55%. Factor analysis and item analysis identified two dimensions of pharmaceutical care. We labeled the dimensions Friendly Explanation (including items related to friendliness of care, the setting of care, and medication counseling) and Managing Therapy (items dealing with the concept of pharmaceutical care-managing drug therapy and solving therapy problems). Respondents scored items on the Managing Therapy scale lower than they did items on the Friendly Explanation scale. The scales were highly correlated. Two other hypothesized dimensions of care-Consideration/Caring Relationships and Setting-were subsumed in the final scale of Friendly Explanation. CONCLUSION: The instrument provides information on patients' satisfaction with two dimensions of pharmacy services. The instrument may be useful to practicing pharmacists, but it should be used cautiously until it is tested among patrons of pharmacies known to provide different levels of care.