National trends in reported past year opioid misuse among black women.

BACKGROUND: The opioid crisis within the United States has been widely studied; however, some gaps within the literature still exist. There is limited information on trends in opioid misuse as it relates to income among a national sample of Black Women. Given the recent increase in opioid overdose deaths in Black Americans and the vulnerability of women who misuse opioids, research in this population is important. OBJECTIVE: The objective of this study is to evaluate trends of past year opioid misuse (PYOM) among Black women by income over the study period. METHODS: A cross-sectional study among adult aged Black women captured in the National Survey on Drug Use and Health (NSDUH) from 2015 to 2019 was conducted. Descriptive statistics for all study variables was conducted. Weighted logistic regression analyses were conducted to evaluate predictors of PYOM. A stratified analysis was also conducted to examine possible differences between income strata on predictors of PYOM. RESULTS: A total of 15,196 Black women were included in the study (16,008,921 weighted visits). Among the women included, 41.5% were age 50+, 57.7% were unemployed, 63.8% reported very good/good health, 59.5% had past year alcohol use, 44.1% had never been married, 39.1% received government assistance, and 90.1% resided in a metro area. An estimated 3.14% of Black women reported PYOM. Findings from the regression analysis showed that Black women who were between 18 and 25, had past year major depressive episode, had alcohol use, illicit drug use, and who received government assistance had significantly greater odds of PYOM. Those reporting an excellent general health rating and higher education had significantly lower odds of PYOM. Income was not associated with PYOM in this study. CONCLUSION: Overall, income was not found to be a significant predictor of PYOM. However, income was found to modify the effects of major depressive episode and alcohol use on PYOM, especially among Black women who reported earning ≥$75,000/year. These findings suggest that high-earning Black women may be just as at risk for opioid misuse as low-earning Black women. Further studies are warranted to explore these effects among other gender/racial groups to determine if this trend is unique to Black women.

A Cross-Sectional Survey on the Post-Pandemic Acceptability of Pharmacist-Delivered Telehealth Services Among HCV-HIV Patients.

The COVID-19 pandemic enhanced the use of telehealth as a means of delivering services to patients who required continued and uninterrupted care. This helped to reduce readmission to hospitals where COVID-19 hospitalization was prioritized. Patients with HCV and HIV and other chronic diseases require this type of care. This study evaluated the post-pandemic acceptability of pharmacist-delivered telehealth services among HCV and HIV monoinfected and coinfected patients in Washington DC. This was a cross-sectional study conducted in a community pharmacy setting in Washington DC whose primary outcome was the acceptability of pharmacist-delivered telehealth services through a proposed platform(docsink). A validated questionnaire, borrowed from the literature was used to determine telehealth acceptability, measured as behavioral intention, among patients who receive care from this pharmacy. The study recruited 100 participants. Descriptive statistics were conducted as well as bivariable and multivariable analyses to assess predictors of telehealth acceptability. In the unadjusted model, PU/EM (OR 0.571, 95% confidence interval (0.45-0.73), P < .0001)), PEOU(OR 0.72, 95% confidence interval (0.61-0.85)) and IM(OR 0.733, 95% confidence interval (0.62-0.87), P = .0003)) were significant predictors of behavioral intention. Overall, the study found that lower Perceived Usefulness/Extrinsic Motivation scores decrease the odds of intending to use pharmacist-delivered telehealth (OR = 0.490, 95% confidence interval (0.29-0.83), P = .008). This study determined that the impact of perceived usefulness and extrinsic motivation was critical to the acceptance of pharmacist-delivered telehealth among a predominantly Black/African American study population.

The 2022 human monkeypox outbreak: Clinical review and management guidance.

PURPOSE: The objective of this clinical review is to provide an overview of antiviral therapies for monkeypox treatment and summarize the role of vaccines in monkeypox prevention. SUMMARY: The human monkeypox virus is a double-stranded DNA virus of the Orthopoxvirus genus of the Poxviridae family. The estimated case fatality rate for monkeypox ranges between 0% and 11%. The first human monkeypox infection was reportedly due to an unidentified animal reservoir. Per the Centers for Disease Control and Prevention, isolation and infection control procedures should be followed in the care of those infected with monkeypox virus. Monkeypox virus infection symptoms include rash, fever, chills, headache, muscle aches, backache, and fatigue that may progress to exhaustion. Severe complications such as encephalitis, pneumonia, and retropharyngeal abscess could appear in immunocompromised or critically ill patients. There are currently no specific Food and Drug Administration (FDA)-approved therapies for monkeypox. As with most viral infections, supportive care is the backbone of monkeypox clinical management. However, therapies effective for smallpox, such as cidofovir, brincidofovir, and tecovirimat, have previously been reported to be effective in the management of monkeypox. Pre- and postexposure prophylaxis to prevent monkeypox transmission are recommended in the US for those at high risk for disease transmission. CONCLUSION: There are no FDA-approved treatments for monkeypox infection. Surveillance and detection of monkeypox among high-risk populations should be implemented to help understand the epidemiology of this disease.

Evaluation of knowledge of the new Pregnancy and Lactation Labeling Rule among pharmacists and physicians.

OBJECTIVE: This study aimed to assess and evaluate knowledge and application of the Food and Drug Administration (FDA) Pregnancy and Lactation Labeling Rule (PLLR) among pharmacists and physicians. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study was conducted to evaluate the knowledge of and attitudes toward the new FDA PLLR among pharmacists and physicians. The primary outcome for this study was knowledge of the FDA PLLR. Descriptive statistical analysis was conducted for all study variables, and linear regression analyses were conducted to assess predictive factors of knowledge of the FDA PLLR. SPSS version 25 was used, and all analyses were conducted at an alpha value of 0.05. RESULTS: In a cross-sectional study that included 167 pharmacists and physicians, majority were pharmacists (78.4%), and the rest were physicians (21.6%). The overall knowledge score was low with the average number of items answered correctly being 3.03 out of 7. Of all explored predictors, only gender (P < 0.01) and pregnancy letter category knowledge score (P < 0.05) were significant predictors of PLLR knowledge, adjusting for the other factors. CONCLUSION: The study's findings showed several gaps in the knowledge of the new PLLR among physicians and pharmacists, thus demonstrating a need to have concerted continuing pharmacy and medical education efforts. Increasing knowledge in this area will lead to better risk communication and quality of care for expectant and nonexpectant women of reproductive age.

Barriers to the Treatment of Hepatitis C among Predominantly African American Patients Seeking Care in an Urban Teaching Hospital in Washington, D.C.

BACKGROUND: In the United States, it is estimated that 2.4 million people are currently infected with the hepatitis C virus (HCV). In order to address HCV infection management in the U.S., several government entities collaborated to develop and release a multistep plan for the prevention, care, and treatment of viral hepatitis. Optimal health outcomes from the plan are contingent upon addressing each of the several steps in the HCV care cascade. Among the critical challenging steps is linkage to care and access to treatment. Of the nearly three million people in the U.S. infected with HCV, only 43% have been linked to care, 16% have received treatment, and 9% have had their infection resolved. OBJECTIVE: This retrospective study aims to identify predictors within the HCV treatment cascade that contribute to failures in care of HCV-infected patients in an urban hospital setting located in the District of Columbia. SETTING: The outpatient clinics of a tertiary-care urban teaching hospital. METHODS: A retrospective study was conducted using electronic medical records of persons 18 years and older who were HCV antibody positive and had at least one visit at any of the outpatient clinics from August 1, 2015 to August 1, 2016. Descriptive analysis of HCV positive persons was conducted, and predictors of HCV treatment were assessed. RESULTS: A total of 252 patients were included in the study. Overall, patients were predominantly male (63.1%), African American (97.6%), under the age of 65 (71.4%), covered by public insurance (89.3%), and were diagnosed with HCV after the year 2001 (53.2%). Additionally, majority of patients had not been treated for their HCV infection (58%). Multiple barriers resulted in HCV infected patients not obtaining access to treatment. Fibrosis stage (p < 0.001) and prior insurance denial (p < 0.05) were significant predictors of HCV treatment. Age, gender, insurance type, substance abuse, alcohol abuse, and year of HCV diagnosis were not associated with limited access of HCV treatment. CONCLUSION: HCV infections remain a major public health concern among patients in the District of Columbia. This study identified fibrosis stage and prior insurance denial as primary barriers to access of HCV treatment. While there are many points in the hepatitis cascade of care in which patients can lose access to or fail treatment completion, the primary point of intervention in our patient population appears to be during the initiation of treatment and insurance prior authorization process.

Pharmacists' perspectives on prescribing hormonal contraception in Washington, DC, with a focus on young people.

OBJECTIVE: To assess pharmacists' interest, comfort level, training needs, and barriers to prescribing hormonal contraceptives, particularly in the context of serving young people in Washington, DC. DESIGN: In this mixed-methods study, we conducted a focus group discussion with pharmacists in February 2017, which was analyzed thematically using inductive and deductive coding. In January 2018 to June 2018, we conducted a survey with pharmacists, which was analyzed using descriptive statistics. SETTING AND PARTICIPANTS: Community and outpatient pharmacists in Washington, DC. OUTCOMES MEASURES: Pharmacists' interest and comfort level to begin prescribing hormonal contraception, particularly in the context of serving young people. RESULTS: A total of 6 pharmacists participated in the focus group discussion, and 82 pharmacists participated in the online survey. In the survey, 59% of pharmacists were interested in prescribing hormonal contraception as independent practitioners and 63% through collaborative practice agreements; focus group participants believed that other pharmacists might be less likely to participate. In addition, focus group and survey respondents reported high levels of comfort with activities related to prescribing hormonal contraception, including 96% of survey participants reporting comfort taking blood pressure and 93% reporting comfort counseling young women on hormonal contraceptive methods. Only 25% of pharmacists reported having a private consultation space that provided both visual and auditory privacy. To ensure that pharmacies were ready to implement this service, pharmacists identified multiple concerns that needed to be addressed, including workload, liability issues, compensation, and a need for additional training on hormonal contraceptive methods, and how to counsel young people on them. CONCLUSION: Pharmacists in Washington, DC, are interested in and comfortable with activities related to prescribing hormonal contraception, including to young people. However, to become ready to offer these services, pharmacists desire additional training, and pharmacies need to ensure confidentiality for young people and address pharmacists' concerns about workload, liability, and compensation.

Patterns of Hepatitis C-Related Inpatient Mortality in the United States in the Era of Direct-Acting Antivirals.

BACKGROUND & AIMS: Direct-acting antivirals (DAA) have revolutionized the management of hepatitis C virus (HCV) infection. Data on national inpatient mortality in this new era are scarce. This study aimed to evaluate inpatient mortality among HCV-related hospital stays in the United States (US) during the years DAA were available. METHODS: We conducted a cross-sectional analysis of the National Inpatient Sample (NIS) between 2012 and 2016. Using discharge weights, national estimates of HCV-related hospitalizations were calculated. Simple and multiple logistic regressions were performed to identify factors associated with inpatient mortality. RESULTS: A total of 67,630 hospitalizations from NIS were HCV-related, accounting for an estimated 338,150 hospitalizations during 2012 - 2016. These hospitalizations have estimated average annual total charges of $4.6 billion, adjusted to 2020 US dollars. The rate of inpatient mortality declined modestly from 5.25% in 2012 to 4.75% in 2016 (P=0.07). Over the 5-year study period, the proportion of in-hospital deaths increased for black patients, Medicaid beneficiaries, and patients with substance-related disorders. Controlling for known predictors, the odds of inpatient mortality were significantly greater among black patients compared to white patients (OR= 1.27 [95% CI=1.16 - 1.39]). CONCLUSIONS: The burden of HCV infection is substantial given the disease is now curable. Our findings indicate that major disparities in the HCV disease burden exist in the era of DAA.

Factors Associated with Prescribing Broad-Spectrum Antibiotics for Children with Upper Respiratory Tract Infections in Ambulatory Care Settings.

OBJECTIVES: Broad-spectrum antibiotics are frequently prescribed for children with upper respiratory tract infections (URI). Excessive use of broad-spectrum antibiotics leads to the emergence of resistant bacteria. This study aimed to identify factors associated with prescribing broad-spectrum antibiotics among children younger than 18 years presenting with URI in outpatient settings. METHODS: We conducted a cross-sectional analysis of the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey-Outpatient Departments (NHAMCS-OPD) between 2006 and 2010. Descriptive statistics of visits from children with URI were estimated. Simple and multiple logistic regression analyses were used to identify socio-demographic and clinical characteristics associated with broad-spectrum antibiotic prescribing. We also completed a stratified analysis by age (⩽2 vs >2). RESULTS: A total of 4013 outpatient visits for children with URI from both NAMCS and NHAMCS-0PD data were examined. Broad-spectrum antibiotics were prescribed in 39% of the visits, accounting for an estimated 6.8 million visits annually. Multivariable analysis showed that visits in the South region (odds ratio [OR] = 2.38; 95% confidence interval [CI]: 1.38-4.10) compared with the West region and visits with diagnoses of acute sinusitis (OR = 2.77; 95% CI: 1.65-4.63) and acute otitis media (OR = 1.90; 95% CI: 1.32-2.74) compared with those with acute pharyngitis were associated with greater odds of broad-spectrum antibiotic prescribing. CONCLUSIONS: The prescribing of broad-spectrum antibiotics is common for children with URI in ambulatory care settings. Diagnosis and management of URI remain a critical area for awareness campaigns promoting judicious use of antibiotics.

Predictors of hepatitis C testing intention among African American Baby Boomers.

Baby Boomers (BBs) are responsible for three-quarters of hepatitis C virus (HCV) infections in the United States; however, HCV testing is distinctly underused by them. A cross-sectional study was conducted to assess the prevalence of HCV testing and to evaluate predictors of HCV testing intention among African-American BBs. The study was guided by the Health Belief Model and theory of reasoned action frameworks. Of the 137 participants included in the study, 44.8% had at least a college education; 13.9% received prior to 1992 blood transfusion. Findings related to HCV testing showed that 32.1% of the participants intended to test for HCV within 6months and 43.8% had received a previous HCV test. Significant predictors of HCV testing intention within 6months included having a blood transfusion prior to 1992 [odds ratio (OR)=8.25, 95% confidence interval (CI): 2.02-33.61], perceptions of benefits (OR=1.57, 95% CI: 1.13-2.18), severity (OR=1.39, 95% CI: 1.17-1.65), and subjective norms (OR=1.42, 95% CI: 1.12-1.79). These predictors of HCV testing intention can be used to develop future HCV testing initiatives for African-American BBs.

An evaluation of hepatitis C knowledge and correlations with health belief model constructs among African American "baby boomers".

BACKGROUND: Baby boomers (people born between 1945 and 1965) are responsible for three-quarters of Hepatitis C (HCV) infections in the US; however, HCV testing is distinctly underused by them. AIM: To assess the status, predictors, and correlates of HCV knowledge among African-American baby boomers (AABBs) in Washington, DC. METHODS: A cross-sectional survey among persons aged 46-69 was conducted using audio computer-assisted self-interviewing (ACASI). Data on HCV knowledge, socio-demographics, prior history of HCV testing, health-related characteristics, HCV vulnerability and HCV treatment perceptions were collected. Descriptive statistics was used to describe the study population. Pearson correlations were used to examine linear associations between HCV knowledge and Health Belief Model constructs related to HCV. Linear regression analysis was conducted to assess the predictors of knowledge. RESULTS: Out of the 137 participants, about sixty percent (60.6%) were females, mean age 59±6.40; 44.8% had at least a college education. The average knowledge score was low (48.7%). HCV knowledge was significantly correlated with constructs of perceived severity and perceived benefits. Age (ß=-0.10; p=0.003), and level of education (ß=0.93, p=0.027) were significant predictors. CONCLUSIONS: Overall, respondents have a low level of knowledge. The lower level of education and older age were significant predictors of inadequate HCV knowledge. Thus, HCV education among these people may be a vital component in reducing the gaps in HCV knowledge.

Pulmonary sarcoidosis in an HIV/human T-cell lymphotrophic viruses I/II coinfected patient.

Coexistence of HIV, pulmonary sarcoidosis, and human T-cell lymphotrophic viruses (HTLV) I/II has not been well reported and studied. Although the exact etiology of sarcoidosis is unknown, immunologic abnormalities have been the focus of human immunodeficiency virus (HIV)-related sarcoidosis and it is thought to be a manifestation of immune reconstitution inflammatory syndrome. We report the case of an African American woman with HIV and HTLV I/II coinfection who developed pulmonary sarcoidosis several months after the initiation of antiretroviral therapy. Despite the fact that most common etiologies of pulmonary nodules in HIV patients include mycobacterial and fungal infections, sarcoidosis should be considered in differential diagnosis. This disease may continuously rise due to the increasing number of people who are receiving antiretroviral therapy, leading to an improved immune system.

Managing mentally and physically challenged HIV patients.

Management of mentally and physically challenged patients is complex, as it can involve ethical, social, and medical issues, and adding the provision of human immunodeficiency virus (HIV) care further complicates management. There continues to be limited information in the literature in caring for these types of patients. We provide 2 unique HIV cases--one who is mentally challenged and the other who is blind--and how management was approached. A list of select resources to aid both providers and patients is provided.

Malignancies in HIV: pre- and post-highly active antiretroviral therapy.

OBJECTIVES: A study was conducted at a large metropolitan tertiary-care teaching hospital to investigate the incidence of cancers among HIV-infected patients over a 13-year period. DESIGN: Retrospective cohort study. METHODS: A retrospective cohort study was conducted among HIV-infected patients diagnosed with cancer between January 1990 and December 2003 at a large metropolitan teaching hospital. Any HIV-infected patient who also had a confirmed diagnosis of Kaposi's sarcoma, primary central nervous system lymphoma, invasive cervical cancer or non-Hodgkin's lymphoma was categorized as having AIDS-defining cancer (ADC) according to the CDC's initial case definition for AIDS, while patients with other malignancies were classified as having non-ADCs. A clinical database was created consisting of HIV patients diagnosed with cancer at this teaching hospital, and data were abstracted for the current project. RESULTS: A total of 203 HIV-infected patients diagnosed with cancer were identified during the study period. Ninety-three cases occurred before 1995 and 110 after 1996. The median age of patients (at cancer diagnosis) in the era before highly active antiretroviral therapy (HAART) was 37 years and in the post-HAART era was 43 years (p<0.05). Mean CD4 count at cancer diagnosis in the pre-HAART era was 101 cells/mm3, and 183 cells/mm3 in the post-HAART period (p<0.05). Six patients had diagnoses of both ADC and NADC during the study period. Of the 197 remaining cases, 129 (65.4%) were ADCs and 68 (34.6%) were NADCs (p<0.05). The incidence of Kaposi's sarcoma decreased significantly, while the incidence of lung cancer increased significantly. CONCLUSIONS: Of 197 patients with a single diagnosis of either ADC or NADC, there was statistically a larger proportion of NADC cases diagnosed in the post-HAART period compared to the pre-HAART period. The number of ADC diagnoses decreased between the pre- and post-HAART period.

Campus-community pharmacy partnership to foster awareness and use of MedlinePlus.

OBJECTIVE: To determine the impact of a campus-community pharmacy partnership to foster awareness and use of National Library of Medicine (NLM) databases, including MedlinePlus, among minority populations. DESIGN: Uncontrolled study with pretest and posttest. SETTING: Two community pharmacies and Bethel World Ministry in the Washington, D.C., metropolitan area. PARTICIPANTS: 8 student pharmacists and pharmacy residents and 92 patients. INTERVENTION: Training of patients by student pharmacists and pharmacy residents in the use of NLM databases during prescription-fill wait time. MAIN OUTCOME MEASURES: Pre- and post-survey responses and telephone followup designed to assess familiarity with NLM databases, including MedlinePlus. RESULTS: Overall, the familiarity of the participants with MedlinePlus and NLM databases increased fivefold before versus after training. The 1-week follow-up confirmed this trend. However, no statistically significant differences in responses (pre-and posttest/follow-up) to the surveys were observed in regard to specific questions on daily and future use of the NLM databases available on the Internet. CONCLUSION: Awareness and use of MedlinePlus by study participants increased.

Avascular necrosis and protease inhibitors.

Avascular necrosis (AVN) indicates ischemic death of the bone due to insufficient arterial blood supply. The incidence rate of AVN is higher in HIV-infected patients than in the general population. Although the exact etiology of AVN remains unclear, the literature has shown a relationship between AVN and exposure to highly active antiretroviral therapy (HAART). It should be noted, however, that AVN has been reported before the era of HAART, thus suggesting the involvement of other causative factors as well. Three case reports based on patients attending the infectious disease clinic are presented. No cases of AVN are reported in our clinic population prior to this report. Affected sites of AVN included the hip and shoulders. The incidence of AVN within our patient population was higher than the general population. Although the introduction of HAART has improved patient longevity, it has also led to longer exposure to antiretroviral (ARV) therapy. Thus, it is likely that treatment-related complications may become more apparent in the HIV-infected population. This may be the case with AVN. Therefore, clinicians need to be alert to the potential complication of AVN in HIV-infected patients treated with HAART.

Geriatric education in US schools of pharmacy: a snapshot.

OBJECTIVE: The objective of this study was to assess the structure, resources, and activities of academic geriatrics courses in U.S. pharmacy schools. DESIGN: A cross-sectional study. PARTICIPANTS: Schools of pharmacy in the United States identified through the American Association of Colleges of Pharmacy (AACP). The survey was e-mailed (May 2003) to the academic chairs of the clinical pharmacy department and/or the head of geriatric pharmacy practice at each of the 84 schools of pharmacy in the United States. MEASURES: The primary measure was to assess the nature and extent of geriatrics course content in the responding schools. In addition, we elicited information on the type of geriatrics material taught, faculty involvement, student population, type of school, academic requirements, and experiential education. The questionnaire items were based on the current course content in geriatrics courses taught at the institution. Content validity of the questionnaire was assessed by administering the survey to three survey experts (including one in geriatrics); their suggestions were incorporated in redesigning the questionnaire. RESULTS: A total of 42 (50%) out of 84 schools responded. All responding schools had some form of geriatric education incorporated into their curriculum. However, the depth and breadth of the geriatric curriculum reported by the responding schools did not seem to be that different from results obtained by a 1985-1986 survey. CONCLUSION: Geriatric education in pharmacy schools has not increased proportionally with the expected increase in the geriatric population in the United States. Schools of pharmacy should make geriatric education a priority because the majority of patients whom pharmacists need to monitor or counsel currently are, and will continue to be, 65 years and older. Compared with a past study, the focus of current geriatrics education in pharmacy schools does not seem to have improved much despite the increasing need for geriatric practitioners and drug misadventures in the elderly.