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.

Some People are Different from You: A Case Study of a Cultural and Ethical Problem in Global Health.

Pharmacists, student pharmacists, and other healthcare providers are frequent participants on short-term medical service trips (MSTs) to medically underserved areas. Many such MSTs take place in areas like sub-Saharan Africa where cultural beliefs about healthcare and society may be very different from what volunteers from the Global North believe. These cultural divergences may then give rise to ethical problems MST volunteers need to navigate. This case study provides an example of such an ethical problem developing from a difference in cultures - the case of female genital cutting. Often, the ethical training that most MST volunteers receive during their clinical education is inadequate to help them address these kinds of cultural differences and the problems that result. A six-step process to provide MST volunteers with the tools to address such cultural-ethical problems is included. Medical, Public Health, and Microfinance Teams with local interpreters in Nana Kenieba, Cercle of Kati, Koulikoro Region, Southwest Mali.

Short-term medical service trips: what is the cost of patient care and student training?

BACKGROUND: Evaluations of the costs and effects of medical service trips (MSTs) are increasingly necessary. Estimates of costs can inform decision making to determine if participation is likely to be a wise use of resources. METHODS: This study estimates the costs and effects of a 1-week MST for 20 health professions students and seven providers to the Dominican Republic. Costs were defined as direct costs for students and providers and opportunity costs for providers. Effects were defined as the cost to treat one patient and the cost to train one student. Students were surveyed about their costs before and after the MST. Most provider costs were assumed to be the same as those of the students. RESULTS: The mean direct cost per student was US${\$}$1764 and US${\$}$2066 for providers. Total opportunity costs for seven providers was US${\$}$19 869. The total cost for the trip was US${\$}$69 612 to treat 464 patients. With and without provider opportunity costs, the cost to treat one patient was US${\$}$150 and US${\$}$107, and the cost to train one student was US${\$}$3481 and US${\$}$2487, respectively. CONCLUSIONS: Short-term MSTs may be more expensive than previously thought. The cost to treat one patient was similar to a medical office visit in the USA.

Short-term Experiences in Global Health: What is the Cost of Cultural Competence?

Students in a wide variety of health professions are increasingly interested in volunteering on a short-term experience in global health (STEGH). The literature suggests that STEGHs pose a variety of potential risks and benefits, and may carry a significant cost to plan and provide. One potential mitigating factor for any risks and costs is that student participation on a STEGH may enhance their cultural competence. Since monies spent on STEGHs are fungible, and there may be other opportunities to improve students' cultural competence, the objectives of this study were to determine if participation on a STEGH increased students' cultural competence and if so, what the cost for any such increase was. In this study, 20 students who participated on a 1-week STEGH to the Dominican Republic completed the Inventory for Assessing the Process of Cultural Competence Among Health Care Professionals - Student Version (IAPCC-SV) before and after the STEGH. The costs for all students and 7 supervising health professionals to volunteer for the STEGH were calculated, and the size of any increase in cultural competence was determined. The cost was divided by the change in cultural competence to ascertain the cost of the change. Students showed a measureable increase on the IAPCC-SV overall and on the subscales of knowledge and skill. The cost of a 1% overall increase in students' cultural competence ranged from $287 to $401. These results may allow schools offering STEGHs to determine if their offerings are cost-effective or not.

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.

Recommendations for Planning and Managing International Short-term Pharmacy Service Trips.

International pharmacy service trips by schools and colleges of pharmacy allow students to provide health care to medically underserved areas. A literature review (2000-2016) in databases and Internet searches with specific keywords or terms was performed to assess current practices to establish and maintain successful pharmacy service trips. Educational documents such as syllabi were obtained from pharmacy programs and examined. A preliminary draft was developed and authors worked on sections of interest and expertise. Considerations and current recommendations are provided for the key aspects of the home institution and the host country requirements for pharmacy service trips based on findings from a literature search and the authors' collective, extensive experience. Evaluation of the trip and ethical considerations are also discussed. This article serves as a resource for schools and colleges of pharmacy that are interested in the development of new pharmacy service trips and provides key considerations for continuous quality improvement of current or future activities.

Motivations, barriers and ethical understandings of healthcare student volunteers on a medical service trip: a mixed methods study.

BACKGROUND: The motivation to volunteer on a medical service trip (MST) may involve more than a simple desire for philanthropy. Some volunteers may be motivated by an intrinsic interest in volunteering in which the context of the volunteer activity is less important. Others may volunteer because the context of their volunteering is more important than their intrinsic interest in volunteering. Furthermore, MSTs may pose a variety of ethical problems that volunteers should consider prior to engaging in a trip. This study evaluated the motivations and barriers for graduate health care students volunteering for an MST to either the Dominican Republic or Mississippi. Volunteers' understanding of some of the ethical issues associated with MSTs was also assessed. METHODS: Thirty-five graduate health professions students who volunteered on an MST were asked to complete an online survey. Students' motivations and barriers for volunteering were assessed using a 5-point Likert scale and Fisher's exact test. Ethical understanding of issues in volunteering was assessed using thematic analysis. RESULTS: Students' motivations for volunteering appeared to be related to the medical context of their service more than an inherent desire for volunteer work. Significant differences were seen in motivations and barriers for some student groups, especially those whose volunteer work had less opportunity for clinical service. Thematic analysis revealed two major themes and suggested that students had an empirical understanding that volunteer work could have both positive and negative effects. CONCLUSIONS: An understanding of students' motivations for volunteering on an MST may allow faculty to design trips with activities that effectively address student motivations. Although students had a basic understanding of some of the ethical issues involved, they had not considered the impact of a service group on the in-country partners they work with.

A drug procurement, storage and distribution model in public hospitals in a developing country.

BACKGROUND: There is growing interest in pharmaceutical supply chains and distribution of medications at national and international levels. Issues of access and efficiency have been called into question. However, evaluations of system outcomes are not possible unless there are contextual data to describe the systems in question. Available guidelines provided by international advisory bodies such as the World Health Organization and the International Pharmacy Federation may be useful for developing countries like Vietnam when seeking to describe the pharmaceutical system. OBJECTIVE: The purpose of this study was to describe a conceptual model for drug procurement, storage, and distribution in four government-owned hospitals in Vietnam. METHOD: This study was qualitative and used semi-structured interviews with key informants from within the Vietnamese pharmaceutical system. Translated transcriptions were used to conduct a content analysis of the data. RESULTS: A conceptual model for the Vietnamese pharmaceutical system was described using structural and functional components. This model showed that in Vietnam, governmental policy influences the structural framework of the system, but allows for flexibility at the functional level of practice. Further, this model can be strongly differentiated from the models described by international advisory bodies. This study demonstrates a method for health care systems to describe their own models of drug distribution to address quality assurance, systems design and benchmarking for quality improvement.

Quality and stability of artemether-lumefantrine stored under ambient conditions in rural Mali.

BACKGROUND: The quality and stability of anti-malarial drugs in the Global South has long been of significant concern. Drug quality can be affected by poor or fraudulent manufacturing processes, while drug stability is affected by temperature and humidity. Knowledge of drug quality and stability is often the unique contribution of pharmacists volunteering on short-term medical mission trips. OBJECTIVE: To determine the quality and stability of artemether-lumefantrine 20/120 mg under ambient storage conditions in rural Mali. METHODS: One unopened blister pack of artemether-lumefantrine 20/120 mg (IPCA Laboratories, Mumbai) was stored under ambient conditions in a warehouse in a Malian village for one year. A second pack from the same lot number was stored under temperature and humidity controlled conditions in a university laboratory. The active ingredients of tablets from both packages were analysed using thin layer chromatography, nuclear magnetic resonance and infrared spectroscopy. The IPCA samples were referenced for drug identity and content to an identical American made product (Coartem(®), Novartis Pharmaceuticals). RESULTS: Thin layer chromatographs, nuclear magnetic resonance and infrared spectroscopy results were identical for both IPCA samples and the reference product. CONCLUSIONS: The IPCA products contained the same drugs in the same amount as on their package label and were identical to the reference product. It is concluded that they were of good quality. Spectroscopy results demonstrate the sample stored in Mali was stable for one year. Pharmacists volunteering on medical mission trips may dispense this product with confidence. At the end of a mission trip, pharmacists may store left over artemether-lumefantrine under ambient conditions for up to one year without concern for significant degradation of the active ingredients.

Expanding the scope of medical mission volunteer groups to include a research component.

BACKGROUND: Serving on volunteer groups undertaking medical mission trips is a common activity for health care professionals and students. Although volunteers hope such work will assist underserved populations, medical mission groups have been criticized for not providing sustainable health services that focus on underlying health problems. As members of a volunteer medical mission group, we performed a bed net indicator study in rural Mali. We undertook this project to demonstrate that volunteers are capable of undertaking small-scale research, the results of which offer locally relevant results useful for disease prevention programs. The results of such projects are potentially sustainable beyond the duration of a mission trip. METHODS: Volunteers with Medicine for Mali interviewed 108 households in Nana Kenieba, Mali during a routine two-week medical mission trip. Interviewees were asked structured questions about family demographics, use of insecticide treated bed nets the previous evening, as well as about benefits of net use and knowledge of malaria. Survey results were analyzed using logistic regression. RESULTS: We found that 43.7% of households had any family member sleep under a bed net the previous evening. Eighty seven percent of households owned at least one ITN and the average household owned 1.95 nets. The regression model showed that paying for a net was significantly correlated with its use, while low perceived mosquito density, obtaining the net from the public sector and more than four years of education in the male head of the household were negatively correlated with net use. These results differ from national Malian data and peer-reviewed studies of bed net use. CONCLUSIONS: We completed a bed net study that provided results that were specific to our service area. Since these results were dissimilar to peer-reviewed literature and Malian national level data on bed net use, the results will be useful to develop locally specific teaching materials on malaria prevention. This preventive focus is potentially more sustainable than clinical services for malaria treatment. Although we were not able to demonstrate that our work is sustainable, our study shows that volunteer groups are capable of undertaking research that is relevant to their service area.

Self-assessment tool for screening patients at risk for drug therapy problems.

OBJECTIVE: To describe the development, use, and evaluation of a patient self-assessment tool for screening patients at risk for drug therapy problems (DTPs) and potentially interested in receiving a personal consultation with a pharmacist. DESIGN: Quasi-experimental, nonrandomized, controlled study. SETTING: Area Agency on Aging-affiliated senior centers in Florida from April 2005 to December 2005. PARTICIPANTS: 175 clients of an Area Agency on Aging. INTERVENTION: While attending a free seminar on obtaining the best value from their medications, participants completed a 12-item self-assessment tool. The tool was designed to (1) identify participants who were at risk for a DTP and (2) motivate those at risk to participate in a personal pharmacotherapy consultation with a pharmacist on a fee-for-service basis. MAIN OUTCOME MEASURE: Relationship between total score on self-assessment tool and patient acceptance of offer of personal pharmacotherapy consultation. RESULTS: Of 175 participants who attended a free seminar, 69 (39.4%) accepted the offer of a personal pharmacotherapy consultation. The median score on the self-assessment tool in these participants was significantly higher compared with participants who declined a consultation (3 vs. 1, P = 0.0489). The number of DTPs eventually identified during the personal pharmacotherapy consultation was significantly and positively correlated with the total score on the self-assessment tool (ρ = 0.3259, P = 0.0110). CONCLUSION: The self-assessment tool appeared to be of use in predicting individuals who were likely to accept the offer of a personal consultation. Higher scores on the self-assessment tool may also predict patients who are likely to have a higher number of DTPs.

A guided interview process to improve student pharmacists' identification of drug therapy problems.

OBJECTIVE: To measure agreement between advanced pharmacy practice experience students using a guided interview process and experienced clinical pharmacists using standard practices to identify drug therapy problems. METHODS: Student pharmacists enrolled in an advanced pharmacy practice experience (APPE) and clinical pharmacists conducted medication therapy management interviews to identify drug therapy problems in elderly patients recruited from the community. Student pharmacists used a guided interview tool, while clinical pharmacists' interviews were conducted using their usual and customary practices. Student pharmacists also were surveyed to determine their perceptions of the interview tool. RESULTS: Fair to moderate agreement was observed on student and clinical pharmacists' identification of 4 of 7 drug therapy problems. Of those, agreement was significantly higher than chance for 3 drug therapy problems (adverse drug reaction, dosage too high, and needs additional drug therapy) and not significant for 1 (unnecessary drug therapy). Students strongly agreed that the interview tool was useful but agreed less strongly on recommending its use in practice. CONCLUSIONS: The guided interview process served as a useful teaching aid to assist student pharmacists to identify drug therapy problems.

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.