Perceived roles and barriers in caring for the people who are homeless: a survey of UK community pharmacists

Abstract

Background Community pharmacists can be an accessible source for advice and support for the people who are homeless, given their utilisation of a variety of currently available services such as dispensing of medicines, drugs and alcohol services. Objective To determine community pharmacists' training, experiences and behavioural determinants in counselling and management of homeless population. Setting UK community pharmacies. Method A questionnaire based on literature and theoretical domains framework was mailed to randomly sampled community pharmacies in England and Scotland (n = 2000). Data were analysed using descriptive and inferential statistics. Main outcome measures Pharmacists' perspectives, pharmacists' training, pharmacists' experiences and behavioural determinants. Results A total of 321 responses (RR 16.1%) were received. Respondents indicated lack of knowledge, skills, intentions as well as contextual factors such as lack of guidelines impacted on their counselling and management of homeless patients. Less than a third (n = 101, 32.2%) indicated that they knew where to refer a homeless patient for social support. Broaching the subject of homelessness was outside their comfort zone (n = 139, 44.3%). Only four (1.2%) respondents could correctly answer all knowledge assessment questions. Conclusions Community pharmacist identified lack of education, training opportunities and guidelines in counselling and management of homeless patients. Targeting community pharmacists' knowledge, skills and intention to provide care to the homeless patients may enable addressing health inequality through community pharmacy.

http://bit.ly/2VZf5E9

A novel leptin receptor antagonist uncouples leptin’s metabolic and immune functions

Abstract

Leptin links body energy stores to high energy demanding processes like reproduction and immunity. Based on leptin's role in autoimmune diseases and cancer, several leptin and leptin receptor (LR) antagonists have been developed, but these intrinsically lead to unwanted weight gain. Here, we report on the uncoupling of leptin's metabolic and immune functions based on the cross talk with the epidermal growth factor receptor (EGFR). We show that both receptors spontaneously interact and, remarkably, that this complex can partially overrule the lack of LR activation by a leptin antagonistic mutein. Moreover, this leptin mutant induces EGFR phosphorylation comparable to wild-type leptin. Exploiting this non-canonical leptin signalling pathway, we identified a camelid single-domain antibody that selectively inhibits this LR-EGFR cross talk without interfering with homotypic LR signalling. Administration in vivo showed that this single-domain antibody did not interfere with leptin's metabolic functions, but could reverse the leptin-driven protection against starvation-induced thymic and splenic atrophy. These findings offer new opportunities for the design and clinical application of selective leptin and LR antagonists that avoid unwanted metabolic side effects.

http://bit.ly/2RPGJ7u

Comparison between cuff-based and radial tonometry exercise-induced central blood pressure

Abstract

Purpose

Non-invasive central blood pressure assessed during exercise may provide better cardiovascular prognostic than measurements taken at rest. Radial tonometry is the only technique validated to perform this type of assessment; however, it relies on the experience of the tester. Cuff-based devices have been developed to avoid operator dependency, although these systems have yet to be validated during exercise. The purpose of this study was to compare exercise-induced central blood pressure estimations between a cuff-based device and radial tonometry.

Methods

Twenty young healthy subjects were recruited to perform a three-workload steady-state exercise test at blood lactate levels of < 2, 2–4, and > 4 mmol/L, respectively. Central systolic and diastolic blood pressure (cSBP and cDBP, respectively), central pulse pressure (cPP), and augmentation index (AIx) were assessed at rest and during each workload with a cuff-based device and radial tonometry. Statistical analysis included Bland–Altman analysis for agreement between techniques. Agreement was considered when 95% of the data set for each central blood pressure parameter was within 1.96 standard deviations from the mean difference. Significance was considered at α = 0.05.

Results

Central blood pressure measurements with the cuff device were obtained only at rest and during low-intensity exercise. During low-intensity exercise, all measurements showed agreement between both devices (cSBP 95% CI [− 6.0 to 10.7], cDBP 95% CI [− 4.5 to 6.3], cPP 95% CI [− 4.7 to 8.3], and AIx (95% CI [− 20.1 to 22.2]).

Conclusion

A cuff-based device can estimate central blood pressure at low-intensity exercise, without operator dependency, and showing agreement to radial tonometry.

http://bit.ly/2Hm66tt

Psychische Erkrankungen und genetische Dispositionen: ethische Aspekte

Zusammenfassung

Der Umgang mit prädiktiven genetischen Testungen gerade im Bereich psychischer Erkrankungen bedarf eines sensiblen Umgangs. Insbesondere Direct-to-consumer-Angebote über das Internet können eine angemessene Interpretationsleistung von Eintrittswahrscheinlichkeiten nicht leisten. Stattdessen sollte ein Arzt-Patienten-Verhältnis durch hermeneutische und nichttechnizistische Hilfestellung für Klarheit sowohl hinsichtlich der Notwendigkeit einer Testung als auch im Blick auf die Deutung des Testergebnisses sorgen.

http://bit.ly/2CrLqL4

Mitteilungen der DGPPN 1/2019

http://bit.ly/2RB5WD9

An assessment of bone-seeking radionuclides for palliation of metastatic bone pain in a vertebral model

Abstract

Objective

Bone-seeking radiopharmaceuticals have the main role in the treatment of painful bone metastases. The aim of this study was to dosimetrically compare radiopharmaceuticals in use for bone pain palliation therapy and bone scan.

Methods

The MCNPX code was used to simulate the radiation transport in a vertebral phantom. Absorbed fractions were calculated for monoenergetic electrons, photons and alpha particles. S values were obtained for radionuclides ³²P, ³³P, ⁸⁹Sr, ⁹⁰Y, ^99mTc, ^117mSn, ¹⁵³Sm, ¹⁶⁶Ho, ¹⁶⁹Er, ¹⁷⁷Lu, ¹⁸⁶Re, ¹⁸⁸Re, ²²³Ra, ²²⁴Ra and their progenies for target regions including the active marrow and the bone endosteum.

Results

The results demonstrated the dependence of dosimetric parameters on the source or target size, particle energy and location of the source. The electron emitters including ³³P, ^117mSn, ¹⁶⁹Er and ¹⁷⁷Lu and ²²³Ra as an α-emitter gave the lower absorbed dose to the active marrow. These radionuclides gave the highest values of the Relative Advantage Factor (RAF).

Conclusions

According to the results, ³³P, ^117mSn, ¹⁶⁹Er, ¹⁷⁷Lu and ²²³Ra have fewer side effects on the active marrow than other investigated radionuclides. Therefore, these radionuclides may be a better choice for use in palliative radiotherapy.

http://bit.ly/2FzOlFk

Skin damage by tropospheric ozone

Abstract

Tropospheric (ground level) ozone (O₃) is a secondary pollutant, emerging from other pollutants in the sunshine. Exposure to O₃ correlates with higher pulmonary and cardiovascular mortality and affects reproductive health and the central nervous system acutely and chronically. Skin might be a potentially overlooked target organ of ambient O₃. The experimental evidence suggests a positive correlation of O₃ exposure with oxidative damage, impaired antioxidant defence and proinflammatory response in the skin. In time series studies it was observed that acute rises in O₃ levels correlated with seeking medical help for skin conditions; however, whether these findings are specific to O₃, is not yet clear. There is preliminary epidemiological evidence that long-term exposure to O₃ is associated with premature skin aging. This finding was independent of co-exposure to other environmental factors affecting skin (e.g. ultraviolet radiation and air pollution). As concentrations of O₃ are rising in many regions of the world, adverse cutaneous effects of O₃ present a relevant public health concern.

http://bit.ly/2FMIPib