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1.  Analgesic use, pain and daytime sedation in people with and without dementia in aged care facilities: a cross-sectional, multisite, epidemiological study protocol 
BMJ Open  2014;4(6):e005757.
Introduction
People living with dementia may experience and express pain in different ways to people without dementia. People with dementia are typically prescribed fewer analgesics than people without dementia indicating a potential difference in how pain is identified and treated in these populations. The objectives of this study are to (1) investigate the prevalence of analgesic load, pain and daytime sedation in people with and without dementia in Australian residential aged care facilities (RACFs), and (2) investigate the clinical and diagnostic associations between analgesic load, pain and daytime sedation in people with and without dementia in Australian RACFs.
Methods/analysis
This will be a cross-sectional study of 300 permanent residents of up to 10 low-level and high-level RACFs in South Australia with and without dementia. Trained study nurses will administer validated and dementia-specific assessments of self-reported and clinician-observed pain, sedation and other clinical and humanistic outcomes. Medicine-use data will be extracted directly from each resident's medication administration chart. Binary and multinominal logistic regression will be used to compute unadjusted and adjusted ORs and 95% CIs for factors associated with pain, analgesic load and daytime sedation. These factors will include dementia severity, behavioural and psychological symptoms, quality of life, resident satisfaction, attitudes towards medicines, activities of daily living and nutritional status.
Ethics and dissemination
Institutional ethics approval has been granted. The findings will be disseminated through public lectures, professional and scientific conferences and in peer-reviewed journal articles. The findings of this study will allow for a better understanding of the prevalence and factors associated with analgesic use, pain and other outcomes in residential care. The findings of this study will be used to inform the development and implementation of strategies to improve the quality of life of people with dementia.
doi:10.1136/bmjopen-2014-005757
PMCID: PMC4067818  PMID: 24948752
Epidemiology; Geriatric Medicine; Pain Management
2.  Impact of High Risk Drug Use on Hospitalization and Mortality in Older People with and without Alzheimer’s Disease: A National Population Cohort Study 
PLoS ONE  2014;9(1):e83224.
Background
Evidence is lacking about outcomes associated with the cumulative use of anticholinergic and sedative drugs in people with Alzheimer’s disease (AD). This retrospective cohort study investigated the relationship between cumulative exposure to anticholinergic and sedative drugs and hospitalization and mortality in people with and without AD in Finland.
Methods
Community-dwelling people aged 65 years and over, with AD on December 31st 2005 (n = 16,603) and individually matched (n = 16,603) comparison persons (age, sex, region of residence) were identified by the Social Insurance Institution of Finland. Drug utilization data were extracted from the Finnish National Prescription Register. Exposure to anticholinergic and sedative drugs was defined using the Drug Burden Index (DBI). Hospitalization and mortality data were extracted from national registers. Cox and zero-inflated negative binomial analyses were used to investigate the relationship between DBI and hospitalization and mortality over a one-year follow-up.
Results
In total, 5.8% of people with AD and 3.7% without AD died during 2006. For every unit increase in DBI, the adjusted hazard ratio for mortality was 1.21 (95% confidence intervals [CI]: 1.09–1.33) among people with AD, and 1.37 (95%CI: 1.20–1.56) among people without AD. Overall, 44.3% of people with AD and 33.4% without AD were hospitalized. When using no DBI exposure as the reference group, the adjusted incidence rate ratio for length of hospital stay among high DBI group (≥1) in people with AD was 1.15 (95%CI: 1.05–1.26) and 1.63 (95%CI: 1.41–1.88) in people without AD.
Conclusion
There is a dose-response relationship between cumulative anticholinergic and sedative drug use and hospitalization and mortality in people with and without AD.
doi:10.1371/journal.pone.0083224
PMCID: PMC3890276  PMID: 24454696
3.  Nepalese Pharmacy Students' Perceptions Regarding Mental Disorders and Pharmacy Education 
Objective
To determine Nepalese pharmacy students' perceptions of whether mental disorders impact performance in pharmacy school.
Method
All first- and third-year undergraduate pharmacy students (n=226) in Nepal were invited to complete a modified version of the Mental Illness Performance Scale.
Results
Among the 200 respondents (response rate 88.5%), 14% reported that they had a mental disorder. The majority (92%) of third-year students agreed or strongly agreed that depression would interfere with a student's academic performance. Almost half of first-year students agreed or strongly agreed that alcohol or drug abuse would be grounds for both rejecting an applicant from pharmacy school (49%) and dismissal of a student from pharmacy school (46%).
Conclusions
Students perceived a high level of academic impairment associated with mental disorders, but the majority did not perceive that mental disorders were grounds for dismissal from or rejection of entry to pharmacy school. Students' attitudes may discourage them from seeking help or providing mental health support to others.
PMCID: PMC2907854  PMID: 20798796
attitude of health personnel; mental disorders; pharmacy students; mental health
6.  Coexisting social conditions and health problems among clients seeking treatment for illicit drug use in Finland: The HUUTI study 
BMC Public Health  2013;13:380.
Background
Illicit drug use is an important public health problem. Identifying conditions that coexist with illicit drug use is necessary for planning health services. This study described the prevalence and factors associated with social and health problems among clients seeking treatment for illicit drug use.
Methods
We carried out cross-sectional analyses of baseline data of 2526 clients who sought treatment for illicit drug use at Helsinki Deaconess Institute between 2001 and 2008. At the clients’ first visit, trained clinicians conducted face-to-face interviews using a structured questionnaire. Logistic regression was used to compute adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for factors associated with social and health problems.
Results
The mean age of the clients was 25 years, 21% (n = 519) were homeless, 54% (n = 1363) were unemployed and 7% (n = 183) had experienced threats of violence. Half of the clients (50%, n = 1258) were self-referred and 31% (n = 788) used opiates as their primary drugs of abuse. Hepatitis C (25%, n = 630) was more prevalent than other infectious diseases and depressive symptoms (59%, n = 1490) were the most prevalent psychological problems. Clients who were self-referred to treatment were most likely than others to report social problems (AOR = 1.86; 95% CI = 1.50–2.30) and psychological problems (AOR = 1.51; 95% CI = 1.23–1.85). Using opiates as primary drugs of abuse was the strongest factor associated with infectious diseases (AOR = 3.89; 95% CI = 1.32–11.46) and for reporting a combination of social and health problems (AOR = 3.24; 95% CI = 1.58–6.65).
Conclusion
The existence of illicit drug use with other social and health problems could lead to increased utilisation and cost of healthcare services. Coexisting social and health problems may interfere with clients’ treatment response. Our findings support the call for integration of relevant social, medical and mental health support services within drug treatment programmes.
doi:10.1186/1471-2458-13-380
PMCID: PMC3639872  PMID: 23617549
HUUTI study; Illicit drug use; Homelessness; Depression; Hepatitis C; Comorbidity
7.  Pharmacy Students' and Graduates' Attitudes Towards People With Schizophrenia and Severe Depression 
Objectives
To compare the attitudes of third-year pharmacy students and pharmacy graduates towards people with schizophrenia and severe depression.
Methods
Third-year pharmacy students (n = 216) and pharmacy graduates (n = 232) completed a survey instrument with 21 common items. The third-year students had not yet received any mental health lectures or tutorials as part of their pharmacy course. The graduates had completed their university education, including mental health lectures and tutorials, plus 6 months of supervised clinical practice in the pharmacy workplace.
Results
There were no significant differences between the third-year students and pharmacy graduates in terms of social distance from people with schizophrenia. The rates of stigmatization of people with schizophrenia and severe depression were also similar between the groups.
Conclusions
Mental health lectures and tutorials delivered by pharmacists and supervised clinical practice in the pharmacy workplace may not decrease students' social distance or stigmatization of people with mental illness. The results of our study suggest that more comprehensive education and training programs are needed to improve the ability of pharmacists to meet the needs of people with mental illness.
PMCID: PMC1636970  PMID: 17136196
schizophrenia; depression; mental illness
8.  Consumer-led Mental Health Education for Pharmacy Students 
Objective
To evaluate a consumer-led teaching intervention to reduce pharmacy students' stigma towards depression and schizophrenia, and improve attitudes toward providing pharmaceutical care for consumers with mental illness.
Design
Third-year bachelor of pharmacy degree students were given a series of mental health lectures, undertook supervised weekly placements in the community pharmacy setting, and attended a tutorial led by trained mental health consumer educators.
Assessment
A previously validated 26-item survey instrument was administered at baseline, 6 weeks postintervention, and 12 months postintervention, and 3 focus groups were conducted. Survey instruments were completed by 225 students at baseline, 230 students postintervention, and 228 students at 12 months. Students' stigma decreased (p < 0.05) and their attitudes toward the provision of pharmaceutical services to consumers with a mental illness showed significant improvements (p < 0.05). These improvements were maintained at the 12-month follow-up. Four themes emerged from the focus groups: knowledge and experience of mental illness, mental health stigma, impacts on attitudes and self-reported behavior, and the role of the pharmacist in mental healthcare.
Conclusions
Consumer-led education for pharmacy students may provide a sustainable reduction in stigma and improve attitudes towards providing pharmaceutical services to consumers with a mental illness.
PMCID: PMC2996757  PMID: 21301601
consumer; attitude; stigma; depression; schizophrenia; mental health; pharmacy student
9.  Medication adherence: a review of pharmacy education, research, practice and policy in Finland  
Pharmacy Practice  2010;8(3):147-161.
Aims
To describe pharmacy education, research, practice and policy related to medication adherence in Finland since the year 2000.
Methods
The three universities that provide pharmacy education (Åbo Akademi, University of Eastern Finland, and University of Helsinki) completed a structured pro-forma questionnaire regarding education related to medication adherence. A MEDLINE and EMBASE literature search was performed to identify English language peer-reviewed research that reported medication compliance, adherence or persistence. The Ministry of Social Affairs and Health was invited to nominate policies and documents related to medication adherence. A narrative review of medication counselling practices and professional service delivery through Finnish community pharmacies was undertaken.
Results
Medication adherence was a theme integrated into obligatory and elective courses for bachelors and masters degree students. The literature search identified 33 English language peer-reviewed research articles reporting medication compliance, adherence or persistence published since the year 2000. Policy documents of the Ministry of Social Affairs and Health recognise that poor medication adherence may lead to suboptimal treatment outcomes, and encourage patient participation in treatment decision making. Adherence practice in Finnish pharmacies has been strongly linked to the development of medication counselling services.
Conclusions
Adherence research and education has focused on understanding and addressing the contextual factors that contribute to medication nonadherence. Adherence practice in community pharmacies has tended to focus on medication counselling and programs specific to particular disease states. Medication adherence is a topic that is integrated into courses for bachelor’s and master’s level pharmacy students in Finland.
PMCID: PMC4127049  PMID: 25126134
Medication Adherence; Pharmacists; Education; Pharmacy; Finland
10.  Barriers to medication counselling for people with mental health disorders: a six country study 
Pharmacy Practice  2010;8(2):122-131.
Provision of medication information may improve adherence and prevent medication related problems. People with mental health disorders commonly receive less medication counselling from pharmacists than people with other common long term and persistent disorders.
Objective
The objective of this study was to compare and contrast barriers pharmacy students perceive toward providing medication counselling for people with mental health disorders in Australia, Belgium, Estonia, Finland, India and Latvia.
Methods
Barriers identified by third-year pharmacy students as part of the International Pharmacy Students’ Health Survey were content analysed using a directed approach. Students’ responses were categorised as pharmacist related, patient related, health-system related, or social or cultural related. Quantitative data were analysed using SPSS version 14.0.
Results
Survey instruments were returned by 649 students. Of the respondents, 480 identified one or more barriers to medication counselling for people with mental health disorders. Patient related factors accounted for between 25.3% and 36.2% of barriers identified by the pharmacy students. Pharmacist related factors accounted for between 17.6% and 45.1% of the barriers identified by the pharmacy students. Students in India were more likely to attribute barriers to pharmacist and social and cultural related factors, and less likely to health-system related factors, than students studying in other countries.
Conclusion
The nature of barriers identified by pharmacy students differed according to the country in which they studied. Undergraduate and postgraduate pharmacy education programs may need to be amended to address common misconceptions among pharmacy students.
PMCID: PMC4133066  PMID: 25132880
Mental Disorders; Community Pharmacy Services; Attitude of Health Personnel; Australia; Belgium; Estonia; Finland; India; Latvia
11.  Design and Implementation of an Educational Partnership Between Community Pharmacists and Consumer Educators in Mental Health Care 
Objective
To design and implement an interactive education program to improve the skill and confidence of community pharmacists in providing pharmaceutical services to people with mental illnesses.
Design
A literature review was conducted and key stakeholders were consulted to design a partnership that involved community pharmacists and consumer educators. The partnership was designed so that all participants shared equal status. This facilitated mutual recognition of each others' skills.
Assessment
Four 2-hour training sessions were conducted over a 2-week period in March 2005. Seven pharmacists, 5 consumer educators, and 1 caregiver educator participated in the partnership. Pharmacists indicated that their participation caused them to reflect on their own medication counseling techniques. Consumer educators reported that speaking about their experiences aided their recovery.
Conclusion
Developing a better understanding and improved communication between community pharmacists and people with mental illnesses is an important aspect of facilitating a concordant approach to patient counseling. Implementing mental health education programs utilizing consumer educators in pharmacy schools is a promising area for further research.
PMCID: PMC1636921  PMID: 17149408
continuing education; patient counseling; community pharmacy; mental health care

Results 1-11 (11)