Laura J. Sahm

Prevalence and predictors of periconceptional folic acid uptake—prospective cohort study in an Irish urban obstetric population

BACKGROUND Neural tube defects (NTDs) are severe abnormalities of the central nervous system that occur as a result of abnormal development in the third and fourth weeks of gestation. Studies have shown that periconceptional folic acid (FA) can reduce both the incidence and recurrence of NTDs. METHODS A cohort study was carried out using the electronic hospital booking records of women delivering in a large Dublin maternity hospital between 2000 and 2007. Logistic regression analyses were performed to measure the associations between maternal factors and optimal FA use. RESULTS Of the 61,252 women in the cohort, 85% reported taking FA at some point during the periconceptional period; however, only 28% took FA as recommended. Factors associated with taking the recommended amount of FA included nulliparity [adjusted OR: 1.35 (95% CI: 1.28-1.43)], early booking (<12 weeks) [OR: 1.24 (95% CI: 1.17-1.31)], increasing maternal age (e.g. 30-34 years) [OR: 1.39 (95% CI: 1.30-1.48)], private health care [OR: 4.32 (95% CI: 4.1-4.6)] and fertility treatment [OR: 2.88 (95% CI: 2.44-3.40)]. Factors associated with taking less than recommended or no FA included unplanned pregnancy [OR: 0.08 (0.07-0.08)], lower socio-economic status (e.g. unemployed) [OR: 0.63 (95% CI: 0.55-0.71)], non-Irish nationality [OR: 0.82 (0.74-0.90)] and smokers [OR: 0.51 (95% CI: 0.47-0.55)]. CONCLUSIONS Social, demographic and economic factors have an important influence on the FA uptake. Vulnerable groups who report limited uptake of FA need to be specifically targeted in future Public Health campaigns and further consideration needs to be given to the debate on food fortification in countries where this is currently not available.

The success of microneedle-mediated vaccine delivery into skin

ABSTRACT Microneedles (MNs) are designed to specifically target the outermost, skin barrier layer, the stratum corneum, creating transient pathways for minimally invasive transcutaneous delivery. It is reported that MNs can facilitate delivery without stimulating the pain receptors or damaging blood vessels that lie beneath, thus being perceived as painless and associated with reduced bleeding. This immunocompetence of the skin, coupled with its ease of access, makes this organ an attractive vaccination site. The purpose of this review was to collate primary scientific literature pertaining to MN-mediated in vivo vaccination programmes. A total of 62 original research articles are presented, compiling vaccination strategies in 6 different models (mouse, rat, guinea pig, rabbit, pig, macaque and human). Vaccines tested span a wide range of viral, bacterial and protozoan pathogens and includes 7 of the 13 vaccine-preventable diseases, as defined by the WHO. This review highlights the paucity of available clinical trial data. MN-delivered vaccines have demonstrated safety and immunogenicity in pre-clinical models and boast desirable attributes such as painless administration, thermostability, dose-sparing capacity and the potential for self-administration. These advantages should contribute to enhanced global vaccine access.

Prevalence of Limited Health Literacy Among Irish Adults

The authors conducted 2 health literacy investigations in Cork, Ireland. Study 1 was undertaken in 5 community pharmacies and the outpatient department of 2 urban hospitals and assessed patients’ health literacy skills using the Rapid Estimate of Adult Literacy in Medicine (REALM) and the Newest Vital Sign (NVS). Study 2 took place in 1 outpatient department and evaluated health literacy using the REALM and the short form of the Test of Functional Health Literacy.in Adults (S-TOFHLA). The authors collected data relating to age, gender, ethnicity, and educational level achieved. All subjects were asked items relating to their ability to use health-specific materials. A total of 1,759 people (61.2% female) completed either Study 1 (n = 1,339) or Study 2 (n = 420). Limited health literacy ranged from 18.4% (REALM) and 57.2% (NVS) in Study 1, and 21.9% (REALM) and 14.1% (S-TOFHLA) in Study 2 and was associated with increased age and lower educational attainment across all three tools (p < .001). Patients with limited health literacy were significantly more likely to report problems with using health materials received from a doctor or pharmacist. At minimum, 1 in 7 Irish adults were found to have limited health literacy, which may affect their ability to promote, protect, and manage health. As in the United States and in the United Kingdom, improving health literacy should be a public health objective for Ireland.

Determining the frequency and preventability of adverse drug reaction-related admissions to an Irish University Hospital: a cross-sectional study

Background Adverse drug reactions (ADR) cause considerable morbidity and mortality. Methods This 4-week study was undertaken in Cork University Hospital, Ireland, for all admissions from the emergency department (ED). A panel independently reviewed patients with suspected ADRs. Causality assessment was performed using the Naranjo ADR probability scale and the Hallas criteria was used to assess preventability of the ADRs. Results During the study period, 1258 patients were admitted from the ED; of these, 856 patients were included in the study; 75 patients (8.8%) had an ADR-related admission. Over half were deemed to be ‘possibly’ or ‘definitely’ avoidable. The level of agreement between reviewers using the Naranjo and Hallas criteria was very low. In the ADR group (n=75), 50.7% were men compared with 53.1% in the non-ADR group (n=781). The median age for patients in the ADR group was 73 years compared with 45 years in the non-ADR group. The average number of prescribed drugs per patient in the ADR group was 7.5 (SD±3.8) compared with 2.4 (SD±3.6) in the non-ADR group. Classified by drug type, 74.2% of the ADRs were attributed to cardiovascular and central nervous system drugs. Conclusions This study estimated the incidence of ADR-related admissions to an Irish hospital at 8.8%, with 57.3% of these deemed to have been potentially avoidable. Older patients were more likely to have an ADR-related admission. Prescribers must be aware of this increased likelihood of an ADR when prescribing new drugs to this patient population, and regularly review treatment.

Knowledge, attitudes and beliefs of patients and carers regarding medication adherence: a review of qualitative literature

PurposeThe aim of this review is to cohere evidence on the knowledge, attitudes and beliefs of patients and carers regarding medication adherence. Medication adherence refers to “the extent to which the patient’s action matches the agreed recommendations”. Medication adherence is vital in preventing, managing and curing illnesses and, hence, is linked with positive health outcomes.MethodsA search was conducted using the following databases: CINAHL, Embase, PubMed and Web of Knowledge from inception to November 2013. Titles and abstracts were screened for inclusion in the review according to pre-defined inclusion and exclusion criteria. Studies were assessed for quality, and data were extracted into a data extraction form. Results were analysed thematically.ResultsThe final results included 34 articles. Eight analytical themes were identified: (i) beliefs and experiences of medicines, (ii) family support and culture, (iii) role of and relationship with health-care practitioners, (iv) factors related to the disease, (v) self-regulation, (vi) communication, (vii) cost and (viii) access. The theme, “beliefs and experiences of medicines”, was present in 33 studies, with many discussing the influence that side effects have on medication adherence.ConclusionsThere are a number of variables that impact upon the knowledge, attitudes and beliefs of patients and carers regarding medication adherence. This review presents an overview of the analytical themes which offers the opportunity to examine interventions and their relative efficacies to increase medication adherence.

What’s in a label? An exploratory study of patient-centered drug instructions

ObjectiveTo assess the efficacy of patient-centered label (PCL) instructions on the knowledge and comprehension of prescription drug use compared to standard instructions.MethodsA total of 94 participants recruited from an outpatient clinic in Ireland were each randomly assigned to receive: (1) standard prescription instructions written as times per day (usual care), (2) PCL instructions that specify explicit timing with standard intervals (morning, noon, evening, bedtime) or with mealtime anchors (both PCL), or (3) PCL instructions with a graphic aid to visually depict dose and timing of the medication (PCL + Graphic). The outcome was correct interpretation of the instructions.ResultsPCL instructions were more likely to be correctly interpreted than the standard instructions [adjusted relative risk (RR) 1.08, 95% confidence interval (CI) 0.98–1.18]. The inclusion of the graphic aid (PCL + Graphic) decreased the rates of correct interpretation compared to PCL instructions alone (RR 0.98, 95% CI 0.91–1.05). There was a significant interaction between instruction type and health literacy (p = 0.01). Those with limited health literacy were more likely to correctly interpret the PCL labels (91%) than the standard labels (66%), and those with adequate health literacy performed equally well.ConclusionThe PCL approach may improve patients’ understanding and use of their medication regimen.

Microneedle technology for immunisation: Perception, acceptability and suitability for paediatric use

OBJECTIVE To examine published research which explores the perception and acceptability of microneedle technology for immunisation and to investigate the suitability of this technology for paediatric use. METHODS A series of keywords and their synonyms were combined in various combinations and permutations using Boolean operators to sequentially search four databases (PubMed, Web of Science, Embase and CINAHL). Following removal of duplications and irrelevant results, 12 research articles were included in the final literature review. RESULTS The opinions of patients, parents, children and healthcare professionals (HCP) were collated. A positive perception and a high level of acceptability predominated. CONCLUSION Microneedle technology research has been focussed on demonstrating efficacy with minimal focus on determining HCP/public perception and acceptability for paediatric use, exemplified by the paucity of studies presented in this review. Commercial viability will depend on HCP/public acceptability of microneedle technology. An effort must be made to identify the barriers to acceptance and to overcome them by increasing awareness and education in stakeholder groups pertaining to the paediatric population.

Knowledge, attitudes and beliefs of parents regarding fever in children: a Danish interview study

Fever and febrile illness are some of the most common conditions managed by parents. The aim of this study was to examine the knowledge, attitudes and beliefs of parents around fever in children under five years of age.

Health literacy and the Clozapine patient

Aims: To estimate the prevalence of limited health literacy in patients receiving clozapine for schizophrenia. To develop and produce a pharmacist-designed clozapine patient information leaflet (PIL) which has a higher readability score than the company–produced PIL. Study design: This was a cross sectional prevalence study. Methods: Ethical approval for the study was granted by the local ethics committee. Patients, over 18 years, attending the Clozapine Clinic of a Cork urban teaching hospital, were asked to participate in the study. Demographics such as gender, age, employment and smoking status, were gathered from all participants. The total daily clozapine dose, duration of clozapine treatment, and information regarding the clozapine DVD was also noted. The Rapid Estimate of Adult Literacy in Medicine (REALM) health literacy (HL) screening tool was then administered to each patient. A user-friendly PIL on clozapine was designed by the pharmacist, which was assessed for readability and compared to the company-produced PIL using the FRES and FKGL. Data were analysed using SPSS Version 15. Results: Forty patients (65% male, 95% unemployed and 70% smokers) of average age 38.0 years (±11.2) completed the REALM. The average score was 60.6 (±8.7). Twenty-nine patients (72.5%) were found to have “adequate” health literacy. The remaining eleven patients were found to have either “marginal” or “low” health literacy. The pharmacist-designed PIL would have been readable by 95% of the study population, in contrast to 72.5% with the company-designed PIL. Conclusions: More than a quarter of the population were found to have marginal or low health literacy. Patient information should be matched to the health literacy level of the target population.

Substance use in young persons in Ireland, a systematic review.

Adolescence is a time of physical and mental development when small changes can impact on the rest of a persons life. Substance use in this crucial period can have long-lasting consequences for the individual and for society. The prevalence of substance use in young people is an area of concern for policy makers and health workers. This systematic review looked at prevalence for four substances: alcohol, tobacco, cannabis, and benzodiazepines, across the Republic of Ireland for persons between the ages of 13 and 24, and compared usage between 2000 and 2012. Eighteen articles were included in the review. It was seen that tobacco, alcohol, and cannabis use has fallen in the lifetime and previous month use. The level of benzodiazepine use has remained similar in the period of study. Future work should redress the imbalance in substance use research that sees the majority of researchers looking at a few substances while little work is done on the others.