The influence of excipients on physical and pharmaceutical properties of oral lyophilisates containing a pregabalin-acetaminophen combination

Objectives: The purpose of the study was to investigate and characterize the oral lyophilisates containing the pregabalin-acetaminophen drug combination and as xcipients mannitol with microcrystalline cellulose or hydroxypropyl methylcellulose, in order to conclude upon drug-excipient interactions and their stability implications, impact of excipients on drug release and on the physicochemical and mechanical properties of the pharmaceutical formulations.

Methods: The oral tablets were made by using a Christ freeze-dryer alpha 2–4-LSC lyophilizer, and evaluated for stability, drug-excipient compatibility and homogeneity of the prepared pharmaceutical formulations. The formulations were evaluated for in vivo absorption in rabbits by histopathological exams.

Results: FTIR and thermogravimetric analyses, DLS technique, SEM and NIR-CI studies confirmed the compatibility between compounds. From the determined physical and biochemical parameters of the formulations it was established that they are stable, homogeneous, and meet the conditions for orally disintegrating tablets.

Conclusion: In the case of the investigated pharmaceutical formulations the study evidenced the assembling through physical bonds between the excipients and the ‘codrug’ complex, which do not affect the release of the bioactive compounds.     

Someone to talk to: the association of mentorship and cyberbullying with suicidality among US high school students

Objective

Suicide is the second-leading cause of death in youth. We tested whether having a mentoring relationship associated with lower risks for suicidality, particularly among youth at higher risk due to cyberbullying.

Methods

This study pooled the 2017 Youth Risk Behavior Survey (YRBS) data from five jurisdictions that asked students if there was at least one teacher or other adult in their school that they could talk with, if they have a problem (mentorship). Students self-reported cyberbullying exposure and suicidality in the past 12 months. Odds of suicidal ideation, planning, and attempts were estimated using multivariable weighted logistic regression in overall and sex-stratified stepwise models. Interactions between mentorship and cyberbullying were also tested.

Results

Of the 25,527 student respondents, 87% reported having a mentoring relationship. Mentoring relationships were associated with lower odds of suicidal ideation (aOR, 0.44; 95% CI 0.33–0.57), planning (aOR, 0.59; 95% CI 0.41–0.85), and suicide attempts (aOR, 0.42; 95% CI 0.31–0.56). Stratified analyses showed a significant interaction between cyberbullying and mentorship with suicidal attempts among males, and a near-significant association between cyberbullying and mentorship with suicidal thoughts among females. Compared to male students with no cyberbullying and no mentorship, odds of attempting suicide were lower for males with no cyberbullying and mentorship (aOR, 0.55, 95% CI 0.32–0.92), higher for males with cyberbullying and no mentorship (aOR, 7.78, 95% CI 3.47–17.47), but not significantly different for males with cyberbullying and mentoring relationships (aOR, 1.49, 95% CI 0.86–2.48). Similarly, compared with females with no cyberbullying and no mentorship, odds of having suicidal thoughts were lower for females with no cyberbullying and mentorship (aOR, 0.40, 95% CI 0.28–0.57), and higher for females with cyberbullying and no mentorship (aOR, 2.54, 95% CI 1.59–4.07).

Conclusion

School-based mentoring may mitigate risk of suicidality among adolescents and limit the toxic effects of cyberbullying.

     

Fungal burden exposure assessment in podiatry clinics from Ireland

Fungi are amongst the bioaerosols of most importance, as indicated by the growing interest in this field of research. The aim was to characterize the exposure to fungal burden in podiatry clinics using culture-based and molecular methods. Methods: Airborne fungi were collected using an impaction air sampler and surface samples were also performed. Fourteen air samples were collected for direct detection of fungal DNA from filamentous fungi and dermatophytes. Overall, 63.6 % of the evening samples and 46 % of the morning samples surpassed the threshold values (150 CFU/m³). Molecular detection, by real time PCR, of the target fungal species/strains (Aspergillus and Stachybotrys species) was negative for all samples collected. Trichophyton rubrum was detected by PCR analysis in one DNA sample collected on day six. Results suggest the use of both culture-based and molecular methodologies are desirable for a complete evaluation of fungal burden in this particular health care setting.     

Distributed health literacy among people living with type 2 diabetes in Portugal: Defining levels of awareness and support

This study embraces a patient‐centred and narrative‐oriented notion of health literacy, exploring how social networks and personal experiences constitute distributed health literacy (DHL) by mapping out health literacy mediators of each individual and how they enable self‐management skills and knowledge of health conditions. Semi‐structured interviews with 26 patients with type 2 diabetes were conducted in a Primary Care Center of Porto (Portugal) from October 2014 to December 2015. Data were collected based on McGill Illness Narrative Interview (MINI). Following the grounded theory, interviews were analysed as case‐based and process‐tracing‐oriented. Three awareness narratives emerged: (i) a narrative of minimisation revealing minimal impact of diabetes in patients’ lives and daily routines, resignation towards “inevitable” consequences of the diagnosis and dependence of a large network of health literacy mediators; (ii) a narrative of empathy, where patients tended to mention readjustments in their lives by following medical recommendations regarding medication without criticism and with few health literacy mediators; (iii) a narrative of disruption, with patients highlighting the huge impact of diabetes on their lives and their individual responsibility and autonomy with respect to the management of diabetes and the search for alternatives to medication, relying on a very restrictive network of mediators. Exploring meanings given to diagnosis, identifying health mediators and analysing the structure of social networks can contribute to understand the distributed nature of health literacy. Assessing DHL can assist health professionals and those providing care in the community in promoting health literacy and providing models for a more patient‐centred health system.     

Are children rational decision makers when they are asked to value their own health? A contingent valuation study conducted with children and their parents

Despite the importance of including children's preferences in the valuation of their own health benefits, no study has investigated the ability of children to understand willingness‐to‐pay (WTP) questions. Using a contingent valuation method, we elicit children's and parents' WTP to reduce children's risk of an asthma attack. Our results suggest that children are able to understand and value their own health risk reductions, and their ability to do so improves with age. Child age was found to be inversely related to parents' and children's WTP. The results also suggest that non‐paternalistic altruism is predictive of children's WTP. For parents, care for their own health was found to be inversely related with their WTP for children's risk reductions. Comparison of parents' and children's WTP suggests that parents are willing to sacrifice for their child's health risk reduction an amount that is approximately twice that of their children. The analysis of matched pairs of parents and children suggest that there are within‐household similarities as the child's WTP is positively related to parents' WTP.