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Background and Objective: Most evidence about difficult‐to‐treat and severe asthma (DTTA) comes from clinical trials and registries. We aimed to identify people with DTTA from a large nationally representative asthma population and describe their characteristics and healthcare utilization compared with people whose asthma was not 'difficult‐to‐treat'. Methods: We conducted a cross‐sectional survey of Australians aged ≥18 years with current asthma from large web‐based survey panels. Enrolment was stratified by gender, age‐group and state/territory based on national population data for people with asthma. Difficult‐to‐treat or severe asthma was defined by poor symptom control, exacerbations and/or oral corticosteroid/biologic use despite medium/high‐dose inhaled therapy. Outcomes included exacerbations, healthcare utilization, multimorbidity, quality of life and coronavirus disease of 2019 (COVID‐19)‐related behaviour. Weighted data were analysed using SAS version 9.4. Results: The survey was conducted in February–March 2021. The weighted sample comprised 6048 adults with current asthma (average age 47.3 ± SD 18.1 years, 59.9% female), with 1313 (21.7%) satisfying ≥1 DTTA criteria. Of these, 50.4% had very poorly controlled symptoms (Asthma Control Test ≤15), 36.2% were current smokers, and 85.4% had ≥1 additional chronic condition, most commonly anxiety/depression. More than twice as many participants with DTTA versus non‐DTTA had ≥1 urgent general practitioner (GP) visit (61.4% vs. 27.5%, OR 4.8 [4.2–5.5, p < 0.0001]), or ≥1 emergency room visit (41.9% vs. 17.9%, OR 3.8 [3.3–4.4, p < 0.0001]) in the previous 12 months. Conclusion: Our findings emphasize the burden of uncontrolled symptoms, current smoking, multimorbidity and healthcare utilization in people with DTTA in the community, who may be under‐represented in registries or clinical trials. In this cross‐sectional study of a nationally‐representative population of 6048 adults with current asthma, 21.7% had difficult‐to‐treat asthma. Burden for patients and health system was seen in poor general health status, poor asthma symptom control, frequent urgent GP and emergency department (ED)/hospital visits and high prevalence of multimorbidity, particularly anxiety and/or depression. See relatededitorial [ABSTRACT FROM AUTHOR]

Background and Objective: Breathlessness is prevalent and associated with medical consequences. Obesity is related to breathlessness. However, the magnitude of its contribution has not been clearly documented. This investigation aimed to determine the contribution of obesity to breathlessness by estimating the population attributable fraction (PAF) in a representative sample of Australian adults. Methods: A cross‐sectional, nationally representative survey of Australian residents aged ≥18 years was conducted in October 2019. Breathlessness was defined as modified Medical Research Council (mMRC) dyspnoea scale grade ≥2. BMI was calculated from self‐reported height and weight. Adjusted relative risks (aRRs) were estimated using a generalized linear model with Poisson distribution, adjusted for age group and/or participant‐reported diagnosed illnesses. Adjusted PAFs were estimated using aRR and obesity prevalence in Australian adults. Results: Among those who completed the National Breathlessness Survey, 9769 participants (51.4% female) were included in the analysis; 28.1% of participants were obese. The prevalence of breathlessness was 9.54%. The aRR of obesity for breathlessness was 2.04, adjusted for age. Adjusting for various co‐morbid conditions, the aRR was slightly attenuated to around 1.85–1.98. The PAF, adjusted only for age, was 24.6% (95% CI 20.1–29.1) and after further adjustment for co‐morbid conditions, the PAF ranged from 21.1% to 23.6%. Obesity accounted for a higher proportion of breathlessness in women than in men. Conclusion: Our results demonstrate that obesity accounts for around a quarter of breathlessness symptoms in Australian adults. This has important implications for health policy in light of the global trend in increasing obesity. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: Chronic pain is a global public health problem that negatively impacts individuals' quality of life and imposes a substantial economic burden on societies. The use of medicinal cannabis (MC) is often considered by patients to help manage chronic pain as an alternative or supplement to more conventional treatments, given enabling legalization in a number of countries. However, healthcare professionals involved in providing guidance for patients related to MC are often doing so in the absence of strong evidence and clinical guidelines. Therefore, it is crucial to understand their perspectives regarding the clinical use and relevance of MC for chronic pain. As little is known about attitudes of HCPs with regard to MC use for chronic pain specifically, the aim of this review was to identify and synthesize the published evidence on this topic. Methods: A systematic search was conducted across six databases: MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and PubMed from 2001 to March 26, 2021. Three authors independently performed the study selection and data extraction. Thematic analysis was undertaken to identify key themes. Results: A total of 26 studies were included, involving the United States, Israel, Canada, Australia, Ireland, and Norway, and the perspectives of physicians, nurses, and pharmacists. Seven key themes were identified: MC as a treatment option for chronic pain, and perceived indicated uses; willingness to prescribe MC; legal issues; low perceived knowledge and the need for education; comparative safety of MC versus opioids; addiction and abuse; and perceived adverse effects; Conclusion: To support best practice in the use of MC for chronic pain, healthcare professionals require education and training, as well as clinical guidelines that provide evidence‐based information about efficacy, safety, and appropriate dosage of products for this indication. Until these gaps are addressed, healthcare professionals will be limited in their capacity to make treatment recommendations about MC for people/patients with chronic pain. [ABSTRACT FROM AUTHOR]

Objective: Immigrants, specifically African‐born black persons, are affected by the HIV epidemic in the U.S. The low level of condom use among immigrants is a risk factor for contracting HIV and STIs. Immigrants go through acculturation process in their new adopted countries—a process reported to influence many health risks and protective factors; however, the mechanism through which acculturation influences health behaviors is not well understood. Thus, study examined the mediating role of attitude in the relationship between acculturation and the intention to use male condoms in steady heterosexual relationships among Somali and Ethiopian immigrants in Minnesota. Design and Sample: The study was a regression analysis and the method of data collection cross‐sectional. Participants were (n = 205) Somali and Ethiopian immigrants in Minnesota who volunteered for the study. Measures: Study participants responded to questions on attitudes, behavioral intention, and acculturation levels. Results: The indirect effect of acculturation through the mediator, attitude, was not significant, product coefficient (a × b) = 0.04, 95% CI: [0.00, 0.11]; hence attitude did not mediate the relationship between acculturation and the intention to use condoms in the study population. However, there were significant direct and total effects of acculturation (c′ = .27, p < .05; c = .31, p < .05), respectively, on intention to use condoms. Conclusion: Results of the study may suggest that public health intervention strategies targeting condom use among immigrants should incorporate programs that improve English language training tailored to the cultural practices and values of the immigrants, and consider the effect of acculturation on condom use. [ABSTRACT FROM AUTHOR]

Background Correct inhaler technique is vital in the management of asthma and chronic obstructive pulmonary disease. However, inhaler misuse is ubiquitous and patients seldom receive effective education on how to use inhalers. Prisoners may have additional contributing factors for inhaler misuse, i.e. low health literacy and intellectual disability. Consequently, health professionals within correctional service facilities have a unique opportunity, and arguably an even more critical role, in the training of inmates in inhaler use. Aim To evaluate correctional services health professionals' baseline inhaler techniques; to assess the impact of training on inhaler techniques; and to evaluate the impact of the training on service delivery to inmates. Method Nurses working in a correctional services hospital complex were recruited. Their baseline inhaler technique (i.e. prior to training) was assessed using inhaler technique checklists. An education intervention was then delivered, following which participants' inhaler technique was reassessed. Results A total of 23 nurses participated in the study. At baseline, proportions demonstrating correct technique were 42, 0 and 5% for metered dose inhalers, Turbuhaler and Accuhaler, respectively. Following training, there was a statistically significant increase in the proportion of participants demonstrating correct inhaler techniques (84% (p = 0.008), 84% (p < 0.001) and 90% (p < 0.001)). Conclusions Nurses in correctional care are expected to check inmates' inhaler techniques as part of clinical care, but were unable to use inhalers correctly and needed training in this regard. Pharmacists are well placed to provide this training. [ABSTRACT FROM AUTHOR]

The survey was completed by 12 152 people of which 7285 (61%) reported a history of doctor-diagnosed asthma.5 People with asthma were particularly vulnerable to the impacts of smoke exposure, with 93.6% experiencing respiratory symptoms compared to 70.2% in those without asthma (Fig. Notably, people with asthma reported significantly higher rates of serious health outcomes including attending the ED (5.9%), hospitalization (2.4%) and requiring corticosteroid medication (16.3%) compared to those without asthma (1.4%, 0.6% and 2.4%, respectively). Keywords: asthma; bushfire; impact EN asthma bushfire impact 296 297 2 03/22/21 20210401 NES 210401 The impact of bushfire, particularly on those with chronic lung diseases, is now recognized.1,2 Individuals with asthma are among the most vulnerable groups.3 As bushfires are anticipated to be longer and more intense in many regions of the world, their adverse impact, particularly in asthmatic individuals, will impose a significant burden. [Extracted from the article]

Aim: To create a database of refrigerated medications along with comprehensive data on their stability when stored outside the recommended conditions; and to develop an educational tool for managing cold chain emergencies at the hospital. Method: Phase 1: a searchable database was created with fields on product stability, stored temperatures and storage conditions. Phase 2: the database was populated with the products' stability data from various sources, such as literature searches, approved product information and pharmaceutical companies. Phase 3: focus groups were held with the hospital's stakeholders (nurses, pharmacists, pharmacy technicians) to develop an educational tool for managing cold chain emergencies. Results: Of the 36 pharmaceutical companies contacted, 29 responded (response rate 81%) and provided 'extra' stability data for 28 products (n = 150; 19%). Pursuant to issues raised by the pharmaceutical companies about concerns of breaching the registration conditions of their products and misinterpretation of the provided in-house stability data, a stakeholder meeting was held with the Therapeutic Goods Administration. At the meeting, the need for short-term 'end of shelf life' real-time stability studies for refrigerated products was discussed. An educational tool was designed based on a survey of local practices at the hospital pertaining to monitoring refrigerators used to store medications. Conclusion: Creation of the database has resulted in a critical analysis of the existing stability data on refrigerated medications. Hospital staff lack guidance on the selection, monitoring and maintenance of refrigerators used to store medications, and to manage cold chain emergencies. There is an opportunity for professional pharmacy organisations to provide this guidance. [ABSTRACT FROM AUTHOR]

The article presents a cohort study regarding the assessment of the differences of Blacks and Whites in the quality of the treatment for colon cancer. It says that colorectal cancer is the third most common cancer with higher mortality rates in Blacks. An analysis of the cancer registry, billing and medical records of 175 Blacks and 190 Whites with stage II-IV colon cancer is made. The results show similarity in the sociodemographic characteristics of the two races.

The article reports on a study aimed at increasing awareness of cancer clinical trials (CCT) and SB37 through a mass multimedia campaign (MMC) in the University of California (UC) Davis (UCD) Cancer Center catchment area. Participants of the study were from UCD and University of California San Diego (UCSD). The study revealed that respondents from UCD had a greater awareness of CCT and SB27 compared with UCSD respondents. It concluded that awareness on CCT and SB37 increased significangly in the UCD cohort after the MMC.

This study focuses on the process of making sense of the experience of being exposed to. It looks at audience interpretations of the experience of having viewed a stranger's genitals in a public place and the effects on viewer self concepts. The study is based on in-depth interviews with 25 adult women. Finding indicate that women typically incorporate their definitions of the experience into their self images which, as a result, are impuned and discredited. Women often saw the self as having played a role in the production of the event. Although women generally were critical in their assessment of themselves and their management of the situation they used vocabularies of non-responsibility when recounting the experience thereby reducing the likelihood of criticism by others. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the editorial about the importance and effectiveness of medication management reviews like the home medicines review in Australia in the March 2014 issue.