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Understanding models of pharmacy education and practice in low-to-middle income countries (LMIC) can drive best practices and resource utilization. However, there is a paucity of literature in this setting. The purpose of this report is to describe the length and breadth of pharmacy education and training in Tanzania as well as pharmacy practice models at 3 institutions. Lessons learned and implications for global pharmacy practice described herein aim to advance the profession and pharmacists’ impact in LMIC settings. The Muhimbili campus is located in Dar es Salaam, the largest city in Tanzania, a LMIC in East Africa, and is comprised of 3 institutes and a health professions school. Despite variance in patient populations, all Muhimbili institutions have developed pharmacy services in outpatient and inpatient pharmacies, central pharmacy stores, intensive care units, and operating theaters. Unique pharmacy practice areas result from a variance in patient populations serviced and include services in pharmacovigilence/drug information, compounding, oncology, nephrology, and emergency departments. Medication availability and the complexity and time commitment of patient billing are consistent challenges, and multidisciplinary collaboration a common strength across the 3 institutions. Pharmacists at Muhimbili perform innovative and critical functions to support optimal patient care tailored to specific patient populations. The detailed review of these services can serve as a model for pharmacy practice at other health systems in LMIC and beyond.

An increased risk for coronary artery disease (CAD) is associated with a reduced plasma androgen concentration in men. The purpose of the present study was to determine if plasma testosterone (T), sex hormone-binding globulin (SHBG), and dehydroepiandrosterone sulfate (DHEAS) concentration were altered with an exercise training program which reduced CAD risk. Thirteen men (mean +/- SE, age 47.2 +/- 1.5 yrs) were examined before and after 14 weeks of endurance-oriented physical training (3-4 days/week, 30-45 min/day). There were no changes in basal plasma T, SHBG and DHEAS concentration despite a significant (p < 0.05) increase in insulin sensitivity, plasma HDL cholesterol, and a decrease in plasma triglyceride and adiposity. Exercise training thus appears to reduce CAD risk irrespective of androgen concentration in men.

The purpose of the present study was to determine the effects of exercise training on the chemical composition of plasma low-density lipoprotein (LDL). Thirteen men (mean age +/- SE, 47.2 +/- 1.5 years) were examined before and after 14 weeks of endurance-oriented exercise training (3 to 4 d/wk, 30 to 45 min/d). Although calculated plasma LDL concentrations remained unaltered (3.49 +/- 0.24 versus 3.65 +/- 0.23 mmol/L), changes in the chemical composition of LDL (increased LDL free cholesterol, cholesterol ester, and phospholipid content) were associated with a reduction in adiposity, umbilical girth, and basal plasma insulin and glucose concentration with training intervention. Increases in LDL molecular weight and particle diameter were associated with a reduction in fat mass, plasma triglyceride concentration, and basal plasma glucose concentration with physical activity. The LDL lipid-to-protein ratio also increased (P < .01) with training by 7%, primarily due to an increase in LDL free cholesterol content (P < .01). These findings indicate the formation of LDL particles that are more cholesterol enriched and protein poor with exercise training, which provides additional evidence for the cardioprotective effect of long-term physical activity.

This study examined if measures associated with distance running performance were affected by short-term (14 d) training cessation in 12 distance runners. VO2max decreased by approximately 3 ml.kg-1.min-1 (mean +/- SE, 61.6 +/- 2.0 vs 58.7 +/- 1.8 ml.kg-1.min-1, p < 0.05) with training cessation. Time to exhaustion (TTE) during the incremental VO2max test decreased by 1.2 min (13.0 +/- 0.5 vs 11.8 +/- 0.5 min, p < 0.001) and maximal heart rate increased (p < 0.001) by 9 beats per minute (BPM). No changes in running economy (75 and 90% VO2max) were evident, although submaximal heart rate increased by 11 BPM (p < 0.001) at both running speeds. Other evidence for detraining were decreases in estimated resting plasma volume (-5.1 +/- 1.9%) and muscle citrate synthase activity (-25.3 +/- 2.6%, p < 0.05). Muscular atrophy (muscle fiber cross-sectional area) was not evident. TTE and submaximal heart rate exhibited relatively large percent changes (-9 and +6%, respectively) compared to VO2max (-4%). These findings indicate that the reduction in VO2max with short-term training cessation is relatively small. TTE and submaximal heart rate may be easily measured, yet more sensitive indicators of decrements in distance running performance.

Competitive swimmers progressively reduce training volume or "taper" prior to an important competition in an effort to improve performance capabilities. The purpose of the current study was to determine the effects of taper upon factors associated with swim performance. Twelve intercollegiate swimmers were tested before and after taper in preparation for their season-ending meet. Power during a tethered sprint swim increased significantly (P < 0.05) by approximately 5% with taper. No significant changes occurred in distance per stroke, oxygen consumption, and post-exercise blood lactate level during a 182.9-m submaximal swim with taper. Five swimmers were additionally tested after shaving exposed body hair upon completion of taper. Swim power did not increase further with hair removal. In contrast, shaving significantly increased distance per stroke (P < 0.05) by approximately 5%. These data indicate that reduced training specifically improves swim power; however, removing exposed body hair after taper may additionally enhance performance capabilities by increasing distance per stroke.