Cognitive impairment (CI) is known to be mediated by several risk and protective factors, many of which are potentially modifiable. Therefore, it is important to have up-to-date studies that address ...a standard assessment of psychosocial, clinical and lifestyle variables.
We conducted a cross-sectional observational study, with a 24-month timeframe, to estimate the relationship between risk and protective factors associated with dementia, according to the A-to-Z Dementia Knowledge. Participants were considered at CI risk if they tested positive for at least one of three validated CI screening tests: The Memory Impairment Screening, Short Portable Mental State Questionnaire, and Semantic Verbal Fluency. The A-to-Z data Collection included Mediterranean Diet Adherence Screener and Geriatric Depression Scale.
The estimated prevalence of CI was 22.6% in a sample of 709 patients with an average of 69.3±10.3 years. The risk factors gradually associated with cognitive decline were hypertension, loneliness, and depression. In contrast, the protective factors gradually associated with less cognitive decline were internet use, reading, and intellectually stimulating jobs. Finally, living alone, having diabetes, taking benzodiazepines, and sleeping more than 9 h were statistically significant associated with CI, whereas to do memory training or a family history of dementia was characteristic of patients without CI.
A joint assessment of the influence of psychosocial, clinical, and lifestyle-related factors is needed to develop dementia prevention strategies.
Dementia is a neurodegenerative disease with no cure that can begin up to 20 years before its diagnosis. A key priority in patients with dementia is the identification of early modifiable factors ...that can slow the progression of the disease. Community pharmacies are suitable points for cognitive-impairment screening because of their proximity to patients. Therefore, the continuous training of professionals working in pharmacies directly impacts the public health of the population. The main purpose of this study was to assess community pharmacists' knowledge of dementia-related factors. Thus, we conducted a cross-sectional study of 361 pharmacists via an online questionnaire that quizzed their knowledge of a list of dementia-related factors, which we later arranged into the A-to-Z Dementia Knowledge List. We found that younger participants had a better knowledge of risk factors associated with dementia. The risk factors most often identified were a family history of dementia followed by social isolation. More than 40% of the respondents did not identify herpes labialis, sleep more than 9 h per day, and poor hearing as risk factors. A higher percentage of respondents were better able to identify protective factors than risk factors. The least known protective factors were internet use, avoidance of pollution, and the use of anti-inflammatory drugs. Pharmacists' knowledge of dementia-related factors should be renewed with the aim of enhancing their unique placement to easily implement cognitive-impairment screening.
Background:
The usefulness of the community pharmacy blood pressure (BP) (CPBP) method in assessing the effectiveness of antihypertensive treatment has not been adequately studied. The aim of this ...study was to assess the agreement between community pharmacy, home, and physician office BP (POBP) measurement methods in treated hypertensive patients.
Methods:
BP was measured at the pharmacy (three visits), at home (4 days) and at the physician office (three visits). The Lin correlation-concordance coefficient (CCC) was used to evaluate the quantitative agreement. The qualitative agreement between methods to establish the patient's hypertensive state was evaluated using the κ-coefficient. Using home BP (HBP) monitoring as the reference method, the sensitivity, specificity, positive and negative likelihood ratios of the CPBP and POBP measurement methods were calculated.
Results:
The study included 70 patients. Agreements were acceptable-moderate between CPBP and HBP (CCC (systolic BP (SBP)/diastolic BP (DBP)) = 0.79/0.66; κ = 0.56), moderate between CPBP and POBP (CCC = 0.57/0.61; κ = 0.35), and moderate-poor (CCC = 0.56/0.49; κ = 0.28) between POBP and HBP. The sensitivity, specificity, positive and negative likelihood ratio for the CPBP and the POBP measurement methods were: 60.7%, 92.9%, 8.5, 0.4 and 75.0%, 54.8%, 1.7, 0.5, respectively.
Conclusions:
In this sample of treated hypertensive patients, the agreement between the community pharmacy and HBP measurement methods was acceptable-moderate and greater than other agreements. The CPBP measurement method was more reliable than the POBP measurement method for detecting the presence of both uncontrolled and controlled BP and could be a good alternative to HBP monitoring when the latter lacks suitability.
The aim of this study was to measure the community pharmacy white-coat effect (CPWCE) in treated hypertensive patients and to compare its magnitude with the WCE in the physician's office (POWCE). ...This cross-sectional study attempted to cover the treated hypertensive population, of more than 18 years of age and users of a rural CP located in Palmera (Valencia, Spain). Blood pressure (BP) was measured at three different settings, according to clinical guidelines: CP (three visits), PO (three visits), and home (4 consecutive days). The WCE was defined as the difference between the average CPBP or the average PO BP and the average home BP: CPWCE and POWCE, respectively. Differences between BP measurements were assessed by paired t-tests. The study sample consisted of 70 patients. The CPWCE was not significant, both for systolic BP (SBP) and for diastolic BP (DBP): 1.4 mmHg standard deviation (SD): 11.3; 95% confidence interval (CI): -1.3 to 4.1 and -1.1 mmHg (SD: 7.5; 95% CI: -2.9 to 0.7), respectively. The POWCE was positive and statistically greater than 0 for SBP 13.3 mmHg (SD: 11.5); 95% CI: 10.5-16.0 and for DBP 2.4 mmHg (SD: 9.3); 95% CI: 0.2-4.6. Finally, the POWCE was greater than the CPWCE both for SBP and for DBP (P<0.001). In this sample of treated hypertensive patients, the CPWCE was not statistically significant and was statistically lower than the POWCE.
When home blood pressure (HBP) measurements are taken, the readings can be registered manually by the patient and/or stored in the device's memory. The instructions provided by healthcare ...professionals would be particularly relevant to guarantee the reliability of manual blood pressure (BP) figures and enhance clinical decision making. The aim of this study is assess the agreement between HBP measurements manually registered by patients and those stored in the device's memory after an educational session provided by community pharmacists. Secondary data of the MEPAFAR and the Palmera studies have been used in this analysis. All the (treated hypertensive) patients attended an individual educational session in which they were instructed on how to use the measurement device and properly measure and manually register HBP. The same device and HBP monitoring protocol were used in both studies: 4 consecutive days (three morning measurements and three in the evening). HBP measurements were both manually registered by patients and stored in the device's memory. To evaluate the agreement between BP figures, Lin's correlation-concordance coefficient and κ coefficient were used for quantitative and qualitative agreement, respectively. One hundred and sixty-sixty patients were included in this analysis. The agreement between the average manual and the stored HBP was very good systolic=0.99, 95% confidence interval (CI): 0.99-0.99; diastolic=0.99, 95% CI: 0.99-1.00. 99.4% of patients were classified in the same category by both alternatives κ index=0.99 (95% CI: 0.98-1.00). In this sample of treated hypertensive patients, the agreement between manually registered and stored BP figures was very good. This high concordance may be explained by the pharmacist's intervention.
Background
Cognitive impairment (CI) is often diagnosed at moderate stages, with an estimated time for diagnosis of two years. However, the early diagnosis of CI allows the control of modifiable risk ...factors to prevent the development of dementia at later ages. In addition, the community pharmacy is a close, accessible, and trustworthy health establishment where the pharmacist often participates in disease prevention, becoming a suitable healthcare center for facilitating the detection of cases of CI
Method
A cross‐sectional observational study was designed using a structured personal interview. Participants were aged 50 or older with subjective memory complaints. Pharmacies in the province of Valencia (Spain) were invited to participate voluntarily by the organization entities. Before the start‐up of the service, the participating pharmacists received specific training. In the personal interview with the patient, after signing the corresponding informed consent, three validated questionnaires were conducted to assess their cognitive status: Memory Impairment Screening (MIS), Semantic Verbal Fluency (FVS), and Pfeiffer’s Short Portable Mental State Questionnaire (SPMSQ). Whenever possible, a fourth questionnaire was carried out: Brief Informant Test (Brief TIN). Data collection was carried out through a computer platform. This project was approved by the Ethics Committee of the University CEU‐Cardenal Herrera (registration number CEEI21/198).
Result
Between February 2021 and July 2023, 44 pharmacies participated, and 534 patients were screened. Of them, 194 (36%) had at least one positive test result, therefore having possible CI. After their corresponding referral to the doctor, 52 (29%) patients were referred to the hospital neurology department, of which 42 (81%) had been diagnosed with cognitive decline. Finally, the average time from the first evaluation by a pharmacist to a diagnosis by the specialist was six months.
Conclusion
Preliminary results of the screening for cognitive impairment show that the community pharmacy is a critical point in the approach to early detection of dementia and that collaboration and coordination between different levels of care is enhanced through such programs.
Objective
: To determine whether age, gender, body mass index (BMI), community pharmacy blood pressure (CPBP), daytime ambulatory BP (ABP) variability, treatment compliance, number of ...anti-hypertensive drugs and smoking status are factors associated with the community pharmacy white-coat effect (CPWCE) in treated hypertensive patients.
Setting
: Eight community pharmacies in Gran Canaria, Spain.
Method
: A cross-sectional study was carried out from June 2008 to June 2009. The study included treated hypertensive patients older than 18 years. Patients were excluded if: systolic BP (SBP)/diastolic BP (DBP) ≥200/110 mmHg, not-recommended or unable to perform home BP measurements, changes in anti-hypertensive treatment <4 weeks, history of cardiovascular disease <6 months or pregnancy. Blood pressure (BP) was measured by a community pharmacist at 4 visits to the community pharmacy and using ABP monitoring (24 h).
Main outcome measure
: The CPWCE was calculated as the difference between the mean BP in the community pharmacy and daytime ABP. Independent predictors of the CPWCE were identified using multivariate linear regression analysis.
Results
: Two hundred thirteen patients agreed to participate in the study. After exclusion and withdrawal, 169 patients were included in the analysis. Multiple linear regression analysis for systolic CPWCE revealed only community pharmacy SBP as an independent factor (β = 0.35;
P
< 0.001). The regression analysis for diastolic CPWCE revealed female gender (β = 4.88;
P
< 0.001), BMI (β = 0.48;
P
< 0.001) and community pharmacy DBP (β = 0.24;
P
< 0.001) as independent determinants.
Conclusion
: In this sample of treated hypertensive patients, factors such as gender, community pharmacy DBP and BMI were positively associated and may exert an important influence on the magnitude of the diastolic CPWCE. On the other hand, the CPWCE on SBP increased as the community pharmacy SBP increased.
Objetivo: detectar personas en riesgo alto o muy alto de padecer diabetes mellitus tipo 2 (DM2) o alteraciones del metabolismo de los hidratos de carbono, derivación para posible diagnóstico al ...médico y realizar una intervención educativa. Métodos: estudio observacional transversal y longitudinal prospectivo con intervención educativa en farmacias comunitarias situadas en la provincia de Valencia entre junio y noviembre de 2018. Se incluyeron usuarios de las farmacias comunitarias, mayores de 18 años, no diagnosticados de DM2 que aceptaron realizar la encuesta. Muestreo no probabilístico. Variable principal: puntuación en el test Findrisc, determinación capilar (si F≥15), intervención y número de diagnósticos de DM2 y preDM2. Las diferencias entre grupos se calcularon con el test de chi-cuadrado, t de Student o de Wilcoxon. Resultados: el estudio se realizó en 25 farmacias. La muestra incluyó a 752 usuarios. De ellos, 148 (19,7 %) tenían alto o muy alto riesgo de DM2 (F≥15). Se realizaron 118 determinaciones capilares válidas (22 no aceptaron y 8 no la repitieron), 78 (10,4 %) tuvieron resultados superiores a los normales y a 48 (6,4 %) se les derivó al médico. 32 de estos no fueron al médico o no informaron al farmacéutico del resultado. De los 16 que conocemos el resultado, 12 (1,6 %) fueron diagnosticados de diabetes o prediabetes. Conclusiones: los resultados de este estudio piloto dejan entrever la utilidad de la farmacia comunitaria como agente con un papel importante en el cribado de DM2 al detectar el presente trabajo casi un 20 % de usuarios con un riesgo elevado de padecer la enfermedad.
PDF
