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 may contribute to impaired glucose metabolism and an increased risk of type 2 diabetes.

Herpesviruses are one of the most common viruses in humans, with 8 types currently known. Any of these can cause lifelong latent infections after an initial, usually mild or asymptomatic primary infection.

Type 2 diabetes is also common, with an estimated 9.3% of the world’s population diagnosed with the condition as of 2019. There are many known behavioral, environmental, and genetic risk factors but until recently, viruses had only been proposed as a potential cause for the development of type 1 diabetes.

The new study was based on health data from 1967 subjects in a population-based health research platform in southern Germany. Participants underwent detailed health examinations at baseline and at follow-up, which included testing for the presence of human herpesviruses, oral glucose tolerance tests, and measurement of glycated hemoglobin.

Participants in the study group had a median age of 54 years at baseline, 49% were men, and 51% were women. Incidence analysis for the development of diabetes used the data for those 1257 participants with normal glucose tolerance at baseline.

According to the study, participants with no prior diagnosis of type 2 diabetes underwent a standard oral glucose tolerance test with diabetes status assigned using thresholds recommended by the American Diabetes Association. Further analyses of blood samples were performed to detect the presence of antibodies to 7 of the 8 known human herpesviruses, which would indicate the presence of both primary and latent infections.

Other variables known to be associated with diabetes risk were also assessed, including sex, age, body mass index (BMI), years of education, ever-smoking status, physical activity during leisure time, parental diabetes, and hypertension.

Researchers found that the prevalence of prediabetes was 27.5% at baseline and 36.2% at follow-up, whereas type 2 diabetes was present in 8.5% of participants at baseline and 14.6% at follow-up.

Out of the 1257 volunteers with normal glucose tolerance at baseline, 364 went on to develop prediabetes and 17 developed type 2 diabetes during the mean follow-up period of 6.5 years. Furthermore, the authors found that age, BMI, smoking, and years of education were all associated with an individual’s risk of developing both prediabetes and type 2 diabetes.

Blood testing performed at the beginning of the study found that Epstein-Barr virus was the most prevalent herpesvirus, with 98% of the sample group being seropositive, followed by herpes simplex virus 1 (HSV1; 88%), human herpesvirus 7 (HHV7; 85%), varicella zoster virus (VZV; 79%), cytomegalovirus (CMV; 46%), human herpesvirus 6 (HHV6; 39%), and herpes simplex virus 2 (HSV2; 11%). Participants were seropositive for an average of 4.4 herpesviruses at baseline and 4.7 at follow-up. Furthermore, 34% tested positive for more viruses at the end of the follow-up period, 54% had the same number, and only 12% were positive for fewer viruses at the start.

Although herpesviruses are persistent in their hosts, they may not always be detectable by blood antibodies. Infection usually occurs in early childhood but can take place later in life, so although the observed seroconversions may be new cases, they are more likely to be due to the immune response to a previously undetected virus. Similarly, individuals who lose seropositivity cannot be considered free of the virus and are much more likely to be in an undetectable latency state.

Of the 7 herpesviruses examined in the study, HSV2 and CMV were associated with incidence of prediabetes and diabetes among individuals with normal glucose tolerance at baseline that were independent of other risk factors. Individuals with HSV2 were 59% more likely to develop either prediabetes or diabetes than those who were seronegative, although CMV infection was associated with a 33% increased incidence.

The researchers found that both HSV2 and CMV consistently and complementarily contributed to the development of prediabetes and diabetes, even after accounting for sex, age, BMI, education, smoking, physical activity, parental diabetes, hypertension, lipid levels, insulin resistance, and fasting glucose. HSV2 was also found to be associated with HbA1C levels, independent of other confounders and the prevalence of prediabetes or diabetes.

“Our study suggested that while (pre)diabetes incidence was primarily explained by age, BMI, cholesterol, and fasting glucose, both HSV2 and CMV added additional complementary risk information, despite high viral prevalence and co-occurrence,” the authors wrote.

New study reveals that herpesvirus infection may increase the risk of developing diabetes. News release. EurekAlert; May 11, 2022. Accessed May 16, 2022. 

https://www.eurekalert.org/news-releases/952286

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Of the 7 herpesviruses examined in the study, herpes simplex virus and cytomegalovirus were associated with incidence of prediabetes and diabetes among individuals with normal glucose tolerance.

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Study: Herpesvirus Infection May Increase Risk of Diabetes

Hepatitis is a disease characterized by liver inflammation, with hepatitis A, B, and C being the 3 most common viral hepatitis types in the United States.

Each type of hepatitis elicits similar symptoms, despite differences in the route of transmission. Hepatitis A is spread via the fecal-oral route, whereas hepatitis
B and C are transmitted mainly through bodily fluids, such as blood. Prevention with universal vaccination remains essential, with pharmacists playing an integral part in this endeavor. Vaccinations exist for hepatitis A and B but not for hepatitis C. By contrast, there are effective pharmacologic treatments for hepatitis B and C, but only supportive care is available for hepatitis A infection. Prevention and appropriate treatment of viral hepatitis decreases associated morbidity, mortality, and transmission.

 It is vital for pharmacists to be familiar with the common types of viral hepatitis to encourage appropriate vaccination, recognize key considerations, and understand treatment options for viral hepatitis.

Hepatitis A and B immunizations can prevent the morbidity and mortality associated with viral hepatitis. Hepatitis B and C viruses (HBV, HCV) persist as the most significant global risk factors for hepatocellular carcinoma.

 Despite the efforts of the Advisory Committee on Immunization Practices (ACIP), the CDC, and the World Health Organization, vaccination rates are suboptimal, and adherence to completing the entire series is a concern. The COVID-19 pandemic reduced vaccination rates for both ACIP-recommended childhood vaccinations and adult vaccinations in at-risk populations.

 Routine hepatitis A vaccination in children aged 12 to 23 months caused a 95.5% reduction in reported acute hepatitis A infections between 1999 and 2011. A 2-dose series is recommended for hepatitis A in children, adults who have not been vaccinated, and those traveling to endemic areas. Outbreaks of hepatitis A have been attributed to low vaccination rates, which substantiates the need for health care professionals to promote appropriate vaccinations.

 The ACIP recommends HBV vaccinations be given at birth, during early childhood, to those who are at risk of infection, and to those who have been exposed and qualify for postexposure prophylaxis.

 Patients who are immunocompromised and have significant renal impairment may not have seroconversion with standard doses. Specific guidelines can be found in the ACIP HBV vaccination recommendation.

The CDC recommends one-time HCV testing of all adults as well as HBV screening in those who are at an increased risk of acquiring HBV. Those with risk factors, such as individuals who inject drugs and undergo hemodialysis, should be tested regularly. Coinfection prevalence with HIV and viral hepatitis varies substantially according to risk group.

 In 2009, approximately 21% of adults with HIV were also positive for HCV, emphasizing the need to rule out other coharbored infections.

 Up to 82% of individuals who inject drugs are coinfected with HCV and HIV.

 Early detection and screening ensures improved clinical outcomes and helps clinicians initiate adequate therapy. It also provides an opportunity to counsel patients about hepatitis and mitigation of risky behaviors and to emphasize the need for vaccinations.

Despite available treatment and vaccinations, there is no cure for chronic hepatitis B (CHB), as covalently closed circular DNA remains in the liver, posing a lifelong risk for reactivation. Treatment goals are to reduce morbidity and mortality through functional cure, defined as the loss of hepatitis B surface antigen (HBsAg) and sustained HBV DNA.

 Therapies for CHB include direct-acting antivirals and interferon alpha. Therapy limitations consist of drug resistance, which is related to adherence; HBsAg loss; and toxicities.

New drugs targeting different stages in the HBV life cycle are in development. Bulevirtide (Hepcludex), a novel entry inhibitor, was recently approved in Europe for treatment of chronic hepatitis D (CHD). Additionally, the results of one study showed that combination therapy with bulevirtide and tenofovir disoproxil (Viread) reduced HBsAg without serious adverse events.

 In a phase 2 trial, vebicorvir (ABI-H0731), an oral capsid assembly modulator, combined with entecavir (Baraclude) in treatment-naïve patients with CHB showed higher HBV DNA and RNA decline at 12 weeks compared with the placebo.

 Finally, the OSPREY trial (NCT05123599) is investigating the reduction of HBsAg with therapeutic vaccination once every 4 weeks combined with nucleoside analogues.

The therapeutic drug pipeline for CHB is expanding, which may lead to the identification of a cure. The HCV treatment landscape has dramatically changed, with therapies offering a complete cure. To review a comprehensive guideline on specialty populations, therapy selection, and drug interaction management, visit the American Association for the Study of Liver Diseases website.

Pharmacists play a key role in treating viral hepatitis by administering important vaccinations and educating patients about screening and vaccination. Expanding their knowledge on the resources for managing the disease enhances their understanding of emerging and existing antiviral therapies.

, is an assistant professor of pharmacy practice at South College in Knoxville, Tennessee.

, is a PGY-2 infectious diseases pharmacy resident at University of Florida Health in Gainesville, Florida.

1. Viral hepatitis surveillance – United States. CDC. Updated May 19, 2021. Accessed January 21, 2022. https://www.cdc.gov/hepatitis/statistics/SurveillanceRpts.htm

2. McGlynn KA, Petrick JL, El-Serag HB. Epidemiology of hepatocellular carcinoma. 

. 2021;73(suppl 1):4-13. doi:10.1002/hep.31288

3. DeSilva MB, Haapala J, Vazquez-Benitez G, et al. Association of the COVID-19 pandemic with routine childhood vaccination rates and proportion up to date with vaccinations across 8 US health systems in the vaccine safety datalink. 

. 2022;176(1):68-77. doi:10.1001/jamapediatrics.2021.4251

4. Advisory Committee on Immunization Practices (ACIP); Fiore AE, Wasley A, Bell BP. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). 

5. CDC. Viral hepatitis. Updated May 19, 2021. Accessed May 10, 2022. https://www.cdc.gov/ hepatitis/statistics/index.htm

6. Schillie S, Vellozzi C, Reingold A, et al. Prevention of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices. 

. 2018;67(1):1-31. doi:10.15585/mmwr.rr6701a1

7. Amjad W, Alukal J, Zhang T, Maheshwari A, Thuluvath PJ. Two-dose hepatitis B vaccine (Heplisav-B) results in better seroconversion than three-dose vaccine (Engerix-B) in chronic liver disease. 

. 2021;66(6):2101-2106. doi:10.1007/s10620-020-06437-6

8. Negro F. Hepatitis D virus coinfection and superinfection. 

d. 2014;4(11):a021550. doi:10.1101/cshperspect. a021550

9. People coinfected with HIV and viral hepatitis. CDC. Updated September 21, 2020. Accessed February 23, 2022. https://www.cdc.gov/hepatitis/populations/hiv.htm#ref0

10. Terrault NA, Bzowej NH, Chang KM, Hwang JP, Jonas MJ, Murad MH; American Association for the Study of Liver Diseases. AASLD guidelines for treatment of chronic hepatitis B. 

. 2016;63(1):261-283. doi:10.1002/hep.28156

11. Tang Y, Liang H, Zeng G, Shen S, Sun J. Advances in new antivirals for chronic hepatitis B. 

. 2022;135(5):571-583. doi:10.1097/CM9.0000000000001994

12. Wedemeyer H, Bogomolov P, Blank A, et al. Final results of a multicenter, open-label phase 2b clinical trial to assess safety and efficacy of Myrcludex B in combination with Tenofovir in patients with chronic HBV/HDV co-infection. 

. 2018;68(1):S3. doi:10.1016/ S0168-8278(18)30224-1

13. Ma X, Lalezari J, Nguyen T, et al. Interim safety and efficacy results of the ABI-H0731 phase 2a program exploring the combination of ABI-H0731 with Nuc therapy in treatment-naive and treatment-suppressed chronic hepatitis B patients. 

. 2019;70(1):e130. doi:10.1016/S0618-8278(19)30230-0

14. A study of JNJ-73763989, JNJ-64300535, and nucleos(t)ide analogs in virologically suppressed, hepatitis B e antigen (HBeAg)-negative participants with chronic hepatitis B virus infection (OSPREY). ClinicalTrials.gov. Updated March 16, 2022. Accessed April 8, 2022. https://clinicaltrials.gov/ct2/show/NCT05123599

15. Practice guidelines. American Association for the Study of Liver Diseases. Accessed April 8, 2022. https://www.aasld.org/publications/practice-guidelines

They play an indispensable role in the vaccination and management of complex regimens.

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Pharmacists Can Identify, Prevent, and Treat Viral Hepatitis

 spoke with Melissa Castora-Binkley, PQA Senior Director of Research, about what specific research PQA is conducting to promote health equity. 

 Yeah, so health equity is really important to us at PQA. It's one of our 4 pillars that we're working on. And we have a quarry engagement award where we have brought together over 50, pharmacy stakeholders and patients to better understand how to address social determinants of health in the community pharmacy setting. So there are many initiatives that are going on right now related to this. But as far as we know, in the literature, there isn't any that have really focused on patients and what the patients need to better understand how to have these conversations in the pharmacy setting, how to build trust, how to understand what to do with that information, how to follow up with them, how to make sure that any social risk or social need that was identified was resolved. So these are really complex issues. And we're really excited to bring together all these stakeholders and really figure out how to address this led by patients themselves.

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There are many initiatives that are going on at PQA right now that are related to health equity.

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PQA Research Strives to Promote Health Equity

The COVID-19 pandemic has put increasing pressure on health care professionals over the past 2 years. As the virus mutates and variants emerge, demands for COVID-19 medication therapy and vaccinations have grown, and this has led to acute shortages of pharmacists and pharmacy technicians.

Since the pandemic started, patients’ access to care has been limited for many reasons, including canceled appointments (especially elective procedures and preventive care visits), cutbacks in transportation options, and fear of going to health care settings.

 Health care providers, including technicians, quickly implemented telehealth solutions that have allowed patients to receive many health care services without leaving their homes. Fewer than 1% of Medicare fee-for-service visits were performed via telehealth before the COVID-19 public health emergency was declared in March 2020. One year later, more than 43% of these visits were performed using telehealth technologies.

There are numerous challenges to pharmacy employees using telehealth to serve patients in multiple states, such as obtaining licenses to practice in each of these states. Pharmacists and technicians must maintain their original licenses and generally are required to be licensed in the state or territory where their patients are located when an encounter occurs, regardless of where the pharmacist or technician may be physically.

Discrepancies among states regarding continuing education requirements, the examinations needed to become licensed, and licensure renewal periods further complicate the process. In 2020, the American Society of Health-System Pharmacists (ASHP) House of Delegates adopted a policy on interstate pharmacist licensure, which in part states that the “ASHP advocates for interstate pharmacist licensure to expand the mobility of pharmacists and their ability to practice, especially during emergencies, and to enhance their ability to practice in multiple states, which is particularly important to telehealth pharmacy practice.”

In 2021, the American Pharmacists Association (APhA) evaluated policies for the multistate practice of pharmacy. APhA’s House of Delegates then adopted policy statements that urge “state boards of pharmacy to reduce administratively and financially burdensome requirements for licensure while continuing to uphold patient safety.” The statements also note that the APhA “calls for development of professionwide consensus on licensing requirements for pharmacists and pharmacy personnel to support contemporary pharmacy practice.”

The Public Readiness and Emergency Preparedness Act allows the US Department of Health & Human Services (HHS) to issue a variety of declarations in the event of a public health emergency.

 APhA leaders have reached out to HHS officials to advocate for the ability to facilitate multistate licensure during an emergency where pharmacy employees in one part of the country are needed to support the provision of pharmacy services in other areas.

In 2019 Idaho became the first state to enact a mutual recognition pharmacist licensure pathway. Pharmacists who are licensed in a state that enters a mutual recognition agreement with Idaho’s Board of Pharmacy do not have to obtain a license or registration in Idaho to practice pharmacy or provide pharmacy services to state residents.

 A mutual recognition agreement can be entered into by other states as long as they have similar requirements for licensure, require fingerprint criminal history background checks, and grant the same multistate practice privileges to Idaho-licensed certified technicians, interns, and pharmacists.

 However, as of February 2022 several states had considered Idaho’s proposal but none had yet entered into a mutual recognition agreement, according to Jennifer Adams, PharmD, EdD, FAPhA, FNAP, associate dean for academic affairs at Idaho State University College of Pharmacy in Boise.

Other health care professions have taken steps to allow multistate licensure and practice. In these cases, states’ licensure compacts allow an expedited pathway to licensure for care providers practicing in multiple states. For example, a nursing licensure compact has been in effect for more than 15 years with 34 member states. For physicians, an interstate medical licensure compact has been agreed to among 29 states and became operational in 2017.
A licensure compact for physical therapists also started in 2017 with 21 state members.

 Those streamlined systems allow licensees to obtain licenses in other states efficiently and quickly. However, one issue with licensure compacts is that state licensure authorities may suffer a loss of revenue because they are issuing fewer licenses than they would if the compacts did not exist. This loss of revenue may reduce their ability to provide suitable oversight and services
to licensees.

The National Association of Boards of Pharmacy (NABP) has taken steps to allow its member boards to harmonize pharmacy practice regulations and respond to the need for pharmacy employees to become licensed in multiple states, particularly during times of emergency. In April 2020, NABP launched the Emergency Passport Program, which allows participating states to provide the authority for interns, pharmacists, and technicians to practice in other states on an emergency, temporary basis.

 The program lets interns, pharmacists, and technicians practicing in another state be efficiently granted emergency or temporary licensure, with no fees charged by the NABP to participants.

Twenty states, including Idaho, have participated in the Emergency Passport Program, and as of February 2022 NABP had processed more than 62,000 applications. More than 57,000 of these applications were approved by the participating states, according to Al Carter, PharmD, RPh, the NABP’s executive director.

Noting an increased need for pharmacies and pharmacy employees to provide services across states in nonemergency situations, the NABP launched the Verify Program in April 2022.

 This program, which is only accepted by North Carolina right now, provides a way to verify that pharmacist applicants are in good standing in all states of licensure, allowing for the issuance of a state- specific credential.

 This credential has practice authority by means of state regulatory or statutory reference and allows pharmacists to provide services such as remote medication order entry and verification across states.

The NABP will charge applicants $50 per year to participate in the program.

 The “NABP would like to establish a platform that enables consistent processes and procedures across all states,” Carter said.

Multistate licensure of pharmacy employees and the development of interstate pharmacy practice credentials can help redistribute the pharmacy workforce and prevent acute staffing shortages. National and state pharmacy associations can work with pharmacy employers and state regulatory agencies to break down many of the barriers that prevent pharmacy employees from providing services across multiple states.

Enhancing multistate pharmacy practice will provide numerous benefits, including ensured continuation of care, expanded access to care for patients in rural areas or living on state lines, a faster speed for transferring and reciprocating pharmacist licenses, increased access to medications, a lower cost burden for pharmacy professionals who are maintaining licenses in multiple states, and a reduced burden on pharmacies and pharmacist professionals.

, works in the Advance Pharmacy Practice Experience: Community rotation at Beth Israel Lahey Health in Boston, Massachusetts.

, is a professor in the Department of Pharmacy and Health Systems Sciences in the School of Pharmacy at Northeastern University in Boston, Massachusetts.

1. Reduced access to care. CDC. August 6, 2021. Accessed February 22, 2022. https://www.cdc.gov/nchs/covid19/rands/reduced-access-to-care.htm

2. Executive order on improving rural health and telehealth access. National Archives and Records Administration. August 3, 2020. Accessed February 24, 2022. https://trumpwhitehouse.archives.gov/presidential-actions/executive-order-improving-rural-health-telehealth-access/

3. Policy positions. American Society of Health-System Pharmacists. Accessed February 22, 2022. https://www.ashp.org/pharmacy-practice/policy-positions-and-guidelines/browse-by-document-type/policy-positions?loginreturnUrl=SSOCheckOnly

4. 2020-2021 House of Delegates report of the Policy Reference Committee. American Pharmacists Association. 2021. Accessed February 22, 2022. https://aphanet.pharmacist.com/sites/default/files/audience/2021%20Policy%20Reference%20Cmt%20Report%20-%20DRAFT_0.pdf

5. Public Readiness and Emergency Preparedness Act. US Department of Health & Human Services. Accessed February 24, 2022. https://aspr.hhs.gov/legal/PREPact/Pages/default.aspx

6.House bill No. 10. Legislature of the State of Idaho. 2019. Accessed February 23, 2022. https://legislature.idaho.gov/wp-content/uploads/sessioninfo/2019/legislation/H0010.pdf

7. NABP Emergency Passport Program. National Association of Boards of Pharmacy. 2020. Accessed February 23, 2022. https://nabp.pharmacy/nabp-emergency-passport-program/

8.NABP Verify. National Association of Boards of Pharmacy. Accessed May 4, 2022. https://nabp.pharmacy/programs/licensure/verify/#:~:text=NABP%20Verify%20is%20a%20credentialing,current%20proof%20of%20your%20status.

But meeting regulatory requirements may entail a great deal of financial expertise and time.

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Advancing Multistate Licensure Is Vital in Telehealth Era

Up to 30% of adults experience insomnia, and pharmacists need to know how to identify this condition that many patients think is normal and do not discuss.

Insomnia is not just difficulty falling asleep but also refers to difficulty staying asleep and early morning awakenings with trouble falling back asleep.

 Regardless of the type of insomnia, this condition can have significant consequences for patients. Chronic illness, difficulty concentrating, and irritability are just a few problems that may occur in those who suffer from insomnia.

Insomnia can be difficult to spot. In our fast-paced society, everyone seems to have difficulty sleeping from time to time. Insomnia is chronically underreported

 and patients may rarely seek help, because the condition is often viewed as benign and inconsequential.

When patients were asked about reasons for not seeking treatment, the 5 most common answers were as follows

I did not recognize the difficulty with sleep was an illness.

I have developed my own treatments or ways of coping.

I thought difficulty with sleep was an expected response to a life situation.

I thought it was something I should be strong enough to manage myself.

I thought the problem would get better by itself.

A 2019 study assessed the likelihood that community pharmacists would offer counseling when patients purchase OTC sleep aids. It found that pharmacists rarely questioned patients’ medical history or symptoms during the sale. Most often, pharmacists provided only the recommended dose and administration time—information that patients can read on the label. They never offered information to patients regarding proper lifestyle and sleep habits.

 The study shines light on an obvious lack of adequate counseling in the community setting. As the most accessible health care providers, community pharmacists can be a vital resource for patients with insomnia. Knowing the risk factors for insomnia (

) can prompt pharmacists to identify those who may be struggling.

One key area is for pharmacists to identify patients who may be experiencing insomnia as an adverse effect (AE) of a medication.

 Prescription medications are widely used across the United States, with nearly 60% of adults reporting daily use, and certain classes can cause insomnia as an AE (

Proper sleep habits can help ensure a better night’s sleep. Habits such as background noise, excessive blue light before bedtime, irregular bedtimes, and staying up late can negatively affect sleep quality.

 Pharmacists should screen patients struggling with insomnia to determine whether the cause of their sleep problems stems from poor sleep habits. Asking open-ended questions can help gather information regarding sleep habits.

How often do you use alcohol, nicotine, or other stimulants before going to bed?

How often do you use a cell phone or tablet or watch television before bedtime?

The CDC recommends multiple tips for improving sleep habits. These include making sure the bedroom is set up for optimal sleep with a comfortable temperature (cooler is better) and dim lights, and is free from excessive noise. Avoiding alcohol, large meals, and stimulants before bedtime and being consistent with a bedtime routine are also critical.

Pharmacists can identify insomnia and offer the necessary interventions to combat its repercussions. Provided there is a proper assessment and patient counseling, insomnia is treatable by both pharmacologic and nonpharmacologic means. Most often patients will not say they are suffering from insomnia, so it is crucial that pharmacists use contextual clues and maintain an empathetic, questioning attitude when assisting patients. Knowing what to look for and asking the proper questions can allow pharmacists to make a difference in patients’ sleep quality.

, is a multispecialty clinical pharmacist at Yale New Haven Health in Connecticut.

1. Suni E. Sleep statistics. Sleep Foundation. Updated March 11, 2022. Accessed April 10, 2022. https://www.sleepfoundation.org/how-sleep-works/ sleep-facts-statistics

2. Insomnia. Mayo Clinic. October 15, 2016. Accessed April 12, 2022. https:// www.mayoclinic.org/diseases-conditions/insomnia/symptoms-causes/syc-20355167

3. Morin CM, LeBlanc M, Daley M, Gregoire JP, Mérette C. Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. 

. 2006;7(2):123-130. doi:10.1016/j.sleep.2005.08.008

4. Wazaify M, Elayeh E, Tubeileh R, Hammad EA. Assessing insomnia management in community pharmacy setting in Jordan: a simulated patient approach. 

. 2019;14(12):e0226076. doi:10.1371/journal.pone.0226076

5. Basheti MM, Gordon C, Bawa Z, Grunstein R, Saini B. Sleep health management in community pharmacy: where are we and where should we be heading?

. 2021;17(11):1945-1956. doi:10.1016/j.sapharm.2021.02.011

6. Torrens Darder I, Argüelles-Vázquez R, Lorente-Montalvo P, Torrens-Darder MDM, Esteva M. Primary care is the frontline for help-seeking insomnia patients. 

. 2021;27(1):286-293. doi:10.1080/13814788.2021.1960308

7. Patel D, Steinberg J, Patel P. Insomnia in the elderly: a review. 

. 2018;14(6):1017-1024. doi:10.5664/jcsm.7172

8. Stinson K, Tang NK, Harvey AG. Barriers to treatment seeking in primary insomnia in the United Kingdom: a cross-sectional perspective. 

. 2006;29(12):1643-1646. doi:10.1093/sleep/29.12.1643

9. Do D. Trends in the use of medications with insomnia side effects and the implications for insomnia among US adults. 

. 2020;29(4):e13075. doi:10.1111/jsr.13075

10. Bonnet MH, Arand DL. Risk factors, comorbidities, and consequences
of insomnia in adults. UpToDate. Updated April 15, 2022. Accessed April
26, 2022. https://www.uptodate.com/contents/risk-factors-comorbidities-and-consequences-of-insomnia-in adults?search=drugs%20causing%20insomnia&source=search_result&selected Title=1~150&usage_ type=default&display_rank=1#H1582169839

11. Chung KF, Lee CT, Yeung WF, Chan MS, Chung EW, Lin WL. Sleep hygiene education as a treatment of insomnia: a systematic review and meta-analysis. 

. 2018;35(4):365-375. doi:10.1093/fampra/cmx122

12. Tips for better sleep. CDC. Updated July 15, 2016. Accessed April 11, 2022. https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.html

Pharmacists must communicate more than drugs and dosages and offer counseling on lifestyle and sleep habits.

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Insomnia Is Hiding in Plain Sight

Even though 2 out of 3 women diagnosed with depression or anxiety say they have reached or are approaching their breaking point in their mental health, a small percentage thought they should see a health care provider, according to new research.

In a nationwide survey from Myriad Genetics, Inc, 72% of women said they “just need to take a break,” with 31% saying “I need to try harder.” Only 13% said they thought “I should see a doctor” when feeling overwhelmed.

The breaking point can include a negative impact or significant strain on things such as social life, professional responsibilities, and caring for loved ones. Whereas two-thirds of women with a depression or anxiety diagnosis said they were reaching this point, 4 out of 10 women without a diagnosis said they have reached or are approaching this point.

“Women often feel pressure to ‘hold it all together’ and not admit when they are struggling,” said Betty Jo Fancher, PA, in a press release. “Yet, if you are sobbing on the floor of your shower, throwing things in anger, or repeatedly screaming into a pillow, these are signals that you have crossed a line and should see a health care provider about your mental health.”

Despite the widespread mental health concerns in the survey, delaying mental health treatment was common. More than half (51%) of women diagnosed with anxiety and/or depression said they waited at least 1 year before seeking treatment or never sought treatment at all.

The top reasons for this delay included the belief that this was “just a phase,” a reluctance to let anyone know they were struggling, a reluctance to take medication, and inability to afford treatment or find the time.

“The GeneSight Mental Health Monitor found that women are waiting more than a year—longer than they should—to get the mental health treatment they need,” said Rachael Earls, PhD, a medical science liaison with Myriad Genetics, in the press release. “It is critical to receive treatment for mental health because we know that mental health conditions are highly comorbid with other physical diseases, such as cancer, stroke, heart disease. Why live with a mental health condition that can impact every aspect of your life until you reach a breaking point?”

The reluctance to seek treatment could sometimes be rooted in how mental health concerns were received by family and friends, as well. Six in 10 women surveyed with depression or anxiety diagnoses said they have been ignored or dismissed by family and friends when they tried to discuss mental health concerns. Less than half of women say they talk to friends or family to relieve stress and anxiety.

Additionally, despite available treatment options, fewer than 2 in 10 women believe they will ever be free from anxiety or depression symptoms.

However, 6 in 10 women diagnosed with depression or anxiety agreed that taking a prescription medication was the most helpful step in treating their anxiety or depression symptoms. Taking medication was more helpful than any other action or treatment option offered in the survey, including therapy.

Only approximately 30% of women who have been prescribed psychiatric medication said they are aware of genetic testing that could help their physicians with prescribing decisions, and only 8% of these respondents have had genetic testing. However, 67% of diagnosed women whose physician did not use genetic testing said they wish their physician had told them about a genetic test that could provide information on how their genes may impact medication outcomes.

Two-thirds of women with anxiety and depression are reaching a breaking point with their mental health. News release. GeneSight; April 26, 2022. Accessed May 11, 2022. 

http://genesight.multimedia-newsroom.com/index.php/2022/04/26/survey-two-thirds-of-women-with-anxiety-and-depression-say-they-are-reaching-a-breaking-point-with-regard-to-their-mental-health/

More than half of women diagnosed with anxiety and/or depression said they waited at least 1 year before seeking treatment, or never sought treatment at all.

Mental Health

® Mental Health Resource Center is a comprehensive resource for clinical news and expert insights on conditions that affect mood, thinking, and behavior, including clinical depression, bipolar disorder, schizophrenia, anxiety, and post-traumatic stress disorder.

Despite Reaching ‘Breaking Point,’ Many Women Wait a Year Before Seeking Mental Health Treatment

Tuberculosis (TB) is the leading cause of death from a single pathogen in humans before the emergence of SARS-CoV-2, but there have been reports of infections and deaths in elephants worldwide.

Additionally, elephant-to-human transmission has also been reported. Most human cases of TB develop from long-term asymptomatic infection, known as latent TB, making methods for early detection necessary to help control the infectious disease spread.

However, it is difficult to apply the tests physicians use in humans, such as chest X-rays or sputum collection to elephants. Antibody tests use serum, which is easy to collect, but only a few types of antigens have been investigated so far.

At the Fukuyama Zoo in Hiroshima, Japan, an Asian elephant, named Fuku, developed TB in 2015 and was treated for 3 years, ending in 2018. This is the first TB treatment for elephants in Japan, and for this case, sera from 12 years prior to the development of the disease to 1 year after completion of treatment had been cryopreserved.

A team of investigators from Niigata University, the University of Miyazaki, and others, investigated IgG antibodies against 

proteins in Fuku’s serum using Enzyme-Linked Immuno Sorbent Assay (ELISA).

 proteins, ESAT6/CFP10 and MPB83, was tested by DPP, a rapid TB test kit for elephants that is already used worldwide.

As a result, antibodies again ESAT6/CFP10 were detected in all sera tested. This could suggest that the elephant had been infected with 

12 years prior to the development of disease and developed the disease after a prolonged asymptomatic infection, which is latent TB in humans.

The investigators tested for the presence of IgG antibodies to 11 

 proteins, including ESAT6/CFP10 and MPB83, by ELISA. In addition to ESAT6/CFP10 and MPB83, IgG antibodies to the protein Antigen 85B (Ag85B) were detected. By contrast, IgG antibodies against Ag85B and ESAT6/CFP10 were not detected in sera of 7 healthy elephants, which suggested that they are specifically evident in elephants with TB.

The monitoring of IgG levels against these proteins showed that IgG against ESAT6/CFP10 remained at high levels consistently, without effects by the development of TB or treatment.

However, IgG against Ag85B were not found 12 years prior to onset but increased 2 years prior to disease development and declined with treatment.

There is no sustainable tool to predict TB development form latency before disease development, according to investigators.

The study results imply that Ag85B IgG could be useful in the detection of TB progression from latent TB.

Investigators suggested a new test method for the infection with ESAT6/CFP10 and to monitor the disease development and treatment with Ag85B.

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