Natural health products (NHPs) are sold over-the-counter and are often perceived to be safe, despite potential risks. The current Canadian reporting system collects information on suspected adverse drug reactions (ADRs) and suffers from severe under-reporting. As retailers, pharmacists and health food store personnel may be in a position to facilitate collection of herbal ADR reports because of their accessibility to consumers. Objective: To investigate retailer and consumer responses to herbal ADRs. Methods: In-depth interviews were conducted with retailers and consumers across Toronto until theoretical saturation was achieved (n=36). Participants were purposefully selected to ensure diverse backgrounds and experiences. Interviews were transcribed and coded for key emerging themes. Results: Consumers tended to self-prescribe NHPs and were only likely to discuss their NHP use with people they trusted – usually health food store personnel, family and friends. Many consumers did not have good relationships with their conventional health providers, which inhibited discussions about NHP-related ADRs. When consumers did disclose suspected ADRs to retailers, the retailers generally did not report these NHP-related ADRs to Health Canada. Most pharmacists found workplace challenges insurmountable, although pharmacist approaches to herbal ADRs tended to vary depending on their professional disposition. Pharmacists who saw themselves as knowledge generators were more likely to report. Health food store personnel offered generous product return policies and actively returned NHPs suspected of causing an ADR to the manufacturer. However, they had no knowledge of the Canadian ADR reporting system and thus did not submit any reports. Conclusion: Consumers tended to disclose suspected NHP-related ADRs only rarely and to retailers with whom they had developed previous good relationships. This highlights the importance of improving patient-practitioner (or retailer) communication. Pharmacists generally did not report ADRs due to workplace challenges, unless they had a very strong professional disposition. These results have important implications with respect to pharmacy education. Health food store return policies resulted in suspected ADR reports to the manufacturers. Manufacturers are mandated to report ADRs to Health Canada, so this finding may have important implications within industry for the future of ADR reporting systems involving herbal products and public health.

Natural health products (NHPs) are sold over-the-counter and are often perceived to be safe, despite potential risks. The current Canadian reporting system collects information on suspected adverse drug reactions (ADRs) and suffers from severe under-reporting. As retailers, pharmacists and health food store personnel may be in a position to facilitate collection of herbal ADR reports because of their accessibility to consumers. Objective: To investigate retailer and consumer responses to herbal ADRs. Methods: In-depth interviews were conducted with retailers and consumers across Toronto until theoretical saturation was achieved (n=36). Participants were purposefully selected to ensure diverse backgrounds and experiences. Interviews were transcribed and coded for key emerging themes. Results: Consumers tended to self-prescribe NHPs and were only likely to discuss their NHP use with people they trusted – usually health food store personnel, family and friends. Many consumers did not have good relationships with their conventional health providers, which inhibited discussions about NHP-related ADRs. When consumers did disclose suspected ADRs to retailers, the retailers generally did not report these NHP-related ADRs to Health Canada. Most pharmacists found workplace challenges insurmountable, although pharmacist approaches to herbal ADRs tended to vary depending on their professional disposition. Pharmacists who saw themselves as knowledge generators were more likely to report. Health food store personnel offered generous product return policies and actively returned NHPs suspected of causing an ADR to the manufacturer. However, they had no knowledge of the Canadian ADR reporting system and thus did not submit any reports. Conclusion: Consumers tended to disclose suspected NHP-related ADRs only rarely and to retailers with whom they had developed previous good relationships. This highlights the importance of improving patient-practitioner (or retailer) communication. Pharmacists generally did not report ADRs due to workplace challenges, unless they had a very strong professional disposition. These results have important implications with respect to pharmacy education. Health food store return policies resulted in suspected ADR reports to the manufacturers. Manufacturers are mandated to report ADRs to Health Canada, so this finding may have important implications within industry for the future of ADR reporting systems involving herbal products and public health.

Nucleic acid analysis is one of the most important disease diagnostic approaches in medical practice, and has been commonly used in cancer biomarker detection, bacterial speciation and many other fields in laboratory. Currently, the application of powerful research methods for genetic analysis, including the polymerase chain reaction (PCR), DNA sequencing, and gene expression profiling using fluorescence microarrays, are not widely used in hospitals and extended-care units due to high-cost, long detection times, and extensive sample preparation. Bioassays, especially chip-based electrochemical sensors, may be suitable for the next generation of rapid, sensitive, and multiplexed detection tools. Herein, we report three different microelectrode platforms with capabilities enabled by nano- and microtechnology: nanoelectrode ensembles (NEEs), nanostructured microelectrodes (NMEs), and hierarchical nanostructured microelectrodes (HNMEs), all of which are able to directly detect unpurified RNA in clinical samples without enzymatic amplification. Biomarkers that are cancer and infectious disease relevant to clinical medicine were chosen to be the targets. Markers were successfully detected with clinically-relevant sensitivity. Using peptide nucleic acids (PNAs) as probes and an electrocatalytic reporter system, NEEs were able to detect prostate cancer-related gene fusions in tumor tissue samples with 100 ng of RNA. The development of NMEs improved the sensitivity of the assay further to 10 aM of DNA target, and multiplexed detection of RNA sequences of different prostate cancer-related gene fusion types was achieved on the chip-based NMEs platform. An HNMEs chip integrated with a bacterial lysis device was able to detect as few as 25 cfu bacteria in 30 minutes and monitor the detection in real time. Bacterial detection could also be performed in neat urine samples. The development of these versatile clinical diagnostic tools could be extended to the detection of various cancers, genetic, and infectious diseases.

Objective: To reach consensus on entry-to-practice natural health product (NHP)-related competency statements for Canadian pharmacy students. Methods: Four rounds of a modified Delphi method were conducted. Participants; pharmacy educators,and representatives from Canadian pharmacy organizations (n=17), ranked their level of agreement using a 5-point Likert scale. Results: Consensus occurred when all participants ranked a statement 4 or 5. Three core NHP-related competencies were identified: 1) the ability to incorporate NHP knowledge when providing pharmaceutical care; 2) the ability to access and critically appraise NHP-related information sources, and 3) the ability to provide appropriate education to patients and other health care providers on the effectiveness and potential adverse effects and drug interactions of NHPs. Two additional NHP-related competency statements emerged as important, but consensus was not achieved. Conclusions: If the developed core NHP-related competency statements are widely implemented, Canadian pharmacists will be able to fulfill their NHP-related professional responsibilities upon entry-to-practice.

Natural health products (NHPs) are increasingly sold in pharmacies. The purpose of this study was to determine Canadian pharmacists’ attitudes about their professional responsibilities regarding natural health products. A cross-sectional, random sample survey design was used: 3356 questionnaires were mailed to a random sample of licensed pharmacists in all provinces/territories in Canada (except Nunavut). Survey responses were evaluated using descriptive statistics and logistic regression analyses. Response rate was 61%. Overall, respondents were most likely to endorse pharmacist responsibilities related to vitamins and minerals, followed by herbal medicines, then homeopathic medicines. Responsibilities regarding knowledge of NHPs and counseling on NHPs were more frequently endorsed than responsibilities associated with NHP-related documentation. Self-reported knowledge was positively associated with endorsement of NHP-related responsibilities for all NHP types.

BACKGROUND: Alcohol and tobacco misuse and dependence are highly comorbid disorders. Varenicline alleviates symptoms of cigarette craving while preventing nicotine from binding to nicotinic acetylcholine receptors, thereby reducing nicotine’s reinforcing effects. Recent studies have shown that varenicline decreased alcohol self-administration in animal models and in one human study of heavy-drinking smokers. AIMS: To assess the effect of two-week varenicline (0.5-2mg) vs. placebo administration on cue-induced craving for tobacco and alcohol in smokers with heavy alcohol use (n = 24). METHODS: Subjects participated in two study visits where nicotine and alcohol craving and withdrawal were assessed with self-report questionnaires under four conditions (abstinence/one cigarette/neutral cues/tobacco-alcohol cues). RESULTS: Two-week administration of varenicline reduced tobacco-alcohol cue-induced cigarette cravings and reduced emotionality aspects of alcohol craving after smoking a cigarette compared to abstinence in heavy-drinking smokers. CONCLUSION: It is possible that varenicline may have particular advantages as a smoking cessation aid in heavy drinkers.

Background: Older Canadian women are not meeting recommended calcium intake levels and therefore require calcium supplementation to maintain bone mass. Objective: To examine factors associated with calcium supplementation among older community-dwelling women, using the Health Belief Model (HBM) as a conceptual framework. Methods: Data previously collected from Ontario community-dwelling women aged 65 to 90 years (n=798) were analyzed. Multivariable logistic regression was utilized to determine HBM factors associated with calcium supplement use. Results: About half (54%) of women reported taking calcium supplements. Positive correlates of calcium supplementation included: perceived osteoporosis susceptibility, perceived calcium benefits, natural health product use, residing in Toronto and general osteoporosis management factors (discussion with a physician or pharmacist, osteoporosis screening, falls history and preventive health check-ups); a negative correlate included: use of etidronate therapy. Conclusion: Only half of older women were taking calcium supplements. Discussions with healthcare practitioners may help to improve recommended calcium intake levels.

Natural health products (NHPs) are increasingly sold in pharmacies. The purpose of this study was to determine Canadian pharmacists’ attitudes about their professional responsibilities regarding natural health products. A cross-sectional, random sample survey design was used: 3356 questionnaires were mailed to a random sample of licensed pharmacists in all provinces/territories in Canada (except Nunavut). Survey responses were evaluated using descriptive statistics and logistic regression analyses. Response rate was 61%. Overall, respondents were most likely to endorse pharmacist responsibilities related to vitamins and minerals, followed by herbal medicines, then homeopathic medicines. Responsibilities regarding knowledge of NHPs and counseling on NHPs were more frequently endorsed than responsibilities associated with NHP-related documentation. Self-reported knowledge was positively associated with endorsement of NHP-related responsibilities for all NHP types.

BACKGROUND: Alcohol and tobacco misuse and dependence are highly comorbid disorders. Varenicline alleviates symptoms of cigarette craving while preventing nicotine from binding to nicotinic acetylcholine receptors, thereby reducing nicotine’s reinforcing effects. Recent studies have shown that varenicline decreased alcohol self-administration in animal models and in one human study of heavy-drinking smokers. AIMS: To assess the effect of two-week varenicline (0.5-2mg) vs. placebo administration on cue-induced craving for tobacco and alcohol in smokers with heavy alcohol use (n = 24). METHODS: Subjects participated in two study visits where nicotine and alcohol craving and withdrawal were assessed with self-report questionnaires under four conditions (abstinence/one cigarette/neutral cues/tobacco-alcohol cues). RESULTS: Two-week administration of varenicline reduced tobacco-alcohol cue-induced cigarette cravings and reduced emotionality aspects of alcohol craving after smoking a cigarette compared to abstinence in heavy-drinking smokers. CONCLUSION: It is possible that varenicline may have particular advantages as a smoking cessation aid in heavy drinkers.

Background: Older Canadian women are not meeting recommended calcium intake levels and therefore require calcium supplementation to maintain bone mass. Objective: To examine factors associated with calcium supplementation among older community-dwelling women, using the Health Belief Model (HBM) as a conceptual framework. Methods: Data previously collected from Ontario community-dwelling women aged 65 to 90 years (n=798) were analyzed. Multivariable logistic regression was utilized to determine HBM factors associated with calcium supplement use. Results: About half (54%) of women reported taking calcium supplements. Positive correlates of calcium supplementation included: perceived osteoporosis susceptibility, perceived calcium benefits, natural health product use, residing in Toronto and general osteoporosis management factors (discussion with a physician or pharmacist, osteoporosis screening, falls history and preventive health check-ups); a negative correlate included: use of etidronate therapy. Conclusion: Only half of older women were taking calcium supplements. Discussions with healthcare practitioners may help to improve recommended calcium intake levels.