Pharmacists have the same duty as prescribers to prevent inappropriate use of dangerous drugs. Loperamide, for example, is an over-the-counter medication that has been reported to be potentially misused for euphoric effects. Pharmacists and prescribers alike face challenges in providing optimal care for patients and protecting communities from drug misuse. These challenges include cognitive bias, underdeveloped safety culture, and differing expectations of responsibilities of the other party in ensuring safe prescribing. This commentary explores legal, ethical, and practical considerations for pharmacists and prescribers working together to address uncertainty in drug prescribing.Pediatricians have obligations to respond with care to all children's clinical and social vulnerabilities. Finding and addressing causes of children's stress (ie, family separation, child abuse, and trauma) are also obligations. Preventive and rescue interventions should be implemented to address potential short- and long-term harms of toxic stress and their short- and long-term consequences.The "model minority" myth (MMM) has far-reaching implications for Asian Americans in many settings, including medicine. For clinicians working with first-generation Asian American college students, this article considers 3 factors that affect how the MMM plays out in clinical care clinicians' racial identity awareness, cross-racial dynamics, and the extent to which a patient has internalized racism or oppression.Addressing intergenerational trauma remains a public health priority in Native American (NA) communities.  https://www.selleckchem.com/products/ccs-1477-cbp-in-1-.html  Clinicians working with NA patients must express humility, understand local culture, collaborate, and develop an insider's perspective on NA past and present life in order to earn trust. This case considers an NA adolescent suffering from mental distress, possible substance use, and multiple traumas. The commentary argues that trauma-informed therapies are lacking in some current psychiatric and primary care practices in the Indian Health Service and that an interprofessional, trauma-informed approach that considers the interplay between relevant somatic and psychological factors can better motivate patient-centered care. Cultivating safe environments in which interventions are pursued within the patient-clinician therapeutic alliance is key to generating optimal outcomes and healing among NA patients.Establishing trust is essential to a healthy patient-surgeon relationship. Respecting patient autonomy while seeking to understand patients' unique perspectives can strengthen trust. This article discusses cultural mistrust, a response shaped by historical iatrogenic harm (ie, unintentional harm caused by health care professionals or the health care system) and transgenerational trauma (ie, the transfer of attitudes and behaviors from survivors of trauma to their children and subsequent generations) and the importance of recognizing how patients' life experiences impact their health decision making.On 1 May 2018, a pertussis outbreak was declared and widespread vaccination recommended at an all-female secondary boarding school in southern England. We conducted a retrospective cohort study to determine the extent of pertussis transmission and identify risk factors in this semi-closed population. Of 504 students and staff assessed before post-exposure vaccination, 48% (n = 240) had evidence of pertussis. A sub-analysis of 409 students found that both residential dormitory (p = 0.05) and school year (p = 0.03) were associated with pertussis, with odds decreasing by 11% for each increase in school year (95% confidence interval 0.7-20.2). Odds of pertussis were 1.7 times higher in those assumed to have received acellular vaccines for their primary course compared with those assumed to have received whole-cell vaccines (based on date of birth), although this difference was not significant (p = 0.12). Our findings support the need for timely, widespread vaccination following identification of cases among adolescents in a semi-closed United Kingdom (UK) setting and to review the evidence for the introduction of an adolescent pertussis booster to the UK routine vaccination programme.BackgroundAnalyses of temporal trends in immunisation coverage may help to identify problems in immunisation activities at specific points in time. These data are essential for further planning, meeting recommended indicators, monitoring, management and advocacy.AimThis study examined the trends of mandatory vaccination coverage in the period 2000-2017 in Serbia.MethodsData on completed immunisations were retrieved from annual national reports of the Institute of Public Health of Serbia during the period 2000-2017. To assess the trends of immunisation coverage, both linear and joinpoint regression analyses were performed. A probability p  less then  0.05 was considered significant.ResultsOver the period 2000-2017 linear regression analysis showed a significant decline in coverage with the primary vaccination against poliomyelitis, diphtheria, tetanus, pertussis and measles, mumps, rubella (MMR) (p ≤ 0.01). In the same period, coverage of all subsequent revaccinations significantly decreased, namely, first revaccination for pertussis (p  less then  0.01); first, second and third revaccination against diphtheria, tetanus and poliomyelitis (p  less then  0.01); and second dose against MMR before enrolment in elementary school (p  less then  0.05). Although linear regression analysis did not show change in vaccination coverage trend against tuberculosis (Bacillus Calmette-Guérin; BCG), hepatitis B (HepB3) in infants and diseases caused by Haemophilus influenzae type b (Hib3), the joinpoint regression analysis showed that the coverage declined for BCG after 2006, HepB3 after 2010 and Hib3 after 2008.ConclusionTo achieve and keep optimum immunisation coverage, it is necessary to address barriers to immunisation, such as the availability of all vaccines and vaccine-hesitancy among parents and healthcare workers in Serbia.Thrombosis with thrombocytopenia (TTS) has been identified as a rare adverse event following COVID-19 vaccination with Vaxzevria. We modelled the benefits and risks of Vaxzevria distribution from May to September 2021 in metropolitan France where other vaccines are available, considering French hospitalisation data and European data on TTS. Across different scenarios, benefits of Vaxzevria distribution in people 55 years and older exceeded the risk of death from COVID-19. In young adults, risks were at least of similar magnitude as benefits.