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Background: The World Health Organization (WHO) estimates that there is a global healthcare workforce shortage of 7.2 million, which is predicted to grow to 12.9 million by 2035. Globally, people are living longer with multiple co-morbidities and require increased access and use of medicines. Pharmacists are a key component of the healthcare workforce, and in many countries, pharmacists are the most accessible healthcare profession. This paper identifies key issues and current trends affecting the global pharmacy workforce, in particular workforce distribution, country economic status, capacity, and workforce gender balance. Methods: National professional pharmacy leadership bodies, together with other contacts for professional bodies, regulatory bodies, and universities, were approached to provide country-level data on pharmacy workforce. A descriptive and comparative analysis was conducted to assess each country's pharmacy workforce. Results: A total of 89 countries and territories responded to the survey. To standardise the capacity measure, an analysis of the population density of pharmacists (per 10 000 population) was performed. The sample mean was 6 pharmacists per 10 000 population (n = 80). There is considerable variation between the surveyed countries/territories ranging from 0.02 (Somalia) to 25.07 (Malta) pharmacists per 10 000 population. African nations have significantly fewer pharmacists per capita. Pharmacist density correlates with gross national income (GNI) and health expenditure. The majority of pharmacists are employed in community settings, followed by hospital, industry-related, academia, and regulation. There is a greater proportion of females in the pharmacy workforce globally, with some WHO regions showing female representation of more than 65 % with an increasing trend trajectory. Conclusions: Pharmacy workforce capacity varies considerably between countries and regions and generally correlates with population-and country-level economic indicators. Those countries and territories with lower economic indicators tend to have fewer pharmacists and pharmacy technicians; this has implications for inequalities regarding access to medicines and medicine expertise.

Aim: To develop and evaluate the comparative effectiveness of behavioural interventions of enhanced prevention counselling (EPC) and simple educational counselling (SEC) in reducing hepatitis C viral (HCV) infection in sero-negative injecting drug users (IDU). Design: Randomised controlled trial (RCT) of EPC intervention in comparison with simple educational counselling (SEC).Setting Specialised: Drug services in London and Surrey, United Kingdom. Participants and Measurements:Ninety five IDUs were recruited and randomised to receive EPC (n = 43) or SEC (n = 52). Subjects were assessed at baseline using the Addiction Severity Index (ASI), the Injecting Risk Questionnaire (IRQ), and Drug Injecting Confidence Questionnaire (DICQ). The primary outcome was measured by the rate of sero-conversion at 6 months and 12 months from baseline and by the ASI, IRQ and DICQ at 6 months from baseline. Hepatitis C testing was undertaken by the innovative test of the dried blood spot (DBS) test which increased the rate of testing by 4 fold compared to routine blood testing.Findings Seventy: Eighty two subjects (82%) out of the 95 recruited were followed up at 6 months and 62 (65%) were followed up at 12 months. On the primary outcome measure of the rate of seroconversion, 8 out of 62 patients followed-up at twelve months seroconverted, three in the EPC group and five in the SEC group, indicating incidence rates of 9.1 per 100 person years for the EPC group, 17.2 per 100 person years for the SEC group, and 12.9 per 100 person years for the cohort as a whole. Analysis of the secondary outcome measures on alcohol use, risk behaviour, psychological measures, quality of life, showed no significant differences between the EPC and the SEC groups. However, there were significant changes on a number of measures from baseline values indicating positive change for both groups. Conclusion:We were not able to prove the efficacy of EPC in comparison with SEC in the prevention of hepatitis C in IDUs. This was related to low recruitment and retention rates of the participants. Moreover there was a low adherence rate to EPC. The study provided the benefits of developing and introducing behavioural interventions of the EPC and SEC and the DBS screening for Hepatitis C. Moreover the main lessons learnt were that piloting of a new intervention is a crucial first step before conducting pragmatic RCTs of psychological interventions in the field of addiction; that an infrastructure and culture for psychosocial interventions is needed to enable applied research in the service environment, and research funding is needed for enabling the recruitment of dedicated trained therapists for the delivery of these interventions.

Dysfunctions of the (S)-␣-amino-3-hydroxy-5-methylisoxazole-4-propionate (AMPA) subtype of ionotropic receptor for the brain's major excitatory neurotransmitter, L-glutamate, occur in various neurological conditions. We have previously demonstrated that AMPA receptor-mediated excitotoxicity occurs by apoptosis and here examined the influence of the expression of cell death repressor gene Bcl-2 on this excitotoxic insult. Using neuronal cortical cultures prepared from transgenic mice expressing the human Bcl-2 gene, the influence of Bcl-2 on AMPA receptor-mediated neuronal death was compared with that seen with staurosporine and H 2 O 2 . At day 6 cultures were exposed to AMPA (0.1-100 M), and cellular injury was analyzed 48 h after insult using phase-contrast microscopy, a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide viability assay, and DNA staining with 4,6-diamidino-2-phenylindole and Sytox Green. AMPA produced a concentrationdependent increase in cell death that was significantly attenuated by human Bcl-2. AMPA (3 M) increased the number of apoptotic nuclei to 60% of control in wild-type cultures, and human Bcl-2 significantly decreased the number of apoptotic nuclei to 30% of AMPA-treated cultures. Human Bcl-2 only provided significant neuroprotection against neuronal injury induced by low concentrations of staurosporine (1-10 nM) and H 2 O 2 (0.1-30 M) and where neuronal death was by apoptosis, but not against H 2 O 2 -induced necrosis. Our findings indicate that overexpression of Bcl-2 in primary cultured neurons protects in an insult-dependent manner against AMPA receptor-mediated apoptosis, whereas protection was not seen against more traumatic insults. This study provides new insights into the molecular therapeutics of neurodegenerative conditions. Key Words: (S)-␣-Amino-3-hydroxy-5-methylisoxazole-4-propionate-Bcl-2-Apoptosis-Necrosis-Glutamate-Excitotoxicity.

BackgroundHuman resources for health are at a critical low. The World Health Organization estimates that the current shortage of health workers, including pharmacists, is in excess of 7.2 million worldwide and that, by 2035, the shortage will reach 12.9 million. Pharmacists, in particular, are lacking in the workforce in many countries. The International Pharmaceutical Federation (FIP) and academic partners have conducted periodic global pharmacy workforce surveys in 2006, 2009 and 2012 which have monitored and reported on the status of the pharmacy workforce at the country and territory levels. This current analysis is a synthesis of workforce capacity data from these date points to provide an overview of the global trends and changes to pharmacy workforce capacity over this time period.MethodsThe methodology proceeded with accessing workforce capacity data collated in 2006, 2009 and 2012 held on file at the FIP Collaborating Centre. This data had previously been validated and made available to WHO Human Resources for Health. The data focused (due to limitations from 2006 databank) on pharmacist workforce capacity. Countries and territories were identified that had data available across at least two of the three time points (2006, 2009 and 2012). Missing time-point data for some countries (data gaps) were subject, where possible, to literature and online data searching to capture possible missing data. Country-level capacity data were plotted against time to identify trends coupled with comparative analysis of the trends.ResultsThe countries and territories identified as having valid data for each of the time points 2006, 2009 and 2012 were present in all WHO regions, with Europe having the most countries with data available and South East Asia the fewest.All WHO regions have experienced an increase in the density of pharmacists (measured as number of pharmacists per 10 000 population) over the period 2006–2012. However, some countries show a reduction in the density of pharmacists. African countries show large relative increases in acceleration of capacity building but remain significantly behind in terms of absolute capacity per capita. South East Asian and Middle Eastern countries also show large proportional changes in pharmacist workforce.ConclusionThe global trend is an increase in workforce across all nations and regions, and this is a move in the right direction towards improved access to, and availability of, pharmaceutical expertise. However, there is still much to be done, with some regions and low-income countries still displaying a disproportionately low number of pharmacists on small overall capacity for delivering pharmacy services.Electronic supplementary materialThe online version of this article (10.1186/s12960-018-0267-y) contains supplementary material, which is available to authorized users.

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This review article discusses how social approaches to tuberculosis elimination might contribute to realizing the targets stipulated in the World Health Organization’s (WHO) End TB Strategy (2016–2035), with an emphasis on opportunities for progress in Asia and the Pacific. Many factors known to advance tuberculosis transmission and progression are pervasive in Asia and the Pacific, such as worsening drug resistance, unregulated private sector development, and high population density. This review article argues that historically successful social solutions must be revisited and improved upon if current worldwide tuberculosis rates are to be sustainably reduced in the long term. For the ambitious targets laid down in the WHO’s End TB Strategy to be met, biomedical innovations such as point-of-care diagnostics and new treatments for multidrug-resistant tuberculosis (MDR-TB) must be implemented alongside economic, social, and environmental interventions. Implementing social, environmental, and economic interventions alongside biomedical innovations and universal healthcare coverage will, however, only be possible if the health and other government sectors, civil society, and at-risk populations unite to work collaboratively in coming years.

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