Background National Medicines Regulatory Authorities like the Pharmacy Board of Sierra Leone are responsible for protecting and promoting public health, implementing rigorous regulatory standards, and maintaining an assured supply of medical products that are safe, effective, and of good quality. This retrospective study assesses the quality improvement of the Pharmacy Board of Sierra Leones’ processes and the influence of internal and external audits on the quality management system and services provided to customers. Methods Data was collected on identified counterfeit drugs from 2013 to 2021 using a data collection tool prepared to collate relevant information that could address the different objectives. All data were sourced from the Department of Quality Assurance and the Department of Enforcement and Narcotics at the Pharmacy Board of Sierra Leone. Internal audit records from 2016 to 2020 and external audit reports from external auditors and the World Health Organisation Global benchmarking self-assessment tool were also used. Results The study showed marked changes in identifying counterfeit drugs by the Pharmacy Board of Sierra Leone post-ISO 9001:2015 certification compared to yearly Pre-ISO 9001:2015 certification. Critical functions of the Pharmacy Board of Sierra Leone from 2016 to 2021 showed that several indicators had been addressed post-ISO9001:2015 certification and an improvement in the level of maturity for the quality assurance (Regulatory systems) and Pharmacovigilance functions. There was also an improvement in addressing the number of identified non-conformances from internal and external audits post-ISO9001:2015 certification. conclusions This study revealed that regular checks through self-assessment, internal audits and standard management review meetings that generate followed up timelines and corrective actions for non-conformances are essential quality improvement tools for the efficient functioning of the Pharmacy Board of Sierra Leone.

Clinical trials during public health emergencies of novel medical products such as therapeutics and vaccines in resource-limited settings are daunting due to the limited capacity for regulatory assessment. Regulating clinical trials during the Ebola outbreak in Sierra Leone required expedited evaluation to identify medical products that could be promptly introduced to combat the epidemic in the absence of approved treatment or prevention. This article explored the decisions taken by the Pharmacy Board of Sierra Leone through its Expert Committee on Medicine Safety and Clinical Trials regarding clinical trials oversight during the Ebola epidemic and the lessons learned. This independent expert committee assessed and provided scientific opinions to the Pharmacy Board of Sierra Leone to inform approval of all clinical trials within 10–15 working days. We also requested for assisted review from the African Vaccine Regulatory Forum and support from the US Food and Drug Administration through a unilateral recognition and reliance memorandum of understanding. In addition, the Agency-ensured structures and systems were in place for reporting and reviewing adverse events and serious adverse events, management of biological samples, submission and review of progress reports, and good clinical practice inspections. Unfortunately, the Ebola epidemic revealed many weaknesses in the country’s clinical trials regulatory structure and processes. Government and partners should further offer more resources to build the clinical trial structures and systems so that the Agency will be better poised to handle future public health emergencies.

Monitoring antibiotic consumption is crucial to tackling antimicrobial resistance. However, currently there is no system in Sierra Leone for recording and reporting on antibiotic consumption. We therefore conducted a cross-sectional study to assess national antibiotic consumption expressed as defined daily dose (DDD) per 1000 inhabitants per day using all registered and imported antibiotics (categorized under the subgroup J01 under the anatomical and therapeutic classification (ATC) system) as a proxy. Between 2017–2019, total cumulative consumption of antibiotics was 19 DDD per 1000 inhabitants per day. The vast majority consisted of oral antibiotics (98.4%), while parenteral antibiotics made up 1.6%. According to therapeutic/pharmacological subgroups (ATC level 3), beta-lactam/penicillins, quinolones, and other antibacterials (mainly oral metronidazole) comprised 65% of total consumption. According to WHO Access, Watch, and Reserve (AWaRe), 65% of antibiotics consumed were Access, 31% were Watch, and no Reserve antibiotics were reported. The top ten oral antibiotics represented 97% of total oral antibiotics consumed, with metronidazole (35%) and ciprofloxacin (15%) together constituting half of the total. Of parenteral antibiotics consumed, procaine penicillin (32%) and ceftriaxone (19%) together comprised half of the total. Policy recommendations at global and national levels have been made to improve monitoring of antibiotic consumption and antibiotic stewardship.

The purpose of this essay is to help BCBAs realize the importance of ensuring Autistic clients as active leads rather than passive recipients in intervention services. This essay will also explore personal experiences of the author (an Autistic woman) as it relates to the importance of neurodiversity and as it applies to assent, autistic autonomy, and social validity. This essay will discuss and examine theoretical underpinnings, which validate that it is essential to include the client in all interventions. It is important that BCBAs develop a professional repertoire involving the Autistic community as key stakeholders in order to determine what should and should not be targeted for intervention and to help facilitate neurodiverse directives.

This article presents findings from a grounded theory study in which we explored how self-identifying gay men between 40 and 76 years of age manage their health in the context of homophobia, heteronormativity and discrimination. Data were collected with 25 men over a 6-month period in a large urban setting in Western Canada. A preliminary theory of health management is discussed, consisting of the central phenomenon of overcoming adversity. Three thematic processes are considered that illustrate how adversity and health management are situated within the interrelationships of historical and ongoing discrimination inclusive of and external to the healthcare encounter, the complexity of men's illnesses, and the temporal aspects of HIV epidemics and treatments that occurred throughout their lives. These themes include: advocating for health needs, knowing about health issues and treatments, and engaging in health promoting practices. These findings help to address a gap in knowledge concerning health management among older gay men and support that initiatives aimed at health care with gay men must appreciate the systemic role of discrimination, while supporting men's individual efforts in actively managing their health.

The number of men in the Canadian workforce who have prostate cancer is increasing. The purpose of the study was to explore the processes involved in men's return to work post radical prostatectomy and understand how these events are connected to masculinities. Drawing on data collected through individual interviews with 24 participants, constructivist grounded theory method was used to develop the substantive theory of Reformulating the Worker Identity which comprises two processes, recovering after radical prostatectomy and renegotiating work expectations. Recovering after radical prostatectomy revealed how men overcame side effects at home and evaluated their potential for returning to work. Renegotiating work expectations included participant's strategies for securing graduated return to work accommodations. Study findings revealed that the challenges for fully returning to work post prostatectomy are often underestimated by clinicians and patients. In this context, preempting return to work challenges preoperatively might allay significant anxieties for many men.

Background: Gay men, particularly middle aged and older men (over 40 years of age) experience a disproportionate burden of mental health issues compared to heterosexual men. Despite ample evidence that chronic exposure to structural and interpersonal discrimination negatively affect their mental health, little is known from gay men's perspectives how they understand mental health or their strategies to address their mental health concerns. Aim: This study's aim was to investigate how middle aged and older gay men experience their mental health and the mitigation strategies used to promote mental health. Method: Semi-structured interviews were conducted with 25 men who self-identified as gay. Data were analyzed using an interpretive descriptive approach. Results: Three overarching themes that best illustrate how men perceived their mental health and manage their mental health concerns were identified: gaining perspective, engaging with health services, and promoting and maintaining mental health. Conclusions: This study provides insight into how gay men come to acknowledge the validity of their mental health concerns, engage with health services, and their participation in other activities deemed essential for mental health promotion. These findings are ideally poised to inform development of health resources to promote and protect the mental health of aging gay men.

As chronic conditions are on the rise in the USA, management initiatives outside of the inpatient setting should be explored to reduce associated cost and access disparities. Chronic conditions disproportionately affect African American public housing residents due to the effects of historical marginalization on the manifestation of economic and social problems exacerbating health disparities and outcomes. Informed by participatory research action tenets, this study focused on identifying the challenges to management of chronic conditions and developing community-envisioned initiatives to address these challenges in a predominantly African American public housing community. Two focus groups were conducted with former and current public housing residents and were analyzed using inductive content analysis. Physical activity, the cost associated with healthy eating, and lack of information were noted as challenges to chronic disease management. Initiatives discussed were the formation of a walking partner's program to promote physical activity, a shopper's club to exchange coupons and learn how to prepare healthy meals, and a natural remedy's book to share information intergenerationally about management tactics. Challenges identified existed predominantly on the individual and the system level, while the initiatives generated target engaging interpersonal and community relationships. These community-envisioned approaches should be explored to facilitate chronic disease management in public housing neighborhoods.

Distress among young immigrant and refugee men has drawn increasing research attention in recent years. Nuanced understandings of distress are needed to inform mental health and public health programming. The purpose of this research was to examine distress from the perspectives of young immigrant and refugee men living in Greater Vancouver, British Columbia, Canada. Thirty-three young men (aged 15-22 years) from diverse immigrant and refugee backgrounds participated in interviews, which were conducted between 2014 and 2015. Data were examined using narrative analysis and theories of masculinities. Three narratives were identified-norming distress, acknowledging distress as ongoing, and situating distress. The findings reveal that the narratives offer different frames through which distress was rendered a norm, or acknowledged and situated in relation to the participants' relationships and to masculine discourses that shaped their expressions of distress. The findings can inform initiatives aimed at providing spaces for diverse young men to acknowledge their distress and to receive support for mental health challenges.

Gay men experience marked health disparities compared to heterosexual men, associated with profound discrimination. Resilience as a concept has received growing attention to increase understanding about how gay men promote and protect their health in the presence of adversity. Missing in this literature are the perspectives and experiences of gay men over 40 years. This investigation, drawing on grounded theory methods, examined how gay men over 40 years of age develop resilience over the course of their lives to promote and protect their health. In-depth interviews were undertaken with 25 men ranging between 40 and 76 years of age who experienced an array of health concerns including depression, anxiety, suicidality, and HIV. Men actively resist discrimination via three interrelated protective processes that dynamically influence the development of resilience over their life course: (a) building and sustaining networks, (b) addressing mental health, and (c) advocating for respectful care encounters. Initiatives to promote and protect the health of gay men must be rooted in the recognition of the systemic role of discrimination, while supporting men's resilience in actively resisting discrimination.

Mental health challenges are the leading health issue facing youth globally. To better respond to this health challenge, experts advocate for a population health approach inclusive of mental health promotion; yet this area remains underdeveloped. Further, while there is growing emphasis on youth-engaged research and intervention design, evidence of the outcomes and impacts are lacking. The purpose of this paper is to contribute to addressing these gaps, presenting findings from the Social Networking Action for Resilience (SONAR) study, an exploration of youth-driven mental health promotion in a rural community in British Columbia, Canada. Mixed methods including pre- and post-intervention surveys (n = 175) and qualitative interviews (n = 10) captured the outcomes and impacts of the intervention on indicators of mental health, the relationship between level of engagement and benefit, and community perceptions of impact. Findings demonstrate the feasibility and benefits of youth engaged research and intervention at an individual and community-level.

Prostate cancer diagnosis can occur at a time when men’s work and careers are central to their masculine identity, sense of purpose, and family life. In Canada, an aging male population, along with medical advances, has resulted in increasing numbers of working men being diagnosed with, and treated for, prostate cancer. Little is known about the linkages between men’s work and their experiences of prostate cancer. In this qualitative study, 24 Western Canadian men were interviewed to distil the connections between work, prostate cancer screening, diagnosis, and the decision to undergo radical prostatectomy. Data were analyzed using constant comparison in the context of masculinities theory. The findings demonstrated that work was central to men’s masculine identities and afforded financial security, social status, and a sense of personal growth. However, work-related strain and demands were also found to affect participants’ health and distance them from their families. A diagnosis of prostate cancer tended to diminish the importance of work, wherein participants focused on optimizing their health and strengthening family relations. In deciding on radical prostatectomy as a treatment to eradicate prostate cancer, few men considered the implications for returning to work. The current study findings indicate that clinicians and patients should explicitly explore and discuss how surgery side effects may affect work and career plans during treatment decision-making.

While the gendered nature of suicide has received increased research attention, the experiences of women who have lost a man to suicide are poorly understood. Drawing on qualitative photovoice interviews with 29 women who lost a man to suicide, we completed a narrative analysis, focused on describing the ways that women constructed and accounted for their experiences. We found that women’s narratives drew upon feminine ideals of caring for men’s health, which in turn gave rise to feelings of guilt over the man’s suicide. The women resisted holding men responsible for the suicide and tended to blame themselves, especially when they perceived their efforts to support the man as inadequate. Even when women acknowledged their guilt as illogical, they were seemingly unable to entirely escape regret and self-blame. In order to reformulate and avoid reifying feminine ideals synonymous with selflessly caring for others regardless of the costs to their own well-being, women’s postsuicide bereavement support programs should integrate a critical gender approach.

This article is based on findings from a qualitative study with 27 adolescents in northern British Columbia, Canada. Our aim was to explore youths' perspectives on the sources of emotional distress in their lives and how these are connected to peer-based aggression and victimization within their community. Our analysis of narrative findings suggests that youths' narratives about bullying reflect intersecting and socially embedded configurations of race, neocolonialism, and place. We argue that mainstream approaches to addressing bullying as a relationship-based problem must be re-oriented to account for the role of the social or structural contexts of youths' lives. By applying an intersectional lens, we make the case for a widening of the focus of interventions away from individual victims and perpetrators, toward a contextual approach that addresses how adolescents experience bullying as a site of health and social inequities in their community.

In Canada, the issue of creating safe and inclusive school environments for lesbian, gay, bisexual, transgender, and queer students has been in the spotlight. Several researchers and advocates have pointed out the positive effects of lesbian, gay, bisexual, transgender, and queer-positive policy frameworks on the health and wellbeing of all young people. In this article, we take a critical approach to analyzing narrative findings from qualitative interviews conducted with youth in three communities in British Columbia, Canada: “the North,” Vancouver, and Abbotsford. Using a Foucauldian Discourse Analytic Approach and Butler’s concept of Citationality, our analysis suggested that although explicit homophobia was largely absent from youth discussions, young people discursively constructed lesbian, gay, bisexual, transgender, and queer identities and “communities” in ways that reified heteronormativity. Youth made references to sociopolitical discourses of libertarianism and liberalism and to homonormative stereotypes regarding gay masculinity. A few young people also alluded to egalitarian, queer-positive discourses, which appeared to interrogate structures of heteronormativity. Since studies suggest a connection between the existence of institutional supports for lesbian, gay, bisexual, transgender, and queer students in schools and their mental and physical wellbeing, we conclude by considering the limitations and possibilities of these sociopolitical discourses in the struggle for sexual and gender equity, and how they might help frame future health-related, anti-homophobia policy frameworks in educational settings.

In recent years, the experiences of immigrant and refugee young men have drawn attention worldwide. Human-induced environmental disasters, local and global conflicts, and increasingly inequitable distributions of wealth have shaped transnational migration patterns. Canada is home to a large immigrant and refugee population, particularly in its urban areas, and supporting the mental health and well-being of these communities is of critical importance. The aim of this article is to report findings from a qualitative study on the social context of mental health among immigrant and refugee young men, with a focus on their migration and resettlement experiences. Informed by the conceptual lens of social context, a thematic narrative analysis approach was used to examine qualitative data from individual and group interviews with 33 young men (age 15 to 22 years) self-identified as immigrants or refugees and were living in Greater Vancouver, western Canada. Three thematic narratives were identified: a better life, living the (immigrant) dream, and starting again from way below. The narratives characterized the social context for immigrant and refugee young men and were connected by a central theme of negotiating second-class citizenship. Implications include the need for mental health frameworks that address marginalization and take into account the contexts and discourses that shape the mental health of immigrant and refugee populations in Canada and worldwide.

Depression, a disorder often thought of as a women's health issue, is underreported in men, and little is known about how heterosexual couples respond when the male partner is depressed. Within the context of men's depression, couples may be challenged to make life adjustments that impact their gender relations. The findings detailed in this article are drawn from an innovative qualitative study of 26 Canadian heterosexual couples (26 men and their 26 women partners) in which the man had a formal diagnosis and/or self-identified as depressed. Participants completed individual, semi structured interviews that focused on exploring how masculinities and femininities intersect to forge particular heterosexual gender relations in the context of men's depression. A social constructionist gender analysis revealed three couple patterns: trading places, business as usual, and edgy tensions. Trading places refers to couples who embodied some atypical masculine and feminine roles to compensate for the men's depression-induced losses (e.g., men as homemakers and women as breadwinners). Women partners in these dyads broke with feminine ideals in how they provided partner support by employing tough love strategies for self-protection and a means of prompting the men's self-management of their depression. Couples involved in business as usual co-constructed men's alignment with masculine workman ideals and women's support of their partner to counter and conceal men's depression induced-deficits. Also described were edgy tensions, where a mismatch of gender expectations fueled resentment and dysfunction that threatened the viability of some relationships. Overall, the limits of women's resilience and care-giving were evident, yet the findings also reveal how men's management of their depression was directly influenced by their partner. Opportunities for couples to assess their relationship dynamics within a broad range of gender relations might support couples' connectedness and life quality amid the challenges that accompany men's depression.

Information interventions that influence health behavior are a major element of the public health toolkit and an area of potential interest and investigation for library and information science ( LIS ) researchers. To explore the use of information as a concept within dominant public health behavior models and the manner in which information practices are handled therein, we undertook a scoping study. We scoped the use of “information” within core English‐language health behavior textbooks and examined dominant models of health behavior for information practices. Index terms within these texts indicated a lack of common language around information‐related concepts. Nine models/theories were discussed in a majority of the texts. These were grouped by model type and examined for information‐related concepts/constructs. Information was framed as a “thing” or resource, and information practices were commonly included or implied. However, lack of specificity regarding the definition of information, how it differs from knowledge, and how context affects information practices make the exact role of information within health behavior models unclear. Although health information interventions may be grounded in behavioral theory, a limited understanding of the ways information works within people's lives hinders our ability to effectively use information to improve health. By the same token, information scientists should explore public health's interventionist approach.