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This cohort study evaluates the association between weight indices in childhood and changes in cognition and psychopathology.

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OBJECTIVE: Since 2009, the Big Ten Pharmacy Assessment Collaborative has surveyed their Doctor of Pharmacy (PharmD) graduates regarding their first employment plans. The current study updates the results from 2013-2017, since which the nationwide demand for pharmacists decreased, then increased again due to COVID-19. METHODS: Quantitative first-position employment data from 2018-2022 were tracked among 6687 Big Ten PharmD graduates. Outcomes included job/residency/fellowship placement; satisfaction with placement; salary; time spent searching; and perceived difficulty finding placement. RESULTS: Over the study period, 5276 usable surveys were received (survey participation rate 79%). Respondents who reported applying for employment (2699) spent nearly 3 months searching for a position, although 64% had received employment offers before graduation. Annual salaries in pharmacy positions of at least 32 h per week (excluding residencies or fellowships) trended downward from $113,754 in 2018 to $99,175 in 2021, rebounding to $114,097 in 2022. Approximately 42% of respondents who applied for jobs reported difficulty finding a position in 2018 and 2019, decreasing to 20% in 2022. In total, 73% of respondents were satisfied with the offers they received, with 72% finding positions in their preferred job setting. An average of 57% applied for residencies from 2018 to 2022, nearly 10% higher than 2013-2017, with 76% of applicants matching. An additional 19% planned to pursue additional academic degrees, fellowship training, or both. CONCLUSION: From 2018 to 2022, Big Ten PharmD graduates found pharmacy-related first positions to the same extent as did Big Ten PharmD graduates from 2013-2017, at similar salaries.

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OBJECTIVE: Pharmacy colleges and schools invest substantial faculty effort and financial resources in North America Pharmacist Licensure Exam (NAPLEX) preparation, including vendor products purported to improve NAPLEX pass rates. The objective of this project was to examine NAPLEX preparation program characteristics associated with first-time pass rates. METHODS: A national survey investigated which pharmacy schools provided a formal NAPLEX preparation program in the 2021/2022 academic year, and what resources students were required to use. Pharmacy school characteristics and the unique resources provided in NAPLEX preparation programs were separately analyzed for association with 2022 NAPLEX first-time pass rates. RESULTS: The survey response rate was 71% (100 pharmacy schools). Of the 6 pharmacy school characteristics analyzed, offering a formal NAPLEX preparation program and private status were both weakly correlated with a decrease in the 2022 NAPLEX pass rate, while founding year of 2000 or earlier was weakly correlated with an increase in the pass rate. In a generalized linear model, a decrease in 2022 NAPLEX pass rate was associated with offering a formal NAPLEX preparation program (-5.90% [-11.55 to -0.23]) and with a 3-year accelerated curriculum (-9.15% [-15.55 to -2.75]). Of 12 resources required in NAPLEX preparation programs, 3 were weakly correlated with a decrease in 2022 pass rate: a vendor question bank, vendor review book/materials, and a live, synchronous faculty-led review. In a generalized linear model, a decrease in 2022 NAPLEX pass rate was associated with a live, synchronous faculty-led review (-6.62% [-11.16 to -2.08]). Among schools without a formal preparation program, NAPLEX pass rates consistently exceeded the national average in 2020, 2021, and 2022, while the proportion of schools with NAPLEX preparation programs and first-time pass rates above the national average dropped from 59% in 2021 and 58% in 2020 to 44% in 2022. CONCLUSION: Simply implementing a NAPLEX preparation program is insufficient to overcome other systemic/programmatic influences of successfully passing the NAPLEX; programs should invest earlier resources to address NAPLEX competencies.

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OBJECTIVE: The purpose of this study was to describe the different strategies used to supplement North American Pharmacist Licensure Examination (NAPLEX) and Multistate Pharmacy Jurisprudence Examination (MPJE) preparation in the US pharmacy programs. METHODS: An online survey was developed to gather information from 141 accredited schools/colleges of pharmacy about the preparation methods used during the 2021-22 academic year. The questionnaire contained 19 NAPLEX- and 10 MPJE-specific questions related to timing, content, use of commercial products and programs, faculty involvement, and whether these activities were required or recommended. Characteristics of schools/colleges were compared based on the presence or absence of preparation programs; preparation programs were descriptively reported. RESULTS: The response rate was 71%. Most schools (87/100 respondents) provided NAPLEX preparation programs starting in the advanced pharmacy practice experiential year, required students to participate, and focused on reviewing the content instead of assessing students' examination readiness. Similar elements were reported among 61 schools providing MPJE preparation programs. Schools used a variety of resources including access to vendor-based question banks or review materials, and completing live, proctored, NAPLEX-like examinations. Characteristics of schools or colleges did not differ significantly based on presence or absence of a preparation program. CONCLUSION: Schools/colleges of pharmacy use a variety of strategies to prepare students for licensing examinations. Many require student participation in vendor-based preparation programs for NAPLEX, and homegrown programs for MPJE preparation. The next step will be to determine the effectiveness of various approaches used by the schools/colleges on first-time licensure examination attempts.

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Importance: Lifestyle change is central to diabetes risk reduction in youth with overweight or obesity. Feeling susceptible to a health threat can be motivational in adults. Objective: To evaluate associations between diabetes risk perception and/or awareness and health behaviors in youth. Design, Setting, and Participants: This cross-sectional study analyzed data from the US National Health and Nutrition Examination Survey 2011 to 2018. Participants included youths aged 12 to 17 years with body mass index (BMI) in the 85th percentile or higher without known diabetes. Analyses were conducted from February 2022 to February 2023. Main Outcomes and Measures: Outcomes included physical activity, screen time, and attempted weight loss. Confounders included age, sex, race and ethnicity, and objective diabetes risk (BMI, hemoglobin A1c [HbA1c]). Exposures: Independent variables included diabetes risk perception (feeling at risk) and awareness (told by clinician), as well as potential barriers (eg, food insecurity, household size, insurance). Results: The sample included 1341 individuals representing 8 716 794 US youths aged 12 to 17 years with BMI in the 85th percentile or higher for age and sex. The mean age was 15.0 years (95% CI, 14.9-15.2 years) and mean BMI z score was 1.76 (95% CI 1.73-1.79). Elevated HbA1c was present in 8.6% (HbA1c 5.7%-6.4%: 8.3% [95% CI, 6.5%-10.5%]; HbA1c ≥6.5%: 0.3% [95% CI, 0.1%-0.7%]). Nearly one-third of youth with elevated HbA1c reported risk perception (30.1% [95% CI, 23.1%-38.1%), while one-quarter (26.5% [95% CI, 20.0%-34.2%]) had risk awareness. Risk perception was associated with increased TV watching (ß = 0.3 hours per day [95% CI, 0.2-0.5 hours per day]) and approximately 1 less day per week with at least 60 minutes of physical activity (ß = -1.2 [95% CI, -2.0 to -0.4) but not with nutrition or weight loss attempts. Awareness was not associated with health behaviors. Potential barriers had mixed associations: larger households (≥5 members vs 1-2) reported lower consumption of non-home-prepared meals (OR 0.4 [95% CI, 0.2-0.7]) and lower screen time (ß = -1.1 hours per day [95% CI, -2.0 to -0.3 hours per day), while public insurance (vs private) was associated with approximately 20 fewer minutes per day of physical activity (ß = -20.7 minutes per day [95% CI, 35.5 to -5.8 minutes per day]). Conclusions and Relevance: In this cross-sectional study including a US-representative sample of adolescents with overweight or obesity, diabetes risk perception and awareness were not associated with greater engagement in risk-reducing behaviors in youth. These findings suggest the need to address barriers to engagement in lifestyle change, including economic disadvantage.

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Neuroinflammation is both a consequence and driver of overfeeding and weight gain in rodent obesity models. Advances in magnetic resonance imaging (MRI) enable investigations of brain microstructure that suggests neuroinflammation in human obesity. To assess the convergent validity across MRI techniques and extend previous findings, we used diffusion basis spectrum imaging (DBSI) to characterize obesity-associated alterations in brain microstructure in 601 children (age 9-11 years) from the Adolescent Brain Cognitive DevelopmentSM Study. Compared with children with normal-weight, greater DBSI restricted fraction (RF), reflecting neuroinflammation-related cellularity, was seen in widespread white matter in children with overweight and obesity. Greater DBSI-RF in hypothalamus, caudate nucleus, putamen, and, in particular, nucleus accumbens, correlated with higher baseline body mass index and related anthropometrics. Comparable findings were seen in the striatum with a previously reported restriction spectrum imaging (RSI) model. Gain in waist circumference over 1 and 2 years related, at nominal significance, to greater baseline RSI-assessed restricted diffusion in nucleus accumbens and caudate nucleus, and DBSI-RF in hypothalamus, respectively. Here we demonstrate that childhood obesity is associated with microstructural alterations in white matter, hypothalamus, and striatum. Our results also support the reproducibility, across MRI methods, of findings of obesity-related putative neuroinflammation in children.

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Childhood obesity has been associated with lower cognitive performance and worse mental health in cross-sectional studies. However, it is unclear whether these findings extend longitudinally and in what causal direction. Using data from the Adolescent Brain Cognitive Development (ABCD) Study (maximum analytical n = 6671, 48.3% girls, 42.8% non-White), we examined how body mass index (BMI) at baseline (ages 9-11) relate prospectively to changes in cognition or psychopathology across the 2 years thereafter, and vice versa. Cognitive tests included the National Institutes of Health Toolbox Cognition Battery, Little Man Task of mental rotation, and Rey Auditory Verbal Learning Test. Psychopathology was assessed using caregiver-reported Child Behavior Checklist. Linear mixed models adjusted for sociodemographic and developmental covariates indicated that lower baseline performance on most cognitive tests was associated with greater longitudinal BMI gain (eg, 1 point lower than median on Picture Vocabulary corresponded to 0.012 kg/m2 [1.6%; 95% CI, 0.008 to 0.016 kg/m2] more annual BMI gain, PFDR < .001), whereas baseline BMI was unrelated to longitudinal changes in cognition (PFDR ≥ .12; including after considering practice effects). Greater broad-spectrum psychopathology at baseline was associated with increased BMI gain (eg, each endorsement of externalizing problems than none corresponded to 0.015 kg/m2 [2.2%; 95% CI, 0.009 to 0.021 kg/m2] more annual BMI gain, PFDR < .001) and, reciprocally, greater baseline BMI was linked specifically to more longitudinal withdrawn/depressed and depression problems (0.010 [22%; 95% CI, 0.004 to 0.016] and 0.011 [15%; 95% CI, 0.004 to 0.017] more problems annually per 1 kg/m2 above median BMI, PFDR = .003 and .008). The associations did not differ in boys vs. girls (PFDR ≥ .40), and remained stable with waist circumference as the weight index and in subgroups of participants without weight-altering medications or common baseline psychiatric diagnoses. Our longitudinal findings expand previous cross-sectional works and highlight the importance of cognitive and mental health to children's weight development and links between weight and depression.

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OBJECTIVE: (1) Describe the progression of diabetes mellitus over time in an observational study of Wolfram syndrome, a rare, genetic, neurodegenerative disorder, which often includes diabetes mellitus and is typically diagnosed during childhood or adolescence. (2) Determine whether C-peptide could be used as a marker of diabetes progression in interventional trials for Wolfram syndrome. METHODS: N = 44 (25F/19M) participants with genetically confirmed Wolfram syndrome attended the Washington University Wolfram Research Clinic annually from 2010 to 2019. Medical history, physical examinations, blood sampling, and questionnaires were used to collect data about diabetes mellitus and other components of Wolfram syndrome. Beta-cell function was assessed by determination of C-peptide during a mixed meal tolerance test. Random coefficients models evaluated the rate of progression of C-peptide over time, and power analyses were used to estimate the number of subjects needed to detect a change in C-peptide decline during an intervention trial. RESULTS: 93.2% of patients had diabetes mellitus. Mean HbA1c across all study visits was 7.9%. C-peptide significantly decreased with increasing duration of diabetes mellitus (p < 0.0001); an optimal break point in C-peptide decline was identified to occur between 0.1 and 2.3 years after diabetes mellitus diagnosis. Twenty patients per group (active vs. control) were estimated to be needed to detect a 60% slowing of C-peptide decline during the first 2.3 years following diabetes diagnosis. CONCLUSION: C-peptide declines over time in Wolfram syndrome and could potentially be used as a marker of diabetes progression in interventional studies for Wolfram syndrome, especially within the first 2 years after diabetes diagnosis.

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Early intervention for students at risk of academic difficulty can be more effectively accomplished using a team-based approach that capitalizes on the expertise of many in a pharmacy education community. Authored by members of the Big Ten Alliance Pharmacy Assessment Collaborative, this commentary advocates for better integration of assessment professionals, pharmacy faculty, and student support services to capture academic, accountability, and behavior-related data that might signal student intellectual and/or behavioral challenges and manifest as marginal academic performance. Assessment professionals can assist with creating data dashboards/monitoring systems, recognizing trends within the data, refining formulas to identify at-risk students, and measuring the impact of interventions to determine which approaches positively and significantly influence outcomes. Effective early warning and intervention takes a village and should go beyond narrowly focused attempts that fail to account for the complexity of students as individuals or fail to acknowledge the multifaceted skill set students are expected to develop to become competent and responsible pharmacists.

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Type 1 diabetes (T1D) is one of the most common chronic childhood diseases, and its prevalence is rapidly increasing. The management of glucose in T1D is challenging, as youth must consider a myriad of factors when making diabetes care decisions. This task often leads to significant hyperglycemia, hypoglycemia, and glucose variability throughout the day, which have been associated with short- and long-term medical complications. At present, most of what is known about each of these complications and the health behaviors that may lead to them have been uncovered in the clinical setting or in laboratory-based research. However, the tools often used in these settings are limited in their ability to capture the dynamic behaviors, feelings, and physiological changes associated with T1D that fluctuate from moment to moment throughout the day. A better understanding of T1D in daily life could potentially aid in the development of interventions to improve diabetes care and mitigate the negative medical consequences associated with it. Therefore, there is a need to measure repeated, real-time, and real-world features of this disease in youth. This approach is known as ecological momentary assessment (EMA), and it has considerable advantages to in-lab research. Thus, this viewpoint aims to describe EMA tools that have been used to collect data in the daily lives of youth with T1D and discuss studies that explored the nuances of T1D in daily life using these methods. This viewpoint focuses on the following EMA methods: continuous glucose monitoring, actigraphy, ambulatory blood pressure monitoring, personal digital assistants, smartphones, and phone-based systems. The viewpoint also discusses the benefits of using EMA methods to collect important data that might not otherwise be collected in the laboratory and the limitations of each tool, future directions of the field, and possible clinical implications for their use.

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BACKGROUND: This study aimed to further elucidate correlated weight changes in parent-child dyads enrolled in family-based treatment (FBT) by modeling the interdependence of weight changes during treatment. METHODS: Parent-child dyads (n = 172) with overweight/obesity (child mean zBMI = 2.16 ± 0.39; parent mean BMI = 37.9 ± 9.4 kg/m2 ) completed 4 months of FBT and were randomized to one of three 8-month maintenance interventions (Social Facilitation Maintenance [SFM]-high dose, SFM-low dose or control). Weight/height was measured at 0, 4 and 12 months. Structural equation models simultaneously estimated the effect that an individual had on their own (actor effect) and on one another's (partner effect) weight-status across time using the actor-partner interdependence model. RESULTS: Actor paths were significant over time for parent and child. Partner paths were significant for child zBMI predicting parent BMI at 4 and 12 months. Maintenance condition moderated actor/partner paths in the model. CONCLUSIONS: Child weight change may motivate parents to make environmental and behavioural changes that impact their own weight. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00759746.

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BACKGROUND: Learning portfolios enable student pharmacists to connect program outcomes and related learning experiences to future practice as healthcare providers. Assessment programs also require data to inform decisions regarding curriculum quality and maintain program accreditation. Our goal was to create a portfolio meeting multiple needs, including learning improvement, curricular assessment, and accreditation. EDUCATIONAL ACTIVITY: In this required, longitudinal, learning e-portfolio course, students upload artifacts and reflect on how the corresponding learning experiences link to program outcomes and their own continuous professional development. Baseline and annual self-assessment ratings and guided reflections document progress toward learning outcome attainment. Individualized formative feedback from pharmacist reviewers develops student capacity for reflection, improves ability to assess their own strengths and weaknesses, and promotes lifelong learning. De-identified quantitative and qualitative data is shared with stakeholders for purposes of improvement. CRITICAL ANALYSIS OF THE EDUCATIONAL ACTIVITY: Through deliberate design of the course, a corresponding plan for assessment, and modification of portfolio software platform reporting capabilities, the program has been able to acquire rich quantitative and qualitative data regarding individual student and cohort performance. This has enabled us to review these data to make improvements in individual learning experiences and make informed decisions regarding curricular effectiveness and accreditation requirements as part of the collegiate assessment plan. This course provides a wealth of opportunity for student growth and generation of assessment data, but it is best suited for programs with ample support resources to maintain its integrity as designed.

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INTRODUCTION: A range of approaches are needed to bolster the mental health and well-being of pharmacists and student pharmacists. COMMENTARY: In recent years, medical and nursing educators have been training students to use mindfulness-oriented meditation (MOM) techniques such as Mindfulness-Based Stress Reduction (MBSR) for mental health, wellness, and greater attention and presence. MOM training should be considered for incorporation into pharmacy education. Mindfulness can be included in the pharmacy curriculum in a variety of ways. These include introducing students to the topic didactically, encouraging and facilitating students to take an MBSR course, workshop, or online self-study, and integrating mindfulness through mindful moments during critical educational activities like product verification and communication assessments. IMPLICATIONS: Mindfulness may be a valuable skill for student pharmacists, thus we encourage schools to expose students to the concepts of mindfulness and MOM techniques like MBSR. Additionally, more robust and rigorous research is needed to better understand the effects of MOM in different settings and contexts.

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Differences in trait suggestibility among those with obesity may help explain differential responses to weight-loss interventions. Ubiquitous advertising of unhealthy foods, weight-loss products that are not evidence-based, and myths regarding weight loss could be particularly sabotaging in individuals with high levels of suggestibility, with or at risk of developing obesity. This study explored relationships between suggestibility, body mass index (BMI), and self-reported eating-related behaviors that vary among those with obesity. A sample of ethnically diverse adults (N = 73) with a BMI ≥25 completed the Short Suggestibility Scale (SSS), Palatable Eating Motives Scale (PEMS), Binge Eating Scale (BES), Dutch Eating Behavior Questionnaire-Restraint (DEBQ-R), and Barratt Impulsiveness Scale (BIS). Impulsiveness was controlled in analyses due to its strong association with suggestibility. Analyses revealed that BMI was not related to SSS scores, consistent with studies using hypnotic-suggestibility scales. However, SSS scores were positively associated with eating caloric food more frequently for Reward, Social, and Conformity motives, and with greater actual dieting behavior, and binge eating. Suggestibility was not related to eating for Coping motives or effort to diet. If supported by future replications, knowledge of these associations could potentially help inform and tailor weight-loss interventions to protect those that may be most susceptible to adopting invalid messages and products.

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Introduction: Social support for healthy eating can influence child eating behaviors; however, little is known about the impact of social support during family-based behavioral weight-loss treatment (FBT). This study aimed to determine the impacts of both baseline and change in family support on change in child diet and weight during FBT. Methods: Children (n = 175; BMI percentile ≥85th; ages 7-11; 61.1% female; 70.9% white) and a participating parent completed 4 months of FBT. Parents were active participants and learned social support-related strategies (i.e., praise and modeling of healthy eating). Child perceived family encouragement and discouragement for healthy eating, child diet quality (via 24-hour recalls), and child weight were assessed pre- and post-FBT. Results: Family encouragement for healthy eating increased during FBT, and this increase was related to increases in child healthy vegetable intake and overall diet quality, as well as decreases in refined grains consumed. Low pre-FBT family encouragement predicted greater increases in healthy vegetable intake, greater weight reduction, and greater increases in family encouragement for healthy eating. Family discouragement for healthy eating did not change during treatment nor did it predict dietary or weight outcomes. Conclusions: FBT successfully improves family encouragement, which is associated with improvements in child diet. Furthermore, even children who began treatment with low family encouragement for healthy eating show great improvements in dietary intake and weight during treatment. Results suggest that changes in child eating behavior during treatment is influenced by active, positive parenting techniques such as praise of healthy eating rather than negative family support.

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Objective. To determine the prevalence of social isolation and associated factors in graduate and professional health science students. Methods. Quantitative and qualitative data were gathered via an online survey from graduate and professional students in the colleges of dentistry, medicine, nursing, pharmacy, and public health at a Midwestern university. Questions assessed students' demographics, weekly activity hours, support systems, and financial concerns, and included the 20-item UCLA Loneliness Scale. Logistic regression was performed using the binary outcome of feeling socially isolated (yes/no) and examined program-related respondent comments using thematic analysis. Results. There were 427 survey respondents with 398 completing the full survey. Students answering the social isolation question (n=386) were included in the regression analysis. Nearly one-fifth (19.4%) of respondents indicated social isolation, with the highest percentage among nursing respondents (40.7%). Lacking a strong support, being a non-native English speaker, having caregiving responsibilities, and experiencing "lonely" items described in the UCLA Loneliness Scale were positively associated with social isolation. The ability to discuss feelings with friends in their professional program and experiencing "non-lonely" items were negatively associated with social isolation. Ninety-six comments revealed nine risk factor themes in four categories: individual (feeling different from peers, personality, employment), interpersonal (competition/exclusionary atmosphere, faculty relationship), organization (too busy with coursework, isolating program) and community (relocation reduces social support). Student-involvement in organizations (activities encouraging socialization) and community (support from outside the group) were protective factors. Conclusion. Understanding associated factors and designing strategies to reduce student social isolation may enhance the quality and well-being of future health professionals and scientists.

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