Pharmacists and Chemsex: A Knowledge Gap With a Twist
Turns out the best predictor of chemsex knowledge among community pharmacists isn't training or education — it's having actually been asked about it. Which is a problem, because 86% of the 261 French pharmacy professionals surveyed had never received a single chemsex-related question.
This regional French KAP survey — the first of its kind in pharmacy settings — found that only 67% could define chemsex, and 68% incorrectly flagged cannabis or hallucinogens as core chemsex substances, suggesting many conflate "drugs during sex" with the specific harm profile chemsex describes. Meanwhile, 69% felt unable to manage drug interactions, and only 18% recognized intravenous injection ("slamming") as part of chemsex — notable given that pharmacies already dispense sterile injection kits.
The unexpected finding: professionals who had previously fielded a chemsex-related request scored lower on perceived resource adequacy. The authors are careful not to over-interpret this, noting reverse causality is possible — but it hints that direct exposure sharpens awareness of how little structured support exists.
CYP450-mediated interactions with antiretrovirals remain an underappreciated knowledge gap. As the authors put it: "the discrepancy between low demonstrated knowledge of drug–drug interactions or reference resources and high self-reported referral capacity further suggests that professionals may conceptualise chemsex primarily as a psychosocial issue requiring referral, potentially overlooking medication-safety responsibilities at the point of dispensing."
The takeaway: harm reduction already runs through pharmacies. Whether chemsex-specific training could activate that infrastructure is a question this study raises — but doesn't yet answer.
Source: BMJ Open
Your Gut Knows When You've Taken a Hit
Football players absorb hundreds of head impacts a season that never get called concussions — and it turns out their gut microbiomes may be keeping score.
A new Colgate University study tracked six NCAA Division I football players across a full competition season, monitoring every helmet impact alongside fecal microbiome samples. Players averaged 261 head impacts and an impact load score of 6,308 per season. Within 48 to 72 hours of high-impact sessions, the microbiome showed measurable shifts from baseline — and 2 taxa, Prevotellaceae and Prevotella, showed correlations with impact load that survived multiple-testing correction. Three others (Coriobacteriales, Ruminococcus, Verrucomicrobiales) showed associations that didn't hold after adjustment.
The sneaky part: microbiome composition drifted across the season even in the complete absence of diagnosed concussions — suggesting cumulative sub-threshold hits may matter biologically, not just clinically.
Why? The authors lean on prior TBI literature suggesting Prevotella depletion may reduce short-chain fatty acid and butyrate production, potentially compromising blood-brain barrier integrity. But that mechanistic thread remains undemonstrated here. As the authors put it, these findings suggest "NHIs may nudge the gut microbiome towards an inflammation-promoting state that could contribute to longer-term neurological consequences."
Significant caveats apply: six participants, no control group, and statistical power under 3%. This is a signal worth watching, not a practice-changer — but for clinicians working with contact sport athletes, it's a compelling reason to take sub-concussive exposure seriously.
Source: PLOS One
PMS and psychiatric illness keep putting each other first
Nearly half of the women who received a clinical premenstrual disorder diagnosis had a prior psychiatric diagnosis on record — and the arrow points both ways with almost the same force.
A Swedish nationwide cohort study following 3.6 million women found that a prior psychiatric disorder roughly doubled the odds of later getting a premenstrual disorder (PMD) diagnosis (OR 2.41). Flip the timeline: women diagnosed with PMD had a 2.23-fold higher hazard of developing a new psychiatric condition over a mean follow-up of 8.2 years. The associations were strongest for depression (HR 2.70), anxiety (HR 2.43), ADHD (HR 3.55), bipolar disorder (HR 3.36), and personality disorder (HR 3.34).
The sneaky part: When researchers compared affected women only to their unaffected full sisters — controlling for shared genes and childhood environment — the associations held up. Attenuated, yes, but still there (HR 1.82). Shared family factors alone don't explain this. And schizophrenia? No association in either direction, which raises its own questions.
The proposed mechanisms involve HPA axis dysregulation, fluctuating estrogen and progesterone acting on serotonin, dopamine, and GABA systems, and likely some shared genetic architecture. For ADHD and autism, delayed diagnosis in women may also inflate apparent post-PMD detection rates.
Clinical takeaway
The authors stop short of a formal screening recommendation, but call for "raising awareness among health care providers on the higher risk of co-occurrence." The data make a reasonable case for heightened vigilance: a PMD diagnosis in the chart is worth a second look at mood, anxiety, and attention — and vice versa.
"These findings suggest that PMD and psychiatric disorders share bidirectional associations, highlighting the need for sex-specific and menstrual cycle–informed approaches in psychiatric assessment and care."— Zhou, Muse, et al.
Source: JAMA Network Open
The Unwritten Rules of Calling a Colleague
A new qualitative study out of Iran embedded researchers inside a national ob-gyn teleconsultation network and interviewed 16 physicians about what actually happens cognitively when 2 doctors try to reason through a case over a voice-only phone call. No video. No physical exam. Just words. What emerged was a five-pillar framework: data collection and sharing, situation analysis, collaborative decision-making, ethical and emotional factors, and resource logistics.
Here's the sneaky part: the most interesting finding isn't about technology at all. It's about cognitive bias. Physicians described callers who had already made up their minds and were essentially fishing for confirmation — selectively presenting data that favored their working diagnosis. The study calls this "error awareness," and it lives inside the consulting physician's head, largely unacknowledged.
The emotional load also flew under the radar. Residents reported significant stress just getting the consultant on the phone.
The authors conclude that "successful teleconsultation relies not merely on technological infrastructure but critically on a complex interplay of human, cognitive and ethical factors."
The clinical implication: remote consultation is a sophisticated, largely self-taught skill set — and formal training rarely addresses it.
Source: BMJ Open