[Update on current care guidelines: Self-medication, Current Care Guideline]

Self-medication should always be temporary. Self-medication can be used to relief or treat many symptoms and conditions. In general self-medication is safe when used properly. However all medicines may cause adverse events or have interactions with other drugs. It is important to consider all used drugs and other self-medication products when new drugs are added to the medication list. Persons using the drugs as well as health care personnel should be aware of benefits and harms of drugs.The guideline has recommendations for 10 symptoms that are typically treated with self-medication.

Self-medication in Central Saudi Arabia. Community pharmacy consumers' perspectives

Objectives:

To determine the prevalence of self-medication and assess the knowledge, attitudes, and perception of consumers toward self-medication.

Methods:

This cross-sectional survey was conducted over 4 weeks in May 2011 in Riyadh city, Kingdom of Saudi Arabia. Community pharmacies within 5 areas of the city (North, South, West, East, and Middle) were randomly selected for the study. All consumers were approached to participate in the study, with the exception of those buying cosmetic and medicinal equipments. A validated self-administered questionnaire was used to collect the data.

Results:

A total of 538 out of 707 consumers attending community pharmacies in Riyadh city, agreed to participate in the study. Most responders were male (73%), 23-33 years old (35%), and college graduates (42%). A total of 285 medications were bought without a prescription. Of these, 149 (49%) medications should be dispensed by prescription only, and 155 (51%) were over the counter medications. The most common prescription medications dispensed without prescriptions were antibiotics (22%) and analgesics/antipyretics (19%). The most common reasons for buying medications without a prescription were that the symptoms were too minor to visit a doctor (54%), time saving (40%), and minor illnesses for which the participants knew the required treatment (40%). Overall, most participants had poor knowledge, and negative perceptions regarding self-medication. More than 68% of participants did not know whether the medicine they bought is a prescription-only or over the counter medication.

Conclusion:

Irresponsible self-medication is common in Saudi Arabia. Future studies should focus on improving the consumers’ awareness of self-medication and the proper use of medications.

Medicine-taking experiences and associated factors: comparison between Arabic-speaking and Caucasian English-speaking patients with Type 2 diabetes

AIM

The aim of this study was to explore and compare medication-taking experiences and associated issues in Arabic-speaking and Caucasian English-speaking patients with Type 2 diabetes in Australia.

METHODS

Various healthcare settings in metropolitan Melbourne, Australia, were purposefully selected to obtain a diverse group of participants with Type 2 diabetes. Recruitment occurred at diabetes outpatient clinics in two tertiary referral hospitals, six primary care practices and ten community centres. Face-to-face semi-structured individual interviews and group interviews were employed. All interviews were audiotaped, transcribed and coded thematically. Data collection continued until saturation was reached.

RESULTS

In total, 100 participants were recruited into two groups: 60 were Arabic-speaking and 40 were Caucasian English-speaking. Both groups had similar demographic and clinical characteristics. Only 5% of the Arabic-speaking participants had well-controlled diabetes compared with 17.5% of the participants in the English-speaking group. Arabic-speaking participants actively changed medication regimens on their own without informing their healthcare professionals. Arabic-speaking patients had more knowledge gaps about their prescribed treatments, compared with the English-speaking group. Their use of diabetes medicines was heavily influenced by peers with diabetes and family members; conversely, they feared revealing their diagnosis within the wider Arabic community due to stigma and collective negative social labelling of diabetes. Confidence in non-Arabic-speaking healthcare providers was lacking.

CONCLUSIONS

Findings yielded new insights into medication-taking practices and associated factors in Arabic-speaking patients with diabetes. It is vital that healthcare professionals working with Arabic-speaking patients adapt their treatment approaches to accommodate different beliefs and views about medicines.

[Epidemiology, pathophysiology, and symptoms of headaches]

According to representative analyses about 71% of people in Germany suffer from headaches at least occasionally during their life. There are about 9 million people suffering from migraine and about 29 million people who have tension-type headache. These data underline the great socio-economic importance of these types of headaches. In principle the primary headache disorders migraine (with and without aura) as well as the episodic tension-type headache are indications for self-medication. In order to professionally guide these patients, the pharmacist requires a profound knowledge about the different types of headaches and their origin.

[Pharmacotherapy of headache apart from self-medication]

The pharmacotherapy of headache differentiates between self-medication and prescribed medication. Furthermore, pharmacotherapy has to consider the different headache disorders. In this article, the evidence-based treatment recommendations of the German Migraine and Headache Society for the different idiopathic headache disorders including trigeminal neuralgia are described. In addition, for most headache disorders acute and preventive medication has to be differentiated. It has to be noted that acute mediation against headache should not be taken too frequently and that in chronic headache disorders most often only a multimodal treatment results in a sufficient pain reduction.

[Self-medication of headaches]

Of the relevant people suffering from headaches only about 20% consult a physician until the age of 35. Accordingly, the pharmacy poses the most commonly used contact point for the consultation of patients with headaches. Besides the therapy of headaches with non-opioid analgesics, including non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen and analgesics without anti-inflammatory action such as paracetamol, two triptans are available for self-medication of prior diagnosed migraine. The professional guidance of patients in using these drugs requires a subtle knowledge of contraindications, unwanted side effects and interactions.

Herbal self-medication use in patients with diabetes mellitus type 2

BACKGROUND/AIM

A considerable number of patients suffering from diabetes mellitus (DM) turn to self-medication using medicinal plants, preparations, and medicine. The aim of this study was to investigate self-medication using medicinal plants and the potential influence of health care professionals' advice or media information regarding the use of herbal dietary supplements with hypoglycemic effect in a population of patients with type 2 DM.

MATERIALS AND METHODS

This research, in the form of an analytic cross-sectional study, was conducted in 6 pharmacies in the territory of Nis, Serbia, during October 2013. The criterion set for the study was to include patients diagnosed with type 2 diabetes who used pharmacotherapy in addition to herbal supplements.

RESULTS

Surveyed women showed a statistically significant difference in the frequency of using herbal supplements compared to men (P < 0.001). More frequent symptoms of hypoglycemia were reported in the group of diabetic respondents who used herbal dietary supplements (P < 0.05). The media was most responsible for influencing decisions about self-medication that included the use of herbal dietary supplements.

CONCLUSION

The role of health professionals is indispensable and very important, especially when the media is a potential cause of seeking self-medication.

Where Failure Is Not an Option -Personalized Medicine in Astronauts

Drug safety and efficacy are highly variable among patients. Most patients will experience the desired drug effect, but some may suffer from adverse drug reactions or gain no benefit. Pharmacogenetic testing serves as a pre-treatment diagnostic option in situations where failure or adverse events should be avoided at all costs. One such situation is human space flight. On the international space station (ISS), a list of drugs is available to cover typical emergency settings, as well as the long-term treatment of common conditions for the use in self-medicating common ailments developing over a definite period. Here, we scrutinized the list of the 78 drugs permanently available at the ISS (year 2014) to determine the extent to which their metabolism may be affected by genetic polymorphisms, potentially requiring genotype-specific dosing or choice of an alternative drug. The purpose of this analysis was to estimate the potential benefit of pharmacogenetic diagnostics in astronauts to prevent therapy failure or side effects.

Self-Medication for Dermatologic Diseases among Children Treated at the HRH Princess Maha Chakri Sirindhorn Medical Center

BACKGROUND

Skin diseases are one of the common problems in Pediatrics Outpatient Department. Because self-medication is practiced, it raises concerns of incorrect self-diagnosis, adverse drug reactions, and the cost of self-treatment. The aim of this study was to investigate the prevalence and the features of self-medicating for skin diseases among children who were observed at the dermatology clinic.

MATERIAL AND METHOD

This prospective study was conducted in the Pediatric Outpatient Department. All patients seen on a first visit for skin problems were recruited, interviewed, and examined.

RESULTS

Four hundred thirty seven patients were recruited in the study and the mean age was 4.6 years of age. Eczema was the most common diagnosis (43.7%), followed by fungal skin infections (7.1%), insect bites and infestations (6.9%), and bacterial skin infections (6.2%). Of all the patients, 204 (46.7%) had used self-medication. The most common reasons for self-medicating were convenience (82.3%), a friend and/or relative's recommendation (15.2%), and avoiding the cost of doctors' visits (2.0%). The most frequently encountered categories of medicines were topical corticosteroids (25.4%), antifungal agents (13.4%), antibacterial agents (8.2%), and others. Most products were obtained from pharmacies (66.2%). The average cost for self-medications was 204.7 Thai baht. Products applied by the topical route were the most common medications used (81.3%) and most patients had reported dissatisfaction with the results (95.1%). Adverse reactions resulting from self-medications were found to be at a rate of 17.1%. There were no significant relationships (p > 0.05) between the practice of self-medication and the potential factors.

CONCLUSION

Self-medication use is most prevalent. Most patients had reported dissatisfaction from the use of self-medications. Adverse reactions resulting from self-medication were also found.

OPINIONS AND ATTITUDES OF CZECH CITIZENS ON SELECTED ISSUES OF DRUGS IN SOCIETY

The social sciences within health care and pharmacy provide various points of view on issues often managed by professionals both inside and outside of the health care system. This multidisciplinary perspective often leads to divergent views and sometimes seemingly contradictory viewpoints and solutions. This paper is devoted to the opinions and attitudes of Czech citizens on selected issues of healthcare and pharmacy, the elucidation of which could be a source for understanding the relationships among participants in our pluralist health care system as a whole. This article presents the results of a sociological survey featuring a representative sample in terms of gender, age and region of 1,797 respondents from the Czech population aged 15 and over. The research is focused on the issues of self-medication, choice of pharmacy, out of pocket expenditures on prescription drugs and over-the-counter medicines, experiences with side effects and finally an evaluation of patient comprehension of information leaflets accompanying health care products. According to the results presented here, at the onset of a health problem most of the population tries to treat the condition themselves before seeing a doctor (54.1% always, 30.9% sometimes). Over-the-counter drugs are purchased generally in classic pharmacies without self-service (96.1%). The choice of pharmacy is determined primarily by proximity, with much less importance placed on personal experience or lower price. According to the survey, Czechs spend around 150 CZK (€ 5.9) for over-the-counter medicines and around 143 CZK (€ 5.6) for prescription drugs per month; 77.9% of Czech citizens were shown to understand the information provided on package leaflets. These data help to understand the perception, orientation and behavior of the patient in the healthcare system, with the ultimate goal of leading to higher system effectiveness as well as greater satisfaction for all parties involved.

Women's interpretation of and responses to potential gynaecological cancer symptoms: a qualitative interview study

OBJECTIVE

To explore women's experiences of symptoms potentially indicative of gynaecological cancer in a community-based sample without imposing a cancer perspective.

DESIGN

A qualitative interview study with thematic analysis of transcripts.

PARTICIPANTS

26 women aged ≥30 years, who had experienced a symptom that might indicate gynaecological cancer in the past 3 months, were recruited using a screening questionnaire distributed online and in community settings.

SETTING

London, UK.

RESULTS

Women attributed gynaecological symptoms to existing illnesses/conditions or considered themselves to be predisposed to them, either through their 'genes' or previous personal experience. Normalising symptoms by attributing them to demographic characteristics (eg, age, sex) was common, as was considering them a side effect of hormonal contraception. When women raised cancer as a possible cause, they often dismissed it as unlikely. Responses to symptoms included self-management (eg, self-medicating, making lifestyle changes), adopting a 'lay system of care', or consulting a healthcare professional. Triggers to help-seeking included persistent, painful or debilitating symptoms, concern about symptom seriousness, and feeling that help-seeking was legitimised. Barriers to help-seeking included lack of concern, vague symptoms, unusual symptom location, competing time demands, previous negative experiences with the healthcare system, and not wanting to be perceived as a time-waster.

CONCLUSIONS

Attributions of symptoms potentially indicative of a gynaecological cancer were varied, but most often involved women fitting symptoms into their expectations of what was 'normal'. Normalising acted as a barrier to seeking help from a healthcare professional, alongside competing time demands and negative attitudes towards help-seeking. These barriers may lead to later diagnosis and poorer cancer survival. Our findings could be used to inform the development of interventions to encourage appropriate help-seeking.

KNOWLEDGE, ATTITUDE AND PERCEPTION REGARDING ANTIBIOTICS AMONG POLISH PATIENTS

Antibiotics are drugs often used. This drugs used without legitimate indications or incorrectly may cause not satisfactory clinical results. It is therefore important for the society members to be aware of what is an antibiotic and which benefits and risks its use may bring. The survey was conducted in 2010. Objective of the study was to obtain information on the current knowledge and beliefs about antibiotic therapy of Poles. The research material consisted of 609 questionnaires and interviews, conducted among the adult population residing in the Lublin voivodeship. The study shows that rural inhabitants don't know the term herbal medicine or antibiotic more often than inhabitants in the city. Similarly, they more often don't know the action of antibiotics as well as use them less frequently. Poles treat them as an emergency exit if they are not helped by home treatments. There was a problem of overuse of antibiotics, related to young people, which were busy and have no time for illness. Self-medication in the antibiotic therapy also occurs and is caused, among others, by undisciplined patients. The respondents admited that they have antibiotics from the previous treatment, from pharmacy, or from family or friends. However, residents of rural areas using an antibiotic most frequently, cited a pharmacy as the source of this drug. Other issues dealt within this study generally doesn't differ for rural inhabitants from the data obtained among the urban population.

Diving behavior and fishing performance: the case of lobster artisanal fishermen of the Yucatan coast, Mexico

An average of 209 cases of decompression sickness (DCS) have been reported every year among artisanal fishermen. divers of the Yucatan Peninsula, Mexico. DCS is a major problem among fishermen divers worldwide. This paper explores how diving behavior and fishing techniques among fishermen relate to the probability of experiencing DCS (Pdcs). Fieldwork was conducted in two communities during the 2012-2013 fishing season. Fishermen were classified into three groups (two per group) according to their fishing performance and followed during their journeys. Dive profiles were recorded using Sensus Ultra dive recorders (Reefet Inc.). Surveys were used to record fishing yields from cooperative and individual fishermen along with fishing techniques and dive behavior. 120 dives were recorded. Fishermen averaged three dives/day, with an average depth of 47 ± 2 feet of sea water (fsw) and an average total bottom time (TBT) of 95 ± 11 minutes. 24% of dives exceeded the 2008 U.S. Navy no-decompression limit. The average ascent rate was 20 fsw/minute, and 5% of those exceeded 40 fsw/minute. Inadequate decompression was observed in all fishermen. Fishermen are diving outside the safety limits of both military and recreational standards. Fishing techniques and dive behavior were important factors in Pdcs. Fishermen were reluctant to seek treatment, and symptoms were relieved with analgesics.

Peak ages of risk for starting nonmedical use of prescription stimulants

BACKGROUND

To produce population-level, year- and age-specific risk estimates of first time nonmedical use of prescription stimulants among young people in the United States.

METHODS

Data are from the National Surveys on Drug Use and Health 2004-2012; a nationally representative probability sample survey administered each year. Subpopulations included youths aged 12 to 21 years (n=240,160) who had not used prescription stimulants nonmedically prior to their year of survey assessment. A meta-analytic approach was used to produce population-level age-, year-, and cohort-specific risk estimates of first time nonmedical use of prescription stimulants.

RESULTS

Peak risk of starting nonmedical use of prescription stimulants was concentrated between ages 16 and 19 years, when an estimated 0.7% to 0.8% of young people reported nonmedical use of these medicines for the first time in the past twelve months. Smaller risk estimates ranging from 0.1% to 0.6% were observed at ages 12 to 15 years and 20 to 21 years. Compared with males, females were more likely to have started nonmedical use of prescription stimulants (odds ratio=1.35; 95% CI, 1.13-1.62), particularly between the ages of 14 and 19. Females showed a peak annual incidence rate of 1% at age 18, while males the same age showed an incidence rate of 0.5%.

CONCLUSIONS

Peak annual incidence rates for nonmedical use of prescription stimulants were observed between the ages of 16 and 19 years. There is reason to initiate interventions during the earlier adolescent years to prevent youths from starting nonmedical use of prescription stimulants.

Is 'self-medication' a useful term to retrieve related publications in the literature? A systematic exploration of related terms

BACKGROUND

Self-Medication (SM), i.e. using medications to treat oneself, is a major concern for health researchers and policy makers. The terms "self medication" or "self-medication" (SM terms) have been used to explain various concepts while several terms have also been employed to define this practice. Hence, retrieving relevant publications would require exhaustive literature screening. So, we assessed the current situation of SM terms in the literature to improve the relevancy of search outcomes.

METHODS

In this Systematic exploration, SM terms were searched in the 6 following databases and publisher's portals till April 2012: Web of Science, Scopus, PubMed, Google scholar, ScienceDirect, and Wiley. A simple search query was used to include only publications with SM terms. We used Relative-Risk (RR) to estimate the probability of SM terms use in related compared to unrelated publications. Sensitivity and specificity of SM terms as keywords in search query were also calculated. Relevant terms to SM practice were extracted and their Likelihood Ratio positive and negative (LR+/-) were calculated to assess their effect on the probability of search outcomes relevancy in addition to previous search queries. We also evaluated the content of unrelated publications. All mentioned steps were performed in title (TI) and title or abstract (TIAB) of publications.

RESULTS

1999 related and 1917 unrelated publications were found. SM terms RR was 4.5 in TI and 2.1 in TIAB. SM terms sensitivity and specificity respectively were 55.4% and 87.7% in TI and 84.0% and 59.5% in TIAB. "OTC" and "Over-The-Counter Medication", with LR+ 16.78 and 16.30 respectively, provided the most conclusive increase in the probability of the relevancy of publications. The most common unrelated SM themes were self-medication hypothesis, drug abuse and Zoopharmacognosy.

CONCLUSIONS

Due to relatively low specificity or sensitivity of SM terms, relevant terms should be employed in search queries and clear definitions of SM applications should be applied to improve the relevancy of publications.

The relationship between bipolar disorder and cannabis use in daily life: an experience sampling study

Objectives

Although cannabis use is common in bipolar disorder and may contribute to worse clinical outcomes, little is understood about the relationship between this drug and bipolar disorder over the course of daily life. The aim of study was to examine the effect of cannabis on affect and bipolar symptoms in a group of individuals with bipolar disorder.

Methods

Twenty-four participants with bipolar disorder type I or type II completed diaries for 6 days using Experience Sampling Methodology to investigate the temporal associations between cannabis, affect and bipolar disorder symptoms.

Results

The results indicated that higher levels of positive affect increase the odds of using cannabis (OR:1.25 ,CI:1.06–1.47, P=0.008). However, neither negative affect, manic nor depressive symptoms predicted the use of cannabis. Cannabis use was associated with subsequent increases in positive affect (β=0.35, CI:0.20-0.51, P=0.000), manic symptoms (β=0.20,CI:0.05-0.34, P=0.009) and depressive symptoms (β= 0.17,CI:0.04-0.29, P=0.008).

Conclusion

The findings indicate that cannabis use is associated with a number of subsequent psychological effects. However there was no evidence that individuals with BD were using cannabis to self-medicate minor fluctuations in negative affect or bipolar disorder symptoms over the course of daily life. The findings in relation to existing literature and clinical implications are discussed.

[The interaction of Rhodiola rosea and antidepressants. A case report]

OBJECTIVE

Rhodiola rosea (Russian Rhodiola/Golden Root) is a high mountain plant from the arctic regions of Europe and Asia which has the active substance phenylpropanoide. It has sedative, anti-depressive, drive-enhancing and stress-modulated properties stimulating the distribution of dopamine and serotonin; in combination with other drugs, an increase of side effects and risk profile has to be expected.

METHODS

A case report is presented in order to illustrate the interaction between Rhodiola rosea and antidepressants.

RESULTS

We report the case of a 68-year-old female patient with recurrent moderate depressive disorder with somatic syndrome (ICD-10 F33.11) who developed vegetative syndrome, restlessness feeling and trembling since she began to ingest Rhodiola rosea in addition to paroxetine.

CONCLUSIONS

Prescribing Rhodiola rosea with paroxetine, pharmacokinetic and -dynamic interactions have to be assumed. The symptoms of the patient can be interpreted as a serotonergic syndrome. Because of its different effects, the plant is widely used. An increase of clinical relevant risks should be considered in the add-on treatments.

[Self-medication in smoking cessation among smokers]

INTRODUCTION

According to the World Health Organization defines self-medication by using OTC (over-the-counter) to treatment diseases or symptoms recognized by yourself without pay a visit to the doctor's office. Increasing availability of OTC medicines cause that Poles are more and more willing to take self-medication, even when they want to smoking cessation. The aim of the study was to investigate what nicotine replacement therapy for smoking cessation without prescription were chosen by smokers, who wanted without help to smoking cessation.

MATERIALS AND METHODS

The study included 323 people (68.1% were men and 31.9% women). The average age of respondents was 49 +/-11 years. The average pack-years in the study group was 17. The research tool was the author's questionnaire, which was distributed among patients for self- fulfillment. Subjects were divided into three groups: group I up to 10 pack-years (average 7.5 pack-year), group II between-11-20 pack-years (average 15.5 pack-year), group III--between 21-35 pack-year (average 28.5 pack-year).

RESULTS

All subjects, at least once in their lives, bought OTC for self-medication nicotine addiction. Among the respondents in I and II group the most often chose the nicotine replacement therapy in the form of chewing gum, and in III group Cytisine tablets and pills nicotine (p<0.001). One-time purchase of OTC in group I decided 54%, in group II 47.5% and in III group 46.6% of respondents. The number of preparations used in each group was 3.1 in group I; 3.6 in group II, and 3.3 among subjects in the group III (p<0.001). 94% of respondents dissatisfied with the results of treatment ended after 1 month to self-medication. A strong self-motivation to smoking cessation was declared by 78.3% of respondents. On the other hand, Schneider test was positive in only 5% of patients.

CONCLUSIONS

Smokers want to own attempt to smoking cessation by using nicotine preparations without a prescription, should be aware that self-assessment of readiness to smoking cessation is not a real preparation to quit smoking addiction. All the more should consult a doctor if subsequent attempts fail.

[Alleged suicide by insulin]

A 26-year-old man, who was on probation, was found dead in his home by his mother. Insulin vials and 2 insulin pens, which the man's stepfather (an insulin-dependent diabetic) had been missing for over a week, were found next to the deceased. The circumstances suggested suicide by an injected insulin overdose. At the time of the autopsy, the corpse showed already marked signs of autolysis. Clinical chemical tests confirmed the injection of insulin, but indicated hyperglycemia at the time of death. Toxicological analyses revealed that the man had consumed amphetamine, cannabinoids, and tramadol in the recent past. Histological examination finally revealed extensive bronchopneumonia as the cause of death. The most plausible explanation for the results of the autopsy and the additional examinations was an injection of insulin as a failed attempt of self-treatment. It is conceivable that the man had discovered by a rapid test that he was a diabetic, but had decided not to go to a doctor to avoid disclosure of parole violation due to continued drug abuse. He may have misinterpreted the symptoms caused by his worsening bronchitis and the developing bronchopneumonia as symptoms of a diabetic metabolic status and may have felt compelled to treat himself with insulin.

Use of selected OTC drugs: comparing Greece and the Czech Republic

The use of OTC (over-the-counter) drugs containing Ibuprofen and Paracetamol in solid peroral dosage forms was researched. The questionnaire was distributed in 6 pharmacies in Athens, pharmacists interviewed the patients and recorded the answers from June to August 2014. Data from 50 patients for each substance were gathered and analyzed. The most of purchasers of Paracetamol bought it repeatedly (70.00% of respondents); Ibuprofen was preferred to be used in treating headache (81.82% of repeated users, 35.29% of the first time users), and both of the researched drugs were used with almost equal frequency in treating toothache and muscle and joint pain. Ibuprofen is used to treat awider range of symptoms than Paracetamol. People buying Paracetamol for the first time assume that it is free of side effects (73.33%) and people using it repeatedly did not observe any side effects (88.57%). The results were compared with the same research performed in the Czech Republic several years ago. Differences were detected in expecting side effects of Paracetamol (26.67% in Greece, 54.84% in the CR) and in using Ibuprofen to treat muscle and joint pain (17.65% in Greece, 47.60% in the CR).Key words: self-medication paracetamol ibuprofen Greece.