Self-Care Practices with Psychedelics - A Qualitative Study of Users' Perspectives

This article explores the psychedelic experience from the users' point of view and through the lens of self-care, a concept within the domain of health and well-being. In a time of renewed interest in psychedelic-assisted psychotherapy, we aim to contribute to a better understanding of these substances by exploring their role in different settings. A phenomenological approach was used in this study. We conducted semi-structured interviews with 19 psychedelic users and inquired about the relationship between their experiences and self-care. Analysis of the interview data was based on inductive content analysis. Most participants reported using psychedelics with self-care intentions in ceremonial, recreational, or private settings. Self-perception and existential meaningfulness were identified as the main mechanisms of self-care. Participants also mentioned difficult experiences and adversities that impair self-care. The results suggest that for some people, the use of psychedelics may be experienced as part of a self-care process and may improve self-care abilities in naturalistic settings.

In the midst of curricular revision, remember the importance of over-the-counter and self-care education

INTRODUCTION

Over-the-counter (OTC) and self-care products are frequently utilized by adult patients as initial treatment for common health issues. This availability of OTC/self-care products, coupled with the accessibility of community-based pharmacists, uniquely positions pharmacists to serve as stewards of appropriate OTC/self-care treatment. As a result, community-based pharmacists must be competent in the practice of providing individualized, patient-specific, OTC recommendations and self-care education to assist patients in achieving optimal self-managed health outcomes.

COMMENTARY

Schools and colleges of pharmacy often undergo curricular revision/integration. As a result, it is often necessary to reallocate credit hours dedicated to OTC/self-care content. Curriculum committees should therefore be aware of several best-practice resources that may assist them with this task.

IMPLICATIONS

The impact on OTC/self-care content during curricular revision/integration directly effects the preparation of graduate ready student pharmacists and ultimately patient's self-managed health outcomes. Considerations include appointing an OTC/self-care champion to oversee the integration of OTC/self-care content as well as post-revision monitoring to ensure core topic areas are being adequately covered in the didactic curriculum and in accordance with best practices.

Prevalence of Self Medication Practice among Dental Undergraduates in a Dental college

Introduction: Self-medication practice among future prescribers can cause a serious threat to thehealth care profession. There has been an increasing trend among medical and dental students forself-medication. The objective of our study was to find the prevalence and practice of self-medicationamong dental undergraduates in Kantipur Dental College and Teaching Hospital. Methods: A descriptive cross-sectional study was conducted among all the dental undergraduatestudents of Kantipur Dental College, Kathmandu, from July to September 2018. Ethical clearancewas obtained from the institutional review board. A convenience sampling method was used. A prevalidated questionnaire was handed to the students in their classroom to collect the data. The datawere analyzed using Statistical Package for the Social Sciences version 16 and Microsoft Excel 2010and presented as frequency and percentage. Results: The prevalence of self-medication among dental undergraduates was found to be in 150(83.3%) out of a total of 180 students who participated in the study. Conclusions: Self-medication was commonly practiced by dental students. Self-medication shouldbe considered as a serious threat, especially among the students with inadequate knowledge of drug,dose, and duration of treatment.

Primary dysmenorrhea and self-care strategies among Chinese college girls: a cross-sectional study

OBJECTIVES

To explore the prevalence of primary dysmenorrhea (PD), the characteristics of PD and self-care strategies for managing PD among Chinese college girls.

DESIGN

Cross-sectional study.

SETTING

Changsha, China.

PARTICIPANTS

A total of 2555 college girls were recruited using multistage cluster random sampling.

OUTCOME MEASURES

A self-report questionnaire was used to measure sociodemographic information, characteristics of PD and self-care strategies for managing PD. Additionally, a Visual Analogue Scale was used to measure pain severity.

RESULTS

Of the 2555 girls, 1306 had experienced PD, representing a 51.1% prevalence. In addition, the prevalence rates of mild, moderate and severe pain in PD were 18.1%, 27.7% and 5.4%, respectively. The most common symptoms associated with PD were cramps (96.9%), weakness (70.0%), backache (65.1%), facial blemishes (55.3%) and irritability (55.3%). Commonly used self-care strategies for managing PD comprised reducing physical activity (94.6%), keeping warm (84.6%), communicating dysmenorrhea with friends or classmates (79.0%), drinking warm beverages (75.7%) and avoiding cold drinks and foods (74.2%). In addition, only 34.8% self-medicated with Western medicine (15.6%), traditional Chinese medicine (8.6%), or both (10.6%). Medical advice was sought by 27.4% of subjects from a Western medical doctor (10.3%), a doctor of traditional Chinese medicine (13.6%), or both (3.5%). Girls who had greater pain severity were more likely to be self-medicated (OR=7.01; 95% CI 4.50 to 10.91), use complementary therapies (OR=2.64; 95% CI 1.70 to 4.10) and seek medical advice (OR=5.93; 95% CI 3.80 to 9.24).

CONCLUSIONS

PD is highly prevalent among Chinese college girls, with a high burden of symptoms. In addition, these girls are most likely to change their lifestyle, communicate dysmenorrhea with friends or mothers, use heat therapy and engage in self-talk, but less likely to self-medicate or seek medical advice for managing PD.

Implementation of Medication Event Reminder Monitors among patients diagnosed with drug susceptible tuberculosis in rural Viet Nam: A qualitative study

Background

Despite the criticality of adherence to tuberculosis treatment, there is paucity of rigorous experimental research exploring the efficacy of interventions to promote adherence and a greater lack of inquiry addressing the integral role of adherence behaviour. The aim of this formative study was to examine the way in which the Wisepill evriMED Medication Event Reminder Monitor (MERM) was used among outpatients with drug susceptible pulmonary tuberculosis.

Methods

In depth interviews were conducted with 20 outpatients receiving treatment from two public healthcare facilities in Thanh Hoa, a rural province in northern Viet Nam. Patients had been enrolled in a randomized controlled trial evaluating the effect of using the MERM device upon adherence for between 1–3 months. The control group used the device without an alert, while the intervention group used the device with a daily alert and scheduled dosing history review.

Findings

All 20 patients interviewed were supportive of using the MERM device. Those able to be at home at the time that their treatment was due (50%) used the device as intended. Patients who worked all reported separating the time when the box was opened from the time at which they ingested their medication. Patients expressed fidelity to the prescribed medication taking time and concerns regarding the portability of the device. Limitations of the study surround the inclusion of a small sample population that did not experience factors that further compromise adherence.

Conclusions

Data recorded by the box did not always accurately reflect usage patterns. The alert in the intervention arm was able to support adherence only in patients who did not work while completing their treatment. MERM implementation can be improved by better aligning prescriber instructions with patients’ daily routines, and increasing the use of adherence data to guide adherence support practices. Healthcare staff need to be aware of potential barriers to optimal use of MERM devices. A rigorous qualitative approach to formative assessment is essential to inform the scale up of new digital technologies.

Reasons for smoking and barriers to cessation among adults with serious mental illness: A qualitative study

AIMS

Most research into reasons for smoking among adults with serious mental illness (SMI) has focused on reasons related to SMI symptoms. The current study reports reasons for smoking and barriers to cessation that are both related and unrelated to SMI symptoms among adults with SMI.

METHODS

Four focus groups were conducted among current smokers receiving outpatient care for a psychotic disorder in 2017 (N = 24). Participants were asked why they currently smoke and their barriers to quitting smoking.

RESULTS

Smoking as a coping mechanism and to self-medicate SMI symptoms were reasons for current smoking and barriers to cessation. Avoidance of other unhealthy behaviors, routine, and enjoyment emerged as reasons for smoking and barriers to cessation that were unrelated to mental illness.

CONCLUSION

Consideration of factors that are both related and unrelated to SMI symptoms in smoking cessation interventions and brief cessation counseling may improve cessation success in this population.

Corticoïdes et culture: un cas d'épisode psychotique aigu cortico-induit

Les effets secondaires psychiatriques des corticoïdes sont décrits depuis longtemps. Certaines réactions sont sévères et concernent environ 5% des patients. Ces effets secondaires sont plus difficiles à évaluer lorsque le recours aux corticoïdes sort du cadre thérapeutique habituel et s'intègre dans une automédication en lien avec certaines influences culturelles. Nous rapportons le cas d'une jeune femme ayant présenté un épisode psychotique aigu dans les suites d'une auto-prise de corticoïdes dans un but de gain de poids. Nous discutons l'intérêt d'un diagnostique et d'une prise en charge précoce ainsi que l'importance du volet préventif multidisciplinaire, en particulier devant l'implication de l'aspect culturel dans l'observation présentée.

Implications of self-medication among medical students-A dilemma

OBJECTIVE

To evaluate the knowledge, attitude and practice of self-medication in medical undergraduate students.

METHODS

This cross-sectional questionnaire-based survey was conducted from January to June, 2017, among undergraduate students of Ayub Teaching Hospital, Women Medical College, International Medical College and Frontier Medical College in Abbottabad, Pakistan. The sample comprised students of first, second, third, fourth and fifth professional year. Data was collected using self-generated questionnaire.

RESULTS

Of the 400 subjects approached, 300(75%) returned the questionnaire fully completed. Of them, 208 (69.3%) were females and 92(30.66%) were males. The most common age group was 22-25 years 182(60.7%). Self-medication was found to be prevalent among 297(99%) subjects and 139(46.3%) respondents had practised self-medication in the preceding 6 months more than two times. Over-the-counter drugs were commonly used for the self-medication in 295(98.3%) cases. Overall, 285(95%) respondents had a positive attitude towards self-medication. Media was found to be the most common source of information for 93(31%) cases.

CONCLUSIONS

High prevalence of self-medication was noticed, with over-the-counter drugs being the most commonly used. Proper educational awareness programmes about self-medication can control the issue.

Medications that reduce emergency hospital admissions: an overview of systematic reviews and prioritisation of treatments

BACKGROUND

Rates of emergency hospitalisations are increasing in many countries, leading to disruption in the quality of care and increases in cost. Therefore, identifying strategies to reduce emergency admission rates is a key priority. There have been large-scale evidence reviews to address this issue; however, there have been no reviews of medication therapies, which have the potential to reduce the use of emergency health-care services. The objectives of this study were to review systematically the evidence to identify medications that affect emergency hospital admissions and prioritise therapies for quality measurement and improvement.

METHODS

This was a systematic review of systematic reviews. We searched MEDLINE, PubMed, the Cochrane Database of Systematic Reviews & Database of Abstracts of Reviews of Effects, Google Scholar and the websites of ten major funding agencies and health charities, using broad search criteria. We included systematic reviews of randomised controlled trials that examined the effect of any medication on emergency hospital admissions among adults. We assessed the quality of reviews using AMSTAR. To prioritise therapies, we assessed the quality of trial evidence underpinning meta-analysed effect estimates and cross-referenced the evidence with clinical guidelines.

RESULTS

We identified 140 systematic reviews, which included 1968 unique randomised controlled trials and 925,364 patients. Reviews contained 100 medications tested in 47 populations. We identified high-to moderate-quality evidence for 28 medications that reduced admissions. Of these medications, 11 were supported by clinical guidelines in the United States, the United Kingdom and Europe. These 11 therapies were for patients with heart failure (angiotensin-converting-enzyme inhibitors, angiotensin II receptor blockers, aldosterone receptor antagonists and digoxin), stable coronary artery disease (intensive statin therapy), asthma exacerbations (early inhaled corticosteroids in the emergency department and anticholinergics), chronic obstructive pulmonary disease (long-acting muscarinic antagonists and long-acting beta-2 adrenoceptor agonists) and schizophrenia (second-generation antipsychotics and depot/maintenance antipsychotics).

CONCLUSIONS

We identified 11 medications supported by strong evidence and clinical guidelines that could be considered in quality monitoring and improvement strategies to help reduce emergency hospital admission rates. The findings are relevant to health systems with a large burden of chronic disease and those managing increasing pressures on acute health-care services.

Treatment of Scabies and Pediculosis in Health Education Publications and Folk Medicine of Eastern Croatia - Slavonija, Baranja, and Western Srijem County

Scabies and pediculosis are common parasitic infestations of the skin and hair, manifesting with intense pruritus and effectively treated with modern medications. Because of the attached social stigma linking it with poverty and poor hygiene, patients will often attempt alternative folk-based remedies before confiding in their physicians. We conducted a comprehensive bibliographical study of historic folk literature and interviewed 70 individuals experienced in everyday application of folk medicine in order to categorize available remedies and provide a modern, scientific comment on their effectiveness and dangers. Compositions containing sulfur, copper sulfate, petroleum, coal, tar, and highly alkaline soaps and washing solutions undoubtedly have scabicidal and pediculicidal properties, but they are used either in high concentrations with greater possibility of intoxication and irritation or lower concentrations with questionable therapeutic benefit. These remedies, extracted from historical-cultural frameworks, are poorly adapted to modern standards and can lead to side-effects and complications. Physicians today have to be aware of the reasons their patients seek alternative remedies and know the substances and procedures they may use in self-healing, so as to be able to provide the help that may be needed if those complications occur.

Victimization, Suicidal Ideation, and Alcohol Use From Age 13 to 15 Years: Support for the Self-Medication Model

PURPOSE

Recent years have seen increased coverage of adolescent victimization and suicide. Both adolescent peer victimization and substance use have been associated with suicidal ideation, with evidence suggesting that all three factors are interrelated. There are at least four models which can explain the associations between these factors (i.e., self-medication, secondary mental disorder, bidirectional, and common factor). However, none of them is being empirically supported as the dominant model because few longitudinal studies have explored the association between these factors.

METHODS

The present study compared longitudinal paths of all four models simultaneously using a cross-lagged model. This was done using self-reported measures of peer victimization, suicidal ideation, and alcohol use at age 13, 14, and 15 years in a longitudinal sample of 238 adolescents.

RESULTS

All three variables were moderately stable across time. Significant cross-lagged associations were found, showing that frequent peer victimization at age 13 years was associated with higher odds of having suicidal ideation at age 14 years (odds ratio, 1.82; p < .05). In turn, presence of suicidal ideation at age 14 years was significantly associated with higher alcohol use frequency at age 15 years (β = .13; p < .05).

CONCLUSIONS

Results support previous literature suggesting that peer victimization predates alcohol use and extends it by showing clear directionality between suicidal ideation and alcohol use over 1 year, supporting the self-medication model. Clarifying the empirical basis of these underlying models could allow for earlier prevention strategies, by targeting the risk factor that appears the earliest in the model.

The determinants of self-medication: Evidence from urban Vietnam

This study examines the primary determinants of self-medications among urban citizens in Ho Chi Minh City, Vietnam using survey data. Employing logistic models, the article finds that the probability of self-medication is positively associated with the respondents' high school degree or vocational certificate, married status, and income while it is negatively related to employed status, the number of children, the geographical distance from home to the nearest hospital, doing exercise, and living in a central region. Meanwhile, using Poisson models the article finds that the frequency of self-medication is positively associated with the respondents' high school and vocational, married, income, and chronic disease while the frequency of self-medication is adversely related to male, employed, children number, distance, being close to health professional and central areas.

[Cross-sectional study of family drug stockpile and children medication in China]

OBJECTIVE

To investigate the current situation of family medicine stockpile and children medication in China, analyze the existing problems and provide the rationalized suggestions.

METHODS

The questionnaire was designed and convenient sampling survey was performed in 20 children hospitals in China. Descriptive analysis was conducted on the survey results.

RESULTS

A total of 13 940 completed questionnaires were returned, 98.33% of the families had medicine stockpile, the top three types of the medicine for children were cold medicine(73.95%), oral paregoric/febrifuge(48.01%)and external used drugs for skin disease(wound)(41.10%). The medicine was bought according to physician's prescription and guide(71.18%). Drug poisoning occurred in children of 238 families(1.71%), overdose use was the first cause(44.96%). 22.33% of the parents didn't read the specification carefully before medicine use. The non-appropriate medication for children were mainly the use of adult medicine(32.70%), untimely medication(30.90%), non-rational or unneeded use of febrifuge(26.35%).

CONCLUSIONS

In China, the families mainly store common medicine for their children. The parents bought medicine mainly according to physician' s prescription and paid attention to the safety and efficiency of the medicine, but non-appropriate use of medicine was still common. It is necessary to improve the rational use of medicine for children through expert counsel and guidance.

Sexually transmitted disease symptom management behaviours among female sex workers in Tashkent, Uzbekistan

The objective of this cross-sectional study was to assess prevalence and correlates of self-treatment of sexually transmitted diseases (STD) among female sex workers (FSW) in Tashkent, Uzbekistan. Enrolled FSW completed a self-administered questionnaire, HIV serologic testing and optional pelvic examination. STD diagnosis was based on physical examination and/or microscopic findings. Of 448 women, 337 (75.0%) accepted examination; of these, 316 (93.8%) received at least one STD-related diagnosis. Nearly half (45.4%) reported prior STD self-treatment, which was associated with HIV infection (age-adjusted odds ratio [AOR] = 3.20, 95% confidence interval [CI] = 1.45–7.53) and condom knowledge (AOR = 2.10, 95% CI = 1.16–3.80). For those with history of STD, immediate resumption of sex work before completing treatment was common (87.0%). STD self-treatment is common among FSW in Tashkent, particularly women with HIV infection. Confidential venues for STD care and condom utilization programmes targeted to FSW and their clients are needed to prevent STD in this setting.

Episodic oral antibiotic use in CF: Discordance between the electronic medical record and self-report

BACKGROUND

Accurate accounting of antibiotic use is necessary for studies comparing the CF airway microbiota across clinically relevant disease states. While poor adherence to chronic therapies is well described for individuals with CF, use patterns of episodic oral antibiotics are less clear.

METHODS

Eleven individuals with CF completed daily questionnaires regarding antibiotic use for a mean of 458days. Self-report of episodic oral antibiotic use was compared to antibiotic prescription data in the electronic medical record (EMR).

RESULTS

Self-reported use of episodic oral antibiotics differed from EMR data an average of 8.3% of days per subject. The majority of these discrepancies were due to self-reported use of oral antibiotics outside of the EMR-documented dates of antibiotic prescription.

CONCLUSIONS

Discrepancies exist between self-reported use of episodic oral antibiotics and EMR data that have implications for studies of the CF airway microbiota.

Use of a food allergy care management pathway in adolescents

The prevalence of allergic diseases is increasing, parents/carers. Healthcare staff also need training on with estimates suggesting that 3.9% of 0-19 year olds how best to deliver information to this age group and have a food allergy. Adolescents are seen as a high-risk to monitor them. More technically stylish adrenaline group for anaphylaxis because of their risk-taking auto-injectors, designed with the involvement of behaviours and challenges in using adrenaline adolescents, together with clearer food labelling, auto-injectors. The Royal College of Paediatrics would also help avoid episodes of anaphylaxis. and Child Health provides an allergy care pathway to assist health professionals with these issues. The pathway could be implemented more effectively with the adolescent age group if education on how to follow it was improved for young people and their parents/carers. Healthcare staff also need training on how best to deliver information to this age group and to monitor them. More technically stylish adrenaline auto-injectors, designed with the involvement of adolescents, together with clearer food labelling, would also help avoid episodes of anaphylaxis.

Self-medication Practice Amongst Patients Visiting a Tertiary-care Dental Hospital in Central India

PURPOSE

To assess self-medication practice-related awareness for correct usage and its association with demographic factors among patients reporting to a dental college.

MATERIALS AND METHODS

This descriptive cross-sectional questionnaire-based study was conducted among 300 patients reporting to the People's College of Dental Sciences and Research Centre, Bhopal, India. Only patients ≥ 18 years of age were included and consenting participants anonymously completed the questionnaire, with incomplete questionnaires being excluded from the study. The semi-structured questionnaire containing both open- and closedended questions was prepared in the local language and included demographic data, name of self-medication, frequency of self-medication, periods of illness, duration, dose, frequency of drug administration, symptoms for which drugs were used, satisfaction with healthcare facilities, source of information for self-medication, presence of chronic illness, adverse effects to self-medication seen in patients and drug interactions. The unpaired t-test and chi-square test were used for statistical analysis. p-values < 0.05 were considered statistically significant.

RESULTS

A significant association was seen between education and self-medication. It was observed that the subjects who fell ill more frequently consumed medications on their own more often. Medications were most commonly taken for cough, cold and fever. The most preferred medicine was paracetamol. Most of the subjects found the medicines effective in helping them relieve their symptoms. However, not even half of the subjects were aware of the dose, duration, side-effects or interactions of medicines. There was a significant association between knowledge about side-effects and side-effects experienced from medication. A significant association was also seen between knowledge about side-effects and frequency of self-medication.

CONCLUSION

Self-medication and non-doctor prescribing are relatively common in Bhopal. Knowledge regarding the appropriate usage of medication is inadequate. Education to help patients decide on the appropriateness of selfmedication is required.

Patient Acceptance of Self-Injected Enfuvirtide at 8 and 24 Weeks

PURPOSE

Enfuvirtide is the first of a new class of antiretrovirals called the fusion inhibitors. It is administered twice daily by self-injection. This study assessed patient acceptance of enfuvirtide self-injection.

METHOD

Patients (n = 661, intent-to-treat [ITT]) in two ongoing phase 3 trials were surveyed at treatment Weeks 8 and 24 using the Subcutaneous Injection Survey. This validated instrument contains 18 items measuring patients' assessment of ease of injection, impact on daily functioning, and activities of daily living.

RESULTS

The majority (65%-92%) of patients assessed all items relating to ease of injection as "very easy" or "easy" at both 8 and 24 weeks. Similarly, at both visits, the majority (69%-90%) of patients assessed their daily functioning as "not at all" or "a little" limited by enfuvirtide self-injection, and 96%-98% gave these assessments for impact on activities of daily living.

CONCLUSION

These findings indicate that most patients taking enfuvirtide in clinical trials learn to integrate enfuvirtide dosing in their daily routines; with appropriate education and training, enfuvirtide self-injection becomes routine with relatively little subjective impact on daily functioning and activities of daily living. Patient acceptance of self-injected enfuvirtide is high and does not decline over 24 weeks of therapy.

Augmented Reality: Real-Time Information Concerning Medication Consumed by a Patient

This paper describes a mobile prototype capable of recognizing characters from a photograph of a medication package. The prototype was built to work on the iOS platform and was developed using Objective-C and C programming languages. The prototype, capable of recognizing text out of an image, included image processing algorithms, text processing algorithms, and techniques to search and handle information from a database. This prototype is presented as an option for capturing reliable and validated information by using new technologies available to the general population.

Use of self-medication among adolescents: a systematic review and meta-analysis

BACKGROUND

We performed a systematic review and proportion meta-analysis in order to investigate the prevalence and the adverse effects of the self-medication among the teenagers.

METHODS

We selected observational studies published from January 1990 until January 2014 that examined the use of self-medication in the adolescents (aged from 13 to 18 years). Keywords used on PubMed, ISI Web of Knowledge and Scopus were 'self medication', 'adolescent*', 'self prescription', 'over the counter preparations' and 'self administration'.

RESULTS

Finally, 15 articles met the inclusion criteria, for a total of 143 213 subjects involved. Overall, 50% of adolescents use to take drugs without consulting a physician. Further analyses stratified by number of drugs used demonstrated that in the studies reporting that adolescents use more than one type of drug the prevalence rises up to 63%. Only one study reported the possible adverse effects related to the inappropriate use of drugs, which were experienced by 31.1% of the females and 19.6% of the males.

CONCLUSIONS

Self-medication use among adolescents is a widespread phenomenon. It would be advisable to give more attention on this public health concern and to promote initiatives, such as mass media campaigns and governmental actions, in order to make the citizens more aware to the risks related to the consumption of drugs without medical consultation. Further studies on adverse effects are urgently needed.

Ultrasound and MRI features of penile augmentation by "Jamaica Oil" injection. A case series

Penile paraffinoma is a rare but well-known entity. There have been few studies describing the ultrasound and MRI features of penile paraffinoma. In this case series we describe the imaging findings of 4 patients who self-injected "Jamaica oil" into their penises for the purpose of penile augmentation and discuss the utility of US and MRI in the management of these patients.

A Cases of Near-fatal Anaphylaxis: Parsley &#147;Over-use&#148; as an Herbal Remedy

The use of herbal products in patients with allergic diseases is a special problem and still controversial. But, many people often use herbs to maintain good health. The patients use self-prescribed remedies as medications but do not inform their physicians about herbal use. Unfortunately, some herbal self-medications may have unexpected effects and interactions which may lead to fatal complications. In this report, we describe a female patient who suffered near-fatal anaphylaxis to parsley.

Non-superiority of Kakkonto, a Japanese herbal medicine, to a representative multiple cold medicine with respect to anti-aggravation effects on the common cold: a randomized controlled trial

OBJECTIVE

Kakkonto, a Japanese herbal medicine, is frequently used to treat the common cold not only with a physician's prescription, but also in self-medication situations. This study aimed to examine whether Kakkonto prevents the aggravation of cold symptoms if taken at an early stage of illness compared with a well-selected Western-style multiple cold medicine.

METHODS

This study was a multicenter, active drug-controlled, randomized trial. Adults 18 to 65 years of age who felt a touch of cold symptoms and visited 15 outpatient healthcare facilities within 48 hours of symptoms onset were enrolled. The participants were randomly assigned to two groups: one treated with Kakkonto (Kakkonto Extract-A, 6 g/day) (n=209) and one treated with a Western-style multiple cold medicine (Pabron Gold-A, 3.6 g/day) (n=198) for at most four days. The primary outcome of this study was the aggravation of cold, nasal, throat or bronchial symptoms, scored as moderate or severe and lasting for at least two days within five days after entry into the study.

RESULTS

Among the 410 enrollees, 340 (168 in the Kakkonto group and 172 in the Pabron group) were included in the analyses. The proportion of participants whose colds were aggravated was 22.6% in the Kakkonto group and 25.0% in the Pabron group (p=0.66). The overall severity of the cold symptoms was not significantly different between the groups. No harmful adverse events occurred in either group.

CONCLUSION

Kakkonto did not significantly prevent the progression of cold symptoms, even when prescribed at an early stage of the disease.

A qualitative study about self-medication in the community among market vendors in Fuzhou, China

Despite government efforts to increase healthcare insurance and access in China, many individuals, regardless of insurance status, continue to engage in high levels of self-medication. To understand the factors influencing common self-medication behaviour in a community of food market vendors in Fuzhou China, a total of 30 market vendors were randomly recruited from six food markets in 2007. In-depth interviews were conducted with each participant at their market stalls by trained interviewers using a semi-structured open-ended interview protocol. Participants were asked broad questions about their health-seeking behaviours as well as their past experiences with self-medication and hospital care. ATLAS. ti was used to manage and analyse the interview data. The results showed that hospital-based healthcare services were perceived as better quality. However, self-medication was viewed as more affordable in terms of money and time. Other factors prompting self-medication, included confidence in understanding the health problem, the easy accessibility of local pharmacies and the influences of friends/peers and advertising. Three broad domains, attitude, cost and effectiveness, were all seen to determine past decisions and experiences with self-medication. Interestingly, the effective management of self-medication via pharmacy resources raised particular concern because of perceived variation in quality. In conclusion, self-medication was found to be an important and common health-seeking behaviour driven by multiple factors. A sound and comprehensive public health system should systematically attend to these behaviours and the pharmacies, where much of the behaviour occurs.

The prevalence of herbs use in conjunction with conventional medicines in Jamaica

Due to the global rise in the popularity of herbal medicines, adversities resulting from concomitant use of both prescription drugs and herbs are becoming an increasingly important public health issue.

OBJECTIVES

To estimate the prevalence of the use of herbal medicines among persons on prescription medicines in Jamaica. Findings are thought to aid in estimates of the risk of adversities from drug-herb interactions through laboratory investigations and to provide awareness among policy makers responsible for the design of appropriate pharmacovigilance systems in the country.

METHODS

A survey was conducted in eighteen pharmacies throughout Jamaica and patients or parents/carers of children who were on at least one prescription medicine were administered a structured questionnaire by trained interviewers.

RESULTS

Of 399 persons invited to participate in the study 365 (91.5% response rate) agreed to do so and were included in the study. This study population consisted of 306 adults and 60 children and of that 243 adults (80.6%) and 45 children (75.6%) engaged in the concomitant use of herbs and drugs. Patients with a variety of disease conditions, in both rural and urban environs engaged in concomitant herb-drug use. Persons with higher salary (P<0.1) and those with health insurance (P<0.02) tended to have a lower prevalence of herb-drug concomitant use. Among persons indicating such practices the most commonly cited reason for concurrent use of prescription medicine and herbal preparations was the belief that there was no harm in taking both (269, 94.0%) followed by the belief that the prescription medicine alone was not adequate cure (211, 71%). Only 55 (18%) respondents who practised such co-medication indicated that their doctors knew of their use of herbal preparations.

CONCLUSION

There is a high prevalence of herb-drug concomitant use in Jamaica, and an awareness within the medical community and those monitoring adversities would serve well to mitigate risks from potential drug-herb interactions.

Self-medication for infants with colic in Lagos, Nigeria

BACKGROUND

Infantile colic is a self-limiting condition that is distributed worldwide. It is often misdiagnosed as an organic disease for which an infant is admitted to the hospital. Many studies have described the aetiopathogenesis, pharmacologic and non-pharmacologic management of colic but none has evaluated self-medication for infants with colic. The aim of this study was therefore to determine the knowledge of Nigerian mothers about colic, their home-based management, extent of self-medication for the infants with colic and the types of medicines involved.

METHODS

It is a prospective study conducted at the vaccination clinics of 20 primary health care centres, each from different Local Government Areas in Lagos, Nigeria. Eight hundred mothers that brought their infants for vaccination between April and September, 2006 were interviewed with open-and close-ended questionnaire.

RESULTS

Six hundred and eighty three (85.4%) mothers claimed they had a good knowledge of colic. Incessant and excessive cry was the main clinical feature of colic identified by 430(62.9%) mothers. Three hundred and seventy eight (67.7%) infants were treated by self-medication, 157 (28.1%) sought medical intervention and 17 (3.1%) were treated at a traditional birth attendant home. Herbal medicines constituted 51.8% of the self-medicated medicines, of which 48 (26.2%) were "Ororo Ogiri". Nospamin (49.5%) and Gripe water (43.0%) were the two frequently prescribed and self-medicated medicines for infants with colic.

CONCLUSION

Nigerian mothers are deficient in their knowledge of colic. Self-medication was the most frequently used home-based intervention. Health education would appear necessary to improve parental management of this self-limiting condition.

Self medication with St. John's wort in depressive disorders: an observational study in community pharmacies

BACKGROUND

Depressive disorders are frequent. They are frequently unrecognised or sufferers use self help or self medication, e.g. with St. John's wort (SJW), instead of seeking professional help. The purpose of this study is to examine patients who buy SJW for the treatment of depression.

METHODS

In pharmacies from all over Germany customers who bought SJW and the pharmacists were asked to fill in a questionnaire on the cause for buying SJW, their health status and the type of counselling they received.

RESULTS

588 individuals were included, 293 purchased SJW as an OTC preparation, 230 had a prescription (65 missing answers). The majority in both groups were women (78.8% in OTC group, 74.3% in prescription group. Self medication patients were significantly younger. Subjects with a prescription took SJW longer (26.99+/-26.84 vs. 15.25+/-20.84 months). Both groups did not differ in self rated symptoms of depression (severity of depression, anxiety, endurance).

LIMITATIONS

No standardized interviews were used to establish the diagnosis of depression.

CONCLUSIONS

Patients who buy SJW for self medication report pronounced and persistent depressive symptoms. As this is a large group of patients they should get more attention in research. Pharmacists are the only professionals who come in contact with these patients and should therefore be considered as an important group of carers.

Self-treatment with bleach by a Latino farmworker

Skin disease is common among migrant Latino farmworkers. These workers rarely use formal health care services but commonly engage in self-treatment of their skin disease. We present a patient with dermatitis who self-treated with bleach. This patient illustrates a common practice that exacerbates skin disease and sheds light on social and cultural factors of which health care providers serving this community should be aware.

Comparison of individual perceptions of medication costs and benefits between intentional and unintentional medication non-adherence among Japanese patients

OBJECTIVE

To identify Japanese patients' perceptions of the costs and benefits of their medications by administering a questionnaire validated in Western patients and to compare the association between the perception levels and non-adherence to medication in the two non-adherent patient types, intentional, and unintentional.

METHODS

Japanese patients with chronic diseases were given a questionnaire and interviewed, and the validity and reliability of the scales generated were assessed. Logistic regression was used to analyse the association between individual perception levels and non-adherence to the medication regimen.

RESULTS

From 151 responses, two kinds of scales were generated following a report of Western patients; the necessity scale showed satisfactory reliability (Cronbach's alpha 0.79) but the concerns scale did not. Individual levels of perception of the necessity of medications were associated with unintentional non-adherence (the higher the level, the lower the odds ratio 1.0, 0.56, 0.40, and 0.15), while they were not associated with intentional non-adherence.

CONCLUSION

Japanese patients' perceptions of the benefits of medications, but not the costs were similar to those of Western patients, and these perceptions were likely to be different between intentionally and unintentionally non-adherent patients.

PRACTICE IMPLICATIONS

Strategies to improve non-adherence should be designed according to the non-adherent type.

Medicine sellers and malaria treatment in sub-Saharan Africa: what do they do and how can their practice be improved?

Medicine sellers are widely used for fever and malaria treatment in sub-Saharan Africa, but concerns surround the appropriateness of drugs and information provided. Because there is increasing interest in improving their services, we reviewed the literature on their characteristics and interventions to improve their malaria-related practices. Sixteen interventions were identified, involving a mixture of training/capacity building, demand generation, quality assurance, and creating an enabling environment. Although evidence is insufficient to prove which approaches are superior, tentative conclusions were possible. Interventions increased rates of appropriate treatment, and medicine sellers were willing to participate. Features of successful interventions included a comprehensive situation analysis of the legal and market environment; buy-in from medicine sellers, community members and government; use of a combination of approaches; and maintenance of training and supervision. Interventions must be adapted to include artemisinin-based combination therapies, and their sustainability and potential to operate at a national level should be further explored.

Incidence and types of illness when traveling to the tropics: a prospective controlled study of children and their parents

Increasingly, families travel to tropical destinations exposing them to infectious agents and tropical diseases not encountered at home. We studied 157 children (0-16 years) and their adult relatives traveling to the tropics, who attended a pretravel clinic and were generally adherent to prescribed advice. Incidence rates of common illness in children and adults were respectively 16.9 (14.3-19.7) and 15.1 (12.7-17.8) episodes/100 person-weeks. Diarrhea, abdominal pain, and fever were the most frequent complaints. There was no significant difference in the incidence of morbid episodes between children and adults, except for fever (more frequent in children). Most episodes occurred in the first 10 days of travel. The similar incidence of morbidity in children and adults and the episodes' mildness challenge the view that it is unwise to travel with small children.

Treatment of fever and over-the-counter medicines

Health policy is aimed at increasing homecare and deregulating the supply of drugs. This study used parental reports of the treatment of fever as an indicator of possible problems that may result from this policy, finding that the use of ineffective treatments and the overuse of drugs were common.

Herbal remedies for psoriasis: what are our patients taking?

The objective of this study was to review and explore the top 15 currently used and the historically used herbal remedies in the treatment of psoriasis. Articles, press releases, message boards, product marketing sites, and patient education lines through the National Library of Medicine (www.pubmed.gov), National Psoriasis Foundation (www.psoriasis.org), Google (www.google. com), and Yahoo (www.yahoo.com) were reviewed. Despite widespread use of complementary and alternative medications, specifically herbals, there is limited scientific data regarding their benefits and interactions. Studies on the efficacy and side effect profiles of these remedies are needed. Additionally, both providers and patients need to be cognizant of both potential benefit distortion and adulteration of the herbal products.

A comparison of two methods of partner notification for sexually transmitted infections in South Africa: patient-delivered partner medication and patient-based partner referral

The objective of this study was to determine acceptability and feasibility of patient-based partner referral (PBPR) and patient-delivered partner medication (PDPM) among female sexually transmitted infection (STI) patients in a community-based STI screening study. Women were randomized to STI screening at home or at a clinic. STI patients could choose between PBPR and PDPM. Six-week follow-up interviews, and in-depth interviews, were conducted. STI prevalence was high. Most of the 106 women with an STI chose PDPM, mainly because partners would not have time or would not want to attend a clinic, and to ensure that partners received treatment. Nearly all partners reportedly took medication (94; 89% took it in front of the woman) or went to a clinic for treatment (92%). No adverse events were reported. Good communication emerged as the key to successful partner notification. In conclusion, PDPM could be used as a strategy to improve STI treatment coverage.

Self-medication practices with antibiotics and antimalarials among Sudanese undergraduate university students

BACKGROUND

In many developing countries, up to 60-80% of health problems are self-medicated.

OBJECTIVE

To estimate the prevalence of self-medication with antibiotics and/or antimalarials and identify factors promoting such use among university students in Sudan.

METHODS

A descriptive cross-sectional study was performed, using a pretested questionnaire on a sample of 1300 students selected from 5 universities in Khartoum State, Sudan.

RESULTS

Eight hundred ninety-one (79.5%; 95% CI 77.0 to 81.8) students from the study population had used antibiotics or antimalarials without a prescription within 1-2 months prior to the study. Four hundred ninety (55%; 95% CI 51.7 to 58.3) of the respondents stated that they had used antibiotics, 39 (4.4%; 95% CI 3.2 to 6.0) had used antimalarials, and 362 (40.6%; 95% CI 37.4 to 43.9) had used both. Overall, self-medication with antibiotics or antimalarials was significantly more common among students 21 years of age or older compared with those 20 years of age or younger (OR 1.55; 95% CI 1.15 to 2.09; p = 0.004) and among students attending private universities compared with those attending public universities (OR 1.42; 95% CI 1.04 to 1.95; p = 0.028). Self-medication with antibiotics followed a similar pattern, which was significantly more common among students 21 years of age or older (OR 1.36; 95% CI 1.03 to 1.81; p = 0.03) and private university respondents (OR 1.52; 95% CI 1.15 to 2.02; p = 0.003). Self-medication with antimalarials was found to be significantly less common among females (OR 0.76; 95% CI 0.59 to 0.97; p = 0.028) and higher among the 21 years or older age group (OR 1.84; 95% CI 1.42 to 2.40; p < 0.001). The most common reason indicated for self-medication was the respondents' previous experiences with similar ailments. The main source of drugs was community pharmacies.

CONCLUSIONS

The prevalence of self-medication with antibiotics/antimalarials among undergraduate university students in Khartoum State is high. Our findings highlight the need for planning interventions to promote the judicious use of antibiotics/antimicrobials.

Self-reported treatment patterns in patients with Sturge-Weber syndrome and migraines

Migraine is common in patients with Sturge-Weber syndrome, yet treatment options are poorly described. An Internet-based questionnaire was completed anonymously by 104 Sturge-Weber syndrome patients, 74 of whom reported experiencing migraines (median age, 25 years; range, 3-64 years). Sixteen (22%) subjects self-reported trying triptans. Five of 12 (42%) describing triptan response believed they were very efficacious (median time of onset of 26 minutes), compared to 13 of 65 (20%) using over-the-counter analgesics (P = .08). Eighty-eight percent (14/16) of triptan users self-reported that when they do not use medications, migraines had a moderate to severe impact on their quality of life; however, while taking triptans, only 50% (7/14) of users reported such an impact (P = .03). Two patients using triptans reported transient unilateral weakness. Of the 26 patients (35%) who received daily preventative medications, 80% experienced improved quality of life. In addition, only 10 of 24 (42%) reported a significant negative impact of migraines on quality of life with daily preventative use, compared to 22 of 26 (85%) without their use (P = .002). Sturge-Weber syndrome patients with migraines are using triptans and preventative agents and self-reporting good efficacy. The small sample size precludes any safety analysis, however, and future prospective trials of both treatment options are needed.

Travelling with medications - some lessons learned

Travelling with medication overseas can require additional care and thought in case the medication is lost or stolen. There are basic steps to follow to ensure medications can be easily replaced while overseas. This article outlines some valuable lessons learned from one patient's experience.

Effect of reading additional safety information on planned use of over-the-counter analgesics

OBJECTIVES

This study was used to test the effect on planned safe use of over-the-counter (OTC) analgesics of adding information about the potential for nonsteroidal anti-inflammatory drug (NSAID) interaction with antihypertensive medications, the potential for interaction of alcohol and acetaminophen, and NSAID ceiling effects to the Federal Drug Administration's (FDA's) OTC analgesics pamphlet.

DESIGN

A randomized posttest-only double-blind experimental design was used to test an intervention with a comparison group reading the FDA pamphlet, and treatment group reading the pamphlet with added information.

SAMPLE

Participants included 137 adults.

INTERVENTION

Participants read the treatment or the comparison pamphlet.

RESULTS

Both groups responded with similar planned use of OTC analgesics. The majority were likely to read the label before taking an OTC analgesic, but were unlikely to give acetaminophen to a family member using antihypertensive medication.

CONCLUSIONS

Reading additional information about OTC analgesics resulted in no greater intention to safely use analgesics. Responses indicated reluctance to use OTC analgesics, and the potential need for increased health teaching regarding use of OTC analgesics with antihypertensive medication. Public health teaching should include the importance of treating pain and selecting the safest OTC analgesics for the clinical situation.