Antagonism of Neurotensin Receptors in the Ventral Tegmental Area Decreases Methamphetamine Self-Administration and Methamphetamine Seeking in Mice

Background

Neurotensin is a peptide that modulates central dopamine neurotransmission and dopamine-related behaviors. Methamphetamine self-administration increases neurotensin levels in the ventral tegmental area, but the consequences for self-administration behavior have not been described. Here we test the hypothesis that antagonizing neurotensin receptors in the ventral tegmental area attenuates the acquisition of methamphetamine self-administration and methamphetamine intake.

Methods

We implanted mice with an indwelling catheter in the right jugular vein and bilateral cannulae directed at the ventral tegmental area. Mice were then trained to nose-poke for i.v. infusions of methamphetamine (0.1 mg/kg/infusion) on a fixed ratio 3 schedule.

Results

Mice receiving microinfusions of the neurotensin NTS1/NTS2 receptor antagonist SR142948A in the ventral tegmental area (10 ng/side) prior to the first 5 days of methamphetamine self-administration required more sessions to reach acquisition criteria. Methamphetamine intake was decreased in SR142948A-treated mice both during training and later during maintenance of self-administration. Drug seeking during extinction, cue-induced reinstatement, and progressive ratio schedules was also reduced in the SR142948A group. The effects of SR142948A were not related to changes in basal locomotor activity or methamphetamine psychomotor properties. In both SR142948A- and saline-treated mice, a strong positive correlation between methamphetamine intake and enhanced locomotor activity was observed.

Conclusion

Our results suggest that neurotensin input in the ventral tegmental area during initial methamphetamine exposure contributes to the acquisition of methamphetamine self-administration and modulates later intake and methamphetamine-seeking behavior in mice. Furthermore, our results highlight the role of endogenous neurotensin in the ventral tegmental area in the reinforcing efficacy of methamphetamine, independent of its psychomotor effects.

Inappropriate self-medication among adolescents and its association with lower medication literacy and substance use

BACKGROUND

While self-medication is common, inappropriate self-medication has potential risks. This study assesses inappropriate self-medication among adolescents and examines the relationships among medication literacy, substance use, and inappropriate self-medication.

METHOD

In 2016, a national representative sample of 6,226 students from 99 primary, middle, and high schools completed an online self-administered questionnaire. Multiple logistic regression analysis was used to examine factors related to inappropriate self-medication.

RESULTS

The prevalence of self-medication in the past year among the adolescents surveyed was 45.8%, and the most frequently reported drugs for self-medication included nonsteroidal anti-inflammatory drugs or pain relievers (prevalence = 31.1%), cold or cough medicines (prevalence = 21.6%), analgesics (prevalence = 19.3%), and antacids (prevalence = 17.3%). Of the participants who practiced self-medication, the prevalence of inappropriate self-medication behaviors included not reading drug labels or instructions (10.1%), using excessive dosages (21.6%), and using prescription and nonprescription medicine simultaneously without advice from a health provider (polypharmacy) (30.3%). The results of multiple logistic regression analysis showed that after controlling for school level, gender, and chronic diseases, the participants with lower medication knowledge, lower self-efficacy, lower medication literacy, and who consumed tobacco or alcohol were more likely to engage in inappropriate self-medication.

CONCLUSION

Lower medication literacy and substance use were associated with inappropriate self-medication among adolescents.

Use of medicines by patients of the primary health care of the Brazilian Unified Health System

OBJECTIVE

To characterize the use of medicines by patients of the primary health care of the Brazilian Unified Health System (SUS).

METHODS

This is a cross-sectional, exploratory, and descriptive study, part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). Interviews were carried out with patients present in the services by semi-structured questionnaires. Sociodemographic, clinical, and use of medicines variables were assessed and the use of medicines in the 30 days prior to the interview was also verified. The population was stratified into three age groups: 18 to 44, 45 to 64, and 65 years or more. The differences between the age groups were verified using the Student's t-test for continuous variables and chi-square test for the categorical ones. The complex samples analysis plan was employed. The medicines were classified according to the Anatomical Therapeutic Chemical Classification System.

RESULTS

Of the 8,803 patients interviewed, 6,511 (76.2%) reported to have used medicines in the 30 days prior to the interview. On average, each patient used 2.32 medicines, without difference between the sexes. Among medicine users, 18.2% were aged 65 years or more. Compared to the other age groups, older adults presented more comorbidities, used more medicines, and self-reported worse health conditions. They were also less educated, reported worse economic situation, and lived alone. The medicines that were mostly used were "other analgesics and antipyretics" (3rd ATC level) and Losartan (5th ATC level).

CONCLUSIONS

Most medicine users had lower education level and presented comorbidities. The most used medicines were the antihypertensive ones. Self-medication was higher among young people. Most patients reported to use generic medicines. The average number of medicines and the prevalence of use increased with age. Due to the characteristics observed and the difficulties in the use of medicines, older adults are in a situation of greater vulnerability.

Effects of Self-Knee Massage With Ginger Oil in Patients With Osteoarthritis: An Experimental Study

BACKGROUND AND PURPOSE

The purpose of our study was to assess the effects of self-knee massage with ginger oil on pain and daily living activities in patients with knee osteoarthritis.

METHODS

Participants (N = 68) were asked about their sociodemographic characteristics, pain level in the last week using the Visual Analog Scale (VAS), and functionality in activities of daily living with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Standard treatment prescribed by a physician was given to the patients with osteoarthritis. In addition to the standard treatment, self-knee massage with ginger oil twice a week was recommended to the intervention group (n = 34). At the end of the first and fifth week, participants in both groups were assessed regarding pain and functional state.

RESULTS

The mean VAS Pain scores of the intervention group were significantly lower at the end of the first and fifth weeks (p< .05). The mean total scores and mean Function subscale scores of the WOMAC were significantly lower in massage group in the first- and fifth-week assessments (p < .05).

IMPLICATIONS FOR PRACTICE

Self-massage of the knee with ginger oil may be used as a complementary method to standard medical treatment. Nurses can easily train patients and their caregivers on knee massage, and the intervention can be implemented by patients at home without any restrictions on location.

Use of traditional eye medicine and self-medication in rural India: A population-based study

OBJECTIVE

To determine the type and nature of traditional eye medicine (TEM), their sources and use and practices related to self-medication for ophthalmic diseases in a rural Indian population.

METHODS

A population-based, cross-sectional study was conducted in 25 randomly selected clusters of Rural Gurgaon, Haryana, India as part of CORE (Cornea Opacity Rural Epidemiological) study. In addition to comprehensive ophthalmic examination, health-seeking behavior and use of self-medication and TEM was assessed in the adult population using a semi-structured questionnaire. Physical verification of available ophthalmic medications in the enumerated households was conducted by the study team. Descriptive statistics were computed along with multivariable logistic regression analysis to determine associated factors for use of self-medication and TEM.

RESULTS

Of the 2160 participants interviewed, 396 (18.2%) reported using ophthalmic medications without consulting an ophthalmologist, mainly for symptoms like watering (37.1%), redness (27.7%), itching (19.2%) and infection (13.6%). On physical verification of available eye drops that were being used without prescription, 26.4% participants were practicing self-medication. Steroid, expired/unlabeled and indigenous eye drops were being used by 151(26.5%), 120(21.1%) and 75 (13.2%) participants respectively. Additionally, 25.7% (529) participants resorted to home remedies like 'kajal'(61.4%), honey (31.4%), ghee (11.7%) and rose water (9.1%).

CONCLUSION

Use of TEM is prevalent in this population. The rampant use of steroid eye drops without prescription along with use of expired or unlabelled eye drops warrants greater emphasis on safe eye care practices in this population. Public awareness and regulatory legislations must be implemented to decrease harmful effects arising due to such practices.

Gastrointestinal parasite infections and self-medication in wild chimpanzees surviving in degraded forest fragments within an agricultural landscape mosaic in Uganda

Monitoring health in wild great apes is integral to their conservation and is especially important where they share habitats with humans, given the potential for zoonotic pathogen exchange. We studied the intestinal parasites of wild chimpanzees (Pan troglodytes schweinfurthii) inhabiting degraded forest fragments amid farmland and villages in Bulindi, Uganda. We first identified protozoan and helminth parasites infecting this population. Sixteen taxa were demonstrated microscopically (9 protozoa, 5 nematodes, 1 cestode, and 1 trematode). DNA sequence analysis enabled more precise identification of larval nematodes (e.g. Oesophagostomum stephanostomum, O. bifurcum, Strongyloides fuelleborni, Necator sp. Type II) and tapeworm proglottids (genus Bertiella). To better understand the ecology of infections, we used multidimensional scaling analysis to reveal general patterns of association among parasites, climate, and whole leaf swallowing-a prevalent self-medicative behaviour at Bulindi linked to control of nodular worms (Oesophagostomum spp.). Prevalence of parasites varied with climate in diverse ways. For example, Oesophagostomum sp. was detected in faeces at higher frequencies with increasing rainfall but was most clearly associated with periods of low temperature. Certain parasites occurred together within chimpanzee hosts more or less frequently than expected by chance. For example, the commensal ciliate Troglodytella abrassarti was negatively associated with Balantidium coli and Oesophagostomum sp., possibly because the latter taxa make the large intestine less suitable for T. abrassarti. Whole leaves in faeces showed independent associations with the prevalence of Oesophagostomum sp., Strongyloides sp., and hookworm by microscopic examination, and with egestion of adult O. stephanostomum by macroscopic inspection. All parasites identified to species or genus have been reported in wild chimpanzees inhabiting less-disturbed environments than Bulindi. Nevertheless, several disease-causing taxa infecting these chimpanzees are potentially transmissible between apes and humans (e.g. rhabditoid and strongyle nematodes), underscoring the importance of identifying and reducing risks of pathogen exchange in shared landscapes.

Attention Deficit Hyperactivity Disorder, Aggression, and Illicit Stimulant Use: Is This Self-Medication?

This study compares adults with and without attention deficit hyperactivity disorder (ADHD) on measures of direct and displaced aggression and illicit drug use. Three hundred ninety-six adults were administered the Wender Utah Rating Scale, the Risk Behavior Assessment, the Aggression Questionnaire (AQ), and the Displaced Aggression Questionnaire (DAQ). Those with ADHD were higher on all scales of the AQ and DAQ, were younger at first use of amphetamines, and were more likely to have ever used crack and amphetamines. A Structural Equation Model found a significant interaction in that for those with medium and high levels of verbal aggression, ADHD predicts crack and amphetamine. Follow-up logistic regression models suggest that blacks self-medicate with crack and whites and Hispanics self-medicate with amphetamine when they have ADHD and verbal aggression.

A cross-sectional analysis of traditional medicine use for malaria alongside free antimalarial drugs treatment amongst adults in high-risk malaria endemic provinces of Indonesia

Background

The level of traditional medicine use, particularly Jamu use, in Indonesia is substantial. Indonesians do not always seek timely treatment for malaria and may seek self-medication via traditional medicine. This paper reports findings from the first focused analyses of traditional medicine use for malaria in Indonesia and the first such analyses worldwide to draw upon a large sample of respondents across high-risk malaria endemic areas.

Methods

A sub-study of the Indonesia Basic Health Research/Riskesdas Study 2010 focused on 12,226 adults aged 15 years and above residing in high-risk malaria-endemic provinces. Logistic regression was undertaken to determine the significant associations for traditional medicine use for malaria symptoms.

Findings

Approximately one in five respondents use traditional medicine for malaria symptoms and the vast majority experiencing multiple episodes of malaria use traditional medicine alongside free antimalarial drug treatments. Respondents consuming traditional medicine for general health/common illness purposes every day (odds ratio: 3.75, 95% Confidence Interval: 2.93 4.79), those without a hospital in local vicinity (odds ratio: 1.31, 95% Confidence Interval: 1.10 1.57), and those living in poorer quality housing, were more likely to use traditional medicine for malaria symptoms.

Conclusion

A substantial percentage of those with malaria symptoms utilize traditional medicine for treating their malaria symptoms. In order to promote safe and effective malaria treatment, all providing malaria care in Indonesia need to enquire with their patients about possible traditional medicine use.

[Self-medication with cannabidiol oil in a patient with primary lateral sclerosis]

Many patients with neurological disorders have symptoms which are difficult to treat with conventional medication. In this case report we present a 40-year-old male patient with primary lateral sclerosis who used cannabidiol oil as therapy. We discuss the evidence of the effects of cannabidiol in the treatment of patients with neurological disease, and we raise the question: "Should patients who use illegal cannabis products as self-medication be diagnosed as drug abusers?"

Predisposing factors to the practice of self-medication in Brazil: Results from the National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM)

OBJECTIVE

To understand the predisposing factors that lead to the practice of self-medication and the factors associated with the use of medicines via self-medication in the adult population of Brazil.

METHODS

The analyzed data are part of the National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM), a survey whose population consisted of individual residents permanently domiciled in urban areas in Brazil. In this work, the data references the 31 573 respondents aged 20 or higher (76.2% of the final PNAUM sample). Poisson regression models with robust variance were used for estimating the independent effect of each variable with medicine use via self-medication.

RESULTS

Of the interviewees, 73.6% stated they had used some medication without medical recommendation if they had previously used the same product; 73.8% stated they had used non-prescribed medicine when the medicine was already present at home; and 35.5% stated they had used some non-prescribed medication when they knew someone who had already taken the same medication. The prevalence of self-medication was 18.3%. The variables associated with the highest probability of using medicine via self-medication were: geographic region within Brazil, gender, age group, per capita income, self-assessment of health, self-reported use of previously used non-prescribed medication, and self-reported use of non-prescribed medication when that medication was already present at home.

CONCLUSIONS

The use of medicines via self-medication in Brazil is relatively frequent and influenced by previous experience and familiarity with the medications, and is more common among women and individuals with low self-assessment of health.

Pharmaceutical Care in Community Pharmacies: Practice and Research in Sweden

Objective:

To describe the organization and delivery of community pharmacy and medical care, as well as pharmaceutical care practice and research, in Sweden.

Findings:

The Swedish retail pharmacy system of 800 community pharmacies and nearly 80 hospital pharmacies is unique in that it is organized into one single, government-owned chain, known as Apoteket AB. The pharmacy staff consists of pharmacists, prescriptionists, and pharmacy technicians. Some activities related to pharmaceutical care have been directed toward specific patient groups during annual theme campaigns. In the past few years, there has been a growing emphasis on the identification, resolution, and documentation of drug-related problems (DRPs) in Swedish pharmacy practice. A classification system for documenting DRPs and pharmacy interventions was developed in 1995 and incorporated into the software of all community pharmacies in 2001. A national DRP database (SWE-DRP) was established in 2004 to collect and analyze DRPs and interventions on a nationwide basis. Recently, a new counseling technique composed of key questions to facilitate the detection of DRPs has been tested successfully. Patient medication profiles are kept in 160 pharmacies, and a new national register of drugs dispensed to patients became available in 2006. Most pharmaceutical care studies in Sweden have focused on DRPs and resulting pharmacy interventions.

Discussion:

Swedish community pharmacy DRP work is in the international forefront but there is a potential for further developing cognitive services, given the beneficial organization of the country's pharmacies into one single pharmacy chain. The introduction of patient medication profiles has been both late and slow and has only had a marginal effect on pharmaceutical care practice so far. The universities do not appear to have any desire to influence the practice of pharmacy and could potentially take on a more active role in preparing pharmacy students for patient-oriented services. Current threats to pharmaceutical care practice and research include organizational changes, budget cuts, and reduced manpower of Apoteket AB.

Conclusions:

The identification, resolution, and documentation of DRPs are central to community pharmacy practice in Sweden, resulting in a number of research studies. A national DRP database, patient medication profiles, and a new national register of drugs dispensed to patients provide opportunities for growth in pharmaceutical care practice and research in the country.

Rare Case of Metformin-Induced Leukocytoclastic Vasculitis

Objective:

To report a case of leukocytoclastic vasculitis (LV) related to metformin.

Case Summary:

A 33-year-old woman developed palpable purpura on her lower limbs after starting self-medication with metformin 850 mg/day for weight loss. Drug-induced vasculitis was suspected, metformin was stopped, and the rash improved significantly. One month later, the woman again took metformin. Similar cutaneous lesions recurred, and skin biopsy showed LV, which was managed by discontinuing metformin and applying topical antiseptics. The patient had no further episodes of skin rash over a follow-up period of 3 months.

Discussion:

Metformin has widespread use throughout the world. It has a variety of metabolic and vascular effects. Our patient developed a rash within a few days of metformin administration. Resolution of skin manifestations within several days after withdrawal of the drug and their recurrence when the drug was reintroduced were consistent with a pathogenic role of metformin. Other known causes of vasculitis were excluded in a reasonable way. According to the Naranjo probability scale, the vasculitis experienced by our patient was probably due to metformin.

Conclusions:

Clinicians should be aware of the ability of metformin to induce cutaneous LV.

Quality of Life in Migraine Patients: A Qualitative Study

The impact of migraine on quality of life has been traditionally evaluated by quantitative analysis, but diverse aspects remain insufficiently assessed, so a complementary qualitative approach may have advantages. The aim of this study was to assess the impact of migraine on the quality of life of migraineurs through the perception of patients and their relatives, and healthcare professionals. Qualitative methods were used, including six focus groups and nine personal interviews with 33 migraine patients under physician-directed treatment, five self-medicated patients, five relatives of migraine patients and seven healthcare professionals. Migraine has a negative affect on the quality of life, including physical, emotional and social aspects of daily life such as family, work and social relationships. Family environment and psychological well-being of patients were the aspects most affected according to patients and relatives. Health professionals emphasized work impairment and focused on pharmacological management and on the need for adequate information about migraine for non-medicated patients and patients' relatives. Qualitative methods, such as focus groups and interviews, are a valuable resource for assessing quality of life and well-being of migraine patients. These techniques open up new areas for further research.

CONSUMER EXPECTATION ON SERVICE QUALITY PROVIDE BY PHARMACIST IN SELF MEDICATION PRACTICES AND ITS ASSOCIATED FACTORS IN BANDUNG, INDONESIA

Self-medication is the use of medicines for therapeutic intent without a clinician’s advice or prescription. The National Socioeconomic Survey for Indonesia in 2009 found the percentage of the Indonesians engaging in self-medication is increasing. The objectives of this study were to assess consumers’ expectations regarding service quality provide by pharmacist in self-medication practices and determine the factors associated with self-medication in Bandung, Indonesia. We conduct a cross-sectional survey at eight randomly selected community pharmacies during July-November 2012 and purposely sampled 1,200 costumers purchasing medication at those sites. Subjects reported they understood the information about the medicines given by the pharmacist but still wanted more information and time to consult with the pharmacist about their medicines. Factors associated with self-medication were younger age, male gender, greater education and lower income. The intervention is needed to improve appropriate self-medication.

Non-steroidal anti-inflammatory drugs vs. Paracetamol: drug availability, patients' preference and knowledge of toxicity

BACKGROUND

Self-medication is a common practice which is influenced by level of education, society factors and health care facilities availability. In our region, Pakistan, it is very common and awareness regarding prescription implementation needs to be ensured. Hence the current study highlights the preference, availability and knowledge of toxicity of non-steroidal antiinflammatory medications and paracetamol in Pakistan.

METHODS

It was a Descriptive, cross sectional, conducted in Rawalpindi and Islamabad, Pakistan from May to august 2012. A total of 1000 questionnaires comprising of 21 questions were distributed to the persons with age groups from 18 years to 40 years. Non-probability convenience sampling technique was used for results deduction. Data was analysed using descriptive statistics.

RESULTS

The most commonly used medicine was Mefenamic acid (n=191, 40.8%). Paracetamol was second on the priority list (n=146, 31.3%). About 178 out of 467(38.1%) used these medications for headache. Very few responders knew about the toxic doses of the medicines they used. Only 52 (11%) were aware of the raised bleeding tendency being the most common side effect of acetylsalicylic acid and 129 (28%) were aware of liver damage by paracetamol toxicity.

CONCLUSIONS

In Pakistan, common people take NSAIDs and Paracetamol without prescription and majority of them are unaware of the side effects of these medicines. This is the reason it is important to make the general public aware of the problems they may face if they misuse or over use the drugs without the prescription.

It's a Matter of Trust: Older African Americans Speak About Their Health Care Encounters

PURPOSE

To examine perceptions of older African Americans' encounters with health care providers and ways to enhance trust.

METHOD

Transcribed semi-structured interviews with African American senior center members were analyzed, using Pattern Coding method.

RESULTS

Four themes emerged: "Added Insult of Ageism," "Alternative Remedies," "Good Providers in a 'Broken' System," and "The Foundation of Trust Is Person Recognition." Provider behaviors leading to mistrust included erroneously assuming stereotypical preferences and competence, spending inadequate time listening to patients, disregarding patient preferences, and insufficiently explaining treatments.

DISCUSSION

Of importance to improving trust among older African American patients is valuing individual histories and preferences by reallocating scarce time to person-centered listening, individualizing treatments, more completely explaining interventions, and assuring that patients understand and agree with treatment plans.

[Pharmacy Medicines not Subject to Medical Prescription: Compatible Access and Security]

Keywords: Community Pharmacy Services; Nonprescription Drugs; Portugal; Safety; Self Medication.

Interrupted (self -)medication with pancuronium(bromide) and fatal outcome

Pancuronium(bromide) is used because of its relaxing effect on striated muscles and usually requires artificial respiration. A 52-year-old woman suffered from long-standing "generalized dystonia", which had become resistant to conventional therapy. Therefore, an anesthetist established a permanent medication scheme with pancuronium using a PCA pump. This pump had been controlled by the patient herself ensuring an acceptable quality of life with broad personal autonomy. Finally, the woman was found dead in her flat by a member of a home nursing service. The infusion hose showed a fixed knot and further blocking by a clamp. The autopsy findings were non-specific, except for the presence of opioid tablets in the colon. Toxicological analyses showed 72ng/ml pancuronium and 21 ng/ml oxycodone (therapeutic) in the femoral venous blood. The range of published pancuronium levels varies from approx. 80 to 2,000 ng/ml. Thus it had to be assumed that the pancuronium level was too low (72 ng/ml) so that symptoms of dystonia recurred. Based on extensive literature research, the described case can be qualified as unique. The therapy concept had been innovative, sufficient and effective for more than 10 years. It allowed the patient to enjoy a maximum of autonomy. Ultimately, death was due to the blocked pancuronium infusion. The relatively low pancuronium level had provoked the dystonia to return with generalized spasms also involving the respiratory muscles resulting in respiratory arrest. During the police investigations, two previous suicide attempts came to light.

Combined assessment of clinical and patient factors on doctors' decisions to prescribe antibiotics

BACKGROUND

Antibiotic overprescription is a worldwide problem. Decisions regarding antibiotic prescription for respiratory tract infections (RTIs) are influenced by medical and non-medical factors.

METHODS

In family medicine practices in Białystok, Poland, family medicine residents directly observed consultations with patients with RTI symptoms. The observing residents completed a questionnaire including patient data, clinical symptoms, diagnosis, any prescribed antibiotic, and assessment of ten patient pressure factors.

RESULTS

Of 1546 consultations of patients with RTIs, 54.26 % resulted in antibiotic prescription. Antibiotic prescription was strongly associated with rales (OR 26.90, 95 % CI 9.00-80.40), tonsillar exudates (OR 13.03, 95 % CI 7.10-23.80), and wheezing (OR 14.72, 95 % CI 7.70-28.10). The likelihood of antibiotic prescription was increased by a >7-day disease duration (OR 3.94, 95 % CI 2.80-5.50), purulent nasal discharge (OR 3.87, 95 % CI 2.40-6.10), starting self-medication with antibiotics (OR 4.11, 95 % CI 2.30-7.30), and direct request for antibiotics (OR 1.87, 95 % CI 1.30-2.80). Direct request not to prescribe antibiotics decreased the likelihood of receiving antibiotics (OR 0.34, 95 % CI 0.27-0.55).

CONCLUSION

While clinical signs and symptoms principally impact prescribing decisions, patient factors also contribute. The most influential patient pressure factors were starting self-medication with antibiotics, and directly requesting antibiotic prescription or no antibiotic prescription. Interventions aiming to improve clinical sign and symptom interpretation and to help doctors resist direct patient pressure could be beneficial for reducing unnecessary antibiotic prescribing.

THE USE OF PANAX GINSENG AND ITS ANALOGUES AMONG PHARMACY CUSTOMERS IN ESTONIA: A CROSS-SECTIONAL STUDY

The aim of the cross-sectional study was to evaluate the pattern of complementary self-treatment with P. ginseng and its analogues amongst pharmacy customers in Estonia. The study instrument consisted of multiple-choice items related to personal knowledge about and experience with the use of P. ginseng and its analogues. In total, 1233 customers participated in the study. Of study participants, 18.1% reported the use of P. ginseng and its analogues in their lives. P. ginseng preparations were used mostly according to the well- known indications (tiredness, weakness and decreased mental and physical capacity). Of P. ginseng users 44.3% reported positive treatment effects and 12.0% had experienced different side effects. With increase of age (p < 0.01) and at lower levels of education (p = 0.04), the use of ginseng or its analogues decreased. The better the users evaluated their health, the better they perceived the effect of P. ginseng preparations (p < 0.01). This study reported rather frequent use of P. ginseng and its analogues. P. ginseng could be seen in the treatment of conditions, where the use of local medicinal plants has not been established. Further research is needed to learn more about public knowledge and experiences about efficacy and safety of P. ginseng and its analogues.

Women's Management of Recurrent Bacterial Vaginosis and Experiences of Clinical Care: A Qualitative Study

BACKGROUND

Few data are available on how women manage recurring bacterial vaginosis (BV) and their experiences of the clinical care of this condition. This study aimed to explore women's recurrent BV management approaches and clinical care experiences, with a view to informing and improving the clinical management of BV.

METHODS

A descriptive, social constructionist approach was chosen as the framework for the study. Thirty-five women of varying sexual orientation who had experienced recurrent BV in the past 5 years took part in semi-structured interviews.

RESULTS

The majority of women reported frustration and dissatisfaction with current treatment regimens and low levels of satisfaction with the clinical management of BV. Overall, women disliked taking antibiotics regularly, commonly experienced adverse side effects from treatment and felt frustrated at having symptoms recur quite quickly after treatment. Issues in clinical care included inconsistency in advice, misdiagnosis and inappropriate diagnostic approaches and insensitive or dismissive attitudes. Women were more inclined to report positive clinical experiences with sexual health physicians than primary care providers. Women's frustrations led most to try their own self-help remedies and lifestyle modifications in an attempt to treat symptoms and prevent recurrences, including well-known risk practices such as douching.

CONCLUSION

In the face of considerable uncertainty about the cause of BV, high rates of recurrence, unacceptable treatment options and often insensitive and inconsistent clinical management, women are trying their own self-help remedies and lifestyle modifications to prevent recurrences, often with little effect. Clinical management of BV could be improved through the use of standardised diagnostic approaches, increased sensitivity and understanding of the impact of BV, and the provision of evidence based advice about known BV related risk factors.

Correlates of Abusing and Misusing Over-the-Counter Pain Relievers Among Adult Population of Wrocław (Poland)

BACKGROUND

Almost 90% of households in Poland buy medicines on their own initiative. The most popular OTC medicines bought by Polish consumers are painkillers and non-steroid-anti-inflammatory drugs.

OBJECTIVES

The aim of this article was to recognize and describe the most important predictive factors of the abuse and misuse of over-the-counter pain relievers among adults in Wrocław (Poland). The groups of users were selected and described. Some examples of misuse were analyzed.

MATERIAL AND METHODS

Three hundred eighty six adult inhabitants of Wrocław took part in the survey. The quota sample was representative referring to the most important socio-demographic factors (sex and median age).

RESULTS

Almost 91% of participants declare taking OTC pain relievers, and 1.3% of them are their daily users. Only 6.2% of adult inhabitants of Wrocław never take OTC pain relievers. The category of "heavy users" embraces 11% of participants. The most important risk factors of overusing OTC pain relievers are sex (female), age over 55 years and the low health status. Only half of participants read the box label regularly and 25% of users admit they have modified recommended doses. Over 60% shortened recommended intervals between doses and 16% took two or more different pain medications (containing different substances). The non-medical purposes of using OTC pain relievers were: tiredness (7%), stressful situations (5.4%), and discomfort (18.4%). Some users take pain medications to cure hangovers (26%), or instead of the appropriate medicine (7%). About 20% take pain medications without a doctor's advice for longer than the recommended 3 days, and 10% never consult taking such medications with doctors.

CONCLUSIONS

Pain should be treated aggressively and successfully, especially among chronically ill patients. We should monitor the consumption of OTC pain relievers and limit their current excessively supply and high availability.