[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.

[Myocardial ischemia caused by overuse of headache medications]

Myocardial infarction as the most severe clinical manifestation of coronary atherosclerosis is the major cause of death in western countries. Although rupture of an atherosclerotic plaque is generally causal for this event, in recent years differential diagnoses have been discussed to further optimize diagnosis and treatment of myocardial ischemia. The "universal definition of myocardial infarction" defines five subtypes of myocardial infarction: in particular, type 2 myocardial infarction includes other diseases related to myocardial ischemia such as hyper- or hypotension, coronary artery spasms, arrhythmia, etc. Some medications for the acute therapy of migraine like triptans can lead to myocardial infarction.

Cross-sex hormone use, functional health and mental well-being among transgender men (Toms) and Transgender Women (Kathoeys) in Thailand

There exists limited understanding of cross-sex hormone use and mental well-being among transgender women and, particularly, among transgender men. Moreover, most studies of transgender people have taken place in the Global North and often in the context of HIV. This exploratory study compared 60 transgender men (toms) with 60 transgender women (kathoeys) regarding their use of cross-sex hormones, mental well-being and acceptance by their family. Participants also completed a dispositional optimism scale (the Life Orientation Test Revised), the Social Functioning Questionnaire and the Short Form Health Survey 36 assessing their profile of functional health and mental well-being. Cross-sex hormones were used by 35% of toms and 73% of kathoeys and were largely unsupervised by health-related personnel. There were no differences in functional health and mental well-being among toms and kathoeys. However, toms currently using cross-sex hormones scored on average poorer on bodily pain and mental health, compared to non-users. Furthermore, compared to non-users, cross-sex hormone users were about eight times and five times more likely to be associated with poor parental acceptance among toms and kathoeys, respectively. This study was the first to compare cross-sex hormone use, functional health and mental well-being among transgender women and transgender men in Southeast Asia.

Analysis of chats on French internet forums about drugs and pregnancy

PURPOSE

Some pregnant women use the internet to search for medical information. However, online information is not controlled. The objectives were to describe French online chats about drugs and pregnancy and evaluate the quality and reliability of information shared by internet users.

METHODS

This French descriptive study was performed in November 2012. In order to identify drugs and pregnancy-related forum websites, we used three French key words: forum, pregnancy and drug. We explored the first 10 websites from the search result. Diseases were described using the International Classification of Diseases and drugs classified with the Anatomical Therapeutic Chemical codes and the FDA risk classification.

RESULTS

We selected 115 questions that were mainly posted by pregnant internet users in French forums. Drugs raising questions were mostly "nervous system," "anti-infective for systemic use" and "respiratory system" drugs. The risk during pregnancy for nearly half of these drugs had not been evaluated properly. Health professionals were only involved in 7% of the 214 answers. Internet users advised to take a drug in 21% of their answers. Thirty-four percent of those recommended drugs had not been well-evaluated or were potentially at risk during pregnancy. Finally, 12% of the answers could be at risk for pregnant woman.

CONCLUSIONS

This study shows that information related to drugs and pregnancy in online chats could be at risk for pregnant women. Internet users must be aware that online forums are not reliable sources of information.

Frequency of dysmenorrhoea, its impact and management strategies adopted by medical students

BACKGROUND

Dysmenorrhea is quite frequent and may affect the daily activities especially during the early years of adolesence. This study aimed to evaluate the prevalence of dysmenorrhoea, its impact, and the management strategies adopted.

METHODS

This cross-sectional study was done with 356 consenting females studying at Mohiuddin Islamic University, Mirpur Azad Kashmir, between 18-25 years of age, with regular menstrual cycles and normal abdomino-pelvic ultrasound and not taking any medication. Information was gathered regarding age, residence, menstrual history, body mass index (BMI), associated symptoms, remedies used and days lost.

RESULTS

A total of 56.1% females had dysmenorrhoea. The mean age of participants was 21.01±1.54 years, mean age of menarche was 12.9±1.65 years, mean duration of menstrual flow was 4.75±1.27 days and mean BMI was 24.1±1.6. 17% of the participants were dieting and 26% had daily milk intake. 25% reported being absent due to pain and number of days lost was 1.5±1.0 days. Common symptoms associated with the dysmenorrhoea were difficulty concentrating in 65%, less involvement in social activities and sleep affected in 64%, mood disturbances in 58% and headache in 56%. Household remedies for dysmenorrhea were used by 43% and 66% used analgesics and only 4% sought medical advice for pain.

CONCLUSION

Dysmenorrhoea is a very common problem affecting academic performance and limiting daily activities requiring appropriate intervention.

Patients' experience compared with physicians' recommendations for treating fecal incontinence: a qualitative approach

INTRODUCTION AND HYPOTHESIS

Using qualitative methods, we compared physician-recommended treatment options for fecal incontinence to patient knowledge of treatment options. Our hypothesis was that physician recommendations were not being communicated well to patients and that this impaired patients' ability to cope with fecal incontinence.

METHODS

Cognitive interviews were conducted with physicians who routinely care for women with fecal incontinence. Physicians were asked to describe their typical nonsurgical treatment recommendations and counseling for fecal incontinence. Women with bothersome fecal incontinence were recruited to participate in focus groups and asked about personal experience with fecal incontinence symptoms and treatment options. For both physician interviews and patient focus groups, qualitative data analysis was performed using grounded-theory methodology.

RESULTS

Physicians identified several barriers patients face when seeking treatment: lack of physician interest toward fecal incontinence, and patient embarrassment in discussing fecal incontinence. Physicians universally recommended fiber and pelvic floor exercise; they felt the majority (approximately 70-80 %) of patients will improve with these therapies. Collectively, patients were able to identify all treatment recommendations given by physicians, although many had discovered these treatments through personal experience. Three concepts emerged regarding treatment options that physicians did not identify but that patients felt were important in their treatment: hope for improvement, personal effort to control symptoms, and encouragement to go on living life fully.

CONCLUSIONS

Whereas physicians had treatment to offer women with fecal incontinence, women had already found the best treatments through personal research and effort. Women want to hear a message of hope and encouragement and perceive personal effort from providers.

Attitude and practice of pregnant women regarding self-medication in Yazd, Iran

BACKGROUND

Medications, a main strategic commodity in any country, are strictly related to community health and sustainable development. Self-medication and irregular use of medications can increase their adverse effects. This study investigated the factors related to irregular and arbitrary use of medications in pregnant women admitted to health centers and clinics of Yazd, Iran, and their practice in this context.

METHODS

This was a descriptive- analytic cross-sectional study conducted among 180 pregnant women. Participants were selected by cluster sampling. We chose six health centers and clinics from all medical centers in Yazd by a simple random method. A questionnaire was completed by the pregnant women who were consecutively admitted to each center. Data were analyzed by ANOVA, t-test, Chi-square, and Pearson tests with SPSS-15 software.

RESULTS

More than 35% of the women self-medicated during pregnancy. Women with academic degrees scored higher in the knowledge section; however, this difference was not significant.  The mean attitude scores for academic and nonacademic graduates were 34.92 (from 60) and 29.87, respectively while the mean practice scores were 15 (from 20) and 14.25 for academic and non-academic graduates, respectively.

CONCLUSION

The results of this study showed an increased prevalence of self-medication among pregnant women. Because of potential fetomaternal hazards related to medications, it is necessary to conduct educational programs to prevent this harmful habit and attitude in pregnant women.

[PHARMAGRIPS: structured pharmaceutical counseling in the self-medication of the common cold. A randomised controlled study (RCT)]

Many minor ailments are treated in Germany by self-medication. Most drugs dispensed by pharmacy staff are those for the common cold, general pain and gastrointestinal disorders. Whilst pharmacists express their need for further training in counseling on side effects, interactions and contraindications, they tend to receive feedback from patients to the effect that the drugs used have not worked. From July to October 2013 we carried out a prospective, single-blind, quasi-randomised controlled study on the effect of training on structured pharmaceutical advice in self-medication of the common cold (PHARMAGRIPS Study). Using a controlled, interventional study design we investigated whether it is possible to improve the pharmaceutical counseling in self-medication within a short time, by using an appropriate teaching method. The counseling should be made in a systematic way and refer to evidence-based content in order to avoid incorrect advice. We enrolled 86 pharmacists and assigned them randomly into the study protocol. Of those, 56 completed the study as planned and were analysed. In this study, we reviewed the structure of the average pharmaceutical consultation and added evidence-based content from the Cochrane Reviews on common cold. We then integrated this structured consultation in a methodical modem training program consisting of e-learning and live classes which we evaluated scientifically. For this purpose, we conducted telephone interviews with the participating pharmacists by using standardized case report forms. The case report forms contained the questions that the participants were supposed to ask. For every question asked, the participant received a certain amount of points, 18 in total. The training was stated to be successful at the primary endpoint when an improvement of at least 3.5 out of 18 points was achieved on average. The secondary endpoints were related to various aspects of the interview process (medical history, limits of self-medication, evidence-based drug selection and integration of customer input in the consultation interaction). The training group improved in the primary endpoint by an average of 5.93 points (p < 0.001) and compared to the control group significantly in all secondary endpoints, with one participant managing to achieve the full score. The participants recognized the importance and practical relevance of the exercise in a short time and were able to implement even integrate complex content in their consultations and to give the customer appropriate advice.

Oral health behaviours amongst homeless people attending rehabilitation services in Ireland

STATEMENT OF THE PROBLEM

Research on oral health behaviours and dental care service uptake of drug users and those in recovery remains scant.

PURPOSE OF THE STUDY

The research aimed to explore and describe perspectives of drug users on their oral health behaviours, awareness of oral health complications caused by alcohol, cigarette and drug use, dental service uptake and opinions on improved dental service for active and recovering addicts.

MATERIALS AND METHODS

Two focus groups with a purposeful sample of participants (n = 15) were conducted in two treatment and rehabilitation settings. The semi-structured guide consisted of open questioning relating to dental access and uptake, oral health, awareness of oral cancers, nutrition and substance consumption on oral health, and opinions around optimum oral health and dental service provision for active drug users and those in recovery. Thematic analysis of narratives was conducted.

RESULTS

Participants described barriers to access and uptake, poor levels of preventative dental care, DIY dentistry in the event of dental emergencies, substance use to self-medicate for dental pain, mixed awareness of the effects of sugary products and substance use on oral health and cancers, and emphasised the importance of preventative dental care and dental aesthetics when in recovery.

CONCLUSIONS

Findings illustrate a profile of oral health behaviours in Irish drug users, with information useful for private and public practice, and in the further development of street, community and treatment setting oral health interventions.

Drug packaging in 2013: small changes would reap big benefits

Drug packaging is important both in protecting and informing patients. Some improvements were made in 2013, but many of the products examined by Prescrire still had poor-quality or even dangerous packaging. Problem packaging is a major concern for patients who are more vulnerable to adverse effects, particularly children and pregnant women. Several problems were noted with products intended for self-medication (umbrella brands), oral solutions sold with dosing devices, and injectable drugs. Looking back at 20 years of Red Cards that Prescrire has issued to products with dangerous packaging reveals several improvements, but too many dangers persist. Urgent action needs to be taken by regulatory agencies and drug companies: patient leaflets must be more explicit with regard to adverse effects, especially those of nonsteroidal anti-inflammatory drugs during pregnancy; accidental ingestion by children must be prevented; and companies must design safer dosing devices. Healthcare professionals and patients must remain vigilant and report all packaging issues to the relevant authorities.

The drugs don't sell: DIY heart health and the over-the-counter statin experience

This paper draws on a study of over-the-counter statins to provide a critical account of the figure of the 'pharmaceutical consumer' as a key actor in the pharmaceuticalisation literature. A low dose statin, promising to reduce cardiovascular risk, was reclassified to allow sale in pharmacies in the UK in 2004. We analysed professional and policy debates about the new product, promotional and sales information, and interviews with consumers and potential consumers conducted between 2008 and 2011, to consider the different consumer identities invoked by these diverse actors. While policymakers constructed an image of 'the citizen-consumer' who would take responsibility for heart health through exercising the choice to purchase a drug that was effectively rationed on the NHS and medical professionals raised concerns about 'a flawed consumer' who was likely to misuse the product, both these groups assumed that there would be a market for the drug. By contrast, those who bought the product or potentially fell within its target market might appear as 'health consumers', seeking out and paying for different food and lifestyle products and services, including those targeting high cholesterol. However, they were reluctant 'pharmaceutical consumers' who either preferred to take medication on the advice of a doctor, or sought to minimize medicine use. In comparison to previous studies, our analysis builds understanding of individual consumers in a market, rather than collective action for access to drugs (or, less commonly, compensation for adverse effects). Where some theories of pharmaceuticalisation have presented consumers as creating pressure for expanding markets, our data suggests that sociologists should be cautious about assuming there will be demand for new pharmaceutical products, especially those aimed at prevention or asymptomatic conditions, even in burgeoning health markets.

Chinese Elders' views on their interactions in general practice: a Grounded Theory study

OBJECTIVES

The Chinese ethnic population are among the UK's largest visible minority but there is limited evidence about this population, their views about their interactions with General Practitioners (GPs) and how this impacts on their health. This study aimed to explore Chinese Elders' experiences of and attitudes towards the provision of health services in primary care.

DESIGN

The method of investigation was a Grounded Theory study using open-ended in-depth interviews. Purposive and theoretical sampling was used to recruit thirty-three Chinese Elders from Chinese communities in the North West of England. Face-to-face interviews were conducted and audio-recorded; transcripts were translated, back translated, analysed and coded by all members of the research team to identify concepts following the Grounded Theory approach. Themes were generated from the data and were used to guide the study into the theoretical sampling phase of the investigation.

RESULTS

Chinese Elders were inclined to present to GPs only when health concerns were perceived as serious. This was defined as being beyond their ability to self-manage. Elders tended to adopt self-management strategies rather than follow professional advice. This was mainly due to communication difficulties, poor understanding of the advice doctors gave, and the way that Chinese patients interpreted and used the advice they were given. Chinese Elders reported that the purpose of contacting doctors was to obtain medicines. They presumed that once medication had been prescribed their symptoms would be cured, and then they believed that they could self-manage their health, usually without further GP or other medical follow up.

CONCLUSION

These data suggest that significant misunderstandings between Chinese Elders and GPs exist. The findings highlight the dissatisfaction expressed by Elders regarding their interactions with UK health professionals. Chinese Elders' perceptions are influenced by the way Chinese people think about health and illness, and also by their GPs' assumptions. These findings are of value to UK GPs and family doctors worldwide who are concerned with improving the quality of health services provided to an increasingly ageing migrant Chinese population.

[Smoking as a form of self-medication for depression or anxiety in young adults: results of a mixed-methods study]

Tobacco use and mental health problems in the depression/anxiety spectrum often begin in adolescence as co-occurring phenomena. Epidemiologically, the relationship between them is bidirectional, but in the case of young people it appears to be explained best by the unidirectional self-medication hypothesis. The aim of this study is to explore the relationship between tobacco use, symptoms of depression or anxiety, and the perception of adolescents and young adults concerning tobacco use as a form of self-medication. A sample of 105 young people between the ages of 17 and 21 years was selected from a longitudinal sociological study to create three groups of participants: 1) subjects with a previous diagnosis of depression or anxiety; 2) subjects with self-perceived but undiagnosed distress compatible with depression or anxiety; 3) and a group of control. A mixed quantitative/qualitative questionnaire on substance consumption was administered, as well as the BDI-II depression scale, the GHQ anxiety and depression scales, and the MISS (Mannheim Interview on Social Support) scale. The final results show that the subjects experiencing symptoms of depression or anxiety in adolescence start smoking later than subjects in the control group, and those who smoke give self-medication as the main reason for doing so. The association between habitual tobacco use and BDI scores for depression was not statistically significant for the sample as a whole, only for the male participants (OR: 6,22, IC 95%, 1,06-36,21, p=.042). Anti-smoking campaigns targeting young people should take into consideration their use of tobacco as a form of self-medication for emotional distress.

Reconceive shamanism related theory of schizophrenia

In this review we try to summarize the concepts, hypotheses and facts about schizophrenia and shamanism. Because during this dispute the evolutionary approach has been cited lately we briefly discuss this point of view as well. To make a proper comparison first we discuss the main characteristic of the two concepts. After a hundred years of medical research, schizophrenia is a diagnostic term useful in clinical practice but ambiguously defined scientifically. In ethnology the term shamanism also cover a wide phenomenological spectrum, so we exclude the differences to stipulate the essence of shamanism in order to make the comparison with schizophrenia possible. Than we discuss the pros and cons data on phenomenological similarity, course and prognosis, epidemiology and available psychological items. We finally reach the same conclusion as the recent ethnological literature that in connection with shamanism schizophrenia should be avoided. However we consider the possible compromising explanations as well.

"Nonmedical" prescription opioid use in North America: a call for priority action

Nearly four years after the United States Congress heralded a "decade of pain control and research", chronic pain remains a mounting public health concern worldwide. The escalating prevalence of chronic pain in recent years has been paralleled by a rise in prescription opioid availability, misuse, and associated human and social costs. However, national monitoring surveys in the U.S. and Canada currently fail to differentiate between prescription opioid misuse for the purposes of euphoria versus pain or withdrawal management. Furthermore, there is a lack of evidence-based guidelines for pain management among high-risk individuals, and a glaring lack of education for practitioners in the areas of pain and addiction medicine. Herein we propose multiple avenues for intervention and research in order to mitigate the individual, social and structural problems related to undertreated pain and prescription opioid misuse.