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Makki M, Akmal Shafie A, Awaisu A, Hussain R, Al Hail M, ElMotasim WM, Mohamed Ali Taha MY, Abdoun E, Al-Khuzaei NMJ, Salama G, Pallivalapila A, El Kassem W, Thomas B. Patients' knowledge, attitude, and practices toward unused medications in Qatar: A cross-sectional survey. Heliyon 2024; 10:e31931. [PMID: 39015807 PMCID: PMC11250874 DOI: 10.1016/j.heliyon.2024.e31931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/18/2024] [Accepted: 05/24/2024] [Indexed: 07/18/2024] Open
Abstract
Background Global evidence has linked unused medications and their inappropriate disposal to adverse health, economic, environmental, and ethical impacts. However, such evidence is scarce in Qatar. This study explored patients' knowledge and attitude toward unused medications and their practices toward medication supply and disposal (KAP) in Qatar.Materials and methods. Study design A cross-sectional survey using a pretested questionnaire was performed between February 2020 and October 2020. Descriptive statistics, Man Whitney U, and Kruskal-Wallis Rank-Sum tests were applied. The Chi square test assessed the association between socio-demographic characteristics and KAP scores. Characteristics that were found significantly associated with KAP (i.e., p-values <0.05) were further included as predictor variables in the multiple linear regression model. Results All items pertaining to patients' knowledge were found to be good (mean score > 3), except for "awareness of unwanted medication return policy" (mean score < 3), i.e., the lowest level of patient agreement (31 %) (median (M) = 3, Interquartile Range (IQR) = 3). Their attitude was generally good (mean score > 3). Conversely, their practice toward medication supply was poor (mean score < 3). Possible future use was the most reported reason (79 %) for keeping medications at home, and home trash was the most widely disposing place of unused ones (76 %). Knowledge was significantly higher among non-laborers and other occupations than among patients with no work (p < 0.001) and (p = 0.005), respectively. The attitude was significantly lower among patients with healthcare providers (HCPs) in their household than among those without (p = 0.001). Practices were also significantly lower among those aged 40-49 years and those with HCPs in their household than those aged 18-29 years (p = 0.012) and those without HCPs, (p < 0.001), respectively. Conclusions Overall, patients' knowledge and attitude toward unused medications seem good, while their practices toward medication supply and disposal are bad. To mitigate the health, economic, and environmental impacts of unused medications, interventions including rationalizing drug supply, use, disposal, prescribing, manufacturing, and promotion are recommended.
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Affiliation(s)
- Mutaseim Makki
- Pharmacy and Drug Control Department, Ministry of Public Health-Qatar, P.O Box 1919, Qatar
| | - Asrul Akmal Shafie
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, 11800, Malaysia
| | - Ahmed Awaisu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O.Box 2713, Doha, Qatar
| | - Rabia Hussain
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, 11800, Malaysia
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Michelin ADF, Bonifácio NA, Nagata WB, da Silva VMS, Gobbo LEM, Bresciani KDS. Guidance provided by pharmacists to customers regarding to destination of unused household medications: disposal of household medications. BMC Health Serv Res 2023; 23:1350. [PMID: 38049849 PMCID: PMC10694965 DOI: 10.1186/s12913-023-10319-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 11/14/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Discarding pharmaceuticals in the garbage or into the sewage system are still the most common methods in many countries. This study aims to investigate the guidance provided by pharmacists to customers on the disposal of unused and expired household medications in São Paulo State, Brazil. METHOD The study population consisted of 630 pharmacists from the State of São Paulo, who work in community pharmacies. They answered an online questionnaire with questions composed in three blocks: demographic, work, and academic information on the pharmacist; guidance about the disposal of household medications; and knowledge regarding the reverse logistics of these medications. An invitation to participate in the questionnaire was made via WhatsApp, individually and collectively. Inferential statistics were performed using the chi-square test and were considered significant when p < 0.05%. RESULTS Among the participating pharmacists, the majority were women under 60 years old,56 (8.89%) stated that they never orient the customer regarding the disposal of unused and expired household medications, while 574 (91,12%) indicated that they almost provide guidance. The frequency with which they provided guidance was influenced by the number of years since graduation (p = 0.0047), the time they had worked in pharmacies and drugstores (p = 0.0007), and whether or not they had a graduate degree (p = 0.0181). Regarding the disposal of medications, among the 643 responses provided by the pharmacists,516 (80.25%) indicated that they oriented customers to return them to a pharmacy. CONCLUSION A small number of pharmacists always orient customers on the proper disposal that should be followed for unused and expired household medications, prioritizing their return to a pharmacy. In general, these pharmacists have longer periods of work experience and higher academic qualifications. Thus, it is important to increase knowledge through professional training and further education programs.
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Affiliation(s)
- Aparecida de Fatima Michelin
- School of Veterinary Medicine, São Paulo State University (Unesp), Rua Clóvis Pestana, no 793, Araçatuba, 16050-680, SP, Brazil.
- Institute of Health Sciences, Paulista University, Araçatuba, SP, Brazil.
| | - Neuza Alves Bonifácio
- School of Veterinary Medicine, São Paulo State University (Unesp), Rua Clóvis Pestana, no 793, Araçatuba, 16050-680, SP, Brazil
- Institute of Health Sciences, Paulista University, Araçatuba, SP, Brazil
| | | | - Valéria Maria Savoya da Silva
- School of Veterinary Medicine, São Paulo State University (Unesp), Rua Clóvis Pestana, no 793, Araçatuba, 16050-680, SP, Brazil
| | | | - Katia Denise Saraiva Bresciani
- School of Veterinary Medicine, São Paulo State University (Unesp), Rua Clóvis Pestana, no 793, Araçatuba, 16050-680, SP, Brazil
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Xu BX, Ding Y, Bilal M, Wang MY. Event-related potentials for investigating the willingness to recycle household medical waste. Heliyon 2023; 9:e20722. [PMID: 37842614 PMCID: PMC10570574 DOI: 10.1016/j.heliyon.2023.e20722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023] Open
Abstract
Household medical waste (HMW) recycling in the reverse supply chain has become a primary channel for infectious, toxic, or radioactive substances for environmental protection and a circular economy. Recycling managers need to understand the recycling decision-making mechanisms of households to improve the intention-behavior gap and recycling participation rate, especially in cognitive neuroscience. This study designed an event-related potential (ERPs) experiment to explore the differences in ERPs components between the willingness and unwillingness to make recycling decisions. Our findings confirmed that willingness and unwillingness to recycle can lead to a significant difference in the P300 and N400 scores. A larger P300 was evoked by willingness rather than unwillingness in the prefrontal, frontal, and frontal-temporal regions. This indicates that willingness to recycle results from a rational choice in the decision-making process. However, a larger N400 was evoked by unwillingness rather than willingness in the parietal, parietal-occipital, and occipital regions. A negative wave was evoked in households unwilling to recycle because they thought it was dangerous and unsanitary, causing a higher conflict with intrinsic cognition. The combination of HMW recycling decisions and neurology may accurately measure pro-environmental decision-making processes through brain science. Advancing the knowledge of psychological and brain mechanism activities for understanding pro-environmental choices. In turn, this can help recycling managers to accurately understand household demands for increasing the recycling intention and designing effective HMW take-back systems to solve the intention-behavior gap related to the global recycling dilemma.
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Affiliation(s)
- Bin-Xiu Xu
- School of Economics and Management, Anhui Polytechnic University, Wuhu, PR China
| | - Yi Ding
- School of Economics and Management, Anhui Polytechnic University, Wuhu, PR China
| | - Muhammad Bilal
- School of Economics and Management, Anhui Polytechnic University, Wuhu, PR China
| | - Mia Y. Wang
- Department of Computer Science, College of Charleston, SC, USA
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Hajj A, Domiati S, Haddad C, Sacre H, Akl M, Akel M, Tawil S, Abramian S, Zeenny RM, Hodeib F, Salameh P. Assessment of knowledge, attitude, and practice regarding the disposal of expired and unused medications among the Lebanese population. J Pharm Policy Pract 2022; 15:107. [PMID: 36585685 PMCID: PMC9802024 DOI: 10.1186/s40545-022-00506-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Medication waste is a public health problem affecting developed and developing countries. In Lebanon, a developing country in the Middle East, efforts are being deployed in hospitals but not in the community. OBJECTIVE This study aimed to validate a questionnaire to explore the knowledge, attitude, and practice (KAP) towards the disposal of unused and expired medicines among the Lebanese population and then identify the factors associated with these variables comparatively between the general population and healthcare professionals. METHODS A cross-sectional study was conducted among the general Lebanese population in May-June 2022 using a standardized questionnaire. The validity and reliability of the KAP scales were assessed, then a thorough statistical analysis was done to explore the factors associated with these scales. RESULTS The KAP scales generated by this study were valid and reliable. Using these scales, 24.5%, 22.6%, and 21% of participants demonstrated proper knowledge, attitude, and practice, respectively. Higher knowledge scores were significantly associated with female gender (Beta = 0.97), a high monthly income (Beta = 1.68), a secondary (Beta = 6.11) or university (Beta = 6.80) education level, and postgraduate education (Beta = 7.13). However, older age (Beta = - 0.06) and a low monthly income (Beta = - 3.06) were significantly associated with lower knowledge scores. A higher knowledge score (Beta = 0.06) was significantly associated with a more positive attitude regarding unused or expired medication disposal. Being a healthcare professional (Beta = 0.72) was significantly associated with a higher practice score, while being a female (Beta = - 0.32) and living in a rural area (Beta = - 0.37) were significantly associated with lower practice scores. CONCLUSION This study validated KAP scales regarding medication waste in Lebanon and showed low KAP scores in the majority of respondents. Factors associated with higher KAP scores in various aspects of medication disposal, including gender, age, education level, and profession (healthcare professionals), suggest the need to consider those when implementing targeted corrective measures. Although further studies are required to confirm our findings, this study could be the ground for a medication waste management national strategy in Lebanon.
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Affiliation(s)
- Aline Hajj
- grid.23856.3a0000 0004 1936 8390Faculty of Pharmacy, Université Laval, Québec City, Canada ,INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon ,grid.411081.d0000 0000 9471 1794Oncology Division, CHU de Québec-Université Laval Research Center, Québec City, QC Canada ,grid.42271.320000 0001 2149 479XLaboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité Des Médicaments (LPCQM), Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Souraya Domiati
- grid.18112.3b0000 0000 9884 2169Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon
| | - Chadia Haddad
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon ,grid.411323.60000 0001 2324 5973School of Medicine, Lebanese American University, Byblos, Lebanon ,grid.512933.f0000 0004 0451 7867Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon ,grid.444428.a0000 0004 0508 3124School of Health Sciences, Modern University for Business and Science, Beirut, Lebanon
| | - Hala Sacre
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon ,Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon
| | - Maria Akl
- grid.8991.90000 0004 0425 469XFaculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Marwan Akel
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon ,grid.444421.30000 0004 0417 6142Pharmacy Practice Department, School of Pharmacy, Lebanese International University, Beirut, Lebanon ,grid.475243.30000 0001 0729 6738International Pharmaceutical Federation, The Hague, Netherlands
| | - Samah Tawil
- grid.411323.60000 0001 2324 5973School of Medicine, Lebanese American University, Byblos, Lebanon ,Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon
| | - Soula Abramian
- Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon
| | - Rony M. Zeenny
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon ,grid.411654.30000 0004 0581 3406Department of Pharmacy, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Hodeib
- grid.444421.30000 0004 0417 6142Department of Biomedical Sciences, School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Pascale Salameh
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon ,grid.411323.60000 0001 2324 5973School of Medicine, Lebanese American University, Byblos, Lebanon ,grid.413056.50000 0004 0383 4764Department of Primary Care and Population Health, University of Nicosia Medical School, 2417 Nicosia, Cyprus ,grid.411324.10000 0001 2324 3572Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
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Rogowska J, Zimmermann A. Household Pharmaceutical Waste Disposal as a Global Problem-A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192315798. [PMID: 36497873 PMCID: PMC9737308 DOI: 10.3390/ijerph192315798] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 05/31/2023]
Abstract
The negative effect of the pharmaceuticals presence (persistence?) in various components of the environment is a global problem today. These compounds are released into the environment as a result of, inter alia, their use and improper disposal. Therefore, it is important to reduce excessive drug consumption and to develop a system for the collection of unused/expired pharmaceuticals. The effectiveness of actions in this area is inextricably linked with the need to educate society on how to deal properly with unwanted medications. The aim of the study was to show that the inappropriate handling of unused/expired drugs by society is an important problem in waste management systems, and it impacts the state of the environment. Forty-eight scientific articles published between 2012 and 2021 were taken into account that discussed the systems in various countries for the collection of unused/expired pharmaceuticals. This literature review shows that the main method of disposing of unused/expired medications, according to respondents from different countries, is either by disposing of them in household waste or flushing them into the sewage system. This is also the case in countries with systems or programs for the return of redundant drugs, which indicates that these systems are not sufficiently effective. This may be influenced by many factors, including the lack or ineffective education of the society.
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Aluko OO, Imbianozor GT, Jideama CO, Ogundele OV, Fapetu TE, Afolabi OT, Odewade OL. The perception and disposal practices of unused and expired medicines by households in an urban municipality, southwest Nigeria: A comparative cross-sectional study. WASTE MANAGEMENT (NEW YORK, N.Y.) 2022; 140:121-132. [PMID: 35078076 DOI: 10.1016/j.wasman.2022.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/22/2021] [Accepted: 01/16/2022] [Indexed: 06/14/2023]
Abstract
Unused, damaged, and expired medicines (UEMs) pose disposal challenges globally, despite their importance. The environmental disposal of UEMs portends public health consequences, hence, this study in high-density (HDS) and low-density (LDS) urban households in Southwest Nigeria. The comparative, cross-sectional study utilised multi-stage samplingto enrol 404 females, experienced in use and medicines safekeeping. The response rate was 93%. Data were analysed by IBM-SPSS, version 20. Continuous and categorical variableswere presentedin tables as mean(±SD), proportions (%), respectively while χ2 and logistic regression statistics determined differences between LDS and HDS (Pα > 0.05). 53.4% and 71.2% of respondents respectively had good knowledge and positive attitudes to safe disposal of UEMs. At least 31.5% of households don't stock medicines while antimalarial (57.3%), analgesics (52.7%) and antibiotics (49.7%) predominate in households and significantly different between LDS and HDS. 72.9% and 67.8%; 47.9% and 55.6% respondents in LDS and HDS, respectively, disposed of solid and liquid UEMs in storage bins, though 34.9% (LDS) and 16.7% (HDS) disposed of liquid UEMs in toilet/sink. There were significant differences in medicines abundance and disposal practices between LDS and HDS for solid and liquid medicines. 37.1% of respondents perceived consequences for the poor UEMs disposal, including accidental ingestion (76.6% vs 26.7%), land pollution (69.6% vs 36.7%), water pollution (72.4% vs 32.8%) and toxicity (58.3% vs 32.8%), respectively in LDS and HDS. Respondents' good knowledge and positive attitudes contrasted with poor UEMs disposal practices, which compromise public health. Legislation, compliance monitoring and enforcement are germane for incentive-driven UEMs recovery.
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Affiliation(s)
- O O Aluko
- Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - G T Imbianozor
- Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - C O Jideama
- Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - O V Ogundele
- Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - T E Fapetu
- Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - O T Afolabi
- Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - O L Odewade
- Department of Environmental Management, Faculty of Earth and Environmental Sciences, Bayero University, Kano, Nigeria
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Mathur P, Sanyal D, Callahan DL, Conlan XA, Pfeffer FM. Treatment technologies to mitigate the harmful effects of recalcitrant fluoroquinolone antibiotics on the environ- ment and human health. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 291:118233. [PMID: 34582925 DOI: 10.1016/j.envpol.2021.118233] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/06/2021] [Accepted: 09/24/2021] [Indexed: 06/13/2023]
Abstract
Antibiotic proliferation in the environment and their persistent nature is an issue of global concern as they induce antibiotic resistance threatening both human health and the ecosystem. Antibiotics have therefore been categorized as emerging pollutants. Fluoroquinolone (FQs) antibiotics are an emerging class of contaminants that are used extensively in human and veterinary medicine. The recalcitrant nature of fluoroquinolones has led to their presence in wastewater, effluents and water bodies. Even at a low concentration, FQs can stimulate antibacterial resistance. The main sources of FQ contamination include waste from pharmaceutical manufacturing industries, hospitals and households that ultimately reaches the wastewater treatment plants (WWTPs). The conventional WWTPs are unable to completely remove FQs due to their chemical stability. Therefore, the development and implementation of more efficient, economical, convenient treatment and removal technologies are needed to adequately address the issue. This review provides an overview of the technologies available for the removal of fluoroquinolone antibiotics from wastewater including adsorptive removal, advanced oxidation processes, removal using non-carbon based nanomaterials, microbial degradation and enzymatic degradation. Each treatment technology is discussed on its merits and limitations and a comparative view is presented on the choice of an advanced treatment process for future studies and implementation. A discussion on the commercialization potential and eco-friendliness of each technology is also included in the review. The importance of metabolite identification and their residual toxicity determination has been emphasized. The last section of the review provides an overview of the policy interventions and regulatory frameworks that aid in retrofitting antibiotics as a central key focus contaminant and thereby defining the discharge limits for antibiotics and establishing safe manufacturing practices.
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Affiliation(s)
- Purvi Mathur
- TERI-Deakin NanoBiotechnology Centre, Sustainable Agriculture Division, The Energy and Resources Institute, New Delhi, 110003, India; Deakin University, School of Life and Environmental Sciences (Burwood Campus), 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Doyeli Sanyal
- TERI-Deakin NanoBiotechnology Centre, Sustainable Agriculture Division, The Energy and Resources Institute, New Delhi, 110003, India; Amity University Punjab, IT City, Sector 82A, Mohali, 140308, India.
| | - Damien L Callahan
- Deakin University, School of Life and Environmental Sciences (Burwood Campus), 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Xavier A Conlan
- Deakin University, School of Life and Environmental Sciences, (Waurn Ponds Campus), 75 Pigdons Road, Locked Bag 20000, Geelong, VIC, 3220, Australia
| | - Frederick M Pfeffer
- Deakin University, School of Life and Environmental Sciences, (Waurn Ponds Campus), 75 Pigdons Road, Locked Bag 20000, Geelong, VIC, 3220, Australia
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Duca DA, Dan ML, Vaszilcsin N. Recycling of Expired Ceftamil Drug as Additive in the Copper and Nickel Electrodeposition from Acid Baths. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189476. [PMID: 34574398 PMCID: PMC8467844 DOI: 10.3390/ijerph18189476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/03/2021] [Accepted: 09/05/2021] [Indexed: 11/16/2022]
Abstract
Due to the large quantity of expired and unused drugs worldwide, pharmaceutical disposal has become a serious problem that requires increased attention. In the present paper, the study on recycling ceftazidime (CZ) as an additive in copper and nickel electrodeposition from acid baths is highlighted. CZ is the active substance from expired commercial drug Ceftamil®. Its electrochemical behavior was studied by cyclic voltammetry. As well, kinetic parameters for copper and nickel electrodeposition were determined using Tafel plots method at different temperatures and CZ concentrations in these acid baths. The activation energy was calculated from Arrhenius plots. Electrochemical impedance spectroscopy was used to investigate the charge transfer resistance and coverage degree in the electrolyte solutions at several potential values. Gibbs free energy values, calculated from Langmuir adsorption isotherms, revealed the chemical nature of CZ–electrode surface interactions. The favorable effect of the organic molecules added in copper and nickel electroplating baths was emphasized by optical microscope images. The morphology of the obtained deposits without and with 10−4 mol L−1 CZ was compared. The experimental results revealed that expired Ceftamil® is suitable as additive in copper and nickel electroplating processes from acid baths.
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Luo Y, Reimers K, Yang L, Lin J. Household Drug Management Practices of Residents in a Second-Tier City in China: Opportunities for Reducing Drug Waste and Environmental Pollution. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168544. [PMID: 34444293 PMCID: PMC8391123 DOI: 10.3390/ijerph18168544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 11/16/2022]
Abstract
The total amount of drug waste is expanding significantly as populations age and societies become wealthier. Drug waste is becoming a problem for health and the environment. Thus, how to reduce and effectively dispose of drug waste is increasingly becoming an issue for society. This study focuses on household drug management, which involves five sub-practices: selection, purchasing, using, storing, and disposing of drugs. A questionnaire survey was conducted in a second-tier Chinese city that reveals both problems and opportunities in these five sub-practices. The results show that consumers are aware of significant issues with regard to the safe and effective use of drugs as well as with regard to proper ways of disposing of and recycling drugs. Moreover, our analysis reveals promising opportunities for addressing these issues by developing novel services based on the idea of connecting the five involved sub-practices of household drug management. Connecting and adjusting practices in this manner can be seen as an important factor in reducing drug waste and pharmaceutical pollutants.
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Affiliation(s)
- Yumei Luo
- School of Business and Tourism Management, Yunnan University, Kunming 650106, China; (Y.L.); (L.Y.)
| | - Kai Reimers
- School of Business and Economics, RWTH Aachen University, 52062 Aachen, Germany;
| | - Lei Yang
- School of Business and Tourism Management, Yunnan University, Kunming 650106, China; (Y.L.); (L.Y.)
| | - Jinping Lin
- School of Resource Environment and Earth Science, Yunnan University, Kunming 650106, China
- Correspondence:
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Disposal Practices of Unused and Leftover Medicines in the Households of Dhaka Metropolis. PHARMACY 2021; 9:pharmacy9020103. [PMID: 34065255 PMCID: PMC8162525 DOI: 10.3390/pharmacy9020103] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background: This fact-finding study aimed to attain an overall idea and knowledge about medicine disposal practices in Dhaka Metropolitan households. Methods: This mixed study (both quantitative and qualitative) was orchestrated to inspect the household leftover medicine disposal pattern's governing status. A cross-sectional survey was conducted following a structured questionnaire and key informant interview with a household person and in-depth interviews with the top pharmaceutical and government officials. Results: Findings disclose that, for most of the key informants, the terms "drug disposal" and "drug pollution" were unknown; more precisely, 67% and 74% of key informants even did not hear these two terms. Almost all (87%) households faced undesired incidents due to the insecure storage of medicines. People disposed of excess and expired medication in regular dustbins (47%), threw out of the window (19%), flushed within commode (4%), burnt in fire (2%), and reused (4%). A good percentage of people (21%) returned unexpired drugs to the pharmacy and bought other medicines on a need basis. A total of 72% wanted a medicine take-back program, and 100% agreed on mass education on this issue. Officials of pharmaceuticals conferred mixed opinion: top-ranked pharmaceuticals will adopt leftover medicine disposal practices; middle and low-ranked pharmaceutical companies are reluctant, merely denied mentioning the less important issue. Conclusions: The absence of mass awareness and standard laws and policies may explain these existing aberrant practices.
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Hsu Y, Thomas J, Tang Chang C, Ma CM. Enhanced Photocatalytic Degradation of Antibiotic and Hydrogen Production by Iron Doped Cerium(IV) Oxide. JOURNAL OF NANOSCIENCE AND NANOTECHNOLOGY 2021; 21:3099-3106. [PMID: 33653485 DOI: 10.1166/jnn.2021.19150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Norfloxacin (NF) is an emerging antibiotic contaminant due to its significant accumulation in the environment. Photocatalytic degradation is an effective method for removing emerging contaminant compounds in aqueous solution; however, it is not commonly applied because of the poor solubility of contaminant compounds in water. In this study, a photocatalytic degradation experiment was carried out on NF using a self-made ceria catalyst. At an initial concentration of NF of 2.5 mg L-1, the dosage of CeO₂ was 0.1 g L-1 photocatalyst in water, and the initial pH of the NF solution was 8.0. With a reaction time of 180 min, the total removal rate of NF could reach 95%. Additionally, the studies on hydrogen production show that the maximum hydrogen production with 2% Fe-CeO₂ can reach 25,670 μmol h-1 g-1 under close to 8 W of 365 nm, a methanol concentration of 20%, and a catalyst dose of 0.1 g L-1 photocatalyst in water. Furthermore, the intensities of photoluminescence (PL) emission peaks decreased with increased Fe-doped amounts on CeO₂, suggesting that the irradiative recombination seemed to be weakened.
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Affiliation(s)
- Yang Hsu
- Department of Environmental Engineering, National Ilan University, 260, Taiwan
| | - Joy Thomas
- Department of Environmental Engineering, National Ilan University, 260, Taiwan
| | - Chang Tang Chang
- Department of Environmental Engineering, National Ilan University, 260, Taiwan
| | - Chih Ming Ma
- Department of Cosmetic Application and Management, St. Mary's Junior College of Medicine, Nursing and Management, 266, Taiwan
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Bombaywala S, Mandpe A, Paliya S, Kumar S. Antibiotic resistance in the environment: a critical insight on its occurrence, fate, and eco-toxicity. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:24889-24916. [PMID: 33765260 DOI: 10.1007/s11356-021-13143-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
The overuse, misuse, and underuse of antibiotics tend to increase the antibiotic burden in the environment resulting into the evolution in microbial community to possess resistance that renders antibiotics ineffective against them. The current review recapitulates the present state of knowledge about the occurrence and fate of antibiotics in various environmental matrices. Also, the prevalence of antibiotic-resistant bacteria/antibiotic-resistant genes (ARB/ARGs) in various biological and non-biological systems, eco-toxicity of antibiotics on non-target organisms, and remediation methods for antibiotics and ARB/ARGs removal were critically reviewed. Furthermore, a comparison of various technologies for their efficiency to eliminate antibiotic residues and ARB/ARGs is made. The study identified gaps in the investigation of toxic effects of low concentration of antibiotics and the mixture of multiple antibiotics on non-target organisms. The study of antibiotics' phytotoxicity and toxicity towards sediment and soil-dwelling organisms are also recognized as a knowledge gap. The review also details policies implemented across the globe to fight against antibiotic resistance, and the scarcity of data on lab to land transferred remediation technology was identified. The present study entails a critical review of literature providing guidelines for the articulation of policies for prudent use of antibiotics, limits on the amount of antibiotics in pharmaceutical formulations, and regular surveillance in the Indian context.
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Affiliation(s)
- Sakina Bombaywala
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 2010 02, India
- CSIR-National Environmental Engineering Research Institute (CSIR-NEERI), Nehru Marg, Nagpur, 4400 20, India
| | - Ashootosh Mandpe
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 2010 02, India
- CSIR-National Environmental Engineering Research Institute (CSIR-NEERI), Nehru Marg, Nagpur, 4400 20, India
| | - Sonam Paliya
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 2010 02, India
- CSIR-National Environmental Engineering Research Institute (CSIR-NEERI), Nehru Marg, Nagpur, 4400 20, India
| | - Sunil Kumar
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 2010 02, India.
- CSIR-National Environmental Engineering Research Institute (CSIR-NEERI), Nehru Marg, Nagpur, 4400 20, India.
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Vatovec C, Kolodinsky J, Callas P, Hart C, Gallagher K. Pharmaceutical pollution sources and solutions: Survey of human and veterinary medication purchasing, use, and disposal. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2021; 285:112106. [PMID: 33588165 DOI: 10.1016/j.jenvman.2021.112106] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/13/2021] [Accepted: 01/31/2021] [Indexed: 05/26/2023]
Abstract
Human and veterinary pharmaceuticals offer many benefits, but they also pose risks to both the environment and public health. Life-cycle stewardship of medications offers multiple strategies for minimizing the risks posed by pharmaceuticals, and further insight is required for developing best practices for pharmaceutical management. The goal of this study was to clarify points of intervention for minimizing environmental and public health risks associated with pharmaceuticals. Specifically, our objectives were to provide insight on purchasing, use, and disposal behaviors associated with human and veterinary medications. This study used a state-wide representative sample of Vermont adults (n = 421) to survey both human and veterinary pharmaceuticals as potential sources of the unintended consequences of prescribed and over-the-counter (OTC) medications. The majority (93%) of respondents had purchased some form of medication within the past twelve months, including OTC (85%), prescription (74%), and veterinary (41%) drugs. Leftover drugs of any kind were reported by 59% of respondents. While 56% of people were aware of drug take-back programs, the majority reported never being told what to do with leftover medications by their physician (78%), pharmacist (76%), or veterinarian (53%). Among all respondents, take-back programs were the most common disposal method (22%), followed by trash (19%), and flushing (9%), while 26% of respondents reported keeping unused drugs. Awareness of pharmaceutical pollution in the environment and having received information about proper disposal were both significantly associated with participation in take-back programs. These findings indicate that a large volume of drugs are going unused annually, and that only a portion of leftover medications are returned to take-back programs where they can be appropriately disposed. Our results warrant further investigation of clinical interventions that support lower dose prescribing and dispensing practices in order to reduce the unintended environmental and public health consequences of pharmaceuticals within the consumer sphere. In addition, our findings suggest that directed efforts to raise awareness of proper disposal may be more effective than broad awareness campaigns, and we recommend research on the efficacy of providing disposal instructions on drug packaging.
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Affiliation(s)
- Christine Vatovec
- Gund Institute for Environment & Larner College of Medicine, University of Vermont, Burlington, VT, USA.
| | - Jane Kolodinsky
- Community Development and Applied Economics, University of Vermont, Burlington, VT, USA
| | - Peter Callas
- Department of Mathematics & Statistics, University of Vermont, Burlington, VT, USA
| | - Christine Hart
- Rubenstein School of Environment & Natural Resources, University of Vermont, Burlington, VT, USA
| | - Kati Gallagher
- Community Development and Applied Economics, University of Vermont, Burlington, VT, USA
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Makki M, Hassali MAA, Awaisu A, Chemaitelly H. Development, translation, and validation of a bilingual questionnaire on unused medications in homes. Saudi Pharm J 2021; 29:648-655. [PMID: 34400858 PMCID: PMC8347668 DOI: 10.1016/j.jsps.2021.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/21/2021] [Indexed: 11/19/2022] Open
Abstract
Background Unused medications in homes pose significant health, economic, and environmental risks. Patients are the medications end users and their knowledge, attitude, and practices (KAP) play an important role towards medication use, unuse and wastage. Thus, a valid instrument to reliably measure patients’ KAP towards unused medications in homes may help manage the associated risks. Objective To develop, translate, and validate a questionnaire for the assessment patients’ KAP towards unused medications in Qatar homes (i.e., QUM-Qatar). Setting This cross-sectional validation study was conducted among randomly selected outpatients visiting various public and private pharmacies in Qatar between September 2019 and February 2020. Method Nine experts in the field of pharmacy practice with Qatar contextual background established the content validity of the instrument. The validity was quantified using content validity index (CVI). Furthermore, construct validity was performed using principal component analysis (PCA), whereas internal consistency reliability of items was determined using Cronbach’s alpha. Statistical analyses were performed using STATA 15 statistical software. Main outcome measure The psychometric properties of the QUM-Qatar assessment instrument. Results An English/Arabic questionnaire was developed and validated. Content validity in the form of scale-level-CVI (S-CVI)/Average and S-CVI/UA was 0.88 and 0.84, respectively, suggesting adequate relevant content of the questionnaire. Variation explained by the multivariate model was 85.0% for knowledge, 94.8% for attitude, and 89.8% for practice. Cronbach’s alpha coefficients were 0.68, 0.82, and 0.84, for knowledge, attitude, and practice domains, respectively. From the psychometric results obtained, the questionnaire's validity and reliability were attained. Conclusion The QUM-Qatar instrument has acceptable psychometric properties and has the potential for future use in research and practice to assess KAP towards unused medications in Qatar and elsewhere. It may consequently help in improving medication use and mitigating the negative health, economic, and environmental impacts of unused medications. Impacts on practice.There is now a valid and reliable English/Arabic language questionnaire to assess patients’ KAP towards unused medications. Policymakers can utilize this questionnaire to develop evidence-based policies and strategies for managing unused medications and their disposal. To improve medication use review, rational use of medicines, and adherence, it is necessary to consider patient-reported outcomes that may eventually reflect on saving health, economic resources, and environment.
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Affiliation(s)
- Mutaseim Makki
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia
- Corresponding author.
| | | | - Ahmed Awaisu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O.Box 2713, Doha, Qatar
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
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Mahara G, Wu Z, Ge Q, Li Z, Zhang J. Assessment on the Impact on Human Health, Environment, Water and Soil by Disposing Household Expired Drugs: A Cross-Sectional Study in China. Risk Manag Healthc Policy 2021; 14:1711-1721. [PMID: 33935525 PMCID: PMC8079354 DOI: 10.2147/rmhp.s301910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background The household expired drugs disposal has been a huge public issue in many countries, including China, which may affect various side and toxic effects on human health and environment, water resources, and soil too. This paper explores the knowledge, attitude, and practice of Guangzhou city residents regarding household expired drugs and their effect on human health and provided the scientific pieces of evidence to carry out the long-term recovery mechanism for expired medicines. Methods An observational, cross-sectional study was conducted using a self-structured questionnaire. Descriptive analysis, including univariate and unconditional logistic regression models, was carried out to analyze the data. Results A total of 613 community residents with a 99.4% response rate enrolled for the study. More than half 60.2% of residents stated that expired drugs pollute the environment, soil, and water resources, where 81.2% of respondents knew that it would produce side effects or toxic effects. However, still, 71.6% of respondents disposed of directly into the trash bin or sink, and, only 24.8% had good practice that they use a designed recycling bin. Likewise, only 8.3% of respondents placed expired drugs into collection points nearly 3-5 times in a year, while 65.1% of participants never disposed of in the collection point, which found a worse practice. Conclusion Overall, the knowledge, attitude, and practice of Guangzhou residents regarding household expired drugs disposal were not ideal. To improve the resident's awareness about family expired drugs disposal, ensure the financial support for the recycling process, establish an accessible and acceptable recycling point, and introduce relevant laws and regulations for the long-term mechanism.
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Affiliation(s)
- Gehendra Mahara
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China
| | - Zhihong Wu
- Research Center, Baiyunshan Hejigong Pharmaceutical Factory, Guangzhou Baiyunshan Pharmaceutical Holdings Co., Ltd, Guangzhou, 510080, People's Republic of China
| | - Qi Ge
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China
| | - Zhiwei Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China
| | - Jinxin Zhang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China
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ÖZDAMAR EN, MUTLU HH. Üçüncü basamak bir hastanenin obezite polikliniğinde Dünya Sağlık Örgütü temel reçete göstergeleri kullanılarak akılcı ilaç kullanımının değerlendirilmesi. EGE TIP DERGISI 2021. [DOI: 10.19161/etd.887128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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de Campos EAR, Tavana M, Ten Caten CS, Bouzon M, de Paula IC. A grey-DEMATEL approach for analyzing factors critical to the implementation of reverse logistics in the pharmaceutical care process. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:14156-14176. [PMID: 33206293 DOI: 10.1007/s11356-020-11138-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 10/04/2020] [Indexed: 06/11/2023]
Abstract
There is an increasing interest in product recovery, closed-loop supply chains, and reverse logistics (RL) for mitigating environmental impairment. Although RL is becoming a mandatory policy in developed countries, it is still in an embryonic stage in some industrial sectors of emerging economies. The purpose of this study is twofold: (1) identify the critical factors to the successful implementation of RL in the Brazilian pharmaceutical care process (PCP) and (2) determine the cause-and-effect relationships among them. We use snowball sampling to select the relevant RL studies and deductive reasoning and classification to identify the critical factors and a grey decision-making trial and evaluation laboratory (DEMATEL) to evaluate the cause-and-effect relationships among them. The study revealed management, collaboration, information technology, infrastructure, policy, financial and economic, end-of-life management practices, and logistic performance factors as the most relevant factors to the successful implementation of RL in the Brazilian PCP. The end-of-life management practices were identified as the most critical factor, and information technology was identified as the least critical factor. We further determined the end-of-life management practices and policy have the strongest casual relationship. The municipal PCP coordinators can use the findings of this study to formulate mitigating strategies to identify and eliminate barriers to the successful implementation of RL in the Brazilian PCP.
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Affiliation(s)
| | - Madjid Tavana
- Business Systems and Analytics Department, Distinguished Chair of Business Analytics, La Salle University, Philadelphia, PA, 19141, USA.
- Business Information Systems Department, Faculty of Business Administration and Economics, University of Paderborn, Paderborn, Germany.
| | - Carla Schwengber Ten Caten
- Department of Industrial Engineering, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Marina Bouzon
- Department of Production and Systems Engineering, Federal University of Santa Catarina (UFSC), Santa Catarina, Brazil
| | - Istefani Carísio de Paula
- Department of Industrial Engineering, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Leishman E, Wang Y, Channu R, Boyst E, Hartmann M, Stas J. Development and implementation of SafeMedWaste, a chemical denaturant for non-hazardous disposal of controlled medications. Sci Rep 2021; 11:1129. [PMID: 33441864 PMCID: PMC7806595 DOI: 10.1038/s41598-020-80388-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022] Open
Abstract
Substance use disorders are a significant public health issue. Options to dispose of controlled medications are limited, increasing the risk of diversion. Providing an alternative for disposal, a chemical denaturant, SafeMedWaste, was designed to destroy controlled substances irreversibly and safely be placed in non-hazardous landfills. Via HPLC–MS, four formulations of SafeMedWaste were tested with 34 different liquid controlled medications from DEA schedules I–V. Beta testing assessed the efficacy of SafeMedWaste in a clinical setting and on waste generated in a manufacturing setting. Furthermore, a formulation of SafeMedWaste was tested on solid controlled medications. All 34 of the liquid medications tested (e.g., amphetamine, diazepam, fentanyl, ketamine) were fully destroyed in SafeMedWaste within 2–24 h. Analysis of a beta test sample of SafeMedWaste containing fentanyl, midazolam, and morphine waste collected in a hospital showed full denaturation of these drugs in 24 h. Variants of SafeMedWaste were optimized to denature six different controlled substance waste samples from a manufacturing facility. In contrast to side-by-side studies with a charcoal disposal system using the same drugs, SafeMedWaste fully inactivated and destroyed the controlled substances in the waste streams. Another formulation of SafeMedWaste was tested on solid medications, which were fully denatured in 48–72 h. In conclusion, SafeMedWaste irreversibly denatures controlled medications that present a problem in our society.
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Alhomoud FK, Alsadiq Y, Alghalawin L, Alhifany A, Alhomoud F. Pharmacy students' knowledge and practices concerning the storing and disposal of household medication in Saudi Arabia. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:5-13. [PMID: 33131618 DOI: 10.1016/j.cptl.2020.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 07/05/2020] [Accepted: 08/10/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Pharmacists, and thus pharmacy students, must participate in promoting awareness about proper storage and disposal of expired or unused medications. This study aimed to determine Saudi Arabian pharmacy students' knowledge and personal practices regarding storing and disposing of household medications. METHODS This was a descriptive, cross-sectional, questionnaire-based study of pharmacy undergraduates or postgraduates across Saudi Arabia. The online survey was distributed to a convenience sample of participants and supplemented with snowball sampling on social media. RESULTS Of 807 pharmacy students who viewed the questionnaire, 464 students completed it (response rate 57.5%). Common reasons for keeping medications included having left-over medication (74%) and self-discontinuation of therapy (63.5%). The majority of students (79%) stored their medication in a bedroom or kitchen. Gender-specific variables revealed a gender difference in storing and disposing of these medications. Many students reported previously discarding medicines in the garbage (89%) or giving them to someone else to use (22%). More than half of the sample (60%) had not received any information on how to store or dispose of medications. CONCLUSIONS The current practice and knowledge of Saudi Arabian pharmacy students regarding storage and disposal of household medications was inappropriate. Concerned authorities (e.g., Ministry of Health, Ministry of Education) should provide proper education to all students on the safe storage and disposal of medications, which may necessitate curriculum reform.
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Affiliation(s)
- Farah Kais Alhomoud
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, 2835 King Faisal Road, Dammam 34212, Saudi Arabia.
| | - Yara Alsadiq
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Laila Alghalawin
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah Alhifany
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Faten Alhomoud
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Wilcox H, Carr C, Seney S, Reid G, Burton JP. Expired probiotics: what is really in your cabinet? FEMS MICROBES 2020. [DOI: 10.1093/femsmc/xtaa007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
ABSTRACT
The popularity of using probiotics has surged, since they became widely accepted as safe and help improve general health. Inevitably, some of these products are used after expiration when microbial cell viability is below the recommended effective dose. Given that probiotics must be live microorganisms administered in adequate amounts, the aim of this study was to measure viability in expired products and assess how packaging and storage conditions impact efficacy, if at all. Thirty-three expired probiotic products were evaluated, of which 26 were stored in conditions recommended by the manufacturer. The viable microbial cells were enumerated and representative isolates identified by 16S and internally transcribed spacer rRNA gene sequencing. While the products had a mean past expiration time of 11.32 (1–22) years, 22 still had viable contents, and 5 were within or above the original product cell count claim. Product formulation and the number of species present did not appear to impact the stability of the products. However, overall packaging type, storage conditions and time since expiry were found to affect viability. All products with viable cells had the strain stipulated on the label. Despite some selected probiotic products retaining viability past their expiry date (indicating long-term storage is possible), the total counts were mostly well below that required for efficacious use as recommended by the manufacturer. Consuming expired probiotics may not yield the benefits for which they were designed.
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Affiliation(s)
- Hannah Wilcox
- Department of Microbiology and Immunology, University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7, Canada
- Canadian Centre for Human Microbiome and Probiotics, LHRI, 268 Grosvenor St. London, ON, N6A 4V2 Canada
- Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada
| | - Charles Carr
- Canadian Centre for Human Microbiome and Probiotics, LHRI, 268 Grosvenor St. London, ON, N6A 4V2 Canada
- Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada
| | - Shannon Seney
- Canadian Centre for Human Microbiome and Probiotics, LHRI, 268 Grosvenor St. London, ON, N6A 4V2 Canada
- Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada
| | - Gregor Reid
- Department of Microbiology and Immunology, University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7, Canada
- Canadian Centre for Human Microbiome and Probiotics, LHRI, 268 Grosvenor St. London, ON, N6A 4V2 Canada
- Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada
| | - Jeremy P Burton
- Department of Microbiology and Immunology, University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7, Canada
- Canadian Centre for Human Microbiome and Probiotics, LHRI, 268 Grosvenor St. London, ON, N6A 4V2 Canada
- Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada
- Division of Urology, Department of Surgery, Schulich School of Medicine, LHRI, 268 Grosvenor St. London, ON, N6A 4V2 CANADA
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Foon PY, Ganesan Y, Iranmanesh M, Foroughi B. Understanding the behavioural intention to dispose of unused medicines: an extension of the theory of planned behaviour. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:28030-28041. [PMID: 32405948 DOI: 10.1007/s11356-020-09125-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/29/2020] [Indexed: 06/11/2023]
Abstract
This study examined behavioural intention to dispose of unused medicines using a comprehensive model integrating the theory of planned behaviour (TPB), with knowledge as a driver of personal norms; attitudes, personal norms, and perceived busyness as additional drivers of behavioural intention; and perceived convenience as a moderator. The model was tested with data collected from 204 respondents using the partial least squares technique. Knowledge about the proper disposal of unused medicines was recognized as a strong predictor of personal norms and attitudes towards proper disposal of waste medications. The results showed that attitudes, personal norms, perceived busyness, and perceived behavioural control have significant effects on intention to dispose of unused medicines. Furthermore, perceived convenience moderates the impacts of attitude, personal norms, and perceived behavioural control on intention to dispose of unused medicines. The extended TPB explained 55.7% of the variance of intention to dispose of unused medicines properly. Our results indicate the importance of integrating additional variables into the TPB to enhance its explanatory power in predicting behavioural intention. The results suggest to governments that in order to implement planned programs for proper collection and destruction of waste medication, a plan is needed to enhance public knowledge on the impacts of improper medication waste disposal on the environment, and also that collection points should become accessible for anyone.
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Affiliation(s)
- Phooi Yut Foon
- Graduate School of Business, University Science Malaysia (USM), 11800, Penang, Malaysia
| | - Yuvaraj Ganesan
- Graduate School of Business, University Science Malaysia (USM), 11800, Penang, Malaysia
| | - Mohammad Iranmanesh
- School of Business and Law, Edith Cowan University (ECU), Joondalup, 6027, Australia.
| | - Behzad Foroughi
- Department of International Business Administration, I-Shou University, Kaohsiung City, Taiwan
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Alnahas F, Yeboah P, Fliedel L, Abdin AY, Alhareth K. Expired Medication: Societal, Regulatory and Ethical Aspects of a Wasted Opportunity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030787. [PMID: 32012703 PMCID: PMC7037917 DOI: 10.3390/ijerph17030787] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 01/01/2023]
Abstract
A massive volume of expired medications amasses annually around the world because of pharmaceutical overprescription, combined with overproduction. The accumulation of pharmaceutical waste imposes ecological, economic and social/ethical burdens. Managing this presumed “waste” has developed into a global challenge due to the absence of specific regulations, unreasonable behavior of the patients, and an improper understanding of the concept of “expired medications” in general. This paper summaries, first, the recent literature reporting practices related to the disposal of unused medications. In this context, 48 papers from 34 countries with a total of 33,832 participants point towards a significant lack of public awareness regarding the appropriate disposal of such biologically potent chemicals. These findings are corroborated by a local survey on the disposal practices of unused medicines among pharmacy students at Saarland University. The regulatory aspects surrounding this topic, often based on the official guidelines for the disposal of expired medications and local waste management strategies, are then discussed in light of these findings. Finally, a closer inspection of the epistemic values of expired medications and different strategies for managing expired medications have been reviewed.
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Affiliation(s)
- Faez Alnahas
- Division of Bioorganic Chemistry, School of Pharmacy, Saarland University, 66123 Saarbruecken, Germany; (F.A.); (P.Y.); (A.Y.A.)
| | - Prince Yeboah
- Division of Bioorganic Chemistry, School of Pharmacy, Saarland University, 66123 Saarbruecken, Germany; (F.A.); (P.Y.); (A.Y.A.)
| | - Louise Fliedel
- UTCBS (Chemical and Biological Technologies for Health Group), Faculté de Pharmacie de Paris, Université de Paris, CNRS, INSERM, 75006 Paris, France;
| | - Ahmad Yaman Abdin
- Division of Bioorganic Chemistry, School of Pharmacy, Saarland University, 66123 Saarbruecken, Germany; (F.A.); (P.Y.); (A.Y.A.)
| | - Khair Alhareth
- UTCBS (Chemical and Biological Technologies for Health Group), Faculté de Pharmacie de Paris, Université de Paris, CNRS, INSERM, 75006 Paris, France;
- Correspondence:
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Bilal M, Ashraf SS, Barceló D, Iqbal HMN. Biocatalytic degradation/redefining "removal" fate of pharmaceutically active compounds and antibiotics in the aquatic environment. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 691:1190-1211. [PMID: 31466201 DOI: 10.1016/j.scitotenv.2019.07.224] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/12/2019] [Accepted: 07/14/2019] [Indexed: 02/05/2023]
Abstract
Recently, the increasing concentration and persistent appearance of antibiotics traces in the water streams are considered an issue of high concern. In this context, an array of antibiotics has been categorized as pollutants of emerging concern due to their complex and highly stable bioactivity, indiscriminate usage with ultimate release into water bodies, and notable persistence in environmental matrices. Moreover, antibiotics traces containing household sewage/drain waste and pharmaceutical wastewater effluents contain a range of bioactive/toxic organic compounds, inorganic salts, pharmaceutically-active ingredients, or a mixture of all, which possesses negative influences ranging from ecological pollution to damage biodiversity. Moreover, their uncontrolled and undesirable bioaccumulation also poses a potential threat to target and non-target organisms in the environment. Aiming to tackle this issue effectively, various detection, quantification, degradation, and redefining "removal" processes have been proposed and investigated based on physical, chemical, and biological strategies. Though both useful and side effects of antibiotics on humans and animals are usually investigated thoroughly following safety and toxicity measures, however, their direct or indirect environmental impacts are not well reviewed yet. Owing to the considerable research gap, the environmental perfectives of antibiotics traces and their effects on target and non-target populations have now become the topic of research interest. Based on literature evidence, over the past several years, numerous individual studies have been performed and published covering various aspects of antibiotics. However, a comprehensive compilation on enzyme-based degradation of antibiotics is still lacking and requires careful consideration. Hence, this review summarizes up-to-date literature on enzymes as biocatalytic systems, explicitly, free as well as immobilized forms and their effective exploitation for the degradation of various antibiotics traces and other pharmaceutically-active compounds present in the water bodies. It is further envisioned that the enzyme-based strategies, for antibiotics degradation or removal, discussed herein, will help readers for a better understanding of antibiotics persistence in the environment along with the associated risks and removal measures. In summary, the current research thrust presented in this review will additionally evoke researcher to engineer robust and sustainable processes to effectively remediate antibiotics-contaminated environmental matrices.
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Affiliation(s)
- Muhammad Bilal
- School of Life Science and Food Engineering, Huaiyin Institute of Technology, Huaian 223003, China.
| | - Syed Salman Ashraf
- Department of Chemistry, College of Arts and Sciences, Khalifa University, PO Box 127788, Abu Dhabi, United Arab Emirates
| | - Damiá Barceló
- Department of Environmental Chemistry, IDAEA-CSIC, Jordi Girona 18-26, Barcelona 08034, Spain; ICRA, Catalan Institute for Water Research, University of Girona, Emili Grahit 101, Girona 17003, Spain; Botany and Microbiology Department, College of Science, King Saud University, PO Box 2455, Riyadh 11451, Saudi Arabia
| | - Hafiz M N Iqbal
- Tecnologico de Monterrey, School of Engineering and Sciences, Campus Monterrey, Ave. Eugenio Garza Sada 2501, Monterrey, N.L. 64849, Mexico.
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Rogowska J, Zimmermann A, Muszyńska A, Ratajczyk W, Wolska L. Pharmaceutical Household Waste Practices: Preliminary Findings from a Case Study in Poland. ENVIRONMENTAL MANAGEMENT 2019; 64:97-106. [PMID: 31076828 PMCID: PMC6598946 DOI: 10.1007/s00267-019-01174-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/30/2019] [Indexed: 05/30/2023]
Abstract
Pharmaceutical consumption continues to grow constantly. Unused/expired pharmaceuticals are disposed of to the municipal sewage system or waste disposal. Consequently, many countries have implemented a system of collecting pharmaceutical waste, with pharmacies playing an important role. It is important to educate consumers on rational consumption and the appropriate disposal of unused/expired pharmaceuticals and to identify the level of public awareness. Two studies were conducted in Poland to estimate the problem of collection and disposal of expired/unused pharmaceuticals. The purpose of the Survey I was to identify the scale of pharmaceutical consumption and the way pharmaceuticals are disposed of by various social groups. The Survey II was aimed to identify patients' attitudes regarding expired/unused pharmaceuticals at home. Of the respondents who participated in in Survey I, almost 74% indicated that analgesics were among the over-the-counter drugs they purchased. Group of pharmaceuticals 65% of the respondents purchased were medicines for treating flu symptoms. Almost 68% of the respondents said they usually disposed of expired pharmaceuticals in their household waste or by flushing them down the toilet. In Survey II more than 35% reported that they disposed of pharmaceuticals in the same ways. Of all respondents, ~30% returned their expired pharmaceuticals to pharmacies. Most respondents (over 65%) who participated Survey I indicated that they were aware that pharmaceutical waste can be returned to pharmacies. It should be noted that local governments are currently not obliged by law to work with or compensate pharmacies in the collection and proper disposal of unused pharmaceuticals.
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Affiliation(s)
- Justyna Rogowska
- Department of Environmental Toxicology, Faculty of Health Sciences, Medical University of Gdańsk, Dębowa Str. 23A, Gdańsk, 80-204, Poland.
| | - Agnieszka Zimmermann
- Department of Medical and Pharmacy Law, Chair of Social Medicine, Faculty of Health Sciences, Medical University of Gdańsk, Tuwima Str. 15, Gdańsk, 80-210, Poland
| | - Agnieszka Muszyńska
- Department of Environmental Toxicology, Faculty of Health Sciences, Medical University of Gdańsk, Dębowa Str. 23A, Gdańsk, 80-204, Poland
| | - Wojciech Ratajczyk
- Department of Environmental Toxicology, Faculty of Health Sciences, Medical University of Gdańsk, Dębowa Str. 23A, Gdańsk, 80-204, Poland
| | - Lidia Wolska
- Department of Environmental Toxicology, Faculty of Health Sciences, Medical University of Gdańsk, Dębowa Str. 23A, Gdańsk, 80-204, Poland
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Kumar M, Jaiswal S, Sodhi KK, Shree P, Singh DK, Agrawal PK, Shukla P. Antibiotics bioremediation: Perspectives on its ecotoxicity and resistance. ENVIRONMENT INTERNATIONAL 2019; 124:448-461. [PMID: 30684803 DOI: 10.1016/j.envint.2018.12.065] [Citation(s) in RCA: 234] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/02/2018] [Accepted: 12/31/2018] [Indexed: 05/28/2023]
Abstract
Antibiotic is one of the most significant discoveries and have brought a revolution in the field of medicine for human therapy. In addition to the medical uses, antibiotics have broad applications in agriculture and animal husbandry. In developing nations, antibiotics use have helped to increase the life expectancy by lowering the deaths due to bacterial infections, but the risks associated with antibiotics pollution is largely affecting people. Since antibiotics are released partially degraded and undegraded into environment creating antibiotic pollution, and its bioremediation is a challenging task. In the present review, we have discussed the primary antibiotic sources like hospitals, dairy, and agriculture causing antibiotic pollution and their innovative detection methods. The strong commitment towards the resistance prevention and participation, nations through strict policies and their implementations now come to fight against the antibiotic resistance under WHO. The review also deciphers the bacterial evolution based strategies to overcome the effects of antibiotics, so the antibiotic degradation and elimination from the environment and its health benefits. The present review focuses on the environmental sources of antibiotics, it's possible degradation mechanisms, health effects, and bacterial antibiotics resistance mechanisms.
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Affiliation(s)
- Mohit Kumar
- Soil Microbial Ecology and Environmental Toxicology Laboratory, Department of Zoology, University of Delhi, Delhi 110007, India
| | - Shweta Jaiswal
- Enzyme Technology and Protein Bioinformatics Laboratory, Department of Microbiology, Maharshi Dayanand University, Rohtak 124001, Haryana, India
| | - Kushneet Kaur Sodhi
- Soil Microbial Ecology and Environmental Toxicology Laboratory, Department of Zoology, University of Delhi, Delhi 110007, India
| | - Pallee Shree
- Soil Microbial Ecology and Environmental Toxicology Laboratory, Department of Zoology, University of Delhi, Delhi 110007, India
| | - Dileep Kumar Singh
- Soil Microbial Ecology and Environmental Toxicology Laboratory, Department of Zoology, University of Delhi, Delhi 110007, India
| | - Pawan Kumar Agrawal
- National Agriculture Science Fund, Krishi Anusandhan Bhavan-I, Indian Agricultural Research Institute, Delhi 110012, India
| | - Pratyoosh Shukla
- Enzyme Technology and Protein Bioinformatics Laboratory, Department of Microbiology, Maharshi Dayanand University, Rohtak 124001, Haryana, India.
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Abstract
Background: Most adolescents who misuse controlled prescription medications acquire them from home settings. However, little is known regarding household management (storage, administration, and disposal) of these medications. Objective: To describe household management of controlled medications. Methods: This was a cross-sectional study with paired data using brief, online, confidential surveys of adolescents and parents via an adolescent medicine clinic associated with a large academic center. Eligible adolescents were 12-18 years with at least one controlled prescription medication in the home. Six core safe management strategies for controlled medications were identified based on current recommendations. Data were collected and analyzed in 2017. Results: Of the 243 adolescent-parent dyads, 78.2% (n = 190) dyads store medication out of sight, 68.7% (n = 167) lock up medications, 78.2% (n = 190) do not store pills besides a school nurse's office or a parent's place of work, 43.6% (n = 106) provide periodic parental monitoring, 64.6% (n = 157) frequently dispose of unused controlled medications (at least every 3-4 months), and 80.2% (n = 195) dispose of controlled medications in a prescription drug take-back program or by flushing. Families with an adolescent prescription for a controlled medication were more likely to use several core management strategies (periodic parental monitoring, frequent disposal, and appropriate disposal location). Families with a household pain reliever were 8.7 times (95% CI 3.3, 23.3) as likely to not keep spare pills in inappropriate locations. Conclusions/Importance: Most families do not practice all recommended safe management strategies for controlled medications. Healthcare professionals should promote safe management to reduce controlled prescription medication misuse.
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Affiliation(s)
- Stacey A Engster
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Debra L Bogen
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Brooke S G Molina
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Psychology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Pilot Study on the Utility and Feasibility of a House-Call Checkup of the Medicine Cabinet. PHARMACY 2018; 6:pharmacy6030074. [PMID: 30042288 PMCID: PMC6164397 DOI: 10.3390/pharmacy6030074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/05/2018] [Accepted: 07/20/2018] [Indexed: 11/23/2022] Open
Abstract
The storage at home of medicines is a poorly researched topic, but it can be a major source of medication errors and other unsafe practices. In this pilot-study, we wanted to get an idea of the scope of the problem and research the feasibility and acceptability of a home-based intervention by a pharmacist. In a convenience sample of 48 households, we encountered numerous problems in a sizable percentage of households. Medicines were frequently not stored out of reach of children, usage instructions and indications were unknown, organization was absent, and there were a plethora of expired medicines present. Refrigeration was less of a problem. Acceptability and perception of utility of the intervention were generally very high. We developed a protocol-based intervention to be used in future research to increase the safe use of medicines at home.
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