Internet survey of home storage of paracetamol by individuals in the UK

Paracetamol (acetaminophen): A familiar drug with an unexplained mechanism of action

Paracetamol (acetaminophen) is undoubtedly one of the most widely used drugs worldwide. As an over-the-counter medication, paracetamol is the standard and first-line treatment for fever and acute pain and is believed to remain so for many years to come. Despite being in clinical use for over a century, the precise mechanism of action of this familiar drug remains a mystery. The oldest and most prevailing theory on the mechanism of analgesic and antipyretic actions of paracetamol relates to the inhibition of CNS cyclooxygenase (COX) enzyme activities, with conflicting views on the COX isoenzyme/variant targeted by paracetamol and on the nature of the molecular interactions with these enzymes. Paracetamol has been proposed to selectively inhibit COX-2 by working as a reducing agent, despite the fact that in vitro screens demonstrate low potency on the inhibition of COX-1 and COX-2. In vivo data from COX-1 transgenic mice suggest that paracetamol works through inhibition of a COX-1 variant enzyme to mediate its analgesic and particularly thermoregulatory actions (antipyresis and hypothermia). A separate line of research provides evidence on potentiation of the descending inhibitory serotonergic pathway to mediate the analgesic action of paracetamol, but with no evidence of binding to serotonergic molecules. AM404 as a metabolite for paracetamol has been proposed to activate the endocannabinoid and the transient receptor potential vanilloid-1 (TRPV1) systems. The current review gives an update and in some cases challenges the different theories on the pharmacology of paracetamol and raises questions on some of the inadequately explored actions of paracetamol. List of Abbreviations: AM404, N-(4-hydroxyphenyl)-arachidonamide; CB1R, Cannabinoid receptor-1; Cmax, Maximum concentration; CNS, Central nervous system; COX, Cyclooxygenase; CSF, Cerebrospinal fluid; ED50, 50% of maximal effective dose; FAAH, Fatty acid amidohydrolase; IC50, 50% of the maximal inhibitor concentration; LPS, Lipopolysaccharide; NSAIDs, Non-steroidal anti-inflammatory drugs; PGE2, Prostaglandin E2; TRPV1, Transient receptor potential vanilloid-1.

Pilot Study on the Utility and Feasibility of a House-Call Checkup of the Medicine Cabinet

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.

Estoque domiciliar de medicamentos de pessoas assistidas por uma equipe de profissionais da Estratégia de Saúde da Família

O estoque domiciliar de medicamentos é uma prática comum a muitas famílias, mas pode representar um risco à saúde. Foi realizado um estudo transversal em 100 domicílios em uma área de abrangência da Estratégia Saúde da Família (ESF) em Blumenau, SC, entre fevereiro e março de 2012. Nos domicílios visitados, 91% tinham medicamentos, sendo encontrados 737 medicamentos (média de 7,6 por domicílio). O grupo terapêutico de medicamentos mais frequente foi o dos que atuam no sistema digestivo 148 (20,1%) e o medicamento mais encontrado foi o paracetamol (48,7%). Dentre os entrevistados, 29 (31,9%) relataram descartar medicamentos no lixo comum, 12 (13,2%) não observavam o aspecto físico antes de utilizar e 74 (81,3%) tiveram acesso a medicamentos em farmácias comunitárias e ESFs. Observou-se associação entre número de medicamentos e número de pessoas no domicílio (p<0,01) e com presença de doenças crônicas (p<0,05). Pessoas com mais escolaridade armazenam mais medicamentos (p<0,001). Contudo, pessoas com baixa escolaridade utilizam mais medicamentos prescritos por médicos (p<0,001).

Nonprobability Web surveys to measure sexual behaviors and attitudes in the general population: a comparison with a probability sample interview survey

Background

Nonprobability Web surveys using volunteer panels can provide a relatively cheap and quick alternative to traditional health and epidemiological surveys. However, concerns have been raised about their representativeness.

Objective

The aim was to compare results from different Web panels with a population-based probability sample survey (n=8969 aged 18-44 years) that used computer-assisted self-interview (CASI) for sensitive behaviors, the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3).

Methods

Natsal-3 questions were included on 4 nonprobability Web panel surveys (n=2000 to 2099), 2 using basic quotas based on age and sex, and 2 using modified quotas based on additional variables related to key estimates. Results for sociodemographic characteristics were compared with external benchmarks and for sexual behaviors and opinions with Natsal-3. Odds ratios (ORs) were used to express differences between the benchmark data and each survey for each variable of interest. A summary measure of survey performance was the average absolute OR across variables. Another summary measure was the number of key estimates for which the survey differed significantly (at the 5% level) from the benchmarks.

Results

For sociodemographic variables, the Web surveys were less representative of the general population than Natsal-3. For example, for men, the average absolute OR for Natsal-3 was 1.14, whereas for the Web surveys the average absolute ORs ranged from 1.86 to 2.30. For all Web surveys, approximately two-thirds of the key estimates of sexual behaviors were different from Natsal-3 and the average absolute ORs ranged from 1.32 to 1.98. Differences were appreciable even for questions asked by CASI in Natsal-3. No single Web survey performed consistently better than any other did. Modified quotas slightly improved results for men, but not for women.

Conclusions

Consistent with studies from other countries on less sensitive topics, volunteer Web panels provided appreciably biased estimates. The differences seen with Natsal-3 CASI questions, where mode effects may be similar, suggest a selection bias in the Web surveys. The use of more complex quotas may lead to some improvement, but many estimates are still likely to differ. Volunteer Web panels are not recommended if accurate prevalence estimates for the general population are a key objective.

Pack size and paracetamol overdose: 16 years later

In 1998 the United Kingdom limited the availability of paracetamol sold over-the-counter in an effort to reduce serious paracetamol overdose. Since that time debate has continued on the effectiveness of this policy in reducing what is acknowledged as a major public health problem. This commentary reviews recent publications on this topic which suggest that the effects were small. Reasons for this are discussed using data from recent work.

Factors affecting satisfaction with treatment in European women with chronic constipation: An internet survey

BACKGROUND

Data on factors affecting treatment satisfaction in European women with chronic constipation are limited.

OBJECTIVE

To assess factors associated with treatment satisfaction among European women with chronic constipation.

METHODS

A 2011-2012 internet survey was conducted in men and women from 12 European countries. Respondents analysed were female with self-reported chronic constipation (≥1 symptoms for ≥6 months of lumpy/hard stools, feeling of incomplete evacuation, and pain during defecation, as well as <3 bowel movements/week). For laxative users, satisfaction with treatment, factors affecting satisfaction, and interactions with healthcare professionals were collected.

RESULTS AND CONCLUSIONS

In total, 4805/50,319 participants fulfilled the inclusion criteria (female with chronic constipation). Of the laxative users (1575/4805), 57% (n = 896) were satisfied with their treatment, while 26% were neutral, and 17% dissatisfied. Dissatisfied respondents visited their GP less frequently in the past 12 months, were more likely to obtain over-the-counter laxatives, and took a dose higher than recommended more frequently than those satisfied. Respondents were most satisfied with ease of use of treatment and least satisfied with relief from bloating. Newer treatments aimed at alleviating symptoms, particularly bloating, are required for respondents neutral or dissatisfied with their current treatment.