Social pharmacology: unresolved critical issues

Unnecessary antimicrobial prescribing for upper respiratory tract infections in children in Pietermaritzburg, South Africa

Background

Acute upper respiratory tract infections (URTIs) are contagious diseases of the upper airways, but they are self-limiting in nature. Therefore, antimicrobial-use for the majority of the URTIs is considered inappropriate. Unfortunately, globally, antimicrobials are still being prescribed for the treatment of URTIs, especially in children. However, there is insufficient evidence on the causes of this phenomenon in South Africa.

Objective

To investigate whether the parents/guardians accompanying children with URTIs expected/influenced physicians and/or nurses to prescribe antibiotics.

Methods

This was a prospective descriptive and explorative questionnaire-based study. Participants were guardians who accompanied children aged five years and below, diagnosed with acute URTIs.

Findings

Three hundred and six parents/guardians participated in this study. Seventy six percent (n=233) of participants received antibiotics for URTIs for their children, and 67% (n=156) of these did not make requests for antimicrobial therapy. On overall, there was a statistically significant (p < 0.0001) chance (with OR of 5.9; 95% CI, 2.4 – 14.2) for receiving antibiotics for URTIs without a request.

Conclusion

Physicians and other healthcare providers need education on rational prescribing of antimicrobials, and to implement evidence-based standard treatment guidelines, to reduce inappropriate use of antibiotics in children with self-limiting URTIs.

Experiences of long-term tranquillizer use: a psychodynamic perspective

The aim of the article is to analyse narrative descriptions and experiences of long-term tranquillizer use. The analysis is based on a Danish in-depth study of 50 informants with a self-diagnosed dependency on tranquillizers. The theoretical analysis is dependent on psychodynamic reasoning. Further, the psychodynamic perspective is integrated within a multi-dimensional model that considers biological, cognitive, identity, gender and social learning factors. The analysis reveals the possibility of achieving a detailed understanding of the dynamic processes involved in the development of long-term tranquillizer use. Important themes frequently mentioned in the clients' descriptions are traumatic childhood experiences, identity problems, life crises in adulthood and difficulties in stopping taking psychotropic drugs.

Introduction: the need for a multidimensional and multidisciplinary approach

This special issue combines contributions from several disciplines within the social sciences on how to understand long-term use or dependency on various kinds of psychotropics. It emphasizes the need for a multidisciplinary approach in order to understand the complexity of such long-term use. The papers in this issue will base their arguments on psychological, sociological, anthropological, clinical, and social pharmacy perspectives. Different disciplines focus specially on certain topics. For example, psychology can help us to understand what kind of mental processes that are involved in the development of long-term tranquillizer use. Sociology, anthropology and social pharmacy have a particular contribution to make in helping us, in different ways, to understand the social meanings of psychotropic drug use.

Toward an integrative approach in the analysis of dependency problems

This article takes some preliminary steps towards an integrated analysis of dependency problems e.g., long-term tranquillizer use, alcohol dependence, problematic use of narcotics. It argues for the need to outline important theoretical, epistemological, and methodological prerequisites in the analysis of the complex dynamic developmental processes involved in dependency problems. The dynamic process leading to dependence can be studied by the aid of an artificial science neural network approach in combination with a mixed method strategy including a clarification of a combination of different epistemological positions. It is intended that the empirical output of this complex strategy will provide a starting point for a new theoretical analysis which, in turn, will lead to new and more relevant input variables in the neural network approach that will help us to extend our knowledge of the dynamic processes leading to dependency.

Epilogue: drawing together the threads and perspectives on the long-term use of psychotropics

The aims of the epilogue are to draw together the threads in this issue by reviewing some themes presented in the previous chapters and to consider the relationship between the perspectives mentioned. The implications of a multidimensional perspective for future research, treatment and prevention are discussed. It is emphasized that the social sciences have an important part to play in helping us understand long-term use of psychotropics. The social sciences provide insights of importance for research, treatment and prevention of dependency on psychotropics, and also, may help us deal better with these kind of problems in the future.

O indivíduo e o coletivo: alguns desafios da Epidemiologia e da Medicina Social

Alguns conceitos fundamentais da Epidemiologia são revisados, explorando contrapontos de suas principais contradições filosóficas. Nesse sentido, discute-se a interdependência conceitual entre o indivíduo e o coletivo, a complementaridade das abordagens quantitativas e qualitativas, o caráter natural e social da existência humana e, finalmente, as expressões coletiva e individual do risco. Da análise conclui-se que o conceito de risco traz em si potencial para uma revisão da prática epidemiológica. Sem fugir aos limites que a ciência coloca à produção do conhecimento, essa revisão é proposta a partir da prática da confluência dos métodos quantitativo e qualitativo de investigação, mais próxima das necessidades imediatas dos indivíduos. Suas chances de contribuir para tornar mais eficientes as ações da Medicina Social crescem à medida que o conhecimento da realidade coletiva ganha sentido para eles.

Prescribing for leg ulcers in general practice, Part 1

A review to determine the information and factors that determine product selection by community nurses for patients with leg ulcers.

Health state preferences of persons with anxiety

We compared patient ratings of the desirability of anxiety health states with measures of psychological distress and functional status and investigated how these ratings predicted treatment by primary care and mental health clinicians. As expected, associations between desirability ratings and psychological and physical health status were low to moderate. Persons who rated their current anxiety health state as more desirable received fewer mental health referrals and were statistically more likely to receive a prescription for psychotropic medication. Simple ratings of health state desirability may help clinicians evaluate patients' views of their health status and discuss potential treatment options.

Toward a theory of social pharmacology: the actor-spectator paradox applied to the psychotropic prescribing process

Traditionally, drug prescribing was regarded as part of the physician's decision-making role. However, recently it has been recognized that such a perspective is insufficient to understand the psychotropic prescribing process. To understand this process, a drug communication perspective is necessary. This article describes the actor-spectator paradox and its influence on drug communication and psychotropic drug prescribing. The actor-spectator paradox postulates that the actor and the spectator have divergent perspectives about the cause of the actor's behavior. The spectator makes assumptions about the actor's cognitive system other than the actor herself is making. This difference is often the basis for misunderstandings between a health professional and a patient. If a health professional can learn to make more realistic assumptions about a patient's cognitive system, communication between the two will improve. In the same way a patient has to learn to make more realistic assumptions about the cognitive systems of health professionals. The actor-spectator paradox can be applied to different areas of Social Pharmacology such as the diagnosis of patients suffering from mental health problems, drug compliance, informed consent, and the prescribing of psychotropics.