Prevalence of self-medication during COVID-19 pandemic: A systematic review and meta-analysis

Effects of the COVID-19 Pandemic on Microbial Keratitis: A 5-Year Comparative Study

PURPOSE

To report the clinical and microbiological profiles of microbial keratitis and its antimicrobial resistance before, during, and after COVID-19.

METHODS

This was a retrospective case-note review of all corneal scrape specimens collected from patients with microbial keratitis from January 2018 to December 2023. Case records were analyzed for demographic characteristics, microbiological diagnosis, and antibiograms. All outcome variables were collected, stratified, and compared between 3 periods: the pre-COVID-19 group (January-December 2019), the COVID-19 group (January 2020-December 2022), and the post-COVID-19 group (January-December 2023).

RESULTS

A total of 947 corneal cultures from 947 patients were reviewed. Gram-positive bacteria predominated in all periods, with no significant differences in their distribution. Staphylococcus epidermidis was the most frequently identified organism. Pseudomonas aeruginosa was the most common Gram-negative bacterium, with its incidence significantly lower in the post-COVID period. Fungal infections showed a significant increase in the post-COVID group, with Fusarium sp. being the most common fungus and showing a significant increase in incidence in the post-COVID group.

CONCLUSIONS

Despite a stable incidence of microbial keratitis, this study highlights a concerning trend in antibiotic resistance. Although some pathogens became less common, those that persisted have become increasingly difficult to treat. Understanding the clinical and microbiological profiles of microbial keratitis and antimicrobial resistance patterns before and after the COVID-19 pandemic is crucial for informed treatment decisions.

Prevalence and causes of self-medication for oral health problems: a systematic review and meta-analysis

INTRODUCTION

Self-medication, particularly for oral and dental health problems, stands as a significant health and social concern. Therefore, the current systematic review and meta-analysis study was conducted to evaluate the prevalence and underlying causes of self-medication for oral and dental health problems.

METHOD

Articles published until August 30, 2023, were searched in Scopus, PubMed, and Web of Science databases. A manual search was also done in Google Scholar, references, citations, and Gray literature. The screening of articles was done independently by two members of the research team. The quality of reporting in the articles was evaluated using the JBI Critical Appraisal Checklist For Analytical Cross-Sectional Studies. Meta-analysis was performed using the fixed effects model in Stata software (StataCorp, version 16).

RESULTS

The results of 37 studies involving 12,110 participants with a mean age of 32 years and 48% male were analyzed. Most of the studies were conducted in low- and middle-income countries. The overall prevalence of self-medication was estimated at 59% [95%CI: 55-63%], with 58% [95% CI: 53-63%] among dental patients, and 60% [95% CI: 52-67%] in the general public. Analgesics (60%) and antibiotics (19%) were the most commonly used drug categories. In terms of the mean proportion, having previous experience, unbearable pain, and lack of time had the highest percentages, and in terms of the number of repetitions among the reviewed articles, economic problems, lack of time, and limited access were the most repeated reasons. The most significant related factors in self-treatment were female gender, higher education, and occupation. Pharmacies were the primary source of self-treatment medications.

CONCLUSION

The results showed a very high prevalence of self-medication for oral health problems, necessitating prompt and effective interventions. It is recommended to focus on regulating the consumption of analgesics and antibiotics, addressing financial issues, and overseeing the pharmacy operations.

Self-medication among general population in the European Union: prevalence and associated factors

Self-medication (SM) forms an important part of public health strategy. Nonetheless, little research has been performed to understand the current state of self-medication in the European Union (EU). Utilizing data from the third wave of the European Health Interview Surveys, this study finds an estimated SM prevalence of 34.3% in the EU (95%CI = 34.1-34.5%; n = 255,758). SM prevalence, as well as SM prevalence inequality between men and women, varies substantially between EU member countries. Via multivariable analysis, we also identify a number of variables associated with SM, most notably the substantial impact of health systems on SM behavior (Adjusted Odds Ratio [AOR] = 4.00; 95% Confidence Interval [95%CI] = 3.81-4.21). Several demographics are also associated with greater SM prevalence, including those aged 25-44 (versus ages 75+: AOR = 1.21; 95%CI = 1.12-1.31), women (AOR = 1.74; 95%CI = 1.68-1.81), immigrants born in other EU states (AOR = 1.16; 95%CI = 1.04-1.30), those with higher education (AOR = 1.83; 95%CI = 1.60-2.09), and urban dwellers (AOR = 1.14; 95%CI = 1.04-1.30). Additionally, long-standing health problems (AOR = 1.39; 95%CI = 1.33-1.45), visits to doctors (both general practitioners and specialists) (AOR = 1.21, 95%CIs = 1.15-1.26, 1.17-1.26), and unmet needs for health care due to waiting lists (AOR = 1.38; 95%CI = 1.23-1.55) or inability to afford medical examinations/treatment (AOR = 1.27; 95%CI = 1.12-1.42) serve as conditioners for SM. We also find that smoking (AOR = 1.05; 95%CI = 1.01-1.10), vaping (AOR = 1.19; 95%CI = 1.06-1.32), drinking alcohol (AOR = 1.23; 95%CI = 1.19-1.28), and higher levels of physical activity (AOR = 1.27; 95%CI = 1.22-1.32) are factors associated with SM. Analysis of these variables reveals that though women self-medicate more than men, the patterns that govern their consumption are similar.

Increases in benzodiazepine prescribing for postpartum anxiety during COVID-19

PURPOSE

Postpartum mood disorders affect many women following childbirth. Prescribing medication for depression and anxiety is one strategy for the effective treatment of postpartum mood disorders. Left untreated, mothers experiencing these disorders and their infants face increased risks of adverse health outcomes. Little is known about how diagnosis and treatment of postpartum mood disorders changed during COVID-19.

METHODS

We used a retrospective pooled cross-sectional design in a sample of privately-insured postpartum women in U.S. claims data from January 1, 2016 to December 31, 2020. We measured changes in diagnoses of anxiety and depression and changes in prescription fills and days supplied of classes of medications used to treat these conditions (antidepressants, benzodiazepines, and z-drugs). We used ordinary least squares (OLS) regression for each outcome variable during the pre-pandemic period and forecast expected outcomes the observation period. Forecasted and actual values of the outcomes were then compared.

RESULTS

Following the onset of the COVID-19 pandemic in March 2020, diagnoses of depression and anxiety were not significantly higher among privately insured postpartum women in the United States. The proportion of privately-insured postpartum women filling a benzodiazepine prescription increased by 15.2%.

CONCLUSIONS

We find diagnosis of postpartum mood disorders did not increase after the onset of the COVID-19 pandemic, however, fills of benzodiazepines increased among privately-insured postpartum women. Given prior evidence of increased depressive and anxiety symptoms among postpartum women during COVID-19, this suggests increased barriers to appropriate diagnoses and treatment for depression during this period.

Impact assessment of self-medication on COVID-19 prevalence in Gauteng, South Africa, using an age-structured disease transmission modelling framework

OBJECTIVE

To assess the impact of self-medication on the transmission dynamics of COVID-19 across different age groups, examine the interplay of vaccination and self-medication in disease spread, and identify the age group most prone to self-medication.

METHODS

We developed an age-structured compartmentalized epidemiological model to track the early dynamics of COVID-19. Age-structured data from the Government of Gauteng, encompassing the reported cumulative number of cases and daily confirmed cases, were used to calibrate the model through a Markov Chain Monte Carlo (MCMC) framework. Subsequently, uncertainty and sensitivity analyses were conducted on the model parameters.

RESULTS

We found that self-medication is predominant among the age group 15-64 (74.52%), followed by the age group 0-14 (34.02%), and then the age group 65+ (11.41%). The mean values of the basic reproduction number, the size of the first epidemic peak (the highest magnitude of the disease), and the time of the first epidemic peak (when the first highest magnitude occurs) are 4.16499, 241,715 cases, and 190.376 days, respectively. Moreover, we observed that self-medication among individuals aged 15-64 results in the highest spreading rate of COVID-19 at the onset of the outbreak and has the greatest impact on the first epidemic peak and its timing.

CONCLUSION

Studies aiming to understand the dynamics of diseases in areas prone to self-medication should account for this practice. There is a need for a campaign against COVID-19-related self-medication, specifically targeting the active population (ages 15-64).

Development and psychometric properties of a self-medication behavior inventory

Introduction

Self-medication is a prevalent behavior with significant health implications. Understanding its psychosocial determinants can inform preventative strategies and interventions.

Methods

We evaluated the psychometric properties of the Self-Medication Behavior Inventory (SMBI-9) in a binational study with 779 Colombian and Mexican participants. Concurrent validity was assessed through correlations with related inventories, and confirmatory factor analysis tested the proposed four-factor model.

Results

The SMBI-9 demonstrated high model fit (CFI = 0.995, TLI = 0.991) and invariance across countries. The factors-Social Influence, Attitude toward Medicine, Avoidance, and Prevention-varied significantly with knowledge of medicine, schooling, health insurance status and gender, underscoring the role of social and personal beliefs in self-medication practices.

Discussion

SMBI-9 emerged as a reliable tool for capturing the multifaceted nature of self-medication behaviors. Findings highlight the influence of social norms and personal attitudes, suggesting targeted approaches for behavioral interventions.

Dynamic Trends in Surgical Oromaxillofacial Trauma Epidemiology: A Comparative Study of Pre-COVID-19 and COVID-19 Periods in Tertiary Referral Hospitals in Madrid

Introduction: The COVID-19 pandemic has induced profound societal and healthcare transformations globally. Material and methods: This multicenter retrospective study aimed to assess potential shifts in the epidemiology and management of oromaxillofacial trauma requiring surgical intervention over a 1-year period encompassing the onset of the COVID-19 pandemic, in comparison to the preceding year. The parameters investigated included age, sex, injury mechanisms, fractured bones, and treatment modalities. The statistical significance was set at p < 0.05. Results: A notable 39.36% reduction in oromaxillofacial fractures was identified (p < 0.001), with no significant alterations in sex distribution, types of fractured bones, or treatment modalities. An appreciable increase in mean age was observed (35.92 vs. 40.26) (p = 0.006). Analysis of the causes of oromaxillofacial trauma revealed diminished incidents of interpersonal violence (41% vs. 35%) and sports-related injuries (14% vs. 8%), alongside an escalation in cases attributed to falls (27% vs. 35%), precipitation events (2% vs. 5%), and traffic accidents (12% vs. 13%). The mandible emerged as the most frequently fractured bone. Conclusion: In conclusion, the COVID-19 pandemic has decreased the number of maxillofacial fractures treated surgically and has changed the epidemiology and the etiology of facial traumas.

Sarcopenia and risk factors among Japanese community-dwelling older adults during the COVID-19 pandemic: A cross-sectional study

The COVID-19 pandemic exposed older adults to high risk of sarcopenia. This study aimed to investigate the prevalence of sarcopenia and its risk factors among Japanese community-dwelling older adults during the COVID-19 pandemic. We collected data through questionnaires and physical measurements among 242 older adults. Sarcopenia was assessed using the Asian Working Group for Sarcopenia 2019 criteria. The results revealed that 14.5% had sarcopenia, which was significantly associated with age, nutritional status, number of prescription medications, body mass index, and self-rated health. On multivariate analysis, the risk of malnutrition was independently significantly associated with sarcopenia. Approximately 70% of participants reported decreased social interaction and going outside, but with no significant association with sarcopenia. In addition, approximately 65% of the participants had an exercise habit and went outside at least once a week, thus maintaining a good level of activity. These findings suggest that prevention of sarcopenia during the pandemic required provision of opportunities for older adults to remain active and positive assessment of nutritional status and well-being.

Development of a Remote Health Support Program by Pharmacists and Elucidation of Its Effectiveness: A Randomized Controlled Study

No progress has been made in using remote communication tools for less urgent but equally important health support services, such as preventive medicine and health education. In this study, we developed a remote health support program by pharmacists for community residents and conducted a randomized controlled study on its effectiveness in proper self-medication through pharmacists. People over the age of 20 years who lived in the vicinity of Gifu City, Japan were eligible to participate in this study. Participants were recruited using posters and brochures. This program comprised a lecture, based on the health belief model and behavioral economics, and access to remote health support. The participants were randomly assigned to two groups: the medicine/health class only (control) and the medicine/health class along with the program (intervention) groups. The participants were administered questionnaire surveys immediately before (the first survey) and 2 months after (the second survey) the medicine/health class, which allowed us to compare the changes in the two groups' behavior regarding performing proper self-medication through pharmacists. The percentage of individuals who started consulting pharmacists about self-medication in the intervention group (63.9%, 23/36) was significantly higher than that in the control group (15.2%, 5/33; p < 0.001). The percentage of individuals who started recording information about their self-medication in their medication notebooks in the intervention group (16.7%, 6/36) was significantly higher than that in the control group (0%, 0/33; p = 0.026). We clarified the effectiveness of this program for behavioral changes toward proper self-medication using support from pharmacists.

Assessing the Effects of Medical Information on Parental Self-Medication Behaviors for Children's Health: A Comparative Analysis

Background and Objectives: Health professionals have voiced concerns about the danger of self-medication in times of growing use of over-the-counter medicines and, in some contexts, the unregulated selling of them. Previous research has examined the incidence of parental self-medication as well as the use and abuse of antibiotics without medical advice. However, these studies have limited evidence on the role of family doctors and the perceived severity of self-medication in the case of parents. Based on the Health Belief Model, our research tested the effects of exposure to medical information on the parents' attitudes toward self-treating their children, without medical advice. Specifically, we aimed to assess whether exposure to information warning about the risks of treating children without a medical prescription influences parents' attitudes toward administering medicines to their children without medical advice. Materials and Methods: 210 parents engaged in the study, and were divided into two groups. One group was exposed to educational materials related to the perils of self-medication and the second one was not. All participants answered the same questionnaire and the answers were compared between the two groups. Results: The results showed that our respondents evaluated the practices of self-medication negatively (a higher score indicates a more negative evaluation), especially when it came to treating their children without medical advice (3.91 ± 1.04 for unexposed and 3.98 ± 1.08 for exposed). However, their attitudes towards self-medication varied depending on their beliefs about administering certain medications. Both those exposed to the warning information and those who were not exposed have agreed that they are unable to avoid treatment of their ill child without medical advice. Conclusions: In general, our respondents evaluate negatively the practices of self-medication, especially the treatment of their children without medical advice. Therefore, future health education campaigns need to be targeted specifically, with messages that guide how to act in particular cases depending on the medication used and the child's condition.

The Impact of the COVID-19 Pandemic on Outcomes in Acute Pancreatitis: A Propensity Score Matched Study Comparing before and during the Pandemic

We aimed to evaluate the outcomes and survival of patients with acute pancreatitis who shared the same clinical form, age, and sex before the pandemic, during the pandemic, and among those with confirmed COVID-19 infection upon hospital admission. This consideration used the sparse data in the existing literature on the influence of the pandemic and COVID-19 infection on patients with acute pancreatitis. To accomplish this, we conducted a multicentric, retrospective case-control study using propensity score matching with a 2:1 match of 28 patients with SARS-CoV-2 infection and acute pancreatitis, with 56 patients with acute pancreatitis pre-pandemic, and 56 patients with acute pancreatitis during the pandemic. The study outcome demonstrated a six-fold relative risk of death in patients with acute pancreatitis and SARS-CoV-2 infection compared to those with acute pancreatitis before the pandemic. Furthermore, restrictive measures implemented during the pandemic period led to a partial delay in the care of patients with acute pancreatitis, which likely resulted in an impairment of their immune state. This, in certain circumstances, resulted in a restriction of surgical treatment indications, leading to a three-fold relative risk of death in patients with acute pancreatitis during the pandemic compared to those with acute pancreatitis before the pandemic.

A Cross-Sectional Study on Self-Medication Prevalence and Usage Patterns: An Alarming Concept Among the Saudi Population

BACKGROUND

Self-medication (SM) has many potential drawbacks, including toxicity, drug resistance, severe adverse effects, drug interactions, drug abuse, and drug dependence, but it is still widely used for a variety of reasons, including time and money savings, symptom prevention or treatment of minor illnesses, a lack of access to doctors, etc. This study aimed to describe and analyse the usage of antibiotics without a prescription, self-medication practises, and patterns of using them among Saudis.

MATERIALS AND METHODS

In 13 provinces of Saudi Arabia, a community-based cross-sectional study was done. After gaining consent, data were gathered from 420 adults during face-to-face interviews using a questionnaire. SPSS was used to analyse the data once it had been entered into Microsoft Excel (Microsoft® Corp., Redmond, WA).

RESULTS

Regarding self-medication, among 208 participants, there was a male predominance and among upper lower class with respect to socioeconomic status. The self-medication rate was found to be higher among graduates and professionals with respect to education and occupation. Self-medication was discovered to be more prevalent among metropolitan residents. The majority of those who started using self-medication got their knowledge from various advertisements. The most frequent symptom of self-medication was fever, followed by a common cold. The most commonly used medication was paracetamol, followed by cough syrups. Weight loss advertisements influence participants the most for self-medication, followed by hair loss and diabetes. TV advertisements have the highest influence on people practising self-medication.

CONCLUSION

The study calls for greater knowledge of the impacts of antibiotic self-medication, which can be accomplished through efficient measures including behaviour change communication and encouraging more research into its causes and effects.

Complicated appendicitis, acute pancreatitis, pleural effusion, and sinus bradycardia in a COVID-19 patient

This study shows that complicated appendicitis and acute pancreatitis could occur during a COVID-19 infection, since the same gastrointestinal manifestations are notable in all aforementioned diseases. Sinus bradycardia is a side effect of remdesivir. Both COVID-19 infection and remdesivir therapy can elevate liver transaminases.