Determinants of self-medication with NSAIDs in a Portuguese community pharmacy

Background: Non-steroid anti-inflammatory drugs (NSAIDs) are a widely used therapeutic group in the world, and particularly in the Portuguese population. Objective: To compare NSAID’s use by prescription and self-medication acquisition and to determine the pattern of indication of NSAIDs, their usage profile and possible implications for patients’ safety. Methods: A cross-sectional design was used where individuals presenting at a community pharmacy requesting NSAIDs during the study period (one month) were invited to answer a face-to-face interview where socio-demographic characteristics, the indication pattern and previous experience of side effects were assessed. A follow-up interview was performed one week later to assess the incidence of adverse effects. The study was ethically approved. Results: A sample of 130 NSAIDs users was recruited, comprising mostly women (n=87; 66.9%), actively employed (n=77; 59.2%) and presenting a mean age of 49.5 years old (SD=20.49). An equal proportion of individuals acquired NSAIDs by self-medication and with medical prescription (n=65; 50%). Over 4/5 of patients (n=57; 87.7%) acquiring NSAIDs without a prescription were self-medicated by their own initiative, and only 10.8% (n=7) had been advised by the pharmacist. The most commonly acquired active substances were ibuprofen and diclofenac. Self-medicated users more frequently resorted to topical NSAIDs following short term treatments. The major underlying condition motivating NSAIDs sought were musculoskeletal disorders (45.0%), regardless of the regimen. An important proportion of prevalent users of NSAIDs reported previous experience of adverse effects (11.3%). One week after initiating NSAID therapy, a small proportion of patients reported incidence of adverse effects. Conclusion: Self-medication with NSAIDs is sought for numerous medical conditions. Reported adverse effects (prevalent and incident) confirm the need for a more rational use of NSAIDs and ongoing pharmacovigilance.

Food consumption and risk of malnutrition in community-dwelling very old Spanish adults (≥ 80 years)

Introduction: There are few studies assessing overall diet and food patterns of the oldest population. Objectives: To examine food groups consumption (grams and servings) and their compliance with the dietary guidelines in community-dwelling very old Spanish adults. The relationship with the risk of malnutrition was also studied. Methods: Within the cross-sectional health study of elderly people of Villanueva de la Cañada (Madrid, Spain), in 98 non-institutionalized elders aged ≥ 80 years (66% women) food consumption was calculated from a 24-hour dietary recall and nutritional risk was assessed by Mini Nutritional Assessment (MNA). Statistical significance was evaluated at 95% confidence level (p < 0.05). Results: Men consumed significantly higher amounts of snacks/pickles and alcoholic beverages. The consumption of cereals/grain products (2 servings/day), vegetables (1.5 servings/day) and meat, fish, eggs (1.4 servings/day), was below desirable levels. As nutritional status got worse, fruit consumption was significantly smaller (p = 0.039). Relatively weak but highly significant correlations were found between MNA and oils/fats, fruits and alcoholic beverages. After adjustment for energy intake, oils and fats and fruits associations disappeared whereas a negative association between milk/dairy products and MNA was found. Conclusions: Dietary patterns of the elderly population of Villanueva are departing from the traditional Mediterranean diet and though adequate consumption of fruits, milk/dairy products, oils/fats and sugar/confectionery has been achieved, cereals/grain products, vegetables and the meat,fish,eggs group consumption was below the desirable levels. Deterioration of the nutritional status coincided with a reduction in the consumption of all food groups except for ready meals and milk/dairy products whose consumption increased. Further research on the influence of fruit, milk/dairy products, wine and olive oil consumption on nutritional status is required.