Medicines information sources and services for consumers : A special focus on the Internet and people with depression

The range of consumer health and medicines information sources has diversified along with the increased use of the Internet. This has led to a drive to develop medicines information services and to better incorporate the Internet and e-mail into routine practice in health care and in community pharmacies. To support the development of such services more information is needed about the use of online information by consumers, particularly of those who may be the most likely to use and to benefit from the new sources and modes of medicines communication. This study explored the role and utilization of the Internet-based medicines information and information services in the context of a wider network of information sources accessible to the public in Finland. The overall aim was to gather information to develop better and more accessible sources of information for consumers and services to better meet the needs of consumers. Special focus was on the needs and information behavior among people with depression and using antidepressant medicines. This study applied both qualitative and quantitative methods. Consumer medicines information needs and sources were identified by analyzing the utilization of the University Pharmacy operated national drug information call center (Study I) and surveying Finnish adults (n=2348) use of the different medicines information sources (Study II). The utilization of the Internet as a source of antidepressant information among people with depression was explored by focus group discussions among people with depression and with current or past use of the antidepressant(s) (n=29, Studies III & IV). Pharmacy response to the needs of consumers in term of providing e-mail counseling was assessed by conducting a virtual pseudo customer study among the Finnish community pharmacies (n=161, Study V). Physicians and pharmacists were the primary sources of medicines information. People with mental disorders were more frequent users of telephone- and Internet-based medicines information sources and patient information leaflets than people without mental disorders. These sources were used to complement rather than replace information provided face-to-face by health professionals. People with depression used the Internet to seek facts about antidepressants, to share experiences with peers, and for the curiosity. They described that the access to online drug information was empowering. Some people reported lacking the skills necessary to assess the quality of online information. E-mail medication counseling services provided by community pharmacies were rare and varied in quality. Study results suggest that rather than discouraging the use of the Internet, health professionals should direct patients to use accurate and reliable sources of online medicines information. Health care providers, including community pharmacies should also seek to develop new ways of communicating information about medicines with consumers. This study determined that people with depression and using antidepressants need services enabling interactive communication not only with health care professionals, but also with peers. Further research should be focused on developing medicines information service facilitating communication among different patient and consumer groups.

The North in the Old English Orosius : A Geographical Narrative in Context

This doctoral dissertation examines the description of the North as it appears in the Old English Orosius (OE Or.) in the form of the travel accounts by Ohthere and Wulfstan and a catalogue of peoples of Germania. The description is discussed in the context of ancient and early medieval textual and cartographic descriptions of the North, with a special emphasis on Anglo-Saxon sources and the intellectual context of the reign of King Alfred (871-899). This is the first time that these sources, a multidisciplinary approach and secondary literature, also from Scandinavia and Finland, have been brought together. The discussion is source-based, and archaeological theories and geographical ideas are used to support the primary evidence. This study belongs to the disciplines of early medieval literature and (cultural) history, Anglo-Saxon studies, English philology, and historical geography. The OE Or. was probably part of Alfred s educational campaign, which conveyed royal ideology to the contemporary elite. The accounts and catalogue are original interpolations which represent a unique historical source for the Viking Age. They contain unparalleled information about peoples and places in Fennoscandia and the southern Baltic and sailing voyages to the White Sea, the Danish lands, and the Lower Vistula. The historical-philological analysis reveals an emphasis on wealth and property, rank, luxury goods, settlement patterns, and territorial divisions. Trade is strongly implied by the mentions of central places and northern products, such as walrus ivory. The references to such peoples as the Finnas, the Cwenas, and the Beormas appear in connection with information about geography and subsistence in the far North. Many of the topics in the accounts relate to Anglo-Saxon aristocratic culture and interests. The accounts focus on the areas associated with the Northmen, the Danes and the Este. These areas resonated in the Anglo-Saxon geographical imagination: they were curious about the northern margin of the world, their own continental ancestry and the geography of their homeland of Angeln, and they had an interest in the Goths and their connection with the southern Baltic in mythogeography. The non-judgemental representation of the North as generally peaceful and relatively normal place is related to Alfredian and Orosian ideas about the unity and spreading of Christendom, and to desires for unity among the Germani and for peace with the Vikings, who were settling in England. These intellectual contexts reflect the innovative and organizational forces of Alfred s reign. The description of the North in the OE Or. can be located in the context of the Anglo-Saxon worldview and geographical mindset. It mirrors the geographical curiosity expressed in other Anglo-Saxon sources, such as the poem Widsith and the Anglo-Saxon mappa mundi. The northern section of this early eleventh-century world map is analyzed in detail here for the first time. It is suggested that the section depicts the North Atlantic and the Scandinavian Peninsula. The survey of ancient and early medieval sources provides a comparative context for the OE Or. In this material, produced by such authors as Strabo, Pliny, Tacitus, Jordanes, and Rimbert, the significance of the North was related to the search for and definition of the northern edge of the world, universal accounts of the world, the northern homeland in the origin stories of the gentes, and Carolingian expansion and missionary activity. These frameworks were transmitted to Anglo-Saxon literary culture, where the North occurs in the context of the definition of Britain s place in the world.