Prescription medication hoarding and borrowing or sharing behaviours in older residents in the Illawarra, New South Wales, Australia

Aim: To examine prescription medication hoarding and borrowing or sharing (PMHBS) behaviours in older people, particularly which medications are subject to these behaviours and the circumstances that enable these behaviours.

Methods: A mixed methods triangulation design, using consecutive qualitative (focus groups) and quantitative (survey) methodologies in a convenience sample of people older than 65 years, living independently in the Illawarra region (New South Wales).

Results: Focus group participants (n= 28) acknowledged PMHBS behaviours were widespread; however, very few survey respondents (n= 226) admitted to engaging in these behaviours. Main findings in the study were enablers for these behaviours: the prescription medication is considered the same as that prescribed previously; and self-medicating for pain relief.

Conclusions: The prevalence of PMHBS behaviours in this study was low, although it was acknowledged such behaviours occurred in the wider community. Sharing strong pain medication and the same prescription medication appeared to be acceptable in this population.

Antibiotics overuse in children with upper respiratory tract infections in Saudi Arabia : risk factors and potential interventions

Background: Antibiotics misuse is currently one of the major public health issues worldwide. This misuse can lead to the development of bacterial resistance, increasing the burden of chronic diseases, rising costs of health services, and the development of side effects. Several factors may influence this pattern of overuse. Objectives:This article will review the pertinent factors contributing to the overuse of antibiotics worldwide, and to assess the intervention strategies to limit this overuse. Methods: studies about antibiotics use in children were reviewed from several electronic databases, such as MEDLINE and Pubmed. Results: Factors contributing to the overuse of antibiotics could include psychosocial factors, such as behaviors and attitudes (e.g. self-medication, over-the-counter medication, or patients/parents pressure), and demographic factors, such as socio-economic status and education level. Several intervention strategies were reported to be effective in reducing the overuse of antibiotics, such as health education, doctor-patient communication, and policies change. Multifaceted interventions were found to be the most effective in reducing the antibiotics overuse.

Community Pharmacies and the Needs of Mobile EU Citizens - A study on Finns living in Spain

Migration within the European Union (EU) has increased since the Union was established. Community pharmacies provide open access to health care services and can be the first, most frequently used or even the only contact with a nation s health care system among mobile community residents. In some of the mass-migration areas in Southern Europe, most of the customers may represent mobile citizens of foreign background. This has not always been taken into consideration in the development of community pharmacy services. Mobile patients have been on the EU's health policy agenda, but they have seldom been mentioned in the context of community pharmacies. In most of the EU member states, governments control the specific legislation concerning community pharmacies and there is no harmonised pharmaceutical policy or consistent minimal standards for community pharmacy services in the EU. The aim of this study was to understand medication use, the role of community pharmacies and the symptom mitigation process of mobile community residents. Finns living in Spain were used as an example to examine how community pharmacies in a EU member state meet the needs of mobile community residents. The data were collected by a survey in 2002 (response rate 53%, n= 533) and by five focus group discussions in 2006 (n=30). A large number (70%) of the respondents had moved to Spain for health reasons and suffered from chronic morbidity. Community pharmacies had an important role in the healthcare of mobile community residents and the respondents were mostly satisfied with these services. However, several medication safety risks related to community pharmacy practices were identified: 1) Availability of prescription medicines without prescription (e.g., antibiotics, sleeping pills, Viagra®, asthma medications, cardiovascular medicines, psoriasis medicines and analgesics); 2) Irrational use of medicines (e.g., 41% of antibiotic users had bought their antibiotics without a prescription, and the most common reasons for antibiotic self-medication were symptomatic common colds and sore throats); 3) Language barriers between patients and pharmacy professionals; 4) Lack of medication counselling; 5) Unqualified pharmacy personnel providing pharmacotherapy. A fifth of the respondents reported experiencing problems during pharmacy visits in Spain, and the lack of a common language was the source of most of these problems. The findings of this study indicate that regulations and their enforcement can play a crucial role in actually assuring the rational and safe use of medicines. These results can be used in the development of pharmaceutical and healthcare policies in the EU. It is important to define consistent minimum standards for community pharmacy services in the EU. Then, the increasing number of mobile community residents could access safe and high quality health care services, including community pharmacy services, in every member state within the EU.

Coping style and ecstasy use motives as predictors of current mood symptoms in ecstasy users

Background Elevated depressive and anxiety symptoms during childhood and adolescence have been associated with greater risk of later ecstasy use. Ecstasy users have reported using ecstasy to reduce depression or worry, or to escape. While these findings suggest that some people use ecstasy as a form of self-medication, limited research has been conducted examining the relationship between affective symptoms, coping styles and drug use motives in ecstasy users. This cross-sectional study aimed to determine if coping style and/or ecstasy use motives are associated with current mood symptoms in ecstasy users. Methods A community sample (n = 184) of 18–35 year olds who had taken ecstasy at least once in the past 12 months completed self-report measures of depression, anxiety, ecstasy use motives and coping styles. Timeline followback methods were used to collect information on lifetime ecstasy, recent drug use and life stress. Trauma exposure was measured using the Composite International Diagnostic Interview—Trauma List. Results Coping motives for ecstasy use and an emotion-focused coping style were significantly associated with current depressive and anxiety symptoms. Emotion-focused coping mediated the relationship between a history of trauma and current anxiety symptoms and moderated the relationship between recent stressful life events and current depressive symptoms. Conclusions These findings highlight the importance of interventions targeting motives for ecstasy use, and providing coping skills training for managing stressful life events among people with co-occurring depressive/anxiety symptoms and ecstasy use.

Propaganda de medicamentos. É possível regular ?

A regulação da propaganda de medicamentos no Brasil incorpora quatro fragilidades: 1. A monitoração, fiscalização e punição de irregularidades são realizadas a posteriori do acometimento da infração (quando a população já foi submetida a risco sanitário); 2. As multas cobradas pela Anvisa têm valor irrisório frente aos investimentos do marketing farmacêutico; 3. Não há mecanismo que impeça que mesmo os valores irrisórios das multas sejam repassados aos preços dos produtos, onerando o consumidor; 4. A frase tida como de alerta - A PERSISTIREM OS SINTOMAS O MÉDICO DEVERÁ SER CONSULTADO - ao invés de conscientizar a população a respeito dos riscos da automedicação, estimula o uso de medicamentos sem receita, aconselhando a busca de um médico apenas no caso da persistência dos sintomas. Segundo dados da Anvisa e de estudos acadêmicos, 90% da publicidade exibida contém irregularidades. Assim, a RDC 102/2000 da Anvisa, que regulamenta o setor, se constitui em um aparente sistema de regulação, que beneficia o infrator e mantém a população sob risco. Este trabalho analisa o conceito e o uso dos mecanismos de marketing na busca de se elevar a comercialização de produtos farmacêuticos (no que se denomina produção de doenças), examina os conceitos de propaganda, medicamento, regulação e manipulação; percorre alguns estatutos internacionais referentes ao setor da publicidade de medicamentos (com foco nas diretivas da União Européia) e expõe a avaliação de organismos europeus de defesa do consumidor sobre o desempenho destas normas. Ao final, este estudo expõe as posições do setor regulado brasileiro (indústria, agências de publicidade e meios de comunicação) frente às posições de órgãos de defesa dos consumidores, da academia e da sociedade organizada no âmbito do SUS, para propor como alternativa um modelo regulador que supere as fragilidades do atual.

Subclinical Depressive Symptoms and Continued Cannabis Use: Predictors of Negative Outcomes in First Episode Psychosis

Background Although depressive symptoms in first episode psychosis have been associated with cannabis abuse, their influence on the long-term functional course of FEP patients who abuse cannabis is unknown. The aims of the study were to examine the influence of subclinical depressive symptoms on the long-term outcome in first episode-psychosis patients who were cannabis users and to assess the influence of these subclinical depressive symptoms on the ability to quit cannabis use. Methods 64 FEP patients who were cannabis users at baseline were followed-up for 5 years. Two groups were defined: (a) patients with subclinical depressive symptoms at least once during follow-up (DPG), and (b) patients without subclinical depressive symptoms during follow-up (NDPG). Psychotic symptoms were measured using the Positive and Negative Syndrome Scale (PANSS), depressive symptoms using the Hamilton Depression Rating Scale (HDRS)-17, and psychosocial functioning was assessed using the Global Assessment of Functioning (GAF). A linear mixed-effects model was used to analyze the combined influence of cannabis use and subclinical depressive symptomatology on the clinical outcome. Results Subclinical depressive symptoms were associated with continued abuse of cannabis during follow-up (beta=4.45; 95% confidence interval [CI]: 1.78 to 11.17; P=.001) and with worse functioning (beta=-5.50; 95% CI: -9.02 to -0.33; P=.009). Conclusions Subclinical depressive symptoms and continued cannabis abuse during follow-up could be predictors of negative outcomes in FEP patients.

Novos sistemas terapêuticos de administração transcutânea

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Ciências Farmacêuticas

Can the protein costs of bacterial resistance be offset by altered feeding behaviour?

1. Mounting an immune response is likely to be costly in terms of energy and nutrients, and so it is predicted that dietary intake should change in response to infection to offset these costs. The present study focuses on the interactions between a specialist grass-feeding caterpillar species, the African armyworm Spodoptera exempta, and an opportunist bacterium, Bacillus subtilis.
2. The main aims of the study were (i) to establish the macronutrient costs to the insect host of surviving a systemic bacterial infection, (ii) to determine the relative importance of dietary protein and carbohydrate to immune system functions, and (iii) to determine whether there is an adaptive change in the host's normal feeding behaviour in response to bacterial challenge, such that the nutritional costs of resisting infection are offset.
3. We show that the survival of bacterially infected larvae increased with increasing dietary protein-to-carbohydrate (P:C) ratio, suggesting a protein cost associated with bacterial resistance. As dietary protein levels increased, there was an increase in antibacterial activity, phenoloxidase (PO) activity and protein levels in the haemolymph, providing a potential source for this protein cost. However, there was also evidence for a physiological trade-off between antibacterial activity and phenoloxidase activity, as larvae whose antibacterial activity levels were elevated in response to immune activation had reduced PO activity.
4. When given a choice between two diets varying in their P:C ratios, larvae injected with a sub-lethal dose of bacteria increased their protein intake relative to control larvae whilst maintaining similar carbohydrate intake levels. These results are consistent with the notion that S. exempta larvae alter their feeding behaviour in response to bacterial infection in a manner that is likely to enhance the levels of protein available for producing the immune system components and other factors required to resist bacterial infections (‘self-medication’).

Economic aspects of pharmacotherapy for chronic constipation

Constipation is one of the most common digestive complaints. It is a symptom, not a disease. The subjectivity that this involves means that assessments of clinical epidemiology, socioeconomic costs and pharmacotherapy are difficult, since there is no definition of 'normal' bowel habit. Although constipation can affect all ages, the problem increases with age, and is of particular concern for those who are frail and in long term care. Cultural influences may affect the prevalence in older people. Drug therapy of constipation cannot be considered in isolation, since there are issues in the prevention of constipation and the principles of good management that also apply. Furthermore, some consideration of the pathophysiology and diagnosis is important. This is because a number of remediable causes can be identified, and the diagnostic process involves patient education, which in turn may be effective in reducing costs. It is the complaint of constipation which leads either to self-medication or to consultation with the medical profession. Both of these courses of action have a significant influence on utilisation of laxatives (cathartics), obtained both over-the-counter and by prescription. Although there are a large number of laxative preparations available, therapy has changed little in half a century. Costs may vary considerably, and with such a significant problem there is a need for comparative studies. However, study methodologies are difficult, and a significant placebo response may be found. Education and preventive measures have been shown to reduce laxative use and costs in institutions. Unfortunately, there are few comparative studies of individual laxatives and even fewer cost-effectiveness studies. Those that there are have been based in institutions, and so extrapolation to other situations may be difficult. In general, little attention is given to constipation. It is, however, an area with significant resource implications in which education and preventive measures have been shown to be beneficial. Even so, there is still a need for good comparative studies, particularly where cost effectiveness is concerned.

Health vulnerabilities: the diagnosis of freshmen from a portuguese university

The start of university is presented as a crucial stage in the life of the student. If, on the one hand, it is a period of increased autonomy and freedom, on the other, it is a period that also increases the sense of responsibility and self discipline. In this study, based on a quantitative approach, we identified the main risk situations experienced by freshmen at the University of Evora, by applying a questionnaire developed for this purpose and the Beck inventory. Key findings are highlighted, such as the consumption of harmful substances (tobacco, alcohol and illicit drugs), whose values exceed the average population. The consumption of alcoholic beverages begins early and is continuous and excessive. Also, the presence of symptoms compatible with dysphoria and depression is noted in about 9% of students. Self-medication practices were found in 58.7% of the freshmen. Our findings reveal the need for preventive intervention by health professionals, due to these young people’s great exposure to health risks.

Substance use and misuse in burn patients: testing the classical hypotheses of the interaction between posttraumatic symptomatology and substance use

Background: We aimed to test whether the three classical hypotheses of the interaction between posttraumatic symptomatology and substance use (high risk of trauma exposure, susceptibility for posttraumatic symptomatology, and self-medication of symptoms), may be useful in the understanding of substance use among burn patients. Methods: We analysed substance use data (nicotine, alcohol, cannabis, amphetamines, cocaine, opiates, and tranquilizers) and psychopathology measures among burn patients admitted to a Burns Unit and enrolled in a longitudinal observational study. Lifetime substance use information (n = 246) was incorporated to analyses aiming to test the high risk hypothesis. Only patients assessed for psychopathology in a six months follow-up (n = 183) were included in prospective analyses testing the susceptibility and self-medication hypotheses. Results: Regarding the high risk hypothesis, results show a higher proportion of heroin and tranquilizer users compared to the general population. Furthermore, in line with the susceptibility hypothesis, higher levels of symptomatology were found in lifetime alcohol, tobacco and drug users during recovery. The self-medication hypothesis could be tested partially due to the hospital stay “cleaning” effect, but severity of symptoms was linked to caffeine, nicotine, alcohol and cannabis use after discharge. Conclusions: We found that the three classical hypotheses could be used to understand the link between traumatic experiences and substance use explaining different patterns of burn patient’s risk for trauma exposure and emergence of symptomatology.

Effets motivationnels des cannabinoïdes dans un modèle animal de la schizophrénie

Depuis quelques décennies, la consommation de cannabis et son usage thérapeutique sont le sujet de nombreux débats. Le cannabis est la drogue illicite la plus consommée au monde et cette consommation se trouve dix fois plus élevée chez les patients atteints de schizophrénie que dans la population générale. L’hypothèse d’une automédication initialement proposée afin d’expliquer la consommation élevée de cannabis chez les patients atteints de schizophrénie est maintenant remise en question. En effet, les rapports indiquant une aggravation des symptômes plutôt qu’une amélioration suite à une consommation à long terme sont de plus en plus nombreux. Sachant que le cannabis peut induire des effets soit plaisants soit aversifs, la question se pose à savoir si une prédominance de la valence motivationnelle positive ou une diminution de la valence négative du cannabis peut expliquer la consommation élevée parmi les individus ayant un diagnostic de schizophrénie? Bien qu’un grand nombre de recherches pré-cliniques aient été menées chez l’animal normal pour évaluer l’effet motivationnel du Δ9-tétrahydrocannabinol (THC) et autres cannabinoïdes synthétiques, aucune n’a abordé cette problématique dans un modèle animal de la schizophrénie. Cette lacune nous a donc amené à étudier la valence motivationnelle du THC et de l’agoniste cannabinoïde WIN55,212-2 (WIN) dans un modèle animal de la schizophrénie: la lésion néonatale de l’hippocampe ventral (NVHL). Dans le premier article, nous présentons les résultats de quatre expériences. Une première avait pour objectif de déterminer si la procédure expérimentale que nous avons utilisée permettait de reproduire des signes distinctifs du modèle animal de la schizophrénie. Par la suite, nous avons évalué i) l’effet d’une dose de WIN sur l’activité locomotrice spontanée et ii) la valence motivationnelle du THC (0.5 mg/kg, i.p) et du WIN (1 mg/kg, i.p) chez les rats adolescents (jour post-natal 28-40, PD28-40) et adultes (PD56) au moyen du paradigme de préférence de place conditionnée (PPC). Tel qu’attendu, la réponse locomotrice à l’amphétamine (0.75 et 1.5 mg/kg) chez les rats NVHL adultes était supérieure à celle des rats contrôles (test distinctif du modèle). Le THC a induit une tendance aversive chez les rats contrôles adultes. Enfin, le WIN a stimulé l’activité locomotrice et induit une aversion significative chez les rats adultes NVHL. Dans un deuxième article, nous avons évalué la valence motivationnelle du THC (0.5 mg/kg), du WIN (1 et 3 mg/kg) et l’effet de l’amphétamine au moyen du paradigme d’autostimulation électrique intracérébrale (ASI). Les résultats montrent que : i) l’effet amplificateur de l’amphétamine sur l’ASI était de plus courte durée chez les rats NVHL; ii) le THC produit une légère atténuation de la récompense chez les rats contrôles tandis que le WIN a produit une atténuation plus prononcée de la récompense chez les rats NVHL, un effet qui a été bloqué par l’antagoniste aux récepteurs CB1, le AM251 (3 mg/kg). Pour la première fois les résultats suggèrent une altération du système endocannabinoïde dans un modèle animal de la schizophrénie. Ils indiquent qu’une exposition aigüe conduit à une prédominance de la valence négative. Bien qu’en apparente contradiction avec les études cliniques, ces résultats soulignent l’importance du contexte socio-environnemental pour expliquer les effets du cannabis chez les patients. De plus ils encouragent les futures études à évaluer cette valence sur un modèle d’exposition chronique.

Des principes de responsabilité et de solidarité pour un accès équitable aux soins de santé : le cas des travailleurs de l'informel urbain du Cameroun en situation de vulnérabilité

La question de l’accès financier des personnes socialement défavorisées aux soins de santé est aujourd’hui un enjeu éthique de grande importance dans de nombreux pays à faible revenu ou en voie d’émergence. On peut se demander comment l’équité dans l’accès aux soins peut être rendue effective puisque l’égalité des chances pour tous et la santé sont des pré-requis aux choix de vie et à la réalisation de soi. Les soins de santé sont donc d’une importance éthique particulière du fait qu’ils contribuent à préserver notre statut comme citoyens pleinement fonctionnels. Au Cameroun, bien que des efforts considérables soient consentis par les pouvoirs publics et leurs partenaires extérieurs pour favoriser l’accès aux soins des personnes défavorisées, le secteur de la santé reste encore très marqué par l’inégalité dans l’accès financier aux prestations sanitaires. Les médicaments les plus essentiels ne sont pas financièrement à la portée de tous et les coûts d’accès aux soins ambulatoires et hospitaliers dans les formations sanitaires sont manifestement prohibitifs pour une large frange de la population. Lors des épisodes de maladie, l’accès aux soins se fait par le paiement direct au point d’accès, et la pratique de l’automédication s’est répandue du fait de l’incapacité des personnes socialement défavorisées à payer leurs soins sans courir le risque de perdre l’essentiel de leur revenu. Les mesures de prise en charge sociale ou des systèmes de financement qui garantissent la réduction des inégalités entre les classes sociales sont fortement limitées par les faibles capacités d’une économie qui repose essentiellement sur l’informel. Sur la base de cette réalité, cette thèse analyse à partir du cas des travailleurs vulnérables du secteur informel urbain, la pertinence du choix politique de la couverture universelle santé au Cameroun à travers les principes de responsabilité et de solidarité. La population d’étude choisie est celle des travailleurs vulnérables du secteur informel en considération des problématiques liées à leur accès aux soins de santé, de l’importance de leur apport dans l’économie du pays ( 90 % des travailleurs) et du rôle qu’elle pourrait jouer dans l’atteinte de l’objectif de la couverture universelle santé. La thèse analyse donc, d’une part, les conditions et les modalités de répartition des biens sociaux qui répondent à la nécessaire redistribution équitable des ressources, en l’occurrence l’accès aux soins de qualité. Après avoir montré les préoccupations d’ordre politique, social, économique et éthique liées au problème d’accès universel aux soins, la thèse propose des stratégies opérationnelles susceptibles de conduire à l’amélioration de la qualité des soins et à un assainissement de la gestion du secteur des services de soins (éthique du care et éthique de bonne gouvernance). Aussi, dans la perspective de la recherche d’un financement local soutenable et durable de l’accès de tous aux soins, la thèse propose une approche participative. L’exploration de cette perspective aboutit au résultat qu’une approche inclusive et intégrée de promotion de l’économie informelle (dynamisation de ses activités et potentialisation de ses acteurs) pourrait faire de ce secteur un véritable levier de développement économique et social. Un développement social et solidaire durable et susceptible, sur le long terme, de réaliser l’objectif de la couverture universelle santé. En d’autres termes, elle propose des stratégies de capabilisation et de responsabilisation des travailleurs du secteur informel, en vue d’une société plus impliquée, plus responsable et plus solidaire. Une approche susceptible de matérialiser le droit à la santé, de construire l’autonomie des travailleurs en situation de vulnérabilité et de renforcer leurs capacités contributives à travers une opérationnalisation adaptée au contexte des principes de responsabilité et de solidarité.

Prevalencia y factores asociados a dismenorrea en estudiantes de la Universidad del Rosario

Antecedentes: la dismenorrea es el dolor asociado al ciclo menstrual. Presenta una prevalencia entre el 60 y 93%. Se han descrito factores asociados como: edad de la menarquía, índice de masa corporal, ejercicio, tabaquismo, antecedente de dismenorrea materna entre otros. Materiales y Métodos: se realizó un estudio de corte transversal, basado en una encuesta anónima a 127 mujeres de la Universidad del Rosario pertenecientes a las facultades de Medicina y Psicología. Resultados: ee encontró una prevalencia de dismenorrea del 73%, el 67% de las participantes que presentaron dolor menstrual refirió tomar medicamentos para aliviar el dolor, el 42% fue auto formulado. El 44,6% de las encuestadas con dismenorrea se han ausentado de sus labores académicas o sociales, con un porcentaje de ausentismo escolar a causa del dolor del 74.5% en al menos 1 día. El antecedente materno de dismenorrea se asocio positivamente a la aparición de la enfermedad en las adolescentes (P 0.02). Conclusiones: La dismenorrea es una enfermedad con una alta prevalencia, y con impacto importante sobre el ausentismo académico. El antecedente materno de dismenorrea fue el único factor asociado positivamente en este estudio. Es necesario realizar estudios a mayor escala para poder establecer el impacto de esta enfermedad en la calidad de vida de las pacientes, así como para poder determinar otros factores asociados.

Aproximación teórica al fenómeno de la automedicación desde la psicología del consumidor

La automedicación es un fenómeno global creciente que tradicionalmente se ha definido como la acción individual de tomarse un medicamento o seguir un tratamiento sin prescripción médica. Sin embargo, esta visión se ha quedado corta ante las manifestaciones contemporáneas del fenómeno que van más allá del autocuidado y se asocian cada vez más al consumo masivo inducido por la publicidad. En ese sentido, este artículo presenta las definiciones y teorías explicativas de la automedicación ofrecidas por la literatura científica y ofrece una nueva hipótesis sobre la automedicación, como comportamiento individual de consumo, explicada por un posicionamiento cognitivo causal simple de la acción de los medicamentos, a su vez facilitado por la publicidad y el mercadeo de éstos. Se concluye mostrando la importancia de contrarrestar el efecto de la publicidad mediante la educación del consumidor acerca del riesgo que implica la complejidad la automedicación a partir de la acción de los medicamentos en el organismo.