Over the Counter Pain Medications Used by Adults: A Need for Pharmacist Intervention.

BACKGROUND: The safety of pharmacotherapy for geriatric patients is an essential aspect of the demographic perspective in view of the increasing size of this population. Non-opioid analgesics (NOAs) are among the most popular and often overused over-the-counter medications (OTC). The reasons for drug abuse are common in the geriatric population: musculoskeletal disorders, colds, inflammation and pain of various origins. The popularity of self-medication and the ability to easily access OTC drugs outside the pharmacy creates the danger of their misuse and the incidence of adverse drug reactions (ADRs). The survey included 142 respondents aged 50-90 years. The relationship between the prevalence of ADRs and the NOAs used, age, presence of chronic diseases, and place of purchasing and obtaining information about the mentioned drugs were evaluated. The results of the observations were statistically analyzed using Statistica 13.3. The most commonly used NOAs among the elderly included paracetamol, acetylsalicylic acid (ASA) and ibuprofen. Patients consumed the medications for intractable headaches, toothaches, fevers, colds and joint disorders. Respondents indicated the pharmacy as the main location for purchasing medications, and the physician as the source of information for selecting the therapy. ADRs were reported most frequently to the physician, and less frequently to the pharmacist and nurse. More than one-third of respondents indicated that the physician during the consultation did not take a medical history and did not ask about concomitant diseases. It is necessary to extend pharmaceutical care to geriatric patients that includes advice on adverse drug reactions, especially drug interactions. Due to the popularity of self-medication, and the availability of NOAs, long-term measures should be taken to increase the role of pharmacists in providing effective, safe health care to seniors. We are targeting pharmacists with this survey to draw attention to the problem of the prevalence of selling NOAs to geriatric patients. Pharmacists should educate seniors about the possibility of ADRs and approach patients with polypragmasy and polypharmacy with caution. Pharmaceutical care is an essential aspect in the treatment of geriatric patients, which can contribute to better results in their existing treatment and increase the safety of medication intake. Therefore, it is important to improve the development of pharmaceutical care in Poland in order to enhance patient outcomes.

Acesso da população a medicamentos durante a pandemia do novo coronavírus / Access of the population to medicines during the pandemic of the new coronavirus / Acceso de la poblacióna medicamentos durante la pandemia del nuevo coronavirus

Introdução:Em 2020 a Organização Mundial da Saúde declarou a pandemia do novo coronavírus. Diante desse cenário vários estudos começaram a ser realizados em busca de uma terapia eficaz para o manejo clínico dos pacientes. A Cloroquina e a Hidroxicloroquina foram os primeiros medicamentos testados. A divulgação dos resultados iniciais fez aumentar a procura desses medicamentos em farmácias e drogarias. Objetivo:Avaliar o acesso da população a medicamentos na pandemia e o uso das "promessas terapêuticas":Cloroquina, Hidroxicloroquina e Ivermectina para prevenção e tratamento da COVID-19. Metodologia:Trata-se de um estudo descritivo exploratório de abordagem quantitativa, não probabilístico e por conveniência. A coleta de dados foi realizada online,via Google Formulários. Participaram 1.754 pessoas, resultando em 1.748 questionários válidos. A amostra foi distribuída em 3 grupos, de acordo com a pergunta de nº 11 do formulário de pesquisa: "Você já teve COVID-19?". Resultados:Dos 1.748 respondentes, 200 (11,4%) pertenciam ao grupo que "teve COVID-19", 1.041 (59,6%) ao grupo que não teve a doença, e 507 (29%) responderam não saber se foram infectados. No que diz respeito ao acesso a medicamentos na pandemia, 55,2% do total da amostra relatou não ter sido afetado, e 29% disseram ter tido o acesso afetado de alguma forma. Em relação ao uso das "promessas terapêuticas", 61% dos respondentes disse não ter feito uso com finalidade de prevenção, e sim para tratamento, já 52,6% da população do estudo disse que não fez uso de jeito nenhum, e 46,2% relatou que fez uso dos medicamentos mencionados para tratar a COVID-19. Conclusões:Constatou-se que a explosão na busca por medicamentos durante a pandemia não afetou o acesso da população. Além disso, a Cloroquina e a Hidroxicloroquina, não foram amplamente utilizadas para prevenção da doença (AU).

Introduction:In 2020the World Health Organization declared the new coronavirus pandemic. In view of this scenario, several studies began to be carried out in search of an effective therapy for the clinical management of patients. The release of initial results has increased demand for Chloroquine and Hydroxychloroquine in pharmacies and drugstores. Objective: To assess the population's access to medicines in the pandemic and the use of "therapeutic promises": Chloroquine, Hydroxychloroquine and Ivermectin for the prevention and treatment of COVID-19. Methodology:Exploratory descriptive study with a quantitative approach, non-probabilistic and for convenience. Data collection was performed online, via Google Forms. 1,754 people participated, resulting in 1,748 valid questionnaires. The sample was divided into 3 groups, according to question #11 of the survey form: "Have you ever had COVID-19?". Results:Of the 1,748 respondents, 200 (11.4%) belonged to the group that "had COVID-19", 1,041 (59.6%) to the group that did not have the disease, and 507 (29%) answered not knowing if they were infected. With regard to access to medicines in the pandemic, 55.2% of the total sample reported not being affected, and 29% said their access was affected in some way. Regarding the use of "therapeutic promises", 61% of respondents said they did not use it for prevention purposes, but for treatment, while 52.6% of the study population said they did not use it at all, and 46, 2% used the medications mentioned to treat COVID-19. Conclusions:It wasfound that the explosion in the search for medicines during the pandemic did not affect the population's access. Furthermore, Chloroquine and Hydroxychloroquine have not been widely used for disease prevention (AU).

Introducción:En 2020, la Organización Mundial de la Salud declaró la nueva pandemia de coronavirus. Ante este escenario, se comenzaron a realizar varios estudios en busca de una terapia eficaz para el manejo clínico de lospacientes. La publicación de los resultados iniciales ha aumentado la demanda de cloroquina e hidroxicloroquina en farmacias y droguerías. Objetivo:Evaluar el acceso de la población a medicamentos en la pandemia y el uso de "promesas terapéuticas": cloroquina, hidroxicloroquina e ivermectina para la prevención y tratamiento de COVID-19. Metodología:Se trata de un estudio descriptivo exploratorio con enfoque cuantitativo, no probabilístico y por conveniencia. La recopilación de datos se realizó en línea, a través de Google Forms. Participaron 1.754 personas, resultando 1.748 cuestionarios válidos. La muestra se dividió en 3 grupos, de acuerdo con la pregunta # 11 del formulario de la encuesta: "¿Alguna vez ha tenido COVID-19?". Resultados: De los 1.748 encuestados, 200 (11,4%) pertenecían al grupo que "tenía COVID-19", 1.041 (59,6%) al grupo que no tenía la enfermedad y 507 (29%) respondieron sin saber si estaban infectados. Con respecto al acceso a medicamentos en la pandemia, el 55,2% del total de la muestra informó no estar afectado y el 29% dijo que su acceso se vio afectado de alguna manera. Con respecto al uso de "promesas terapéuticas", el 61% de los encuestados dijo que no lo usaba con fines de prevención, sino de tratamiento, mientras que el 52,6% de la población del estudio dijo que no lo usaba en absoluto, y el 46,2% informó que utilizaron los medicamentos mencionados para tratar COVID-19. Conclusiones: Se encontró que la explosión en la búsqueda de medicamentos durante la pandemia no afectó el acceso de la población. Además, la cloroquina y la hidroxicloroquina no se han utilizado ampliamente para la prevención de enfermedades (AU).

[Pain management in cancer patients in a Tunisian hospital]. / La gestion de la douleur chez les patients atteints du cancer dans un hôpital tunisien.

Pain is a common symptom in cancer patients. It is subjective and difficult to communicate. It continues to be outsourced and often overlooked despite the existence of multiple recommendations. The objective of this study is to describe pain management in cancer patients in a Tunisian hospital. This is a prospective study, conducted over one month at the maternity centre of Monastir by an intern in pharmacy using a questionnaire. Of 128 patients assessed, 50 were algic. Twenty-six percent of algic patients were not treated. The neuropathic component of pain was present in 30 % of cases but under treatment. Relief opioids were prescribed in 43 % of cases to relieve pain. Paracetamol was prescribed in 26 % of cases. Ten percent of patients use paracetamol self-medication. Sixteen percent of patients have tried non-pharmacological means, of which 62 % consume plants. To optimise the management of pain at our centre, the available analgesic sheets have been developed, validated by the medical staff and disseminated in the departments of carcinology and oncohematology. Therapeutic education sessions were also scheduled to warn patients about the risks of self-medication and misuse of medicinal plants. Pain management is complex. It requires respect for international recommendations, but especially for the efforts made by all stakeholders.

Attitudes towards and use of cannabis in New Zealand patients with inflammatory bowel disease: an exploratory study.

AIMS: We aimed to assess the use of and attitudes towards cannabis use (medicinal and recreational) by people with IBD in New Zealand. METHODS: People with IBD were invited to complete an anonymous online questionnaire. Participants were recruited via postal mail using a hospital database of patients with IBD (developed by the Gas-troenterology Department at Dunedin Public Hospital) and via online recruitment (advertised on the Crohn's and Colitis New Zealand website, Facebook page and e-mail list). Inclusion criteria were ages 18+ and self-reported confirmed IBD diagnosis. RESULTS: In total, 378 participants completed the questionnaire, with 334 eligible responses. Partici-pants were predominantly New Zealand European (84%) and female (71%). Sixty-one percent of re-spondents had CD and 34% UC. Overall, 51% of respondents reported having ever used cannabis. Of those, 63% reported use as recreational and 31% for reduction of IBD symptoms. Users were more likely to be younger (on average by 6.4 years), with on-going symptoms, unemployed or self-employed and current or ex-smokers. There were no differences by disease status or severity. Symp-toms most reported as improved by cannabis use were abdominal pain/cramping, nausea/vomiting and loss of appetite. Fifty-four percent of participants reported that if cannabis were legal, they would request it for medicinal use to help manage their symptoms. CONCLUSIONS: Overall, our research aligns with previous observational research that reports im-provements in symptoms of IBD with cannabis use. Studies of a higher evidence level (eg, RCTs) would be needed to guide prescribing. In the meantime, this research provides useful background to clini-cians about patients' views and experiences.

The COVID-19 cannabis health study: Results from an epidemiologic assessment of adults who use cannabis for medicinal reasons in the United States.

Background: Clinical indications for medicinal cannabis include chronic conditions; thus users (MCUs) are at an increased risk of morbidity and mortality resulting from SARS-CoV-2 infection (COVID-19). The study aimed to provide data on cannabis use and self-reported behavioral changes among MCUs with preexisting chronic conditions in response to the pandemic.Methods: An internet-based questionnaire was administered to adults ≥18 who self-reported medicinal cannabis use within the past year. Data are from respondents between March 21 and April 23, 2020; response rate was 83.3%. Health conditions and cannabis frequency, route, and patterns of use were assessed via the COVID-19 Cannabis Health Questionnaire (Vidot et al. 2020).Results: Participants (N = 1202) were predominantly non-Hispanic white (82.5%) and 52.0% male (mean age 47.2 years). Mental health (76.7%), pain (43.7%), cardiometabolic (32.9%), respiratory (16.8%), and autoimmune (12.2%) conditions were most reported. Those with mental health conditions reported increased medicinal cannabis use by 91% since COVID-19 was declared a pandemic compared to those with no mental health conditions (adjusted odds ratio: 1.91, 95% CI: 1.38-2.65). 6.8% reported suspected COVID-19 symptoms. Two percent (2.1%) have been tested for COVID-19 with only 1 positive test result. Some MCUs (16%) changed their route of cannabis administration, switching to nonsmoking forms.Conclusions: The majority of MCUs reported at least one preexisting chronic health condition. Over half report fear of COVID-19 diagnosis and giving the virus to someone else; yet only some switched from smoking to nonsmoking forms of cannabis. Clinicians may consider asking about cannabis use among their patients, particularly those with chronic health conditions.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Usage and co-prescription with other potentially interacting drugs in elderly: A cross-sectional study.

Globally, usage of non-steroidal anti-inflammatory drugs (NSAIDs) in elderly with chronic pain has been reported as frequent. Though NSAIDs are fundamental in maintaining their quality of life, the risk of polypharmacy, drug interactions and adverse effects is of paramount importance as the elderly usually require multiple medications for their co-morbidities. If prescriptions are not appropriately monitored and managed, they are likely to expose patients to serious drug interactions and potentially fatal adverse effects. This study was conducted to assess the appropriateness of NSAIDs use and determine the risk of NSAIDs related potential interactions in elderly. An analytical cross-sectional study was conducted among elderly out-patients (aged 60 and above) who visited three hospitals in Asmara, Eritrea, between August 22 and September 29, 2018. A stratified random sampling design was employed and data was collected using an interview-based questionnaire and by abstracting information from patients' prescriptions and medical cards. Descriptive and analytical statistics including chi-square test and logistic regression were employed using IBM SPSS (version 22). A total of 285 respondents were enrolled in the study with similar male to female ratio. One in four of all respondents were chronic NSAIDs users and NSAIDs risk practice was reported in 24%. Using chronic NSAIDs without prophylactic gastro-protective agents, self-medication, polypharmacy and drug-drug interactions were the main problems identified. A total of 322 potential interactions in 205 patients were identified and of which, 97.2% were classified as moderate, 0.6% severe and the rest were mild. Those who involved in self-medication were more likely to be exposed to drug interactions. Diabetes (AOR = 2.39, 95% CI: 1.14, 5.02) and hypertension (AOR = 9.06, 95% CI: 4.00, 20.51) were associated with chronic NSAIDs use and incidence of potential drug interactions (AOR = 3.5, 95%CI: 1.68, 4.3; AOR = 2.81, 95%CI: 1.61, 4.9 respectively), while diabetes AOR = 4.5, 95% CI: 2.43, 8.35) and cardiac problems (AOR = 4.29, 95% CI: 1.17, 15.73) were more likely to be associated with incidence of polypharmacy. In conclusion, chronic use of NSAIDs without gastro-protective agents and therapeutic duplication of NSAIDs were commonly which requires attention from programmers, health facility managers and healthcare professionals to safeguard elderlies from preventable harm.

Maternal education, health profession and cigarette smoking are decisive factors for self-medication in children by parents.

Self-medication of children by their parents (SMCP) is an important public health issue as the effects and potential risks may be unpredictable. The objective of this first national Montenegrin study was to assess the prevalence of and factors influencing SMCP among schoolchildren. Data were obtained from a national representative sample of 4496 schoolchildren aged 7-13 years (50.4 % boys). Parents/caregivers completed a questionnaire concerning their demographic characteristics, socio-economic and cultural status, as well as the self-medication (SM) of their children. The association between SMCP and parents' socio-economic, demographic or cultural status was assessed by logistic regression analyses. The prevalence rate of SMCP was 24.6 %. Univariate logistic regression showed that maternal socio-demographic characteristics (educational level, employment status, health care profession and smoking habits) were relevant for SMCP. In a multiple logistic regression the independent effect /adjusted odds ratio (AOR) (95 % CI)/of maternal factors on SMCP remained for: education /2.23 (1.18-4.24)/, university-level vs. no education; profession /1.50 (1.07-3.00)/, health profession vs. non-health profession; and smoking habit /1.22 (1.04-1.42)/smokers vs. non-smokers. SMCP may be expected for every fourth child in Montenegro. Specific maternal factors that independently raise the probability of SMCP are higher education, health profession and smoking.

Prevalence of cannabis use has significantly increased in patients with cyclic vomiting syndrome.

INTRODUCTION: Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder which leads to multiple hospitalizations and causes significant impairment of quality of life. Cannabis use is common in patients with CVS, and there are limited data on the national trends in the prevalence of its use in the United States. METHODS: We used the National Inpatient Sample (NIS) database from 2005 to 2014 and identified hospitalizations with a primary diagnosis of CVS by utilizing the International Classification of Diseases, 9th revision Clinical Modification (ICD-9 CM) coding system. The primary objective of the study was to analyze the prevalence and trends in cannabis use in CVS patients. We also assessed healthcare resource utilization associated with cannabis use. RESULTS: A total of 129 090 hospitalizations with a primary diagnosis of CVS were identified and included in the study. In the United States, the overall rate of cannabis use among these patients was 104 per 1000 hospitalizations (N = 13 460). Over the last decade, the prevalence of cannabis use increased by 10-fold, from 2.2% in 2005 to 21.2% in 2014. CONCLUSION: Our analysis of the national database suggests that nearly 1 in 5 CVS hospitalizations have concurrent cannabis use. This prevalence is significantly rising over the last decade, perhaps due to changing legislation and increased utilization of cannabis. Age younger than 35, male gender, African American and Native American race, personal history of alcohol abuse and tobacco use were some of the strongest predictors of cannabis use.

Uso de medicamentos por adultos na atenção primária: inquérito em serviços de saúde de Minas Gerais, Brasil / Use of medicines by adults in primary care: Survey on health services in Minas Gerais, Brazil

RESUMO: Introdução: O uso inadequado e o crescimento dos gastos em saúde reforçam a necessidade de ampliar o conhecimento sobre a qualidade de uso de medicamentos. Objetivos: Descrever e avaliar o perfil de utilização de medicamentos em uma amostra representativa de usuários adultos da atenção primária do Sistema Único de Saúde (SUS) de Minas Gerais. Método: Estudo transversal, com 1.159 entrevistados em 104 municípios e 253 serviços de saúde. Foram coletados dados sobre características sociodemográficas, condições de saúde e uso de medicamentos, sendo essas características estratificadas por faixas etárias. Análises univariada e multivariada, por meio de regressão logística, foram conduzidas para identificar preditores de automedicação. Para todos os testes, foi adotado o nível de significância de 5%. Resultados: A prevalência de uso de medicamentos foi de 81,8%, com média de 2,67 medicamentos por usuário, que aumenta com a faixa etária. Os medicamentos mais utilizados foram losartana, hidroclorotiazida e sinvastatina, com diferenças entre as faixas etárias. Observou-se automedicação significativa não só em adultos jovens, mas também entre idosos. Os preditores de automedicação foram: ser adulto jovem, ter maior nível de escolaridade, não apresentar doenças crônicas, ter pior autopercepção de saúde e não aderir a medicamentos prescritos. Adultos jovens e idosos apresentaram características que os tornaram mais vulneráveis em relação ao uso racional de medicamentos. Conclusão: O estudo pode contribuir para melhorar o cuidado na atenção primária, pois identificou problemas relevantes relacionados à qualidade do uso de medicamentos, especialmente entre adultos jovens e idosos em Minas Gerais.

ABSTRACT: Introduction: Inappropriate use and increase of health care spending reinforce the need to extend our knowledge about the quality of medication use. Objectives: To describe and evaluate the profile of medication use in a representative sample of adult users of primary care services in the Unified Health System (SUS) of Minas Gerais. Method: Cross-sectional study, with 1,159 interviewees in 104 municipalities and 253 health care services. Data on sociodemographic characteristics, health conditions and use of medicines were collected, and these variables were stratified by age group. Univariate and multivariate analyses, using logistic regression, were conducted to identify predictors of self-medication. We set a significance level of 5% for all tests. Results: The prevalence of medication use was 81.8%, with an average of 2.67 medicines per user, which increased with age. The most used drugs were losartan, hydrochlorothiazide and simvastatin, which differed between age groups. Significant self-medication was observed not only in young adults but also in the elderly. The predictors of self-medication were: being a young adult, having a higher level of education, not having chronic diseases, having worse self-perception of health and not adhering to prescription drugs. Young and elderly adults showed characteristics that made them more vulnerable in relation to the rational use of medicines. Conclusion: This study can contribute to improving primary care, where it identified problems related to the extent of medication use, especially among young adults and the elderly in Minas Gerais.

The use of analgesics and risk of self-medication in an urban population sample: cross-sectional study / Uso de analgésicos e o risco da automedicação em amostra de população urbana: estudo transversal

Abstract Background and objectives: There are few data in the literature characterizing the pattern of analgesic use in Latin American countries, including Brazil. Little is known about the undertreatment of pain and its influence on the habit of self-medication with analgesics. The aim of this study is to define the pattern of analgesic use among chronic pain patients and its potential association with self-medication with analgesics. Method: Cross-sectional observational study with an urban population sample. Chronic pain was defined as a pain lasting for at least 90 days. The study was approved by the Research Ethics Committee of the institution. Results: 416 subjects were included; 45.7 % (n = 190) had chronic pain, with females (72.3 %; p = 0.04) being the most affected. Self-medication with analgesics is practiced by 78.4% of patients with chronic pain. The most common current analgesic treatment consists of non-steroidal anti-inflammatory drugs (dipyrone and acetaminophen). Weak opioids are rarely used and only 2.6% of subjects with chronic pain were taking these analgesics. None of the subjects were taking potent opioids. Conclusions: The practice of self-medication with analgesics is frequent among patients with chronic pain, which may be due to the underprescription of more potent analgesics, such as opioids. It can also be said that, given the data presented, there is no crisis of recreational opioid use in the studied population.

Resumo Justificativa e objetivos: Há poucos dados na literatura que caracterizam o padrão de uso de analgésicos na América Latina e no Brasil. Também se sabe pouco sobre o subtratamento da dor e sua influência no hábito de automedicação analgésica. O objetivo desta pesquisa é definir o padrão de uso de analgésicos entre os portadores de dor crônica (DC) e a sua potencial associação à automedicação analgésica. Método: Estudo observacional transversal com amostra de população urbana. A dor crônica foi definida como aquela presente por pelo menos 90 dias. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa institucional. Resultados: Foram incluídos 416 indivíduos; 45,7% (n = 190) portadores de dor crônica, sendo os do sexo feminino (72,3%; p = 0,04) os mais acometidos. A automedicação analgésica é praticada por 78,4% dos portadores de dor crônica. O tratamento analgésico vigente mais frequente é composto pelos anti-inflamatórios não esteroides (AINES), dipirona e paracetamol. Os opioides fracos são pouco usados e apenas 2,6% dos indivíduos com dor crônica fazem uso desses analgésicos. Nenhum dos indivíduos estava em uso de opioides potentes. Conclusões: A prática de automedicação analgésica é frequente entre os portadores de dor crônica, o que pode ser consequência da pouca prescrição de analgésicos mais potentes, como os opioides. Pode-se também dizer que, pelos dados apresentados, não ocorre uma crise de uso recreativo de opioides na população estudada.

Characteristics of hormone use by travestis and transgender women of the Brazilian Federal District.

INTRODUCTION: Travestis and transgender women resort to the use of hormones for body modification. Due to restrictions in the access to health services, self-medication is frequent. The aim of this study was to describe the self-reported prevalence of hormones used by travestis and transgender women in the Federal District. Method: This is a cross-sectional study with Respondent Driven Sampling (RDS) and Knowledge, Attitudes and Practices questionnaire (KAP) along with travestis and transgender women over 18 years in the FD. Prevalence was calculated using the RDS-II estimator. Logistic models were used to investigate the associated factors. A total of 201 volunteers participated. RESULTS: There was a young sample (median age of 24 years). The overall prevalence of continuous use of hormones was 64.5%. The most used formulation was the combination of estrogen and progesterone (86.2%) by injectable (75.1%) and oral (66%) administration. Most participants (84%) got the hormones without a prescription. Guidance on the use of these hormones came from their peers in 41% of the cases. We observed that the continuous use of hormones is associated with race, income and age, as well as the search for guidance of healthcare professionals, which is also associated with schooling. DISCUSSION: The reality of the process of hormone use by these people in the quest for femininity is reflected in high rates of self-medication. CONCLUSION: This study contributes to the visibility of the need to improve the access conditions of these people to health services.

Exploring biocultural models of chewing tobacco and paan among reproductive-aged women: Self-medication, protection, or gender inequality?

OBJECTIVES: Tobacco and areca nut are two of the most widely used psychoactive plant substances worldwide, yet the biocultural factors that account for variation in use patterns are not well understood. Here we attempt to understand the high prevalence of, and variation in, tobacco and areca nut use among reproductive-aged women. METHODS: Research was carried out in Mysore, Karnataka, India. First, we conducted a qualitative investigation where participants engaged in semistructured interviews and focus group discussions to uncover cultural norms of women's tobacco use. Findings informed the second stage of research which quantitatively tested three models of tobacco and areca nut use (N = 74). RESULTS: The qualitative study found that women were more likely to chew "natural" forms of tobacco and areca nut products (kaddipudi and paan). Quantitative tests of our hypotheses revealed that kaddipudi and combined tobacco use were best explained by the self-medication model, with somatic and environmental stress as strong indicators of use. The presence of cotinine, our biological indicator of tobacco use, was best modeled by gender inequality. We also found that men and women reported approximately equal tobacco use, even though their preferred types of tobacco and areca nut products differed. CONCLUSIONS: Findings did not support the protection hypothesis as it relates to plant toxins. Instead, this study suggests that women might exploit neurotoxins such as nicotine and arecoline to offset the cognitive and energetic costs associated with iron deficiency in stressful environments.

Marijuana use among patients with epilepsy at a tertiary care center.

The expansion of medical and recreational marijuana legalization facilitates patient access to cannabis, and many patients with epilepsy pursue marijuana as a treatment for seizures. We administered a nine-item survey on marijuana use to patients seen in an epilepsy clinic over a 9 month period at a tertiary care center in Oregon where recreational use was legalized in 2015. The majority of respondents (n = 39) reported cannabis use for the purpose of treating epilepsy (87.2%, n = 34), and strongly agreed (53.8%, n = 21) or agreed (28.2%, n = 11) that cannabis use improved seizure control. The most commonly selected cannabis strains were high cannabidiol (CBD) (30.8%, n = 12) or multiple types (30.8%, n = 12), with administration methods of smoking (66.7%, n = 26), edibles (48.7%, n = 19), and concentrates (43.6%, n = 17). More participants reported using marijuana with primarily CBD than primarily tetrahydrocannabinol (THC) or equal CBD:THC content, and very few women reported using marijuana with primarily THC compared with men (10% of female versus 47% of male respondents). Only 2 of 39 participants were able to give an exact dosage used in milligrams. Medical and recreational dispensaries were the most common cannabis sources, followed by homegrown and friends/family members. Although pharmaceutical CBD extract is now Food and Drug Administration (FDA)-approved for certain epilepsy types, access remains limited. Further research is needed to understand recreational cannabis use among patients with epilepsy while clinical research for pharmaceutical cannabis products continues.

Potentially inappropriate medications in older kidney transplant recipients: a Brazilian prevalence study.

Background Older kidney transplant recipients take a larger number of medications than younger patients, but there is currently no evidence that this affects health outcomes or that is it associated with potentia medicine-related problems. Objective To evaluate the prevalence and number of potentially inappropriate medications in older kidney transplant recipients and also the possible associated factors (sex, age, comorbidities, number of medications, etc.). Setting A renal post-transplant ambulatory outpatient clinic of a university hospital in Fortaleza, Brazil. Method PIMs were defined according to the Beers criteria, version 2015. Medications were classified following the Anatomical Therapeutic Chemical Classification System. Chi squared tests and analysis of variance were used for the analyses. Main outcome measure Prevalence of potentially inappropriate medications and medication groups with higher prevalence rates of PIMs, including associated factors. Results Among 143 kidney transplant recipients, 77.6% had at least one potentially inappropriate medication as part of their prescription regime. Medication groups that were most implicated in PIM are medicines that act on the alimentary tract and metabolism (55.9%), cardiovascular system (32.2%) and nervous system (21.7%). We detected a high prevalence (63.6%) of self-medication (use of OTC medicines without indication of a healthcare professional) among the population studied. There was a statistically significant association between the number of prescribed medications and the presence of potentially inappropriate medication in the prescription regime (P < 0.01). Conclusion Our data draw attention to the need of medicine therapy management by clinical pharmacists and clinicians in this group of patients and also assessing the real clinical impacts of these medications in the prescription regimes of elderly renal transplant patients.

Perfil de automedicación en funcionarios de una industria farmacéutica / Self-medication profile of employees in a pharmaceutical industry

La automedicación es una práctica riesgosa cuyas consecuencias incluyen enmascaramiento de una enfermedad, aparición de reacciones adversas, interacciones medicamentosas, aumento de la resistencia a ciertos tipos de fármacos y farmacodependencia. El objetivo fue determinar el perfil de automedicación en funcionarios de una industria farmacéutica. Estudio descriptivo, observacional, con muestreo no probabilístico y por conveniencia realizado de octubre a noviembre del 2015, a 61 funcionarios que trabajan en una planta industrial farmacéutica. Las edades estaban comprendidas entre 20 y 30 años, en su mayoría mujeres. Consumían medicamentos 97% de los funcionarios. El 53% se automedicaba para patologías menores y 90,3% lo hacía según necesidad. Utilizaban mezcla de analgésicos y antiinflamatorios. Los motivos más frecuentes, 58% dijo no tener tiempo para ir al médico y 42% fue un familiar o amigo el que le sugirió el medicamento que debía consumir. De los que se automedicaban, el 74% consideraba que la publicidad no es importante para elegir un medicamento, el 81% utilizaba la información del prospecto. El 48% no recibía información sobre el medicamento en la farmacia y el 93% consideraba que la automedicación es peligrosa. La automedicación es una práctica común en la población de funcionarios estudiada y en su entorno social inmediato, a pesar de que la mayoría de la población entiende que la automedicación constituye una práctica riesgosa(AU)

Polydrug use and polydrug markets amongst image and performance enhancing drug users: Implications for harm reduction interventions and drug policy.

BACKGROUND: Over the past two decades, the use of image and performance enhancing drugs (IPEDs) has increased significantly. Once largely confined to professional athletes, IPED use has transcended the elite sporting arena and is now predominantly found among non-elite, recreational gym users. This paper presents research findings from a qualitative study of IPED use and supply in a 'hardcore' bodybuilding gym in the north of England. This article makes an original contribution to the field by providing an in-depth account of the use and supply of IPEDs among this population, demonstrating the intersectionality that exists across IPEDs, diverted medication and both licit and illicit substance use and supply. METHODS: The findings are based on the research team's privileged access to an independent, 'hardcore' body building gym in the north of England. Four fieldworkers undertook overt systematic observations, supplemented by 20 semi-structured interviews. RESULTS: Amongst this sample of bodybuilders, substance use transcended IPEDs to encompass a much broader cocktail of substances all who used IPEDs concomitantly used diverted medication as a means of negating anticipated side-effects, and over half used illegal psychoactive drugs. Furthermore, virtually all of these substances were available to buy via the gym, through fellow gym members and, at times, staff. CONCLUSION: This article draws three main conclusions. (1) We are witnessing a convergence of IPED use and supply with diverted medication and 'traditional' recreational substances. (2) The extensive poly-substance use reported by interviewees in this sample necessitates a review of existing harm reduction advice for IPED users that takes into consideration the full range of substances currently being used. (3) Punitive drug policy reform that aims to reduce IPED markets needs to consider the potential to displace social supply towards more commercially-driven dealing. Harsher drug laws may also risk criminalising and stigmatising IPED users.

Self-medication practice trend among the Brazilian elderly between 2006 and 2010: SABE Study. / Tendência da prática de automedicação entre idosos brasileiros entre 2006 e 2010: Estudo SABE.

INTRODUCTION: Self-medication involves the concept of the spontaneous search by the individual for some drug that he or she considers appropriate to solve a health problem. Self-medication practice is little explored by the elderly according to other studies based in population data. OBJECTIVE: To examine the trends in self-medication practice among the Brazilian elderly between 2006 and 2010. METHODS: This is a population-based study whose data were obtained from the Health, Well-being and Ageing Study (SABE Study). Thesample consisted of 1,257 elderly people in 2006 and 865 in 2010, who used drugs. RESULTS: The findings showed self-medication reduction from 42.3% in 2006 to 18.2% in 2010. In both periods, predominant utilized therapeutic classes were those acting on the nervous system (27.9% in 2006, and 29.6% in 2010) and on the alimentary tract and metabolism (25.5% in 2006, and 35.9% in 2010). The most commonly used medicines in 2006 and 2010 were analgesics, anti-inflammatories, and vitamins. There was a tendency to decrease the use of potentially inappropriate medicines between 2006 (26.4%) and 2010 (18.1%). The elderly themselves were the main responsible for the decision about the drug use in 2006 (62.5%) and 2010 (66.5%). CONCLUSION: Theextent of self-medication practice among the elderly who participated in the study decreased between 2006 and 2010, but the use of medicines that offer risks to health was still reported. Thus, the findings reinforce the importance of monitoring, evaluating, and continuously educating the elderly about risks and benefits of drug consumption, particularly over-the-counter medicines.

INTRODUÇÃO: Automedicação retrata o princípio do próprio indivíduo buscar espontaneamente por algum medicamento que considere adequado para resolver um problema de saúde. Essa prática é ainda pouco explorada entre idosos de acordo com outros estudos baseados em dados populacionais. Objetivo: Examinar as tendências da prática de automedicação dos idosos do Estudo SABE entre 2006 e 2010. MÉTODO: Estudode base populacional cujos dados foram obtidos do Estudo Saúde, Bem-Estar e Envelhecimento (SABE). Aamostra de 2006 foi constituída de 1.258 idosos e a de 2010, de 865 idosos que utilizaram medicamentos. RESULTADOS: Observou-se redução da automedicação de 42,3% em 2006 para 18,2% em 2010. Em ambos os períodos, as classes terapêuticas predominantes foram as dos medicamentos com ação no sistema nervoso (27,9% em 2006 e 29,6% em 2010) e trato alimentar e metabolismo (25,5% em 2006 e 35,9% em 2010). Entreos medicamentos mais usados nos anos de 2006 e 2010 estão os analgésicos/anti-inflamatórios e vitaminas. Houve tendência a declínio da utilização de medicamentos potencialmente inapropriados entre 2006 (26,4%) e 2010 (18,1%). Oidoso foi o principal responsável pela indicação da automedicação em 2006 (65,2%) e 2010 (66,5%). CONCLUSÃO: A extensão da prática de automedicação nos idosos do SABE apresentou redução entre 2006 e 2010, porém o emprego de medicamentos que oferecem risco à saúde ainda foi relatado. Desse modo, os achados reforçam a importância de monitorar, avaliar e educar continuamente os idosos acerca dos riscos e benefícios do consumo de medicamentos, sobretudo daqueles isentos de prescrição.

Automedicação em adolescentes da rede estadual de ensino na cidade de Picos/Piauí / Self-medication in adolescents of the systemeducatinalin the city of Picos/Piauí / Automedicaciónen adolescentes de laredlaenseñanzaenlaciudad de Picos/Piauí

Objetivo: Analizar La práctica de La automedicación por los adolescentes em lãs escuelas públicas de Picos-PI. Método: Estudio descriptivo transversal que incluyó a 209 adolescentes. La recolección de datos se llevó a cabo em lãs reuniones semanales a través de um cuestionario. Resultados: El grupo de edad más frecuente fue de 17 años 94 (44,9%), 122 (58,4%) eranmujeres, vivía con la familia 129 (61,7%) enlas zonas urbanas 179 (85,7%) y católticos149 (71,2%). 209 (100%) se dedican a La automedicación, y fiebreel síntoma principal 120 (57,4%), y la forma de dosificación de latableta más consumido 168 (57,4%). La principal motivación para La automedicación fuel afacilidad de conseguir las drogas fuera de los establecimientos de salud 103 (49,3%), y 141 (67,5%) está de acuerdoen que los anuncios influyenen este comportamento. Conclusión: Los adolescentes practican La automedicacióncon alta frecuencia, que se refiere a lanecesidad de iniciativas estratégicas e ne lámbito local conelfin de reducir esta práctica

Objetivo: Analisar a prática de automedicação por adolescentes da rede estadual de ensino de Picos-PI. Método: Estudo descritivo e transversal, realizado com 209 adolescentes. A coleta de dados ocorreu em encontros semanais por meio de um questionário. Resultados: A faixa etária mais prevalente (94) foi de 17 anos (44,9%);122 (58,4%) do sexo feminino;129 moravam com a família (61,7%); 179 na zona urbana (85,7%);e 149 católicos (71,2%). 209(100%) praticam a automedicação, sendo a febre (120)o principal sintoma (57,4%), e o comprimido(168) a forma farmacêutica mais consumida (57,4%). A principal motivação para automedicação foi a facilidade de conseguir medicamentos fora dos estabelecimentos de saúde (103) (49,3%);e 141 (67,5%) concordam que propagandas influenciam esse comportamento.Conclusão: Os adolescentes praticam automedicação com elevada frequência, o que remete à necessidade de ações estratégicas a nível local com vistas à redução dessa prática

Objective: To analyze the practice of self-medication by adolescents of the Picos-PI state education system. Method: A descriptive and cross-sectional study with 209 adolescents. The data collection took place in weekly meetings through a questionnaire. Results: The most prevalent age group was 17 years (94.9%), 122 (58.4%) female, living with family 129 (61.7%), urban area 179 (85.7%), , And catholics149 (71.2%). 209 (100%) practice self-medication, fever being the main symptom 120 (57.4%), and the tablet the most consumed pharmaceutical form 168 (57.4%). The main motivation for self-medication was the ease of obtaining drugs outside health facilities 103 (49.3%), and 141 (67.5%) agree that advertisements influence this behavior. Conclusion: Adolescents practice self-medication with high frequency, which points to the need for strategic actions at the local level to reduce this practice