Assessment of factors associated with self-medication practices during the COVID-19 pandemic in southwestern Ethiopia: a community-based cross-sectional survey.

BACKGROUND: Self-medication practices involve the use of medications without healthcare professional requests. The threat of coronavirus disease 2019 (COVID-19) caused the practice of a fittest to survive action, with the assumption that something is better than nothing. Moreover, owing to the lack of effective treatment for COVID-19, the general public has shifted toward self-medication and symptomatic treatment, with approximately 80% of people stockpiling medication for use during the pandemic. Thus, this study aimed to assess the factors associated with self-medication practices during the COVID-19 pandemic crisis in southwestern Ethiopia. METHODS: A community-based cross-sectional study design was employed at selected drug retail outlets in southwestern Ethiopia for 415 community pharmacy clients from July 1, 2021, to September 1, 2021. Purposive sampling techniques were employed to select five drug retail outlets on the basis of high patient flows, and we took the study participants until the required quota allotted to each selected drug retail outlet had been filled. Bivariable and multivariable logistic regression analyses were employed to identify factors associated with self-medication. AORs with 95% CIs were used to report associations, and the level of significance was set at P < 0.05. RESULTS: Self-medication was significantly associated with being female (AOR 3.51, 95% CI 1.04-12.41), having a college education or above (AOR 47, 95% CI 4.32-55.21), time wastage at public health facilities (AOR 2.71, 95% CI 3.47-5.21), being afraid of contracting COVID-19 (AOR 0.006, 95% CI 0.004-0.185), and having high fees at public health facility (AOR 0.006, 95% CI 0.004-0.185). The most frequently used medications to treat or prevent the COVID-19 pandemic were analgesics (42.4%) and cold medicines (29.5%). Headache (22.2%), fever (13.2%), respiratory infection (14.3%), and cold (21.4%) were the most frequently reported symptoms of the COVID-19 pandemic. CONCLUSION: This study revealed high self-medication practices among study area residents during the COVID-19 pandemic. The primary reasons for self-medication in the context of COVID-19 are fear of the pandemic and time wastage at public health facilities. Therefore, special attention should be given to educating public and health care providers on the types of illnesses that can be self-diagnosed and self-treated and the types of drugs to be used for self-medication.

Prevalence of self-medication practices among pregnant women in India: A systematic review and meta-analysis.

BACKGROUND: Self-medication practice among pregnant women is a global concern. However, its understanding in the Indian context is limited due to a lack of comprehensive studies. PURPOSE: This study aimed to comprehensively assess the prevalence of self-medication, the medications used for self-medication, diseases/conditions associated with self-medication, and the reasons for self-medication among Indian pregnant women. METHODS: This study was carried out following the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A thorough search was done in PubMed, Embase, and Google Scholar to find articles that were published up until May 2023. Inclusion criteria comprised observational studies reporting self-medication prevalence among pregnant women in India. Data were extracted using a standardized sheet, and a random-effects model was applied to determine the overall prevalence of self-medication using R software. The I2 statistic was employed to assess the heterogeneity among the studies. RESULTS: This study analyzed eight studies with a collective sample size of 2208 pregnant women. The pooled prevalence of self-medication among pregnant Indian women was 19.3% (95% CI: 7.5%-41.3%; I2 = 99%; p < 0.01). Common self-treated conditions were cold, cough, fever, headache, and stomach disorders. Antipyretics, analgesics, antihistamines, and antacids were frequently used for self-medication. The perception of mild ailment, immediate alleviation, convenience, time savings, and advice from family, friends, or the media were all reasons for self-medication. Local pharmacies were the most usual source for obtaining drugs, and pharmacists, family, friends, and past prescriptions were common sources of medicine information. CONCLUSIONS: A low yet substantial number of pregnant women in India are engaged in self-medication practices. Appropriate strategies need to be planned to reduce self-medication practices to attain sustainable developmental goals for maternal health in India.

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).

Patterns of self-medication and intention to seek pharmacist guidance among older adults during the COVID-19 pandemic in Macao: a cross-sectional study.

INTRODUCTION: Self-medication was remarkably popular during the COVID-19 pandemic. In older populations, the risk of self-medication is higher. Pharmacists are well positioned to provide public health education and disease prevention. This study aims to explore the self-medication patterns and intention to seek pharmacist guidance among older adults in Macao. METHODS: A face-to-face cross-sectional survey was subsequently performed in March-April 2023 among older adults in Macao. The questionnaire was designed based on the Theory of Planned Behavior (TPB) framework. Multiple logistic regression was used to analyze predictors of self-medication behavior and multiple linear regression analysis to determine whether the TPB construct was the predictor of older adults' intention to seek guidance from pharmacists. RESULTS: A total of 412 participants completed the questionnaire. The self-medication rate among older adults in Macao was 64.2%. The most commonly used types of medications were over-the-counter and traditional Chinese medicine, mainly from government anti-pandemic packages. The majority of individuals engaged in self-medication to treat COVID-19 symptoms or prevent COVID-19 infection. The prevalent reasons for self-medication were the perceived non-seriousness of the illness. 85 years old or older and university degree were significantly associated with self-medication behavior. Older adults had moderate intention to seek pharmacist guidance on medication use. The average scores (standard deviation) were 3.43 (1.10) for Attitude, 2.69 (0.99) for Subjective Norm, 3.56 (1.04) for Perceived Behavioral Control, and 3.07 (1.43) for Intention. Attitude, Subjective Norm, and Perceived Behavioral Control were all strong predictors of intention, which explained 53% of the variance in intention. In demographic factors, age was identified as a significant predictor of intentions. CONCLUSIONS: Self-medication was widely practiced in Macao during the COVID-19 pandemic. To better control the risks associated with self-medication, the role of pharmacists is paramount. Enhancing the recognition and trust of pharmacists within society, modifying pharmacy management models, and strengthening pharmacists' self-perception of their profession are all pivotal directions areas to further enhance their role.

Prevalence and predictors of self-medication to prevent or treat COVID-19 among undergraduate students in Southern Brazil.

Self-medication (SM) is the practice of consuming medicines without a prescription. Despite being a potentially dangerous action, SM is practiced globally and has been highlighted during the COVID-19 pandemic. The aim of this study was to evaluate SM for the prevention or treatment of COVID-19 and the factors associated with this practice among undergraduate students in Southern Brazil. A cross-sectional study was conducted between July and November 2020 using an electronic questionnaire to collect information about the practice of SM and the associated sociodemographic characteristics, health perception, and lifestyle. We collected 1,553 responses and identified a prevalence of 14.9% for SM. The risk factors for SM were earning between BRL 2,101 and BRL 5,250, studying at a public university, and studying a distance undergraduate course. The protective factors were age above 30 years, female sex, working or participating in internships, occasionally recommending their own medications to other people, and worsening health during the pandemic. The main drugs or products used were ivermectin, vitamins C and D, tea, azithromycin, zinc, and propolis. Our data could help in the development of health education measures to reduce SM among undergraduate students and guide the population regarding the risks of this practice.

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.

The Risk of Severe Fibromyalgia, Depression, Anxiety, and Insomnia Symptoms in Arab Women: An Implication of Self-Medication with Analgesics? A Cross-Sectional Study.

Background and Objectives: The investigation of the psychosomatic symptoms in women residing in developing countries is still emerging. To be precise, the prevalence and correlates of severe fibromyalgia, depression, anxiety, and insomnia are understudied in Arab women, as these symptoms could relate to improper self-medication. This study mainly investigated the association between self-medication with analgesics and fibromyalgia, depression, anxiety, and insomnia symptoms among a community-based cohort of females in Jordan. Materials and Methods: We used a web-based cross-sectional study design. Fibromyalgia, depression, anxiety, and insomnia were assessed using validated scales. The used over-the-counter (OTC) painkillers were recorded. Results: Data were analyzed from 741 women, and fibromyalgia was screened in 16.4%, depression in 37.4%, anxiety in 27.8%, and insomnia in 38.3%. Fibromyalgia was associated with "married" (OR = 1.5, 95% CI = 1.017-2.305), "using OTC acetaminophen" (OR = 1.75, 95% CI = 1.15-2.69), "using herbal remedies" (OR = 2.02, 95% CI = 1.33-3.07), and "using antiseizure medications" (OR = 2.43, 95% CI = 1.38-4.28). Severe depression was significantly associated with "age" (OR = 0.97, 95% CI = 0.96-0.99), "high school education" (OR = 1.90, 95% CI = 1.21-2.98), "smoking" (OR = 1.72, 95% CI = 1.15-2.56), "OTC acetaminophen" (OR = 1.40, 95% CI = 1.02-1.92), "OTC non-steroidal anti-inflammatory drugs" (OR = 1.75, 95% CI = 1.15-2.65), and "antiseizures" (OR = 2.19, 95% CI = 1.30-3.70). Severe anxiety was significantly associated with "smoking" (OR = 2.08, 95% CI = 1.40-3.12), "OTC acetaminophen" (OR = 1.48, 95% CI = 1.06-2.06), and "antiseizure medications" (OR = 2.04, 95% CI = 1.22-3.41). Severe insomnia was significantly associated with "age" (OR = 0.98, 95% CI = 0.96-0.99), "high school education" (OR = 1.58, 95% CI = 1.01-2.47), "smoking" (OR = 1.51, 95% CI = 1.01-2.25), "OTC non-steroidal anti-inflammatory drugs" (OR = 1.74, 95% CI = 1.13-2.64), "antiseizure medications" (OR = 1.84, 95% CI = 1.09-3.11), and "No analgesics" (OR = 0.48, 95% CI = 0.32-0.71). Conclusions: Self-medication with analgesics is associated with a high burden of psychosomatic symptoms in Arab women, and awareness campaigns are required to guide self-medication behavior.

Assessment of self-medication practices in the context of the COVID-19 outbreak in Togo.

BACKGROUND: To date, there is no effective treatment for COVID-19, which is a pandemic disease, caused by a novel coronavirus called SARS-CoV-2. In Togo, where four in five people practice self-medication, the absence of a cure for COVID-19 and the constant progression of the disease requires an assessment of self-medication patterns in the context of the pandemic. This study aimed to estimate the prevalence of self-medication to prevent COVID-19 and its associated factors in Lomé, Togo. METHODS: A cross-sectional study was conducted in Lomé, the capital city of Togo, from April 23rd to May 8th, 2020, with a sample of participants from five sectors: the healthcare, air transport, police, road transport and informal sectors. The participants were invited to provide information about their self-medication practices to prevent COVID-19 in the 2 weeks preceding the survey. RESULTS: A total of 955 participants (71.6% men) with a median age of 36 (IQR 32-43) were included. Approximately 22.1% were in the air transport sector, 20.5% were in the police sector, and 38.7% were in the health sector. The overall prevalence of self-medication to prevent COVID-19 was 34.2% (95% CI: 31.2-37.3%). The most commonly used products were vitamin C (27.6%) and traditional medicine (10.2%). Only 2.0% of participants reported using chloroquine/hydroxychloroquine. Female sex (aOR=1.90; p< 0.001), work in the health sector (aOR=1.89; p= 0.001), secondary education level (aOR= 2.28; p= 0.043) and university education level (aOR= 5.11; p< 0.001) were associated with self-medication. CONCLUSION: One-third of the individuals in high-risk populations in Lomé practiced self-medication. Intensifying awareness campaigns is crucial to fight misinformation about alleged COVID-19 prevention products on social media.

Prevalence of pain, analgesic self-medication and mental health in German pre-hospital emergency medical service personnel: a nationwide survey pilot-study.

PURPOSE: The aim of this study was to estimate the prevalence of pain, the extent of analgesics intake and the mental health status of German pre-hospital emergency medical service (EMS) personnel. METHODS: We conducted a nationwide online survey, which consisted of sociodemographic and job-related items, questions on pain and analgesics intake and the short-version of the validated Depression-Anxiety-Stress Scale (DASS-21). RESULTS: A total of 774 EMS personnel with a mean age of 33.03 (standard error [SE] 0.37) years were included into the final analysis of which 23.77% were female. Pain was reported by 58.64% (454 of 774) of the study participants with 10.72% (95% confidence interval [CI] 8.54%; 13.29%) suffering from chronic, 1.68% (95% CI 0.89%; 2.87%) from acute and 46.25% (95% CI 41.49%; 51.30%) from recurrent pain, respectively. Most frequent location of pain was lumbar spine. Analgesics were used by 52.76% (239 of 454) of pre-hospital EMS personnel with pain (acute 76.92% / chronic 69.88% / recurrent 47.90%). Moreover, participants with chronic and recurrent pain indicated significantly higher depression (p ≤ 0.001), anxiety (p ≤ 0.001), and stress (p ≤ 0.001) levels compared to those without pain, respectively. CONCLUSION: This study indicates a high prevalence of pain and analgesics usage in participating German pre-hospital EMS personnel and a poorer mental health in those with chronic and recurrent pain. Therefore, disease prevention and health promotion measures are needed to preserve health of pre-hospital EMS personnel.

Memantine misuse and social networks: A content analysis of Internet self-reports.

PURPOSE: Memantine is a N-methyl-D-aspartate (NMDA) receptor antagonist currently used for moderate-to-severe Alzheimer's disease. Although the risk of memantine abuse is very low, other NMDA receptor antagonists, such as phencyclidine and ketamine, are well known to drug users. The purpose of this study was to collect data on social networks in order to identify unexpected forms of memantine abuse. METHOD: A Google Trends search was used to highlight reddit.com as a major source of social discussions about memantine. Self-reported users experiences posted on reddit.com were recorded and sorted using representative keywords. RESULTS: From 2010 to November 2019, 307 topics citing memantine were identified on reddit.com and 136 users experiences extracted from the topics were recorded. The main use identified was "self-medication" based on off-label uses of memantine such as anxiety, depression, attention-deficit hyperactivity disorder, or obsessive-compulsive disorder (n = 87 reports), followed by nootropic (42) and recreational (39) uses. The average reported doses for acute and chronic uses were 156 ± 110 mg and 23 ± 24 mg respectively. For chronic use, the average duration was 15 ± 29 weeks. Most chronic users (77 out of 100) reported at least one side effect. CONCLUSION: Memantine misuse seems to be a growing phenomenon. Beyond expected use for recreational purpose; the main uses identified on reddit.com were not reported in the medical literature. Off-label uses and nootropic purposes seemed to be key features of memantine misuse.

Self-medication and knowledge among pregnant women attending primary healthcare services in Malang, Indonesia: a cross-sectional study.

BACKGROUND: Self-medication with over-the-counter (OTC) drugs is an important public health concern, especially in the vulnerable population of pregnant women due to potential risks to both the mother and fetus. Few studies have studied how factors, such as knowledge, affect self-medication. This study investigated self-medication and its associated factors among pregnant women attending healthcare services in Malang, Indonesia. METHODS: A cross-sectional study was conducted from July to September 2018 in five healthcare services. A self-administered questionnaire was used and the data were analyzed using multiple regression models. RESULTS: Of 333 female participants, 39 (11.7%) used OTC medication. Women with a higher level of knowledge of OTC medication were more likely to self-medicate-adjusted odds ratio (aOR) = 2.15, 95% confidence interval (CI) = 1.03-4.46. Compared with those with less knowledge, pregnant women with more correct knowledge of the possible risk of self-medication were less likely to self-medicate-aOR = 0.29; 95% CI = 0.14-0.60. The effect of a higher level of knowledge of OTC medication was significant among women who had middle school and lower education-aOR = 8.18; 95% CI = 1.70-39.35. The effect of correct knowledge on the possible risks of self-medication was significant only among women with high school and higher education-aOR = 0.17; 95% CI = 0.07-0.42. CONCLUSION: Imparting specific knowledge of the potential risks of using non-prescribed medication during pregnancy may help pregnant women navigate and more safely manage their OTC use. We also suggest further collecting data from more healthcare services, such as hospitals, to obtain more findings generalizable to the Indonesian community.

Every medicine is medicine; exploring inappropriate antibiotic use at the community level in rural Ghana.

BACKGROUND: Inappropriate antibiotic use is an important driver of antibiotic resistance. This study sought to explore inappropriate antibiotic use and confusing antibiotics with other medicines in Ghana using ethnomethodology research approach. METHODS: This was an explorative study involving 15 in-depth interviews among health professionals and private dispensers and eight focus group discussions among 55 community members. Qualitative data were coded using Nvivo 12, thematically analysed and presented as narratives with quotes to support the findings. RESULTS: Self-medication was common and antibiotics were used to treat specific diseases but respondents were not aware these were 'antibiotics'. Various antibiotics were used for indications that in principle do not require systemic antibiotics, like stomach ache and sores on the body. Antibiotics, in particular tetracycline and metronidazole, were poured into "akpeteshie" (local gin) to treat hernia and perceived stomach sores (stomach ulcer). These practices were copied/learnt from various sources like over-the-counter medicine sellers, family, friends, radio/television, drug peddlers, pharmacies and doctors. Medicines in capsules were referred to as 'topaye' or 'abombelt' in Twi (local dialect) and perceived to treat pain associated with diseases. Antibiotics in capsules were described with colours which appeared confusing as some capsules with different drugs in them have similar colours. CONCLUSION: Inappropriate antibiotic use were influenced by general lack of knowledge on antibiotics and identification of antibiotics by colours of capsules which leads to confusion and could lead to inappropriate antibiotic use. There is the need for public health education on appropriate antibiotic use and standardization of appearance of antibiotics and other drugs to optimize use.

Demographic, socio-economic and other associated risk factors for self-medication behaviour among university students of Sri Lanka: a cross sectional study.

BACKGROUND: Self-prescribing practices are considered as a significant issue in the health sector due to mal-practices. This has become a more worsen issue in developing countries with easy access to medication. Current study was undertaken to estimate the prevalence of self-medication and to evaluate the driving factors behind this behavior, among university students of Sri Lanka. METHOD: A total of 700 randomly selected undergraduates of three state universities in Sri Lanka, were recruited as the study population for the cross-sectional study. Information on socio-demographic, Knowledge, Attitudes and Practices relevant to Self-Medication (SM) were gathered using an interviewer administered questionnaire. Binary logistic regression was used to calculate the Odds Ratios (OR) and the 95% confidence intervals of the OR for socio-demographic risk factors on SM. RESULTS: Around 78% of the studied population denoted a SM behaviour. Only, 37.7% of respondents were familiar with the classification of "Over the Counter" (OTC) drugs, while majority were well aware of the risks of SM (> 50%). Fever (61.3%) and cough (56.7%) were the major health issues for SM, while antipyretics and drugs for cough and runny nose (73.6%) were the mostly used medication. Previous experience (76%) and trivial nature of health issues (73%) were recognized as the major reasons for SM. Majority of respondents declared that community pharmacies (86.9%) and left over medication from previous prescriptions (51%) were the sources for SM. Based on the binary logistic regression, age, residence locality, field of study and academic year were recognized as significant risk factors (P < 0.05) for SM within the studied undergraduate population. CONCLUSION: Based on the high prevalence rate of SM, the health authorities of Sri Lanka should pay more attention towards the wellbeing and responsible medication usage of undergraduates. Designing of effective tools and regulations to monitor the selling of medication and improving the health education are recommended to ensure responsible SM within the country.

Sexual life and medication taking behaviours in young men: An online survey of 92 620 respondents in China.

OBJECTIVES: To assess sexual life and medication taking behaviours in young Chinese men. METHODS: An online survey was conducted across China between January 2017 and April 2017. Among the participants, men aged 19-40 years were included in the analysis. The respondents filled in the online questionnaire assessing sexual life and medication taking behaviours by themselves, including general information, cognition of erectile dysfunction (ED) and treatment-related questions. Erection hardness score (EHS) was used to measure the erection hardness status. RESULTS: Among the young respondents, 20.54% had grade I-II EHS, 58.14% searched the internet for online ED-related information, 26.49% took an ED medication and 50.89% took an ED medication without the advice of a physician or pharmacist. The respondents who took medication had less sexual intercourse per week (P < .001) and worse EHS (P < .001), and were more willing to seek information from physicians, pharmacists, friends and relatives instead of online sources (P < .001), compared with those not taking medication. The most common comorbidities in patients with grade I-II EHS were hyperlipidaemia, cardiovascular disease (CVD), prostate diseases and diabetes mellitus. CONCLUSION: About 20% of young Chinese men needed further assessment for ED. The majority of respondents obtained ED-related information by online search and took an ED medication without professional advice. These data could help clinicians understand the current status of sexual life and medication taking behaviours of young Chinese men.

Exploration of self-medication practice in Pokhara valley of Nepal.

BACKGROUND: Self-medication (SM) is the practice of consuming medication without the consultation of physician. The drugs most commonly self-medicated are paracetamol, analgesics, ranitidine, oral rehydration solution and antibiotics. The objective of the study was to assess the SM status and its causes in Pokhara valley of Nepal. METHOD: The study was conducted among the people residing in Pokhara metropolitan city. The study duration was of 4 months from April to July, 2018. The study population were patients attending health general and oral health screening programs at Baidam, Birauta, Hemja and Pame areas of Pokhara. Structured questionnaire was used to collect demographics of the patients and the details of the usage of self-medication. RESULT: Out of 201 patients, 38.2% patients were found to be self-medicating. The most common illness sought for SM was ache (headache, body ache) in 50% subjects followed by cough and cold in 31% and gastritis in 23%. Paracetamol was the drug consumed by 16 subjects followed by nimesulide by 11. Lack of knowledge about the disadvantages of SM led to self-medication in 65% of respondents. The personnel most commonly consulted for medication were pharmacists (60%). CONCLUSION: The trend of SM is high in Pokhara valley. The comedics were consulted most often for SM due to lack of knowledge of consultation to physicians. The public should be made aware about SM.

Use of Antibiotics Without a Prescription in the U.S. Population: A Scoping Review.

Background: Use of antibiotics without a prescription may increase unnecessary and inappropriate drug use or doses as well as global risk for antimicrobial resistance. Purpose: To perform a scoping review of research on the prevalence of nonprescription antibiotic use in the United States and to examine the factors that influence it. Data Sources: Searches of PubMed, EMBASE, CINAHL, Scopus, and relevant Web sites without language restrictions from January 2000 to March 2019. Study Selection: Studies reporting nonprescription use of antibiotics, storage of antibiotics, intention to use antibiotics without a prescription, and factors influencing nonprescription use. Data Extraction: Two reviewers independently screened citations and full texts and performed data abstraction. Data Synthesis: Of 17 422 screened articles, 31 met inclusion criteria. Depending on population characteristics, prevalence of nonprescription antibiotic use varied from 1% to 66%, storage of antibiotics for future use varied from 14% to 48%, and prevalence of intention to use antibiotics without a prescription was 25%. Antibiotics were obtained without a prescription from various sources, including previously prescribed courses, local markets or stores, and family or friends. Reported factors contributing to nonprescription use included easy access through markets or stores that obtain antibiotics internationally for under-the-counter sales, difficulty accessing the health care system, costs of physician visits, long waiting periods in clinics, and transportation problems. Limitation: Scarce evidence and heterogeneous methods and outcomes. Conclusion: Nonprescription antibiotic use is a seemingly prevalent and understudied public health problem in the United States. An increased understanding of risk factors and pathways that are amenable to intervention is essential to decrease this unsafe practice. Primary Funding Source: None.

Morbidity Pattern and Choice of Care in an Urban Slum of a Metropolitan State, Southwestern Nigeria.

BACKGROUND: An increased population growth has led to the proliferation of slums in urban areas. Urban slum dwellers are susceptible to ailments which may be worsened from reduced access to health facilities or weak institutional capacity. Understanding the pattern of morbidity and choice of care among slum dwellers can inform appropriate health interventions among this group. This study was conducted to investigate and document the morbidity patterns and choice of care within an urban slum community of South-western Nigeria. METHODS: The study was a descriptive cross-sectional survey involving 480 respondents selected through a random sampling technique in Idikan community of Southwestern Nigeria. The survey was conducted using a pre-tested semi-structured interviewer administered questionnaire on morbidity pattern and choice of care. Data were analyzed using SPSS Vs version 13 to generate frequencies and association between independent variables and choice of care using Chi-square at 5% level of significance. RESULTS: Among those that were ill, slightly over half of the respondents, 254 (52.9%) used self-medication while only 226 respondents (47.1%) sought medical care Majority of the respondents that sought care did so from Christian based health facilities (66.8%). A significantly higher proportion, (74.3%) of those in the higher occupational class compared with those of low occupational class (55.1%) (p = 0.001) sought care in a health facility. Also, a significantly higher proportion of those with tertiary education (69.0%) sought care in facilities compared to other cadres (p = 0.033). CONCLUSION: Disparities in morbidity patterns and access to care still persists in the surveyed community which requires urgent attention in the urban slums. This is evidently linked to educational and socio-economic status. Re-distribution of national funds to educational institutions and creation of jobs in the slums are advocated to improve the health seeking behaviours of slum dwellers in Ibadan and Nigeria at large.

Patterns and Factors Associated with Self-Medication among the Pediatric Population in Romania.

Background and objectives: Self-medication is a global phenomenon in both developed and emerging countries. At present, data regarding the practice, patterns, and factors associated with self-medication in Romanian patient groups of various ages and health are relatively scarce. A pilot study that uses a questionnaire was conducted to observe the attitudes as well as the behaviors of a group of Romanian parents related to self-medication, specifically their beliefs and perceived risks of the administration of medicine to their children without medical advice, frequency of self-medications, symptoms, and types of medications most commonly used without medical advice. Materials and Methods: The questionnaire was sent via e-mail or WhatsApp link on a mobile phone using the existing data at the general practitioner's office together with the protection of data form and the informed consent form; some participants completed the questionnaire when they came for a regular visit at the general practitioner's office. Of 246 applied questionnaires, we had a rate of responses of 98%. Results: We found a high percentage (70%) of parents who self-medicate their children. The data reveals a significant relation between parents' beliefs on self-medication and their tendency to administrate drugs to their children without medical advice. A significant relation was also found between the likelihood of parental self-medication for their children and the number of illnesses experienced by their children over the six-month period prior to the survey. Even when parents have a correct understanding of self-medication risks, these are not aligned with actual behavior; therefore, parents continue to administer drugs to their children without medical advice. Conclusions: Our study helps to describe the patterns of parents' decisions about self-medicating their children and to identify parents who are more predisposed to administering self-medication to their children.

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.

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.