Steroid-induced glaucoma: an avoidable cause of irreversible blindness.

A man in his 70s on regular follow-up with an ophthalmologist for 10 years presented with blurry vision in his right eye for 4 days. He was diagnosed with elevated intraocular pressure (IOP) bilaterally 18 months earlier and treated with antiglaucoma eye-drops. On direct questioning, he admitted to using fixed combination tobramycin 0.3%/dexamethasone 0.1% eye-drops frequently to relieve ocular redness and discomfort in both eyes for 3.5 years without his ophthalmologist's knowledge. Examination disclosed markedly elevated IOP, advanced optic disc cupping and tunnel vision due to steroid-induced glaucoma bilaterally. After cessation of the eye-drops and 2 weeks of antiglaucoma therapy, his IOP returned to normal and his visual field remained stable for 4 years.Our case highlights the danger of habitual self-treatment of prescription medications containing corticosteroids and the importance of taking a detailed medication history in the diagnosis and management of steroid-induced glaucoma.

[Evaluation of self-medication practices and their characteristics among Uvira in Democratic Republic of Congo students]. / Evaluation des pratiques de l'automédication et leurs caractéristiques auprès des étudiants d'Uvira en République Démocratique du Congo.

Introduction: self-medication poses a threat to public health. The purpose of this study was to evaluate self-medication practices among Uvira students in the Democratic Republic of the Congo (DRC). Methods: we conducted a cross-sectional descriptive study based on an indirect interview of 700 students, using a self-administered survey questionnaire. Data were processed using XLSTAT. Results: according to the survey conducted on these 700 students, the prevalence of self-medication was 99.3% (n=695), of which 42.3% (n=294) started during adolescence. Of the total respondents, 57.4% (n=399) said they resorted to self-medication every time they fell ill and were short of money (n=471, 67.7%) for a consultation. The most commonly cited pathology encountered during this practice was malaria (n=212, 30.5%). Of all drugs used, paracetamol was in the first place (n=106, 15.3%) while the tablet was the form most used by these students (n=598, 86%). In terms of the drug combination, Fansidar-Coartem (n=106, 17.2%) was the most common; the dosage was age-dependent in 65.6% (n=456) of cases. This study also showed that 37.4% (n=695) of the students interviewed used phytotherapy, mainly to treat malaria (n=124, 47.3%). Conclusion: among Uvira students, self-medication is extremely used, especially against malaria. Efforts must be made by healthcare personnel in collaboration with policymakers to raise awareness about the rational use of medications, in order to better control and potentially eradicate this practice that is harmful to health.

Self-medication practices with conventional and herbal drugs among ear, nose, and throat patients.

OBJECTIVE: This study evaluates the self-practices with conventional and herbal drug use among ear, nose, and throat outpatients. METHODS: A cross-sectional survey-based study was carried out among all ear, nose, and throat outpatients on their first visit to the otorhinolaryngology department at a tertiary care hospital. The survey comprised a total of 14 questions with 4 different sections, including demographic characteristics, self-medication of conventional medicines, herbal medication usage, and perception regarding herbal medicines. RESULTS: Overall, 255 questionnaires were distributed among patients, of which 183 completed the questionnaire (response rate=71.7%). Respondents reported self-medication (44.8%) with conventional drugs before visiting a hospital. The most commonly used medicine was analgesics (31.7%) and antibiotics (21.9%). Nearly half of the patients (49.2%) used at least one herbal drug. The most commonly used herbal medications were Tilia cordata (78.8%), Zingiber officinale (62.2%), and Camellia sinensis (45.5%). According to the International Union for Conservation of Nature Red List, most of the medicinal herbs were considered as data deficient/least concern. About 36.6% of the participants perceived that herbal drugs are effective for ear, nose, and throat problems. Moreover, 22.9% of the patients did not know about herbal-drug interaction with other medications. CONCLUSIONS: This study observed a considerable prevalence of self-based practices with conventional and herbal medications. Strict national regulations on conventional and herbal medication access and long-term actions should be implemented to discourage inappropriate drug use.

Conhecimento popular e automedicação com plantas medicinais em gestantes de um município do Nordeste brasileiro / Popular knowledge and self-medication with medicinal plants among pregnant women in a Northeastern Brazilian municipality

O objetivo do presente estudo foi avaliar o conhecimento popular e automedicação com plantas medicinais em gestantes do município de Juazeiro do Norte, Ceará, Brasil. Trata-se de uma pesquisa exploratória com abordagem quali-quantitativa. As informações foram coletadas por meio de um questionário semiestruturado e um grupo focal de gestantes. Em relação ao conhecimento e uso de plantas de medicinais, afirma-se que as gestantes utilizam plantas medicinais. Na análise dos riscos, todas plantas relatadas apresentavam toxicidade fetal, com exceção da cebola branca. Nota-se que as gestantes utilizam plantas medicinais por influência da cultura familiar. As gestantes acreditam que as plantas medicinais ingeridas na gestação não causam efeitos nocivos por serem de origem natural, o que contribui para a automedicação. Destaca-se a importância do diálogo entre o saber popular e o conhecimento científico na construção de uma educação terapêutica que previna problemas relacionados ao uso de produtos terapêuticos na gestação.

This study aimed to evaluate the popular knowledge and self-medication with medicinal plants among pregnant women in the municipality of Juazeiro do Norte, Ceará, Brazil. This is an exploratory research with a quali-quantitative approach. The information was collected through a semi-structured questionnaire and a focus group of pregnant women. Regarding the knowledge and use of medicinal plants, the pregnant women used medicinal plants. In the risk analysis, all plants reported presented fetal toxicity, with the exception of white onion. It can be noticed that pregnant women use medicinal plants because of family culture influence. Pregnant women believe that the medicinal plants ingested during pregnancy do not cause harmful effects because they are of natural origin, which contributes to self-medication. It highlights the importance of dialogue between popular knowledge and scientific knowledge in the construction of therapeutic education that prevents problems related to the use of therapeutic products during pregnancy.

A Case of Phenibut Directed Detoxification Leading to Toxicity During the COVID-19 Pandemic.

BACKGROUND: Phenibut is a non-Food and Drug Administration-approved gamma-aminobutyric acid analog marketed in the United States as an anxiolytic, cognitive enhancer, and alcohol withdrawal treatment through online supplement vendors. In this case report, we describe a woman's self-directed detoxification with phenibut used to manage withdrawal symptoms from fentanyl and benzodiazepines in March 2020 during the height of the COVID-19 pandemic. CASE: A 38-year-old woman with severe opioid, benzodiazepine, gabapentin, stimulant use disorders developed altered mental status after oral phenibut ingestion intended to help self-manage opioid and benzodiazepine withdrawal. She chose self-directed detoxification as she feared COVID-19 exposure in detoxification facilities. Her altered mental status drove her to jump out a third-story window causing multiple spinal fractures. After a long hospitalization, she self-directed her discharge home due to concerns about COVID-19. Her premature discharge disrupted opioid and benzodiazepine use disorder treatment plans. CONCLUSION: This case highlights the risks of phenibut use for selfdirected detoxification. With COVID-19 related changes in the drug supply, people may be more likely to use online pharmaceuticals, therefore, substance use assessments should inquire about the online acquisition of new psychoactive drugs. Public health messaging regarding the risks of infectious disease transmission in addiction care settings is needed to guide addiction treatment choices among people who use substances.

Self-Medication Perceptions and Practice of Medical and Pharmacy Students in Serbia.

BACKGROUND: Attitudes towards conventional and complementary medicine among future healthcare professionals can impact their future pharmacotherapy practice. This study aimed to determine the prevalence and predisposing factors related to self-medication among medical and pharmacy students. METHODS: This cross-sectional questionnaire-based study was performed at the Faculty of Medicine, University of Novi Sad, Serbia, on first- and final-year students of medicine and pharmacy. The multivariate Poisson regression model with robust variance was used to identify the main predictors of self-medication. RESULTS: The overall self-medication prevalence in the past year was 81.3%. Independent risk factors for self-medication identified in the regression analysis were the final study year, housing condition, i.e., living in a leased apartment or in a student dormitory in comparison to living with parents, and cigarette consumption. The conventional drugs were the most frequently used, mostly for the symptoms of cold and pain. Final-year students had more confidence in conventional medicines than in herbal drugs and were more aware of the risks of their concomitant use. CONCLUSION: Self-medication is highly prevalent among students of medical sciences, especially among final-year students. Increased medical knowledge led to the higher awareness of the drug interaction risks.

Percepción de riesgo, automedicación, mitos y creencias relacionados con COVID-19 entre jefes de hogar peruanos / Risk perception, self-medication, myths, and beliefs related with COVID-19 among Peruvian head of households

Resumen Introducción: A más de un año del inicio de la pandemia COVID-19, el número de contagiados y muertes aún presenta frecuencias que escapan al control de manejo hospitalario. Aunado al temor, se acrecentó la aparición de mitos, creencias, automedicación e inadecuada percepción de riesgo en la población. Objetivo: Identificar la percepción de riesgo, automedicación, mitos y creencias de prevención respecto al COVID-19 en adultos jefes de hogar del distrito Gregorio Albarracín de Tacna en el 2020. Material y métodos: Se aplicó una encuesta a una muestra representativa de 250 jefes de hogar, residentes en el distrito Gregorio Albarracín. Resultados: El promedio total del grupo en percepción del riesgo expresado en porcentaje fue de 60,96 % (59,81-62,11) de un total de probable esperado ideal de 100 %. La percepción de "estar en riesgo en la pandemia" es baja. Solo el 15,20 % acató el aislamiento domiciliario estricto cuando fue indicado. El 14,8 % se automedicaba y en este grupo, los productos usados fueron Ivermectina (48,6 %) y dióxido de cloro (45,9 %). Los mitos y creencias más frecuentes fueron "rociarse con alcohol o cloro mata el virus" y "los remedios caseros pueden curar o prevenir el coronavirus". Hubo diferencia según edad (p<0,05), nivel de instrucción (p<0,001). Conclusiones: La automedicación estuvo fuertemente asociada con elevada percepción de riesgo (p<0,001) y presencia de mitos y creencias (p<0,001). El nivel de instrucción estuvo altamente asociado con la presencia de mitos y creencias (p<0,001)

Abstract Introduction: More than a year after the beginning of the COVID-19 pandemic, the number of infections and deaths is still beyond the control of hospital management. In addition to fear, myths, beliefs, self-medication and inadequate risk perception in the population have increased. Objective: To identify the perception of risk, self-medication, myths and prevention beliefs regarding COVID-19 in adult heads of household in the Gregorio Albarracin district of Tacna in 2020. Method: A survey was administered to a representative sample of 250 heads of household residing in the Gregorio Albarracin district. Results: The total average of the group in risk perception expressed as a percentage was 60.96% (59.81-62.11) out of a total expected ideal of 100%. The perception of "being at risk in the pandemic" is low. Only 15.20% adhered to strict home isolation when instructed to do so. The 14.8% self-medicated and in this group, the products used were ivermectin (48.6%) and chlorine dioxide (45.9%). The most frequent myths and beliefs were "spraying with alcohol or chlorine kills the virus" "home remedies can cure or prevent coronavirus"; there were differences according to age (p<0.05) and educational level (p<0.001). Conclusions: self-medication was strongly associated with high-risk perception (p<0.001) and presence of myths and beliefs (p<0.001). Educational level was highly associated with the presence of myths and beliefs (p<0.001).

Autocuidado de catadores de material reciclável: ações de Enfermagem à luz da Pesquisa Convergente-Assistencial / Evaluación de los atributos de la Atención Primaria a la Salud desde la perspectiva de los adultos mayores / Self-care of recyclable material collectors: nursing actions in light of Convergent-Assistance Research

Resumo Objetivo promover o autocuidado de catadores de material reciclável a partir da aplicação da Teoria dos Déficits de Autocuidado. Método Pesquisa Convergente-Assistencial realizada com catadores de material reciclável de duas associações de reciclagem do Sul do Brasil. Os dados foram produzidos por meio de observação participante, entrevistas semiestruturadas e grupos de convergência. Os dados foram analisados segundo os passos propostos pelo método: apreensão, síntese, teorização e transferência. Resultados os participantes possuíam ações deliberadamente empreendidas e motivações para o autocuidado. No entanto, apresentaram déficits relacionados, principalmente, a hábitos que os expunham aos riscos ocupacionais. Nas ações grupais de apoio-educação, os participantes discutiram seus déficits de autocuidado e estratégias para mitigá-los. A pesquisa possibilitou mudanças no cenário laboral, no entanto, alguns déficits de autocuidado persistiram. Conclusões e implicações para a prática pondera-se que mudanças profundas exigem ações permanentes para transformações das iniquidades sociais. No entanto, o Sistema de Enfermagem apoio-educação possibilitou mudanças positivas no autocuidado dos catadores, o que corrobora a contribuição teórico-prática da teoria para o cuidado de Enfermagem.

Resumen Objetivo promover el autocuidado de los recolectores de materiales reciclables basado en la aplicación de la Teoría de los Déficits en el Autocuidado. Método Investigación de Asistencia Convergente realizada con recolectores de material reciclable de dos asociaciones de reciclaje en el sur de Brasil. Los datos fueron producidos mediante observación participante, entrevistas semiestructuradas y grupos de convergencia. Los datos fueron analizados según los pasos propuestos por el método: aprehensión, síntesis, teorización y transferencia. Resultados los participantes habían realizado deliberadamente acciones y motivaciones de autocuidado. Sin embargo, mostraron déficits relacionados principalmente con hábitos que los expusieron a riesgos laborales. En las acciones grupales de apoyo-educación, los participantes discutieron sus déficits de autocuidado y estrategias para mitigarlos. La investigación permitió cambios en el escenario laboral, sin embargo, persistieron algunos déficits de autocuidado. Conclusiones e implicaciones para la práctica se considera que los cambios profundos requieren acciones permanentes para transformar las desigualdades sociales. Sin embargo, el sistema de apoyo-educación de enfermería permitió cambios positivos en el autocuidado de los recolectores, lo que corrobora el aporte teórico-práctico de la Teoría al cuidado de Enfermería.

Abstract Objective to promote the self-care of recyclable material collectors through the application of the Theory of Self-Care Deficits. Method Convergent-Assistance Research conducted with recyclable materials collectorsfrom two recycling associations in Southern Brazil. The data was produced through participant observation, semi-structured interviews and convergence groups. The data was analyzed according to the steps proposed by the method: apprehension, synthesis, theorization, and transfer. Results the participants had deliberate actions undertaken and motivations for self-care. However, they presented deficits related mainly to habits that exposed them to occupational risks. In the supportive-educational group actions, participants discussed their self-care deficits and strategies to mitigate them. The research enabled changes in the work scenario; however, some self-care deficits persisted. Conclusions and implications for the practice it is pondered that profound changes require permanent actions for transformations in social inequities. However, the supportive-education nursing system enabled positive changes in the recyclable materials collectors' self-care, which corroborates the theoretical-practical contribution of the theory to nursing care.

Self-medication against COVID-19 in health workers in Conakry, Guinea

Data regarding the prevalence and consequences of self-medication during the COVID-19 pandemic in Africa are very limited. The study aimed to explore the frequency and risk factors of self-medication against COVID-19 by health personnel in this study. This cross-sectional study took place in June 2021, in Conakry, in the all three national hospitals and the six community medical centers, and five primary health centers. A multivariate logistic regression model was performed to identify factors associated with self-medication. A total of 975 health workers with a median age of 31 (IQR: 27-40) years, with 504 (51.7%) women were included. The majority were clinicians: physicians (33.1%) or nurses (33.1%). Of all, 46.2% reported having had at least one COVID-19 symptom during the 12 months preceding the survey. The proportion of self-medication was 15.3% among national hospital staff, 12.20% in municipality medical centers and 22.6% in primary health centers (p=0.06). More than two-thirds (68.7%) who selfmedicated did not have a test for SARSCoV- 2 infection. They took antibiotics including azithromycin, amoxicillin, ampicillin (42.2%), acetaminophen (37.4%), vitamin C (27.9%), hydroxychloroquine (23.8%) and medicinal plants (13.6%). The median duration of self-medication was 4 days. Fatigue or asthenia, sore throat, loss of smell and sore throat of a close person were independently associated with selfmedication. Health care workers largely practiced self-medication during the Covid pandemic and without diagnostic testing. The results suggest the need for training and sensitization of medical personnel to avoid the consequences of the molecules used, including hepatotoxicity and antibiotic resistance

Polifarmacia en Chile: una investigación descriptiva / Polipharmacy in Chile: a descriptive research

La polifarmacia es un término que, si bien no existe un consenso, se considerará como el uso concomitante de cinco o más medicamentos ya sean recetados o no por un profesional. Con respecto a ésta, se ha visto que se ha acrecentado en los últimos años tanto en Chile como en el mundo. En la presente investigación descriptiva se realizó un análisis de la Encuesta Nacional de Salud de Chile (ENS) 2016-17 y se comparó con los resultados obtenidos en la Encuesta Nacional de Salud 2009-10 y con la Encuesta sobre Salud, Envejecimiento y Jubilación Europea para de esta forma realizar un recuento objetivo sobre el aumento de esta condición en Chile. Al caracterizar a los grupos más afectados, se vio que en Chile la mayor prevalencia se daba en población adulta mayor sobre 65 años, mujeres y personas con escolaridad menor a 8 años cursados. Esto da cuenta del nivel del problema y la necesidad de una visión médica holística para el especial abordaje de la multimorbilidad, pues la polifarmacia trae consigo a su vez riesgos para la salud como lo son el aumento de las reacciones adversas e interacciones medicamentosas, riesgo de hospitalización, mayor deterioro del estado funcional, incremento de alteraciones cognitivas y mayores costos monetarios para el sistema de salud.

Polypharmacy is a term that, although there is no official definition, is understood as the concomitant use of five or more medications, regardless of whether they are prescribed by a professional. Regarding this phenomenon, an increase can be observed in recent years both in Chile and on a global level. This present descriptive research draws on an analysis of the National Health Survey (ENS) from 2016-17 and a comparison with the National Survey of Health from 2009-10 and with Survey of Health, Ageing and Retirement in Europe in order to carry out an objective count on the increase of this phenomenon. When characterizing the most affected groups, this paper shows that in Chile the highest prevalence can be found in the older adult population over 65 years of age, women and people with less than 8 years of schooling. These results reveal the dimension of the issue, and the need for a holistic medical vision to pay particular attention to multiple morbidities since polypharmacy brings with it health risks such as increased adverse reactions and drug interactions, risk of hospitalization, further deterioration of functional status, increase in cognitive alterations and higher monetary costs for the health system

Self-medication practices to prevent or manage COVID-19: A systematic review.

BACKGROUND: Previous studies have assessed the prevalence and characteristics of self-medication in COVID-19. However, no systematic review has summarized their findings. OBJECTIVE: We conducted a systematic review to assess the prevalence of self-medication to prevent or manage COVID-19. METHODS: We used different keywords and searched studies published in PubMed, Scopus, Web of Science, Embase, two preprint repositories, Google, and Google Scholar. We included studies that reported original data and assessed self-medication to prevent or manage COVID-19. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) modified for cross-sectional studies. RESULTS: We identified eight studies, all studies were cross-sectional, and only one detailed the question used to assess self-medication. The recall period was heterogeneous across studies. Of the eight studies, seven assessed self-medication without focusing on a specific symptom: four performed in the general population (self-medication prevalence ranged between <4% to 88.3%) and three in specific populations (range: 33.9% to 51.3%). In these seven studies, the most used medications varied widely, including antibiotics, chloroquine or hydroxychloroquine, acetaminophen, vitamins or supplements, ivermectin, and ibuprofen. The last study only assessed self-medication for fever due to COVID-19. Most studies had a risk of bias in the "representativeness of the sample" and "assessment of outcome" items of the NOS. CONCLUSIONS: Studies that assessed self-medication for COVID-19 found heterogeneous results regarding self-medication prevalence and medications used. More well-designed and adequately reported studies are warranted to assess this topic.

Prevalence and Pattern of Self-medication with Alternative Medicine: Treatment-switch Analysis in Oral Submucous Fibrosis Patients.

AIM: The aim of this study was to investigate prevalence and pattern of self-medication with alternative medicine (ALM) among oral submucous fibrosis (OSF) patients with emphasis on treatment-switch analysis. METHODS: A total of 115 OSF patients were recruited and subjected to scientifically validated questionnaire. Two groups were identified: S-ALM: patients who have previously received modern medicinal treatment but switched to ALM; and DN-ALM: patients who started ALM from De Novo. RESULTS: A total of 37 (32.18%) patients reported use of the ALM at some point of time. Twenty-five (67.56%) switched to ALM, whereas 12 (32.43%) patients used ALM from De Novo. The pattern of switching to ALM in short period was significantly prevalent in patients with advanced stages (stage III and IV) as compared to early stages (stage I and II) of OSF. Clarified butter, glycerin, and honey were the most commonly used ALM in both the groups. The most common reasons for switching to ALM were the cost of treatment (32.00%), longer duration of medicinal treatment (24.00%) and ineffectiveness of the medications (24.00%). CONCLUSIONS: ALM usage is common in OSMF patients with significant percentage of patient switched from modern medicine to ALM. Therapeutic efficacy of ALM in OSF needs exploration in future.

Self-medication in Primary Dysmenorrhea among Medical and Nursing Undergraduate Students of a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Primary dysmenorrhea is one of the most common gynecological problems among adolescent females. It is defined as painful menses in women with normal pelvic anatomy, usually beginning during adolescence. This study aims to find out prevalence of self-medication practice in primary dysmenorrhea among medical and nursing undergraduate students. METHODS: A descriptive cross-sectional study was conducted in a tertiary care hospital from November 2020 to March 2021 after taking ethical approval from the Institutional Review Committee. Convenient sampling technique was used. A total of 269 female medical and nursing students with complaints of dysmenorrhea were enrolled and the remedial methods used by them such as self-medication, medical advice and home remedies for dysmenorrhea were asked using an online questionnaire delivered to participants. Data analysis was done in the Statistical Package of Social Sciences. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Self-medication practice for dysmenorrhea was reported in 175 (65%) of students. The prevalence of mild or moderate pain was commonly present in age group 21-25 years. commonly used for self-medication was mefenamic acid 121 (48%), followed by ibuprofen 51 (20.3%) and paracetamol 41 (16.3%). CONCLUSIONS: Self- medication practice among medical and nursing undergraduate students is high despite awareness of adverse effects.

Predictors of self-medication with herbal remedies during pregnancy based on the theory of planned behavior in Kashan, Iran.

BACKGROUND: The incidence of application of medicinal herbs during pregnancy has increased significantly among women over the past years; however, the safety and efficacy of medicinal herbs during pregnancy are still unclear. The aim of the present study was to categorize the predictors of self-medication with herbal remedies during pregnancy based on the theory of planned behavior (TPB). METHODS: The present descriptive-analytical study was conducted on 300 pregnant women referred to Kashan health center to receive prenatal care services in 2020. The study participants were randomly selected using stratified random sampling with proportional allocation. The data collection tool was a two-part researcher made questionnaire. The first part of the questionnaire included demographic information, midwifery information, and questions related to women's awareness about herbal medicine. The second part of the questionnaire was designed based on the theory of planned behavior including attitudes, perceived behavioral control, subjective norms, intention, and behavior performance. Data were analyzed using descriptive statistics, regression analysis, and SPSS version 18.0. RESULTS: The mean age of participants was 28. 7±5.4 years (range, 15-45 years), the majority were housewives (88.3%) and had secondary education (39.3%). A total of 164 women (57. 1%) used medicinal herbs during pregnancy. The individual's attitude towards herbal medicines consumption, subjective norm, and perceived behavioral control was correlated with behavioral intention (P < 0.05). Similarly, subjective norms were the most predictor of using herbal medicine among pregnant women (P < 0.05). CONCLUSION: The findings revealed that more than 50 % of pregnant women used medicinal herbs during pregnancy. The present study showed that the individual's attitude towards herbal medicines consumption, subjective norm, and perceived behavioral control was correlated with intention of herbal medicine use among pregnant women. Likewise, subjective norms were the most predictor of herbal medicine use among pregnant women. The TPB should be addressed in planning health education programs and modifying health behaviors, including self-medication, especially during pregnancy.

[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.

Self-medication with herbal medicine and breast cancer survival: a prospective monocentric study.

PURPOSE: The use of complementary and alternative medicine (CAM) is common among breast cancer patients, but less is known about whether CAM influences breast cancer survival. The primary aim of this study was to determine the impact of self-use of herbs on the overall survival. METHODS: This was a prospective study including 110 patients with breast cancer. All patients were questioned about the concept of taking herbs. We analyzed the demographic data and the overall survival. RESULTS: The average age was 51 years (30-80 years old). 37 had metastatic disease (33.6%). 48 patients had taken plants (43.6%). 19 patients consumed Graviola (39.6%) and 29 Alenda (60.4%). Overall survival at 3 years and at 5 years were, respectively, 96.2% and 82.4% in the absence of plant consumption versus 78.5% and 78.5% in case of plant consumption (p = 0.015). CONCLUSION: This study concluded that self-medication with Graviola or Alenda may be associated with an increase of death risk in patients with breast cancer. Further studies are needed to confirm these results.

SARS-CoV-2 and self-medication in Cameroon: a mathematical model.

Self-medication is an important initial response to illness in Africa. This mode of medication is often done with the help of African traditional medicines. Because of the misconception that African traditional medicines can cure/prevent all diseases, some Africans may opt for COVID-19 prevention and management by self-medicating. Thus to efficiently predict the dynamics of COVID-19 in Africa, the role of the self-medicated population needs to be taken into account. In this paper, we formulate and analyse a mathematical model for the dynamics of COVID-19 in Cameroon. The model is represented by a system of compartmental age-structured ODEs that takes into account the self-medicated population and subdivides the human population into two age classes relative to their current immune system strength. We use our model to propose policy measures that could be implemented in the course of an epidemic in order to better handle cases of self-medication.

Busca por cuidados de saúde: itinerário terapêutico de crianças egressas de unidades neonatais / Search for health care: therapeutic itinerary of children discharged from the neonatal units / Búsqueda de cuidados de salud: itinerario terapéutico de niños de alta de unidades neonatales

Objetivo: Compreender os caminhos percorridos por mães e cuidadoras na busca pelo cuidado de crianças egressas de unidades neonatais. Métodos: Estudo qualitativo e exploratório, realizado entre maio e junho de 2018, com mães e cuidadoras de crianças nascidas entre 2014 e 2015, egressas de duas unidades neonatais públicas de uma capital do Nordeste brasileiro. Realizaram-se 14 entrevistas semiestruturadas, e se utilizou análise de conteúdo na modalidade temática. Apreenderam-se três categorias que evidenciam possíveis caminhos percorridos para o cuidado, perpassando, em sua maioria, pelos três setores: "O setor informal como ponto de partida para o cuidado", "O uso do setor popular como prática de cura", "O uso do setor profissional: alternativa para consulta". Resultados: O setor informal foi o mais relatado pelas cuidadoras. Em geral, a primeira escolha era pela automedicação orientada de forma transgeracional, pelas avós. O uso do setor popular foi influenciado pelo conhecimento prévio das famílias e sua percepção do processo saúde-doença. A cultura biomédica perpassou os três setores e influenciou na construção do itinerário terapêutico. No setor profissional identificou-se vínculo frágil, principalmente na atenção primária. Conclusão: Os caminhos percorridos por mães e cuidadoras de egressos de unidades neonatais apontaram sobreposição da medicalização em detrimento dos saberes populares. Acolher e manejar os repertórios sociais e culturais das famílias pode contribuir para fortalecer vínculos terapêuticos com o setor profissional. A Atenção Primária à Saúde precisa ser fortalecida para garantir a qualificação do cuidado às crianças.

Objective: To understand the paths taken by mothers and caregivers while searching for care for children discharged from neonatal units. Methods: Qualitative and exploratory study, carried out between May and June 2018, with mothers and caregivers of children born between 2014 and 2015, discharged from two public neonatal units in a capital from a Northeastern Brazil state. Fourteen semi-structured interviews were conducted, and content analysis was used in the thematic modality. Three categories were found that show possible paths taken for the care, mostly passing through the three sectors: "the informal sector as a starting point for the care", "the use of the popular sector as a healing practice", and "the use of professional sector: an alternative for consultation". Results: The informal sector was the most addressed sector by caregivers. In general, the first choice was for self-medication oriented transgenerationally by grandmothers. The use of the popular sector was influenced by the families' prior knowledge and their perception of the health-disease process. Biomedical culture permeated the three sectors and influenced the construction of the therapeutic itinerary. In the professional sector, a fragile bond was identified, mainly in primary care. Conclusion: The paths taken by mothers and caregivers of newborns discharged from neonatal units pointed to an overlap of medicalization to detriment of popular culture. Hosting and managing families' social and cultural repertoires contribute to strengthening therapeutic links with the professional sector. Primary Health Care needs to be strengthened to guarantee the qualification of care for children.

Objetivo: Comprender los caminos recorridos por madres y cuidadoras para la búsqueda del cuidado de niños de alta de unidades neonatales. Métodos: Estudio cualitativo y exploratorio realizado entre mayo y junio de 2018 con madres y cuidadoras de niños nacidos entre 2014 y 2015 de alta de dos unidades neonatales públicas de una capital del Noreste brasileño. Se realizaron 14 entrevistas semiestructuradas y se ha utilizado el análisis de contenido en la modalidad temática. Se ha identificado três categorías que evidencian los posibles caminos recogidos para el cuidado pasando en su mayoría por los tres sectores: "El sector informal para el punto de inicio del cuidado", "El uso del sector popular para la práctica de cura", "El uso del sector profesional: alternativa para la consulta". Resultados: El sector informal ha sido el más relatado por las cuidadoras. En general, la primera elección era el auto medicación orientada por las generaciones de abuelas. El uso del sector popular ha sido influenciado por el conocimiento previo de las familias y su percepción del proceso salud-enfermedad. La cultura biomédica ha pasado por los tres sectores y ha influenciado para la construcción del itinerario terapéutico. Se ha identificado un vínculo frágil en el sector profesional sobre todo en la atención primaria. Conclusión: Los caminos recogidos por madres y cuidadoras de niños de alta de unidades neonatales señalaron el solapamiento de la medicalización con pérdida de los saberes populares. Acoger y manejar los repertorios sociales y culturales de las familias puede contribuir para reforzar los vínculos terapéuticos con el sector profesional. Hace falta el fortalecimiento de la Atención Primaria de Salud para garantizar la cualificación del cuidado de los niños.