Self-Medicating for Pain: A Public Health Perspective.

BACKGROUND: Pain is one of the symptoms for which any man is willing not only to go to the doctor but also to resort to any means, including self-medication, to "get rid" of it. Self-medication is not only a current practice but also a public health problem, under the circumstances that it can influence the way in which a disease is diagnosed and/or treated in a timely manner, and, consequently, repercussions may occur on the cost of treatment, in the case of severe forms. Pain is a vital symptom, and the diminution until the disappearance of pain is a fundamental right of each individual; the analysis of ethical issues in the case of self-administration of analgesic medication has not been a major concern. AREAS OF UNCERTAINTY: Understanding the problem is important to realize whether self-medicating for pain is a necessity or an abuse, and in this respect, we review scientific articles from international databases: PubMed and ProQuest. DATA SOURCES: The study is based on the consultation of scientific articles from international databases-PubMed and ProQuest, the main keywords in the search being pain and self-medication, to which a stigma or public health is sequentially added. RESULTS: Pain is becoming more and more a global problem and the extent of its spread can substantiate our assertion about pathology with pandemic impact. Under the pressure of patient associations, of the media, and of nonmedical authorities, the opinion about the need for a stoic approach to pain has long become an outdated theory, and chronic pain, beyond a multidimensional approach, is increasingly considered not only a useless element but also even a destructive one. CONCLUSIONS: Pain and self-medication must be addressed, including in medical practice, starting from their multidimensionality from the following perspectives: medicobiological, sociocultural, instructive-educational, legal-political, and especially ethical. They are not only individual health problems but also become, when connected with a stigma, a public health problem.

Research Ethics in Behavioral Interventions Among Special Populations: Lessons From the Peer Approaches to Lupus Self-Management Study.

BACKGROUND: Research involving a homogenous cohort of participants belonging to a special population must make considerations to recruit and protect the subjects. This study analyses the ethical considerations made in the peer approaches to lupus self-management project which pilot tested a peer mentoring intervention for African American women with systemic lupus erythematosus. METHODS: Considerations made at the outset of the project are described and their justifications and reasoning are given. Through analysis of feedback from a postintervention focus group and mentors' logs, implications on program outcomes and participant satisfaction are discussed. RESULTS: Feedback indicated the importance of recruiting and training capable mentors, consistent contact from study staff to avert adverse events and avert fear or mistrust and careful consideration that must go into the pairing of mentors and mentees. Participant feedback also indicated that sensitive topics must be addressed carefully to prevent distress and dissatisfaction. CONCLUSIONS: Applying the lessons learned from this work as well as the considerations that proved successful may improve the contextualization and ethical conduct of behavioral interventions in special populations resulting in improved tailoring and acceptability toward historically underserved individuals.

Evaluación de 10 años del primer programa institucional de uso racional de antibióticos en Gipuzkoa: 1999-2009 / Assessment of the first 10 years institutional programme on rational use of antibiotics in Gipuzkoa: 1999-2009

En 1999 el COF de Gipuzkoa puso en marcha un programa institucional con el objetivo de promover el uso racional de antibióticos, conocer la situación de la demanda y dispensación de antibióticos con y sin receta en las farmacias de Gipuzkoa y reforzar la actuación profesional del farmacéutico. En este estudio se presenta la evaluación de los resultados de 10 años de duración del programa. Método: Se diseñó un protocolo de actuación y un procedimiento de recogida de datos en la farmacia, para su posterior evaluación, siendo la participación voluntaria. Resultados: Se presentan los datos obtenidos en 3 puntos de corte, al inicio del programa (1999), a los cinco y a los 10 años del inicio (2009). El número de farmacias participantes disminuyó desde 152 (54,7%) a 86 (30,6%), con una media de 280 farmacias existentes en la provincia. El número de solicitudes de antibióticos sin receta disminuyó de un 13,6% a un 1,5% respecto a la solicitud total de antibióticos, con o sin receta. En cuanto a la dispensación de antibióticos sin receta se pasó de un 68,9% al 39,2% respecto a los solicitados sin receta. Sobre la demanda total de antibióticos, con o sin receta, se pasó del 9,8% al 0,6%. Conclusiones: Durante los 10 años de duración del I Programa institucional de uso racional de antibióticos en Gipuzkoa, se disminuyó tanto la solicitud de antibióticos sin receta, como la dispensación de los mismos sin receta. Este tipo de Programas contribuyen a mejorar el uso prudente de antibióticos

In 1999, Gipuzkoa Professional Association of Pharmacists set up an institutional programme with the following objectives: to promote the rational use of antibiotics; to know the situation of both: the demand and the dispensing of antibiotics, with and without prescription in Gipuzkoa pharmacies and to reinforce the professional role of the pharmacist. This study includes the evaluation of the results of the 10-year programme. Methods: A protocol of action and a data collection procedure in pharmacies were developed. The participation in the programme was voluntary. Results: Data obtained were presented with three different cut-off points: the beginning of the programme (1999), within five years of the beginning and within 10 years (2009). The number of pharmacies decreased from 152 (54.7%) to 86 (30.6%), with an average of 280 chemist’s shops in the province. The number of demands for antibiotics without prescription decreased from 13.6% to 1.5% in relation with the total amount of antibiotics demands, with and without prescription. The dispense of antibiotics without prescription went from 68.9% to 39.2% in relation with the antibiotics demanded without prescription. With respect to the total demand of antibiotics, it went from 9.8% to 0.6%. Conclusions: Both, the demand of antibiotics without prescription and their corresponding dispense were reduced during the 10-year institutional programme on rational use of antibiotics held in Gipuzkoa. This kind of programmes contributes to a better and more rational use of antibiotics

The implications of methylphenidate use by healthy medical students and doctors in South Africa.

BACKGROUND: The use of medical stimulants to sustain attention, augment memory and enhance intellectual capacity is increasing in society. The use of Methylphenidate for cognitive enhancement is a subject that has received much attention in the literature and academic circles in recent times globally. Medical doctors and medical students appear to be equally involved in the off-label use of Methylphenidate. This presents a potential harm to society and the individual as the long-term side effect profile of this medication is unknown. DISCUSSION: The implication of the use of Methylphenidate by medical students and doctors has not been fully explored. This article considers the impact of this use on the traditional role of medicine, society, the patient and suggests a way forward. We discuss the salient philosophy surrounding the use of cognitive enhancement. We query whether there are cognitive benefits to the use of Methylphenidate in healthy students and doctors and whether these benefits would outweigh the risks in taking the medication. Could these benefits lead to tangible outcomes for society and could the off label-use of Methylphenidate potentially undermine the medical profession and the treatment of patients? If cognitive benefits are proven then doctors may be coerced explicitly or implicitly to use the drug which may undermine their autonomy. The increased appeal of cognitive enhancement challenges the traditional role of medicine in society, and calls into question the role of a virtuous life as a contributing factor for achievement. In countries with vast economic disparity such as South Africa an enhancement of personal utility that can be bought may lead to greater inequities. SUMMARY: Under the status quo the distribution of methylphenidate is unjust. Regulatory governmental policy must seek to remedy this while minimising the potential for competitive advantage for the enhanced. Public debate on the use of cognitive enhancement is long overdue and must be stimulated. The use of Methylphenidate for cognitive enhancement is philosophically defendable if long-term research can prove that the risks are negligible and the outcomes tangible.

Automedicación y autodiagnostico del personal de enfermería / Self-medication and self-diagnosis in the nursing staff

El presente trabajo pretende determinar la prevalencia de consumo de medicamentos, cuales son los más usados, la frecuencia de consumo, y la significacion que se da a los mismos.

Automedicación y autodiagnostico del personal de enfermería / Self-medication and self-diagnosis in the nursing staff

El presente trabajo pretende determinar la prevalencia de consumo de medicamentos, cuales son los más usados, la frecuencia de consumo, y la significacion que se da a los mismos.(AU)

Factores que influyen en la automedicación del personal de enfermería a nivel técnico y de estudiantes / Factors influencing self medication nursing staff and students technical level

La automedicación, es “el consumo de medicamentos, hierbas y remedios caseros por iniciativa o consejo de otra persona, sin consultar al médico”, considerada también como un fenómeno que se ha incrementado a través del tiempo, convirtiéndose en un serio problema de salud pública. En México no existen estudios o publicaciones que permitan valorar la real magnitud de esta práctica en la población. Objetivo: Conocer los factores que influyen en la automedicación del personal de enfermería a nivel técnico y estudiantes del Instituto Nacional de Neurología y Neurocirugía.

Self-medication, is “the use of drugs, herbs and home remedies or advice on the initiative of another person, without consulting a doctor”, also regarded as a phenomenon that has been increasing over time, becoming a serious public health problem. In Mexico, there are no studies or publications to assess the real magnitude of this practice in the population. Objective: Understanding the factors that influence self-medication nursing staff technical level, and students of the National Institute of Neurology and Neurosurgery.

Actuaciones profesionales realizadas en la farmacia comunitaria / Professional services carried out in the community pharmacy

Objetivo: Describir todas las actuaciones profesionales (AP) que se llevan a cabo como respuesta a las demandas realizadas por los usuarios en la farmacia comunitaria (FC). Material y métodos: Estudio observacional, descriptivo y transversal, realizado durante 6 meses en dos farmacias comunitarias de Denia (Alicante). La población de estudio fueron todas las demandas de servicio que realizaron los usuarios de ambas farmacias. La variable de estudio fue la AP, es decir, cada uno de los servicios demandados por el usuario en la FC: dispensación, indicación, automedicación, consultas y ventas, clasificándose cada uno en sus resoluciones e incidencias. Resultados: En el estudio se realizaron 30.617 AP, correspondiendo un 42% a la dispensación con receta, y se registró casi un 23% de incidencias. Las indicaciones farmacéuticas supusieron un 9% del total, resolviéndose en la mayoría de casos con la recomendación de un medicamento. Un 33% fueron demandas de automedicación, cursando con casi un 20% de incidencias. Un 7% fueron consultas y un 10% ventas de productos sanitarios. Conclusiones: Del total de AP realizadas, el 90% se consideran farmacéuticas. El 83% fueron dispensaciones de medicamentos, más de la mitad de éstas sin prescripción médica, lo que revela la importancia del asesoramiento farmacéutico en las dispensaciones sin receta. El hecho de que 9 de cada 10 incidencias que se producen en la dispensación con receta y en la automedica ción sean por la falta de información del paciente nos pone en alerta sobre la necesidad de implementar medidas que mejoren esta carencia(AU)

Objective: To describe all the professional actions (PA) carried out by the community pharmacy in response to the requests made by pharmacy users. Methods: Observational, cross-sectional, descriptive study in two pharmacies in Spain, over a 6 month-period. Population: all service requests made by pharmacy users. Study variable: Professional action, each of the services requested by pharmacy users: prescription-drug-dispensing, patient-counseling in minor ailments, self-medication, pharmacist-consultations, and sales-services. Classifying each of them in their decisions and incidents. Results: The study involved 30,617 PA, of which 42% were requests for prescription-drug-dispensing. Incidences were also recorded (23%). Nine percent of requests were for patient-counseling in minor ailments, and these were solved in 99% of cases with recommending of a drug, herbal or homeopathy product. Of the total PA, 33% were self-medication cases, with 20% of incidences. Seven percent were inquiries to the pharmacist and 10% of total requests were sales-services. In one out of four prescription-drug-dispensing event an incidence was detected, and in self-medication cases, in one out of every five. Conclusions: Of all the PA performed in the pharmacies under study, 90% were pharmaceutical activities. Most of these (83%) are directly associated with drug delivery (with/without prescription). The fact that more than a half of the total PA requested were without medical prescription should be further analyzed. The fact that nine out of ten incidents that occur in prescription-drug-dispensing and self-medication are the lack of patient information, it alerts us to implement measures to improve this shortcoming(AU)

Three arguments against prescription requirements.

In this essay, I argue that prescription drug laws violate patients' rights to self-medication. Patients have rights to self-medication for the same reasons they have rights to refuse medical treatment according to the doctrine of informed consent (DIC). Since we should accept the DIC, we ought to reject paternalistic prohibitions of prescription drugs and respect the right of self-medication. In section 1, I frame the puzzle of self-medication; why don't the same considerations that tell in favour of informed consent also justify a right of self-medication? In section 2, I show that the prescription drug system was historically motivated by paternalism. In section 3, I outline the justifications for the DIC in more detail. I show that consequentialist, epistemic, and deontic considerations justify the DIC. In sections 4-6, I argue that these considerations also justify rights of self-medication. I then propose that rights of self-medication require non-prohibitive prescription policies in section 7. I consider two objections in sections 8 and 9: that patients ought not to make medically risky or deadly decisions, and that unrestricted access to prescription-grade pharmaceuticals would result in widespread misuse and abuse. Section 10 concludes.

The value of autonomy and the right to self-medication.

In 'Three Arguments Against Prescription Requirements', Jessica Flanigan argues that 'prescription drug laws violate patients' rights to self-medication' and that patients 'have rights to self-medication for the same reasons they have rights to refuse medical treatment according to the doctrine of informed consent (DIC), claiming that the strongest of these reasons is grounded on the value of autonomy. However, close examination of the moral value of autonomy shows that rather than being the strongest justification for the DIC, respect for the value of autonomy is actually the weakest, and it is dependent upon the first two well-being-based justifications for the DIC. Recognising this has important implications for Flanigan's argument against prescription requirements.

Self-medication with antibiotics in the Republic of Srpska community pharmacies: pharmacy staff behavior.

PURPOSE: Self-medication with antibiotics adds to the global risk of increased spread of bacterial resistance. Attitudes and behavior of health professionals also may reinforce self-medication with antibiotics. The aim of this study was to determine whether self-medication with antibiotics is possible in our community pharmacies and to what extent, and to evaluate the behavior and service of pharmacy health professionals regarding non-prescription antibiotic dispensation. METHODS: An observational, cross-section study was conducted, and pseudo-patient methodology was used to establish the kind of professional service provided in case of patient's explicit demand to buy an antibiotic for treatment of self-diagnosed upper respiratory tract infection. RESULTS: Of the total 318 community pharmacies, 131 (41%) were visited and included in the study. Non-prescription antibiotics were dispensed in 76 (58%) pharmacies. Counseling and symptomatic therapy was offered in 88 (67%) pharmacies. In 25% of pharmacies, no symptomatic therapy was offered; instead, only an antibiotic was sold. Amoxicillin was sold in 85% of cases and, mostly, the one of 1.30 Euro per pack. Both oral and written use instructions were given in 78% cases, whereas none was given in 3% of cases. CONCLUSIONS: Self-medication with antibiotics occurs in our community pharmacies, despite being illegal. Pharmacy staff behavior can be a factor that puts patients at risk for self-medication with antibiotics. Community pharmacies are failing their tasks in enhancing rational use of antibiotics. Such a practice may be a consequence of weak enforcement and control over the legislation and professional standards.

Irrational use of antibiotics and role of the pharmacist: an insight from a qualitative study in New Delhi, India.

WHAT IS KNOWN AND OBJECTIVE: The overall volume of antibiotic consumption in the community is one of the foremost causes of antimicrobial resistance. In developing countries like India, pharmacists often dispense 'prescription-only' drugs, like antibiotics, to patients who do not have a prescription. Not much data is available regarding detailed information on behaviour of antibiotic use by community pharmacists which is of particular significance to develop a suitable and sustainable intervention programme to promote rational use of antibiotics. A qualitative study was conducted to understand the dispensing practices and behaviour of community pharmacists to develop policy interventions that would improve the use of antibiotics at the community level. METHODS: Focus group discussions (FGDs) were held for five municipal wards of Delhi with retail pharmacists, public sector pharmacists and the office bearers of pharmacists' associations. Data on antibiotic use and resistance were collected earlier from these five wards. FGDs (n = 3 with 40 pharmacists) were analysed through grounded theory. RESULTS AND DISCUSSION: Four broad themes identified were as follows: prescribing and dispensing behaviour; commercial interests; advisory role; and intervention strategies for rational use of antibiotics. FGDs with pharmacists working in the public sector revealed that, besides the factors listed above, overstock and near-expiry, and under-supply of antibiotics promoted antibiotic misuse. Suggestions for interventions from pharmacists were the following: (i) education to increase awareness of rational use and resistance to antibiotics; (ii) involving pharmacists as partners for creating awareness among communities for rational use and resistance to antibiotics; (iii) developing an easy return policy for near-expiry antibiotics in public sector facilities; and (iv) motivating and showing appreciation for community pharmacists who participate in intervention programmes. WHAT IS NEW AND CONCLUSIONS: Inappropriate antibiotic dispensing and use owing to commercial interests and lack of knowledge about the rational use of antibiotics and antibiotic resistance were the main findings of this in-depth qualitative study. Community pharmacists were willing to participate in educational programme aimed at improving use of antibiotics. Such programmes should be initiated within a multidisciplinary framework including doctors, pharmacists, social scientists, government agencies and non-profit organizations.

Detección de incumplimiento terapéutico e intervención farmacéutica en ancianos institucionalizados / Detection of therapeutic non-compliance and pharmaceutical intervention in institutionalised geriatric patients

Objetivo. Detectar y analizar el incumplimiento terapéutico en ancianos institucionalizados que se autoadministran su tratamiento en una residencia geriátrica. Valorar la intervención farmacéutica como herramienta útil para detectarlo. Material y métodos. Estudio observacional sobre una población de 386 residentes. Realización de entrevista clínica por el servicio de farmacia a aquellos que se administran su tratamiento. Elaboración de hoja de recogida de datos individual (datos demográficos, clínicos e incidencias encontradas). Entrevista sobre su tratamiento (medicamentos, dosis, posología, indicación y forma de administración) junto al test validado de cumplimiento de Morinsky-Green. Cálculo de incumplimiento comparando las respuestas con la información farmacoterapéutica del servicio de farmacia y la de prescripción médica de la historia clínica. Resultados. El 11% se administran su tratamiento, su edad media es de 81 años, todos acuden a la entrevista y se detecta incumplimiento en el 41%. El test detecta sólo al 55% de incumplidores. Los principales errores fueron incumplimiento de horario, dosificación incorrecta y dejar el tratamiento al encontrarse bien. El 39% fue incumplimiento involuntario. El grupo aparato cardiovascular fue el más implicado en errores. En el 44% de los pacientes el error podía tener repercusión clínica importante. Conclusiones. La entrevista permite detectar incumplimiento y analizarlo. El test, aunque específico, es poco sensible. Los errores principales fueron fáciles de subsanar y sin problemas de aceptación por los pacientes. Siendo fundamental en geriatría conservar la función y evitar la progresión de cualquier dependencia, e incluyendo esto la administración de medicamentos, la intervención farmacéutica es una herramienta útil para detectar y corregir errores e incrementar la adherencia(AU)

Objective. To detect and analyse therapeutic non-compliance in the institutionalised elderly patient who self-administer their own treatment in a geriatric residence. To assess the pharmaceutical intervention with a useful tool to detect non-compliance. Material and methods. An observational study on a population of 386 residents. A clinical interview was conducted on those who treated themselves by the Pharmacy Department. An individual case report card was prepared to record demographic and clinical data, and incidents found). An interview was conducted on their treatment (drugs, dose, posology, indication and administration form), together with the compliance test validated by Morinsky-Green. Non-compliance was calculated by comparing the responses with the pharmacotherapeutic information from the Pharmacy Department and from the medical prescription of the medical charts. Results. Eleven per cent of patients administered their own treatment. Their mean age was 84years and all attended the interview, which detected a non-compliance of 41%. The compliance test only detected 55% of the non-compliers. The main errors were non-compliance to the time, incorrect dosage and not taking treatment when feeling better. There was 39% involuntary non-compliance. The cardiovascular system drug group was the most involved in errors. The error could have a clinically significant repercussion in 44% of the patients. Conclusions. The interview helped to detect and analyse non-compliance. The test, although specific, was not very sensitive. The main errors were easy to correct and there no problems of acceptance by the patients. With it being fundamental to preserve function and to prevent progression to dependence, and adding to this the administering of drugs, pharmaceutical intervention is a useful tool to detect and correct errors and increase adherence(AU)

Neuroethical issues in cognitive enhancement.

Neuroethics is a developing field, concerned with addressing present and future applied ethical issues brought about directly and indirectly by neuroscience advancements. One domain where neuroscience has begun to have far-reaching ethical implications is in the research and development of pharmaceutical cognitive enhancers. Though such drugs are typically developed to treat cognitive disabilities and improve the quality of life for patients with neuropsychiatric disorders and brain injury, research has found that such drugs can improve performance on cognitive tasks in healthy individuals. In line with such findings is the growing use of these drugs by students and others for cognitive-enhancing purposes. The present paper reviews some of the evidence in both neuropsychiatric and healthy individuals and discusses the implications such research can have for society.

Sistema de registro de las actuaciones profesionales demandadas en la Farmacia comunitaria / Registration system of professional performances defendants in Community Pharmacy

INTRODUCCION: El diseño de una herramienta o sistema de registro de todas las actuaciones profesionales (AP) quedemanda el usuario en la farmacia comunitaria, en el mostrador, donde el farmacéutico realiza lamayor parte de su labor, es imprescindible para entender la barrera de falta de "tiempo" para implantar o desarrollar servicios cognitivos en la farmacia comunitaria. MATERIAL Y METODO: El equipo investigador del estudio diseñó la herramienta de registro utilizando como soporte informático el sistema de gestión disponible en las farmacias participantes en el estudio(FARMATCR). Después de un pilotaje de 15 días y de los ajustes necesarios se creó la herramienta definitiva. Los requisitos básicos que se persiguieron para el diseño de la herramienta, fueron: Registrar todas las AP demandadas en el mostrador de la farmacia comunitaria. Recopilar la máxima información para cada una de las AP. Mantener la agilidad en la resolución de las mismas. Se decide hacer un control de calidad de la herramienta para saber si satisface las necesidades para lo que se ha diseñado. RESULTADO: herramienta FINAL. La herramienta consiste en la introducción en el sistema informático (FARMATCR,) de una serie de códigos de trabajo nuevos (artículos, aportaciones y desplegables). DISCUSION: Es difícil encontrar un equilibrio entre agilidad y rigor del registro. La herramienta es capaz de cuantificar las AP que se realizan en el mostrador, pero con limitaciones

INTRODUCCION: Designing a tool or registration system for all professional activities requested by all user over the counter in the community pharmacy, where the pharmacist conducts most of its work, is essential to enable the understanding of the barrier of "lack of time" in order to establish or develop cognitive services in the community pharmacy. METHOD: The research team working on this survey, designed the registered tool using the management system available in all pharmacies participants in the survey, as a computerized record (FARMATICR). The ultimate tool was created after 15 days of pile work and needed adjustments. The basic requirements pursued for the design of the tool were: The recording of all professional activities requested at the counter in pharmacies. The compiling of all information for each of the professional activities to maintain the flexibility in the resolutions of these. It was decided to have constant feedback of the quality of the tool to see if it met the requirements for its designed purpose. RESULTS: The tool is the introduction into the computer system (FARMATICR), of a series of new labor codes (articles, transfers and leaflets). DISCUSSION: It is difficult to find a balance between the speed and the inflexibility of the record. The tool is able to quantify the professional activities carried out in the pharmacy counter, but with its limitations