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2.
Sci Rep ; 10(1): 5639, 2020 03 27.
Artigo em Inglês | MEDLINE | ID: mdl-32221405

RESUMO

Addressing social determinants of tuberculosis (TB) is essential to achieve elimination, including in low-incidence settings. We measured the association between socio-economic status and intermediate social determinants of health (SDHs, including drug misuse, tobacco smoking and alcohol), and TB, taking into account their clustering in individuals. We conducted a case-control study in 23-38 years old UK-born White adults with first tuberculosis episode, and randomly selected age and sex frequency-matched community controls. Data was collected on education, household overcrowding, tobacco smoking, alcohol and drugs use, and history of homelessness and prison. Analyses were done using logistic regression models, informed by a formal theoretical causal framework (Directed Acyclic Graph). 681 TB cases and 1183 controls were recruited. Tuberculosis odds were four times higher in subjects with education below GCSE O-levels, compared to higher education (OR = 3.94; 95%CI: 2.74, 5.67), after adjusting for other TB risk factors (age, sex, BCG-vaccination and stays ≥3 months in Africa/Asia). When simultaneously accounting for respective SDHs, higher tuberculosis risk was independently associated with tobacco smoking, drugs use (especially injectable drugs OR = 5.67; 95%CI: 2.68, 11.98), homelessness and area-level deprivation. Population Attributable Fraction estimates suggested that tobacco and class-A drug use were, respectively, responsible for 18% and 15% of TB cases in this group. Our findings suggest that socio-economic deprivation remains a driver of tuberculosis in England, including through drugs misuse, tobacco smoking, and homelessness. These findings further support the integration of health and social services in high-risk young adults to improve TB control efforts.


Assuntos
Uso Indevido de Medicamentos/efeitos adversos , Etanol/efeitos adversos , Fumar/efeitos adversos , Determinantes Sociais da Saúde/estatística & dados numéricos , Fumar Tabaco/efeitos adversos , Tuberculose/epidemiologia , Tuberculose/etiologia , Adulto , Estudos de Casos e Controles , Usuários de Drogas/estatística & dados numéricos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Reino Unido/epidemiologia
4.
Physiol Res ; 68(Suppl 1): S31-S38, 2019 11 22.
Artigo em Inglês | MEDLINE | ID: mdl-31755288

RESUMO

Although the risks of medication poisoning in children are often reported, there is a lack of studies addressing this issue. The majority of papers deal with a wide range of xenobiotics poisoning and, in particular, alcohol intoxications. All hospital admissions during three years were prospectively recorded. Patients younger than 19 years of age admitted for acute drug intoxications were further evaluated. A total of 15,069 children were admitted. Of them, 55 were hospitalized for acute medication poisoning. The condition was more common in girls (72.7 % vs. 27.3 %, p<0.01). Toddlers were the largest patient group (36.4 %). Non-steroidal anti-inflammatory drugs (NSAIDs) were the most frequently used agents, with ibuprofen being the leading drug (20 % of all cases). The route of intoxication was almost exclusively oral. Solid drug forms were involved in 40 (72.7 %) cases. There was one fatal accidental poisoning. The highest occurrence of accidental drug intoxications was in the age group from one to three years. Attempted suicides were most frequent among adolescents. We are currently actively dealing with the issue. The cohort has been expanded to include a period of ten years and is being analyzed.


Assuntos
Hospitalização/estatística & dados numéricos , Envenenamento/epidemiologia , Adolescente , Criança , Pré-Escolar , Uso Indevido de Medicamentos/efeitos adversos , Uso Indevido de Medicamentos/estatística & dados numéricos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Medicamentos sob Prescrição/envenenamento , Estudos Prospectivos , Tentativa de Suicídio/estatística & dados numéricos
5.
Indian J Ophthalmol ; 67(10): 1650-1655, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31546501

RESUMO

Purpose: To know the pattern of presentations and management outcome of steroid induced glaucoma in vernal keratoconjunctivitis (VKC). Methods: Children of VKC using steroid with two of the following criteria were enrolled: Intraocular pressure (IOP) >21 mm Hg, glaucomatous optic disc and visual field defects. Misused topical steroids were classified in 4 groups; A- Highly potent drugs (dexamethasone, betamethasone), B- Moderate (prednisolone), C- Weak (loteprednol, fluorometholone), D- Unknown drugs. Active/conservative interventions were done to control IOP. Corrected distance visual acuity (CDVA), IOP, anterior segment and fundus examinations were noted. One-way ANOVA test and post hoc Tukey HSD test were used to compare the groups. Results: Out of 1423 VKC patients, 240 were using topical steroid without prescriptions. 92 eyes of 47 patients had steroid induced glaucoma. Hence prevalence of this complication was 3.30% in this study population. Mean age was 14.1 ± 3.8 years. Mean IOP was 38 ± 12 mm of Hg and mean vertical cup disc ratio was 0.67 ± 0.25. IOP was controlled by withdrawal of steroids (9 eyes), with antiglaucoma medications (27), trabeculectomy (57) and glaucoma drainage device (1). Mean CDVA at presentation was better in group C (0.23 log MAR). Mean IOP was highest in group A (43.1 mm Hg) followed by group D (40.5 mm Hg). At presentation 17 were blind (CDVA <3/60). Post treatment marginal improvement in CDVA was found (P = 0.46). However, statistically significantly improvement was noticed in IOP (P < 0.00001). Conclusion: Injudicious use of steroids leads to vision threatening complications like ocular hypertension and glaucoma in children of VKC. Weak steroids like loteprednol or fluorometholone should be used instead of higher potency drugs. Vision and IOP should be monitored fortnightly in children using topical steroids to detect steroid responders at the earliest.


Assuntos
Conjuntivite Alérgica/tratamento farmacológico , Avaliação da Deficiência , Uso Indevido de Medicamentos/efeitos adversos , Glaucoma/induzido quimicamente , Glucocorticoides/efeitos adversos , Saúde Pública , Acuidade Visual , Adolescente , Criança , Pré-Escolar , Conjuntivite Alérgica/epidemiologia , Conjuntivite Alérgica/reabilitação , Feminino , Glaucoma/epidemiologia , Glaucoma/fisiopatologia , Glucocorticoides/uso terapêutico , Humanos , Incidência , Índia/epidemiologia , Pressão Intraocular/fisiologia , Masculino , Estudos Retrospectivos , População Rural
9.
PLoS One ; 14(2): e0212875, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30818373

RESUMO

Benefits of antibiotics are threatened by the self-medication, people's lack of knowledge and inappropriate use of antibiotics, especially in developing countries. This study was designed to determine knowledge; attitudes and practices toward antibiotics use in an urban community, and evaluate the factors that are associated with antibiotic use. Between January and March 2015, a cross sectional and prospective study was conducted in all pharmacies within the Douala IV health district, Cameroon. Anonymous interviews including both open and closed ended questions were conducted in participants selected by convenience sampling Descriptive and logistic regression analysis were performed using StataSE11 software (version 11 SE) and R software (version 3.1.1) in data analysis. Overall 402 (33.7%) of 1,192 customers purchased antibiotics and of these, 47% bought antibiotics without a prescription. 60.7% of purchased antibiotics was for adult 'patients and around 60% of parents carried out self-medication on their children. The vast majority reported that all microbes can be treated with antibiotics (88.3%). The belief that antibiotics are appropriate for bacterial infections was more common among those with a higher level education (OR = 4.03, 95%CI:1.89-8.57, p<0.0001) and among public/private servants (OR = 2.47, 95%CI:1.21-5.08, p = 0.013). Physicians provide less explanations about antibiotics are and their potential side effects than the pharmacy auxiliaries (OR = 0.205, 95%CI = 0.09-0.46, p<0.0001), but more than pharmacists (OR = 3.692, 95%CI:1.44-9.25, p = 0.005). Indications on antibiotics use were 7 times more given to customers with a prescription compared to those without a prescription (OR = 7.37, 95% CI = 2.13-25.43, p = 0.002). Adult male (OR = 2.32, 95%CI:1.24-4.34, p = 0.009) and higher education (OR = 2.05, 95%CI:1.08-3.89, p = 0.027) were significantly associated with self-medication. Misuse, little "practical knowledge" and high self-medication confirm the unsatisfactory prescription and dispensing practices of the antibiotics in our country. These results highlight the important of the development and implementation appropriate guidelines for the responsible use of antibiotics for health care providers and health education targeting community members themselves.


Assuntos
Antibacterianos/uso terapêutico , Conhecimentos, Atitudes e Prática em Saúde , Farmácias , Automedicação , Adolescente , Adulto , Idoso , Antibacterianos/efeitos adversos , Camarões , Criança , Estudos Transversais , Uso Indevido de Medicamentos/efeitos adversos , Uso Indevido de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Uso Indevido de Medicamentos sob Prescrição/efeitos adversos , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Estudos Prospectivos , Automedicação/efeitos adversos , Automedicação/estatística & dados numéricos , Inquéritos e Questionários
11.
Forensic Sci Med Pathol ; 15(3): 502-505, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30632013

RESUMO

We report the case of a 34-year-old woman who died after presenting to hospital with a 2-month history of vomiting, abdominal pain and diarrhea. Subsequent inquiries revealed that she had a history of non-steroidal anti-inflammatory drug (NSAID) abuse, and the autopsy revealed stricture formation consistent with being caused by NSAID enteropathy.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Constrição Patológica/patologia , Enteropatias/induzido quimicamente , Obstrução Intestinal/patologia , Adulto , Constrição Patológica/induzido quimicamente , Uso Indevido de Medicamentos/efeitos adversos , Evolução Fatal , Feminino , Humanos , Obstrução Intestinal/etiologia
12.
Int J Geriatr Psychiatry ; 34(1): 122-129, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30328160

RESUMO

OBJECTIVES: Suicide in older adults is a major public health issue. Past research across the US adult population has linked prescription medication misuse with suicidal ideation. No work has evaluated associations between prescription opioid or benzodiazepine misuse and suicidal ideation in older adults, and this work aimed to address that gap. METHODS/DESIGN: Data were from adults 50 years and older participating in the 2015 to 2016 National Survey on Drug Use and Health (n = 17 608). Design-based logistic regression evaluated links between any past-year prescription opioid or benzodiazepine use without misuse or prescription misuse and past-year suicidal ideation, after controlling for sociodemographic, physical health, mental health, and substance use correlates associated with suicidal ideation. RESULTS: After controlling for all correlates, past-year use without misuse of prescription opioids or benzodiazepines was not associated with past-year suicidal ideation in older adults. In contrast, past-year opioid misuse (AOR = 1.84, 95% CI = 1.07-3.19) and benzodiazepine misuse (AOR = 2.00, 95% CI = 1.01-3.94) were significantly associated with past-year suicidal ideation, even after controlling for all covariates. While 2.2% of US older adults not engaged in either opioid or benzodiazepine misuse reported past-year suicidal ideation, 25.4% of those who misused both medication classes endorsed such suicidality (AOR = 4.73, 95% CI = 2.07-10.79). CONCLUSIONS: Both past-year prescription opioid and benzodiazepine misuse are associated with past-year suicidal ideation in US older adults. Clinicians encountering older adult patients at-risk for or engaged in prescription medication misuse also should screen for suicidality.


Assuntos
Analgésicos Opioides/uso terapêutico , Benzodiazepinas/uso terapêutico , Uso Indevido de Medicamentos/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Ideação Suicida , Suicídio/psicologia , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade
13.
Fundam Clin Pharmacol ; 33(2): 216-222, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30289178

RESUMO

The principal outcome was to identify which hypnotics substances, medicated (benzodiazepines, antihistamine, antidepressant…) or not medicated (herbal medicine, homeopathy, melatonin…), were consumed by community pharmacy patients who reported taking something for sleep disorder, and which factors can influence the consumption of medicated substance rather than nonmedicated substance. Data were collected via a network of 73 partner pharmacies around Nantes, France. Patients who reported taking a substance to sleep completed a questionnaire that collected data relative to the different substances consumed by that person for sleep, and the desired effect. Substances were classified in Hypnotic Drug Substances and nonmedicated hypnotic substances. A logistical regression was done in order to highlight the factors associated with the consumption of Hypnotic Drug Substance rather than nonmedicated hypnotic substances. Six hundred and forty-seven patients were included, with an average age of 58 years and 74% female. The principal strategy employed to combat sleep disorder was the consumption of Hypnotic Drug Substance (54%), followed by herbal medicine (32%) and homeopathy (19%). The factors positively associated with the consumption of a Hypnotic Drug Substance are age, living alone, being out of work, or in the process of looking for a job and being a parent. In our survey, the use of Hypnotic Drug Substance to help patients with sleep is far from systematic. On the other hand, among patients who consume HDS, misuse is still significant, particularly in terms of the duration of consumption.


Assuntos
Serviços Comunitários de Farmácia , Uso Indevido de Medicamentos , Hipnóticos e Sedativos/uso terapêutico , Medicamentos sem Prescrição/uso terapêutico , Preparações de Plantas/uso terapêutico , Medicamentos sob Prescrição/uso terapêutico , Transtornos do Sono-Vigília/tratamento farmacológico , Sono/efeitos dos fármacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Uso Indevido de Medicamentos/efeitos adversos , Feminino , França/epidemiologia , Humanos , Hipnóticos e Sedativos/efeitos adversos , Masculino , Pessoa de Meia-Idade , Medicamentos sem Prescrição/efeitos adversos , Preparações de Plantas/efeitos adversos , Uso Indevido de Medicamentos sob Prescrição/efeitos adversos , Medicamentos sob Prescrição/efeitos adversos , Medição de Risco , Fatores de Risco , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/fisiopatologia , Adulto Jovem
15.
Ir J Psychol Med ; 35(4): 275-288, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30501666

RESUMO

OBJECTIVES: Global concern around over the counter availability of codeine containing products and risk of misuse, dependence and related harms are evident. A phenomenological study of lived experiences of codeine misuse and dependence was undertaken in Ireland, following the Pharmaceutical Society of Ireland's 2010 guidelines for restricted supply of non-prescription codeine containing products. METHODS: In-depth interviews were conducted with a purposive sample of adult codeine misusers and dependents (n=21), both actively using, in treatment and in recovery. The narratives were analysed using the Empirical Phenomenological Psychological five-step method (Karlsson, 1995). A total of 10 themes with 82 categories were identified. Two concepts at a higher level of abstraction above the theme-level emerged during the final stage of analysis. The concepts identified were 'emotional pain and user self-legitimization of use' and 'entrapment into habit-forming and invisible dependent use'. These concepts were reported in different ways by a majority of participants. RESULTS: Findings are presented under the following themes: (1) profile and product preferences; (2) awareness of habit forming use and harm; (3) negotiating pharmacy sales; (4) alternative sourcing routes; (5) the codeine feeling; (6) the daily routine; (7) acute and chronic side effects; (8) social isolation; (9) withdrawal and dependence and (10) help-seeking and treatment experiences. CONCLUSIONS: There is a public health and regulatory imperative to develop proactive responses tackling public availability of codeine containing medicines, risk minimisation in consumer self-treatment for pain, enhanced patient awareness of potential for habit forming use and its consequences and continued health professional pharmacovigilence.


Assuntos
Analgésicos Opioides/efeitos adversos , Codeína/efeitos adversos , Uso Indevido de Medicamentos/efeitos adversos , Dor/tratamento farmacológico , Adulto , Conscientização , Feminino , Humanos , Entrevistas como Assunto , Irlanda , Masculino , Inquéritos e Questionários
17.
Rev. cient. Esc. Univ. Cienc. Salud ; 5(1): 41-49, ene.-jun. 2018. tab
Artigo em Espanhol | LILACS | ID: biblio-979935

RESUMO

Diclofenaco es un fármaco de variado uso por su libre venta en todos los países. Es un derivado de fenil-acético con propiedades analgésicas, antiinflamatorias y antipiréti-cas, debido a su mecánismo de acción: inhi-bición de las ciclooxigenasas con mediana selectividad hacia la ciclooxigenasa. Su principal indicación es para dolor de leve a moderado. El tiempo de uso del diclofenaco dependerá de la forma y objetivo de aplica-ción; los efectos adversos están estrecha-mente relacionados con el tiempo de uso y la idiosincrasia de cada persona. Algunas de las consecuencias destacables se manifies-tan en el sistema gastrointestinal, hematoló-gico, hepático, cardiaco, renal, sistema nervioso central y piel. El uso prescrito del diclofenaco, es de 3 - 5 días y se relaciona con la inducción de dispepsia, esofagitis, náuseas, vómitos, cefaleas e hipercoagula-bilidad, mientras que el uso crónico, alrede-dor de 90 días, puede inducir el desarrollo de hipertensión arterial, accidente cerebro vascular, infarto agudo al miocardio, hepati-tis fulminante, hemorragias gástricas, úlce-ras pépticas, fallo renal agudo, entre otras. El síndrome de Steven-Johnson y la necró-lisis epidérmica tóxica, son reacciones de hipersensibilidad relacionados con el tiempo de uso de este fármaco. Entre otros efectos del diclofenaco encontramos el bloqueo de los canales de sodio, calcio y potasio depen-dientes de voltaje, mecanismo por el cual causa analgesia sin la inhibición de la forma ción de prostaglandinas...(AU)


Assuntos
Humanos , Diclofenaco/efeitos adversos , Acidente Vascular Cerebral/complicações , Pressão Arterial/efeitos dos fármacos , Uso Indevido de Medicamentos/efeitos adversos
19.
Br J Clin Pharmacol ; 84(6): 1121-1127, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29498758

RESUMO

Vitamin D is a particularly important sterol hormone, with evidence emerging of its beneficial effects well beyond bone. In consequence of this and increased global recognition of vitamin D deficiency in the general population, there has been a resurgence in treatment with vitamin D preparations. However, the increasing use of vitamin D treatments has also seen a substantial increase in the number of reports of vitamin D intoxication, with the majority (75%) of reports published since 2010. Many of these cases are a consequence of inappropriate prescribing, and the use of high-dose over-the-counter preparations or unlicensed preparations. This review highlights that the majority of cases were preventable and discusses the inappropriate use of poorly formulated, and unlicensed vitamin D preparations.


Assuntos
Suplementos Nutricionais , Uso Indevido de Medicamentos/efeitos adversos , Prescrição Inadequada/efeitos adversos , Medicamentos sem Prescrição/efeitos adversos , Deficiência de Vitamina D/tratamento farmacológico , Vitamina D/efeitos adversos , Suplementos Nutricionais/efeitos adversos , Relação Dose-Resposta a Droga , Composição de Medicamentos , Humanos , Medição de Risco , Fatores de Risco , Vitamina D/administração & dosagem , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico
20.
Curr Opin Pediatr ; 30(3): 430-437, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29538047

RESUMO

PURPOSE OF REVIEW: Given the pervasiveness of psychotropic medication in the youth population and an increasingly competitive culture regarding educational performance, children, teenagers, and/or their parents may increasingly seek psychotropic substances in an effort to enhance a student's cognitive abilities and/or academic performance. Physicians must become aware of this very important and clinically relevant issue and work to ensure that medications remain in the hands of patients seeking wellness and not enhancement. RECENT FINDINGS: The current article highlights findings on the pervasiveness of stimulant misuse and diversion in youth, the motivations and effects of stimulant use, health and legal consequences associated with use, and physician perceptions and preventive practices. Ethical concerns regarding pharmacological cognitive enhancement in pediatrics are also outlined - including coercion for nonusers, inequities in access, and threats to an individual's sense of self with regard to authenticity and autonomy. SUMMARY: Pharmacological cognitive enhancement in pediatrics will become a larger, clinically relevant issue in the coming years. Physicians who care for children and adolescents must become more aware of this issue. Given the myriad health, legal, and ethical concerns, clinicians should discourage use of pharmaceuticals for enhancement purposes in the pediatric population.


Assuntos
Desempenho Acadêmico , Uso Indevido de Medicamentos , Sobremedicalização , Nootrópicos , Pediatria , Papel do Médico , Padrões de Prática Médica , Adolescente , Comportamento do Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Criança , Comportamento Infantil , Comportamento Competitivo , Uso Indevido de Medicamentos/efeitos adversos , Uso Indevido de Medicamentos/ética , Uso Indevido de Medicamentos/legislação & jurisprudência , Uso Indevido de Medicamentos/prevenção & controle , Humanos , Sobremedicalização/legislação & jurisprudência , Sobremedicalização/prevenção & controle , Nootrópicos/efeitos adversos , Nootrópicos/uso terapêutico , Pediatria/ética , Pediatria/legislação & jurisprudência , Padrões de Prática Médica/ética , Padrões de Prática Médica/legislação & jurisprudência , Estados Unidos
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