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2.
BMC Public Health ; 19(1): 1709, 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31856775

RESUMO

BACKGROUND: Misuse and dependency of opioids especially codeine-containing products is of increasing global concern. Inappropriate use of opioids among healthcare students could affect quality of service and ethical conducts of these future professionals, thereby putting the society at risk. This study aimed to evaluate knowledge and perception of medical and pharmacy students in a Nigerian tertiary University on use of opioids with focus on codeine-containing products. METHODS: A cross-sectional survey among 335-medical and 185-pharmacy students from University of Ibadan, Nigeria, between September and December 2018, using a self-administered semi-structured questionnaire. RESULTS: A total of 178 (34.2%) in multiple responses had used opioid-containing products among the respondents, of this, 171 (96.1%) used codeine-containing formulation. Precisely, 146 (28.1%) of the students had used codeine-containing products before, of this, 16 (11.0%) used the products for non-medical or recreational purpose regarded as a misuse/abuse. In all, 201 (38.7%) had good knowledge of opioid use, with 51 (34.9%) among those who had used opioids and 150 (40.1%) among those who had not used opioids (X2 = 1.186; p = 0.276). Majority (469; 90.2%) had good perception of risks associated with opioid use; comprising (130; 89.0%) among those who had taken opioids and (339; 90.6%) among those who had not taken opioids before (X2 = 0.304; p = 0.508). Logistic-regression shows that students who experienced some side effects to be experienced again 22.1 [AOR = 22.1, 95% CI: (5.98-81.72)] as well as those pressured into using codeine-containing products 10.6 [AOR = 10.6, 95% CI: (1.36-82.39)] had more tendency of misuse. CONCLUSION: There is a potential for misuse of codeine-containing products among medical and pharmacy students. Peer-influence and experience of some side effects are possible predictors of misuse among the students. Thus, healthcare students' curriculum should incorporate preventive programme, while public education and policy that favours peer-support programme on medication misuse is advocated for healthcare students.


Assuntos
Codeína/uso terapêutico , Uso Indevido de Medicamentos/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Estudantes de Medicina/psicologia , Estudantes de Farmácia/psicologia , Adolescente , Estudos Transversais , Feminino , Humanos , Masculino , Nigéria , Estudantes de Medicina/estatística & dados numéricos , Estudantes de Farmácia/estatística & dados numéricos , Inquéritos e Questionários , Universidades , Adulto Jovem
3.
PLoS One ; 14(12): e0226511, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31887163

RESUMO

INTRODUCTION: Multimorbidity in advanced age and the need for drug treatment may lead to polypharmacy, while pharmacokinetic and pharmacodynamic changes may increase the risk of adverse drug events (ADEs). OBJECTIVE: The aim of this study was to determine the proportion of subjects using potentially inappropriate medication (PIM) in a cohort of older and predominantly healthy adults in relation to polypharmacy and morbidity. METHODS: Cross-sectional data were available from 1,382 study participants (median age 69 years, IQR 67-71, 51.3% females) of the Berlin Aging Study II (BASE-II). PIM was classified according to the EU(7)-PIM and German PRISCUS (representing a subset of the former) list. Polypharmacy was defined as the concomitant use of at least five drugs. A morbidity index (MI) largely based on the Charlson Index was applied to evaluate the morbidity burden. RESULTS: Overall, 24.1% of the participants were affected by polypharmacy. On average, men used 2 (IQR 1-4) and women 3 drugs (IQR 1-5). According to PRISCUS and EU(7)-PIM, 5.9% and 22.6% of participants received at least one PIM, while use was significantly more prevalent in females (25.5%) compared to males (19.6%) considering EU(7)-PIM (p = 0.01). In addition, morbidity in males receiving PIM according to EU(7)-PIM was higher (median MI 1, IQR 1-3) compared to males without PIM use (median MI 1, IQR 0-2, p<0.001). CONCLUSION: PIM use occurred more frequently in women than in men, while it was associated with higher morbidity in males. As expected, EU(7)-PIM identifies more subjects as PIM users than the PRISCUS list but further studies are needed to investigate the differential impact of both lists on ADEs and outcome. KEY POINTS: We found PIM use to be associated with a higher number of regular medications and with increased morbidity. Additionally, we detected a higher prevalence of PIM use in females compared to males, suggesting that women and people needing intensive drug treatment are patient groups, who are particularly affected by PIM use.


Assuntos
Uso Indevido de Medicamentos/estatística & dados numéricos , Lista de Medicamentos Potencialmente Inapropriados/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos Transversais , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Polimedicação , Medicamentos sob Prescrição , Prevalência , Caracteres Sexuais , Adulto Jovem
4.
Rev Assoc Med Bras (1992) ; 65(6): 870-879, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31340319

RESUMO

This study aimed to assess the prevalence of medical and nonmedical use of psychiatric medication among undergraduate students of health sciences from a public university in Brasil. Another objective was to determine the frequency of nuclear morphological abnormalities in the buccal mucosa of students using psychiatric drugs. A cross-sectional study based on a Web survey was carried out with 375 health sciences undergraduate students from schools of Pharmacy, Physical Education, Nutrition, and Medicine. Additionally, spontaneous genetic damages in exfoliated cells of the buccal mucosa of 41 individuals by counting micronucleus (MN) and binucleated (BN) cells frequencies were evaluated. The results showed 76 (20.3%) of students reported the use of psychotropic drugs after enrolling in university. The majority of these students were from Pharmacy and Medicine programs, females, aged between 18-25 years old, nonsmokers, alcohol addicts, and with a family history of mental illness. In addition, Medical students, individuals with high-income, who live alone and are in the last period of the program are more likely to use psychotropic drugs. Moreover, exposure to psychiatric medication was able to increase the number of binucleated cells. These results provide evidence that the use of psychoactive drugs is increased in the academic context and may be related to the failure of the cell cycle.


Assuntos
Uso Indevido de Medicamentos/estatística & dados numéricos , Mucosa Bucal/efeitos dos fármacos , Mucosa Bucal/patologia , Psicotrópicos/uso terapêutico , Estudantes de Ciências da Saúde/estatística & dados numéricos , Adolescente , Adulto , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Testes para Micronúcleos , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários , Universidades , Adulto Jovem
5.
PLoS One ; 14(6): e0214779, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31242185

RESUMO

PURPOSE: Overuse and misuse of antibiotics are the primary risk factors for antibiotics resistance. Inadequate professional competence of primary care physicians might exacerbate these problems in China. This retrospective study aims to document the clinical pattern of antibiotics use and its overuse and misuse rates in rural primary care institutions and to evaluate the association between antibiotics use and characteristics of physicians and their patients. METHODS: Medical records from 16 primary care hospitals in rural areas of Guizhou province, China were obtained from the Health Information System in 2018. Classification of unnecessary use, incorrect spectrum of antibiotic, escalated use of extended spectrum and combined antibiotics use was based on the Guiding Principle of Clinical Use of Antibiotics (2015, China) and guidelines from the US Centers for Disease Control and Prevention. Generalized Estimating Equations were employed to determine predictive factors for inappropriate antibiotics use. RESULTS: A total of 74,648 antibiotics prescriptions were retrieved. Uncomplicated respiratory infection was the most common disease accounting for 58.6% of all prescriptions. The main antibiotic group used was penicillins (51.5%) followed by cephalosporins and macrolides (14% each). Of 57,009 patient visits, only 8.7% of the antibiotic prescriptions were appropriate. Combined use, escalated use of extended spectrum antibiotics, incorrect spectrum and unnecessary antibiotics use was found in 7.8%, 1.9%, 4.3% and 77.3% of patient visits, respectively, of which 28.7% were given intravenously. Antibiotics misuse was significantly more likely among newly employed physicians with lower levels of professional education. Adult patients and those who had public insurance had a higher risk of being prescribed unnecessary antibiotics. CONCLUSION: Overuse of antibiotics for uncomplicated respiratory infection and use of cephalosporins, macrolides and injection antibiotics in primary care are the major problems of clinical practice in rural areas of Guizhou.


Assuntos
Antibacterianos/uso terapêutico , Uso Indevido de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica , Infecções Respiratórias/tratamento farmacológico , Adulto , Idoso , China , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde , Estudos Retrospectivos , População Rural
6.
Psychol Health ; 34(9): 1105-1139, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31177850

RESUMO

Objective: To provide a broad overview of the state of drug misuse research, particularly focusing on opioid drug use in the U.S.A. Design: An overview of published reviews of the literature. Results: Prescription opioid use has increased globally from 2008 to 2013, while use of opiates such as heroin and opium have remained stable in many countries, although, decreases have been observed in parts of Europe. Opioid misuse is highest in the United States; approximately 11.8 million Americans misused opioids in 2016. Demographic, genetic, psychosocial and structural/environmental factors all play a role in determining who will become an opioid misuser. Strategies such as increased prescribing of non-opioid derived pain relievers, expansion of medication treatment, distribution of naloxone for overdose reversal and supervised consumption sites are some of the solutions posed to reduce the spread and consequences of opioid misuse. Conclusion: Research focused on understanding of opioid neurobiology, as well as empirically based, effective alternatives to pain management and implementation studies on combined prevention and treatment approaches are needed. It will take the combined effort of community members, healthcare professionals, policymakers and researchers in order to prevent and treat opioid misuse.


Assuntos
Uso Indevido de Medicamentos , Transtornos Relacionados ao Uso de Opioides , Uso Indevido de Medicamentos/prevenção & controle , Uso Indevido de Medicamentos/estatística & dados numéricos , Avaliação do Impacto na Saúde , Humanos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Estados Unidos/epidemiologia
7.
Health Serv Res ; 54(6): 1283-1294, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31172520

RESUMO

OBJECTIVE: To understand public attitudes about and recommendations to address antibiotic overuse by employing public deliberation (a method for eliciting informed input on value-laden issues). DATA SOURCES/STUDY SETTING: Participants in 24 Community Deliberation groups (CD; n = 263), four Citizens' Panel groups (CP; n = 96), and a control group (n = 348). Data were collected in 2012 in four U.S. STUDY DESIGN: Using mixed methods, we analyzed quantitative and qualitative data from a randomized control trial. DATA COLLECTION/EXTRACTION METHODS: Using pre/postdeliberation surveys, we compared CD and CP participant attitude changes regarding antibiotic use to the control group. We analyzed deliberation transcripts using qualitative techniques to provide context for survey results. PRINCIPAL FINDINGS: Compared to control group participants, CD and CP participants had a larger postdeliberation shift in attitudes toward support of government limits on when doctors can prescribe antibiotics. Participants described unawareness about antibiotic overuse and called for education. When discussing prescription limits, participants debated tensions between preserving patient/doctor autonomy and protecting society from antibiotic-related harms. Participants saw patient, physician, and government roles in antibiotic stewardship policies/programs. CONCLUSION: When informed about individual and social consequences of antibiotic overuse, patients may be more receptive to antibiotic prescription limits. Community-physician-government partnerships are needed to create solutions.


Assuntos
Antibacterianos/uso terapêutico , Atitude Frente a Saúde , Uso Indevido de Medicamentos/psicologia , Uso Indevido de Medicamentos/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Alfabetização em Saúde/estatística & dados numéricos , Opinião Pública , Adulto , Tomada de Decisões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Inquéritos e Questionários , Estados Unidos
8.
Int J Occup Med Environ Health ; 32(4): 489-501, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31241049

RESUMO

OBJECTIVES: Many research studies conducted in various toxicology centers point to drugs as the most common cause of intoxication. Long-term observations make it possible to clarify the nature of these poisonings. The aim of this study was to examine the trends and reasons of intoxication in patients hospitalized over a 10-year observation period (2005-2015), as well as to compare the number of patients poisoned with nonsteroidal anti-inflammatory drugs (NSAIDs), mainly over-the-counter (OTC) drugs. MATERIAL AND METHODS: A retrospective observational study examined the medical documentation of patients hospitalized in the Department of Toxicology and Internal Diseases of the T. Marciniak Lower Silesian Specialist Hospital in Wroclaw in 2005-2015, including the analysis of the causes of intoxication as well as total poisoning-related death statistics. Quarterly and annual analyses of the numerical data, and comparisons of the frequency of poisonings were included. The patient population from the area of Lower Silesia, Poland, was examined. RESULTS: The number of hospitalized patients has increased, with attempted suicide being the leading cause of death. Male intoxication and mortality have been found to predominate. Drugs are the most common cause of poisoning, and among these the most common are sedatives and psychotropic drugs. Intoxication due to NSAIDs, especially OTC drugs, increased significantly in the observation period. In 2005 no fatal cases were reported as a result of NSAID intoxication, while in 2015 mortality significantly increased to 43%. CONCLUSIONS: The lack of a common trend in poisonings is observed but the number of hospitalized patients has increased, especially among young people, which is consistent with global trends. Drugs are the most common cause of mortality, and a significant increase in NSAID (mainly OTC) poisonings in particular indicates the growing prevalence of an uncontrolled use of these drugs. Int J Occup Med Environ Health. 2019;32(4):489-501.


Assuntos
Uso Indevido de Medicamentos/estatística & dados numéricos , Envenenamento/epidemiologia , Adolescente , Adulto , Anti-Inflamatórios não Esteroides/envenenamento , Uso Indevido de Medicamentos/mortalidade , Feminino , Humanos , Hipnóticos e Sedativos/envenenamento , Masculino , Pessoa de Meia-Idade , Envenenamento/mortalidade , Polônia/epidemiologia , Psicotrópicos/envenenamento , Estudos Retrospectivos , Suicídio/estatística & dados numéricos , Tentativa de Suicídio/estatística & dados numéricos , Xenobióticos/envenenamento
9.
J Infect Public Health ; 12(4): 460-464, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30981652

RESUMO

Both antimicrobial consumption and antimicrobial resistance are very high in Greece, ranking among the highest of Europe. The link between antimicrobial consumption and resistance is well-known. Here, we discuss the reasons of antimicrobial overuse in Greece in the community (such as self-medication, dispersion of antibiotics by pharmacies without prescription, over-prescription by physicians, patient expectations and liability pressure) and we explore the misuse of antibiotics for common community infections. Furthermore, we discuss how such overuse/misuse can drive antimicrobial resistance, using methicillin-resistance in Staphylococcus aureus as an example. S. aureus is one of the pathogens with high rates of resistance in Greece. Comparing the rate of antimicrobial susceptibility to non-beta lactams between methicillin-resistant and methicillin-sensitive S. aureus we highlight the antibiotics that have the potential to drive methicillin-resistance through co-selection. Based on the above we identify targets for intervention in order to reduce antimicrobial overuse/misuse in the community in Greece.


Assuntos
Uso Indevido de Medicamentos/estatística & dados numéricos , Farmacorresistência Bacteriana Múltipla , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Uso Excessivo de Medicamentos Prescritos/estatística & dados numéricos , Infecções Estafilocócicas/epidemiologia , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Grécia/epidemiologia , Humanos , Testes de Sensibilidade Microbiana , Saúde Pública , Infecções Estafilocócicas/tratamento farmacológico
10.
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.
Therapie ; 74(4): 469-476, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30857740

RESUMO

AIM OF THE STUDY: To provide a tool for drug misuse or potential misuse monitoring by using a healthcare insurance database. METHODS: A cross-sectional study repeated quarterly from 2007 to 2014 was conducted using data from a 1/97th random sample of the French national healthcare reimbursement system. For each drug studied, ad hoc indicators were designed to assess drug misuse, defined as prescriptions that did not comply with the label stipulated in the summary of product characteristics, in terms of the drug (e.g., interactions) or the patient (age, medical history). We focused on specifically identified situations of drug misuse involving non-steroidal anti-inflammatory drugs (NSAIDs), antiemetics in patients with Parkinson's disease and antipsychotics in pediatrics; we also focused on direct anticoagulants, asthma and oral antidiabetic drugs but results for these latter are only shown in supplementary materials. RESULTS: At-risk prescribing of NSAIDs in patients treated by diuretics or renin-angiotensin system inhibitors always remained higher than 14% over the study (maximum: 19%; 2014 quarter 4: 15.4%). Off-label prescribing of contraindicated anti-dopaminergic antiemetics with dopaminergic antiparkinson drugs was marginal (maximum: 2.2%; 2014 quarter 4: 0.5%) but represented at least 5.5% of antiemetic prescriptions. Despite the rise in antipsychotic prescriptions in pediatrics, no dramatic increase in misuse related to age was observed during the study period (2007 quarter 1: 16.1%; 2014 quarter 4: 11.1%). The highest degree of misuse was observed for aripiprazole and for second-generation antipsychotics other than risperidone and aripiprazole. CONCLUSION: This study provides a simple tool to monitor drug misuse or potential misuse using information from a health insurance database. The results highlight the need for the Regulator to rethink risk management information campaigns and to modify the official information on products.


Assuntos
Uso Indevido de Medicamentos/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Bases de Dados Factuais/estatística & dados numéricos , Monitoramento Epidemiológico , Feminino , França/epidemiologia , Pesquisas sobre Serviços de Saúde , Humanos , Revisão da Utilização de Seguros/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/normas , Adulto Jovem
12.
Int J Neuropsychopharmacol ; 22(4): 270-277, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30722037

RESUMO

BACKGROUND: Although originally marketed as safe alternatives to the habit-forming benzodiazepines, growing numbers of zaleplon, zolpidem, and zopiclone ("Z-drugs") clinical concerns relating to their potential of abuse, dependence, and withdrawal have been reported over time. We aimed here at assessing these issues analyzing datasets of adverse drug reactions provided by the European Medicines Agency through the EudraVigilance system. METHODS: Analyzing the adverse drug reactions databases of each Z-drug, descriptive analyses have been performed on cases and proportional reporting ratios (PRRs) computed. RESULTS: An overall number of 33 240 (e.g., 23 420 zolpidem; 9283 zopiclone; and 537 zaleplon) misuse-, abuse-, dependence-, and withdrawal-related adverse drug reactions, corresponding to some 6246 unique patients given Z-drugs, were here identified. Cases were studied and described, including demographic characteristics and clinical data such as concomitant drugs, doses, routes of administration, and outcomes of the reactions (being fatalities recorded). Considering PRR values and in comparison with zopiclone, zolpidem was more frequently involved in both misuse/abuse and withdrawal issues. Zolpidem and zopiclone presented with the same dependence risk, but zopiclone was most involved in overdose adverse drug reactions. Compared with zaleplon, zopiclone presented higher dependence and overdose-related issues but slightly lower misuse/abuse and withdrawal PRR values. CONCLUSION: Current data may only represent a gross underestimate of the real prevalence of Z-drug misuse. Caution should be exercised when prescribing those molecules, especially for patients with psychiatric illnesses and/or history of drug abuse. We recommend the need to invest in proactive pharmacovigilance activities to better and promptly detect, understand, and prevent any possible misuse potential of prescribed medications.


Assuntos
Acetamidas/efeitos adversos , Compostos Azabicíclicos/efeitos adversos , Uso Indevido de Medicamentos/estatística & dados numéricos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Hipnóticos e Sedativos/efeitos adversos , Farmacovigilância , Piperazinas/efeitos adversos , Pirimidinas/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Zolpidem/efeitos adversos , Adolescente , Adulto , Bases de Dados Factuais , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
13.
Artigo em Inglês | MEDLINE | ID: mdl-30691066

RESUMO

Massive misuse of antibiotics is one of the most important reasons for antimicrobial resistance (AMR). Misconceptions of antibiotics contribute to antibiotic misuse behaviors. This study aims to examine whether university students hold the misconception that Antibiotic is a Xiaoyanyao (literally means anti-inflammatory drug in Chinese), and association between this misconception and antibiotic misuse behaviors. A cross-sectional study was conducted among university students using the cluster random sampling method in six universities of six regions in China (one university per region). The Chi-square test was used to assess the relationship between the misconception and antibiotic misuse behaviors. Logistic regression was conducted to identify the risk factors for antibiotic misuse behaviors. 11,192 of university students completed the entire questionnaire. There were 3882 (34.7%) students who were considered to have the misconception. Female students were more likely to have the misconception compared with males (36.7% vs. 32.6%, P < 0.001). Those students with a background of social science/humanities were more likely to have the misconception compared with those from science and medicine (44.1% vs. 30.3% vs. 20.1%, P < 0.001). Students came from rural areas compared with those from urban areas (37.5% vs. 32.5%, P < 0.001) were more likely to have the misconception. Students who had the misconception were 1.51 (95% CI 1.21⁻1.89, P < 0.001) times, 1.34 (95% CI 1.21⁻1.48, P < 0.001) times, and 1.36 (95% CI 1.24⁻1.50, P < 0.001) times more likely to report self-medication, request to obtain antibiotics, and take antibiotics prophylactically than those who did not have this misconception, respectively. The high proportion of university students' misconception on Antibiotic is a Xiaoyanyao is worth more attention. Effective health education and interventions need to be promoted among university students and the whole population.


Assuntos
Antibacterianos , Uso Indevido de Medicamentos/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Estudantes/estatística & dados numéricos , Universidades , Adolescente , Anti-Inflamatórios , Grupo com Ancestrais do Continente Asiático , Distribuição de Qui-Quadrado , China , Estudos Transversais , Uso Indevido de Medicamentos/psicologia , Feminino , Humanos , Modelos Logísticos , Masculino , Fatores de Risco , Automedicação/estatística & dados numéricos , Ciências Sociais , Inquéritos e Questionários , Adulto Jovem
14.
Eur Addict Res ; 25(1): 10-19, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30625491

RESUMO

BACKGROUND: The act of intravenous misuse is common in patients under opioid maintenance treatment (OMT), but information on associated factors is still limited. OBJECTIVES: To explore factors associated with (a) intravenous OMT misuse, (b) repeated misuse, (c) emergency room (ER) admission, (d) misuse of different OMT types and (e) concurrent benzodiazepine misuse. METHODS: We recruited 3,620 patients in 27 addiction units in Italy and collected data on the self-reported rate of intravenous injection of methadone (MET), buprenorphine (BUP), BUP-naloxone (NLX), OMT dosage and type, experience of and reason for misuse, concurrent intravenous benzodiazepine misuse, pattern of -misuse in relation to admission to the addiction unit and ER -admissions because of misuse. According to inclusion/exclusion criteria, 2,585 patients were included. RESULTS: Intravenous misuse of OMT substances was found in 28% of patients with no difference between OMT types and was associated with gender, age, type of previous opioid abuse and intravenous benzodiazepine misuse. Repeated OMT misuse was reported by 20% (i.e., 71% of misusers) of patients and was associated with positive OMT misuse experience and intravenous benzodiazepine misuse. Admission to the ER because of misuse complications was reported by 34% of patients, this outcome being associated with gender, employment, type of previous opioid abuse and intravenous benzodiazepine misuse. OMT dosage was lower than the recommended maintenance dosage. CONCLUSIONS: We offered new information on factors associated with intravenous OMT misuse, repeated misuse and ER admission in Italian patients under OMT. Our data indicate that BUP-NLX misuse is not different from that of BUP or MET. Choosing the more expensive BUP-NLX over MET will likely not lead to the expected reduction of the risk of injection misuse of the OMT. Instead of prescribing new and expensive OMT formulations, addiction unit physicians and medical personnel should better focus on patient's features that are associated with a higher likelihood of misuse. Care should be paid to concurrent benzodiazepine and OMT misuse.


Assuntos
Combinação Buprenorfina e Naloxona/efeitos adversos , Buprenorfina/efeitos adversos , Uso Indevido de Medicamentos/estatística & dados numéricos , Metadona/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Administração Intravenosa , Adolescente , Adulto , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Benzodiazepinas/administração & dosagem , Benzodiazepinas/efeitos adversos , Buprenorfina/administração & dosagem , Combinação Buprenorfina e Naloxona/administração & dosagem , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Itália/epidemiologia , Masculino , Metadona/administração & dosagem , Pessoa de Meia-Idade , Tratamento de Substituição de Opiáceos/efeitos adversos , Fatores de Risco , Adulto Jovem
15.
Pain Med ; 20(1): 113-118, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29237039

RESUMO

Objective: The Current Opioid Misuse Measure (COMM) is a commonly used self-report instrument to identify and monitor aberrant opioid-related behavior in chronic pain patients on opioid therapy. However, the length of the COMM may limit its clinical utility. Additionally, this paper-and-pencil screener requires hand scoring, which increases paperwork and staff burden. Therefore, the current study presents development of the "COMM-9," a brief electronically administered form of the COMM. Methods: Patients (N = 517) with chronic noncancer pain on opioid therapy completed the COMM. Patients were classified as either being positive or negative for aberrant drug-related behavior based on self-report data from a structured interview, physician-report data, and urine toxicology screen (the Aberrant Drug Behavior Index [ADBI]). COMM items with the strongest classification accuracy were identified using the LASSO method as the selection criterion in conjunction with the leave-one-out cross-validation method as the stop criterion. A sub-set of patients (n=55) completed a second administration of the COMM one week later to evaluate test-retest reliability. Results: Nine items were identified before the selection criterion stopped, and logistic regression was utilized to predict probabilities of positive ADBI from the 9 COMM items using all data and the cross-validation procedure. Receiver operating characteristic curves revealed high levels of classification accuracy that were essentially equivalent to the full COMM. Cut-points were identified to classify patients as having no/low risk, moderate risk, and high risk for aberrant opioid-related behavior. Test-retest reliability of the COMM-9 was comparable to the full 17-item COMM. Conclusions: This study presents the successful development of a brief electronic screener to identify current aberrant opioid-related behavior in chronic pain patients on long-term opioid therapy.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Uso Indevido de Medicamentos/estatística & dados numéricos , Curva ROC , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Reprodutibilidade dos Testes , Medição de Risco/métodos , Autorrelato/estatística & dados numéricos
16.
Artigo em Inglês | MEDLINE | ID: mdl-30583571

RESUMO

The unnecessary use of antibiotics and concomitant rapid growth of antibiotic resistance (ABR) is a widely acknowledged threat to global health, development, and sustainability. While the underlying cause of ABR is undoubtedly the overall volume of antibiotic use in general, irrational antibiotic use, which is influenced by several interrelated factors, is a major contributory factor. Here, we aimed to present and describe selected main drivers of irrational use of antibiotics in Europe. We performed a broad search of the current literature in databases such as PubMed, Google Scholar, Cochrane, as well as various institutional websites (World Health Organization, European Observatory, European Commission) to provide a new perspective on selected drivers of irrational antibiotic use in Europe. We also searched for relevant literature using snowballing, i.e., using reference lists of papers to identify additional papers. In this narrative review, we present that major factors among the general public driving antibiotic resistance are lack of public knowledge and awareness, access to antibiotics without prescription and leftover antibiotics, and knowledge attitude and perception of prescribers and dispensers, inadequate medical training, pharmaceutical promotion, lack of rapid and sufficient diagnostic tests, and patient⁻doctor interaction as major factors among healthcare providers. We further discuss initiatives that, if taken and implemented, can have an impact on and improve the current situation in Europe.


Assuntos
Antibacterianos/uso terapêutico , Uso Indevido de Medicamentos/estatística & dados numéricos , Antibacterianos/efeitos adversos , Antibacterianos/farmacologia , Antibacterianos/provisão & distribução , Resistência Microbiana a Medicamentos/efeitos dos fármacos , Europa (Continente) , Saúde Global/estatística & dados numéricos , Saúde Global/tendências , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/educação , Pessoal de Saúde/psicologia , Humanos
17.
Sao Paulo Med J ; 136(5): 407-413, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30570092

RESUMO

BACKGROUND: The consumption of antibiotics has been widely discussed, mainly because of antibacterial resistance, which has become a worldwide concern. In Brazil, sale of antibiotics is currently ruled by Agência Nacional de Vigilância Sanitária (ANVISA) regulation RDC 20/2011, which restricts sales to those made under medical prescription. The aims of this study were to evaluate antibiotic use and associated factors among adults in the Metropolitan Region of Manaus, Amazonas, Brazil, and to assess the proportion of self-medication from this use. DESIGN AND SETTING: Population-based cross-sectional study conducted in the Metropolitan Region of Manaus between May and August 2015. METHODS: Adults aged ≥ 18 years were selected through probabilistic sampling in three stages. Trained interviewers collected data from the participants in their homes. Antibiotic consumption over the last 15 days was reported. Bivariate analysis was used to calculate the prevalence ratio (PR) of antibiotic usage, with 95% confidence interval (95% CI). A multivariate model adjusted according to significant variables at P ≤ 0.20 using Poisson regression with robust variance was constructed. RESULTS: The prevalence of antibiotic use was 3.4% (95% CI 2.8-4.0%). Adjusted analysis showed that consumption was higher among women than among men (PR 1.58; 95% CI 1.11-2.24) and among people with fair health status than among those with good health (PR 1.52; 95% CI 1.08-2.15). The prevalence of self-medication was 19.0%; amoxicillin was the most self-medicated antibiotic (10/26). CONCLUSION: Antibiotic use was associated with women and individuals with fair health status. One fifth of the antibiotics were consumed through self-medication, contrary to the current Brazilian legislation.


Assuntos
Antibacterianos/uso terapêutico , Automedicação/estatística & dados numéricos , Adulto , Distribuição por Idade , Brasil , Estudos Transversais , Uso Indevido de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Distribuição por Sexo , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
18.
Rev Bras Epidemiol ; 21(suppl 1): e180011, 2018 Nov 29.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30517462

RESUMO

INTRODUCTION: This study aimed to analyze the association between nutritional status, body image perception, and extreme weight control behaviors among adolescents. METHODS: This is an analytical cross-sectional study conducted in Brazil based on the National Adolescent Student Health Survey (Pesquisa Nacional de Saúde do Escolar - PeNSE) of 2015, with adolescents aged 13 to 17 years. Nutritional status and body image perception were the independent variables. The two dependent variables were vomiting or laxative use and use of medicines and other formulas for weight control in the 30 days prior to data collection. We used Poisson regression models for association, with demographic variables for control. RESULTS: 7.4% of adolescents (95%CI 6.7 - 8.2) reported vomiting or using laxatives, with no difference between genders. The prevalence of use of medicines and formulas was higher among boys (7.8%; 95%CI 6.6 - 8.9). The association between nutritional status and extreme behaviors was not significant. However, the prevalence of vomiting or laxative use for adolescents who considered themselves very fat was 2.3 (95%CI 1.1 - 4.7) times higher for boys and 5.3 (95%CI 3.3 - 8.6) times higher for girls, while the use of medicines and formulas was 4.0 (95%CI 2.3 - 7.1) times higher for girls who considered themselves very fat. CONCLUSION: Body image perception seems to have a greater influence on extreme behaviors than nutritional status. Strategies involving health services and schools have great potential to impact the self-esteem and health of students positively.


Assuntos
Comportamento do Adolescente/psicologia , Imagem Corporal/psicologia , Inquéritos Epidemiológicos/estatística & dados numéricos , Estado Nutricional , Adolescente , Atitude Frente a Saúde , Estudos Transversais , Uso Indevido de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Laxantes/administração & dosagem , Masculino , Instituições Acadêmicas , Distribuição por Sexo , Fatores Socioeconômicos , Vômito/epidemiologia , Perda de Peso , Percepção de Peso
19.
Dis Mon ; 64(10): 451-466, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30236900

RESUMO

Patients experiencing a terminal drug related event reflect a sentinel event. If this pharmacotherapy is a widely used agent, it may be viewed as a catastrophic problem. If patients are dying from illegal drug use when the medical establishment fails them by withdrawing or minimizing their medically prescribed medication, then the burden rests with their health care providers, legislation, and insurance carriers to actively participate in a collegial fashion to achieve parity. Causing a decay in functionality in previously functional patients, may occur with appropriately prescribed opioid medications addressing non-cancer pain when withdrawing or diminishing either with or without patient consent. The members of the medical profession have diminished their prescribing of opioids for their patients out of apparent fear of reprisal, state or federal government sanctions, and other concerned groups. Diminishing former dosages or deleting the opioid medication, preferably in concert with the patient, often results in inequitable patient care. Enforcing sanctioned decreases or ceasing to prescribe from their former required/established opioid medications precipitate patient discord. In absence of opioid misuse, abuse, diversion or addiction based upon medical "guidelines" and with a poor foundation of Evidence Based Medicine the CDC guidelines, it may be masked as a true guideline reflecting a decrement of clinical judgment, wisdom, and compassion. This article also discusses the role of pharmacy chains, insurance carriers, and their pharmacy benefit managers (PBMs) contribution to this multidimensional problem. There may be a potential solution, identified in this paper, if all the associated political, medical and insurance groups work cohesively to improve patient care. This article and the CDC guidelines are not focused at hospice, palliative, end of life care pain management.


Assuntos
Analgésicos Opioides/efeitos adversos , Analgésicos/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/mortalidade , Analgésicos/uso terapêutico , Analgésicos Opioides/uso terapêutico , Indústria Farmacêutica/economia , Uso Indevido de Medicamentos/mortalidade , Uso Indevido de Medicamentos/estatística & dados numéricos , Overdose de Drogas/epidemiologia , Overdose de Drogas/mortalidade , Medicina Baseada em Evidências/legislação & jurisprudência , Feminino , Pessoal de Saúde/legislação & jurisprudência , Humanos , Seguro Saúde/economia , Seguro Saúde/legislação & jurisprudência , Seguro Saúde/estatística & dados numéricos , Masculino , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Guias de Prática Clínica como Assunto/normas , Estados Unidos/epidemiologia
20.
Pak J Pharm Sci ; 31(4(Special)): 1701-1705, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30203766

RESUMO

With the popularization and application of antiseptic drugs, the abuse of antiseptic drugs and various unreasonable applications have also become a serious medical problem. The prescriptions of antibiotics in our hospital were randomly selected for statistical analysis. Further, we analyzed the various situations of the use of antibiotics in outpatient department, and calculated the DDDs of different drugs based on the defined daily dose (DDD). The results showed that there were 403 unreasonable prescriptions, accounting for 24.9% of the drug prescriptions. The main problems of irrational prescriptions were unsuitable drugs, non indications and improper frequency of administration, which accounted for 27.1%, 21.3% and 18.3%. It is suggested that the quality department of the hospital should strengthen the special training for rational use of antimicrobial agents, intervene in time and effectively, and gradually change post evaluation into prevention and intervention in advance.


Assuntos
Anti-Infecciosos Locais/uso terapêutico , Uso Indevido de Medicamentos/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Ambulatório Hospitalar/estatística & dados numéricos , Humanos
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