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Abstract Introduction Self-medication, particularly for oral and dental health problems, stands as a significant health and social concern. Therefore, the current systematic review and meta-analysis study was conducted to evaluate the prevalence and underlying causes of self-medication for oral and dental health problems. Method Articles published until August 30, 2023, were searched in Scopus, PubMed, and Web of Science databases. A manual search was also done in Google Scholar, references, citations, and Gray literature. The screening of articles was done independently by two members of the research team. The quality of reporting in the articles was evaluated using the JBI Critical Appraisal Checklist For Analytical Cross-Sectional Studies. Meta-analysis was performed using the fixed effects model in Stata software (StataCorp, version 16). Results The results of 37 studies involving 12,110 participants with a mean age of 32 years and 48% male were analyzed. Most of the studies were conducted in low- and middle-income countries. The overall prevalence of self-medication was estimated at 59% [95%CI: 55–63%], with 58% [95% CI: 53–63%] among dental patients, and 60% [95% CI: 52–67%] in the general public. Analgesics (60%) and antibiotics (19%) were the most commonly used drug categories. In terms of the mean proportion, having previous experience, unbearable pain, and lack of time had the highest percentages, and in terms of the number of repetitions among the reviewed articles, economic problems, lack of time, and limited access were the most repeated reasons. The most significant related factors in self-treatment were female gender, higher education, and occupation. Pharmacies were the primary source of self-treatment medications. Conclusion The results showed a very high prevalence of self-medication for oral health problems, necessitating prompt and effective interventions. It is recommended to focus on regulating the consumption of analgesics and antibiotics, addressing financial issues, and overseeing the pharmacy operations.

Abstract Background Antimicrobial resistance (AMR) poses a significant global health threat, particularly in low- and middle-income countries (LMICs). Self-treatment with antibiotics, the practice of using antibiotics without professional guidance, is often considered an important contributor to the emergence and spread of AMR. Method This study investigated the drivers of self-treatment in three common types of agricultural communities in northern Tanzania. The research employed a comprehensive array of methods, including cross-sectional surveys (n = 790), interviews (n = 30) and observations (n = 178) targeting both antibiotic (human and animal) providers and users (patients and farmers). Qualitative interview data were analysed using a coding and association matrix, while descriptive analyses were performed on survey and observation data. Results Self-treatment with antibiotics was highly prevalent in all communities. Between 41.0% (self-reported) and 60.3% (observed) of human antibiotics were obtained without a prescription and we observed that veterinary antibiotics were regularly purchased in retail shops without referral by a professional. Structural deficiencies in the healthcare system drove this practice: limited access to healthcare facilities, medication stockouts and prolonged waiting times were identified as key factors. The absence of safety nets like insurance schemes further contributed to self-medication. Retail shops offered a convenient and cost-effective alternative when antibiotics were inaccessible or unaffordable. Notably, informal networks comprising treatment vendors, friends or neighbours, as well as personal experiences played a crucial role in guiding individuals in their self-treatment decisions by providing advice on treatment choice and modalities. Conclusions Addressing self-treatment requires a multi-faceted approach. Improving the availability and accessibility of antibiotics, enhancing healthcare services and involving retail vendors in antibiotic stewardship are essential. Structural issues like access to diagnostics and medicines must be tackled, alongside reducing barriers and incentivising individuals to use professional healthcare services. Training retail vendors to sell specific first-line antibiotics over the counter with guidance on appropriate usage should be considered. Such bottom-up interventions will enable sustainable promotion of responsible antibiotic use, mitigating AMR emergence and securing a healthier future for all.

Abstract Introduction Traditional medicines are commonly used worldwide, especially in Africa—however, there is limited information on the prevalence and types of traditional eye medicine utilization in Ethiopia. The goal of this study was to determine the prevalence, the type and nature of traditional eye medicine use and practices related to self-medication for ophthalmic diseases in a rural Ethiopian population. Methods A cross-sectional study was conducted in six randomly selected primary health centers in rural Gurage Zone, Southern Ethiopia. Health-seeking behavior, use of self-medication, and traditional eye medicine were assessed in the population using a semi-structured questionnaire. Descriptive statistics and multivariable logistic regression analysis were computed to determine associated factors for using self-medication and traditional eye medicine. Result Of the 814 participants interviewed, 487 (59.8%) reported using traditional eye medicine, mainly for combinations of symptoms of ocular redness, irritation, and eye discharge (95.5%). Besides, 604 (74.2%) participants reported self-treatment with tetracycline 1% eye ointment. Older age, females, low income, no formal education, and lack of access to media were risks for utilizing traditional eye medicine. Conclusion The use of traditional eye medicine and self-treatment are common in this population. Regulatory legislation, public awareness, and making eye care are vital activities required to monitor such practices.

Introduction: Patients' adherence is essential for COPD self-management, as beneficial effects can only be expected in adherent patients. We explored associations between patients’ adherence to COPD exacerbation action plans and health outcomes. Materials and methods: Pooled COPD self-treatment intervention group data from two RCTs were analysed, only including patients who had ≥1 COPD exacerbation or started ≥1 course of oral corticosteroids over one-year follow-up. Optimal adherence was defined as ‘self-treatment initiated ≤1 day before or after exacerbation start’, suboptimal adherence as ‘self-treatment initiated 2 days before or after exacerbation start or no self-treatment initiated for a short (1–3 days) exacerbation’, and significant delay or no treatment as ‘self-treatment initiated >2 days after exacerbation start or no self-treatment initiated for a longer (>3 days) exacerbation’. Regression models were built for several health outcomes, with the number of COPD exacerbation days/patient/year being the primary outcome. Results: Patients with significant delay or no treatment (n = 46) had more exacerbation days/patient/year (33.3 (95 % CI 10.9; 55.6)) than optimal adherent patients (n = 38) (23.7 (95 % CI 1.7; 45.7)). The duration per COPD exacerbation was longer for patients with significant delay or no treatment (15.5 days) compared to optimal adherent patients (7.8 days). No differences in health outcomes were observed between optimal and suboptimal adherent patients. Conclusions: Being adherent to action plans is associated with better health outcomes than significant delayed treatment or no treatment at all. Interestingly, suboptimal adherence demonstrated health benefits comparable to optimal adherence. COPD self-management interventions should prioritise strategies to optimise patients’ adherence to action plans.

ObjectiveThe purpose of this study was to determine, for the first time, whether the application of a self-management program with global postural re-education (GPR) influences stress and sleep quality in female health science students.MethodsIn this randomized controlled trial pilot study, forty-one female health science students were randomized into a control group (n=21) and an intervention group (n=20). Participants underwent 8 weeks of self-management with and without GPR, after familiarization and therapy training. Outcomes included the State-Trait Anxiety Inventory (STAI) questionnaire and cortisol levels in saliva measured with the “CORTISOL Saliva ELISA SA E-6000” kit. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) and a Sleep Diary; total sleep time (TST), sleep onset latency (SOL), wakefulness after sleep onset (WASO), sleep efficiency (SE), and perceived sleep quality or satisfaction were assessed using the Likert scale.ResultsAfter self-treatment with GPR, participants in the intervention group showed lower cortisol levels compared to the control group (p = 0.041). Additionally, the intervention group demonstrated statistically significant improvements in sleep quality according to their PSQI (p = 0.010), STAI (p = 0.043), SOL (p = 0.049), and SE (p = 0.002).ConclusionThis study shows that self-management through GPR helps reduce stress and improve sleep quality in female health science students.Clinical Trial Registrationhttps://clinicaltrials.gov/, identifier NCT05488015.

Abstract Background Self‐medication is a fairly common practice among medical doctors. Although frequently seen in clinical practice, there are few published studies that describe the process of self‐treatment in dermatology, being even lower in number those that evaluate this circumstance among health professionals. Objectives To know the prevalence of self‐medication among medical professionals in our centre, to assess the need for preventive and training actions that help to avoid the misuse of dermatological treatments. Methods Descriptive cross‐sectional study based on the responses of non‐dermatologist medical professionals at the University Hospital of Pontevedra (Spain). Data were collected through a self‐administered, anonymous and voluntary online questionnaire. Results The questionnaire was completed by 283 physicians (50.63% participation rate, 62.90% females). Up to 77.39% of the physicians carried out self‐treatment for any pathology, and 55.12% for dermatological problems. The mean age of the doctors who practiced self‐treatment was significantly higher. The most used drugs were corticosteroids as topical treatment and antihistamines as systemic therapy. Irritant or allergic contact dermatitis was the most frequent pathology considered suitable for self‐medication (18.02%), followed by fungal infections (16.86%). After self‐treatment, the 7.5% needed to be seen by a dermatologist. A large group of 69.23% stated that they would recommend the treatment carried out to someone suffering from a similar process. Conclusions The prevalence of self‐treatment for skin diseases among doctors was strikingly high (55.12%). More than two‐thirds of the surveyed physicians would recommend self‐treatment in the dermatology field. As the literature on this topic is yet scarce, further studies are required to corroborate data collected in this study.

Abstract Acne vulgaris is one of the most common skin diseases worldwide and causes great distress to patients. In addition, most acne patients suffer from low self-esteem and social withdrawal. This study aimed to assess the prevalence of acne and its impact on quality of life among medical students. It also evaluates the patterns of self-treatment use. The study population consisted of all medical students from An-Najah National University (ANU) and the hospital. The questionnaire consists of three parts, and the first part consists of questions regarding demographic information. The second part consisted of questions to measure the severity of acne using the acne severity scale as well as the Cardiff Disability Index, which assesses the quality of life concerning acne in medical students. Finally, the third part consisted of questions exploring and assessing acne self-treatment. The mean age of our study sample was 21.3 ± 1.9 years, with a female predominance of 72.3%. The prevalence of acne among medical students was 80.9%, and 36.6% practiced self-medication. Acne was strongly associated with female sex (p

Introduction: Self-medication is an important health issue. The rising tendency of self-medication has been a cause for concern. Rheumatic patients, being vulnerable to various symptoms like pain and fever, may resort to self-medication. Although several studies have been conducted among different populations, there is a lack of literature focusing on rheumatic disease patients in India. Aim: To investigate the knowledge, attitude, and practice of self-medication among patients attending the Rheumatology Outpatient clinic at a tertiary care centre in eastern India. Materials and Methods: This descriptive cross-sectional study was conducted at the Rheumatology Outpatient Clinic in Medical College Kolkata, a tertiary hospital in West Bengal, India, from July 21, 2021, to September 20, 2021. A total of 105 patients attending the rheumatology outpatient clinic were included in the study. Data were collected by conducting interviews with the patients using prestructured and prevalidated questionnaire after obtaining informed consent. The Knowledge, Attitude, and Practice (KAP) of self-medication were assessed, and the data were statistically analysed using Chi-square tests. Results: The mean age of the study population was 38.77 years±12.56 years. Among the 105 subjects, 61 (58.1%) were suffering from arthritis, 26 (24.8%) from Systemic Lupus Erythematosus (SLE), and 6 (5.7%) from kidney disease. A total of 75 (71.4%) study subjects reported that they knew what self-medication was. The majority of the patients (86.7%) were unaware of the common adverse effects. However, 90 (85.7%) stated that self-medication was generally not beneficial, whereas 9 (8.6%) held the opposite view. A total of 64 (61%) reported having practiced self-medication in the past year. Conclusion: The present study reported a self-medication rate of 61%. Self-medication was found to be more frequent among the younger age group, females, and individuals with higher educational qualifications.

Whereas exacerbation action plans to self-manage Chronic Obstructive Pulmonary Disease (COPD) significantly improve health outcomes, patients’ adherence to those action plans is often poor. This study aimed to identify facilitators and barriers of adherence to tailored multi-disease exacerbation action plans. We also explored patients’ perspectives toward disease management roles. Individual semi-structured interviews were conducted with a sample of COPD patients who completed a Dutch-Australian self-management intervention evaluating tailored exacerbation action plans for COPD and relevant comorbidities. Interviews were thematically analyzed using a deductive approach guided by the Capability, Opportunity and Motivation of Behavior (COM-B) model. In 2016, ten patients (5 Australian; 5 Dutch; 6 men; age 59-83 years) were interviewed at the end of their one-year follow-up. Facilitators of adherence included improved patients’ comprehension of disease and treatment, positive feelings about the intervention, improved self-confidence, and professional support. Barriers included difficulties to recognize symptoms, dislike toward daily symptom monitoring, negative feelings about the intervention, negative mood state, and complexity of symptom diaries and action plans. Patients indicated three distinctive perspectives of their own and their healthcare professional’s role in their disease management: 1) patients felt mainly responsible; 2) patients felt shared responsibility with their healthcare professional; and 3) patients felt not responsible as they perceived their healthcare professional to be mainly responsible. We successfully used the COM-B model as a guide to identify facilitators and barriers of patients’ adherence to multi-disease exacerbation action plans. Improving patients’ adherence in future self-management interventions by targeting specific facilitators or barriers should be considered.

Background: Diabetes is the most common and severe metabolic disease in human. Self-treatment behaviors are common problems among diabetic patients.Aim: The present study was conducted with aim to identify the factors related to self-treatment behaviors among type 2 diabetic patients based on the Theory of Planned Behavior (TPB).Method: This cross-sectional study was carried out on 381 diabetic patients referred to Hamadan Diabetes Research Center in 2019, which were recruited with a simple sampling method. The participants completed a self-administered questionnaire, including demographic characteristics and TPB constructs. Data were analyzed by SPSS software (version 18) and descriptive statistics, one-way ANOVA, Independent t-test, and Linear regression. p

Abstract Background Tuberculosis (TB) is a global public health issue, particularly in resource-constrained countries like Nepal. This case report highlights the consequences of prolonged self-treatment and non-compliance with TB management protocols, emphasizing the need for increased awareness and intervention. Case Presentation A 50-year-old male from Nepal self-medicated with anti-tubercular drugs for 13 years after completing the recommended course of treatment. He experienced worsening symptoms, including respiratory distress and visual impairment. Upon evaluation, he was diagnosed with chronic cavitary pulmonary aspergillosis. The patient received comprehensive treatment, including antifungal therapy, steroids, antibiotics, and respiratory support, resulting in significant improvement. Conclusions This case highlights the dangers of self-treatment and non-compliance with TB management protocols. It emphasizes the importance of patient education, awareness programs, and regular follow-up to ensure treatment adherence and detect complications. The case also reveals gaps in the DOTS (Directly Observed Treatment, Short Course) program, including the need for improved surveillance, and a multidisciplinary approach. The ease of over-the-counter purchase of anti-tubercular drugs in Nepal contributed to the patient’s prolonged self-medication, highlighting a concerning. The complications arising from prolonged self-medication underscore the need for increased awareness, intervention, and patient education in TB management. Improving patient education, raising awareness about the risks of self-medication, and integrating ophthalmologic evaluations into standard management are essential for better TB control in Nepal.

Introduction: Self-medication in children has turned into an important problem for the health of Iranian society. Because children are more sensitive to the harmful effects of drugs due to their immature physiology. This study was conducted in order to investigate the self-medication status of mothers regarding the diseases of children under five years old in the villages of Ardakan. Materials and Methods: This descriptive-cross-sectional study was conducted on 350 mothers with children under five years old in the villages of Ardakan in 2019. Sampling was done by census. The data was collected by a standard five-part self- medication questionnaire. The data was analyzed with spss24and using descriptive statistics and chi-square. Results: The results showed that 57.82% of the mothers had arbitrarily given medicine to their children. The most important causes of self-inflicted drug use were not having a means of commuting to the city with 92.38%, the road not being open for commuting to the city all year round with 27.89%. Also, cold medicines with 96.88% and antipyretics with 93.77% were the most used medicines. A significant relationship was observed between the status of health insurance coverage and self- medication. Conclusion: Considering that about 80% of mothers self- medicate and the reasons for many of them are the lack of transportation facilities to medical centers,the improvement and development of routes and roads as well as the fair distribution of doctors and medical services in rural communities seem necessary.

Oral mucosal burns can occur after contact with various chemical agents, and commonly manifest as areas of mucosal sloughing and ulceration. Policresulen (Albothyl, Celltrion Pharm Inc.) is an over-the-counter topical antiseptic that is frequently used to treat stomatitis. Policresulen solution is highly acidic, with an approximate pH of 0.6; it can thus cause mucosal injury when improperly applied in the oral cavity. Here, we present a rare case of an oral mucosal burn resulting from incorrect self-administration of policresulen and emphasize the importance of increasing understanding of this adverse drug event among consumers and health professionals.

ObjectiveThe present study aimed to evaluate the effect of global postural re-education (GPR) on sleep quality and stress in female health science lecturers.MethodsA total of 24 female university lecturers were allocated in this randomized controlled trial into intervention (n = 12) and control (n = 12) groups. The intervention group underwent familiarization and training on the therapy to execute an 8-week treatment with GPR. Data collected on sleep quality were analyzed using 24-h accelerometry (Actigraphy GT3X+) in addition to the Pittsburgh Sleep Quality Index (PSQI) questionnaire score as well as the State-Trait Anxiety Inventory (STAI) anxiety questionnaire. Data on stress were collected by measuring salivary cortisol.ResultsAfter comparing the GPR of the groups, there was a main effect of the group (F = 5.278, p = 0.044) for PSQI. The post-hoc analysis revealed that both groups decreased scores between pre- and post-treatment. Additionally, post-treatment, there were differences between groups. For sleep latency, there were main effects of group (F = 6.118, p = 0.031) and score × group (F = 9.343, p = 0.011) interactions. The post-hoc analysis revealed that treatment groups decreased scores between pre- and post-treatment, and there were differences between groups (all p < 0.050).ConclusionThe self-administered GPR improves sleep quality in female university lecturers, providing a valuable self-regulation tool for enhanced sleep quality and enhanced academic performance. Further study may help to develop this as a potential tool to help university lecturers' job performance.

Backgroup: the widespread COVID-19 infection worldwide has resulted in the inability of healthcare facilities to receive all infected patients; therefore, most are treated at home. In addition, factors such as high mortality, types and severity of symptoms, and the prevalence of unreliable information have prompted patients to resort to self-treatment. Objectives: To assess prevention, treatment, degree of symptoms, and sources of information among patients with COVID-19 in Arab countries Method: A cross-sectional study was conducted in seven Arab countries: Algeria, Egypt, Iraq, Lebanon, Libya, Tunisia, and the United Arab of Emirates. People who have recovered from COVID-19 completed the study questionnaire. Score of symptoms during and after COVID-19 infection has been calculated by giving the participants a list of 13 symptoms. Results: A total of 3519 participants completed the survey. Mostly females (68.3%), and aged between 18 and 40 years old (59.4%). Prophylaxis treatments, including vaccines and antibiotics, have been used in around 40% of the participants. The total average score of symptoms during the infection period was found 7.31 ± 3.66 out of 13. However, the symptoms score upon recovery was low (0.48 ± 1.11 score). The significant associations with increased incidence of symptoms during infection were reported with older people, married, divorced or widowed, people with chronic diseases, and obese. Moreover, significant associations with decreased symptoms were reported with those who worked in the health sector, non- or ex-smokers, and vaccinated people. Conclusion: The use of medication and other treatments to prevent infection with COVID-19 was common among the participants in the seven countries. Taking the vaccine was the only effect on the number of symptoms experienced by patients. Although nearly two years have passed since the onset of the disease, there is still a need to raise treatment awareness among patients at home.

Background and Objective: Nowadays, medication abuse and, in general, self-medication are among the biggest socio-economic and economic problems in different societies such as Iran. This study aimed to investigate the knowledge, attitude, and practice of mothers with children under five years old about self-treatment in Ardakan villages, Iran. Materials and Methods: This descriptive cross-sectional study was carried out on 350 mothers with children under 5 years of age in Ardakan, 2020. The tool used to gather the required data was a four-part questionnaire (demographic, knowledge, attitude, and practice). Data were analyzed using descriptive and analytical statistics. Results: The mean scores of knowledge, attitude, and practice were obtained at 5.17±4.11, 25.08±8.74, and 3.52±4.31, respectively. It was found that 58% of the mothers had poor knowledge, 51% had a poor attitude, and 62% had low self-medication practice, respectively. There was a statistically significant relationship between the mean knowledge score and mothers' education level. There was also a statistically significant relationship between the variables of mean practice score and family income adequacy. The most important sources of information for mothers with children under the age of five about self-medication were the Internet and social networks, followed by family and friends (P

It is natural for people to think that the increasing popularity of seeking medical treatment and the continuous development of medicine are the important embodiment of the progress of human civilization. Generally speaking, the progress of medical technology and the abundance of medical resources mean that the phenomenon of self-treatment is reduced. However, this study of Chinese medical history found that it had always been a common choice to seek self-treatment for people in all social classes, from literati and bureaucrats to ordinary people in remote mountainous areas, especially during the Ming and Qing Dynasties in China. Such records can be seen especially when looking through historical materials such as medical books, local chronicles, genealogies, notes, and anthologies. Although medical skills in Ming-Qing era were more developed than previous eras and the local medical resources were more abundant, from ordinary people in remote areas to elite groups such as literati and officials, people often regarded self-treatment as a basic choice when they or their family members fell ill, no matter whether they had the ability or the opportunity to delay medical treatment. This article aims to explore the logic and root behind this seemingly contradictory phenomenon. Therefore, this research first raises the question: what accounted for this seemingly contradictory phenomenon? In response to this question, this study confirms the following: Firstly, low barriers to entry and high rewards drove people of varying qualifications into the medical profession, and good doctors were hard to find; thus, self-treatment was no worse than the alternatives. Secondly, in the Ming-Qing dynasties, Confucian physicians tended to write more practical prescriptions, which gave many people the opportunity to improve their own medical knowledge and provided great convenience for self-treatment. Thirdly, since the mid-Ming Dynasty, the high medical cost had caused serious difficulties for ordinary people to seek professional medical care, so they tried their best to save themselves when they fell ill. On this basis, this study further found that the deeper reason for this phenomenon lies in the incoordination between the high degree of daily life style of traditional medical treatment and the corresponding low degree of medical specialization and professionalism. Then, this leads to another question: is this incongruity a historical norm or a product of a certain historical stage? This article argues that during the Ming-Qing era, in the macro trend, the two showed a competitive relationship. However, in the context of a broader and more microscopic time and space, is this competitive relationship valid? Especially at present, chronic non-communicable diseases are becoming the biggest threat to human health. With the professional development of medical technology, the trend of medical life-style has also become a reasonable way to fill the gap from highly authoritative medical treatment and take on the responsibilities of their own health. This kind of medical specialization and life-style seems to be developing in parallel. Therefore, it can be concluded that the dissonance between the two is only the product of a certain historical period. Finally, this study raises another relevant question: what are the social and cultural implications behind the parallel development of medical life and specialization? This is a question to be answered in future research on the topic.

Joanne Sloots,1 Mirthe Bakker,1 Job van der Palen,1,2 Michiel Eijsvogel,1 Paul van der Valk,1 Gerard Linssen,3 Clara van Ommeren,1 Martijn Grinovero,4 Monique Tabak,5,6 Tanja Effing,7 Anke Lenferink1,8 1Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands; 2Department of Research Methodology, Measurement & Data Analysis, University of Twente, Enschede, the Netherlands; 3Department of Cardiology, Hospital Group Twente, Almelo and Hengelo, the Netherlands; 4Amiko Digital Health Limited, London, UK; 5eHealth Group, Roessingh Research and Development, Enschede, the Netherlands; 6Department of Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands; 7College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; 8Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social sciences, Technical Medical Centre, University of Twente, Enschede, the NetherlandsCorrespondence: Joanne SlootsDepartment of Pulmonary Medicine, Medisch Spectrum Twente, Koningsplein 1, Enschede, 7512 KZ, the NetherlandsTel +31651660063Email J.Sloots@mst.nlBackground: Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) often coexist and share periods of symptom deterioration. Electronic health (eHealth) might play an important role in adherence to interventions for the self-management of COPD and CHF symptoms by facilitating and supporting home-based care.Methods: In this pilot study, an eHealth self-management intervention was developed based on paper versions of multi-morbid exacerbation action plans and evaluated in patients with both COPD and CHF. Self-reporting of increased symptoms in diaries was linked to an automated decision support system that generated self-management actions, which was communicated via an eHealth application on a tablet. After participating in self-management training sessions, patients used the intervention for a maximum of four months. Adherence to daily symptom diary completion and follow-up of actions were analyzed. An add-on sensorized (Respiro®) inhaler was used to analyze inhaled medication adherence and inhalation technique.Results: In total, 1148 (91%) of the daily diaries were completed on the same day by 11 participating patients (mean age 66.8 ± 2.9 years; moderate (55%) to severe (45%) COPD; 46% midrange left ventricular function (LVF) and 27% reduced LVF). Seven patients received a total of 24 advised actions because of increased symptoms of which 11 (46%) were followed-up. Of the 13 (54%) unperformed advised actions, six were “call the case manager”. Adherence to inhaled medication was 98.4%, but 51.9% of inhalations were performed incorrectly, with “inhaling too shortly” (< 1.25 s) being the most frequent error (79.6%).Discussion: Whereas adherence to completing daily diaries was high, advised actions were inadequately followed-up, particularly the action “call the case manager”. Inhaled medication adherence was high, but inhalations were poorly performed. Future research is needed to identify adherence barriers, further tailor the intervention to the individual patient and analyse the intervention effects on health outcomes.Keywords: telemedicine, chronic conditions, self-treatment, disease management, dry powder inhalers

Test anxiety remains a challenge for students and has considerable physiological and psychological impacts. The routine practice of slow, Device-Guided Breathing (DGB) is a major component of behavioral treatments for anxiety conditions. This paper addresses the effectiveness of using DGB as a self-treatment clinical tool for test anxiety reduction. This pilot study sample included 21 healthy men and women, all college students, between the ages of 20 and 30. Participants were randomly assigned to two groups: DGB practice (n = 10) and wait-list control (n = 11). At the beginning and the end of 3-weeks DGB training, participants underwent a stress test, followed by measures of blood pressure and reported anxiety. Anxiety reduction in the DGB group as compared to controls was not statistically significant, but showed a large effect size. Accordingly, the clinical outcomes suggested that daily practice of DGB may lead to reduced anxiety. We assume that such reduction may lead to improved test performance. Our results suggest an alternative treatment for test anxiety that may also be relevant for general anxiety, which is likely to increase due to the ongoing COVID-19 pandemic.

Background: Current guidelines recommend that any patient who has experienced anaphylaxis should be prescribed one or more epinephrine autoinjectors (EAI) for immediate self-treatment. However, the etiology of anaphylaxis and prescription patterns of EAI have not been widely examined in Japan. Methods: This was a retrospective cohort study using a large Japanese claims database (JMDC, Tokyo, Japan). We included patients with severe anaphylaxis who received epinephrine in a hospital or outpatient clinic from 2011 to 2016. We extracted patients who were prescribed EAIs and examined the annual trend of EAI prescription rates and refill patterns. Results: We identified 1255 eligible patients. Among them, 361 patients (28.8%) were prescribed EAIs within 30 days after their initial severe anaphylactic episode. In patients who were prescribed EAIs, 65.9% were prescribed EAIs from the same facility in which initial treatment was given for severe anaphylaxis. The prescription rates of EAI significantly increased from 11.1% in 2011 to 30.9% in 2016. Among patients with initial EAI prescriptions, 97.3% refilled their EAI prescriptions at least once and 40.5% refilled their prescriptions annually during the 3 year follow up period. Conclusions: EAI prescription rates were relatively low in patients who experienced severe anaphylaxis in Japan. Physicians should prescribe EAIs to all patients who were treated for anaphylaxis under their care and avoid delegating the responsibility of prescribing EAIs to other facilities. Initial prescription of EAIs can result in improved regular refill and dissemination practices.

Abstract Background Self-treatment is a common and widespread behaviour, of which the risks are multiplied in old age. However, the determinants of self-treatment among elders in rural China remain unclear. This study aims to explore the prevalence and associated factors of self-treatment among elders in rural China, trying to discover the vulnerable groups as well as the service gaps among the rural elders. Methods Based on a multi-stage stratified random sampling method, a cross-sectional household survey was conducted among 30 villages in Sinan County, an impoverished county in western China. Data were collected through a household–individual combined questionnaires. The analysis was restricted to elders who reported illness within the last 2 weeks, and the final sample size was 330 (individuals). Bivariate and multiple logistic regression analysis were performed in the whole sample group and four subgroups to obtain the prevalence ratios regarding the associated factors. Results In the present study, 35.2% of the elders with illness within the last 2 weeks reported self-treatment. The variables associated with self-treatment in the whole sample group were health status (OR 6.75, 95%CI 1.93–23.60), recent alcohol consumption (OR 0.42, 95%CI 0.21–0.83) and the utilisation of family practice services (OR 0.59, 95%CI 0.36–0.96); the same predictors were found in the subgroup of elders with chronic diseases. No significant predictors were found in the subgroup of elders without chronic diseases. Empty-nest elders with higher affinity to traditional Chinese medicine (OR 0.39, 95%CI 0.18–0.86) or drinking alcohol recently (OR 0.28, 95%CI 0.09–0.82) were less likely to self-treat, while the non-empty-nest elders who were no less than 75 years old (OR 3.10, 95%CI 1.33, 7.22) or at better health status (OR 9.20, 95%CI 1.73–48.75) were more likely to self-treat. Conclusion Self-treatment was prevalent among the elders in rural China. Better health status, no recent alcohol consumption and no utilisation of family practice are associated with self-treatment among rural elders. Older elders in the non-empty nest group were more likely to self-treat, while the empty-nest elders with self-care habits in traditional Chinese medicine were less likely to self-treat. Deeper understanding of the self-treatment behaviour among rural elders may provide insights for identifying the potential service gaps and developing improvement strategies in the health care delivery system for the elderly in China.

It can be observed that the legal status of many prescription medicines is being changed to over-the-counter drug products in the Polish pharmaceutical market. This situation creates the possibility of advertising these OTC drugs and consequently, it leads to increased sales and financial benefits for the marketing authorization holder. The increasing availability of OTC drugs makes the self-treatment of patients possible. In this way, public spending on healthcare in Poland may be also reduced. A changing of the legal status from prescription drugs to OTC drugs is called a switch. The legal acts describe in detail a way of drug products qualification to a certain category which is also specified in the marketing authorization. The marketing authorization holder may submit an application for a change in the legal status of a drug product to the President of the Office for Registration of Medicinal Products, Medical Devices and Biocidal Products. The Commission for Medicinal Products provides an opinion on the application submitted by the marketing authorization holder. In recent years, many prescription medicines have changed their legal status to OTC drugs. This so called switch often raises concerns and controversies among doctors and pharmacists. Each drug product may indicate some adverse drug reactions and may also interact with food and other medicines. An increased product availability by changing the legal status to OTC drugs may increase the risk of drug abuse. There is also a risk of using medicines inconsistently with the therapeutic indication or a risk of using drug products for a too long time period. The legitimacy of using OTC drug products should be supervised by the pharmacist dispensing drugs from a community pharmacy. There is no doubt that the availability of OTC drugs may lead to reduce public spending on healthcare in Poland. However, health education of patients is undoubtedly an essential element of responsible self-treatment in which doctors as well pharmacists should be committed.

Cannabis sativa, whose flowers are also known as marijuana or marihuana, is a recreational plant that contains many chemicals that are constantly being studied by scientists around the world. One of these substances is cannabidiol (CBD), which has gained widespread popularity on the internet as a cure for mental health problems, leading many people to use CBD to self-treat depression and anxiety. This article presents an exploratory cohort study (n = 90) of a group of people aged 16–69 using CBD to self-heal depression symptoms. The survey included basic sociodemographic questionnaire and validated Hospital Depression and Anxiety Scale. And was distributed via the Internet. The results were statistically analyzed. High school degree was the most commonly held education (46%), large city was the most popular place of living (33%) and majority of the respondents have a full-time job (53%). Only 19% of the respondents consult their doctor or pharmacists about taking CBD. On the group of psychiatric patients, only 49% of respondents tell their psychiatrist about using the compound. Psychiatrists should be aware of CBD use in their patients during their daily practice, as CBD use can be found within people from all walks of life, and due to public interest, there is a need for education and research on the efficacy and safety of CBD use for mental disorders.

Introduction: Malaria is still a huge social and economic health problem in the world. It especially affects the developing countries of Africa. A particular problem is the misuse and abuse of over-the-counter antimalarials. This problem could lead to the emergence of drug-resistant strains and the subsequent elimination of more antimalarials from the list of effective antimalarials in Ghana. Methods: During the implementation of the study, an original questionnaire was used to collect data among Ghanaians on their knowledge of malaria, attitude towards antimalarials and their use of antimalarials. Results: The proportion in the analyzed subgroups was compared using the chi-square test. The analysis was conducted using TIBCO Software Inc., Krakow, Poland (2017) and Statistica (data analysis software system), version 13. In total, 86.29% of respondents knew the symptoms of malaria (p = 0.02) and 57.2% knew the cause of malaria (p < 0.001). Respondents with higher education were significantly more likely to know the symptoms of malaria (96%) p < 0.001. In the study group, only 74.59% of the respondents consulted medical personnel before taking the antimalarial drug (p = 0.51) and only 14.2% of the remaining respondents performed a rapid diagnostic test for malaria. Conclusions: The awareness of Accra and Yendi native inhabitants about the causes and symptoms of malaria and alternative ways of prevention is quite high. People’s education very significantly influences the way Accra residents deal with suspected malaria. Widespread public education and awareness and accessibility to places where antimalarial drugs are sold play a very important role in the proper use of antimalarial drugs.

Background: Illegal gold miners are currently key hosts for malaria in French Guiana (FG), with a risk of emergence of resistance linked to improper use of artemisinin-based combination therapy (ACT). The remoteness of the mines and regulatory issues hinder their access to health care. Methods: A quasi-experimental researched project (Malakit) implemented in FG borders with Brazil and Suriname aimed at determining the effectiveness of distributed kits for self-diagnosis and self-treatment to illegal gold miners, after training, at strategic border staging areas. Evaluation relied on questionnaires at inclusion and follow-up visits, and pre/post intervention surveys. The primary outcome was the proportion of persons reporting a use of certified ACT after a positive malaria diagnosis. The secondary outcomes assessed antimalarial adherence, kit use and impact on malaria epidemiology. Findings: The proportion of patients reporting a use of certified ACT after a positive diagnosis increased after the intervention (OR 1.8, 95%CI [1.1-3.0]). From April 2018 to March 2020, 3,733 persons participated in the intervention. The kit was used correctly by 71.7% [65.8-77.7] of the 223 persons reporting having used a malakit during the follow-up visits. No serious adverse events related to the misuse of malakit have been reported. The intervention appears to have accelerated the decline in malaria incidence in the region by 42.9%. Interpretation: This innovative international project showed that people with low education can correctly self-manage their malaria symptoms. This strategy could be integrated in the malaria control programs of the countries involved and considered in other regions with residual malaria in remote areas. Funding: This project was funded by the European Union, the Global Fund, Brazil MoH, Cayenne Hospital and FG Health Regional Agency. Editor's note: This translation in French was submitted by the authors and we reproduce it as supplied. It has not been peer reviewed. Our editorial processes have only been applied to the original abstract in English, which should serve as reference for this manuscript. The Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations. Contexte: Les chercheurs d'or illégaux sont actuellement un réservoir clé du paludisme en Guyane, avec un risque d'émergence de résistance lié à une mauvaise utilisation des combinaisons thérapeutiques à base d'artémisinine (ACT). L'isolement de ces sites miniers clandestins et des contraintes règlementaires entravent leur accès aux soins. Méthodes: Un projet de recherche opérationnelle quasi-expérimental (Malakit) a été mis en œuvre aux frontières de la Guyane avec le Brésil et le Suriname. Il visait à déterminer l'efficacité de la distribution de kits d'autodiagnostic et d'autotraitement à des orpailleurs illégaux, après une formation adaptée, dans des zones stratégiques transfrontalières. L'évaluation s'est appuyée sur des questionnaires lors des visites d'inclusion et de suivi, et sur des enquêtes pré/post intervention. L'indicateur principal était la proportion de personnes déclarant avoir utilisé une ACT certifiée après un diagnostic positif de paludisme. Les indicateurs secondaires reposaient sur l'adhérence aux traitements antipaludiques, l'utilisation des kits et l'impact sur l'épidémiologie du paludisme. Résultats: La proportion de patients déclarant une utilisation d'ACT certifiée après un diagnostic positif a augmenté après l'intervention (OR 1,8, 95%CI [1,1-3,0]). D'avril 2018 à mars 2020, 3 733 personnes ont participé à l'intervention. Le kit a été utilisé correctement par 71,7% [65,8-77,7] des 223 personnes revues en visites de suivi ayant déclaré avoir utilisé un malakit. Aucun événement indésirable grave lié à une mauvaise utilisation du malakit n'a été signalé. L'intervention semble avoir accéléré la diminution de l'incidence du paludisme dans la région de 42,9%. Interprétation: Ce projet international innovant a montré que les personnes ayant un faible niveau d'éducation peuvent se prendre en charge par eux-mêmes pour des symptômes de paludisme. Cette stratégie pourrait être intégrée dans les programmes de lutte contre le paludisme des pays impliqués et envisagée dans d'autres régions où du paludisme résiduel persiste dans des zones isolées. Financement: Ce projet a été financé par l'Union Européenne, le Fonds Mondial, le Ministère de la santé du Brésil, le Centre Hospitalier de Cayenne et l'Agence Régionale de Santé de Guyane.

Background: Antimicrobial resistance is a global issue that causes significant morbidity and mortality. Therefore, this study aims to assess knowledge, attitudes, and practices (KAP) of the general Saudi populations toward antibiotics use. Design and methods: A cross-sectional, anonymous online survey was conducted from January 1 to May 11, 2020, across five major regions of Saudi Arabia. Participants (aged ≥18 years) were invited through social media to complete an online self-structured questionnaire. All data were analyzed by Statistical Package (SPSS v.25). Descriptive statistics, Pearson's Chi-squared, t-tests, one-way analysis of variance (ANOVA), and Pearson correlation analyses were conducted. Results: Out of 443 participants, the majority (n=309, 69.8%) were females, 294 (64.4%) were married, 176 (39.7%) were 25-34 years of age, 338 (76.3%) were living in the Eastern Province, 313 (70.7%) had college or higher education, 139 (31.4%) were not working, and 163 (36.8%) had a monthly income of USD 800-1330. Overall, most participants demonstrated good knowledge and practice (88% and 85.6%, respectively). However, 76.8%had inadequate attitude score levels towards antibiotics use. Of all the respondents, 74.9% knew that not completing a full course of antibiotics may cause antibiotics resistance, 91.33% did not agree that antibiotics should be accessed without a prescription, and 94.04% will not hand over leftover antibiotics to family members. Factors associated with adequate knowledge were female, medical jobs, and higher income (p

Abstract Background Psychedelic microdosing is the trending practice of using tiny repeated doses of psychedelic substances to facilitate a range of supposed benefits. With only a few published studies to date, the subject is still under-researched, and more knowledge is warranted. Social media and internet discussion forums have played a vital role in the growing visibility of the microdosing phenomenon, and the present study utilized YouTube contents to improve comprehension of the microdosing practice as well as the social interactions and discussions around microdosing. Methods Microdosing self-disclosure in YouTube videos and their following comments were qualitatively analyzed by inductive thematic analysis. Various software was utilized to enable gathering and sorting relevant data. Results Microdosing of psychedelic substances, primarily LSD and psilocybin, was used for therapeutic and enhancement purposes, and predominantly beneficial effects were reported. Many different applications and outcomes were discussed, and therapeutic effects for depression appeared especially noteworthy. Intentions for use were recognized as an influencing factor for the progression and outcomes of microdosing. The function of social interactions was mainly to discuss views on the microdosing phenomenon, strategies for optimal results, minimize risks, and share emotional support. Conclusions Potentially, microdosing could provide some of the same benefits (for certain conditions) as full-dose interventions with less risk of adverse reactions related to the sometimes intense experiences of higher doses. Microdosing may well also mean additional benefits, as well as risks, through the repeated exposure over extended periods.

Introduction: In spite of the restrictions associated with the sale of medicinal products over the past 8 years, the over-the-counter drug sales have nearly doubled. This is caused by a broad access to pharmaceuticals, abandonment of professional medical advice, and too many long queues to the general practitioner. Aim of the study: The aim of the study was to investigate the dependence in the use of over-the-counter analgesics among three age groups: students (generation I), their parents (generation II) and grandparents (generation III). Material and Methods: The research group consisted of 203 persons (150 women and 53 men) between 19 and 92 years of age (mean age: 48 years, SD: 22.18). The study used a diagnostic questionnaire based on the author’s questionnaire which asked the respondents about their health status and preferences in taking medicines. Results: The most commonly prescribed active ingredient for pain relievers in OTC drugs is ibuprofen (116 people - 65.91%). Then comes paracetamolum, which is chosen by 95 persons (53.98%). Acidum acetylsalicylicum attracts 58 people (32.95%). Less common are such substances as metamizol sodium, diclofenac and naproxenum. About 176 out of 203 respondents (86.70%) declare taking OTC painkillers “on their own”, 61 of them (85.92%) in generation I, 64 (90.14%) in generation II and 51 (83.61%) in generation III. Conclusions: The frequency of taking OTC painkillers in the members of particular generations of the family depends on their age. Older persons (15%) more often take analgesics several times a day. Only (1.4%) of the young do it. On the other hand, a considerably higher percentage of young people (75.7%) use such medications sporadically.

Objectives: The purpose of this study is to investigate a modified Epley maneuver for self-treatment of posterior canal benign paroxysmal positional vertigo (PC-BPPV).Methods: The study recruited 155 patients with PC-BPPV. All patients were randomized into the Epley maneuver group (n = 77) and modified Epley maneuver group (n = 78). We analyzed the resolution rate (1 day and 1 week), residual symptoms after the maneuver, and adverse effects.Results: It was found that the modified Epley maneuver group had a higher resolution rate than that of the Epley maneuver group in the treatment of PC-BPPV after 1 day of the initial maneuver (p < 0.05). However, there was no difference in resolution rate between the Epley maneuver group and the modified Epley maneuver group in resolution rate after 1 week of the initial maneuver (p > 0.05). The modified Epley maneuver group had fewer residual symptoms than that of the Epley maneuver group 1 week after treatment of PC-BPPV (p < 0.05). Significant improvements were also observed in average DHI scores in patients who underwent the modified Epley maneuver compared to the Epley maneuver (p < 0.05). There was no significant difference in adverse effects between the two groups (p > 0.05).Conclusions: The modified Epley maneuver has a satisfactory therapeutic efficacy with less residual symptoms and could be recommended as a self-treatment for patients with PC-BPPV.

Self-treatment with medicines including treatment with antibiotics is a growing global concern, as it can cause public health problems, such as antibiotic resistance and drug toxicity. Therefore, the significance of the self-medication impact of COVID-19 in any region can have an influence on the prevalence of such problems. The review aimed to investigate the self-treatment with antibiotics among the general population in Eastern Mediterranean region countries during COVID-19 pandemic. A comprehensive review of literature in four databases was conducted for the pandemic period from January 2020 to the end of March 2022. Nine studies related to self-treatment with antibiotics were found. The studies were homogeneous in terms of assessing the antibiotic self-treatment usage during the COVID-19 pandemic among the general population and among community pharmacies. The prevalence of self-treatment with antibiotics ranged from 20.8% to 45.8% between the studies. The main reasons for that were cost-saving, fear of COVID-19 infection, quarantine, and ease of accessibility without time limits. Antibiotic self-treatment has been high during the COVID-19 pandemic; however, it was less reported during the study period than before the time of the pandemic. There is a need for more restrictions on dispensing antibiotics from community pharmacies. In addition, there is a need to raise awareness among the population regarding self-treatment with antibiotics.

Abstract Background In recent decades, the Kingdom of Saudi Arabia has seen an exponentially growing antibiotic resistance, which is exacerbated by the use of antibiotics without a prescription and other various factors. However, no published data are available on factors influencing non-prescription use of antibiotics among the general public in Saudi Arabia using an in-depth interview technique. Methods Semi-structured interviews were carried out with 40 Saudi participants from the Eastern Province of Saudi Arabia, selected via snowball sampling technique. Participants were enrolled based on the following inclusion criteria: 18 years of age or older and had self-medicated themselves with antibiotics in the past two years. Data collection was continued until data saturation was attained. Interviews were audiotaped, transcribed verbatim and analysed using NVivo 10 software. Results Participants (80% female) had a mean (SD) age of 30 years (10.2). Self-medication with antibiotics was associated with various inappropriate antibiotic use behaviours and negative outcomes such as antibiotic resistance, treatment failures and adverse events. Interviews revealed that different reasons contribute to the rise of self-medication with antibiotics, ranging from difficulty accessing healthcare services, participant’s cultural beliefs and practices, lack of knowledge about antibiotics and antibiotic resistance, and weak regulatory enforcement. Conclusions The findings of the present study will aid in generating data that may provide an insight when designing future interventions to promote public health awareness regarding safe and effective use of antibiotics.

Abstract Background Alcohol is consumed almost worldwide and is the most widely used recreational drug in the world. Harmful use of alcohol is known to cause a large disease-, social- and economic burden on society. Only a few studies have examined the relationship between CAM use and alcohol consumption. To our knowledge there has been no such research in Norway. The aim of this study is to describe and compare alcohol consumption and injuries related to alcohol across gender and different CAM approaches. Methods The data used in this study is based on questionnaire data gathered from the sixth Tromsø Study conducted between 2007 and 2008. Information on CAM use and alcohol consumption was available for 6819 women and 5994 men, 64.8% of the invited individuals. Pearson chi-square tests and independent sample t-tests were used to describe the basic characteristics of the participants and to calculate the differences between men and women regarding these variables. Binary logistic regression analyses were used to investigate the associations between the different CAM approaches and alcohol consumptions and injuries caused by drinking. Results Women who drank alcohol more than once a month were more likely to have applied herbal or “natural” medicine and self-treatment techniques (meditation, yoga, qi gong or tai-chi), compared to those who never drank, and those who only drank monthly or less. For women, an association was also found between having experienced injuries caused by drinking and use of self-treatment techniques and visit to a CAM practitioner. No association was found between amount of alcohol consumed and use of CAM approaches. For men, an association was found between injuries caused by drinking and use of herbal or “natural” medicine. Conclusion The findings from this cross-sectional study suggests that women who drink frequently are more likely to use “natural” medicine and self-treatment techniques. Both men and women who had experienced injuries because of their drinking were more likely to have used CAM approaches.

Background: The global aging of the population is particularly evident in economically developed countries and has a progressive character, being in the sight of the state, government and of many international organizations. According to statistics, in this period of life, the morbidity is higher in males than females. At the same time, the need to provide medical assistance to the elderly is 50 percent higher than needed for middle-aged people. About 26% of senile patients show complications and side effects due to medications. The reasons may vary: the late doctor attendance, the socio-psychological state, polymorbidity, the chronic outbreaks of diseases, parallel treatment at other physicians’, self-treatment etc. The simultaneous treatment by other physicians, who in their turn, prescribe drugs which might increase the probability of chemical and physical incompatibilities, and especially the pharmacological ones. Self-treatment is a global issue. The patient, quite often, listens to the advice of neighbors, friends, acquaintances who believe they are suffering from the same disease. So appear the different forms of polypragmasia. Conclusions: So appear the different forms of polypragmasia. Polypragmasia is sometimes more dangerous than the insufficient treatment. Anatomicalphysiological modifications of the cardiovascular system of senile patients lead to paradox effects of the administration of some drugs. Before initiating any treatment, it is necessary to determine whether the patient is using any drugs recommended by other specialists, friends, neighbors or drugs, which are not allowed to be prescribed with other drugs, in order to avoid unwanted interactions.

The article reveals the main regulatory legal documents regulating the concept of pharmaceutical counseling. Based on the results of an on-site visitor anonymous survey of 100 pharmaceutical workers in Voronezh the main problems encountered by pharmaceutical workers in the pharmaceutical counseling for the population were identified: lack of information from the client (60 %), lack of understanding on the part of the client (45 %), and the need to improve the knowledge of pharmacists to advise the public and increase the pharmaceutical literacy of the population use of medicines (90 %). Based on the results of an on- site visitor anonymous survey and the Internet survey of 200 consumers the main problems experienced by the population when self-medicating were identified: 50 % of respondents are dissatisfied with the result of self-treatment, only 45 % always follow the recommendations of the pharmacist. Also, the respondents identified the need for reliable information on self-treatment (53 %). The conducted questioning of pharmaceutical workers and consumers revealed the main reserves of increasing the effectiveness of pharmaceutical counseling of the population

This letter to the Editor can prove useful as a mini-guide. Interest in health and quality of life is continuing to grow in the second decade of the 21st century, both among professionals actively involved in giving advice to others and among diverse social groups, as well as individually, among those sick and those healthy. Along with recent novelties, traditional Old Polish methods also feature prominently in discussions, but those interested know relatively little about how to access source materials. This letter therefore describes the possibilities for open access to Polish-language health guides from the Renaissance and Baroque era, whose authors included medical doctors and which focused on describing food and herbs used in self-treatment and promoting the healthy life style of the period. The works of Andrzej from Kobylin, Zawacki, Śleszkowski, Olszowski and Haur are briefly described and information is given about their availability in full-text on-line data bases.

Objectives: There has been no review on the prevalence, possible causes, and clinical outcomes of self-medication with antibiotics (SMA) in the Middle East. Methods: Databases were searched (January 2000 through June 2016) for articles on SMA among adults aged ≥18 years living in the Middle East. A hand search for relevant citations and key journals was also performed. Results: Twenty-two studies were found. The prevalence of SMA ranged from 19% to 82%. Age, sex, and educational and income levels were the main determinants of SMA. Socio-cultural, economic, and regulatory factors were the most commonly cited reasons for SMA. Penicillins were the antibiotics most commonly used; the antibiotics were obtained mainly via stored leftover drugs, pharmacies without prescriptions, and friends/relatives. SMA was mainly for upper respiratory tract problems. The primary sources of drug information included relatives/friends and previous successful experience. Inappropriate drug use such as wrong indication, short and long duration of treatment, sharing of antibiotics, and storing antibiotics at home for use at a later time were reported. Negative and positive outcomes of SMA were identified. Conclusions: It is important to understand the links between different factors promoting SMA and to assess the changing trends in order to derive strategies aimed at reducing drug-related health risks.

Self-treatment by pharmaceuticals is an actual problem of health care, patients more and more often address to the pharmacist, not visiting the family doctor for various reasons. In this case, the role of the pharmacist is not limited to the release of non-prescription drugs "at the request or insistence of the patient." This situation requires from the pharmacist not only specialist knowledge of the pharmacology of drugs, but also a professional approach to the diagnosis and treatment of symptoms and syndromes. Pharmacoepidemiologic research of the department of General and Clinical Pharmacy showed that about 93% of population of Dnepropetrovsk use pharmaceuticals without preliminary consultation with the doctor. The pharmacist in time having recognized the leading symptoms, having provided symptomatic treatment with OTC-medicines and having convinced the patient to ask for the qualified help of the doctor is a link between the patient and the family doctor. In the article by the example of one of the most common symptoms – pharyngalgia – difficulties of diagnostics which is impossible without a deep knowledge of clinical medicine are shown and the need of administering prescription drugs in most cases is confirmed, which in turn is possible only after consultation of the family doctor in most cases.

Self-treatment by pharmaceuticals is an actual problem of health care, patients more and more often address to the pharmacist, not visiting the family doctor for various reasons. In this case, the role of the pharmacist is not limited to the release of non-prescription drugs "at the request or insistence of the patient." This situation requires from the pharmacist not only specialist knowledge of the pharmacology of drugs, but also a professional approach to the diagnosis and treatment of symptoms and syndromes. Pharmacoepidemiologic research of the department of General and Clinical Pharmacy showed that about 93% of population of Dnepropetrovsk use pharmaceuticals without preliminary consultation with the doctor. The pharmacist in time having recognized the leading symptoms, having provided symptomatic treatment with OTC-medicines and having convinced the patient to ask for the qualified help of the doctor is a link between the patient and the family doctor. In the article by the example of one of the most common symptoms – pharyngalgia – difficulties of diagnostics which is impossible without a deep knowledge of clinical medicine are shown and the need of administering prescription drugs in most cases is confirmed, which in turn is possible only after consultation of the family doctor in most cases.

Background and Objectives: Missing data is a big challenge in the research. According to the type of the study and of the variables, different ways have been proposed to work with these data. This study compared five popular imputation approaches in addressing missing data in the questionnaires. Methods: In this study, 500 questionnaires were used for self-medication in diabetic patients. Missing in the observations was artificially generated by random selection of questions and then deleting them. Five imputation ways included: 1) the mean of the questions, 2) the mean of the person, 3) the mode of the person, 4) linear regression, and 5) EM algorithm. For each method, the mean and standard deviation were compared with imputation. The Spearman correlation coefficient, the percentage of incorrectly classified and kappa statistic were also calculated. Results: A kappa higher than 0.81 represented almost perfect agreement at 10% missingness. The EM algorithm showed the highest level of agreement with the results of actual data with a Kappa of 0.886. With increasing missingness to 30%, the EM algorithm and the mean of the person showed a rather similar agreement with a Kappa of 0.697 and 0.687, respectively. Conclusion: In this study, the EM algorithm was the most accurate method for handling missing data in all models. The mean of the person method is easy for handling missing data, especially for most non statisticians.

Currently, the state of the national health system (health) is characterized by a low level of funding for medical and pharmaceutical care and the lack of effective methods of free and preferential dispensing of medicines (drugs) and compensation of their value. Thus the most urgent problem arises is unregulated drugs prescription, which is one of the main negative factors behind the rapid spread of self-medication and polypragmasy. Thus, improving drugs prescription dispensing is one of the current challenges of medicine and pharmacy management which should be solved to provide a safe, rational and effective drug therapy. The results of the questionnaire survey of doctors and pharmaceutical workers identified and explored key factors that contribute to a violation of drugs prescription. The authors analyzed the literature on the current state of drugs prescription in Ukraine, which resulted in selected priority issues that need resolution as soon as possible. Established that the main disadvantages of the national health care system is unreasonable approach to state regulation of the relevant system and the low level of funding. This situation prevents rational regulation of free and preferential delivery of drugs, the introduction of obligatory medical insurance and the reimbursement cost of drugs and other modern approaches that are effective in developed countries. Тhe main motive of view of legislative acts to implement strict drugs prescription in Ukraine is a link to international experience, guided by the standards of European and international practices that do not comply with the Law of Ukraine issued on 18.03.2004 № 1629-IV «On the National Program for Adaptation of Ukraine to the European Union, "and points to the disparity modern domestic rule-making European practice. The fundamental problem here is the comparison of the legal, social, financial and economic status of the counter in Ukraine with the countries in which the system of local government regulation of the drugs cost. The results of the study identified the main directions of improvement of medicines prescription in Ukraine. The major factors of modern problems with drugs prescription include lack of prescription forms F-1. According to respondents thought one of the main directions of reforming the national health care system should be the implementation of local governmental and insurance recipes that will counter the financial status of the document and at the same time effectively solve the problem of drugs prescription. The investigation identified the main directions for improvement of drugs prescription: • Development and installation authority of Health Management Ukraine at all levels to ensure the prescription forms for hospitals in sufficient quantities; • continuous monitoring of the implementation of these powers in the regional offices of health care.

Aims: When facing illness, a person may choose self-treatment as an alternative to hospital (and primary care)-based treatment. Despite its important role in healthcare, the study on self-treatment remains limited. The goal is to collectively report the observations in the literature on the prevalence, characteristics, and effects of self-treatment.Methods: Extensive literature search was conducted, and relevant information was extracted.Results: Published studies have reported that in some regions, the prevalence of self-treatment is high and varies across illness conditions and treatment approaches. Self-medication is the most popular self-treatment approach. Multiple regional, demographic, personal, cultural and religious factors have been implicated in the pursuit of self-treatment. In addition, accessibility of healthcare also plays a role. Self-treatment in general has a positive clinical and financial effect. However there have been concerns on abuse and possible negative effects. Conclusions: This article reviews observations made in recent studies on several important aspects of self-treatment. Comprehensive and systematic study is still lacking. Interventions are needed to solve several problems associated with self-treatment.

The purpose of this study was to determine the effectiveness of exposure and response prevention by self-treatment method on the reduction of obsessive-compulsive symptoms in out-patients who referred to psychiatric and psychological service centers in Isfahan. Therefore 20 patients with obsessive-compulsive disorder who were diagnosed on the basis of clinical interviewed and they did not have a major depressive disorder and personality disorders were randomly selected and assigned to two groups: training and control groups. The training group received a self-treatment manual booklet prepared by the experimenter. This booklet contained practical instructions and homework that were based on exposure and response prevention treatment method. The length of treatment was 6 weeks and the subjects were asked to give weekly reports of their progress to the experimenter by phone. The subjects in control group were assigned to waiting list. Maudsley Obsessive-Compulsive Inventory were administered to all subjects as the pre- test post- test and follow-up. The results of analysis of covariance revealed that the training group showed significantly lower score than the control group on the post-test and on the one-month follow-up of maudsley obsessive-Compulsive Inventory(P

Sowa Magda, Kołłątaj Witold, Kołłątaj Barbara, Karwat Irena Dorota, Szakuła Justyna. Samoleczenie wśród studentów medycyny Uniwersytetu Medycznego w Lublinie = Self-medication practice among medical students of Medical University in Lublin. Journal of Education, Health and Sport. 2015;5(7):439-452. ISSN 2391-8306. DOI 10.5281/zenodo.20851 http://ojs.ukw.edu.pl/index.php/johs/article/view/2015%3B5%287%29%3A439-452 https://pbn.nauka.gov.pl/works/589949 http://dx.doi.org/10.5281/zenodo.20851 Formerly Journal of Health Sciences. ISSN 1429-9623 / 2300-665X. Archives 2011–2014 http://journal.rsw.edu.pl/index.php/JHS/issue/archive Deklaracja. Specyfika i zawartość merytoryczna czasopisma nie ulega zmianie. Zgodnie z informacją MNiSW z dnia 2 czerwca 2014 r., że w roku 2014 nie będzie przeprowadzana ocena czasopism naukowych; czasopismo o zmienionym tytule otrzymuje tyle samo punktów co na wykazie czasopism naukowych z dnia 31 grudnia 2014 r. The journal has had 5 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 1089. (31.12.2014). © The Author (s) 2015; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland and Radom University in Radom, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 20.06.2015. Revised 15.07.2015. Accepted: 15.07.2015. Samoleczenie wśród studentów medycyny Uniwersytetu Medycznego w Lublinie Self-medication practice among medical students of Medical University in Lublin Magda Sowa1, Witold Kołłątaj2, Barbara Kołłątaj3, Irena Dorota Karwat3, Justyna Szakuła4 1Katedra i Zakład Zdrowia Publicznego Uniwersytetu Medycznego w Lublinie 2Klinika Endokrynologii i Diabetologii Dziecięcej z Pracownią Endokrynologiczno - Metaboliczną Uniwersytetu Medycznego w Lublinie 3Katedra i Zakład Epidemiologii Uniwersytetu Medycznego w Lublinie 4Katedra Zdrowia Publicznego, Wydział Nauk o Zdrowiu Uniwersytetu Medycznego w Lublinie Adres do korespondencji: dr hab. n. med. Witold Kołłątaj Klinika Endokrynologii i Diabetologii Dziecięcej z Pracownią Metaboliczną UM w Lublinie ul. Profesora Antoniego Gębali 6, 20-093 Lublin e-mail: wk@data.pl Słowa kluczowe: samoleczenie, studenci medycyny, leki OTC. Streszczenie Wstęp Samoleczenie polega na samodzielnie podjętym przez chorego działaniu, polegającym na stosowaniu leków lub aplikowaniu metod leczniczych, bądź mających potencjalne właściwości lecznicze, w celu przywrócenia zdrowia lub poprawy jakości życia. Głównymi powodami, dla których ludzie sami podejmują próby leczenia są uwarunkowania kulturowe, brak czasu, niedostatki finansowe, trudny dostęp do lekarzy specjalistów (kolejki), przekonanie, iż błahe dolegliwości nie wymagają pomocy specjalisty, oraz łatwy dostęp do wielu środków leczniczych. Cel pracy Celem pracy była ocena zjawiska samoleczenia wśród studentów medycyny Uniwersytetu Medycznego w Lublinie. Materiał i metody Badaniem zostali objęci studenci medycyny Uniwersytetu Medycznego w Lublinie. Dobór próby dokonany został metodą doboru proporcjonalnego reprezentatywnego. Liczba osób poddana badaniu była proporcjonalna do liczby osób z poszczególnych lat studiów. W badaniu udział wzięło 267 studentów w wieku 19-32 lat życia, w tym 168 kobiet (62,9%) i 99 mężczyzn (37,1%). Metodą badawczą był sondaż diagnostyczny, a narzędziem badawczym Autorski Kwestionariusz Ankiety. Badanie przeprowadzono w październiku 2014. Wyniki Termin samoleczenie kojarzy się studentom medycyny na ogół z samodzielnym (bez konsultacji z lekarzem) stosowaniem leków do odręcznej sprzedaży – OTC (over-the-counter drugs) (71% ankietowanych) oraz ze stosowaniem tak zwanych domowych sposobów leczenia (60%). Spośród badanych, 23% studentów metody samoleczenia stosowało „zawsze” lub „niemal zawsze” w razie pojawienia się objawów chorobowych, 58% – okazyjnie, 11% nigdy. Wśród osób decydujących się na samoleczenie, najpopularniejsze było stosowanie leków OTC (99% ankietowanych), fitoterapia (27%), ciepłe okłady i plastry rozgrzewające (24.8%) oraz środki spożywcze używane w sposób niekonwencjonalny (21%). Studenci medycyny bardzo chętnie sięgają po leki OTC. Niemal 90% przyznało, iż zdarza im się z takich leków korzystać, chociaż tylko 6% wyraziło opinię, że takie leki są w pełni bezpieczne i nie stwarzają żadnego zagrożenia dla pacjenta. Stosowanie leków OTC tłumaczą najczęściej łatwością ich zakupu (56% ankietowanych), wcześniej uzyskanymi dobrymi efektami terapeutycznymi (36%) i atrakcyjną ceną (16%). Wśród OTC studenci medycyny preferują leki „na przeziębienie i grypę”, przeciwbólowe i przeciwzapalne, leki z innych grup stosowane są zdecydowanie rzadziej. Wnioski • Studenci medycyny chętnie korzystają z metod samoleczenia. Tylko 11% ankietowanych studentów medycyny nigdy nie korzystało z tych metod leczenia. • Studenci najchętniej sięgają po leki grupy OTC i fitoterapię. • Ze względu na wysoką liczbę osób stosujących metody samoleczenia, należy podjąć próby skutecznej edukacji młodzieży akademickiej w zakresie zalet i wad stosowania takiej formy terapii. Keywords: self-treatment, students of medicine, OTC drugs. Summary Introduction The phenomenon of self-medication is defined as using drugs or applying treatment methods with potential therapeutic properties without consultation or consent of a doctor in order to restore health or improve quality of life. The main reasons why people attempt to treat themselves are cultural factors, lack of time, financial shortcomings, difficult access to specialists (queues), the belief that trivial ailments do not require a specialist, and easy access to a variety of medications. Aim of the study The aim of the study was to assess the scope of phenomenon of self-medication among medical students of the Medical University of Lublin. Materials and methods The survey were conducted among medical students of the Medical University of Lublin. The study group consisted of representative samples of all 1-6 year study groups. The study involved 267 students aged between 19-32 years, including 168 women and 99 men. There was used the diagnostic survey method based on the author's questionnaire. The study was conducted in October 2014. Results Medical students, usually, define the term self-treatment as an independent (without consulting a doctor) use of OTC (over the counter) medications (71% of respondents) or so-called home treatment (60%) applied to restore health or improve quality of life. Among the surveyed students 23% of respondents use methods of self-treatment "always" or "almost always" in case of any symptoms of the disease appearance, 58% – of polled do it occasionally, 11% have never applied such methods of treatment. Among those opting for self-treatment, the most common was the use of OTC drugs (99% of respondents), herbal medicine (27%), warm poultices and warming plasters applying (24.8%) and foodstuffs used in an unconventional way (21%). Medical students are very eager to use OTC drugs. Almost 90% polled confessed that they had been using such drugs in the past, although only 6% of them checked the opinion that such drugs are completely safe and do not pose any danger to the patient. The attitude towards use of OTC drugs has been explained by students by ease of purchase (56%), previously obtained good therapeutic effects (36%) and attractive price (16%). Polled medical students prefer OTC "cold and flu", analgesic and anti-inflammatory medications. Other OTC drugs are used by them much less frequently. Conclusions • Medical students are willing to use methods of self-treatment. Only 11% of polled medical students have never applied such methods of treatment. • While opting for self-medication, they usually use OTC drugs and herbal medicine methods. • Due to the high number of medical students using self-medications methods, it should be made attempts to improve education of students on the advantages and disadvantages of using of these forms of therapy.

Self-medication with over the counter (OTC) and non OTC drugs may provoke serious consequences for users and societies. Recognition of its predictors therefore, is pivotal in plans to hinder the aggregating behavior. This study aimed to identify possibly all predictors of self-medication and the range of its prevalence among different populations.Medline, Amed, Scopus, Medlib, SID, Pub Med, Science Direct, and super searcher of Google Scholar were scrutinized using "self-medication", "self-prescription" and "self-treatment" key words without a time limit with special focus on Iranian studies. Authors independently assessed the title, abstract and full text of identified articles for inclusion and any disagreement was resolved with consensus.The range of reported self-medication in the 70 included publications was 8.5-98.0%. Having a minor illness (15 studies), health care costs (9 studies), lack of adequate time to visit a physician (11 studies), prior experience (7 studies) in using a drug and long waiting time to visit a qualified practitioner (5 studies) were most frequently reported reasons of self-medication.The observed diversity in the reported prevalence and reasons of self-medication among different sub-groups of populations (e.g. males vs. females) and between developed and developing countries highlights the importance of explanatory behavioral chain analysis of self-medication in different population groups and countries. Even within a single country, predictors of this harmful practice could be inconsistent. Lack of sufficient quality re-search to identify precipitating factors of self-medication in developing countries is paramount.

Nonmedical use of prescription drugs has become a serious social problem among American youth. Two general categories of motives for the nonmedical use of prescription drugs include self-treatment and recreational use. This study assesses differences between nonmedical prescription drug users based on their self-reported motivation for using prescription drugs. Data come from more than 11,000 11th grade students in Delaware public schools. Analyses indicate significant differences in prevalence, correlates, and consequences on nonmedical use of prescription drugs based on motivation for use. Analyses reveal that, among those students who reported nonmedical use of prescription drugs, those who are using for recreational purposes are signficantly more likely to engage in other risk behaviors, such as using other illicit substances and engaging in violent behavior.

Abstract Background It is commonly assumed that indigenous medical systems remain strong in developing countries because biomedicine is physically inaccessible or financially not affordable. This paper compares the health-seeking behavior of households from rural Andean communities at a Peruvian and a Bolivian study site. The main research question was whether the increased presence of biomedicine led to a displacement of Andean indigenous medical practices or to coexistence of the two healing traditions. Methodology Open-ended interviews and free listing exercises were conducted between June 2006 and December 2008 with 18 households at each study site. Qualitative identification of households’ therapeutic strategies and use of remedies was carried out by means of content analysis of interview transcriptions and inductive interference. Furthermore, a quantitative assessment of the incidence of culture-bound illnesses in local ethnobiological inventories was performed. Results Our findings indicate that the health-seeking behavior of the Andean households in this study is independent of the degree of availability of biomedical facilities in terms of quality of services provided, physical accessibility, and financial affordability, except for specific practices such as childbirth. Preference for natural remedies over pharmaceuticals coexists with biomedical healthcare that is both accessible and affordable. Furthermore, our results show that greater access to biomedicine does not lead to less prevalence of Andean indigenous medical knowledge, as represented by the levels of knowledge about culture-bound illnesses. Conclusions The take-home lesson for health policy-makers from this study is that the main obstacle to use of biomedicine in resource-poor rural areas might not be infrastructural or economic alone. Rather, it may lie in lack of sufficient recognition by biomedical practitioners of the value and importance of indigenous medical systems. We propose that the implementation of health care in indigenous communities be designed as a process of joint development of complementary knowledge and practices from indigenous and biomedical health traditions.

Abstract Background Self-treatment is a treatment of oneself without professional help, which may cause health-related consequences. This investigation examined the self-treatment behaviors in patients with diabetes mellitus in Iran/kashan. Methods The patients who referred to the clinic of diabetes and those who were admitted to the General hospital in the city of Kashan due to diabetes mellitus were asked to participate in this cross-sectional study. For data collection, The 25 item questionnaire of Likert scale type with four scales was used. Factor analysis was performed to define the patterns of self-treatment. Results 398 patients participated in the study. The mean age of the study population was 54.9 ± 12.9 years. The majority (97%) had type 2 diabetes. 50% of patients reported self- treatment. The self-treatment score was 45.8 ± 8.8 (25-100). Female gender, lower education and co-morbid illnesses of hypertension, hyperlipidemia and cardiac disease had significant relationship with self-treatment. The factor analysis procedure revealed seven factors that explained the 43% of variation in the self-treatment. These seven factors were categorized as knowledge, deficiencies of formal treatments, available self-treatment methods, physician related factors, the tendency to use herbal remedies, underlying factors such as gender and factors related to diabetes. Conclusions There is a medium tendency for self-treatment in diabetic patients. The assessment of self-treatment practices must be an essential part of patients' management in diabetes care.