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ObjectiveTo develop a drug facts label prototype for a combination mifepristone and misoprostol product and to conduct a label-comprehension study to assess understanding of key label concepts.MethodsWe followed U.S. Food and Drug Administration guidance, engaged a multidisciplinary group of experts, and conducted cognitive interviews to develop a drug facts label prototype for medication abortion. To assess label comprehension, we developed 11 primary and 13 secondary communication objectives related to indications for use, eligibility, dosing regimen, contraindications, warning signs, side effects, and recognizing the risk of treatment failure, with corresponding target performance thresholds (80-90% accuracy). We conducted individual structured video interviews with people with a uterus aged 12-49 years, recruited through social media. Participants reviewed the drug facts label and responded to questions to assess their understanding of each communication objective. After transcribing and coding interviews, we estimated the proportion of correct responses and exact binomial 95% CIs by age and literacy group.ResultsWe interviewed 851 people (of 1,507 people scheduled); responses from 844 were eligible for analysis, and 35.7% (n=301) of participants were aged 12-17 years. The overall sample met performance criteria for 10 of the 11 primary communication objectives (93-99% correct) related to indications for use, eligibility for use, the dosing regimen, and contraindications; young people met nine and people with limited literacy met eight of the 11 performance criteria. Only 79% (95% CI 0.76-0.82) of the overall sample understood to contact a health care professional if little or no bleeding occurred soon after taking misoprostol, not meeting the prespecified threshold of 85.0%.ConclusionOverall, high levels of comprehension suggest that people can understand most key drug facts label concepts for a medication abortion product without clinical supervision and recom

Computational models based on recent maps of the RBC proteome suggest that mature erythrocytes may harbor targets for common drugs. This prediction is relevant to RBC storage in the blood bank, in which the impact of small molecule drugs or other xenometabolites deriving from dietary, iatrogenic, or environmental exposures ("exposome") may alter erythrocyte energy and redox metabolism and, in so doing, affect red cell storage quality and posttransfusion efficacy. To test this prediction, here we provide a comprehensive characterization of the blood donor exposome, including the detection of common prescription and over-the-counter drugs in blood units donated by 250 healthy volunteers in the Recipient Epidemiology and Donor Evaluation Study III Red Blood Cell-Omics (REDS-III RBC-Omics) Study. Based on high-throughput drug screenings of 1366 FDA-approved drugs, we report that approximately 65% of the tested drugs had an impact on erythrocyte metabolism. Machine learning models built using metabolites as predictors were able to accurately predict drugs for several drug classes/targets (bisphosphonates, anticholinergics, calcium channel blockers, adrenergics, proton pump inhibitors, antimetabolites, selective serotonin reuptake inhibitors, and mTOR), suggesting that these drugs have a direct, conserved, and substantial impact on erythrocyte metabolism. As a proof of principle, here we show that the antacid ranitidine - though rarely detected in the blood donor population - has a strong effect on RBC markers of storage quality in vitro. We thus show that supplementation of blood units stored in bags with ranitidine could - through mechanisms involving sphingosine 1-phosphate-dependent modulation of erythrocyte glycolysis and/or direct binding to hemoglobin - improve erythrocyte metabolism and storage quality.

PurposeOsteoarthritis (OA) is a frequently occurring, chronic condition; however, few studies describe the clinical characteristics of individuals with OA and the treatments they use to manage their symptoms. We conducted a study to characterize the OA population in the US and describe the nonsurgical management used by this population based on consumer research data collected through an online survey.MethodsData from the 2017 US National Health and Wellness Survey (NHWS) for adults aged ≥35 years were used to evaluate the relationship between OA and certain study participant characteristics and to identify the most commonly used treatment options. NHWS data were collected through a survey of individuals drawn from the internet panel maintained by Lightspeed Research (Bridgewater, New Jersey) and its panel partners. Weighted estimates were generated using data from the 2016 Current Population Survey (Annual Demographics File) of the US Census Bureau. Comparisons between the general and OA populations were made based on body mass index (BMI), exercise frequency, and comorbid diagnoses of hypertension or diabetes. Among the OA population, the use of dietary supplements, prescription or over-the-counter (OTC) treatments with chondroitin with or without glucosamine (Ch ± Gl), prescription treatment by time since OA diagnosis, and utilization of a physical therapist were also recorded.ResultsThe prevalence of OA in the overall population was 17.6 % and was higher for individuals with a BMI ≥ 25 (21.9 %), patients diagnosed with hypertension or diabetes (36.2 %), and those who did not exercise regularly (19.0 %). Adults without OA were more likely to exercise regularly (12 days per month or more) than adults diagnosed with OA. Ch ± Gl (6.0 %) was the most commonly used OTC dietary supplement in the OA population, followed by omega-3 fatty acids (2.8 %), vitamin D (1.9 %), calcium (1.1 %), and multivitamins (0.7 %). Individuals using Ch ± Gl were more likely to use OTC onl

Background : Managing minor ailments in community pharmacy is an evolving pharmacy service in developing countries. Defined scopes of practice for pharmacy staff are essential for the safe management of minor ailments. Limited research exists regarding the perceptions of Indonesian pharmacists’ and pharmacy technicians’ scopes of practice in providing minor ailments management services. Objective : To evaluate pharmacists’ and pharmacy technicians’ understanding of their scopes of practice, perc eived competency and factors influencing the delivery of minor ailments services in Indonesian community pharmacies. Methods : Cross - sectional surveys were conducted during January - February 2020 of pharmacists and pharmacy technicians attending seminars co nducted by relevant Indonesian Associations in Central Java, Indonesia. Percentage of common responses (PCR) described similarity of perceived scopes of practice for pharmacists and pharmacy technicians. Univariate and multivariate analyses ide ntified asso ciations of scopes of practice with pharmacy characteristics. Results : A total of 185 pharmacists and 142 pharmacy technicians participated. Pharmacy technicians performed minor ailment consultations, however, if considered beyond their scope of practice, they referred the patient to the pharmacist (T=120/142, 84.5%). Vaginal thrush, bacterial conjunctivitis, gastro - oesophageal reflux disease, and acute pain were minor ailments perceived only within a pharmacist’s scope (PCR above 60%). Of 34 minor ailments , 11 showed PCR values between 40 - 60% overlapping pharmacists and pharmacy technicians perceived scopes of practice (allergy/rash, back pain, cold sores, dermatitis, diarrhoea, eczema, hayfev er, haemorrhoids, rheumatism, sore throat, and superficial wounds ). Back pain, cold sores, dermatitis, and sore throat associated pharmacists’ scope of practice with years of practice experience (p - value<0.05). Pharmacy technicians perceived their scopes of practice

Background: Community pharmacy teams (CPTs) have an established role in assisting self-medication, contributing to the safe and effective use of non-prescription medicines. Objective: The study aimed to describe CPTs’ performance in self-medication consultation, client-reported outcomes, and satisfaction. A secondary purpose was to develop an explanatory model for better understanding clients’ satisfaction with this service. Methods: Descriptive, cross-sectional exploratory study. Data were collected in a purposive sample of pharmacy clients recruited in six community pharmacies in Portugal. CPTs adopted a structured approach to self-medication consultations, encompassing 11 quality criteria (five for case evaluation and six for counselling). An evaluation score, a counselling score and an overall quality score were estimated. Client-reported outcomes and satisfaction were ascertained via a follow-up telephone interview. Besides descriptive statistics, the association with several independent variables on the clients’ overall satisfaction was explored, using linear regression. Results: Product-based dispensing was more frequent for lower educated clients. Reported compliance with the criteria by CPTs was overall high (93.95% of maximum compliance), mostly missing the ‘other medication’ questioning. Most clients (93%) reported improvement after the consultation. Clients’ satisfaction score was 4.70 out of 5. The variables that seem to better explain clients’ overall satisfaction are pharmacy loyalty, the evaluation score, and the female gender. Conclusions: Clients’ reported outcomes were favourable, as well as satisfaction with the service. Clients’ satisfaction appears to be determined by consultation quality (evaluation score), suggesting the advancement of the pharmacists’ clinical role. A larger study is warranted to confirm these findings.

Background: In Low-and Middle-Income Countries, including India, consumers often purchase antibiotics over-the-counter (OTC) from retail pharmacies. This practice leads to the inappropriate use of antibiotics in the community which is an important driver for the development of antimicrobial resistance. A better understanding of consumers’ views towards this grave public health concern is critical to developing evidence-based intervention programs for awareness among the general population. Objective: To explore knowledge, practice and, behavior of consumers towards antibiotics, antibiotic use, antimicrobial resistance, purchasing behavior of consumers for antibiotics, and to gain insight which will help in developing evidence-based policy interventions. Methods: 72 in-depth consumer interviews were conducted in all 11 districts of the National Capital Territory of Delhi. The qualitative data were analyzed using thematic analysis. Results: Our study found that retail pharmacies were the first point of consultation for common ailments for patients/consumers once home remedies failed; they were largely unaware of the threat of antimicrobial resistance. Consumers’ knowledge of antibiotic use and about antimicrobial resistance was low, they used old prescriptions, and bought antibiotics OTC to save time and money. Despite the presence of regulations constituted to regulate the sale of antibiotics by the Government and the implementation of national campaigns, the practice of self-medication and behaviors such as OTC purchase, non-adherence to prescribed antibiotics was prevalent. Consumers perceive that antibiotics provide quick relief and accelerate the curing process and retail pharmacy shops try to protect their retail business interests by honoring old prescriptions and self-medication for antibiotics. Conclusions: The lack of awareness and insufficient knowledge about what antibiotics are and issues such as antimicrobial resistance or antibiotic resistance resulte

Recently, there has been an increase in the use of over-the-counter (OTC) drugs. The consumption of these medicines can be unsafe, as incorrect self-diagnosis or the ingestion of inappropriate doses can lead to side effects and the occurrence of adverse reactions and drug–drug interactions. A cross-sectional descriptive observational study was carried out, targeting the entire Spanish population by using an online questionnaire. The results showed that 78.9% of the subjects had previously taken or were currently taking OTC drugs. This consumption decreased as the age of the subjects increased, with a prevalence of 36.4% of subjects aged 71 taking OTC drugs. Analgesics were the most consumed OTC drugs (49.1%) especially in women, youngsters with non-formal educational qualifications, and individuals of a low–medium socioeconomic level residing in urban areas. Measures should be implemented to optimize the safe use of OTC drugs in order to avoid the occurrence of secondary events associated with the lack of knowledge related to their the usage.

BACKGROUND: Direct-acting oral anticoagulants (DOACs), such as apixaban, are the most commonly prescribed anticoagulants, with advantages in that they do not require routine monitoring. However, less frequent contact with healthcare professionals may contribute to poor patient knowledge about potential interactions between over-the-counter (OTC) products and DOACs. OBJECTIVE: Determine the prevalence of use of OTC products (OTC medications and dietary supplements) with potentially serious apixaban interactions and assess patient knowledge of potential interactions. DESIGN: Cross-sectional survey. SETTING: Academic-affiliated outpatient medical practices in northern and southern California. PARTICIPANTS: A total of 791 English- or Spanish-speaking patients prescribed apixaban. MEASUREMENTS: Use and knowledge of OTC medications and dietary supplements with potentially serious apixaban interactions. RESULTS: Almost all respondents (n = 771; 97.5%) reported OTC product use. Of respondents, 33% (n = 266) took at least one OTC product with potentially serious apixaban interactions daily/most days and 53 (6.7%) took multiple products (mean = 2.6 [SD = 2.6]). Aspirin was taken daily by 116 (14.7%; of which 75 [64.7%] also consumed other potentially interacting OTC products), and some days/as needed by an additional 82 (10.4%). Ibuprofen and naproxen were taken daily/most days by 14 (1.8%) and occasionally by 225 (28.5%). Dietary supplements with potentially serious interactions were taken daily/most days by 160 (20.2%). Approximately 66% of respondents were either uncertain or incorrect about the potential for increased bleeding from combining nonsteroidal anti-inflammatory drugs and apixaban. Less knowledge about OTC products with potentially serious interactions was associated with greater OTC product use (odds ratio = 0.54; 95% confidence interval = 0.35-0.85). CONCLUSION: Significant numbers of patients take OTC products (particularly dietary supplements) with potential

BackgroundDirect-acting oral anticoagulants (DOACs), such as apixaban, are the most commonly prescribed anticoagulants, with advantages in that they do not require routine monitoring. However, less frequent contact with healthcare professionals may contribute to poor patient knowledge about potential interactions between over-the-counter (OTC) products and DOACs.ObjectiveDetermine the prevalence of use of OTC products (OTC medications and dietary supplements) with potentially serious apixaban interactions and assess patient knowledge of potential interactions.DesignCross-sectional survey.SettingAcademic-affiliated outpatient medical practices in northern and southern California.ParticipantsA total of 791 English- or Spanish-speaking patients prescribed apixaban.MeasurementsUse and knowledge of OTC medications and dietary supplements with potentially serious apixaban interactions.ResultsAlmost all respondents (n = 771; 97.5%) reported OTC product use. Of respondents, 33% (n = 266) took at least one OTC product with potentially serious apixaban interactions daily/most days and 53 (6.7%) took multiple products (mean = 2.6 [SD = 2.6]). Aspirin was taken daily by 116 (14.7%; of which 75 [64.7%] also consumed other potentially interacting OTC products), and some days/as needed by an additional 82 (10.4%). Ibuprofen and naproxen were taken daily/most days by 14 (1.8%) and occasionally by 225 (28.5%). Dietary supplements with potentially serious interactions were taken daily/most days by 160 (20.2%). Approximately 66% of respondents were either uncertain or incorrect about the potential for increased bleeding from combining nonsteroidal anti-inflammatory drugs and apixaban. Less knowledge about OTC products with potentially serious interactions was associated with greater OTC product use (odds ratio = 0.54; 95% confidence interval = 0.35-0.85).ConclusionSignificant numbers of patients take OTC products (particularly dietary supplements) with potentially serious interactions

Background: Community pharmacists are often the first health professional approached to provide treatment for health issues, including the important mental health challenge, stress. Over-the-counter products for stress almost always are complementary and alternative medicines (CAM) and in Australia no protocol exists for their recommendation and sale in community pharmacies. Objective: To assess the quality and relevance of community pharmacists’ information gathering (questioning), counselling and product selection when interacting with customers requesting a CAM product for stress and consequently determine whether Australian pharmacy practice indicates the need for guidelines similar to those provided for ‘pharmacy only’ (S2) and ‘pharmacist only’ (S3) medicines. Methods: A covert simulated patient was used to investigate the response of pharmacists to a request for a natural product for stress. The SPs documented the details of the pharmacist-simulated patient interaction immediately on leaving the pharmacy and then re-entered the pharmacy to debrief the pharmacist. The quality of the interaction was scored as a Total CARE (check, assess, respond, explain) Score, based on anticipated questions and counselling advice. The appropriateness of the product was scored as a Product Efficacy Score, based on evidence-based literature. Results: Data from 100 pharmacies was provided. Information gathering illustrated by the questioning components Check and Assess (C and A) of the total CARE score by pharmacists was poor. The number of questions asked ranged from zero (13 pharmacists) to 7 (four pharmacists), the average being 3.1 (SD 1.9). Provision of advice was generally better (a description of the suggested product was offered by 87 pharmacists) but was lacking in other areas (duration of use and side effects were explained by only 41 and 16 pharmacists respectively). The most common product suggested was B-group vitamins (57 pharmacists) followed by a proprietary flow

Objective: Explore the perceptions, attitudes and experiences of pharmacists relating to the up-scheduling of low dose codeine containing analgesics and the impact on pharmacy practice. Methods: A mixed design method was used consisting of an anonymous online questionnaire survey to quantitatively capture broad pre-scheduling change perceptions paired with a series of in-depth post-scheduling semi-structured interviews to provide a qualitative picture of the impact of codeine up-scheduling on pharmacy practice in Australia. Results: A total of 191 pharmacists completed the quantitative survey and 10 participated in the in-depth interview. The majority of respondents supported the decision to up-schedule over-the-counter combination products containing codeine to some degree. Three main themes emerged from the data: pharmacists’ perceptions of the codeine up-scheduling decision, preparing for the up-schedule and impact of the up-schedule on pharmacy practice. Pharmacists were concerned about the impact of up-scheduling on the pharmacy business, patient access to pain relief and the diminishment of their professional role. Conclusions: There were diverse perceptions, preparedness and impact on practice regarding the up-scheduling of low dose codeine products. Further research should be conducted to gauge if and how these perceptions have changed over time and to identify whether pain is being managed more effectively post codeine up-scheduling.

BackgroundDirect-acting oral anticoagulants (DOACs), such as apixaban, are the most commonly prescribed anticoagulants, with advantages in that they do not require routine monitoring. However, less frequent contact with healthcare professionals may contribute to poor patient knowledge about potential interactions between over-the-counter (OTC) products and DOACs.ObjectiveDetermine the prevalence of use of OTC products (OTC medications and dietary supplements) with potentially serious apixaban interactions and assess patient knowledge of potential interactions.DesignCross-sectional survey.SettingAcademic-affiliated outpatient medical practices in northern and southern California.ParticipantsA total of 791 English- or Spanish-speaking patients prescribed apixaban.MeasurementsUse and knowledge of OTC medications and dietary supplements with potentially serious apixaban interactions.ResultsAlmost all respondents (n = 771; 97.5%) reported OTC product use. Of respondents, 33% (n = 266) took at least one OTC product with potentially serious apixaban interactions daily/most days and 53 (6.7%) took multiple products (mean = 2.6 [SD = 2.6]). Aspirin was taken daily by 116 (14.7%; of which 75 [64.7%] also consumed other potentially interacting OTC products), and some days/as needed by an additional 82 (10.4%). Ibuprofen and naproxen were taken daily/most days by 14 (1.8%) and occasionally by 225 (28.5%). Dietary supplements with potentially serious interactions were taken daily/most days by 160 (20.2%). Approximately 66% of respondents were either uncertain or incorrect about the potential for increased bleeding from combining nonsteroidal anti-inflammatory drugs and apixaban. Less knowledge about OTC products with potentially serious interactions was associated with greater OTC product use (odds ratio = 0.54; 95% confidence interval = 0.35-0.85).ConclusionSignificant numbers of patients take OTC products (particularly dietary supplements) with potentially serious interactions

Substance abuse and self-medication in adolescents and young adults are a major public health concern. With the objective of studying the prevalence of consumption of medicines and its association with alcohol, tobacco and cannabis use among university Spanish students, we carried out a cohort study among university students between November 2005 and March 2015. Consumption of alcohol was measured using the Alcohol use Disorders Identification Test (AUDIT), after assessing its validity. Multilevel logistic regressions for repeated measures were generated to obtain adjusted odds ratios. Our study has revealed that prevalence of binge drinking, risky alcohol consumption, and tobacco and cannabis use had a significant reduction during the follow-up period, while use of medicines without medical prescription increased. Our results have shown a strong association between use of medicines without prescription with alcohol and cannabis use. Education for health and preventive activities should be reinforced in youth to decrease these high levels of poly-consumption. Strategies for handling stress during university should be provided, with greater emphasis on females.

Background: Throughout Europe, legal online pharmacies increasingly sell online drugs as well as other products such as dietary supplements. Online sale of pharmaceuticals however is closely connected to the phenomenon of drug falsification. Objective: The aim of this study was to assess the opinions of a sample of Italian community pharmacists towards the sale of pharmaceuticals on the web, as well as their knowledge and experience with falsified drugs. Methods: A self-administered questionnaire was distributed by means of an online platform between October 2016 and January 2017. Collected information included: demographics, workplace and role, opinions towards the online sale of pharmaceuticals, whether the pharmacy has a website, knowledge and opinions about falsified drugs. Results: A total of 668 community pharmacists completed the questionnaire (mean age: 48.5, SD 12.4 years, 52.3% women). Favourable opinions about online sale of pharmaceuticals were expressed by 4.9% of participants for prescription drugs, 25.4% for nonprescription drugs, and 51.6% for other products. Favourable opinions occurred more often among males and owners/directors of pharmacies in comparison to females and employees, and among pharmacists working in pharmacies with websites doing e-commerce. Knowledge about falsified drugs was limited, with 24.5% of respondents failing to indicate that falsified drugs may contain less or different ingredients, 46.4% less and/or different excipients, and 72.3% ignoring that falsified drugs may be lethal. One in 3 respondents didn't know about falsified drugs in Italy, however 51 participants had previous experience with falsified drugs and 21 provided specific information. Conclusions: Italian community pharmacists have low confidence in the online sale of pharmaceuticals, as well as alarmingly limited knowledge about falsified drugs, even if many of them reported previous experiences. Results may support targeted interventions to increase pharmacists

ObjectiveTo identify frequently reported prescription medications and supplements among couples planning pregnancy because there is a lack of descriptive information on these agents in women and men who are trying to conceive.MethodsFive hundred one couples enrolled in the Longitudinal Study of Infertility and the Environment, which took place between 2005 and 2009. Participants reported prescription medications as well as prescription and over-the-counter supplements used through interviews at study enrollment and through daily dairies during the 12-month follow-up. We identified prescription medications and supplements prospectively reported by ≥1% of women and men at baseline and from daily journal information grouped into 3-month preconception follow-up intervals while couples tried for pregnancy.ResultsThe 5 most reported prescription medications among women were levothyroxine (5.8%), cetirizine (2.6%), fluticasone (2.4%), escitalopram (1.8%), and fluoxetine (1.8%) and for men were lisinopril (2.0%), mometasone (2.0%), fexofenadine (1.8%), atorvastatin (1.6%), and montelukast (1.6%). The most reported supplements were multivitamins (63.3%, 43.5%) and fish oil (13.2%, 9.4%) for women and men, respectively, and prenatal vitamins (22.0%) for women. For women during the first 3 months of follow-up, prenatal vitamins (6.0%) and antibiotics (1.2%-2.6%) were among the most frequently started medications. During the next 3 months, clomiphene (4.5%) was the most frequently initiated medication.ConclusionsCouples trying for pregnancy reported a variety of prescription medications and supplements, and they differed by gender. Preconception guidance should address medication and supplement use to avoid potential exposures associated with adverse reproductive and perinatal outcomes.

ObjectiveTo characterize prescription and other medication use in a geographically and ethnically diverse cohort of women in their first pregnancy.MethodsIn a prospective, longitudinal cohort study of nulliparous women followed through pregnancy from the first trimester, medication use was chronicled longitudinally throughout pregnancy. Structured questions and aids were used to capture all medications taken as well as reasons they were taken. Total counts of all medications taken including number in each category and class were captured. Additionally, reasons the medications were taken were recorded. Trends in medications taken across pregnancy and in the first trimester were determined.ResultsOf the 9,546 study participants, 9,272 (97.1%) women took at least one medication during pregnancy with 9,139 (95.7%) taking a medication in the first trimester. Polypharmacy, defined as taking at least five medications, occurred in 2,915 (30.5%) women. Excluding vitamins, supplements, and vaccines, 73.4% of women took a medication during pregnancy with 55.1% taking one in the first trimester. The categories of drugs taken in pregnancy and in the first trimester include the following: gastrointestinal or antiemetic agents (34.3%, 19.5%), antibiotics (25.5%, 12.6%), and analgesics (23.7%, 15.6%, which includes 3.6%; 1.4% taking an opioid pain medication).ConclusionIn this geographically and ethnically diverse cohort of nulliparous pregnant women, medication use was nearly universal and polypharmacy was common.Clinical trial registrationClinicalTrials.gov, NCT01322529.

Background: Because community pharmacists are the most accessible healthcare professionals, they are often involved in managing minor ailments within the community setting. Objective: This study evaluated the community pharmacists’ history taking practice, medicine dispensing and advice in response to acute diarrhea. Methods: Authors conducted a simulated-patient study in 75 community pharmacies in Baghdad, Iraq from February to May 2015. The female simulated-patient complained of acute diarrhea that had lasted for one day and requested for medicine to treat her condition. After exiting each pharmacy, she then assessed the practices of the community pharmacists through the use of a specially designed checklist adopted with modifications from relevant guidelines. For history taking, a maximum total of eight was the highest obtainable score. Data collected was quantitatively analyzed and Mann-Whitney, Chi-square or Fishers exact tests were used at an alpha level of 0.05. Results: All of the 75 pharmacies visited were managed by professionally qualified pharmacists. The most common questions asked during history taking were number of diarrheal episodes (n=62; 82.7%); duration of symptoms (n=59; 78.7%) and presence of other diseases and if any drug had been taken (n=58; 77.3%). Female pharmacists had a higher total mean score (6.45, SD=1.33) for history taking when compared to their male counterparts (4.34, SD=2.13); p <0.001. Medicine combination of diphenoxylate HCl 2.5mg + atropine sulphate 0.025mg (n=34; 27.9%) was most frequently dispensed while the least was oral rehydration salt (n=1; 0.8%). Around 20% (n=15) of pharmacists dispensed antimicrobial agents. Over half (n=46; 61.3%) of pharmacists indicated the frequency of use on the medicine packet. Conversely, less than half (n=33; 44.0%) gave any advice on food and fluid intake. Conclusions: Majority of the community pharmacists asked at least four questions while taking patient history and was very likely to rec

Introduction: Over the years, malaria has been a major global public health and developmental challenge, with approximately 40% of the world's population, within the tropical and sub-tropical regions at risk. Worldwide, malaria accounts for an estimated 207 million cases leading to 627,000 deaths (0.03%) yearly. Furthermore, and paradoxically the disease is preventable, treatable and curable, thereby indicating the mortality figures being very alarming. There are no vaccines yet for malaria prevention, as such public health effort are still geared towards effective protection and drug treatment. In Nigeria, malaria is holo-endemic implying an all year round transmission and the Nigerian control strategies facing setbacks of trained manpower shortages. Thus, non-pharmacist drug retailers called Patent Medicine Vendors (PMVs) were incorporated by government to fill gaps based on WHO recommendations. But however, an assessments of PMVs performances consistently reveals lack of necessary knowledge, attitudes and practices (KAP) to effectively implement government strategies on malaria control.This study aims to evaluate the effectiveness of a developed Concise Malaria Educational Training (CONMET) on KAP among PMVs in Yobe-South district, Nigeria. Methodology:A single-blinded and placebo effected randomised controlled trial was conducted among PMVs in the study location. A process of simple randomization was used to select and assign 292 PMV respondents into the intervention and control arms of study respectively. The development of module was based on the Information-motivation-behavioural (IMB) skills model of health behaviours. Validated pretested questionnaires were used to measure knowledge, attitude and practice at baseline, at immediate, at three months and at six months post-intervention. Data were analysed using IBM SPSS version 23. A One way ANOVA, mixed design ANOVA and Bonferroni tests were used to assess effectiveness of the intervention. P-value of less th

Introduction: Over the years, malaria has been a major global public health and developmental challenge, with approximately 40% of the world's population, within the tropical and sub-tropical regions at risk. Worldwide, malaria accounts for an estimated 207 million cases leading to 627,000 deaths (0.03%) yearly. Furthermore, and paradoxically the disease is preventable, treatable and curable, thereby indicating the mortality figures being very alarming. There are no vaccines yet for malaria prevention, as such public health effort are still geared towards effective protection and drug treatment. In Nigeria, malaria is holo-endemic implying an all year round transmission and the Nigerian control strategies facing setbacks of trained manpower shortages. Thus, non-pharmacist drug retailers called Patent Medicine Vendors (PMVs) were incorporated by government to fill gaps based on WHO recommendations. But however, an assessments of PMVs performances consistently reveals lack of necessary knowledge, attitudes and practices (KAP) to effectively implement government strategies on malaria control.This study aims to evaluate the effectiveness of a developed Concise Malaria Educational Training (CONMET) on KAP among PMVs in Yobe-South district, Nigeria. Methodology:A single-blinded and placebo effected randomised controlled trial was conducted among PMVs in the study location. A process of simple randomization was used to select and assign 292 PMV respondents into the intervention and control arms of study respectively. The development of module was based on the Information-motivation-behavioural (IMB) skills model of health behaviours. Validated pretested questionnaires were used to measure knowledge, attitude and practice at baseline, at immediate, at three months and at six months post-intervention. Data were analysed using IBM SPSS version 23. A One way ANOVA, mixed design ANOVA and Bonferroni tests were used to assess effectiveness of the intervention. P-value of less th

Medication prior authorization (PA) is a commonly occurring requirement, particularly for medications used for rare conditions. Based on standard definitions, cancer and many blood disorders affecting children are rare. The study aims were to describe the relative frequency of PA requests and their association with payers and medications in order to identify opportunities to improve system efficiency. Requests for medication PA were logged prospectively for patients seen at a single institution over a 7-month period. Period prevalence was used to estimate the relative frequency of PA requests. Descriptive statistics summarized the relationship among payers, medications, and approvals relative to the frequency of PA requests. For the study duration of 150 clinic days, there were 5,583 patient visits. A total of 142 medication PA requests were received resulting in a period prevalence rate of 2.5% patient visits. Of the 137 medication PA requests with available outcome data, 135 (98.5%) were ultimately approved with additional provider efforts. The median clinic staff time spent per request was 46 min with an interquartile range of 25-80 min. There was striking process heterogeneity among different payers. Virtually no medication PA request in pediatric hematology and oncology (PHO) leads to alterations in care. Medication utilization management strategies in PHO fail to provide benefits reported in other areas of medicine and have unmeasured negative effects on timeliness of care and parenteral psychological/emotional health. There is opportunity for increasing efficiency through payer and provider collaboration on the creation of prescribing standards for PHO patients.

Background: The availability of over-the-counter drugs (OTCs) has increased in Sweden since a re-regulation of the pharmacy market in 2009, through which non-pharmacy retailers became permitted to provide certain OTCs. Objective: To examine the adult general public's views on safety, purchasing and information channels, storage and disposal of OTCs in Sweden, three years after the re-regulation of the pharmacy market. Methods: A questionnaire study in 2012-13 in a stratified, random sample of all inhabitants in Sweden >= 18 years old. Results: Totally 8,302 people (42%) answered the questionnaire. Seven percent found OTCs completely harmless regardless of how they are being used, 18% felt they should be used only on health professionals' recommendation. Differences in how OTCs are perceived were however found with regards to respondents' country of birth, family type, educational level and income. The pharmacy was still the preferred OTC drug retailer by 83% of the respondents and preferred information source by 80% Reasons for preferred retailers were primarily due to out of habit (45%), counseling provided (35%), the product range (34%) and the confidence in staff (27%). Analgesics are the most common OTCs to have at home (90%). The bathroom cabinet is the primary site for storage (42%) and 16% throw their OTC leftovers in the trash. Conclusions: The study population does not consider OTCs as harmless regardless of how they are used, but on the other hand feels they should not be taken on health professionals' recommendation only. The pharmacy is still the preferred retailer and information source, and there is room for further improvement in the storage and disposal of OTCs. A return of OTC drug leftovers to the pharmacy should be further encouraged. Due to several limitations, great caution should however be observed when generalizing the results to the adult population of Sweden.

Background: The availability of over-the-counter drugs (OTCs) has increased in Sweden since a re-regulation of the pharmacy market in 2009, through which non-pharmacy retailers became permitted to provide certain OTCs. Objective: To examine the adult general public's views on safety, purchasing and information channels, storage and disposal of OTCs in Sweden, three years after the re-regulation of the pharmacy market. Methods: A questionnaire study in 2012-13 in a stratified, random sample of all inhabitants in Sweden >= 18 years old. Results: Totally 8,302 people (42%) answered the questionnaire. Seven percent found OTCs completely harmless regardless of how they are being used, 18% felt they should be used only on health professionals' recommendation. Differences in how OTCs are perceived were however found with regards to respondents' country of birth, family type, educational level and income. The pharmacy was still the preferred OTC drug retailer by 83% of the respondents and preferred information source by 80% Reasons for preferred retailers were primarily due to out of habit (45%), counseling provided (35%), the product range (34%) and the confidence in staff (27%). Analgesics are the most common OTCs to have at home (90%). The bathroom cabinet is the primary site for storage (42%) and 16% throw their OTC leftovers in the trash. Conclusions: The study population does not consider OTCs as harmless regardless of how they are used, but on the other hand feels they should not be taken on health professionals' recommendation only. The pharmacy is still the preferred retailer and information source, and there is room for further improvement in the storage and disposal of OTCs. A return of OTC drug leftovers to the pharmacy should be further encouraged. Due to several limitations, great caution should however be observed when generalizing the results to the adult population of Sweden.

Background: The availability of over-the-counter drugs (OTCs) has increased in Sweden since a re-regulation of the pharmacy market in 2009, through which non-pharmacy retailers became permitted to provide certain OTCs. Objective: To examine the adult general public's views on safety, purchasing and information channels, storage and disposal of OTCs in Sweden, three years after the re-regulation of the pharmacy market. Methods: A questionnaire study in 2012-13 in a stratified, random sample of all inhabitants in Sweden >= 18 years old. Results: Totally 8,302 people (42%) answered the questionnaire. Seven percent found OTCs completely harmless regardless of how they are being used, 18% felt they should be used only on health professionals' recommendation. Differences in how OTCs are perceived were however found with regards to respondents' country of birth, family type, educational level and income. The pharmacy was still the preferred OTC drug retailer by 83% of the respondents and preferred information source by 80% Reasons for preferred retailers were primarily due to out of habit (45%), counseling provided (35%), the product range (34%) and the confidence in staff (27%). Analgesics are the most common OTCs to have at home (90%). The bathroom cabinet is the primary site for storage (42%) and 16% throw their OTC leftovers in the trash. Conclusions: The study population does not consider OTCs as harmless regardless of how they are used, but on the other hand feels they should not be taken on health professionals' recommendation only. The pharmacy is still the preferred retailer and information source, and there is room for further improvement in the storage and disposal of OTCs. A return of OTC drug leftovers to the pharmacy should be further encouraged. Due to several limitations, great caution should however be observed when generalizing the results to the adult population of Sweden.

Background: The availability of over-the-counter drugs (OTCs) has increased in Sweden since a re-regulation of the pharmacy market in 2009, through which non-pharmacy retailers became permitted to provide certain OTCs. Objective: To examine the adult general public's views on safety, purchasing and information channels, storage and disposal of OTCs in Sweden, three years after the re-regulation of the pharmacy market. Methods: A questionnaire study in 2012-13 in a stratified, random sample of all inhabitants in Sweden >= 18 years old. Results: Totally 8,302 people (42%) answered the questionnaire. Seven percent found OTCs completely harmless regardless of how they are being used, 18% felt they should be used only on health professionals' recommendation. Differences in how OTCs are perceived were however found with regards to respondents' country of birth, family type, educational level and income. The pharmacy was still the preferred OTC drug retailer by 83% of the respondents and preferred information source by 80% Reasons for preferred retailers were primarily due to out of habit (45%), counseling provided (35%), the product range (34%) and the confidence in staff (27%). Analgesics are the most common OTCs to have at home (90%). The bathroom cabinet is the primary site for storage (42%) and 16% throw their OTC leftovers in the trash. Conclusions: The study population does not consider OTCs as harmless regardless of how they are used, but on the other hand feels they should not be taken on health professionals' recommendation only. The pharmacy is still the preferred retailer and information source, and there is room for further improvement in the storage and disposal of OTCs. A return of OTC drug leftovers to the pharmacy should be further encouraged. Due to several limitations, great caution should however be observed when generalizing the results to the adult population of Sweden.

Background: The availability of over-the-counter drugs (OTCs) has increased in Sweden since a re-regulation of the pharmacy market in 2009, through which non-pharmacy retailers became permitted to provide certain OTCs. Objective: To examine the adult general public's views on safety, purchasing and information channels, storage and disposal of OTCs in Sweden, three years after the re-regulation of the pharmacy market. Methods: A questionnaire study in 2012-13 in a stratified, random sample of all inhabitants in Sweden >= 18 years old. Results: Totally 8,302 people (42%) answered the questionnaire. Seven percent found OTCs completely harmless regardless of how they are being used, 18% felt they should be used only on health professionals' recommendation. Differences in how OTCs are perceived were however found with regards to respondents' country of birth, family type, educational level and income. The pharmacy was still the preferred OTC drug retailer by 83% of the respondents and preferred information source by 80% Reasons for preferred retailers were primarily due to out of habit (45%), counseling provided (35%), the product range (34%) and the confidence in staff (27%). Analgesics are the most common OTCs to have at home (90%). The bathroom cabinet is the primary site for storage (42%) and 16% throw their OTC leftovers in the trash. Conclusions: The study population does not consider OTCs as harmless regardless of how they are used, but on the other hand feels they should not be taken on health professionals' recommendation only. The pharmacy is still the preferred retailer and information source, and there is room for further improvement in the storage and disposal of OTCs. A return of OTC drug leftovers to the pharmacy should be further encouraged. Due to several limitations, great caution should however be observed when generalizing the results to the adult population of Sweden.

BackgroundMedication prior authorization (PA) is a commonly occurring requirement, particularly for medications used for rare conditions. Based on standard definitions, cancer and many blood disorders affecting children are rare. The study aims were to describe the relative frequency of PA requests and their association with payers and medications in order to identify opportunities to improve system efficiency.ProcedureRequests for medication PA were logged prospectively for patients seen at a single institution over a 7-month period. Period prevalence was used to estimate the relative frequency of PA requests. Descriptive statistics summarized the relationship among payers, medications, and approvals relative to the frequency of PA requests.ResultsFor the study duration of 150 clinic days, there were 5,583 patient visits. A total of 142 medication PA requests were received resulting in a period prevalence rate of 2.5% patient visits. Of the 137 medication PA requests with available outcome data, 135 (98.5%) were ultimately approved with additional provider efforts. The median clinic staff time spent per request was 46 min with an interquartile range of 25-80 min. There was striking process heterogeneity among different payers.ConclusionVirtually no medication PA request in pediatric hematology and oncology (PHO) leads to alterations in care. Medication utilization management strategies in PHO fail to provide benefits reported in other areas of medicine and have unmeasured negative effects on timeliness of care and parenteral psychological/emotional health. There is opportunity for increasing efficiency through payer and provider collaboration on the creation of prescribing standards for PHO patients.

ObjectiveTo evaluate long-term clinical and economic outcomes of naproxen, ibuprofen, celecoxib or tramadol for OA patients with cardiovascular disease (CVD) and diabetes.DesignWe used the Osteoarthritis Policy Model to examine treatment with these analgesics after standard of care (SOC) - acetaminophen and corticosteroid injections - failed to control pain. NSAID regimens were evaluated with and without proton pump inhibitors (PPIs). We evaluated over-the-counter (OTC) regimens where available. Estimates of treatment efficacy (pain reduction, occurring in ∼57% of patients on all regimens) and toxicity (major cardiac or gastrointestinal toxicity or fractures, risk ranging from 1.09% with celecoxib to 5.62% with tramadol) were derived from published literature. Annual costs came from Red Book Online(®). Outcomes were discounted at 3%/year and included costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios (ICERs). Key input parameters were varied in sensitivity analyses.ResultsAdding ibuprofen to SOC was cost saving, increasing QALYs by 0.07 while decreasing cost by $800. Incorporating OTC naproxen rather than ibuprofen added 0.01 QALYs and increased costs by $300, resulting in an ICER of $54,800/QALY. Using prescription naproxen with OTC PPIs led to an ICER of $76,700/QALY, while use of prescription naproxen with prescription PPIs resulted in an ICER of $252,300/QALY. Regimens including tramadol or celecoxib cost more but added fewer QALYs and thus were dominated by several of the naproxen-containing regimens.ConclusionsIn patients with multiple comorbidities, naproxen- and ibuprofen-containing regimens are more effective and cost-effective in managing OA pain than opioids, celecoxib or SOC.

El consumo de medicamentos es un asunto que actualmente se ha convertido en una preocupación a nivel global, ya que no todos los medicamentos están sujetos a prescripción médica, y esto implica que su consumo dependa de otras fuentes de información, como la publicidad masiva o el consejo de personas legas, entre otros. Esta revisión se basó en la publicidad y el impacto que tiene esta frente al consumidor. La presente revisión se dividió en dos categorías dado la relevancia del tema, en la primera se encuentra las características de los medicamentos de venta libre donde se evidenció cómo funciona el sector de la industria farmacéutica, las características de los medicamentos en general y los riesgos del abuso de este comportamiento. Así mismo, en la segunda categoria se habló sobre la publicidad y mercadeo de ventas libres donde se evidenció el alto impacto que tiene la publicidad en el consumidor, las restricciones que hay en el contexto nacional e internacional., Nowadays, the consumption of medicines is a global concern because not all medicines are subject to medical prescription. This concern implies that their consumption depends on different sources of information such as massive advertising and advising of people, among others. This analysis was based on the advertising and the impact this has on consumers. The present analysis was divided into two categories given the relevance of the topic. The first one is the characteristics of over-the-counter medicines where it is evident how the pharmaceutical industry works, the characteristics of drugs in general and the risks of abuse this behavior. Likewise, in the second category we talked about the advertising and marketing of free sales drugs, where the high impact of advertising on the consumer was analyzed and the different restrictions that can be present in the national and international context., Universidad del Rosario

INTRODUCTION: We know little about the use of vaginal estrogen in perimenopausal and postmenopausal women. We aimed to assess the prevalence of vaginal estrogen use in Denmark.MATERIAL AND METHODS: The study was designed as a nationwide cross-sectional study of all Danish women aged 40-79 years, living in Denmark during the period 2007-2013. The Danish Prescription Register delivered data permitting us to assess the prevalence, age and regional geographical belonging of women purchasing prescribed vaginal estradiol. The number of women using over-the-counter vaginal estriol products was estimated from sale statistics from the same register.RESULTS: In 2013, 10.2% of all Danish women between 40 and 79 years of age used vaginal estradiol. The prevalence of women using this type of vaginal estrogen increased from 8.5% in year 2007 to 10.2% in 2013. The use peaked at 16.5% in women aged 60-74 years. The vaginal tablet was purchased more than the vaginal ring. We found no relevant difference in use between the five regions of Denmark. Taking the sale of vaginal estriol into account, the prevalence of vaginal estrogen use in 2013 could be estimated to a total of 12.1%.CONCLUSIONS: Comparing our result to the prevalence of urogenital atrophy-related symptoms reported in the literature, our study suggests an under-diagnosis and under-treatment of this condition. Teaching women and primary-care physicians about symptomatic urogenital atrophy and its treatment options may increase the quality of life for many women.

Background: In order to provide appropriate advice to the patient at the time of dispensing and over-the-counter (OTC) medication counseling, community pharmacists need access to current and reliable information about medicines. Brazilian pharmacists have assumed new functions such as prescribing medication, in a dependent model, based in protocols.Objective: To examine the practice of community pharmacists in a Brazilian State, focusing on OTC recommendation.Method: A cross-sectional survey of community pharmacists in a state of Brazil was conducted from October 2013 to January 2014, with data collection through a pre-piloted self-administered anonymous survey via Survey Monkey® platform. Following ethical approval, the online instrument was sent to 8,885 pharmacists registered in Parana State, Brazil, focusing on professionals working in community pharmacies. The questionnaire assessed the community pharmacy setting, the search for information, the knowledge of the evidence-based practice, the important factors to consider when recommending an OTC medicine, and the pharmacist prescribing. Responses were imported into SPSS® (version 22.0) for analysis. Nonparametric tests were used to assess the association between responses and demographic information with a significance level less than 5% (p<0.05).Results: Of the pharmacists, 97.4% dispensed medications and counseled patients for a median of six hours per day. Product's efficacy (97%) and adverse effects (62.3%) were the most important factors taken into account when counseling a nonprescription medicine. Few pharmacists knew the meaning of terms related to evidence-based health. Most respondents agreed that pharmacists have the necessary training to prescribe.Conclusion: Over-the-counter medication counseling is a daily practice among Brazilian pharmacists. Learning needs exist for community pharmacists in relation to evidence-based practice. Thus, sources of information with good evidence could be used daily b

Emergency contraceptives (EC) are forms of contraception that women can use after intercourse to prevent pregnancy. EC use is safe for women of all ages, and there are no medical contraindications to its use. There are two types of emergency contraceptive pills currently available: ulipristal acetate (UPA) and levonorgestrel. UPA is the most effective oral option for EC. In the United States, levonorgestrel containing ECPs are available without prescription to women and men without age restrictions. However, the more effective UPA pills require a prescription. ECPs do not cause abortion or harm an established pregnancy. Placement of a copper intrauterine device (IUD) is more effective EC than either UPA or levonorgestrel, and requires a timely visit with a trained clinician. EC pills are less effective for women who are overweight or obese, therefore such women should be offered a copper IUD or ulipristal rather than levonorgestrel pills. Any woman requesting EC after unprotected intercourse should be offered treatment within 120 hours of intercourse, as should all women who are victims of sexual assault. Women requesting EC should be offered information and services for ongoing contraception. Although levonorgestrel EC is now available over-the-counter, ongoing need exists to educate women about emergency contraception to encourage prompt use of EC when it is needed.

Objectives: The objectives of this study were to determine the prevalence of self-medication and to evaluate the clinical impact of pharmaceutical counseling.Methods: A cross-sectional study was used with a prospective component, the latter to evaluate the impact of pharmaceutical counseling . The study was conducted in a rural community pharmacy for 14 consecutive days in December 2012, recruiting all individuals who agreed to participate and met the eligibility criteria. During a face-to-face direct interview demographic and clinical characteristics of patients were registered, followed by a pharmaceutical intervention, which consisted of evaluating the symptoms, selecting the most appropriate non-prescription medicine (NPM) available and advising the patient on pharmacologic and non-pharmacologic measures, all according to established protocols for minor health problems. When appropriate, the patient was referred to a medical appointment. One week later, the clinical outcome of such intervention was measured by asking the patients about the resolution of their minor health problems.Results: Data from 298 patients were analyzed, the majority being female (60.1%) with an average age of 44.84 years (SD=22.41). Respiratory problems were the most frequent (n=78; 26.2%) and respiratory tract medication was the most frequently indicated (n= 77; 27.8%). The observed prevalence of self-medication was 40.7%. Of the 271 patients’ beneficiaries of pharmaceutical counseling, 86.8% had their minor health problems solved after one week (ranging from 77.5% to 88.2% according to a sensibility analysis for drop-outs).Conclusions: This work is important as it demonstrates the beneficial impact of pharmaceutical counseling, a very relevant area for the pharmacist and where literature is particularly scarce.

The aim of this study is to determine the comprehension difficulties adults have regarding the information provided by over-thecounter pharmaceutical products leaflets that contain paracetamol as an active principle. For this purpose, 20 adults were interviewed with a survey especially designed for this research. Following important linguistic comprehension studies, comprehension difficulties were recognized and analyzed. The analysis shows difficulties with lexical, propositional, and micro-structural strategies. However, it is necessary to continue carrying out studies on comprehension to identify difficulties that over-the-counter drug users have to understand information pamphlets., El objetivo de este estudio es identificar y analizar problemas de comprensión que enfrentan los potenciales usuarios al leer la información correspondiente al prospecto de una especialidad medicinal de venta libre que contiene, como principio activo, paracetamol. Para ello, se entrevistó a 20 adultos a partir de un cuestionario especialmente diseñado para esta investigación. Luego, de acuerdo a estudios fundamentales sobre la comprensión lingüística, se detectaron y analizaron las dificultades en la comprensión del prospecto. Los resultados muestran inconvenientes relativos tanto a las estrategias léxicas como a las proposicionales y microestructurales. Es necesario, sin embargo, continuar realizando estudios de comprensibilidad para identificar las dificultades que tienen los usuarios de medicamentos de venta libre para comprender los prospectos

The aim of this study is to determine the comprehension difficulties adults have regarding the information provided by over-thecounter pharmaceutical products leaflets that contain paracetamol as an active principle. For this purpose, 20 adults were interviewed with a survey especially designed for this research. Following important linguistic comprehension studies, comprehension difficulties were recognized and analyzed. The analysis shows difficulties with lexical, propositional, and micro-structural strategies. However, it is necessary to continue carrying out studies on comprehension to identify difficulties that over-the-counter drug users have to understand information pamphlets., El objetivo de este estudio es identificar y analizar problemas de comprensión que enfrentan los potenciales usuarios al leer la información correspondiente al prospecto de una especialidad medicinal de venta libre que contiene, como principio activo, paracetamol. Para ello, se entrevistó a 20 adultos a partir de un cuestionario especialmente diseñado para esta investigación. Luego, de acuerdo a estudios fundamentales sobre la comprensión lingüística, se detectaron y analizaron las dificultades en la comprensión del prospecto. Los resultados muestran inconvenientes relativos tanto a las estrategias léxicas como a las proposicionales y microestructurales. Es necesario, sin embargo, continuar realizando estudios de comprensibilidad para identificar las dificultades que tienen los usuarios de medicamentos de venta libre para comprender los prospectos

Objectives: The objectives of this study were to determine the prevalence of self-medication and to evaluate the clinical impact of pharmaceutical counseling.Methods: A cross-sectional study was used with a prospective component, the latter to evaluate the impact of pharmaceutical counseling . The study was conducted in a rural community pharmacy for 14 consecutive days in December 2012, recruiting all individuals who agreed to participate and met the eligibility criteria. During a face-to-face direct interview demographic and clinical characteristics of patients were registered, followed by a pharmaceutical intervention, which consisted of evaluating the symptoms, selecting the most appropriate non-prescription medicine (NPM) available and advising the patient on pharmacologic and non-pharmacologic measures, all according to established protocols for minor health problems. When appropriate, the patient was referred to a medical appointment. One week later, the clinical outcome of such intervention was measured by asking the patients about the resolution of their minor health problems.Results: Data from 298 patients were analyzed, the majority being female (60.1%) with an average age of 44.84 years (SD=22.41). Respiratory problems were the most frequent (n=78; 26.2%) and respiratory tract medication was the most frequently indicated (n= 77; 27.8%). The observed prevalence of self-medication was 40.7%. Of the 271 patients’ beneficiaries of pharmaceutical counseling, 86.8% had their minor health problems solved after one week (ranging from 77.5% to 88.2% according to a sensibility analysis for drop-outs).Conclusions: This work is important as it demonstrates the beneficial impact of pharmaceutical counseling, a very relevant area for the pharmacist and where literature is particularly scarce.

Studies researching drugs in households are relatively rare, both internationally and in Serbia, even though giving insight into the habits of the population in terms of selfmedication, compliance and proper storage and disposal of drugs. This kind of research can also give insight into the financial burden of expired drugs. The aims of this study were to: I) Analyze the volume and structure of drugs in households (Rp /OTC); 2) Determine whether the drugs are in accordance with the health needs of household members or drugs that can be used in self-medication; 3) Analyze the content of antibiotics in the household and the reasons for their presence in households; 4) Assess the pharmacoeconomic consequences of keeping drugs in households; 5) Assess the way of storing and disposing of drugs in terms of safety and environmental impact. The study was prospective, comparative and randomized. Data were collected from households in the municipality of Novi Sad in the period of 8 months (December 201 I-July 2012). In order to obtain a sample of 383 households, which was calculated on the basis of a pilot study conducted in the municipality of Novi Sad in 20 I 0, 1008 households were contacted (response rate 38.0 percents). The survey consisted of four parts. The first part of the survey was collecting data when the researcher conducted a review and analysis of all drugs in the household and the respondents completed the questionnaire. In the second part drugs were classified according to the A TC classification and then analyzed wheater they were OTC or POM and wheater they were obtained on prescription or bought without prescription. Households with and without children younger than 12 and elderly households were analyzed separately. The third part of the research is the financial analysis of the existing drugs in the households. The fourth part of the research involves the processing of data from the questionnaires, and refers to the analysis of the storage and disposal

Objective To evaluate the current management of over-the-counter (OTC) insomnia complaints in Australian community pharmacies using standardized patient methodology. Methods Trained standardized patients visited a sample of 100 randomly selected South East Queensland community pharmacies in June 2011. The standardized patients enacted two OTC insomnia scenarios: a direct product request (DPR) (n = 50) and a symptom-based request (SBR) (n = 50). Results of the interactions were documented immediately after each visit and evaluated using the Pharmaceutical Society of Australia's WHAT STOP GO protocol as a standard comparison. Key findings Of all DPRs, 30% were handled entirely by the pharmacist, 70% of staff enquired about specific symptoms and 28% investigated the cause of insomnia. No staff investigated the frequency of product use. The DPR scenario resulted in a 92% supply of the requested doxylamine product (Restavit). In the SBR scenario, 18% of requests were handled entirely by the pharmacist, 58% of staff enquired about specific symptoms and 44% investigated the cause of insomnia. Staff recommended medicated products (38%), or herbal (78%) or non-drug techniques (18%). Investigation into smoking and alcohol intake was not undertaken in DPR or SBR interactions, while questioning on caffeine intake was undertaken in 2 and 14% of cases respectively. There were no significant differences found in the handling of sleep requests by pharmacists compared to pharmacy assistants. Conclusion The standardized patient methodology was a successful way to assess the community pharmacy counselling provided with OTC sleep requests and suboptimal staff responses were found when compared with recommended practice standards.

The commercialization status (otc, under medical prescription, under special monitoring or for hospital use only) sets out the circumstances under which it may be publicized and marketed a drug. The otc does not involve consulting the health team, who do not participate in the selection of the drug, its dispensing or therapeutic monitoring. Present work through an observational, descriptive, cross-sectional study from the universe of Colombian drug approvals, identify and describe the variations in the condition of sale of non-steroidal anti-inflammatory drugs. For this pharmacological group, widely consumed in the country, dominated the modality "make and sell", the non-sterile solid dosage forms, the condition of sale under prescription and the enteric route of administration, likewise predominate as active substance diclofenac, followed by ibuprofen and piroxicam. Eight of the active ingredients of this pharmacological group have double condition of sale (otc and under medical prescription) achieving 70% of marketing authorization for nsaids in Colombia. It is evidenced a relationship between the amount of active substance per dosage unit and the commercialization status, a relationship that is not evident with respect to the indication., La condición de comercialización (venta libre, con fórmula médica, bajo control especial o para uso hospitalario exclusivamente) determina las circunstancias en las cuales puede ser publicitado y comercializado un medicamento. La venta libre no involucra una consulta al equipo de salud, quienes no participan de la selección del medicamento, su dispensación ni seguimiento fármaco-terapéutico. El presente trabajo, mediante un estudio observacional descriptivo de corte transversal desarrollado partiendo del universo de registros sanitarios de medicamentos en Colombia, identifica y describe las variaciones en la condición de venta de analgésicos antiinflamatorios no esteroides. Para este grupo farmacológico, de gran consumo en el país, predominan la modalidad de registro "fabricar y vender", las formas farmacéuticas sólidas no estériles, la condición de venta con fórmula médica y la vía de administración enteral; asimismo, predomina como principio activo el diclofenaco, seguido de ibuprofeno y piroxicam. Ocho de los principios activos de este grupo farmacológico poseen doble condición de venta (venta sin prescripción facultativa o libre y venta con fórmula médica) y alcanzan el 70% de las autorizaciones de comercialización de aines en Colombia. Se evidencia una relación entre la cantidad principio activo por unidad posológica y la condición de venta autorizada, relación que no es evidente con respecto a la indicación.

Objective: To determine vending strategies and marketing themes employed by itinerant bus vendors, and assess the accuracy and completeness of information provided on medicines being sold in an urban setting in Nigeria Methods: Cross-sectional study and content analysis of itinerant vending of medicines inside buses recorded with a mobile telephone on purposively selected routes in a mega city with an estimated 18 million residents in southwestern Nigeria over a 2-month period. Two coders independently assessed 192 vending episodes by 56 vendors for 147 OTC and prescription medicines. Inter-rater reliability (Gwet AC1 =0.924; p<0.0001). Results: Fourteen thousands and four hundred potential consumers encountered 192 recorded episodes of vending of medicines inside 192 buses within the study periods. Forty-four (78,5%) of the 56 vendors were females in the 30-45 years age bracket, were mostly (75%) attired in the local Iro and Buba Ankara fabric and showed laminated identity cards (97.5%) issued by the local association for marketers of medicines inside buses, markets, and motor parks. Of the 14400 consumers encountered inside buses during the study period, between 6.7% and 48.3% purchased the medicines promoted. Prayers against death from road traffic accidents and diseases of physical and / or meta-physical origins were the most frequently used (76,8%) ice-breaking opening statement / strategy to gain consumers attention. Hematinics, multi-vitamins, simple analgesic, NSAIDs and corticosteroids were the most frequently vended medicines. Consumers enquiries were related to dosing for children (51.8%), elderly (28.6%), and pregnancy (52.7%); and contraindications during pregnancy (8.9%). Factual medicines information such as dose, frequency, potential side effects and contra-indications were not provided in majority of vending episodes. Conclusion: Itinerant vending of medicines and the use of misleading and melodramatic themes to secure high consumer patronage appear, Objetivo: Determinar las estrategias de venta y los temas de marketing empleados por los vendedores en autobuses itinerantes y evaluar la precisión y compleción de la información sobre medicamentos proporcionada durante la venta en un área urbana de Nigeria. Métodos: Estudio transversal y análisis de contenido de la venta itinerante de medicamentos en autobuses grabadas con un teléfono móvil en rutas seleccionadas a propósito en una mega-ciudad de 18 millones de habitantes en el suroeste de Nigeria durante un periodo de dos meses. Dos codificadores evaluaron independientemente 192 episodios de venta de 56 vendedores para 147 medicamentos OTC y de prescripción. Fiabilidad inter-evaluador (K de Cohen)=0.89 [IC95% 0.76- 0.92]. Resultados: 14.400 potenciales consumidores visitaron los 192 episodios grabados de venta de medicamentos en el interior de 192 autobuses en el periodo de estudio. 44 (78.5%) de los 56 vendedores eran mujeres entre los 30-45 años, estaban mayoritariamente (75%) con tejidos tradicionales Iro and Buba Ankara y mostraban tarjetas identificativas plastificadas (97.5%) emitidas por las autoridades locales para vendedores de medicamentos en autobuses, mercados y aparcamientos. De los 14.400 consumidores que visitaron el interior de los buses durante el periodo de estudio, el 6.7% y el 48.3% compró los medicamentos promocionados. Oraciones contra la muerte en accidentes de tráfico y enfermedades de orígenes físicos o metafísicos eran los mensajes para romper el hielo / estrategias para ganar la atención de los clientes más frecuentemente utilizados (76.8%). Los medicamentos más frecuentemente vendidos eran los hematínicos, multivitamínicos, analgésicos simples, AINE y corticoides. Las preguntas de los consumidores estaban relacionadas con las dosis para niños (51.8%), ancianos (28.6%) y embarazo (52.7%); y contraindicaciones durante el embarazo (8.9%). En la mayoría de los episodios de venta no se proporcionaba informaciones objetivas sobre los medicame

Objective: To determine vending strategies and marketing themes employed by itinerant bus vendors, and assess the accuracy and completeness of information provided on medicines being sold in an urban setting in Nigeria Methods: Cross-sectional study and content analysis of itinerant vending of medicines inside buses recorded with a mobile telephone on purposively selected routes in a mega city with an estimated 18 million residents in southwestern Nigeria over a 2-month period. Two coders independently assessed 192 vending episodes by 56 vendors for 147 OTC and prescription medicines. Inter-rater reliability (Gwet AC1 =0.924; p<0.0001). Results: Fourteen thousands and four hundred potential consumers encountered 192 recorded episodes of vending of medicines inside 192 buses within the study periods. Forty-four (78,5%) of the 56 vendors were females in the 30-45 years age bracket, were mostly (75%) attired in the local Iro and Buba Ankara fabric and showed laminated identity cards (97.5%) issued by the local association for marketers of medicines inside buses, markets, and motor parks. Of the 14400 consumers encountered inside buses during the study period, between 6.7% and 48.3% purchased the medicines promoted. Prayers against death from road traffic accidents and diseases of physical and / or meta-physical origins were the most frequently used (76,8%) ice-breaking opening statement / strategy to gain consumers attention. Hematinics, multi-vitamins, simple analgesic, NSAIDs and corticosteroids were the most frequently vended medicines. Consumers enquiries were related to dosing for children (51.8%), elderly (28.6%), and pregnancy (52.7%); and contraindications during pregnancy (8.9%). Factual medicines information such as dose, frequency, potential side effects and contra-indications were not provided in majority of vending episodes. Conclusion: Itinerant vending of medicines and the use of misleading and melodramatic themes to secure high consumer patronage appear, Objetivo: Determinar las estrategias de venta y los temas de marketing empleados por los vendedores en autobuses itinerantes y evaluar la precisión y compleción de la información sobre medicamentos proporcionada durante la venta en un área urbana de Nigeria. Métodos: Estudio transversal y análisis de contenido de la venta itinerante de medicamentos en autobuses grabadas con un teléfono móvil en rutas seleccionadas a propósito en una mega-ciudad de 18 millones de habitantes en el suroeste de Nigeria durante un periodo de dos meses. Dos codificadores evaluaron independientemente 192 episodios de venta de 56 vendedores para 147 medicamentos OTC y de prescripción. Fiabilidad inter-evaluador (K de Cohen)=0.89 [IC95% 0.76- 0.92]. Resultados: 14.400 potenciales consumidores visitaron los 192 episodios grabados de venta de medicamentos en el interior de 192 autobuses en el periodo de estudio. 44 (78.5%) de los 56 vendedores eran mujeres entre los 30-45 años, estaban mayoritariamente (75%) con tejidos tradicionales Iro and Buba Ankara y mostraban tarjetas identificativas plastificadas (97.5%) emitidas por las autoridades locales para vendedores de medicamentos en autobuses, mercados y aparcamientos. De los 14.400 consumidores que visitaron el interior de los buses durante el periodo de estudio, el 6.7% y el 48.3% compró los medicamentos promocionados. Oraciones contra la muerte en accidentes de tráfico y enfermedades de orígenes físicos o metafísicos eran los mensajes para romper el hielo / estrategias para ganar la atención de los clientes más frecuentemente utilizados (76.8%). Los medicamentos más frecuentemente vendidos eran los hematínicos, multivitamínicos, analgésicos simples, AINE y corticoides. Las preguntas de los consumidores estaban relacionadas con las dosis para niños (51.8%), ancianos (28.6%) y embarazo (52.7%); y contraindicaciones durante el embarazo (8.9%). En la mayoría de los episodios de venta no se proporcionaba informaciones objetivas sobre los medicame

The FAA Office of Aerospace Medicine sets medical standards needed to protect the public and pilots from death or injury due to incapacitation of the pilot. As a part of this process, toxicology testing is performed by the FAA on almost every pilot who is fatally injured in an aviation accident to determine the medical condition of the pilot, medications used by the pilot at the time of the accident, and the extent of impairment, if any. The data were extracted from the FAA toxicology database for all pilots who died from 2004 and 2008 in aviation accidents. The laboratory received and tested specimens from 1,353 pilots who died in aviation accidents between 2004 and 2008. Findings were classified into three separate categories: Controlled Dangerous Substance, Prescription, and Over-the-Counter drugs. The study was conducted to determine the extent of drug use in pilots who have died in aviation accidents from 2004 to 2008 and to determine the types of drugs most commonly found. A comparison of previously published reports with this study's report was made to determine trends in drug use by pilots who have died in aviation accidents over the past 20 years. Factors were examined that could influence drug trends noted over the years. Diphenhydramine, an H1 antihistamine with impairing properties, is the most common drug found in pilots who have died in aviation accidents. The FAA has taken steps to warn pilots of the dangers of using this medication, which is dispensed as both a prescription and an over-the-counter medication. Because significant aviation performance impairment can be associated with diphenhydramine, the Office of Aerospace Medicine will continue to take steps to help pilots decide when it is safe to resume flying duties after taking such an impairing medication., Work was accomplished under approved task AM-B-10-TOX-206.

Average wholesale price (AWP) has been the basis of calculating pharmaceutical pricing and reimbursement for many years. Lawsuits filed, beginning in 2003, have challenged the use of AWP as an inflated benchmark costing government and insurance health plans millions. A final ruling in 2008 ended litigation and mandated a five percent rollback in the basis of AWP, and national pricing compendia agreed to cease publishing AWP in September 2011.

Objective: The objective of this study was to investigate the knowledge of parents and caregivers with respect to the purchase, use and storage of liquid analgesics purchased over the counter (OTC) from pharmacies. This would enable specific strategies to be identified to increase awareness of the potential risks of these products. Methods: Questionnaires were developed and used a combination of Likert Scales, open ended questions and yes/no answers. Randomly chosen New Zealand pharmacies (463) were asked to approach a person purchasing liquid analgesics and ask them to complete the questionnaire. Of the 105 pharmacies that participated, 96 completed parent/caregiver questionnaires were returned. Results: When choosing a product there was a statistically significant difference between the most important factors safety and active ingredient and the least important factors cost and if the parent/caregiver used it before. All parents/caregivers claim to have received verbal information from pharmacy staff, with 40% stating that they always receive information. The majority of parents/caregivers store medicines in a high place (n=61), in a cupboard (n=56) or a combination of these. Over half (52%) of the parents/caregivers thought that children could never open child resistant closures. Conclusion: Whilst parents and caregivers choose products based on perceived safety, there is an over estimation in the perception of the protection that a child resistant closure actually offers. The general public needs to continually be vigilant in the use, storage and administration when using medication in the vicinity of children., Objetivo: El objetivo de este estudio fue investigar el conocimiento de los padres y cuidadores en relación a la compra, uso y almacenamiento de analgésicos líquidos comprados sin receta (OTC) en farmacias. Esto podría ayudar a crear estrategias específicas identificadas para aumentar el conocimiento de los riesgos potenciales de estos productos. Métodos: Se desarrollaron y utilizaron cuestionarios mediante una combinación de escalas Likert, preguntas abiertas y respuestas si/no. Se pidió a 463 farmacias aleatoriamente seleccionadas de Nueva Zelanda que abordasen a una persona que compraba analgésicos líquidos y le pidiese que completase el cuestionario. De las 105 farmacias que participaron, 96 devolvieron cuestionarios de padre/cuidador completos. Resultados: Al elegir un producto, había una diferencia estadísticamente significativa en los factores más importantes seguridad y principio activo y los factores menos importantes coste y si el padre/cuidador lo había usado antes. Todos los padres/cuidadores afirmaron haber recibido información oral del personal de la farmacia, afirmando el 40% que ellos siempre reciben información. La mayoría de los padres/cuidadores almacena medicamentos en un lugar alto (n=61), en un armario (n=56) o en una combinación de ambos. Más de la mitad (52%) de los padres/cuidadores pensaba que los niños nunca podrían abrir los cierres resistentes a niños. Conclusión: Mientras que los padres y cuidadores eligen productos basados en la seguridad percibida, existe una sobre-estimación en la percepción de la protección que ofrece un cierre resistente a niños. El público en general necesita estar continuamente vigilante ante el uso, almacenamiento y administración cuando utilizan medicamentos en la inmediación de niños.

Objective: The objective of this study was to investigate the knowledge of parents and caregivers with respect to the purchase, use and storage of liquid analgesics purchased over the counter (OTC) from pharmacies. This would enable specific strategies to be identified to increase awareness of the potential risks of these products. Methods: Questionnaires were developed and used a combination of Likert Scales, open ended questions and yes/no answers. Randomly chosen New Zealand pharmacies (463) were asked to approach a person purchasing liquid analgesics and ask them to complete the questionnaire. Of the 105 pharmacies that participated, 96 completed parent/caregiver questionnaires were returned. Results: When choosing a product there was a statistically significant difference between the most important factors safety and active ingredient and the least important factors cost and if the parent/caregiver used it before. All parents/caregivers claim to have received verbal information from pharmacy staff, with 40% stating that they always receive information. The majority of parents/caregivers store medicines in a high place (n=61), in a cupboard (n=56) or a combination of these. Over half (52%) of the parents/caregivers thought that children could never open child resistant closures. Conclusion: Whilst parents and caregivers choose products based on perceived safety, there is an over estimation in the perception of the protection that a child resistant closure actually offers. The general public needs to continually be vigilant in the use, storage and administration when using medication in the vicinity of children., Objetivo: El objetivo de este estudio fue investigar el conocimiento de los padres y cuidadores en relación a la compra, uso y almacenamiento de analgésicos líquidos comprados sin receta (OTC) en farmacias. Esto podría ayudar a crear estrategias específicas identificadas para aumentar el conocimiento de los riesgos potenciales de estos productos. Métodos: Se desarrollaron y utilizaron cuestionarios mediante una combinación de escalas Likert, preguntas abiertas y respuestas si/no. Se pidió a 463 farmacias aleatoriamente seleccionadas de Nueva Zelanda que abordasen a una persona que compraba analgésicos líquidos y le pidiese que completase el cuestionario. De las 105 farmacias que participaron, 96 devolvieron cuestionarios de padre/cuidador completos. Resultados: Al elegir un producto, había una diferencia estadísticamente significativa en los factores más importantes seguridad y principio activo y los factores menos importantes coste y si el padre/cuidador lo había usado antes. Todos los padres/cuidadores afirmaron haber recibido información oral del personal de la farmacia, afirmando el 40% que ellos siempre reciben información. La mayoría de los padres/cuidadores almacena medicamentos en un lugar alto (n=61), en un armario (n=56) o en una combinación de ambos. Más de la mitad (52%) de los padres/cuidadores pensaba que los niños nunca podrían abrir los cierres resistentes a niños. Conclusión: Mientras que los padres y cuidadores eligen productos basados en la seguridad percibida, existe una sobre-estimación en la percepción de la protección que ofrece un cierre resistente a niños. El público en general necesita estar continuamente vigilante ante el uso, almacenamiento y administración cuando utilizan medicamentos en la inmediación de niños.

To examine the association between perceived stress and use of over-the-counter analgesics among 25-44-year-olds, and to examine the association across various sociodemographic strata. Furthermore, to examine whether the association attenuates when controlled by stress-related symptoms.

To examine the association between perceived stress and use of over-the-counter analgesics among 25-44-year-olds, and to examine the association across various sociodemographic strata. Furthermore, to examine whether the association attenuates when controlled by stress-related symptoms.

In spite of the fact that severe side effects have been reported, black cohosh [Actaea racemosa (syn. Cimifuga racemosa)] is likely to be one of the most popular herbs used in the treatment of postmenopausal symptoms and menstrual dysfunction. We report the cases of two patients, one with submassive liver necrosis and the other with chronic hepatitis most likely related to the use of two different preparations containing black cohosh. This represents another advice for caution concerning this popular preparation of inconsistent therapeutic value.