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Product consumption is an important yet understudied aspect of marketing. Over-the-counter medicines present a unique consumption context because consumers are expected to follow product label instructions. For acetaminophen, a widely consumed over-the-counter drug, the authors study which consumers tend to deviate from the label instructions, why they do so, and the interventions that are most promising to mitigate such deviations. They develop a dynamic structural model of consumption that enables them to investigate the probability of different types of label deviations (e.g., >4 g per day) and drivers of such behaviors. Label deviations are infrequent "tail area" behaviors, and the model uncovers them well. The analysis is based on a unique online consumption diary in which consumers select from two classes of acetaminophen products (single ingredient or a combination of ingredients) to treat their pain or non-pain-related symptoms. Consumers have a higher probability of taking >4 g of acetaminophen when they have multiple symptoms, and a variety of observable factors explain the individual propensity to deviate from the label. The authors propose two interventions—a new label instruction and consumer education—to mitigate the observed label deviations and assess the expected impact of each. [ABSTRACT FROM AUTHOR]

Many examples of the use of real-world data in the area of pharmacoepidemiology include "big data," such as insurance claims, medical records, or hospital discharge databases. However, "big" is not always better, particularly when studying outcomes with narrow windows of etiologic relevance. Birth defects are such an outcome, for which specificity of exposure timing is critical. Studies with primary data collection can be designed to query details about the timing of medication use, as well as type, dose, frequency, duration, and indication, that can better characterize the "real world." Because birth defects are rare, etiologic studies are typically case‑control in design, like the National Birth Defects Prevention Study, Birth Defects Study to Evaluate Pregnancy Exposures, and Slone Birth Defects Study. Recall bias can be a concern, but the ability to collect detailed information about both prescription and over-the-counter medication use and other exposures such as diet, family history, and sociodemographic factors is a distinct advantage over claims and medical record data sources. Case‑control studies with primary data collection are essential to advancing the pharmacoepidemiology of birth defects. This article is part of a Special Collection on Pharmacoepidemiology. [ABSTRACT FROM AUTHOR]

Serotonin syndrome is a rare, life-threatening toxidrome caused by serotonergic agents. This syndrome classically presents with a combination of mental status changes, autonomic hyperactivity, and neuromuscular abnormalities. However, diagnosing the condition is difficult because of its variable symptoms at presentation. As a result, serotonin syndrome often is underreported, making it harder to understand, recognize, and treat. Patients with this condition may present to primary or urgent care or an ED, and may become acutely symptomatic during an inpatient admission. Clinicians must be able to identify at-risk patients and intervene to prevent potentially lethal complications. [ABSTRACT FROM AUTHOR]

In three preregistered studies, we investigated whether implicit treatment expectations, using a relational implicit measure (the MT-PEP), vary between participants provided opposing information about novel medical treatments (Studies 1 and 2) or who responded based on normative beliefs toward common over-the-counter drugs (Study 3). The studies revealed large Cohen’s d effect sizes of both novel and well-known treatment information within the implicit measure. The studies also provide evidence of convergent validity, with MT-PEP scores associated with explicit beliefs about medicine and over-the-counter drug familiarity. Implicit treatment expectations can be assessed and offer a novel tool for the intersection of social psychology and medicine. [ABSTRACT FROM AUTHOR]

Introduction: Adverse drug reactions are a significant problem in modern society, stemming from the increase in prescribed medications, over-the-counter drugs, and overall polypharmacy. Glomerular disorders are one of the frequently reported renal conditions associated with medication use. VigiBase is a significant tool for evaluating events associated with drug use, and, to the authors' knowledge, no study has yet assessed this database to identify the primary medications associated with glomerular disorders. Materials and Methods: We collected data from VigiBase for 54 years and evaluated data based on global frequencies, disproportionality (IC025 values), nephrotoxic potential, and physiopathological mechanisms. Results: Over the evaluation period, 33.932.051 spontaneous notifications of adverse drug reactions reported in VigiBase were assessed, from which 106.775 notifications of drug-associated glomerular disorders were extracted. The isolated medications were classified as 'potential nephrotoxins' (47.0%), with 40% of the medications lacking scientific references to report any association with the development of glomerular disorders. Among the evaluated medications, Inotersen (IC025 of 8.3), Penicillamine (IC025 6.8), Bevacizumab (IC025 5.9) and Lenvatinib (IC025 5.4) were identified as having the strongest association with these glomerular disorders. For medications classified as 'non-nephrotoxic', a high disproportionality index was observed, suggesting drugs that might be considered as new potential nephrotoxins. Conclusions: Drug-induced glomerular disorders were significantly associated with medications that had no established nephrotoxic role but demonstrated a high disproportionality index in VigiBase. These newly alleged nephrotoxic drugs warrant further evaluation in dedicated studies to assess their true nephrotoxic potential. [ABSTRACT FROM AUTHOR]

The clinical context of drug interactions detected by automated analysis systems is particularly important in older patients with multimorbidities. We aimed to provide unique, up-to-date data on the prevalence of potentially inappropriate medications (PIMs) and drug–drug interactions (DDIs) in the Polish geriatric population over 80 years old and determine the frequency and the most common PIMs involved in DDIs. We analyzed all non-prescription and prescription drugs in a representative national group of 178 home-dwelling adults over 80 years old with excessive polypharmacy (≥10 drugs). The FORTA List was used to assess PIMs, and the Lexicomp® Drug Interactions database was used for DDIs. DDIs were detected in 66.9% of the study group, whereas PIMs were detected in 94.4%. Verification of clinical indications for the use of substances involved in DDIs resulted in a reduction in the total number of DDIs by more than 1.5 times, as well as in a nearly 3-fold decrease in the number of interactions requiring therapy modification and drug combinations that should be strictly avoided. The most common PIMs involved in DDIs were painkillers, and drugs used in psychiatry and neurology. Special attention should be paid to DDIs with PIMs since they could increase their inappropriate character. The use of automated interaction analysis systems, while maintaining appropriate clinical criticism, can increase both chances for a good therapeutic effect and the safety of the elderly during treatment processes. [ABSTRACT FROM AUTHOR]

Seasonal allergies have a negative impact on patients' quality of life. Nurses must be aware of the different treatment options and lifestyle modifications to help patients manage their symptoms. This article discusses the benefits and risks of over-the-counter medications for seasonal allergies and other implications for nurses. [ABSTRACT FROM AUTHOR]

AbstractObjectivesDesignSettingParticipantsMain Outcome MeasuresResultsConclusionThis study compares the demographics, diagnoses, re-admission rates, sick leaves, and prescribed medications of patients accessing digital general practitioner (GP) visits with those of patients opting for traditional face-to-face appointments in a primary health care setting.The study adopted a retrospective analysis of patient record data collected in 2019, comparing visits to a digital primary health center with traditional health center visits.Primary health care.The data encompassed patients who utilized the digital clinic and those who visited public health centers for primary health care services.The study assessed demographics, health diagnoses, prescribed medications, sick leave recommendations, re-admission rates, and differences in costs between digital clinic and face-to-face visits. Secondary outcomes included a comparative analysis of medication categories, resolution rates for health problems, and potential impacts on health care utilization.Digital clinic users were typically younger, more educated, and predominantly female compared with health centre users. Digital visits were well-suited for uncomplicated infections, while health centre appointments were associated with a higher prevalence of chronic conditions. Medication patterns differed between the two modalities, with digital clinic users receiving generic over-the-counter drugs and antibiotics, whereas health centre visits commonly involved cardiac and antihypertensive medications. Sick leave recommendations were slightly higher in the digital clinic, but the difference was not significant. Approximately 70% of health problems addressed in the digital clinic were successfully resolved, and the cost of digital visits was about 50,3% of face-to-face appointments.Digital health care services offer a cost-efficient alternative for specific health problems, appealing to younger, educated individuals, when compared to the users of public health center, and may enable improvement of cost-effectiveness combined with acceptable demand management and patient segmentation practices. The results highlight the potential benefits of digital clinics, particularly for uncomplicated cases, while also emphasizing the importance of suitable referral mechanisms for in-person consultations. [ABSTRACT FROM AUTHOR]

Background: Depression, anxiety, and insomnia are prevalent in older people and are associated with increased risk of mortality, dependency, falls and reduced quality of life. Prior to or whilst seeking treatment, older people often manage these symptoms or conditions using products purchased over the counter (OTC), such as medication or herbal products. This review aims to map the evidence available for OTC medications, herbal medicines and dietary supplements for depression, anxiety and insomnia in older adults. Methodology: We carried out a scoping review, including searches of five databases to identify relevant randomised controlled trials (inception-Dec 2022). We took an inclusive approach to products to represent the wide range that may be available online. Trials were summarised according to condition and product. Results: We included 47 trials and 10 ongoing trial protocols. Most targeted insomnia (n = 25), followed by depression (n = 20), and mixed conditions (n = 2). None evaluated products targeted at anxiety alone. Where reported, most products appeared to be safe for use, but studies rarely included people with multiple comorbidities or taking concomitant medication. Some types of melatonin for insomnia (n = 19) and omega-3 fatty acids for depression (n = 7) had more substantive evidence compared to the other products. Conclusion: There is a substantial gap in evidence for OTC products for anxiety in older people. This should be addressed in future trials. Research should also focus on products that are widely used, and these need to be tested in older populations that are similar to those who would use them in practice. Key points: We carried out a scoping review of over-the-counter products for depression, anxiety and insomnia in older people. Out of 47 trials and 10 ongoing protocols, most studies targeted depression or insomnia - none targeted anxiety alone. Few products had more than one trial available, apart from melatonin and omega-3s, and studies rarely included people with multiple comorbidities or taking concomitant medication. [ABSTRACT FROM AUTHOR]

Background Carbapenemase-producing, carbapenem-resistant Pseudomonas aeruginosa (CP-CRPA) are extensively drug-resistant bacteria. We investigated the source of a multistate CP-CRPA outbreak. Methods Cases were defined as a US patient's first isolation of P. aeruginosa sequence type 1203 with carbapenemase gene bla VIM-80 and cephalosporinase gene bla GES-9 from any specimen source collected and reported to the Centers for Disease Control and Prevention during 1 January 2022–15 May 2023. We conducted a 1:1 matched case-control study at the post–acute care facility with the most cases, assessed exposures associated with case status for all case-patients, and tested products for bacterial contamination. Results We identified 81 case-patients from 18 states, 27 of whom were identified through surveillance cultures. Four (7%) of 54 case-patients with clinical cultures died within 30 days of culture collection, and 4 (22%) of 18 with eye infections underwent enucleation. In the case-control study, case-patients had increased odds of receiving artificial tears versus controls (crude matched OR, 5.0; 95% CI, 1.1–22.8). Overall, artificial tears use was reported by 61 (87%) of 70 case-patients with information; 43 (77%) of 56 case-patients with brand information reported use of Brand A, an imported, preservative-free, over-the-counter (OTC) product. Bacteria isolated from opened and unopened bottles of Brand A were genetically related to patient isolates. Food and Drug Administration inspection of the manufacturing plant identified likely sources of contamination. Conclusions A manufactured medical product serving as the vehicle for carbapenemase-producing organisms is unprecedented in the United States. The clinical impacts from this outbreak underscore the need for improved requirements for US OTC product importers. [ABSTRACT FROM AUTHOR]

The National Center for Complementary and Integrative Health's (NCCIH) "Know the Science" web site is designed for users to learn how to comprehend scientific information regarding various health approaches. Through the use of infographics, quizzes, and interactive modules, users can learn about important concepts in complementary health. This site also emphasizes health literacy through modules about comprehending scientific journals and health media articles. The main purpose of this site is to provide resources to help users make informed and science-backed decisions about their health care. [ABSTRACT FROM AUTHOR]

The article discusses efforts to expand education on skin lightening products. Topics include how skin lightening products are marketed in the U.S., impact of the Coronavirus Aid, Relief, and Economic Security (CARES) Act on over-the-counter (OTC) skin lightening products, and factors that drive the consumer motivation to use skin lightening products.

Medication abortion is safe and effective, but restrictions still limit patients from accessing this method. Alternative models of medication abortion provision, namely advance provision, over-the-counter (OTC), and online, could help improve access to care for some, although there is limited evidence about abortion patients' interest in these models. Between 2017 and 2019, we administered a cross-sectional survey to abortion patients at 45 clinics across 15 U.S. states to explore their interest in and support for advance provision, OTC, and online abortion access. We assessed relationships between sociodemographic characteristics and interest in and support for each model using bivariate logistic regressions and present perceived advantages and disadvantages of each model, as described by a subset of participants. Among 1,965 people enrolled, 1,759 (90%) initiated the survey. Interest in and support for advance provision was highest (72% and 82%, respectively), followed by OTC (63% and 72%) and online access (57% and 70%). In bivariate analyses, non-Hispanic Black and Asian/Pacific Islander respondents expressed lower interest and support for the online model and Alaska Native/Native American respondents expressed higher interest in an OTC model, as compared with white respondents. Among 439 participants naming advantages and disadvantages of each model, the most common advantages included convenience and having the abortion earlier. The most common disadvantages were not seeing a provider first and possibly taking pills incorrectly. Although most abortion patients expressed interest in and support for alternative models of medication abortion provision, variation in support across race/ethnicity highlights a need to ensure that abortion care service models meet the needs and preferences of all patients, particularly people from historically underserved populations. [ABSTRACT FROM AUTHOR]

Copyright of Turkiye Klinikleri Journal of Nursing Sciences is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and Aim: Self-medication practices (SMPs) are a common phenomenon prevalent with both prescription and nonprescription medicines. Still, the availability of a valid and reliable instrument to assess the knowledge, attitude, and practices toward self-medication (SM) remains limited. The current pilot study aimed to develop and validate a tool that effectively evaluates these aspects among consumers in Delhi, India. Materials and Methods: The research involved 100 consumer participants from Delhi, India. Reliability and validity testing was conducted to assess reproducibility, internal consistency, and content validity. The questionnaire underwent validation by a panel of five experts to evaluate face and content validity. Results: Test–retest reliability was assessed using Karl Pearson’s correlation co-efficient yielding values of 0.841 (P = 0.002), 0.827 (P = 0.003), and 0.792 (P = 0.006) for the three domains of knowledge, attitude, and frequency of performing SM, respectively. Cronbach’s alpha statistics were used to determine internal consistency, yielding values of 0.775 and 0.839 for knowledge and attitude domains, respectively. The association between the demographic characteristics of respondents and knowledge, attitude, and frequency of SM was assessed using an independent sample t-test and one-way ANOVA, demonstrating satisfactory known group validity. Conclusions: The developed questionnaire proved valid and reliable for determining consumer’s knowledge, attitudes, and practices toward SM. The final tool could be valuable for future research and interventions to improve consumers’ understanding of SMP.

Childhood is a significant period that affects a person’s health throughout their whole life. Children deserve to receive quality medical care. It is also the responsibility of parents to be aware of treatment methods and to ensure that their children receive the best medical and pharmaceutical care. An essential point of drug therapy in children is the administration of drugs without a doctor’s prescription. The aim of this article is to research the importance of pharmaceutical care provided in counseling parents in the purchase of over-the-counter (OTC) drugs. Material and methods. A review of the scientific literature was performed in the databases of PubMed and Google Scholar. The study was carried out in the period from 01.02.2024 to 31.03.2024 using key words: “pharmaceutical care”, “children”, “OTC drugs”, “adverse drug reactions”. Results. OTC drugs are widely available, allowing patients to self-medicate and also parents to give them to their children. Children get sick much more often and have an elevated body temperature compared to adults. OTC drugs are considered safe for use in pediatric patients when used according to the instructions on their label. Non-prescription drugs also include analgesics such as Aspirin and Paracetamol, some of the medicines for coughs, hay fever, etc. Conclusion. The pharmacist provides information about medicines, their correct use and the possibility of adverse drug reactions and/or interactions with food and other medicines and is also a responsible participant in the provision of primary health care. [ABSTRACT FROM AUTHOR]

Objectives: The use of nonprescribed antibiotics increases the risk of antibiotic resistance, which is a primary public health concern of the 21st century. This study explores structural and cultural determinants of antibiotic misuse among immigrants living in the United States who arrived from home countries with easier access to antibiotics. Methods: Adopting a qualitative approach, we interviewed 34 immigrants living in the United States and who had traveled back to their home countries within 1 year of the interview. We followed the steps of constructive grounded theory to analyze the data. Results: We found two primary influences of immigrants' use of nonprescribed antibiotics. The first was structural barriers to health care access in the host country, including insurance coverage, cost of an emergency department visit, cost of missing a paid day of work, complexity of the healthcare system, and communication issues with health care providers. The second was participants' cultural assumptions, including their experiences of antibiotics use, beliefs about antibiotics, a habit of self-medication, and uncertainty about future medical needs. Conclusions: This study informs policymakers concerned with combating antibiotic resistance. Promoting antibiotic stewardship among immigrants from countries with lax antibiotic-prescribing practices and improving access to appropriate channels for preventative and same-day care may reduce the inappropriate use of antibiotics. [ABSTRACT FROM AUTHOR]

Background. A timely diagnosis of cancer is important for patient outcomes. The delay in the patient interval (time from symptom interpretation to seeking help) is often the longest throughout the cancer patient pathway. Factors extending this interval include vague symptom profiles increasing the difficulty of symptom appraisal and individual demographics influencing help‐seeking behaviours. An underexplored and potential source of delay in cancer diagnosis is associated with managing symptoms using self‐care activities prior to presentation to healthcare. Methods. This study aimed to characterise the use of self‐care activities in the context of managing nonspecific symptoms, prior to cancer diagnosis and their effect on the length of the patient interval. Eligible publications were identified using a rapid systematic review, and their qualitative self‐care data were extracted and analysed using thematic synthesis. Results. Forty‐five qualitative research papers between 2009 and 2024 were included in the final review. Self‐care was used as part of an iterative process, often resulting in delayed presentation to healthcare, if methods were effective in managing nonspecific symptoms. Across the literature, varying types of self‐care activities were reported across all cancers with nonspecific symptoms, including the use of over‐the‐counter or alternative medications, lifestyle changes, and watchful waiting. The individual's decision to self‐care was either prompted externally by a healthcare professional (HCP) (e.g., community pharmacists) or prompted by the individual depending on the availability of home remedies and medication. Patients used self‐care when there was a low perceived need to seek healthcare, to determine whether healthcare was required, or to avoid the use of healthcare. However, across the literature, there is limited evidence to understand the variation by cancer type, symptoms, and individual characteristics. Conclusions. The findings of this rapid review demonstrate that self‐care activities could hinder prompt help‐seeking and delay cancer diagnosis among people who are experiencing nonspecific cancer symptoms. However, more evidence is needed to understand which individual factors facilitate the adoption of self‐care behaviours over prompt help‐seeking for nonspecific cancer symptoms. [ABSTRACT FROM AUTHOR]

Many youth with acute and chronic health conditions require medication to be administered during the school day. This policy statement offers guidance to school physicians, community prescribers, school nurses, other school health professionals, and groups providing oversight to school health activities and ensures patient safety and equity lenses are applied to administration of medications during school and for school-related activities. The American Academy of Pediatrics supports a robust collaborative model that allows all those involved in student health, including the student and family, to communicate, participate in effective medication management, inform delegated medication responsibilities, and promote safe medication storage and administration. School medication administration protocols are developed to help prevent medication administration errors specific to potential risks in the school setting and are responsive to the maturing students' evolving understanding of their health needs, growing autonomy, and responsibility. All protocols involving school nurses, unlicensed assistive personnel, and prescribers must be consistent with state and federal regulations on scope of practice, student privacy laws, and professional nursing organization guidelines. Consistent policies and messaging on safety of the patient and the entire school community enable school health teams to ensure equitable treatment of students prescribed therapeutic agents newly regulated by the US Food and Drug Administration, over-the-counter medications, or products that are currently not regulated by the US Food and Drug Administration. [ABSTRACT FROM AUTHOR]

On January 18, 2024, the US Centers for Disease Control and Prevention issued their most recent guidelines for over-the-counter drugs for coronavirus disease 2019 (COVID-19). Specifically, the organization stated that "Most people with COVID-19 have mild illness and can recover at home. You can treat symptoms with over-the-counter medicines, such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil), to help you feel better." In this review we consider the contributions of different types of evidence and conclude that healthcare providers should make individual clinical judgments for each of their patients in the selection of over-the-counter drugs to treat symptoms of COVID-19. This judgment should be based on the entire benefit to risk profile of the patient. It is our belief that the individual healthcare provider knows far more about each of his or her patients than anyone, including expert members of guideline committees. Their astute and judicious individual clinical decision-making for each individual patient based on all these considerations has the potential to do far more good than harm. [ABSTRACT FROM AUTHOR]

Background: There are few reports on drug use in patients while hospitalised and none regarding management or clinical outcomes. Aims: To describe cases of drug use by inpatients requiring an urgent clinical response. Methods: We retrospectively reviewed cases at a teaching hospital in Sydney, Australia, from February 2019 to March 2021. Results: Thirty cases were identified, with no deaths. Two patient groups were identified: (i) substance use disorders, using illicit drugs and (ii) self‐harm history, using prescribed or over‐the‐counter drugs. Management involved cardiac monitoring (40%), intensive care (30%), charcoal (20%), antidotes (20%) and intubation (13%). Discharge was planned in 22 of 30 patients, against medical advice in four and directed by medical staff in four. Conclusions: Inpatient drug use requiring an urgent clinical response was infrequently recognised but presents a risk of harm to patients and staff and increases service utilisation and costs. Both harm reduction and systematic approaches guided by institutional policy are recommended. Using these events as reachable moments to address driving factors may modify patients' risk from future events. [ABSTRACT FROM AUTHOR]

Background: Vestibular migraine (VM) is a common cause of recurrent vertigo. Migraine headache preventative therapies are currently prescribed to control vertigo symptoms in VM. Clinical trials of nutraceuticals for migraine headache prevention have shown positive outcomes, but, to date, there have been no studies to assess their effectiveness in the management of VM. Aims: To report the effects of nonprescription therapy management on VM symptoms. Methods: We undertook a prospective, questionnaire‐based assessment of patients diagnosed with VM between November 2019 and August 2021 at two Sydney tertiary referral clinics. Patients were advised on optimising sleep, hydration, exercise and nutrition and instructed to use an over‐the‐counter combination product containing riboflavin 200 mg, magnesium 150 mg, coenzyme Q10 75 mg and feverfew 200 mcg. Symptom severity and frequency were assessed using the Dizziness Handicap Inventory (DHI), the Vertigo Symptom Score short‐form (VSS‐sf) and two visual analogue scales for severity (VAS‐s) and frequency (VAS‐f) before and 3 months after commencing treatment. Result: In 82 participants (78% female; mean age, 44 ± 14 years) we recorded a decrease in DHI (mean, 16.8 [95% confidence interval (CI), 12.8–20.9], VSS‐sf (9.3, 7.1–11.5), VAS‐s (3.0, 2.2–3.8) and VAS‐f (2.8, 2.1–3.4), equating to an improvement of 44.1%, 44.9%, 44.1% and 38.9% for each measure respectively. On the DHI and VSS‐sf, 41 (50%) and 44 (53.7%) patients showed improvement in their symptoms; 39 (47.6%) and 36 (43.9%) patients noted no change and two patients reported worsening. The supplement was well‐tolerated. Conclusions: The results provide preliminary evidence that VM symptom frequency and severity can be reduced by using nonprescription therapies. [ABSTRACT FROM AUTHOR]

Aim: To investigate changes in the clinical characteristics of patients who abused benzodiazepine receptor agonists (BZRA) or over‐the‐counter (OTC) drugs before and after COVID‐19 based on the 2018 and 2022 data of the "Nationwide Psychiatric Hospital (NPH) Survey on Drug‐related Psychiatric Disorders." Method: A total of 446 and 155 cases, and 435 and 273 cases, who mainly abused BZRAs or OTC drugs, respectively, were extracted from the database of the two NPH Surveys. Demographic variables, education, employment, criminal record, drug use during the previous year, psychiatric diagnosis, and types of abused drugs were compared between 2018 and 2022. Result: A comparison of BZRA abusers revealed a decreased number of users during the previous year and an increase in the comorbidity rate of other disorders (F3 and F4 in ICD‐10) in 2022. Etizolam, flunitrazepam, triazolam, and zolpidem were used most in both years, with an increase in zolpidem and a decrease in triazolam in 2022. A comparison of OTC drug abusers revealed a higher proportion of women and young patients in 2022. An increase in the comorbidity rate of F3 and F9 and a significant increase in the use of dextromethorphan products were observed in 2022, although codeine products were in the majority in both years. Conclusion: By comparing NPH Surveys before and after the COVID‐19 pandemic, both BZRA abusers and OTC drug abusers present complex pathologies, requiring tailor‐made treatment. The younger OTC drug abusers were particularly evident among women, and the abuse of dextromethorphan‐containing OTC drugs has increased alarmingly. [ABSTRACT FROM AUTHOR]

Background: In a developing country such as India, intentional poisoning is associated with a high degree of morbidity and mortality. Historically, the use of agricultural poisons for attempted deliberate self-harm (DSH) has taken precedence. However, urbanization and stringent laws governing sale of agricultural chemicals, in recent years, may have shifted the focus of seekers toward commercially available therapeutic medications. Further, urbanization, high health-care seeking behavior, and poor regulation on sale of medicines, in Kerala, provide a conducive environment for such attempts. Aims and Objectives: The objective of this study was to determine the contribution of therapeutic medication toward acute poisoning as a means of DSH and the factors contributing to the same. Materials and Methods: Patients who obtained treatment for acute poisoning after DSH, between 2017 and 2023, were screened, those who employed therapeutic medication for the same were further determined. Sociodemographic details, clinical profile, and history of previous such attempts and treatment history including toxicological screening report were gathered and analyzed. Results: In our study of 154 patients arriving at the emergency department with history of DSH, 41% used therapeutic medicines for the same. Majority were women (75%) and most had a high school education (64%) or above. The most common agents were determined as paracetamol (23%) and benzodiazepine (10.6%). Tox screen was performed for 45% of patients. Organ failure developed in 36% patients with drug levels above and 42% of those with levels below the therapeutic range. However, 48% of those who did not undergo toxicological screening developed organ failure. Organ failure developed in 42% of patients, with acute liver injury being the most common culprit (25%). Management was symptomatic unless an antidote was available. Conclusion: Prescription drugs utilization for DSH was common in women and patients with higher educational status. Over-the-counter drugs and psychiatric medication were frequently used. Lack of prompt access to healthcare may contribute to organ failure. Tox-screen is recommended for drug detection. [ABSTRACT FROM AUTHOR]

People living with chronic kidney disease (CKD) often experience multimorbidity and require polypharmacy. Kidney dysfunction can also alter the pharmacokinetics and pharmacodynamics of medications, which can modify their risks and benefits; the extent of these changes is not well understood for all situations or medications. The principle of drug stewardship is aimed at maximizing medication safety and effectiveness in a population of patients through a variety of processes including medication reconciliation, medication selection, dose adjustment, monitoring for effectiveness and safety, and discontinuation (deprescribing) when no longer necessary. This Review is aimed at serving as a resource for achieving optimal drug stewardship for patients with CKD. We describe special considerations for medication use during pregnancy and lactation, during acute illness and in patients with cancer, as well as guidance for the responsible use of over-the-counter drugs, herbal remedies, supplements and sick-day rules. We also highlight inequities in medication access worldwide and suggest policies to improve access to quality and essential medications for all persons with CKD. Further strategies to promote drug stewardship include patient education and engagement, the use of digital health tools, shared decision-making and collaboration within interdisciplinary teams. Throughout, we position the person with CKD at the centre of all drug stewardship efforts. Patients with chronic kidney disease often require complex polypharmacy, require dose adjustments or discontinuation with changes in kidney function, and can be susceptible to the adverse effects of medications. This Review discusses the principles of drug stewardship — that is, the effective, safe and sustainable use of medications — for people with chronic kidney disease. Key points: Medication reconciliation and review is an essential first step in patient-centred drug stewardship. Doses should be adjusted according to a patient's glomerular filtration rate (GFR). Most pharmacokinetic information available is derived from creatinine-based equations, and for many medications, different creatinine-based equations to estimate GFR are interchangeable; however, use of equations that utilize both creatinine and cystatin C, or direct measurement of GFR, is advocated when the therapeutic range is narrow and precision is needed. Drug choice should consider relative and absolute contraindications by GFR, and the increased nephrotoxicity of nephrotoxic medications to people with chronic kidney disease. Acute illness and fluctuations in GFR should prompt frequent reassessment of GFR and medications; however, the implementation of routine sick-day rules has a substantial cost or opportunity cost, is not supported by evidence and may cause more harm than good. For people with chronic kidney disease who might become pregnant, education around potential teratogens is important, but people should not be denied medication on the basis that they might become pregnant. Culturally appropriate, multi-faceted educational and empowerment activities may include written instructional materials and digital technologies. Health care workers and patients should collaborate to promote more equitable access to evidence-based medications within their countries and globally. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The shift of proton pump inhibitors (PPIs) from prescription to nonprescription (nonRx) status in Canada has altered pharmacist treatment options for heartburn. This report examines pharmacist approaches to therapy based on case severity; pharmacist confidence and consult duration were also explored. A 2022 online survey gathered data from Ontario and Québec pharmacists regarding their therapeutic approaches for two hypothetical heartburn cases. A total of 715 pharmacists participated, with most having 1–10 years of experience. In Ontario, common choices for the milder case included a solo histamine-2 receptor antagonist (H2RA) (21.2%), combination H2RA + antacid (29.4%), and nonRx PPI (22.3%). For the more severe case, common choices for Québec were switches to nonRx H2RA (22.1%), combination H2RA + antacid (13.4%), a nonRx PPI (24.9%), or prescription PPI (22.5%). Pharmacists often recommended switching medications or referring patients with recurring symptoms after seven days. The approaches varied significantly between cases and provinces. The Ontario pharmacists favoured a combination H2RA + antacid for the milder case, while the Québec pharmacists preferred a solo H2RA. For the more severe case, both groups often chose nonRx H2RA followed by nonRx PPI. Despite the differences, the pharmacists demonstrated confidence in managing these situations. These findings highlight potential debates regarding optimal therapeutic approaches and the impact of drug scheduling on patient care. [ABSTRACT FROM AUTHOR]

Background: Haemodialysis is Ghana's most common form of renal replacement therapy for end-stage kidney disease (ESKD). However, limited research has explored the experiences of individuals with ESKD receiving haemodialysis in relatively poorer regions, especially in the northern part of the country. This study explored individuals' experiences with accessing haemodialysis in northern Ghana and was guided by Levesque's conceptual framework of access to healthcare. Methods: The study utilized a phenomenological design, and participants were recruited through the purposive sampling method. Individuals with ESKD receiving haemodialysis for at least three months were interviewed using a semi-structured interview guide. Trustworthiness was ensured through credibility, transferability, dependability, and confirmability. Results: Most of the participants had a history of hypertension that progressed to ESKD due to poor management practices – mainly purchasing antihypertensive drugs over the counter without visits to the hypertensive clinic contributed greatly to the delay in diagnosing ESKD in northern Ghana. The geographical location of the dialysis centre and limited dialysis machines were the key barriers to adequate access to dialysis. Many participants had two dialysis sessions per week instead of thrice a week. Some were even having one session per week due to the distance from their residence to the dialysis centre and the costs involved. Conclusion: Access to haemodialysis for individuals with ESKD in the northern part of the country is relatively limited in many ways compared with that in the southern part of the country. Health policies should include funding for haemodialysis and a collaboration with pharmaceutical companies to consider manufacturing dialysis concentrates to reduce the cost. Additionally, there should be deliberate efforts to design and implement programs to promote ESKD awareness in the country, especially in relatively poorer regions. [ABSTRACT FROM AUTHOR]

Over the counter dietary supplements are a massive and growing market; however, there are few regulations or safeguards/protections for ensuring appropriate efficacy and safety. While there is some evidence of memory improvement, in older patients particularly, a significant number of commonly sold supplements have little to no memory-boosting benefits. Further studies are required on the longer-term effects of these supplements, particularly larger and better designed studies than currently available in the literature. Clinicians should also be conscious of any supplements older patients may be taking alongside their prescribed medications. [ABSTRACT FROM AUTHOR]

Drug poisoning has evolved in South Korea, with changes in substance availability and a rise in non-lethal abuse among youth, necessitating an updated understanding of this public health concern. This study aims to investigate the shifts in toxicitycausing substances and their impacts over the past decade, providing a comprehensive overview to inform future interventions. This study were conducted as a retrospective observational study utilizing the Korea National Hospital Discharge In-depth Injury Survey, including data from January 2011-December 2020. Hospitalization patterns, durations and corresponding mortality rates were examined. The study, analyzing 10,017 patients hospitalized for drug poisoning, observed a decrease in average hospital stay (average decrease from 7.1 days in 2011 to 5.8 days in 2020) and mortality rate (7.7% in 2011 to 2.6% in 2020), with older adults having the longest stays and highest mortality. The use of prescription and non-prescription drugs as intoxicants increased, while pesticide use decreased, with older adults showing the highest frequency of pesticide poisoning. Factors affecting length of stay and mortality rate included age, sex and intent, with statistical analyses showing significant correlations. An increase in poisonings was caused by prescription and non-prescription drugs, whereas there was a decrease in poisonings caused by pesticides. Despite decreases in drug poisoning-related deaths in South Korea, largely attributed to national control for high-toxic agents and improved medical systems, the rising number of incidents involving prescription and over-thecounter medications highlights the urgent need for ongoing surveillance and focused interventions. [ABSTRACT FROM AUTHOR]

Background and Aim: Self-medication practices (SMPs) are a common phenomenon prevalent with both prescription and nonprescription medicines. Still, the availability of a valid and reliable instrument to assess the knowledge, attitude, and practices toward self-medication (SM) remains limited. The current pilot study aimed to develop and validate a tool that effectively evaluates these aspects among consumers in Delhi, India. Materials and Methods: The research involved 100 consumer participants from Delhi, India. Reliability and validity testing was conducted to assess reproducibility, internal consistency, and content validity. The questionnaire underwent validation by a panel of five experts to evaluate face and content validity. Results: Test--retest reliability was assessed using Karl Pearson's correlation co-efficient yielding values of 0.841 (P = 0.002), 0.827 (P = 0.003), and 0.792 (P = 0.006) for the three domains of knowledge, attitude, and frequency of performing SM, respectively. Cronbach's alpha statistics were used to determine internal consistency, yielding values of 0.775 and 0.839 for knowledge and attitude domains, respectively. The association between the demographic characteristics of respondents and knowledge, attitude, and frequency of SM was assessed using an independent sample t-test and one-way ANOVA, demonstrating satisfactory known group validity. Conclusions: The developed questionnaire proved valid and reliable for determining consumer's knowledge, attitudes, and practices toward SM. The final tool could be valuable for future research and interventions to improve consumers' understanding of SMP. [ABSTRACT FROM AUTHOR]

Insomnia is caused by a myriad of factors and can be very disruptive to a person's quality of life and health. When people see a health care provider, often a thorough assessment occurs and people are given various treatment options that include lifestyle interventions, medications, and/or cognitive behavior therapy. There are also many people that may choose to take over the counter or herbal medications as a remedy for insomnia. While there are many supplements that claim to have sleep benefits, clinical data supporting such claims are not always present. This article will briefly discuss the three most common herbal supplements taken for insomnia: melatonin, valerian, and lavender. [ABSTRACT FROM AUTHOR]

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Background: Various methods, including the use of probiotics, have been suggested to prevent caries. Caries, which is mainly caused by Streptococcus mutans, is one of the bacterial diseases that imposes a heavy cost on society. The present study was conducted to investigate the probiotic products available in Iranian pharmacies that are used for caries prevention. Materials and Methods: In this double-blind randomized clinical trial, 40 students of medicine and pharmacy were randomly allocated to two equal groups of intervention and control using random allocation software. The intervention group used a probiotic pill containing Streptococcus salivarius MI8 and KI2 bacteria every night before going to bed. The control group used a mouth freshener tablet with the same flavor as the probiotic tablet every night before going to bed. The data were analyzed by SPSS (version 24) software using descriptive statistics (central tendency and dispersion) and inferential statistics (paired t-test and independent t-test). Data were collected using Excel software, and statistical analyses were performed by SPSS software (version 24). Results: The mean number of S. mutans in the intervention group was 754.5 cfu/mm before the intervention and 1701.5 cfu/mm after the intervention, which showed a statistically significant difference (P < 0.05). In the control group, the mean S. mutans was 683 cfu/mm at the beginning of the intervention and 659 cfu/mm at the end of the intervention, which did not indicate a statistically significant difference (P > 0.05). Moreover, the normality of data was checked by the Kolmogorov-Smirnov test. Conclusion: The mean number of S. mutans bacteria in the group using probiotic tablets was significantly increased compared to those of the control group. However, further studies are suggested to evaluate these products. [ABSTRACT FROM AUTHOR]

BACKGROUND: Patient mobility tasks place rehabilitation professionals (Physical and Occupational Therapists) working in hospitals at high risk for work-related musculoskeletal disorders (WMSDs). However, when investigating engagement with a Safe Patient Handling and Mobility program (SPHM), administrative records at a level one trauma hospital showed that rehabilitation professionals reported zero work-related injuries over an eight-year period. OBJECTIVE: As part of a qualitative study conducted to discover their unique work experiences, we explored some of the reasons that rehabilitation professionals might not report work-related injuries to their employers. METHODS: Using a collective case study design, six focus groups were conducted with 25 members of the rehabilitation team within a level-one trauma hospital. Focus groups were recorded; transcripts were analyzed for emergent themes using first and second cycle coding procedures. RESULTS: Participants in this study denied experiencing work-related injuries but frequently described working in pain, often attributed to patient mobility tasks. These experiences were not reported to employers. Self-management of their pain through co-worker treatment, over-the-counter medications, or informal alteration in job tasks were reported as common. CONCLUSION: Administrative injury records may underrepresent injuries among rehabilitation professionals. This may be due to their perception of work-related pain as something different than work-related injuries, or that many of these rehabilitation professionals treat their own work-related pain and symptoms rather than report them. To get a more accurate assessment of injury frequency among rehabilitation professionals, researchers should gather information directly from the participants, and should inquire about work-related pain in addition to injury. [ABSTRACT FROM AUTHOR]

This article discusses a study conducted among medical and nursing students in India to assess their knowledge, attitude, and practice regarding over-the-counter (OTC) drugs. The study found that self-medication with OTC drugs was prevalent among the participants, with fever and headache being the most common conditions they treated themselves for. Lack of time and previous knowledge about medications were the main reasons for self-medication. While the majority of students had good knowledge and a positive attitude towards responsible self-medication, there were some concerning practices, such as continuing to use medications even after they had changed in shape, color, or odor. The study suggests the need for educational programs to promote responsible self-medication practices among future healthcare professionals. [Extracted from the article]

Background: There have been sharp increases in antidepressant and opioid prescriptions over the last 10 years, as well as increased over-the-counter medicine availability. However, the impact on childhood medicinal poisonings rates, particularly by socioeconomic deprivation is unclear. This study reports population level medicinal poisoning substance patterns in England among children aged 0–11 years, helping inform safety advice and poisoning prevention interventions. Methods: An open cohort study of 1,489,620 0–11 year olds was conducted from 1998 to 2018, using the Clinical Practice Research Datalink, to examine inpatient hospital admissions for poisoning. Incidence rates and adjusted incidence rate ratios (aIRR) were calculated for poisoning substance groups by age, sex, socio-economic deprivation and year. Results: 3,685 medicinal poisoning hospital admissions were identified. The most common substances were paracetamol (33.2%), dependence/withdrawal risk drugs (DWRD - antidepressants, opioids, gabapentinoids, benzodiazepines) (13.5%) and other over-the-counter (OTC) analgesics/anti-common cold drugs (13.0%). Over the study period DWRD poisonings decreased 33% (aIRR 0.67, 95%CI 0.50–0.90 comparing 2013/14-2017/18 to 1998/99-2002/03), while paracetamol poisonings increased 43% (aIRR 1.43, 95%CI 1.20–1.70 for the same periods), with no change in incidence rates for other OTC drugs (aIRR 0.82, 95% CI 0.60–1.12) or all medications combined (aIRR 0.97, 95%CI 0.88–1.07). A gradient in poisonings by area-level socioeconomic deprivation was shown for all medications (aIRR 1.32, 95%CI 1.18–1.47 for most deprived compared to least deprived quintile), and DWRDs (aIRR 2.03, 95%CI 1.42–2.88 for 4th most deprived quintile and aIRR 1.88, 95%CI 1.32–2.66 for 5th most deprived quintile, compared to least deprived quintile), but not for paracetamol or other OTC drug poisonings. Conclusions: Poisonings from DWRDs decreased by 33%, while paracetamol poisonings increased by 43% during the study period. There was a gradient by area-level socioeconomic deprivation in prescribed medication poisonings, including drugs with withdrawal/dependence risk, but not OTC medication poisonings. Households in more socioeconomically deprived areas have the potential to benefit most from measures to improve safe storage of medicines and are likely to require targeted interventions providing education and safety equipment. In addition, universal promotion of the safe storage of OTC and prescribed medicines must be provided by prescribers, community pharmacies and other outlets of such medication. [ABSTRACT FROM AUTHOR]

Background: A lack of safety data on postpartum medication use presents a potential barrier to breastfeeding and may result in infant exposure to medications in breastmilk. The type and extent of medication use by lactating women requires investigation. Methods: Data were collected from the CHILD Cohort Study which enrolled pregnant women across Canada between 2008 and 2012. Participants completed questionnaires regarding medications and non-prescription medications used and breastfeeding status at 3, 6 and 12 months postpartum. Medications, along with self-reported reasons for medication use, were categorized by ontologies [hierarchical controlled vocabulary] as part of a large-scale curation effort to enable more robust investigations of reasons for medication use. Results: A total of 3542 mother-infant dyads were recruited to the CHILD study. Breastfeeding rates were 87.4%, 75.3%, 45.5% at 3, 6 and 12 months respectively. About 40% of women who were breastfeeding at 3 months used at least one prescription medication during the first three months postpartum; this proportion decreased over time to 29.5% % at 6 months and 32.8% at 12 months. The most commonly used prescription medication by breastfeeding women was domperidone at 3 months (9.0%, n = 229/2540) and 6 months (5.6%, n = 109/1948), and norethisterone at 12 months (4.1%, n = 48/1180). The vast majority of domperidone use by breastfeeding women (97.3%) was for lactation purposes which is off-label (signifying unapproved use of an approved medication). Non-prescription medications were more often used among breastfeeding than non-breastfeeding women (67.6% versus 48.9% at 3 months, p < 0.0001), The most commonly used non-prescription medications were multivitamins and Vitamin D at 3, 6 and 12 months postpartum. Conclusions: In Canada, medication use is common postpartum; 40% of breastfeeding women use prescription medications in the first 3 months postpartum. A diverse range of medications were used, with many women taking more than one prescription and non-prescription medicines. The most commonly used prescription medication by breastfeeding women were domperidone for off-label lactation support, signalling a need for more data on the efficacy of domperidone for this indication. This data should inform research priorities and communication strategies developed to optimize care during lactation. [ABSTRACT FROM AUTHOR]

Background: Frailty and polypharmacy are common conditions in older adults, especially in those with chronic kidney disease (CKD). Therefore, we analyzed the association of polypharmacy and incident frailty and the effect modification by CKD in very old adults. Methods: In non-frail individuals within the Berlin Initiative (cohort) Study, polypharmacy (≥ 5 medications) was assessed according to multiple definitions based on the number of regular and on demand prescription and over the counter drugs, as well as vitamins and supplements. CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73m2 and/or an albumin-creatinine ratio ≥ 30 mg/g. Incident frailty was assessed at follow-up using Fried criteria. Logistic regression was applied to assess (1) the association of different polypharmacy definitions with incident frailty and (2) effect modification by CKD. Results: In this cohort study, out of 757 non-frail participants (mean age 82.9 years, 52% female, 74% CKD), 298 (39%) participants reported polypharmacy. Over the observation period of 2.1 years, 105 became frail. Individuals with polypharmacy had 1.96 adjusted odds (95% confidence interval (CI): 1.20–3.19) of becoming frail compared to participants without polypharmacy. The effect of polypharmacy on incident frailty was modified by CKD on the additive scale (relative excess risk due to interaction: 1.56; 95% CI 0.01–3.12). Conclusions: This study demonstrates an association of polypharmacy and incident frailty and suggests strong evidence for an effect modification of CKD on polypharmacy and incident frailty. Revision of prescriptions could be a target strategy to prevent frailty occurrence, especially in older adults with CKD. [ABSTRACT FROM AUTHOR]

BACKGROUND: Most research on the impact of medication reconciliation on patient safety focused on the retroactive model, with limited attention given to the proactive model. OBJECTIVE: This study was conducted to compare the proactive and retroactive models in patients hospitalized for acute decompensated heart failure. METHODS: This prospective, quasi-experimental study was conducted over six months, from June to November 2022, at the cardiology unit of an academic hospital in Iran. Eligible patients were those hospitalized for acute decompensated heart failure using a minimum of five regular medications before admission. Medication reconciliation was performed in 81 cases using the proactive model and in 81 using the retroactive model. RESULTS: 556 medications were reconciled using the retroactive model, and 581 were reconciled using the proactive model. In the retroactive cases, 341 discrepancies (both intentional and unintentional) were identified, compared to 231 in the proactive cases. The proportion of patients with at least one unintentional discrepancy was significantly lower in the proactive cases than in the retroactive cases (23.80% versus 74.03%). Moreover, the number of unintentional discrepancies was significantly lower in the proactive cases compared to the retroactive cases (22 out of 231 discrepancies versus 150 out of 341 discrepancies). In the retroactive cases, medication omission was the most frequent type of unintentional discrepancy (44.00). About, 42.70% of reconciliation errors detected in the retroactive cases were judged to have the potential to cause moderate to severe harm. While the average time spent obtaining medication history was similar in both models (00:27 [h: min] versus 00:30), the average time needed to complete the entire process was significantly shorter in the proactive model compared to the retroactive model (00:41 min versus 00:51). CONCLUSION: This study highlighted that the proactive model is a timely and effective method of medication reconciliation, particularly in improving medication safety for high-risk patients. [ABSTRACT FROM AUTHOR]

Federal agencies and self-regulatory bodies help to ensure prescription and nonprescription drug promotion contains accurate information; however, false or misleading claims may cause people to have inaccurate perceptions of a drug and inhibit their ability to make informed decisions. We conducted a systematic review assessing evidence from 2012–2021 on how consumers and healthcare providers (HCPs) interpret claims made indirectly or through inference (implied or implicit claims) as well as synthesizing prescription and nonprescription drug advertising claims that have been the subject of regulatory actions from 2017–2021. Our search identified 16 studies from the peer-reviewed literature and 26 letters or case reports issued by the Food and Drug Administration (FDA) or National Advertising Division (NAD). Results from peer-reviewed studies suggest that implied claims can result in inferences that may not be warranted by the material facts about the drug. Perceptions of a drug's efficacy and, to a lesser extent, risk, are influenced by implied and explicitly false claims in prescription drug promotion. Claims related to implied superiority and overstatement of efficacy were the most prevalent claims flagged for review and examined in the literature. These types of claims were also the subject of many of the compliance actions by the FDA and case reports from the NAD. More research is needed to understand how people interpret varying types of implied claims and the impact of such claims on key outcomes. From a policy standpoint, understanding how people interpret implied claims can inform how the FDA approaches these claims in the marketplace. [ABSTRACT FROM AUTHOR]

This case report presents the clinical scenario of a 15-year-old adolescent admitted to the emergency room with complaints of shortness of breath and a persistent productive cough for the past 3 weeks, despite over-the-counter medication. The cough did not improve with over-the-counter medication. He also sometimes noticed blood stains in his phlegm. During the physical examination, a BCG scar was found on the right upper arm. The results showed that positive HIV status and the absence of BCG scars were significantly associated with miliary TB and extrapulmonary TB. However, in this case, both factors were not detected. The treatment regimen for miliary TB requires therapy for a minimum of 12 months, but teenagers experience difficulties in undergoing therapy due to the consumption of illegal drugs every day for a long period of time. Apart from that, social isolation and disrupted daily activities are also challenges for teenagers. The death rate from miliary TB in children reaches 15-20%, highlighting the importance of awareness of this disease. Therefore, handling and treating TB in adolescents requires special attention and further efforts to reduce the risk of treatment failure. Awareness of TB, especially in adolescents with chronic respiratory symptoms, must be increased to overcome this challenge in the future. [ABSTRACT FROM AUTHOR]

Background: Evidence-based practice (EBP) is essential for pharmacists to select and recommend over-the-counter (OTC) drugs in medical consultations (hereinafter referred to as OTC counseling). Objectives: This study examined the association between pharmacists' perceptions of EBPs and their implementation of OTC counseling. Methods: A web-based survey was conducted. Questions regarding pharmacists' perceptions of EBP and experience in OTC counseling were set, and respondents were asked to respond based on a 5-point scale ranging from 1 (strongly disagree) to 5 (strongly agree). The association between pharmacists' perceptions of EBP and experience in OTC counseling was examined by calculating Spearman's ρ using bivariate correlation analysis. Results: Responses were obtained from 250 pharmacists. Although 70% of respondents indicated that EBP improves service quality, only 39, 31, and 14% had knowledge of the EBP steps, conducted a literature search, and performed a critical appraisal, respectively. Regarding OTC counseling experience, only 31% of respondents indicated that "sufficient evidence information on OTC drugs has been obtained." Over 60% of respondents expressed the need for OTC usage guidelines and support tools and revealed that brand-specific purchases of OTC drugs make EBP difficult. An association was observed between pharmacists' perceptions of EBP and experience in OTC counseling. "Level of recognition of steps for practicing evidence-based medicine" was associated with the "need fulfillment level for evidence information" (ρ = 0.329, P < 0.001), "brand-specific purchases of OTC drugs" (ρ = 0.240, P < 0.001), "perception of product advertisement" (ρ = 0.227, P < 0.001), and "need for OTC guidelines" (ρ = 0.208, P < 0.001). Conclusions: Pharmacists' perceptions of EBP were associated with their experience in OTC counseling [ABSTRACT FROM AUTHOR]

Background: Community pharmacists have an essential role in antimicrobial stewardship by providing self-care advice for self-limiting infections. Aim: To explore community pharmacists' perceptions and experiences of advising patients on management of acute respiratory tract infections (RTIs) and urinary tract infections (UTIs), and to explore issues regarding use of over-the-counter (OTC) medicines, including herbal medicines. Design & setting: A qualitative study using semi-structured interviews with community pharmacists in England. Method: Qualitative interviews with community pharmacists were carried out face to face and by telephone between November 2019 and March 2020. Data were collected through in-depth, semi-structured interviews, recorded and transcribed. A reflexive thematic analysis was undertaken. Results: In total, 18 community pharmacists were interviewed. Three main themes were identified. Theme 1 was self-management recommendations. Community pharmacists considered patients' preferences when recommending self-management strategies. Some believed that conventional OTC medications had quicker and stronger effects, while others preferred herbal OTCs as a more natural approach, particularly for less severe symptoms. Theme 2 was factors influencing pharmacists' recommendations for acute infections. This included pharmacists' perceptions of patient preferences, nature or severity of illness, research evidence, training, commercial pressures, and patient concerns about medication cost. Theme 3 was pharmacist-patient communication. Pharmacists sometimes experienced challenges with language barriers and patients' expectations of receiving antibiotics. Pharmacists emphasised the importance of being trusted by their patients. There was widespread acceptance of their role in self-management advice for acute illness and interest in the role of herbal medicines, but pharmacists did not feel confident in recommending these. Conclusion: Pharmacists are central to the management of self-limiting infections. There is a need to educate the public about appropriate use of antibiotics and provide training and support for pharmacists on self-management strategies including herbal medicine. [ABSTRACT FROM AUTHOR]

The digital transformation movement persuaded many pharma companies towards greater adoption of digital marketing and e-commerce. This was accelerated even more by the COVID-19 crisis. Therefore, this study aims to explore the general perception and attitude of consumers in Malaysia regarding the use of online shopping and digital marketing tactics for OTC drugs. Thirteen in-depth interviews were conducted between September and November 2020. A thematic content analysis approach was used to analyse the qualitative data. Key themes emerging from the interviews included: (1) general perception of OTC drug consumers regarding digital marketing; (2) attitude of consumers towards the purchase of OTC drugs; (3) factors affecting OTC drug consumer behaviour; and (4) perception of consumers towards online advertisements for OTC drugs. The majority of the study participants believe that digital marketing has a direct or indirect impact on their purchasing decisions as OTC consumers. Although most rely mainly on offline purchases for OTC products, they have shown a willingness to increase their adoption of online purchasing methods, particularly in the aftermath of the COVID-19 outbreak. These findings can be useful to public and private healthcare managers on a practical level. [ABSTRACT FROM AUTHOR]

INTRODUCTION Proficiency in nonprescription medicine and first-aid knowledge have become increasingly crucial for school health educators. Given the significant amount of time children spend at school, they are susceptible to various severe health issues, making it imperative to address this concern. Hence, this study evaluates the knowledge of nonprescription medicine, first aid, and associated factors among school health teachers in Phayao Province, Northern Thailand. METHODS A cross-sectional study based on institutions was conducted from June to August 2022. The purposive sampling method was utilized to select 134 head school health teachers from primary schools located in the province. Data collection was performed through a structured, self- administered questionnaire. RESULTS Approximately 67.2% of the participants demonstrated a moderate level of knowledge of nonprescription medicine, while 76.9% exhibited a low level of personal knowledge regarding first aid. The multivariable analysis revealed significant associations between nonprescription medicine knowledge and the following two factors: teaching experience (p=0.013) and previous training experience in nonprescription medicine (p=0.003). Additionally, experience in school health services (p=0.027), previous training in nonprescription medicine (p=0.022), and previous training in first aid (p<0.001) were significantly associated with first-aid knowledge. CONCLUSIONS The study findings underscore the significance of experience and specialized training in enhancing the knowledge and skills of primary school health teachers in nonprescription medicine and first aid. These factors are positively linked to improved health outcomes and effective care in school settings. [ABSTRACT FROM AUTHOR]

The WHO and UNICEF recommend that only breastmilk, vitamin drops, oral rehydration solution, and prescribed medicine can go through the infant's mouth. Non-prescribed medications (NPM) include over-the-counter medications and traditional medicine and are contraindicated during infancy. Furthermore, the updated exclusive breastfeeding (EBF) indicator details that herbal fluids and similar traditional medicines are counted as fluids, and infants who consume these are not exclusively breastfed. However, the use of these items is common among caregivers for various reasons, including religious reasons, cultural beliefs, prevention of diseases, and the treatment of diseases. The practice of administering NPM before six months of age undermines exclusive breastfeeding and can result in undesirable health outcomes. Methods: The purpose of this study was to determine the prevalence of NPM, describe the types of medications used, and explain why caregivers use NMP in infants younger than six months of age. A quantitative approach and a facility-based cross-sectional survey were used to conduct this study. Convenience sampling was used to select clinics, and proportionality and simple random sampling were used to select 146 participants. Data were analyzed using SPSS (29). A p-value of p < 0.05 was considered significant. Results: In this study, the prevalence of NPM was 75.3%. Of the 146 participants, most were 25–35 years old (54%) and first-time mothers (36.3%). More caregivers had high school and matric (67.1%), and 84.2% of caregivers delivered in public health facilities. Almost three-quarters are unemployed (66.7%) and on a child support grant (56.4%). About 43.6% of infants received NPM within the first month of life. The main source of advice to give NPM was family members (86.4%). The main reasons for administering NPM were the treatment of the umbilical cord (57.3%) and the prevention of colic (32.7%). The results show a statistically significant association between the administration of medication and the age of the infant, p < 0.005. Conclusions: Non-prescribed medications are highly prevalent in the rural areas of Polokwane and are practiced by caregivers between the ages of 25–35 years advised by the families. Access to self-medication should be controlled, especially in the first month of life. Interventions to reduce the use of NPM should be targeted at young mothers and their families. [ABSTRACT FROM AUTHOR]