Search

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]

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]

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]

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]

Easy access to over-the-counter (OTC) drugs makes it possible to procure active substances that normally used in therapeutic doses do not raise health problems. The use of high doses of OTC drugs containing codeine, loperamide, pseudoephedrine, diphenhydramine or dimenhydrinate, as well as the use of benzidamine systemically raises concerns regarding the increase in units sold. These drugs are used for recreational or euphorizing purposes, including by young women of childbearing age, psychoactive substance users representing a risk group in terms of the possibility of an unplanned pregnancy. Abusive consumption of OTC products during pregnancy is harmful, with consequences for both fetal and late development that can occur in the infant. This literature review presents the risks (teratogenicity, fetal toxicity, neonatal abstinence syndrome, etc.) associated with the use of potentially psychoactive OTC drugs to emphasize the importance of re-evaluating OTC classification and dispensing. [ABSTRACT FROM AUTHOR]

Introduction: The objective was to characterize real-world outcomes of drug–drug interactions (DDIs) between antiretrovirals (ARVs) and other drugs, including over-the-counter medications (OTC), and treatment outcomes in clinical practice. Methods: www.clinicalcasesDDIs.com is an open-access website for healthcare providers to consult and briefly describe real-world clinical cases on DDI with ARVs. We reviewed all the clinical cases reported to the website between March 2019 and May 2023. Results: A total of 139 cases were reported, mostly involving ritonavir or cobicistat (boosters; 74 cases), unboosted integrase inhibitors (InSTI; 29 cases), and non-nucleoside reverse transcriptase inhibitors (NNRTI; 23 cases). Central nervous system drugs (29 cases) and cardiovascular drugs (19 cases) were the most frequently described co-medications. Notably, OTC medications were implicated in 27 cases, including mineral supplements (11 cases), herbals (8 cases), weight loss drugs (4 cases), anabolic steroids (3 cases), and recreational drugs (1 case). OTC acted as the perpetrator drug in 21 cases, leading to loss of ARV efficacy in 17 instances (mineral supplements in 10 cases, weight loss drugs in 4 cases, herbals in 3 cases). Additionally, toxicity was reported in 4 out of 6 cases where OTC was considered the victim drug of the DDI (anabolic steroids in 3 cases, MDMA in 1 case). Conclusions: Frequent unwanted outcomes resulting from DDIs between ARVs and OTC medications underscore the importance of integrating non-prescription drugs into medication reconciliation. The real-world data available through www.clinicalcasesDDIs.com serves as a valuable resource for assessing the clinical relevance of DDIs. [ABSTRACT FROM AUTHOR]

There is a limited literature regarding factors associated with self-medication of pain and discomfort using alcohol, non-prescription substances or overuse of prescription medications among people living with Human Immunodeficiency Virus (HIV). This cross-sectional analysis used data from the Boston ARCH Cohort among participants with HIV infection and a history of alcohol or other substance use. Among 248 participants, 37% were female, 50% Black, 25% Latinx; 36% reported fair to poor health and 89% had CD4 cell counts >200/mm3. Half reported self-medication and of those, 8.8% reported doing so only with alcohol, 48.8% only with other substances and 42.4% with both alcohol and other substances. Those reporting self-medication were significantly (p <.05) younger (mean 47 vs 50 years), less employed (11% vs 21%), and less likely to have HIV viral suppression (60% vs. 80%). Depression, anxiety, and HIV symptoms were associated with significantly greater odds of self-medicating, as were substance dependence, recent injection substance use, heavy alcohol use, cocaine use, opioid use, sedative use, and cannabis use. Self-medication, highly prevalent and associated with worse mental health symptoms, greater substance use, and lesser HIV disease control, should be explored by HIV clinicians caring for people who use substances. [ABSTRACT FROM AUTHOR]

Over-the-counter (OTC) medicines intended for short-term use for self-care may be abused or misused. To explore the experiences and perceptions of community pharmacists (dispensers, pharmacists, and pharmacy owners) of the use, abuse, and misuse of OTC medicines by pharmacy customers, and to identify their perceptions of the most appropriate methods to prevent inappropriate use of OTC medicines. A cross-sectional national online survey to community pharmacists in Finland. A previously validated structured questionnaire was modified. Three national pharmaceutical associations were contacted to help in recruitment of their members (n = 5594, calculated target sample size n = 360). Descriptive statistical analyses were conducted. In total, 442 responses were received. Most respondents strongly agreed (Md all = 5) that OTC medicines could be abused or misused; pharmacy owners were more likely to strongly agree than pharmacists (p = 0.012). Pharmacy owners were more likely to think that laxatives were liable for abuse than dispensers (p = 0.008), and that travel sickness medicines were liable for misuse than dispensers (p < 0.001) and pharmacists (p = 0.013). Patient counseling was the most commonly employed method to prevent the problem. Respondents perceived that providing training to staff about OTC medicines that can be abused (Md all = 5) was the most appropriate strategy to prevent OTC medicine abuse; pharmacy owners were more likely to strongly agree or agree of this (p = 0.005) than dispensers. Conclusion: Community pharmacists are aware of the liability of OTC medicines for the potential abuse and misuse. They employ various methods as advising and counseling the customer to support the rational use of OTC medicines. [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]

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]

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: 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]

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]

Copyright of Computer und Recht is the property of De Gruyter 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 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]

Objective: Where a person lives is a recognized socioeconomic determinant of health and influences healthcare access. This study aimed to compare the pain treatment profile of persons with chronic pain (CP) living in remote regions to those living in non-remote regions (near or in major urban centers). Methods: A cross-sectional study was performed among persons living with CP across Quebec. In a web-based questionnaire, participants were asked to report in which of the 17 administrative regions they were living (six considered "remote"). Pain treatment profile was drawn up using seven variables: use of prescribed pain medications, over-the-counter pain medications, nonpharmacological pain treatments, multimodal approach, access to a trusted healthcare professional for pain management, excessive polypharmacy (=10 medications), and use of cannabis for pain. Results: 1,399 participants completed the questionnaire (women: 83.4%, mean age: 50 years, living in remote regions: 23.8%). As compared to persons living in remote regions, those living in non-remote regions were more likely to report using prescribed pain medications (83.8% vs. 67.4%), a multimodal approach (81.5% vs. 75.5%), experience excessive polypharmacy (28.1% vs. 19.1%), and report using cannabis for pain (33.1% vs. 20.7%) (bivariable p < 0.05). Only the use of prescribed medications as well as cannabis remained significantly associated with the region of residence in the multivariable models. Discussion: There are differences in treatment profiles of persons with CP depending on the region they live. Our results highlight the importance of considering remoteness, and not only rurality, when it comes to better understanding the determinants of pain management. [ABSTRACT FROM AUTHOR]

This document is a part of the Pharmacotherapy Self-Assessment Program (PSAP) and provides information on the acute management of prescription and nonprescription drug overdoses. It emphasizes the importance of supportive care, exposure history, and understanding toxidromes in guiding treatment decisions. The article discusses the treatment paradigm in toxicology, including decontamination methods, enhanced elimination techniques, and focused antidotes. It recommends consulting toxicologists or poison centers for guidance in managing drug overdoses and highlights the value of involving poison centers and toxicologists in patient care. The document also provides information on the management and treatment of specific drug overdoses, such as Type 1 antiarrhythmics, diphenhydramine, bupropion, digoxin, and various toxic substances. It covers symptoms, treatment options, and the importance of early toxicologist involvement. Additionally, the document presents clinical cases to guide healthcare professionals in making appropriate treatment decisions. [Extracted from the article]

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]

Self‐selection studies assess participants' ability to use label information to decide if a proposed nonprescription drug is appropriate for their use. The optimal use of information from participants' responses in these trials has not been studied. Data from a self‐selection study for a progestogen‐only contraceptive pill (norgestrel 0.075 mg tablets, Opill) were analyzed. Participants (1772 evaluable participants) were provided with the proposed drug facts label and asked sequentially: (1) Given what you have read on the label and your own health history, is this product okay or not okay for you to take home today and start to use?; (2) Why or why not?; (3) Would you like to purchase Opill today to take home for your own use?; (4) Why or why not? The Per Guidance Analysis based on the US Food and Drug Administration's Guidance considered only the response to the first question as defining a selector. The Complete Analysis considered the responses to all four questions to determine a selector. The Per Guidance Analysis characterized 1597 participants as selectors, whereas the Complete Analysis identified 1180 participants as selectors. The decrease in selectors reflected participants who responded "okay" to the initial question but "no" to purchase question while providing rational explanations for their shift in responses. The results support the use of all available information when assessing a participant's intent in self‐selection studies for nonprescription drug candidates. The findings are discussed in the context of findings from the social cognitive and communication sciences. [ABSTRACT FROM AUTHOR]

Over‐the‐counter (OTC) local anesthetics have historically been used to alleviate pain in several common conditions including toothache and sore throat. With a rise in chronic conditions and an aging population, there has been an increase in associated chronic pain‐related disorders. Individuals with chronic pain often seek OTC treatments for quick and accessible pain relief. There are several common OTC local anesthetics, including benzocaine, lidocaine, and dibucaine, which are readily available to patients in several formulations. In order to appropriately advise patients on the use of local anesthetics, it is important to understand their key characteristics, including the mechanism of action, clinical properties, pharmacokinetics, clinical applications, and adverse reactions, which may occur. [ABSTRACT FROM AUTHOR]

Background: Hospital medication errors are frequent and may result in adverse events. Data on non-prescription of regular medications to emergency department short stay unit patients is lacking. In response to local reports of regular medication omissions, a multi-disciplinary team was tasked to introduce corrective emergency department (ED) process changes, but with no additional financing or resources. Aim: To reduce the rate of non-prescription of regular medications for patients admitted to the ED Short Stay Unit (SSU), through process change within existing resource constraints. Methods: A pre- and post-intervention observational study compared regular medication omission rates for patients admitted to the ED SSU. Included patients were those who usually took regular home medications at 08:00 or 20:00. Omissions were classified as clinically significant medications (CSMs) or non-clinically significant medications (non-CSMs). The intervention included reinforcement that the initially treating acute ED doctor was responsible for prescription completion, formal checking of prescription presence at SSU handover rounds, double-checking of prescription completeness by the overnight SSU lead nurse and junior doctor, and ED pharmacist medication reconciliation for those still identified as having regular medication non-prescription at 07:30. Results: For the 110 and 106 patients in the pre- and post-intervention periods, there was a non-significant reduction in the CSM omission rate of −11% (95% CI: −23 to 2), from 41% (95% CI: 32-50) to 30% (95% CI: 21-39). Conclusion: Non-prescription of regular CSMs for SSU patients was not significantly reduced by institution of work practice changes within existing resource constraints. [ABSTRACT FROM AUTHOR]

Context: Much of the existing work on the political economy of vaccine access has focused on how intellectual property rights agreements contribute to inequitable COVID-19 vaccine access between high-income and low- and middle-income countries (LMICs). The two solutions that emerged to scale up access in LMICs involved either voluntary arrangements under COVAX or a waiver of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPs) to allow immediate access to intellectual property. However, an additional constraint on access is weak and ineffective supply chains within LMICs that have eroded over several decades of health-sector reform. Methods: This article reviews the literature on the political economy of supply chain strengthening in LMICs and identifies key challenges to equitable access to emergent vaccines and other medicines emanating from market and state failures in internal supply chains. Findings: Over the past century, supply chain policies in LMICs have alternated among an emphasis on addressing market failures contributing to unaffordability of vaccines/medicines, an emphasis on state failures contributing to unavailability of vaccines/medicines, and a more recent move toward public-private hybrid arrangements to strengthen supply chains. Conclusions: In addition to reshoring production capacity through a TRIPs waiver, the international community must address chronic weakness in internal supply chains in LMICs to ensure access to novel vaccines/medicines. [ABSTRACT FROM AUTHOR]

Background: Adolescent athletes' values ​regarding health behaviors, including their attitudes toward doping, are largely derived from those of their parents. Therefore, clarifying the factors that affect parents' intentions regarding their children's medicine intake and nutrition can help elucidate the process of forming values ​​of healthy behaviors in young athletes. Methods: Between March 8 and March 9, 2021, an online questionnaire survey was conducted via an Internet research company; data from 2,000 residents in Japan were collected. Participants were male and female residents aged 30–59 years with children in elementary or high school and belonging to sports clubs. The survey items included respondent's and child's basic information, respondent's health literacy, and level of sports in which the respondent and child were (or are) engaged. Respondents were also asked if they would like their children to receive prescription drugs, over-the-counter drugs, herbal medicines, vaccines, supplements, or energy drinks. Logistic regression analysis was performed to analyze the relationship between respondents' basic information and health literacy and their intention to receive prescription and over-the-counter drugs, herbal medicines, vaccines, supplements, and energy drinks. Results: Higher parental health literacy was associated with higher children's willingness to receive prescription drugs (odds ratio [OR] = 1.025, 95% confidence interval [CI]: 1.016–1.035), over-the-counter drugs (OR = 1.012, 95% CI: 1.003–1.021), prescription herbal medicines (OR = 1.021, 95% CI: 1.021–1.030), over-the-counter herbal medicines (OR = 1.012, 95% CI: 1.003–1.021), and vaccines (OR = 1.025, 95% CI: 1.016–1.035). Conversely, the children's intention to receive energy drinks (OR = 0.990, 95% CI: 0.980–1.000) decreased significantly. As the child's athletic level increased, parents' willingness for their children to receive oral prescription medicines decreased (OR = 0.886, 95% CI: 0.791–0.992) and that to receive supplements (OR = 1.492, 95% CI: 1.330–1.673) and energy drinks significantly increased (OR = 1.480, 95% CI: 1.307–1.676). Conclusion: Health literacy of adolescent athletes' parents is associated with their children's willingness to receive medicines. Healthcare providers should counsel parents of adolescent athletes to allow their children to receive necessary drug treatments and prevent doping violations caused by supplement intake. [ABSTRACT FROM AUTHOR]

Background: Fewer than 1 in 20 people on the African continent in need of palliative care receive it. Malawi is a low-income country in sub-Saharan Africa that has yet to achieve advanced palliative care integration accompanied by unrestricted access to pain and symptom relieving palliative medicines. This paper studied the impact of Malawi's Waterloo Coalition Initiative (WCI) – a local project promoting palliative care integration through service development, staff training, and increased service access. Methods: Interdisciplinary health professionals at 13 hospitals in southern Malawi were provided robust palliative care training over a 10-month period. We used a cross-sectional evaluation to measure palliative care integration based on 11 consensus-based indicators over a one-year period. Results: 92% of hospitals made significant progress in all 11 indicators. Specifically, there was a 69% increase in the number of dedicated palliative care rooms/clinics, a total of 253 staff trained across all hospitals (a 220% increase in the region), substantive increases in the number of patients receiving or assessed for palliative care, and the number of hospitals that maintained access to morphine or other opioid analgesics while increasing the proportion of referrals to hospice or other palliative care programs. Conclusion: Palliative care is a component of universal health coverage and Sustainable Development Goal 3. The WCI has made tremendous strides in establishing and integrating palliative care services in Malawi with notable progress across 11 project indicators, demonstrating that increased palliative care access is possible in severely resource-constrained settings through sustained models of partnership at the local level. [ABSTRACT FROM AUTHOR]

A Filipino woman in her forties had facial erythema that was being self-treated with over-the-counter (OTC) drugs purchased outside of Japan. The drugs included clobetasol propionate, antibiotic, and antifungal components. Her facial erythema symptoms were worse during summertime. KOH direct examination of annular erythema was positive for fungal hyphae and negative for Demodex folliculorum. Fungal culture revealed Trichophyton indotineae based on internal transcribed spacer sequence analysis. Minimal inhibitory concentration for terbinafine was 0.06 µg/mL. We made a diagnosis of tinea faciei with steroid rosacea. We treated the patient with oral itraconazole. Physicians should be aware of increasing T. indotineae infections and increasing self-medication using topical OTC steroids combined with antifungals and antibiotics not only in India but also among foreign people living in other countries such as Japan. [ABSTRACT FROM AUTHOR]

This study compares Medicare and patient spending for dual over-the-counter and prescription drugs with their over-the-counter cash prices. [ABSTRACT FROM AUTHOR]

The article highlights admission medication history task domains that are valuable in the hospital setting, which are capture of nonprescription medication history, managing patients and caregivers with limited English proficiency (LEP), and use of medication history sources. It recommends a structured interview review approach for nonprescription pharmacotherapy, staff training on identify LEP patients and caregivers, and cautious approach to the use of electronic medication history resources.

Background: Codeine‐containing compound analgesics (CCCAs) are associated with dependence and, when taken in excess, significant risks of harm. A previous audit showed significant costs related to admissions for gastrointestinal (GI) complications of CCCA. Based on this and other evidence of harm, the Australian Therapeutic Goods Administration changed CCCAs to prescription only in 2018. Aims: We aimed to identify the costs associated with codeine‐related GI complications and whether the schedule change in 2018 led to a reduced clinical and financial strain on the health care system. Methods: We conducted an audit of GI admissions and associated costs of CCCAs at a tertiary teaching hospital in Adelaide between 2016 and 2020. Patients were grouped by 2‐year time periods before (group 1) and following (group 2) schedule change. Costs for the index presentation were multiplied for subsequent presentations. Costs and outcomes were compared for groups (standard statistics; P value < 0.05 significant.) Results: Three hundred forty patients (group 1, n = 164; group 2, n = 119) were identified, with the majority of these admitted due to nonsteroidal anti‐inflammatory drugs (NSAIDs) only. For CCCAs (NSAID‐containing), the same patients were admitted repeatedly with a reduction from 31 to eight admissions (P = 0.005), following rescheduling. The total cost of CCCA admissions was reduced from AU$ 561 691 for group 1 to AU$ 261 764 for group 2 (P < 0.001). Conclusions: Australian rescheduling of CCCAs in 2018 resulted in a reduction in hospital admissions and costs related to GI complications. The cost savings, even in a single hospital department, were substantial. [ABSTRACT FROM AUTHOR]

Background National Health Service (NHS) guidance for acute respiratory tract infections (RTIs) advocates self-care, encourages utilization of local pharmacies and recommends consulting general practitioners (GPs) primarily for the vulnerable or those with persistent symptoms. Coronavirus disease 2019 exerted substantial strain on the English NHS, affecting public access to primary care services. Methods For 3 years, public surveys assessed RTI incidences in the previous 12 months and associated health-seeking behaviours. Telephone surveys of 1676 respondents across England were conducted in March 2021 and 1663 respondents in March 2022. Findings were compared with a face-to-face baseline survey of 2022 respondents from March 2020. Key demographics were representative of the population. Results In 2021, the proportion of respondents who reported an RTI (51%) significantly declined from 2020 (70%, P < 0.05), then returned to pre-pandemic rates in 2022 (67%). Respondents reported more proactive symptom management in both 2021 and 2022 from 2020: there were greater reports of seeking over-the-counter treatments (55%, 55% vs. 35%, P < 0.05) and use of alternative remedies (38%, 38% vs. 21%, P < 0.05). 2022 observed a reduction in those who reported consulting their GP for their most recent RTI (15%) compared to 2021 (25%, P < 0.05) and 2020 (23%), which was not accounted for through greater consultation rates with other healthcare services. Conclusions Public health bodies should consider how pandemic-related changes may have facilitated increased self-care for self-limiting infections such as RTIs. Resources and support must include safety-netting advice to safeguard against unintentional consequences of increased self-care. [ABSTRACT FROM AUTHOR]

Sexual and gender minorities (SGMs) often deal with discrimination which can result in maladaptive coping like substance misuse, yet few studies have examined the association between everyday discrimination and various types of substance misuse among SGMs or whether there is heterogeneity in substance misuse or this relationship by SGM identity. Data from 1316 adult SGMs in the United States were recruited from Reddit between February and March 2022. SGM identities (sexual minorities assigned male at birth (AMAB), sexual minorities assigned female at birth (AFAB), gender minorities AMAB, gender minorities AFAB), everyday discrimination, depressive symptoms, marijuana and alcohol misuse, over-the-counter drug misuse, prescription drug misuse, and heroin use were measured, along with demographics. Multivariable logistic regressions examined relationships between everyday discrimination and each substance misuse outcome, adjusting for SGM identity, race/ethnicity, age, income, and depressive symptoms. Interaction terms between everyday discrimination and SGM identities were added to each model to test for moderation. In fully adjusted models, with each additional unit of everyday discrimination score, there were significantly increased odds of substance misuse for all outcomes. SGM by everyday discrimination interactions was significant for alcohol misuse, over-the-counter drug misuse, and heroin use, with the association between everyday discrimination and substance misuse stronger among gender minorities. Substance misuse varied by SGM identity. Everyday discrimination was associated with substance misuse, but there was heterogeneity in this relationship between SGM identity and substance. Substance use disorder treatment and prevention among SGMs should consider heterogeneity by SGM identity and substance. [ABSTRACT FROM AUTHOR]

Background: Over-the-counter drugs are a common practice in developing countries including Egypt. Mothers are prone to drugs errors due to their limited knowledge of medication. Efforts to improve mothers awareness towards Over-the-counter drugs are imperative to correct unhealthy practices among mothers. Aim: This study aimed to evaluate the effect of a coaching program on mothers' awareness regarding administration of Over-the-counter drugs to their children. Study design: A quasi-experimental design was utilized. Setting: The study was conducted at Alshamla pediatric outpatient clinic at Tanta University Hospital. Sampling: Convenience sample composed of 116 Mothers. Tools: Tool (1): An interviewing questionnaire, which cover two parts. Part 1: Socio-demographic characteristics; and Part 2: Mothers' knowledge. Tool (2): Mothers' reported practices regarding using of Over-the-counter drugs. Tool (3): Mothers' attitudes regarding using of Over-the-counter drugs scale. Results: It was Points out that there were highly statistically significance improvements in mothers' knowledge, positive attitude and reported practices immediately post and at follow-up of a coaching program implementation Conclusion: Coaching program application improved mothers' awareness about Over-the-counter drugs administration for their children with a statistically significant difference between pre, post and follow up. Recommendations: Continuous inservice educational programs should be conducted for the mothers about safe medication administration. [ABSTRACT FROM AUTHOR]

This article presents the findings of a study conducted at a hospital in India on adverse drug reactions (ADRs) caused by commonly prescribed antibiotics. The study found that antibiotics were the most common class of drugs associated with ADRs, with anti-tubercular drugs being the most commonly implicated antibiotics. The cutaneous system was the most commonly affected organ system, and pruritus and rash were the most frequently reported ADRs. The majority of ADRs were classified as possible and mild in severity. The article highlights the importance of following antibiotic guidelines and taking appropriate action to prevent ADRs. [Extracted from the article]

Background: Plaque-induced gingivitis is a chronic inflammatory condition characterized by complete reversibility of tissue damage once the periodontal biofilm has been disorganised. The aim of this study was to evaluate the efficacy of two commercially available mouthwashes (MWs) versus a chlorhexidine (CHX) 0.12% MW in reducing gingival bleeding (GB) in adults with plaque-induced gingivitis. Methods: The present study was a double-blind, parallel, randomized controlled trial involving 6492 gingival sites (i.e. 39 subjects × 28 teeth × 6 sites/tooth) aged 18–75 years. During a 2-week period, subjects were randomized to receive MWs: a control CHX 0.12% MW (group C, 1818 sites); a MW test containing CHX 0.09% + Citrox®/P complex (group CX, 2628 sites); a MW test based on natural compounds (group P, 2016 sites). GB was assessed at the inclusion visit (T0) and after 2 weeks of MW use (T1). Analyses of GB were compared between groups and then restricted to subjects with bleeding sites between 10 and 30% (moderate gingivitis) or ≥ 30% (severe gingivitis) at T0. Pairwise comparisons were made between groups and logistic regression was used to identify correlates of GB (T1). Results: For total bleeding site analysis, GB reduction between T0 and T1 ranged from 23% (C), 26% (CX) and 36% (P), respectively (all p < 0.05). Multiple comparison between groups showed that group C was significantly less effective (p < 0.05) than groups CX and P. Splitting the analysis, in patients with severe gingivitis (≥ 30% bleeding sites at T0), all MWs had a positive effect on GB with a reduction at T1 of 36% (C), 33% (CX) and 42% (P), respectively. While GB reduction between T0 and T1, was significant for all groups, the comparison among groups showed no significant difference between group C and CX, whereas the improvement was significant for group P. On the other hand, in adults with moderate gingivitis (< 30% bleeding sites at T0), only CX and P had a positive effect on GB reduction at T1(9% in CX and 2% in P, respectively), although the differences between the three groups were not significant. Conclusion: The daily use of MWs with natural components (groups P and CX) for 2 weeks should be considered positively as an adjunct to individual oral prophylaxis to reduce GB compared to the control MW containing CHX 0.12% (group C) in healthy adults with plaque-induced gingivitis. For subjects with severe gingivitis, it is advisable to first use natural MW (P) and then MW based on CHX 0.09% with natural components (CX), compared to MW with CHX 0.12% (C). For adults with moderate gingivitis, P and CX can be advisable, even if no definitive recommendations can be drawn. Trial Registration: ACTRN12622000215729, 07/02/2022. [ABSTRACT FROM AUTHOR]

School communities are not immune to the alarming increase in opioid-related deaths occurring in the United States during the past decade. The purpose of this article is to share how a middle school in New York State, beginning in the late fall of 2022, successfully implemented a program to reduce the likelihood of opioid overdose deaths in their building through expansion of the accessibility of and education and training in use of naloxone, an opioid antagonist. The program is applicable for all K-12 campuses and follows the Model of Greater Awareness, Improved Training, and Increased Availability of and Accessibility to Intervention Devices, based on the steps successfully used for out-of-hospital cardiac arrest emergencies. Because opioid addiction does not discriminate, it is confidently projected that these targeted actions will proactively and positively reduce the likelihood of opioid overdose deaths in our school setting, including for students, faculty, staff, administrators, and visitors, when and should they occur. [ABSTRACT FROM AUTHOR]

Background: Over the counter (OTC) drugs are the drugs that are legally allowed to be sold 'Over the counter', i.e., without the prescription of a registered medical practitioner. Self-medication represents a global healthcare epidemic. Objectives: To assess the usage of OTC medication among study subjects. To determine the factors associated with use of OTC medication. Materials and Methods: A cross-sectional study was conducted among adults of urban field practice area attached to department of community medicine, Mamata Academy of Medical Sciences, Hyderabad during the months of July and August 2022. Adults aged 18 years and above, who were willing to participate were interviewed. Simple random technique was used for sampling. Data was entered in Microsoft excel and analysed in SPSS version 20. Results: It was found that there was significant increase in the use of OTC drugs from the COVID-19 pandemic as compared to before. Major source of OTC drugs was found to be Medical shops. Most common symptoms for which self medication was taken were fever and body pains. The most common reason for opting OTC was mentioned as convenience. Statistically significant association was found between Social class and OTC drug usage (p value 0.001, X2=11.456, OR=7.4) and also between education status of the OTC drug users and checking expiry date and reading label (p value 0.000). Conclusion: OTC drugs usage among the study subjects was increased from the COVID-19 pandemic as compared to before and risky behaviour was found in around half of the subjects. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to provide a comprehensive overview of self-medication practices among students by conducting a bibliometric analysis of the available scientific literature. This research highlights the importance of promoting safe and responsible healthcare behaviors among students. Methods: A systematic search was conducted in the Scopus database to retrieve all peer-reviewed English articles and reviews published from 1968 onwards. The retrieved documents were analyzed to identify publication trends, citation counts, top journals, geographical distribution, and emerging research themes. Results: The findings indicate a significant increase in published literature about student self-medication over the past fifteen years. However, it was observed that the citation count for these documents was lower than expected, suggesting a need for increased attention toward this critical topic. The analysis also identified several hot topics in student self-medication, including the misuse of over-the-counter medications, dietary supplements, and psychoactive substances. The inappropriate use of antibiotics and the self-medication of mental health issues, such as anxiety and depression, were also identified as significant problems. Conclusions and recommendations: Self-medication among students is a complex and critical issue that requires immediate attention. This study highlights the urgent need for greater awareness and education regarding responsible self-medication practices among students. New policies, interventions, and strategies should be developed to address malpractices, misconceptions, and harmful practices related to self-medication. Educational institutions and health authorities should play a crucial role in providing students with mental health resources and support services. Collaborative efforts among healthcare providers, universities, and policymakers are required to consider this issue as public health priority, establish counseling centers, organize stress management and mental health workshops and develop comprehensive programs to control risks associated with student self-medication. [ABSTRACT FROM AUTHOR]

Background: Preclinical and clinical studies suggest a promising potential of cannabidiol (CBD) for the treatment of substance use disorders (SUD). We therefore aimed to assess the prevalence, patterns, and self-perceived benefits of non-prescription CBD use among SUD patients. Methods: A sample of 469 SUD patients treated as inpatients was included to this study. Information on CBD use was assessed by a standardized questionnaire. The sociodemographic and clinical data were extracted from the electronic medical database. Results: About one-third of the SUD patients reported that they had used CBD at least once, but only about 9% of them were using CBD on a regular basis for more than a year. More than 40% of those patients using CBD for more than a year reported that CBD helped them to relax and to sleep better, and more than 30% of them reported that it helped them to reduce pain and to feel less anxious. Conclusions: Regular use of CBD does not seem to be a common phenomenon among SUD patients, presumably due to its lack of psychotropic effects. However, the results provide a weak indication of selfperceived beneficial effects of long-term CBD use regarding agitation, sleep disorders, anxiety, and pain. [ABSTRACT FROM AUTHOR]

Objective: To determine the clinical profile of patients presenting with medication-related emergencies to the Emergency Department of our institute. Methods: This was an observational study conducted between November 2018 and September 2020 at Bangalore Baptist Hospital, Karnataka. A total of 138 subjects who satisfied the inclusion criteria were included in the study. The severity of adverse drug reactions (ADR) is assessed based on the Hurwitz severity assessment scale of ADR. Glasgow coma scale at the time of presentation and source of medication were noted. The type of drug overdose, requirement of advanced airway and vasopressors, and the outcome were also assessed. Results: Among medication-related emergencies (n=138) in our study, ADR contributed to 70.3% (n=97) of the study population, and drug overdose accounted for 29.7% (n=41). One-third of the ADR occurred in patients aged above 60 years. Most patients were hemodynamically stable and did not require vasopressors, or advanced airway in both groups. Most patients had Glasgow coma scale ranging from 13-15 in both groups. Nonsteroidal antiinflammatory drugs were the most used medicine (17/41, 41.5%) and most medications were over the counter drugs (25/41, 61.0%) in the drug overdose group; meanwhile in the ADR group, anti-diabetic medication was the most used medicine (34/97, 35.1%) and most medications were prescribed in the ADR group (93/97, 95.9%). Conclusions: Our study shows that ADR is the most common type of medication-related emergency. [ABSTRACT FROM AUTHOR]

This article discusses a case report of a 19-year-old Japanese female who experienced prolonged toxic encephalopathy with electroencephalogram (EEG) abnormalities following an overdose of dextromethorphan (DXM), a widely used cough suppressant. The patient ingested a high dosage of DXM in a suicide attempt, along with other over-the-counter medications. She had a history of intermittent DXM abuse, which resulted in mood elevation and hallucinations. The patient exhibited symptoms such as coma, dilated pupils, tachycardia, and hyperthermia. Her consciousness gradually improved after transfer to the psychiatric unit, and she was discharged without any apparent sequelae. The article highlights the potential psychiatric and neurological outcomes of recreational DXM abuse and emphasizes the need for clinicians to remain vigilant. [Extracted from the article]

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 recommend minor modifications.

Background: Caregivers often have difficulty administering pediatric medications which frequently results in increased dosing error risk. Objective: We examined health literacy characteristics of pediatric over-the-counter (OTC) oral suspension acetaminophen and ibuprofen instructional materials and dosing instruments. Methods: We conducted a descriptive analysis of dosing instructions, measuring syringe characteristics, and internet-based resources among a sample of OTC pediatric oral suspension acetaminophen and ibuprofen products (n = 14). Results: All products included Drug Facts Panels, employed consistent abbreviation use, and stated measuring dosage with syringe provided. However, oral syringe dosing increment markings did not match box or bottle dosing charts. Most products had supplemental English-language internet-based content resources available. Conclusions: While OTC pediatric oral suspension acetaminophen and ibuprofen products labeling included key drug fact elements, there were inconsistencies between medication dosing chart labeling guidelines and oral syringe dosing increments/markings. It is vital that oral dosing syringes are clearly marked to match product dosing chart labeling s as a means of potentially reducing caregiver dosing errors.