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Background: Coping strategies used in response to stress have the potential to influence the development of mental health disorders, including alcohol use disorders. The current study investigated whether coping strategies placed an individual at greater likelihood for developing a future alcohol use disorder., Methods: This study used data from the Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey; a nationally representative 16-year follow-up survey, with initial data collected in the 2002 Canadian Community Health Survey - Canadian Forces Supplement. The total sample from the two datasets included 2941 individuals who were Regular Force members in 2002. Coping styles included problem-focused, avoidant, and self-medication. Adjusted logistic regression analyses examined relationships between coping style (in 2002) and alcohol use disorders (developed between 2002 and 2018)., Results: Self-medication coping in 2002 was associated with any alcohol disorder since last interview (i.e., 2002-2018) (AOR 1.26; 95 % CI, 1.02-1.57) and during the past year (adjusted odds ratios [AOR 1.26; 95 % CI, 1.08-1.47]), as well as past-year binge drinking (AOR 1.19; 95 % CI, 1.09-1.29). Problem-focused coping was protective against past-year alcohol abuse (AOR 0.84; 95 % CI, 0.71-1.00) and any alcohol use disorder (AOR 0.87; 95 % CI 0.76-1.00)., Conclusion: Coping styles were strongly associated with future alcohol use disorders. Notably, results show the risk extended over a 16-year period. Findings suggest the use of self-medicating coping strategies places an individual at increased risk of developing alcohol use disorders, while problem-focused coping may decrease future risk of alcohol use disorders., Competing Interests: Declaration of Competing Interest The authors have no competing interests to declare., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Self-medication was remarkably popular during the COVID-19 pandemic. In older populations, the risk of self-medication is higher. Pharmacists are well positioned to provide public health education and disease prevention. This study aims to explore the self-medication patterns and intention to seek pharmacist guidance among older adults in Macao., Methods: A face-to-face cross-sectional survey was subsequently performed in March-April 2023 among older adults in Macao. The questionnaire was designed based on the Theory of Planned Behavior (TPB) framework. Multiple logistic regression was used to analyze predictors of self-medication behavior and multiple linear regression analysis to determine whether the TPB construct was the predictor of older adults' intention to seek guidance from pharmacists., Results: A total of 412 participants completed the questionnaire. The self-medication rate among older adults in Macao was 64.2%. The most commonly used types of medications were over-the-counter and traditional Chinese medicine, mainly from government anti-pandemic packages. The majority of individuals engaged in self-medication to treat COVID-19 symptoms or prevent COVID-19 infection. The prevalent reasons for self-medication were the perceived non-seriousness of the illness. 85 years old or older and university degree were significantly associated with self-medication behavior. Older adults had moderate intention to seek pharmacist guidance on medication use. The average scores (standard deviation) were 3.43 (1.10) for Attitude, 2.69 (0.99) for Subjective Norm, 3.56 (1.04) for Perceived Behavioral Control, and 3.07 (1.43) for Intention. Attitude, Subjective Norm, and Perceived Behavioral Control were all strong predictors of intention, which explained 53% of the variance in intention. In demographic factors, age was identified as a significant predictor of intentions., Conclusions: Self-medication was widely practiced in Macao during the COVID-19 pandemic. To better control the risks associated with self-medication, the role of pharmacists is paramount. Enhancing the recognition and trust of pharmacists within society, modifying pharmacy management models, and strengthening pharmacists' self-perception of their profession are all pivotal directions areas to further enhance their role., (© 2024. The Author(s).)

Objectives: to analyze the validity evidence of the internal structure of the Risk Self-Medication Questionnaire Focused on Health Literacy., Methods: a psychometric study with 499 adults. The internal structure was assessed with exploratory and confirmatory factor analysis to prove the adjustment. Internal consistency was measured by composite reliability and McDonald's omega coefficient (ω)., Results: the parameters revealed a model of 35 items distributed across four factors, explaining 56% of the total variance, with factor loadings ranging from 0.31 to 0.85 and adequate communalities. Accuracy (0.79

The continual social and economic impact of infectious diseases on nations has maintained sustained attention on their control and treatment, of which self-medication has been one of the means employed by some individuals. Self-medication complicates the attempt of their control and treatment as it conflicts with some of the measures implemented by health authorities. Added to these complications is the stigmatization of individuals with some diseases in some jurisdictions. This study investigates the co-infection of COVID-19 and malaria and its related deaths and further highlights how self-medication and stigmatization add to the complexities of the fight against these two diseases using Nigeria as a study case. Using a mathematical model on COVID-19 and malaria co-infection, we address the question: to what degree does the impact of the interaction between COVID-19 and malaria amplify infections and deaths induced by both diseases via self-medication and stigmatization? We demonstrate that COVID-19 related self-medication due to misdiagnoses contributes substantially to the prevalence of disease. The control reproduction numbers for these diseases and quantification of model parameters uncertainties and sensitivities are presented., Competing Interests: Declaration of competing interest The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of their respective institutions. The authors declare no conflict of interest. Ethics and consent: All authors have been personally and actively involved in substantial work leading to the paper, and will take public responsibility for its content., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background and Objectives: The investigation of the psychosomatic symptoms in women residing in developing countries is still emerging. To be precise, the prevalence and correlates of severe fibromyalgia, depression, anxiety, and insomnia are understudied in Arab women, as these symptoms could relate to improper self-medication. This study mainly investigated the association between self-medication with analgesics and fibromyalgia, depression, anxiety, and insomnia symptoms among a community-based cohort of females in Jordan. Materials and Methods: We used a web-based cross-sectional study design. Fibromyalgia, depression, anxiety, and insomnia were assessed using validated scales. The used over-the-counter (OTC) painkillers were recorded. Results: Data were analyzed from 741 women, and fibromyalgia was screened in 16.4%, depression in 37.4%, anxiety in 27.8%, and insomnia in 38.3%. Fibromyalgia was associated with "married" (OR = 1.5, 95% CI = 1.017-2.305), "using OTC acetaminophen" (OR = 1.75, 95% CI = 1.15-2.69), "using herbal remedies" (OR = 2.02, 95% CI = 1.33-3.07), and "using antiseizure medications" (OR = 2.43, 95% CI = 1.38-4.28). Severe depression was significantly associated with "age" (OR = 0.97, 95% CI = 0.96-0.99), "high school education" (OR = 1.90, 95% CI = 1.21-2.98), "smoking" (OR = 1.72, 95% CI = 1.15-2.56), "OTC acetaminophen" (OR = 1.40, 95% CI = 1.02-1.92), "OTC non-steroidal anti-inflammatory drugs" (OR = 1.75, 95% CI = 1.15-2.65), and "antiseizures" (OR = 2.19, 95% CI = 1.30-3.70). Severe anxiety was significantly associated with "smoking" (OR = 2.08, 95% CI = 1.40-3.12), "OTC acetaminophen" (OR = 1.48, 95% CI = 1.06-2.06), and "antiseizure medications" (OR = 2.04, 95% CI = 1.22-3.41). Severe insomnia was significantly associated with "age" (OR = 0.98, 95% CI = 0.96-0.99), "high school education" (OR = 1.58, 95% CI = 1.01-2.47), "smoking" (OR = 1.51, 95% CI = 1.01-2.25), "OTC non-steroidal anti-inflammatory drugs" (OR = 1.74, 95% CI = 1.13-2.64), "antiseizure medications" (OR = 1.84, 95% CI = 1.09-3.11), and "No analgesics" (OR = 0.48, 95% CI = 0.32-0.71). Conclusions: Self-medication with analgesics is associated with a high burden of psychosomatic symptoms in Arab women, and awareness campaigns are required to guide self-medication behavior.

Aim: Based on a large cohort of dual diagnosis patients, the aim of this study was to quantify the patient-perceived problems and advantages of their substance use and relate the quantity of problems to the substance type and psychiatric diagnosis., Material: Data comes from a naturalistic cohort admitted to an in-patient facility in Denmark specialized in integrated dual diagnosis treatment. We included 1076 patients at their first admission to the facility from 2010 to 2017. Participants completed 607 DrugCheck and 130 DUDIT-E questionnaires., Method: we analyzed the questionnaires and included admission diagnosis by use of t -test and ANOVA to depict the patterns in substance use in relation to psychiatric diagnosis., Results: The three most common substance related problems according to the DrugCheck questionnaire were: feeling depressed, financial problems, and losing interest in daily activities. From DUDIT-E, the highest-ranking negative substance related effects were financial ruin, deterioration of health, and problems at work. Effects on social life relationships were also evident with more than 40% of participants. The top three positive substance related effects reported were relaxation, improved sleep, and control over negative emotions. The number of problems listed varied significantly with the type of preferred substance. Patients using pain medication, sedatives, central stimulants, and alcohol reported most problems. Diagnosis did not differentiate the problems experienced. Results partially support the broad self-medication hypothesis for patients with severe mental illness, but also points out that patients are well aware of negative effects.

The nucleus accumbens shell (NAcSh) and its afferent and efferent neuronal projections control key aspects of motivation for cocaine. A recently described regulator of γ-aminobutyric acid (GABA) projections from the dorsal raphe nucleus (DRN) to the NAcSh (DRN → NAcSh) is the neuropeptide neuromedin U (NMU). Here, we find that systemic administration of NMU decreases breakpoint for cocaine on a progressive ratio schedule of reinforcement in male rats. Employing a retrograde adeno-associated virus (AAV), we found that RNAi-mediated knockdown of the NMU receptor 2 (NMUR2) in afferent DRN projections to the NAcSh increases the breakpoint for cocaine. Our previous studies demonstrated that NMU regulates GABA release in the NAcSh, and our current investigation found that systemic NMU administration suppresses cocaine-evoked GABA release in the NAcSh and increases phosphorylated c-Fos expression in neurons projecting from the NAcSh to the ventral pallidum (VP). To further probe the impact of NMU/NMUR2 on neuroanatomical pathways regulating motivation for cocaine, we employed multi-viral transsynaptic studies. Using a combination of rabies virus and retrograde AAV helper virus, we mapped the impact of NMU across three distinct brain regions simultaneously and found a direct connection of GABAergic DRN neurons to the NAcSh → VP pathway. Together, these data reveal that NMU/NMUR2 modulates a direct connection within the GABAergic DRN → NAcSh → VP circuit that diminishes breakpoints for cocaine. These findings importantly advance our understanding of the neurochemical underpinnings of pathway-specific regulation of neurocircuitry that may regulate cocaine self-administration, providing a unique therapeutic perspective., (© 2021. The Author(s), under exclusive licence to American College of Neuropsychopharmacology.)

Objective: This study sought to explore whether individuals who self-medicate with alcohol experience higher levels of depression, and whether symptom level experiences are affected by the behavior of self-medication., Design: Data were from the Wave I (2001-2002) National Epidemiologic Survey on Alcohol and Related Conditions - NESARC. Only participants who answered affirmatively to either one or both of the two stem questions that highlight the key symptoms of depression were included (n = 13,753)., Results: A one-factor model of depression was supported. Experiences of suicidality were more likely to be endorsed by people who self-medicated, compared to those with low mood who do not use alcohol in this way. Typically, more common experiences of depression in the form of appetite difficulties were less likely to be reported by those who self-medicated, compared to those who do not., Conclusions: The findings aid understanding of the drinking patterns and other mental health correlates of those who engage in the behavior of self-medication. Findings indicate that those who self-medicate are at a higher risk for suicidality, given the same level of depression. These findings highlight the importance of identifying these potentially problematic health behaviors as early as possible, due to these risks., (Copyright © 2022 Elsevier Inc. All rights reserved.)

This study examines the mediating role of work-to-family conflict and family-to-work conflict between the Big Five personality traits and mental health thereby enhancing theoretical development based upon empirical evidence. Integrating Conservation of Resources theory with the self-medication hypothesis, we conducted a mega-meta analytic path analysis examining the relationships among employees' Big Five traits, work-to-family conflict and family-to-work conflict, anxiety and depression, and substance use. We produced a ten-by-ten synthetic correlation matrix from existing meta-analytic bivariate relationships to test our sequential mediation model. Results from our path analysis model showed that agreeableness and conscientiousness predicted substance use via mediated paths through both work-to-family conflict and family-to-work conflict and sequentially through depression as well as through family-to-work conflict followed by anxiety. Extroversion and openness-to-experience had relatively weaker influences on substance use through work-to-family conflict, anxiety, and depression. Neuroticism was the strongest driver of the two forms of conflict, the two mental health conditions, and substance use. From this model it can be inferred that work-to-family conflict and family-to-work conflict may be generative mechanisms by which the impact of personality is transmitted to mental health outcomes and then to substance use when analyzed via a Conservation of Resources theory lens., Competing Interests: The authors have declared that no competing interests exist.

Introduction: The misconception and misuse of antibiotics among the public has been widely outlined to be one of the main reasons for bacterial resistance. The aim of the present study was to assess the practices, level of knowledge and attitudes regarding the rational and self-medication use of antibiotics in the general public in different districts of Baghdad province, Iraq., Methodology: A descriptive, cross-sectional study conducted among 384 participants through an interview using a structured 3-parts questionnaire, consisting of 24 items assessing the demographic characteristics, practices, level of knowledge and attitude towards rational antibiotics use., Results: 45.8% of the study participants reported self-medication of antibiotics without prescription. Flu/common cold and sore throat represented the majority of medical conditions for antibiotics intake without prescription (44.9%, 31.3%) respectively. Oral amoxicillin (34.1%) was the most common non-prescription antibiotic. 50.3% had education about the rational use of antibiotics. 41.4% reported intake of antibiotics after having medical advice, 44% suggested their antibiotics not to be used by other members, and 52.9% stated the importance of antibiotic education among the public. However, 57% of the respondents had negative attitudes regarding antibiotics use for sore throat/fever, the effectiveness of antibiotics for cold/flu (54.7%) and cough (49.2%), to keep antibiotics for future use (40.9%) and not completing the antibiotic course after feeling well (49.2%)., Conclusions: A widespread use of antibiotics without prescription was reported, providing some crucial gaps and a lower level of practice, knowledge and attitudes regarding the use of antibiotics among a sample of the Iraqi population., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2021 Anmar Al-Taie, Ali N Hussein, Zahraa Albasry.)

Background: The incidence of application of medicinal herbs during pregnancy has increased significantly among women over the past years; however, the safety and efficacy of medicinal herbs during pregnancy are still unclear. The aim of the present study was to categorize the predictors of self-medication with herbal remedies during pregnancy based on the theory of planned behavior (TPB)., Methods: The present descriptive-analytical study was conducted on 300 pregnant women referred to Kashan health center to receive prenatal care services in 2020. The study participants were randomly selected using stratified random sampling with proportional allocation. The data collection tool was a two-part researcher made questionnaire. The first part of the questionnaire included demographic information, midwifery information, and questions related to women's awareness about herbal medicine. The second part of the questionnaire was designed based on the theory of planned behavior including attitudes, perceived behavioral control, subjective norms, intention, and behavior performance. Data were analyzed using descriptive statistics, regression analysis, and SPSS version 18.0., Results: The mean age of participants was 28. 7±5.4 years (range, 15-45 years), the majority were housewives (88.3%) and had secondary education (39.3%). A total of 164 women (57. 1%) used medicinal herbs during pregnancy. The individual's attitude towards herbal medicines consumption, subjective norm, and perceived behavioral control was correlated with behavioral intention (P < 0.05). Similarly, subjective norms were the most predictor of using herbal medicine among pregnant women (P < 0.05)., Conclusion: The findings revealed that more than 50 % of pregnant women used medicinal herbs during pregnancy. The present study showed that the individual's attitude towards herbal medicines consumption, subjective norm, and perceived behavioral control was correlated with intention of herbal medicine use among pregnant women. Likewise, subjective norms were the most predictor of herbal medicine use among pregnant women. The TPB should be addressed in planning health education programs and modifying health behaviors, including self-medication, especially during pregnancy., (© 2021. The Author(s).)

Background: Pain and substance use are frequently comorbid and have been shown to exert bidirectional effects. Self-medication of pain and distress via substance use is common and can be understood via negative reinforcement, ultimately strengthening the pathway between pain to substance use over time. As such, a testable model of the potentially modifiable candidate mechanisms that underlie the pain to substance use pathway is needed., Purpose: This review proposes a testable model of pain as an antecedent to substance use to guide future research and inform clinical practice., Methods: An integrative review of current evidence regarding pain, substance use, and associated risk factors (i.e., negative affect, pain-related attitudes, negative urgency, and substance use outcome expectancies) was conducted., Results: The Catastrophizing, Anxiety, Negative Urgency, and Expectancy (CANUE) model highlights modifiable risk factors for self-medicating pain with substance use, including increased negative affect and maladaptive pain-related attitudes (i.e., pain catastrophizing, pain anxiety, and fear of pain), negative urgency, and substance-related outcome expectancies for pain relief and enhanced pain coping., Conclusions: Targeted behavioral and psychological interventions that address these factors may facilitate more adaptive pain-coping responses, thereby reducing the impacts of pain on substance use. Systematic research is needed to evaluate the validity and clinical utility of this model., (© Society of Behavioral Medicine 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Self-medication can facilitate patients' access to medicinal products, save time, and reduce financial and health-care service use burden. On the other hand, irresponsible use of self-medications can result in adverse consequences. Self-medication is common among different demographic groups including pregnant women. In general, medicinal products might have harmful effects on mothers and baby. This study aimed to assess self-medication practices among pregnant women in the northern region of Jordan. A cross-sectional study was conducted on pregnant women attending outpatient clinics in the northern region of Jordan. Self-medication practices among the target population were assessed using a survey questionnaire that was administered through interviewer-assisted mode. Data were collected between December 2019 and September 2020, and descriptive statistics and inferential analysis were applied. A total of 1,313 pregnant women were surveyed (response rate = 95.50%). Self-medication and the use of herbal remedies were practiced by 33.10% and 32.14% of the participant, respectively. Headaches and general pains were the most frequently reported conditions treated by self-medication practice with either conventional medicinal products or herbal remedies. The gravidity (≥4) and the gestational stage (≥28 weeks) were the predictors of self-medication practice. This study showed that self-medication was not widely practiced by pregnant women in the northern region of Jordan. Disease simplicity and previous history were the main motives for self-medicating. Efforts should be made by health-care providers to address pregnant women and educate them to increase their awareness about the unsafe use of medicines and the harmful effects on fetus., (© 2021 The Authors. Pharmacology Research & Perspectives published by John Wiley & Sons Ltd, British Pharmacological Society and American Society for Pharmacology and Experimental Therapeutics.)

Despite being a priority population in malaria elimination, there is scant literature on malaria-related behavior among gold miners. This study explores the prevalence and factors influencing malaria prevention, care seeking and treatment behaviors in Guyana gold mining camps. A cross sectional survey was conducted among adult gold miners living in mining camps in the hinterland Regions 1 (Barima-Waini), 7 (Cuyuni-Mazaruni), and 8 (Potaro-Siparuni). Multivariable logistic regressions explored factors associated with miners' self-report of mosquito net use, prompt care-seeking; self-medication; and testing for malaria. A third of miners used a mosquito net the night preceding the survey and net use was higher among those who believed that net use was the norm in their camp (aOR: 3.11; 95% CI:1.65, 5.88). Less than half (45%) of miners had a fever in the past 12 months, among whom 36% sought care promptly, 48% tested positive for malaria while 54% self-medicated before seeking care. Prompt care-seeking was higher among miners with high malaria knowledge (aOR: 1.44; 95% CI: 1.01, 2.05). Similarly, testing rates increased with secondary education (aOR: 1.71; 95% CI: (1.16, 2.51), high malaria knowledge (aOR: 1.45; 95% CI: 1.02, 2.05), positive beliefs regarding malaria transmission, threat, self-diagnosis, testing and treatment, and, trust in government services (aOR: 1.59; 95% CI (1.12, 2.27) and experience of a prior malaria episode (aOR: 2.62; 95% CI: 1.71, 4.00). Self-medication was lower among male miners (aOR: 0. 52; 95% CI: 0.32, 0.86). Malaria prevention and care seeking behaviors among miners are somewhat low and influenced by mosquito net usage, perceived norms, malaria knowledge and prior episode of confirmed malaria. Study findings have implications for malaria interventions in the hinterland regions of Guyana such as the mass and continuous distribution of insecticide treated nets as well as community case management initiatives using trained malaria testing and treatment volunteers to curb malaria transmission among remote gold mining populations. These include efforts to identify and address gaps in distributing mosquito nets to miners and address miners' barriers to prompt care seeking, malaria testing and treatment adherence. Targeted social and behavior change messaging is needed on net acquisition, use and care, prompt care-seeking, malaria testing and treatment adherence. Additional efforts to ensure the overall sustainability of the community case management initiative include increased publicity of the community case management initiative among miners, use of incentives to promote retention rates among the community case management volunteer testers and public private partnerships between the Guyana Ministry of Health and relevant mining organizations., Competing Interests: The authors have declared that no competing interests exist.

Objectives: This study has been aimed at evaluating knowledge, attitudes and behaviour of university students regarding the usage of antibiotics focusing on differences between medical and nonmedical students., Methods: This cross-sectional questionnaire-based study was performed on 800 students of the University of Novi Sad, Serbia., Results: The identified predictors of adequate antibiotic knowledge were enrolled in medical program, higher grade average and appropriate use of antibiotics during last infection. Multivariate regression identified following predictors of self-medication: being medical student (B = 0.715; p < 0.001), more frequent (B = 0.628; p < 0.001) and irregular (B = 0.584; p = 0.001) antibiotic use, a family member engaged in medical profession (B = 0.789; p < 0.001), living in dormitory (B = 0.679; p = 0.007) or rented apartment (B = 0.621; p = 0.002), using antibiotics until symptoms resolved (B = 1.616; p < 0.001) or until the bottle was finished (B = 0.628; p < 0.001) during the last infection., Conclusions: Although a high number of students showed adequate knowledge about antibiotics, numerous misconceptions were recorded, including self-medication. Further educational interventions are necessary to improve their understanding, perceptions as well as their behaviour towards antibiotic use.

Background and Aims: Interventions to improve adherence to medication may be more effective if tailored to the individual, addressing adherence-related beliefs about treatment and overcoming practical barriers to daily use. We evaluated whether an algorithm, tailoring support to address perceptual and practical barriers to adherence, reduced barriers and was acceptable to patients with inflammatory bowel disease [IBD]., Methods: Participants with IBD, prescribed azathioprine and/or mesalazine, were recruited via patient groups, social media, and hospital clinics and allocated to Intervention or Control Groups. The online intervention comprised messages tailored to address beliefs about IBD and maintenance treatment and to provide advice on overcoming practical difficulties with taking regular medication. The content was personalised to address specific perceptual and practical barriers identified by a pre-screening tool. Validated questionnaires assessed barriers to adherence and related secondary outcomes at baseline and at 1 and 3 months of follow-up., Results: A total of 329 participants were allocated to the Intervention [n = 153] and Control [n = 176] Groups; just under half [46.2%] completed follow-up. At 1 and 3 months, the Intervention Group had significantly fewer concerns about IBD medication [p ≤0.01]; and at three months, fewer doubts about treatment necessity, fewer reported practical barriers, and higher reported adherence [p <0.05]. Relative to controls at follow-up, the Intervention Group were more satisfied with information about IBD medicines, and viewed pharmaceuticals in general more positively. Questionnaires, interviews, and intervention usage indicated that the intervention was acceptable., Conclusions: Personalised adherence support using a digital algorithm can help patients overcome perceptual barriers [doubts about treatment necessity and medication concerns] and practical barriers to adherence., (© The Author(s) 2020. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) commonly co-occur and are associated with many negative public health outcomes. There are several etiological models that explain the overlap between PTSD and AUD, including shared genetic risk and phenotypic causality, but the predominant model of etiologic association is the drinking-to-cope self-medication model. Although the self-medication model is conceptually appealing and has been widely accepted within the literature examining alcohol use and anxiety (e.g., PTSD) phenotypes, the findings are inconsistent and there is a lack of rigorous empirical evidence in support of this model. This review, which was, to our knowledge, the first systematic review of the self-medication model in relation to PTSD to date, aimed to synthesize the current literature on the association between PTSD and problematic alcohol use within the context of the self-medication model. In total, 24 studies met the inclusion criteria for the review and assessed the self-medication hypothesis using a variety of measurement instruments and data analytic approaches, such as mediation, moderation, and regression. Overall, the included studies provide evidence for the self-medication hypothesis but are limited in rigor due to methodological limitations. These limitations, which include issues with the operationalization (or lack thereof) of trauma-related drinking to cope, are discussed, and directions for future research are presented., (© 2020 International Society for Traumatic Stress Studies.)

Background: Self-medication with antibiotics (SMA) is one of the most dangerous inappropriate antibiotic use behaviors. This study aims to investigate the impact of parental SMA for children before a consultation on their doctor's subsequent antibiotic prescribing behavior, including intravenous (IV) antibiotic use in the clinical setting of China., Methods: A cross-sectional survey was conducted between June 2017 and April 2018 in three provinces of China. A total of 9526 parents with children aged 0-13 years were investigated. Data from 1275 parents who had self-medicated their children and then visited a doctor in the past month were extracted and analyzed., Results: One-third (410) of the studied children had parental SMA before the consultation and 83.9% of them were subsequently prescribed antibiotics by doctors. Children with parental SMA were more likely to be prescribed antibiotics (aOR = 7.79, 95% CI [5.74-10.58]), including IV antibiotics (aOR = 3.05, 95% CI [2.27-4.11]), and both oral and IV antibiotics (aOR = 3.42, 95% CI [2.42-4.84]), than children without parental SMA. Parents with SMA behaviors were more likely to request antibiotics (aOR = 4.05, 95% CI [2.59-6.31]) including IV antibiotics (aOR = 2.58, 95% CI [1.40-4.76]), and be fulfilled by doctors (aOR = 3.22, 95% CI [1.20-8.63])., Conclusions: Tailored health education for parents is required in both community and clinical settings to discourage parental SMA for children. The doctors should not prescribe unnecessary antibiotics to reinforce parents' SMA behaviors. We recommend expanding the current IV antibiotics ban in outpatient settings of China to cover outpatient pediatrics.

Background: Self-medication by older adults has been always a public health concern. The present study aimed to modify the psychological constructs of Health Belief Model (HBM) in relation to self-medication behaviors using Freire's Adult Education Model (FAEM) among older adults in Khorramabad, Iran, from 2017 to 2018., Methods: The mean age of the older adults was 66.28 ± 7.18 years. This was a randomized controlled trial study conducted on 132 individuals older than 60 who were referred from different health care centers. The participants were selected using multistage sampling method and randomly divided into two groups of intervention and control. The data collection instruments included a questionnaire which was designed based on both HBM and self-medication behaviors questionnaire. The phase of adult education model (AEM) was used to modify the psychological constructs of HBM and self-medication behaviors. Data were analyzed using SPSS software version 20 with a significant level of 0.05. Descriptive statistical tests, chi-squared test, paired t-test, independent t-test, and univariate modeling were employed for the purpose of analyzing data., Results: There was no significant difference between groups in terms of self-medication. Unawareness of the effects of medicine were the most important reason for self-medication (p = 0.50). The two groups were not significantly different in terms of knowledge, HBM constructs, and self-medication behaviors (p > 0.05). However, they came up to be considerably different for the above variables after the intervention was implemented (p <  0.05). When the findings were adjusted for the effects of confounding variables, there were significant differences between the two groups in almost all constructs of HBM and their behaviors (p <  0.05). However, the perceived barrier modality of HBM did not reach to a significant level of difference between two groups., Conclusion: The educational intervention, which was based on Freire's AEM, had positive effects on the constructs of HBM and consequently on self-medication behaviors. The psychological constructs of HBM were affected at the phases of listening to problems. Self-medication was tempered at the action-reflection phase with shared creation and evaluation of the action plan geared toward the achievement of the behavioral objectives. The results might be of importance to healthcare professionals involved in care of older patients., Trial Registration: Current Controlled Trials IRCT2013091814512N2. Registered on January 2 - prospectively registered, the trial was registered in the Iranian Clinical Trials Registry http://www.irct.ir .

Introduction: Patients with substance use disorder may be particularly vulnerable to withdrawal-related complications during the SARS-CoV-2 (COVID-19) pandemic. Limited availability of alcohol and other substances coupled with decreased accessibility to substance use treatment poses a substantial risk to this population. Isopropanol, the active ingredient in rubbing alcohol, is widely available; thus, it may be used in times of scarcity., Case Report: We present a case of intentional isopropanol ingestion used as an ethanol surrogate within the setting of the COVID-19 pandemic., Conclusions: Toxic alcohol ingestions are imperative considerations on the differential for the intoxicated patient particularly during resource-limited times.

Background: It is unknown whether cannabis users self-medicating their inflammatory bowel disease (IBD) symptoms are more likely to have comorbid mental health or personality risk factors associated with an increased potential for substance misuse compared with recreational cannabis users., Methods: We surveyed individuals with IBD about their cannabis use, their mental health symptoms, and personality risk factors associated with substance misuse. We compared risk factors for substance misuse between individuals using cannabis to manage IBD symptoms and those using cannabis recreationally., Results: Of 201 persons with IBD who completed the questionnaire, 108 reported lifetime cannabis use. Of those, a larger proportion of Crohn's disease patients used cannabis to manage IBD symptoms (53% [34/64] vs 28% [12/43]; P = 0.010). Individuals self-medicating with cannabis were more likely to use cannabis for coping reasons (P = 0.016) and demonstrated higher levels of impulsivity (P = 0.004) and depressive symptoms (P = 0.012) when compared with individuals using cannabis recreationally. Logistic regression revealed that cannabis was 4.1 times (P = 0.05) and 3.7 times (P = 0.05) more likely to be used for IBD symptoms by smokers and individuals with moderate-severe depressive symptoms, respectively. Individuals high in impulsivity were 4.1 times more likely to use cannabis for their IBD symptoms than those low in impulsivity (P = 0.005)., Conclusions: Persons with IBD self-medicating with cannabis have characteristics associated with increased vulnerability to substance misuse when compared with those using cannabis recreationally. Screening for mental health comorbidities and vulnerability to substance misuse should be undertaken if cannabis is to be used to treat IBD symptoms., (© 2019 Crohn’s & Colitis Foundation. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Inappropriate antibiotic use is an important driver of antibiotic resistance. This study sought to explore inappropriate antibiotic use and confusing antibiotics with other medicines in Ghana using ethnomethodology research approach., Methods: This was an explorative study involving 15 in-depth interviews among health professionals and private dispensers and eight focus group discussions among 55 community members. Qualitative data were coded using Nvivo 12, thematically analysed and presented as narratives with quotes to support the findings., Results: Self-medication was common and antibiotics were used to treat specific diseases but respondents were not aware these were 'antibiotics'. Various antibiotics were used for indications that in principle do not require systemic antibiotics, like stomach ache and sores on the body. Antibiotics, in particular tetracycline and metronidazole, were poured into "akpeteshie" (local gin) to treat hernia and perceived stomach sores (stomach ulcer). These practices were copied/learnt from various sources like over-the-counter medicine sellers, family, friends, radio/television, drug peddlers, pharmacies and doctors. Medicines in capsules were referred to as 'topaye' or 'abombelt' in Twi (local dialect) and perceived to treat pain associated with diseases. Antibiotics in capsules were described with colours which appeared confusing as some capsules with different drugs in them have similar colours., Conclusion: Inappropriate antibiotic use were influenced by general lack of knowledge on antibiotics and identification of antibiotics by colours of capsules which leads to confusion and could lead to inappropriate antibiotic use. There is the need for public health education on appropriate antibiotic use and standardization of appearance of antibiotics and other drugs to optimize use.

Background: Pain is one of the symptoms for which any man is willing not only to go to the doctor but also to resort to any means, including self-medication, to "get rid" of it. Self-medication is not only a current practice but also a public health problem, under the circumstances that it can influence the way in which a disease is diagnosed and/or treated in a timely manner, and, consequently, repercussions may occur on the cost of treatment, in the case of severe forms. Pain is a vital symptom, and the diminution until the disappearance of pain is a fundamental right of each individual; the analysis of ethical issues in the case of self-administration of analgesic medication has not been a major concern., Areas of Uncertainty: Understanding the problem is important to realize whether self-medicating for pain is a necessity or an abuse, and in this respect, we review scientific articles from international databases: PubMed and ProQuest., Data Sources: The study is based on the consultation of scientific articles from international databases-PubMed and ProQuest, the main keywords in the search being pain and self-medication, to which a stigma or public health is sequentially added., Results: Pain is becoming more and more a global problem and the extent of its spread can substantiate our assertion about pathology with pandemic impact. Under the pressure of patient associations, of the media, and of nonmedical authorities, the opinion about the need for a stoic approach to pain has long become an outdated theory, and chronic pain, beyond a multidimensional approach, is increasingly considered not only a useless element but also even a destructive one., Conclusions: Pain and self-medication must be addressed, including in medical practice, starting from their multidimensionality from the following perspectives: medicobiological, sociocultural, instructive-educational, legal-political, and especially ethical. They are not only individual health problems but also become, when connected with a stigma, a public health problem.

Background and objectives: Self-medication is a global phenomenon in both developed and emerging countries. At present, data regarding the practice, patterns, and factors associated with self-medication in Romanian patient groups of various ages and health are relatively scarce. A pilot study that uses a questionnaire was conducted to observe the attitudes as well as the behaviors of a group of Romanian parents related to self-medication, specifically their beliefs and perceived risks of the administration of medicine to their children without medical advice, frequency of self-medications, symptoms, and types of medications most commonly used without medical advice. Materials and Methods: The questionnaire was sent via e-mail or WhatsApp link on a mobile phone using the existing data at the general practitioner's office together with the protection of data form and the informed consent form; some participants completed the questionnaire when they came for a regular visit at the general practitioner's office. Of 246 applied questionnaires, we had a rate of responses of 98%. Results: We found a high percentage (70%) of parents who self-medicate their children. The data reveals a significant relation between parents' beliefs on self-medication and their tendency to administrate drugs to their children without medical advice. A significant relation was also found between the likelihood of parental self-medication for their children and the number of illnesses experienced by their children over the six-month period prior to the survey. Even when parents have a correct understanding of self-medication risks, these are not aligned with actual behavior; therefore, parents continue to administer drugs to their children without medical advice. Conclusions: Our study helps to describe the patterns of parents' decisions about self-medicating their children and to identify parents who are more predisposed to administering self-medication to their children.

Background: Self-prescribing practices are considered as a significant issue in the health sector due to mal-practices. This has become a more worsen issue in developing countries with easy access to medication. Current study was undertaken to estimate the prevalence of self-medication and to evaluate the driving factors behind this behavior, among university students of Sri Lanka., Method: A total of 700 randomly selected undergraduates of three state universities in Sri Lanka, were recruited as the study population for the cross-sectional study. Information on socio-demographic, Knowledge, Attitudes and Practices relevant to Self-Medication (SM) were gathered using an interviewer administered questionnaire. Binary logistic regression was used to calculate the Odds Ratios (OR) and the 95% confidence intervals of the OR for socio-demographic risk factors on SM., Results: Around 78% of the studied population denoted a SM behaviour. Only, 37.7% of respondents were familiar with the classification of "Over the Counter" (OTC) drugs, while majority were well aware of the risks of SM (> 50%). Fever (61.3%) and cough (56.7%) were the major health issues for SM, while antipyretics and drugs for cough and runny nose (73.6%) were the mostly used medication. Previous experience (76%) and trivial nature of health issues (73%) were recognized as the major reasons for SM. Majority of respondents declared that community pharmacies (86.9%) and left over medication from previous prescriptions (51%) were the sources for SM. Based on the binary logistic regression, age, residence locality, field of study and academic year were recognized as significant risk factors (P < 0.05) for SM within the studied undergraduate population., Conclusion: Based on the high prevalence rate of SM, the health authorities of Sri Lanka should pay more attention towards the wellbeing and responsible medication usage of undergraduates. Designing of effective tools and regulations to monitor the selling of medication and improving the health education are recommended to ensure responsible SM within the country.

Multiple etiological models have been proposed to explain posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) comorbidity, but the predominant model to date is the "drinking to cope" self-medication model. Despite its popularity, the self-medication model lacks rigorous empirical support related to inconsistencies and methodological limitations, particularly the failure to operationalize drinking to cope with trauma symptoms specifically. The present study sought to measure trauma-related drinking to cope (TRD) in order to provide a more specific test of the self-medication model among a representative sample of 1,896 undergraduates with a history of trauma exposure and alcohol use. Using a model-building approach in M plus , a correlated multiple mediator model tested the association between PTSD symptoms and alcohol use problems (AUPs) through TRD and more generalized drinking to cope motives (as assessed by the coping subscale of the Drinking Motives Questionnaire; DMQ-Cope) as moderated by sex. Results indicated that, while accounting for the effects of generalized drinking to cope motives, TRD partially mediated the relation between PTSD symptoms and AUPs and that this relationship was stronger for males than for females. With the exception of moderation by sex, results were substantiated using longitudinal data. Findings were consistent with the self-medication model, suggesting that TRD motives may serve as a mechanism through which PTSD symptoms influence AUPs. TRD may serve as a more specific screening tool for AUP risk among individuals endorsing PTSD symptoms compared with the commonly used DMQ-Cope. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Objectives: To determine the factors motivating the consumers towards self-medication, the intended indications and the consumers' perceptions about complications that may arise due to its use., Design: Cross-sectional community based prospective study., Place and Duration of Study: Community pharmacies located at various locations of Hail, Saudi Arabia from January 2019 to March 2019., Methods: The subjects of this cross-sectional study were people visiting community pharmacies for self-medication. Data on 663 participants was collected through a validated questionnaire prepared on the basis of WHO guidelines for the regulatory assessment of medicinal products for use in self-medication. Two trained data collectors visited the randomly selected community pharmacies, approached and interviewed the consumers purchasing medicines without prescriptions. Data was entered in SPSS and analyzed using descriptive and inferential analyses (alpha level = 0.05)., Results: Out of 663 respondents, 68.6% were university graduates; and 33.9% were healthcare professionals. Consumers preferred self-medication mainly for headache (85.8%), cold and sore throat (80.8%), cough (75.7%) and fever (71.8%) with the justification that these illnesses were minor (90.2%), time saving (82.2%), convenient (74.7%), quicker relief (66.1%), and economical (61.2%). Occupation was significantly associated with the reasons for preferring self-medication (p<0.001). Similarly, age, gender and education were also significantly associated with most of the reasons for opting self-medication. People were quite aware about harmful consequences of self-medication. Multivariate logistic regression analysis showed that the respondents with lower education (AOR = 2.404 [95% CI: 1.579-3.661]), non-healthcare professionals (AOR = 1.712 [95% CI: 1.143-2.565]) and higher monthly income (AOR = 0.376 [95% CI: 0.236-0.599]) preferred self-medication (p <0.001, p = 0.009, p <0.001) respectively., Conclusion: Self-medication was prevalent among young university graduate males for minor ailments mainly due to convenience and time saving. Despite people beliefs about the harmful consequences of self-medication, its use was omnipresent particularly among the respondents with lower education, non-healthcare professionals and people with higher monthly income., Competing Interests: The authors have declared that no competing interests exist.

Background: Illicit, medically unsupervised use of buprenorphine (i.e., "diverted use") among vulnerable and underserved populations, such as corrections-involved adults, remains underexplored., Methods: Survey data (2016-2017) collected as part of a clinical assessment of incarcerated adults entering corrections-based substance use treatment in Kentucky were analyzed. For years examined, 12,915 completed the survey. Removing cases for participants who did not reside in Kentucky for >6 months during the one-year pre-incarceration period (n = 908) resulted in a final sample size of 12,007., Results: Over a quarter of the sample reported past-year diverted buprenorphine use prior to incarceration and 21.8 % reported use during the 30-days prior to incarceration, using 6.5 months and 14.3 days on average, respectively. A greater proportion of participants who reported diverted buprenorphine use had previously been engaged with some substance use treatment (77.0 %) and reported greater perceived need for treatment (79.4 %) compared to those who did not report use. Use was more likely among participants who were younger, white, male, and who reported rural or Appalachian residence. Diverted buprenorphine users also evidenced extensive polydrug use and presented with greater substance use disorder severity. Non-medical prescription opioid, heroin, and diverted methadone use were associated with increased odds of diverted buprenorphine use while kratom was not. Diverted methadone use was associated with a 252.9 % increased likelihood of diverted buprenorphine use., Conclusions: Diverted buprenorphine use among participants in this sample was associated with concerning high-risk behaviors and may indicate barriers to accessing opioid agonist therapies for corrections-involved Kentucky residents, particularly those in rural Appalachia., Competing Interests: Declaration of Competing Interest Nothing declared., (Copyright © 2020 Elsevier B.V. All rights reserved.)

For many, binge drinking behaviors start early and become a persistent pattern of use throughout the lifespan. In an effort to strengthen understanding of etiology, this study considered the mechanisms from the self-medication hypothesis and family socialization theory. The goal was to identify whether emotional distress is a potential shared mechanism that accounts for the development of binge drinking in different developmental periods. This study used the National Longitudinal Study of Adolescent to Adult Health (Add Health) dataset to examine binge drinking across time for n = 9,421 participants ranging in age from 11 to 18 (M = 15.39, SD = 1.62) at Wave I and ranging from 24 to 32 (M = 28.09, SD = 1.61) at Wave IV of the study. Using an autoregressive cross-lagged model, I examined how parent-child closeness, depressive symptoms, and binge drinking were related over three developmental periods. In examining cross-sectional and longitudinal relations, depressive symptoms were significantly related to binge drinking more often than parent-child closeness; however, results indicated the self-medication model may primarily account for concurrent drinking behaviors rather than long-term. The family socialization theory was indicated to account for some variability above and beyond the self-medication hypothesis. No indirect association between binge drinking and the parent-child relationship was detected through depressive symptoms, failing to support a shared mechanism between the two theories. The results provide support for a multifaceted assessment process for substance using clients, and support the use of Multisystemic Family Therapy, Multidimensional Family Therapy, and perhaps Attachment-Based Family Therapy., (© 2018 Family Process Institute.)

Background : Consuming alcohol for coping with negative affect (NA) or enhancing positive affect (PA) may lead to risky drinking patterns. Previous research has yielded mixed findings regarding these affective drinking associations. Objectives : To examine support for the self-medication and expectancy models of alcohol use in an adult community sample, by examining reciprocal associations between alcohol consumption and NA and PA within and between persons. Methods : During seven consecutive days, 162 adults from the community (109 female) reported their affective experiences and alcohol consumption, following a signal contingent ecological momentary assessment protocol on their smartphones. Results : Within-person daily NA preceding the first drinking event was associated with increased likelihood of same-day alcohol consumption. Within-person momentary NA was associated with a decrease in the amount of next-moment alcohol consumption. Within-person momentary PA was positively associated with likelihood of next-moment alcohol consumption. Between persons, levels of daily and momentary NA and PA were not associated with any index of alcohol consumption. The intercepts and slopes of NA were not significantly different before and after alcohol consumption. The intercept of PA was higher after alcohol consumption, whereas the slope of PA decreased after alcohol consumption. Conclusion : In the current sample affective drinking was a within-person process (i.e. persons were sensitive to their varying levels of affect). Some support was found for the self-medication and expectancy models. People may drink for coping with NA, but may also be at risk for developing affective drinking patterns in response to PA.

Objectives: to analyze the practice of self-medication and the associated factors in the riverside population of the Middle Solimões river region - Amazon rainforest., Methods: a cross-sectional population-based study conducted between April and July 2015, through interviews at home., Results: the prevalence of self-medication among the riverside population was 76.3%. Analgesics and antibacterials were the main therapeutic classes used in self-medication. Self-medication proved to be associated with the male gender, young people, not having sought the health service in the last month, longer commuting from the community to the urban area and the habit of consuming allopathic medicines on their own., Conclusions: self-medication among the riverside population of Coari - Amazon may reflect the need to seek self-care by people, with the use of allopathic medicines without prescription, mainly due to the restricted access to health services.

Background : Prescription opioid non-medical use (NMU) and its associated consequences have been of concern in the US in recent years. Objective : We examined peer influence and parental guidance, in addition to peer and parental sources of alcohol, on patterns of prescription opioid use, including NMU, among males and females separately. We hypothesized that peer influence and parental guidance would have a differential influence for males and females. Methods : The National Monitoring of Adolescent Prescription Stimulants Study (N-MAPSS) recruited youth 10-18 years from 10 US cities between 2008 and 2011 (n = 11,048). The cross-sectional survey included questions on past 30-day prescription opioid use (10,965 provided responses), with NMU defined as non-oral use and/or use of someone else's opioids. Multinomial logistic regression was conducted, examining medical use only and NMU in the past 30 days. Results : Among the 10,965 youth, 3.1% (n = 345) reported past 30-day NMU. Obtaining alcohol from parents was associated with increased odds of past 30-day NMU among males (OR = 2.49, 95%CI: 1.54,4.03) only. For each additional close friend who used other substances, odds of past 30-day NMU increased among males (OR = 1.23, 95%CI: 1.11,1.37) and females (OR = 1.15, 95%CI: 1.04,1.27). Increased number of close friends was associated with decreased odds of past 30-day NMU among males (OR = 0.87, 95%CI: 0.78,0.97) and females (OR = 0.86, 95%CI: 0.77,0.96). Conclusions : Peer and parental risk factors for prescription opioid NMU were identified among youth, although not all differed by sex. An increased number of close friends was a protective factor against prescription opioid NMU for both males and females.

Introduction: Medical students are more prone to suffer from various physiological and psychological problems but rather than seeking for formal health care, they tend to do informal consultation and often practice self medication. Thus, this study aimed to find out the health seeking behavior of medical students., Methods: This descriptive cross-sectional study was done among first and second year medical students of a teaching hospital from September to November 2019 after taking ethical approval from Institutional Review Committe. Total of 235 students were included in the study and self administered questionnaire was used. Data entry and analysis was done using Statistical Package for Social Sciences version 20.0., Results: Among 235 students who participated in the study, 172 (73%) reported having health problems in the last 12 months, and fever and headache were commonly reported by 21 (13%) and 18 (50%) students, respectively. Total of 112 (65%) students visited hospital/clinic for health problems and reason given for not visiting hospital/clinic was 12 (28%) thinking that the problem was minor. University hospital was the most preferred place 189 (80%) during health problem and parents were the first people for consultation 116 (49%). Mean duration of absenteeism was 2.17±4.1 days and 167 (88%) visited hospital more than five times., Conclusions: Health problems were common among students and most of them required multiple hospital visits. Many students seeked for health from hospital/ clinic but informal consultations were also seen.

Objectives: To investigate leftover antibiotics and their influence on self-medication with antibiotics (SMA) for Chinese children, and further explore the different influences of leftovers from two main sources: previous prescriptions and pharmaceutical purchases., Design: A cross-sectional questionnaire study., Setting: The participants were approached through kindergartens and primary schools as well as in vaccination clinics., Participants: A total of 9526 parents from three Chinese provinces whose children were aged 0-13 years completed the survey., Outcome Measures: The prevalence of keeping antibiotics at home for children and the proportion of leftover antibiotics from two main sources were measured by a self-administrated questionnaire. Logistic regression models were established to examine the association between keeping antibiotics at home and SMA for children, specifically the risks of leftovers from two main sources., Results: Overall, 4580 (48.1%) reported keeping antibiotics at home for children. Among those who had leftovers, 2891 (63.1%) reported that their leftovers came from previous prescriptions and 1619 (35.3%) reported that their leftovers came from pharmaceutical purchases. Mothers, older age of child, higher household income, higher education level and medical background were significantly associated with keeping antibiotics at home. Keeping antibiotics at home was significantly associated with SMA for children (adjusted OR=4.91, 95% CI 3.84 to 6.28). Particularly, compared with parents who did not keep antibiotics at home, parents who kept leftover antibiotics from previous prescriptions and those whose leftovers came from pharmaceutical purchases were 3.80 (95% CI 2.89 to 5.00) and 6.45 (95% CI 4.89 to 8.51) times more likely to engage in SMA for children, respectively., Conclusions: Keeping antibiotics at home for children was pervasive in China. Most leftovers came from previous prescriptions, while those from pharmacies had a higher risk of SMA for children., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Self-medication (SM) is a common and global health problem. The process of attempting SM is still unclear. Exploration of SM and its contributing factors would help policymakers design and develop preventive programs. This qualitative study aimed to explore the process of attempting SM among Iranian people., Methods: This grounded theory (GT) study was conducted among people with the experience of attempting SM (n = 17) and medical staff (n = 9) in Iran selected via semi-structured interviews. The recorded and transcribed interviews were analyzed using open, axial, and selective coding based on Strauss and Corbin's (1998) approach., Results: The study results revealed that people sought to deal as simply and quickly as possible with their illnesses/symptoms according to their attitudes towards and perceptions of illnesses/symptoms as well as their economic and social problems. This simple and quick approach was the participants' main concern, resulting in taking decision-making strategies as SM facilitators. SM, in turn, provided short-term improvement and temporary satisfaction as a predominant outcome. Overall, "to avoid being trapped in the vortex of illness" was the central category, which covered and connected all the other categories developed in this study., Conclusions: The elements of this model could be used as a guide for healthcare policymakers to design preventive programs and to plan for increasing people's knowledge about the complications and consequences of SM. In addition, identification of barriers to referral to physicians and treatment of illnesses through the right way as well as reducing the health system's problems would help reduce SM.

Background: The use of antimicrobials is associated with the emergence of antimicrobial resistance (AMR), and self-medication increases the risk of the inappropriate use of antimicrobials. This study aims to describe the knowledge, attitudes, and practices (KAP) regarding self-medication with antimicrobials among residents in Lilongwe, Malawi., Methodology: This study has a cross-sectional, mixed-methods design. We conducted two focus group discussions (n=15) to describe community attitudes towards self-medication with antimicrobials and used a structured questionnaire to collect data on individual KAP regarding self-medication from 105 respondents., Results: Self-medication was common, and the sources of these medicines were market vendors, pharmacies, drugs shared with friends and family and those leftover from previous treatments. The lack of medical supplies, long distances to health facilities, poor attitudes of medical professionals towards patients, and past experience with the disease and treatment are the main factors that influence self-medication. KAP respondents had little knowledge of antimicrobials, their use, or any awareness of AMR. Seventy-four per cent (n=78) were unable to differentiate antimicrobials from other categories of medicines, and 92.4% wrongly responded that antimicrobials could be used to stop a fever. Concerning attitudes towards self-medication, over 54% wrongly believe that antimicrobials are effective in treating common colds. In regard to practice, 53% reported that they would use antimicrobials to treat upper respiratory infections, and 41% agreed that they must complete antibiotic therapy even if they are improving. Logistic regression analysis found that stocking antimicrobials at home for future use significantly promotes self-medication whereas an awareness of AMR would reduce self-medication., Conclusion: Self-medication is a public health risk that needs to be addressed urgently. Findings from this study point to the need for multifaceted interventions., (© 2019 The College of Medicine and the Medical Association of Malawi.)

Medications and their associated side effects impact systems treated by speech-language pathologists and audiologists, such as speech, language, voice, swallowing, hearing, tinnitus, and balance. However, students in these disciplines receive limited training in pharmacology, while nursing students receive training in pharmacology but limited training in communication disorders. In this interprofessional simulation experience to increase understanding of the impact of medications on communication, swallowing, and balance, audiology, nursing, and speech-language pathology students worked together to interview standardized patients (SPs) about their medications and symptoms in a simulated clinical setting. Goals were for students to understand professional roles, identify high-risk medications with potential communication implications, provide patient education, and evaluate interdisciplinary collaboration. The SPs demonstrated symptoms patients may have as they take high-risk medications. Students (n = 101) completed a knowledge pretest, online training, simulation, debriefing facilitated by faculty experts, and posttest and impressions survey. Results indicated high satisfaction with teamwork and interprofessional interactions. Student knowledge of high-risk medications was improved as a result of this exercise, with nursing and speech-language pathology students demonstrating statistically significant improvements in posttest results. While knowledge deficits of some high-risk medications were evident across student groups, the overall effects demonstrated benefits of the simulation-enhanced interprofessional education experience.

Objectives: There is a dearth of information on transgender individuals in Nepal, particularly studies exploring their use of hormone therapies. The objectives of this study therefore were to explore (1) how hormones are used, (2) types of hormones used and (3) side effects experienced by transgender women after hormone use. This is the first study of its kind in Nepal addressing this important public health issue., Setting: The study was conducted in four districts of Nepal: Kathmandu, Sunsai, Banke and Kaski., Design and Participants: This qualitative study comprises eight focus group discussions (FGDs) and nine interviews. FGDs and three face-to-face interviews were held with transgender women aged 18 years and older and six interviews with stakeholders working with and advocating on behalf of this population. The study was conducted between September 2016 and March 2017., Results: Our participants were young. The majority of FGD participants had completed school-level education and 40% had been using hormones for 1 to 3 years. Five overlapping themes were identified: (1) reasons and motivations for hormone use; (2) accessibility and use of hormones; (3) side effects; (4) utilisation of healthcare services and (5) discontinuation of hormone use., Conclusion: Hormone use was common in our sample. Most received information on hormone therapy online and through their peer networks. A few study participants sought doctors' prescriptions for hormone therapy, but hormones were more likely to be bought from local private pharmacies or abroad through friends. This kind of self-medication is associated with a range of risks to the physical and mental health of transgender individuals. Incorporating information, education and communication about hormone therapy into existing health promotion interventions targeted to this population may help transgender people to make better informed choices., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The aim of the study was to explore the link between peer victimization and substance use and tested the mediating role of internalizing problems in urban African American adolescents in Chicago. Six hundred and thirty-eight adolescents in Chicago's Southside participated in the study. Results from the hierarchical linear regression analysis showed that youth who reported peer victimization were at risk of internalizing problems. Those who were bullied by their peers were more likely to display internalizing problems, which was also significantly associated with substance use. Consistent with the self-medication hypothesis, findings from the study suggest that bullied youth are likely to display internalizing problems and turn to substance use. Implications for mental health practice in school settings are also discussed., (© Copyright 2019 Springer Publishing Company, LLC.)

Background: Self-medication is a public health concern that may create several problems such as increase in drug resistance, raise in drug use per capita, and creating side effects. This study was conducted to determine predictors of self-medication based on the theory of planned behavior (TPB) among the Iranian women., Methods: This was a cross sectional study. A sample of married women completed a validated, anonymous, self-administered questionnaire. The questionnaire included items on demographic variables, knowledge, and TPB structures, and the checklist of women's self-medication practices. The study was conducted in six urban health centers of Shush and Zarandieh in Iran during January to July 2016. Data were analyzed using SPSS 23.0 applying t-test and logistic regression., Results: A total of 360 women took part in the study. The results showed that 76% of women had a history of self-medication and 98.9% stored drugs at home. The most important reasons for self-medication were perceived self-medication harmless (41%), having history of a disease (35.5%), and availability of medications at home (34%). The most frequent diseases for self-medication were fatigue, weakness, and anxiety (24%), and fever (20%). The results obtained form logistic regression analysis indicated that age, place of residence, education level, health insurance status, as well as all constructs of the TPB were significant predictors for self-medication., Conclusion: The findings indicated that the prevalence of self-medication among Iranian women was high. Since women have important role in shaping the family health, the issue of high prevalence among this population should be considered as a serious problem in Iran. In this regard, it is recommended to consider factors affecting self-medication among women to reduce this health threatening factors.

History and Clinical Findings: In this report, a 60-year old patient with a history of mixed nociceptive and neuropathic chronic pain after successful removal of oral squamous cell cancer is described who received outpatient pain treatment in our clinic. Moreover, the patient presented with a history of alcohol abuse as well as anorexia and weight loss., Examinations and Diagnosis: The patient was in reduced general condition and cachectic nutritional status. In addition, he suffered from oral pain that radiated to both ears and a related loss of appetite., Treatment: In the light of progressive cachexia, we started regular medical cannabis (Sativex ® , contains i. e. delta-9-tetrahydrocannabinol and cannabidiol). Despite good initial tolerability, medical cannabis was stopped early due to alcohol relapse of the patient. After termination of medical cannabis, the patient regained control of alcohol consumption and achieved sobriety., Conclusions: We suggest that medical cannabis only be prescribed with particular caution in patients with a history of alcohol abuse., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Approximately 90% of pregnant women use medications while they are pregnant including both over-the-counter (OTC) and prescription medications. Some medications can pose a threat to the pregnant woman and fetus with 10% of all birth defects directly linked to medications taken during pregnancy. Many medications have documented safety for use during pregnancy, but research is limited due to ethical concerns of exposing the fetus to potential risks. Much of the information gleaned about safety in pregnancy is collected from registries, case studies and reports, animal studies, and outcomes management of pregnant women. Common OTC categories of readily accessible medications include antipyretics, analgesics, nonsteroidal anti-inflammatory drugs, nasal topicals, antihistamines, decongestants, expectorants, antacids, antidiarrheal, and topical dermatological medications. We review the safety categories for medications related to pregnancy and provide an overview of OTC medications a pregnant woman may consider for management of common conditions.

Objective: In most resource-poor settings, there is a paucity of data on self-medication and possible factors that influence this practice. The current study assesses self-medication among the people of Akuse, a rural setting in the Eastern Region of Ghana., Methods: A quantitative cross-sectional study was carried out in Akuse from 4 th January 2016 to 27 th February 2016. Using a questionnaire, interviews were conducted to assess self-medication: class of drugs taken, sources of drugs, knowledge of potential adverse effects, among others., Results: Of the 363 participants enrolled, 361 completed questionnaires administered. Of the 361 respondents, 58.4% were female. A majority of the respondents were within the ages of 30 and 45 years. Respondents were mainly farmers (40.2%), and a majority (44.6%) had primary level as the highest education. One major reason for self-medication was influence from family and friends (32.7%). Antibiotics (32.1%) and analgesics (21.0%) were the most common self-medicated drugs, and these drugs were mostly obtained from licenced chemical sellers (32.5%). A little more than a third (39.9%) of the respondents said that their condition did not change after self-medication. A greater number of the respondents (81.7%) did not have knowledge of potential adverse reactions associated with self-medicated drugs. However, respondents with high educational level had the most knowledge of adverse drug reactions., Conclusion: The study found self-medication as a common practice among a number of residents of Akuse. Findings from this study provide data that could be used for targeted education and sensitisation of self-medication and its demerits in similar resource-poor rural settings., Competing Interests: None

Aims: Most research into reasons for smoking among adults with serious mental illness (SMI) has focused on reasons related to SMI symptoms. The current study reports reasons for smoking and barriers to cessation that are both related and unrelated to SMI symptoms among adults with SMI., Methods: Four focus groups were conducted among current smokers receiving outpatient care for a psychotic disorder in 2017 (N = 24). Participants were asked why they currently smoke and their barriers to quitting smoking., Results: Smoking as a coping mechanism and to self-medicate SMI symptoms were reasons for current smoking and barriers to cessation. Avoidance of other unhealthy behaviors, routine, and enjoyment emerged as reasons for smoking and barriers to cessation that were unrelated to mental illness., Conclusion: Consideration of factors that are both related and unrelated to SMI symptoms in smoking cessation interventions and brief cessation counseling may improve cessation success in this population., (© 2019 Wiley Periodicals, Inc.)

Objective: Abstinence outcomes are typically prioritized in the treatment of cocaine use disorder while ignoring patterns of low-frequency cocaine use. This study examined patterns of cocaine use frequency during treatment and evaluated how these patterns related to baseline characteristics and functioning outcomes 6 and 12 months after treatment., Method: We used a pooled dataset (N = 720) from seven randomized clinical trials for cocaine use disorder. The Addiction Severity Index (ASI) was used to assess functioning. Repeated-measures latent class analysis was used to derive patterns of cocaine use., Results: Three patterns were identified: abstinence (10.6%), low-frequency use (approximately 1 day/week; 66.3%), and persistent frequent use (approximately 4 days/week; 23.1%). The low-frequency group was associated with male gender, younger age, and a criminal justice referral. The abstinent group had the highest alcohol problem severity score at baseline. At Month 6, the low-frequency group reported lower problem severity than the persistent frequent use group across multiple ASI areas, including the cocaine use as well as psychological, family, employment, and legal domains. At Month 12, the low-frequency group did not differ from the abstinent group in problem severity on any ASI domain and, relative to the persistent frequent use group, had lower cocaine use and employment problem severity., Conclusions: These findings highlight the importance of adopting a harm reduction approach and recognizing the potential clinical benefits associated with nonabstinent outcomes.