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Background Self-medication is a common practice worldwide. During COVID-19 pandemic, the constant fear of going outside and to use health services may have had an impact in the number of visits to Community Pharmacies. This research aimed to study self-medication habits of the Portuguese population during the current pandemic, more specifically, to understand which non-prescription drugs and food supplements were taken and the situations that conduced to the use of self-medication. Methods An online structured survey was conducted, with data obtained anonymously and included 170 participants (≥18 years). Data were processed using SPSS v26. Results Participants in this study were mainly female (81.2%), with a mean age of 38.01 ± 1.16 years old and most (84.7%) over 12 years of schooling. Answers allowed to verify that the current pandemic didn’t affect that much the frequency of visits to Pharmacy and the situations where people used self-medication were mainly minor, such as headaches (54.1%) and muscle pains (26.5%). The medications used more often were analgesics (60.0%) and anti-inflammatory (40.0%). However, many people indicated that they didńt seek for more information about medicines (49.4%) and/or supplements (7.6%) used during this period. In general, people visited the Pharmacy with a similar frequency and purpose as the previous year. Conclusions Despite all the changes, the current pandemic has not negatively affected the practice of self-medication. The role of Pharmacy professionals in the rational use of the drugs, particularly those used in self medicated situations is essential, especially when the population shows low health literacy regarding the use of medicines.

Summary What is known and objective Important risk factors and over‐the‐counter (OTC) dispensing of non‐steroidal anti‐inflammatory drugs (NSAIDs) are often not routinely recorded in electronic health records. This study aimed to assess the impact of patient's reports on these factors on the risk of acute myocardial infarction (AMI) for NSAID use. Methods A nested case‐control study was conducted among adults in the Utrecht Cardiovascular Pharmacogenetics study. Cases were patients with a first diagnosis of AMI as a hospital discharge diagnosis and controls were those without AMI. NSAID exposure was either current use of selective COX‐2 inhibitors or conventional NSAIDs. Information was collected from The Dutch PHARMO Database Network (pharmacy records of drug dispensing linked to hospitalization records) and the patient's questionnaire (lifestyle factors, body mass index and history of cardiovascular diseases). Unconditional logistic regression analysis was used to calculate odds ratios (ORs) and to control for confounding factors. Results We identified 970 AMI cases and 2974 controls. Among cases, 11 (1.1%) and 185 (19.1%) were exposed to selective COX‐2 inhibitors and conventional NSAIDs, respectively. Compared to non‐use, none of these drug classes were associated with an increased risk of AMI (adjusted OR 1.07, 95% CI: 0.52‐2.18 and 0.93, 95% CI: 0.77‐1.12, respectively). Additional adjustment for potential confounders from patient's reports did not change the risk estimates (adjusted OR 1.08, 95% CI: 0.53‐2.22 and 0.89, 95% CI: 0.73‐1.09, respectively). What is new and conclusion Additional confounding control for variables from self‐reported data or considering self‐reported OTC NSAID use did not change the risk estimates for the association between NSAIDs and AMI.

Introduction Acute coronary syndrome (ACS) is one of the leading causes of morbidity and mortality worldwide. Secondary cardiovascular risk reduction therapy (consisting of an aspirin, a β-blocker, an ACE inhibitor or an angiotensin II receptor blocker and a statin) is needed for all patients with ACS. Less than 80% of patients with ACS in Qatar use this combination after discharge. This study is aimed to evaluate the effectiveness of clinical pharmacist-delivered intervention at discharge and tailored follow-up postdischarge on decreasing hospital readmissions, emergency department (ED) visits and mortality among patients with ACS. Methods and analysis A prospective, randomised controlled trial will be conducted at the Heart Hospital in Qatar. Patients are eligible for enrolment if they are at least 18 years of age and are discharged from any non-surgical cardiology service with ACS. Participants will be randomised into 1 of 3 arms: (1) ‘control’ arm which includes patients discharged during weekends or after hours; (2) ‘clinical pharmacist delivered usual care at discharge’ arm which includes patients receiving the usual care at discharge by clinical pharmacists; and (3) ‘clinical pharmacist-delivered structured intervention at discharge and tailored follow-up postdischarge’ arm which includes patients receiving intensive structured discharge interventions in addition to 2 follow-up sessions by intervention clinical pharmacists. Outcomes will be measured by blinded research assistants at 3, 6 and 12 months after discharge and will include: all-cause hospitalisations and cardiac-related hospital readmissions (primary outcome), all-cause mortality including cardiac-related mortality, ED visits including cardiac-related ED visits, adherence to medications and treatment burden. Percentage of readmissions between the 3 arms will be compared on intent-to-treat basis using χ2 test with Bonferroni's adjusted pairwise comparisons if needed. Ethics and dissemination The study was ethically approved by the Qatar University and the Hamad Medical Corporation Institutional Review Boards. The results shall be disseminated in international conferences and peer-reviewed publications. Trials registration number [NCT02648243][1]; pre-results. [1]: https://clinicaltrials.gov/ct2/show/NCT02648243

Aims: Electronic prescribing systems may improve medication safety, but only when used appropriately. The effects of task analysis-based training on clinical, learning and behavioural outcomes were evaluated in the outpatient setting, compared with the usual educational approach. Methods: This was a multicentre, cluster randomized trial [EDUCATional intervention for IT-mediated MEDication management (MEDUCATE trial)], with physicians as the unit of analysis. It took place in the outpatient clinics of two academic hospitals. Participants comprised specialists and residents (specialty trainees, in the UK) and their patients. Training took the form of a small-group session and an e-learning. The primary outcome was the proportion of medication discrepancies per physician, measured as discrepancies between medications registered by physicians in the electronic prescribing system and those reported by patients. Clinical consequences were estimated by the proportion of patients per physician with at least one missed drug–drug interaction with the potential for causing adverse drug events. A questionnaire assessed physicians' knowledge and skills. Results: Among 124 participating physicians, primary outcome data for 115 (93%) were available. A total of 1094 patients were included. A mean of 48% of registered medications per physician were discrepant with the medications that their patients reported in both groups (P = 0.14). Due to registration omissions, a mean of 4% of patients per physician had one or more missed drug–drug interactions with the potential to cause a clinically relevant adverse drug event in the intervention group, and 7% in controls (P = 0.11). The percentages of correct answers on the knowledge and skills test were higher in the intervention group (57%) compared with controls (51%; P = 0.01). Conclusion: The training equipped outpatient physicians with the knowledge and skills for appropriate use of electronic prescribing systems, but had no effect on medication discrepancies.

Since last year influenza pandemic has struck again after 40 years, this is the right moment to discuss the different available formulation options for influenza vaccine. Looking back to the last 4 decades, most vaccines are still formulated as liquid solution. These vaccines have shown a poor stability profile and are limited in their potential route of administration. An ideal solution to these problems can be to convert vaccines into a dry and stable powder formulation. Recently, drying and delivery technologies have shown promising results regarding the vaccine stability. Therefore, in future we can envisage a stable dry influenza vaccine. Also with regard to the route of administration developments are accelerating and the potential of non-invasive administration has been demonstrated. © 2010 Landes Bioscience.

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:27:26Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:37:07Z : No. of bitstreams: 1 2-s2.0-84871208600.pdf: 528812 bytes, checksum: 6f68b8a601b5f231ec221b3d041814ae (MD5) Made available in DSpace on 2014-05-27T11:27:26Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-12-21 O presente artigo apresenta uma análise da qualidade das propagandas de medicamentos isentos de prescrição destinadas à classe médica, baseado na nova RDC no96, de 17 de dezembro de 2008. Para análise coletou-se 16 fascículos da Revista Brasileira de Medicina (RBM) a partir de agosto 2009 a dezembro de 2010. Para averiguação da qualidade, elaborou-se um questionário dividido em três partes. Ao todo 160 peças publicitárias foram encontradas, em que 27 delas eram referentes aos medicamentos isentos de prescrição, contemplando nove indústrias farmacêuticas. Observou-se que nenhuma das peças publicitárias cumpriu na íntegra as novas regras exigidas na legislação vigente (RDC 96/08), apresentando infrações desde identificação da mesma até as proibições de figuras humanas e mensagens subjetivas. Portanto, concluiu-se que: há necessidade de implantação de um instrumento mais efetivo de fiscalização, a fim de melhorar à qualidade das propagandas para poderem ser usadas como fonte fidedigna de informação e atualização aos prescritores. This article presents an analysis of the quality of advertisements for over-the-counter (OTC) drugs addressed to the medical profession, based on the new Anvisa resolution RDC 96 (17/12/2008). For this analysis, 16 volumes of the Brazilian Journal of Medicine (RBM) were collected, from August 2009 to December 2010. To investigate the quality of the adverts, we prepared a questionnaire divided into three parts. In total, 160 advertisements were found, of which 27 were related to drugs exempt from prescription, from 9 laboratories. It was observed that none of the advertisements complied fully with the new rules, as required by legislation (RDC 96/08), with violations ranging from identification of the advert to prohibitions of human figures and subjective messages. Therefore, it was concluded that there is a need to implement more effective monitoring, so as to improve the quality of the adverts, so they can be used as a reliable source of information and update by prescribers. Universidade de Marília UNIMAR, Rua Lauzane, 823, ap.64 bl.B - Interlagos, São Paulo/SP - CEP.04782-010 Universidade Estadual Paulista Júlio de Mesquita Filho, Araraquara - SP Universidade Estadual Paulista Júlio de Mesquita Filho, Araraquara - SP

As Reações Adversas a Medicamentos (RAM) podem ser responsáveis por 2,4% a 11,5% das admissões hospitalares. O estudo objetivou conhecer o perfil demográfico dos pacientes internados por possíveis RAM, identificar os medicamentos e as queixas mais freqüentemente relacionadas e estimar a incidência de admissão hospitalar pelo uso de medicamentos. Durante um mês, os pacientes internados em um hospital geral foram entrevistados quanto ao uso de medicamentos antes da internação e as queixas que o levaram ao hospital; as informações foram analisadas, usando-se a base de dados MICROMEDEX® e outras bases oficiais. Observou-se que as admissões por uso de medicamentos ocorreram predominantemente em idosos [47,5% (66/139)] e mulheres [62% (87/139)]. Os medicamentos mais freqüentes foram: omeprazol (16), analgésicos (31), antihipertensivos (31), sinvastatina (7) e formoterol (6); e normalmente os sintomas associados foram do sistema digestório (20,5%), circulatório (20,2%), respiratório (18,2%) e SNC (13,9%). Estima-se que em 15,5% (139/897) das internações, possivelmente, a razão foi o uso de medicamentos. Os dados sugerem medidas de prevenção, como o acompanhamento farmacoterapêutico dos pacientes no âmbito da assistência primária à saúde, principalmente aos idosos, aos portadores de doenças crônicas e aos polimedicados, além da orientação farmacêutica na compra e dispensação de medicamentos, principalmente os isentos de prescrição.According to the Word Health Organization, adverse drug reactions (ADR) are any harmful and non intentional answer which occurred in doses normally used in human beings. The ADR can be responsible for 2.4% to 11.5% of hospital admissions. Therefore, this study aimed at knowing the admitted patient´s demographic profile due to possible ADR, identifying the most frequent drugs and complaints, and evaluating the incidence of hospital admission related to drug use. Patients who were 18 years old or more and were admitted during a period of one month to a medical clinical of a general hospital were interviewed for one month about drug use before being admitted, as well as regarding to the complaint which led them to hospital. These information were analyzed according to official data, like MICROMEDEX® and WHO criteria as well. It was observed that the admission due to drug use occurred in most part of the cases in elderly [47.5% (66/139)] and women [62% (87/139)]. The most frequent drugs used were: omeprazole (16), analgesics (31), antihypertensive (31), simvastatin (7) and formoterol fumarate (6), and the symptoms were normally associated to the digestive (20.5%), circulatory (20.2%), respiratory (18.2%) and central nervous systems (13.9%). It was estimated that 15.5% (139/897) of the hospital admission occurred possibly due to the drug use. The data found by present study suggests some strategies in order to prevent ADR in the context of primary health care services, such as monitoring drug therapy, manly for patients with chronic diseases, elderly and polimedicated people; and pharmaceutical care including dispensation and purchasing of the drugs, a lot of them dispensed over the counter (OTC).

BACKGROUND AND OBJECTIVE: Little is known about how experience with a previous acute myocardial infarction (AMI) impacts individuals' reactions to symptoms of a recurrent episode. Thus, the purpose of this study was to compare the use of coping strategies during an acute cardiac event in patients experiencing a first AMI with those experiencing a recurrent AMI. SUBJECTS AND METHODS: Secondary data analyses were performed to examine differences in the use of coping strategies between individuals with and without a history of AMI. Mann-Whitney U test was performed to compare those with (n = 26) and without (n = 109) a previous AMI with respect to 15 coping strategies, each of which was measured on a 5-point Likert scale. RESULTS AND CONCLUSIONS: Patients with a history of AMI were more likely to use prescribed medications to deal with their symptoms than were patients who did not have a previous AMI (M = 1.5 and 0.20; median = 2.0 and 0.0, respectively; P < .001). However, patients who had no previous AMI were more likely to respond by taking nonprescription medications (M = 0.90 and 0.60; median = 1.0 and 0.0, respectively; P = .04). The results suggest that patients with and without a history of AMI tend to respond to their symptoms with similar coping strategies. When differences occurred, patients with and without a history of AMI differed only with respect to the type of self-medication choices they made. Implications pertaining to these findings are discussed. © 2007 Lippincott Williams & Wilkins, Inc.

Inappropriate polypharmacy, especially in older people, imposes a substantial burden of adverse drug events, ill health, disability, hospitalization, and even death. The single most important predictor of inappropriate prescribing and risk of adverse drug events in older patients is the number of prescribed drugs. Deprescribing is the process of tapering or stopping drugs, aimed at minimizing polypharmacy and improving patient outcomes. Evidence of efficacy for deprescribing is emerging from randomized trials and observational studies. A deprescribing protocol is proposed comprising 5 steps: (1) ascertain all drugs the patient is currently taking and the reasons for each one; (2) consider overall risk of drug-induced harm in individual patients in determining the required intensity of deprescribing intervention; (3) assess each drug in regard to its current or future benefit potential compared with current or future harm or burden potential; (4) prioritize drugs for discontinuation that have the lowest benefit-harm ratio and lowest likelihood of adverse withdrawal reactions or disease rebound syndromes; and (5) implement a discontinuation regimen and monitor patients closely for improvement in outcomes or onset of adverse effects. Whereas patient and prescriber barriers to deprescribing exist, resources and strategies are available that facilitate deliberate yet judicious deprescribing and deserve wider application. Refereed/Peer-reviewed

Studies have demonstrated that co-payments on medication reduce the consumption of both non-essential and essential drugs, and that the latter can lead to worse health outcomes. Far less is known about how patients cope with the cost of medication, particularly if affordability is an issue, and how this compares across two countries with different prescription charge policies. Therefore, the aim of this article is to explore empirically how, and to what extent, costs incurred by patients influence their decision-making behaviour in accessing medicines.Based on the findings from focus groups, a questionnaire was designed that addressed medication cost issues relevant to patients in both the UK and Italy. Using an econometric model, several hypotheses are tested regarding patients' decision-making behaviour and how it is influenced by health status, sociodemographic characteristics and the novel concept of a self-rated affordability measure.Quite a large percentage of patients (70.3% in the UK and 66.5% in Italy) stated they have to think about the cost of medicines at least sometimes. Respondents adopted numerous cost-reducing strategies, subdivided into (i) those initiated by patients and (ii) those involving self-medication. Their use was strongly influenced by income and drug affordability problems, but the self-rated affordability measure was a stronger predictor. Commonly used strategies were not to get prescribed drugs dispensed at all, prioritizing by not getting all prescribed items dispensed or delaying until the respondent got paid. Furthermore, respondents with affordability issues were also cost-conscious when self-medicating with over-the-counter (OTC) products for minor conditions such as dyspepsia. Despite patients in both countries using cost-reducing strategies, their use was more pronounced in the UK, where the prescription charge was significantly higher than in Italy.The results from this study provide detail on the kinds of strategies patients use to reduce the cost burden of prescription charges, and support previous research showing they may be foregoing essential medication. Because the same questionnaire was applied in two European countries, where the national health systems aim to provide healthcare services that are accessible to all citizens in need, it offers interesting insights for policy makers in other countries, where patients may have to pay a larger share of their drugs out-of-pocket, such as the US.