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Purpose: This study examined the prevalence of headache medicine use among Danish adolescents and explores the link between mental health, frequent headaches, and medicine use for headache. We hypothesized that poor mental health increases headache occurrence, leading to greater medicine use. Methods: The 2022 Danish Health Behaviour in School‐aged Children (HBSC) study surveyed 5292 students aged 11, 13, and 15. Self‐reported data included headache frequency, medicine use for headache, and five mental health indicators: life satisfaction, emotional symptoms, loneliness, self‐efficacy, and self‐esteem. Multivariate logistic regression analyses assessed the association between mental health indicators and headache medicine use, adjusting for headache frequency. Results: Weekly headaches were reported by 33.1%, and 43.6% used headache medicine in the past month. Poor mental health correlated with higher headache and medicine use rates. Analyses adjusted for sex, age group, and occupational social class found significantly increased odds ratios (95% confidence interval) for medicine use for headache among students with low life satisfaction (2.27; 1.88–2.75), among students with 2+ emotional symptoms (2.28; 1.92–2.69), students who often felt lonely (2.08; 1.69–2.55), students with low self‐efficacy (1.37; 1.16–1.61) and students with low self‐esteem (1.59; 1.36–1.85). When accounting for headache frequency, the association between poor mental health and medicine use diminished and became nonsignificant. Conclusions: Poor mental health was linked to increased medicine use for headache. The findings suggest that frequent headaches may explain the association between poor mental health and the use of headache medicine. Promoting rational medicine use and enhancing mental health among adolescents is essential. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the association between maternal and paternal licit and illicit drug use, smoking and drinking and autism spectrum disorder (ASD). We conducted a case-control study with children and adolescents diagnosed with ASD and neurotypical individuals. The data were collected using a semi-structured questionnaire administered during interviews with the children’s mothers or guardians. The following variables were analyzed: child sex and age; maternal and parental age; use of medicines before and during pregnancy; classes of medicines used during pregnancy; maternal and paternal smoking; maternal and paternal drinking; maternal and paternal illicit drug use. The data were analyzed using logistic regression and crude and adjusted odds ratios (OR). After adjustment, the results showed an association between maternal use of antipyretics/pain killers during pregnancy (OR = 2.26; 95%CI 1.29-3.95; p < 0.040) and ASD. No association was found between maternal and paternal smoking, drinking and illicit drug use before and during pregnancy and ASD. The findings suggest that the development of ASD is influenced by environmental factors. [ABSTRACT FROM AUTHOR]

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

Self-reported information on medical conditions and medicine use is widely used in epidemiological research. We investigated the validity of self-reported medical conditions and medicine use from Danish participants in the Survey of Health, Ageing and Retirement in Europe. Self-reported health data were linked at individual level with the National Patient Registry and the Danish National Prescription Registry (n = 5572). Agreement was assessed by kappa value and presented as sensitivity, specificity, predictive values, and odds ratios. The agreement of self-reported medical conditions varied by type (κ = 0.23–0.67), lowest for cholesterol-related diseases, highest for diabetes. Self-reported medicine use varied by medication type (κ = 0.33–0.90) lowest for painkillers, highest for diabetes. Women had lower odds for self-reporting medicine use correctly but higher odds for self-reported diseases. Higher age was associated with lower agreement, while higher education with higher agreement. Although Danish data from the Survey of Health, Ageing and Retirement in Europe on medical conditions and medicine vary, the data are valid for epidemiological use for most medicine data, and for diseases associated with hospitalizations or influencing everyday life. Caution is warranted for self-reported data from 70+ year olds and people with lower educational level. • The validity of self-reported medical conditions or medicine use varied by type. • Higher age lowered validity for self-reported diseases and medicine use. • Low educational level lowered validity for self-reported diseases and medicine use. • Medicine intake may be used as proxy for diseases to increase validity. • Self-reported SHARE data are a useful epidemiological tool to investigate health. [ABSTRACT FROM AUTHOR]

Certain medications should be used with caution in older persons, which challenges rational prescribing. Potentially inappropriate medications (PIMs) are defined as medicines whose potential risk of harm typically outweighs the clinical benefits in geriatric population. Earlier studies have found regional differences in PIM use, but the factors underlying this phenomenon are unclear. To compare prescription PIM prevalence among Finnish hospital districts and determine which population characteristics and factors related to social and health care are associated with regional variation. This nationwide register study was based on the Prescription Centre data on all people aged ≥75 years in 2017–2019. Hospital district (n = 20) characteristics were drawn from the Finnish Institute for Health and Welfare's, Finnish Medical Association's, and Finnish Medicines Agency's publicly open data. PIMs were defined according to the Finnish Meds75+ database. A linear mixed-effect model was used to analyze potential associations of regional characteristics with PIM prevalence. Prevalence of PIMs varied between 16.4% and 24.8% across regions. The highest prevalence was observed in the southern regions, while the lowest prevalence was on the west coast. Hospital district characteristics associated with higher PIM prevalence were higher share of population living alone, with excessive polypharmacy, or assessed using the Resident Assessment Instrument, shortage of general practitioners in municipal health centers, and low share of home care personnel. Waiting time in health care or share of population with morbidities were not associated with PIM use. Of the total variance in PIM prevalence, 86% was explained by group-level factors related to hospital districts. The regional variables explained 75% of this hospital-district-level variation. PIM prevalence varied significantly across hospital districts. Findings suggest that higher PIM prevalence may be related to challenges in the continuity of care rather than differences in health care accessibility or share of the population with morbidities. • The prevalence of PIM use varied markedly across Finnish hospital districts. • Factors suggesting poor continuity of care were associated with higher PIM rates. • Living alone and excessive polypharmacy were associated with higher PIM rates. • Majority of the PIM variance was explained by hospital-district-level factors. [ABSTRACT FROM AUTHOR]

The study evaluated the practice of Medication Safety and assesses the knowledge of medication safety practices among hospital pharmacists in a teaching hospital in southeast Nigeria. It was a quantitative study divided broadly into two phases. Phase one involved the collection of the medication error forms filled by pharmacists in the hospital over 3 months; January – March 2021. The second phase was the administration of self-completed questionnaires. The data was collected and analyzed. The medication errors encountered were assessed, classified, and the prevalence determined. Descriptive statistics were used to summarise the data. Overall, 68 medication error forms were collected over the 3-month data collection period. The top category of prescribing error was dose/frequency omitted (24.65%), followed by duration/stop date omitted and dose inappropriate (over), both were 17.81%. The medication safety domain to which pharmacists demonstrated the highest positive response rate (PRR) was Personal Influence Over Safety with 63.33% (SD±20.09), and the domain with the lowest positive response rate was Facilitators and Barriers at the Workplace with 46.25% (SD±25.67). Most of the pharmacists answered yes to having filled out the hospital’s medication error form at least once. 3 of the 4 medication safety domains had above-average positive response rates (PRR). The medication safety domain with the lowest PRR was the facilitators and barriers at the workplace domain with 46.25%. There were no significant differences in associations between pharmacists of different ages, years of experience, and different genders in their attitudes toward medication safety; after applying Pearson’s correlation test.

Background: Cardiovascular disease competes with breast cancer (BC) as the leading cause of death for females diagnosed with breast cancer. Not much is known concerning morbidity and medicine use in the short and long term after a BC diagnosis. Aim: The aim of this study was to determine acute and long-term morbidity in Danish women treated for BC. Method: A nationwide registry-based cohort study of 100,834 BC patients identified in the clinical database of Danish Breast Cancer Cooperative Group (DBCG) and 1,100,320 (10 per patient) age-matched Danish women without BC, serving as controls. Morbidity was studied using complete data on hospital contacts and medicinal use. Results: The risk of hospital contacts was significantly increased in BC survivors compared with controls evaluated both by means of Cox regression and negative binomial regression analysis both during and after cessation of breast cancer treatment. Young age at breast cancer diagnosis was associated with the most pronounced increase in risk of hospital contacts, both during and after cessation of BC treatment. Medicinal use was significantly increased among BC patients compared to controls, both during (HR 1.27 (1.26–1.28), p < 0.0001) and after BC treatment (HR 1.18 (1.17–1.19), p < 0.0001, and present for all subgroups of medicine. Conclusion: Overall, BC survivors have a pronounced increase in hospital contacts and medicinal use compared to women without BC. Premenopausal status at BC diagnosis was associated with an overall higher excess morbidity and a higher burden both during and after treatment. [ABSTRACT FROM AUTHOR]

Aim: The objective of this study was to describe the use of COVID‐19‐related medicines during pregnancy and their evolution between the early/late periods of the pandemic. Methods: Pregnant women who tested positive for SARS‐CoV‐2 from March 2020 to July 2021 were included using the COVI‐PREG registry. Exposure to the following COVID‐19‐related medicines was recorded: antibiotics, antivirals, hydroxychloroquine, corticosteroids, anti‐interleukin‐6 and immunoglobulins. We described the prevalence of medicines used, by trimester of pregnancy, maternal COVID‐19 severity level and early/late period of the pandemic (before and after 1 July 2020). Findings: We included 1964 pregnant patients who tested positive for SARS‐CoV‐2. Overall, 10.4% (205/1964) received at least one COVID‐19‐related medicine including antibiotics (8.6%; 169/1694), corticosteroids (3.2%; 62/1964), antivirals (2.0%; 39/1964), hydroxychloroquine (1.4%; 27/1964) and anti‐interleukin‐6 (0.3%; 5/1964). The use of at least one COVID‐19‐related medicine was 3.1% (12/381) in asymptomatic individuals, 4.2% (52/1233) in outpatients, 19.7% (46/233) in inpatients without oxygen, 72.1% (44/61) in those requiring standard oxygen, 95.7% (22/23) in those requiring high flow oxygen, 96.2% (25/26) in patients who required intubation and 57.1% (4/7) among patients who died. The proportion who received medicines to treat COVID‐19 was higher before than after July 2020 (16.7% vs. 7.7%). Antibiotics, antivirals and hydroxychloroquine had lower rates of use during the late period. Conclusion: Medicine use in pregnancy increased with disease severity. The trend towards increased use of corticosteroids seems to be aligned with changing guidelines. Evidence is still needed regarding the effectiveness and safety of COVID‐19‐related medicines in pregnancy. [ABSTRACT FROM AUTHOR]

Purpose: To study the prevalence of prescribed and over‐the‐counter (OTC) medicine use in children under 12 years of age in Finland and to examine factors associated with the medicine use. Methods: A nationwide population survey was carried out in Finland in spring 2018 with a random sample of children under 12 years (n = 8000). A response rate of 24% (n = 1921) was attained. The questionnaire was sent to the child's primary guardian. Current use of prescribed medicines and the use of OTC medicines in the preceding 2 days were the main outcome measures. Results: Of all the children 19% had used prescribed medicines, 15% OTC medicines, and 31% either prescription or OTC medicines during the preceding 22 days. Children's health related factors were positively associated with prescribed medicine use including fairly good to poor health status, symptoms experienced, and illnesses diagnosed by a physician. The guardian's healthcare education and use of prescribed medicines were also associated with children's prescribed medicine use. Symptoms of illnesses and fairly good health status were found to be associated with childrens' use of OTC medicines. Conclusions: The use of medicines in children under 12 years of age is quite common in Finland. As expected, children's health‐related factors were associated with medicine use. Also, guardians' healthcare education and the use of prescribed medicines were associated with children's prescription medicine use. Children's medicine use should be continuously monitored and investigated further to identify the reasons leading to appropriate and inappropriate medicine use in children. [ABSTRACT FROM AUTHOR]

Ahmad Farid Daanish, Ershad Ahmad Mushkani Department of Pharmacology, Kabul University of Medical Sciences, Kabul, AfghanistanCorrespondence: Ershad Ahmad Mushkani, Department of Pharmacology, Kabul University of Medical Sciences, Kabul, Afghanistan, Tel +93-74460022, Email ershadahmad2605@gmail.comObjective: To compare the prevalence of self-medication among first- and fifth-year medical students at Kabul University of Medical Sciences.Methods: A cross-sectional study was conducted with the participation of all first- and fifth-year medical students by using a short, self-administered questionnaire. The prevalence of self-medication was estimated in the entire study population and also in those who had used medicines in the preceding one week.Results: Of the total 302 students, the prevalence of medicine use was 38%. The prevalence of self-medication in all study population was 25.16%, whereas in those who had used medicines was 64.9%. Prescription-only medicines consisted of 59.2% of self-medication. The practice of self-medication and the use of prescription-only medicines were more prevalent among students in their fifth year and among males. While the prevalence of medicine use was the same among males and females, it differed between students in the fifth and first year. Paracetamol, anti-infectives, and non-steroidal anti-inflammatory drugs (NSAIDs) were more frequently used medicines.Conclusion: The use of medicines, self-medication and the use of prescription-only medicines were more prevalent among fifth-year students compared to those in the first-year. This apparently reflects the effect of medical education and training. More specific studies are required to address the issue in more detail and to facilitate interventions. The estimation of the prevalence of self-medication by using a short acceptable recall period, confined in those who had used medicines, seems to be more reasonable and accurate than by using a longer recall period in the entire study population. The prevalence of prescription-only medicines in self-medication could also be a useful indicator.Keywords: self-medication, medical students, medicine use, prescription-only medicines

Aims: Loneliness is an important public health challenge for all ages. This study reports time trends of loneliness among adolescents over a 12-year period and analyses the strength of the associations between loneliness, health complaints, and medicine use. Methods: Data were derived from the cross-sectional Finnish Health Behaviour in School-aged Children study conducted in 2006, 2010, 2014, and 2018. The study population is based on a random sample of schools with 20,444 participants aged 11–15 years. The trends were analysed with a Mantel–Haenszel test, and the strength of the associations was evaluated by mixed-effects logistic and linear regressions. Results: An increasing prevalence in frequent loneliness (2006: 11%; 2018: 15%) was evident over the 12-year study period, especially in girls and 15-year-olds. Among all adolescents, loneliness was associated with a higher risk of recurrent health complaints and medicine use to treat the corresponding health issues, especially nervousness (odds ratio 5.8) and sleeping difficulties (odds ratio 7.6). Conclusions: Adolescence is a period of higher risk of frequent loneliness and associated health complaints. In this study, loneliness was common among adolescence and an increasing trend of loneliness was observed between 2006 and 2018. Also, psychosomatic health complaints and medicine use were strongly associated with loneliness. Persistent loneliness is a significant health risk and failure to resolve loneliness before entering adulthood may imply significant concerns for future well-being. [ABSTRACT FROM AUTHOR]

As the last step in the care pathway, pharmacies can significantly impact a patient's medication adherence and the success of treatment. The potential impact of patient's pharmacy choice on their medication adherence has yet to be established. This study aims to review the impact a pharmacies ownership model, either independent or chain, has on its users' medication adherence. As a generalisation, independent pharmacies offer a more personal service and chain pharmacies offer medications at lower prices. A keyword search of EMBASE and MEDLINE databases in March 2022 identified 410 studies, of which 5 were deemed to meet our inclusion criteria. The studies mostly took place in North America, measured medication adherence using pharmacy records over a 12-month period. This review was unable to substantiate a difference in the rate of medication adherence between the users of independent and chain pharmacies. However, those with a lower income, greater medication burden, and increased age appeared to use an independent pharmacy more than a chain pharmacy and to have greater medication adherence when doing so. Establishing the differences in service provision between types of pharmacies and why people choose a pharmacy to frequent should be a focus of future research. [ABSTRACT FROM AUTHOR]

Children and adolescents are exposed to medicines and supplements, but only a few studies have evaluated the actual intake in routine care. Thus, we performed a pharmacoepidemiological evaluation of a longitudinal population-based pediatric cohort study (LIFE Child) conducted at the University Hospital of Leipzig between 2014 and 2019. We analyzed all visits of the participants of the LIFE Child cohort between 1 January 2014 and 31 December 2019. Participants were asked to bring their medicines and supplements to their appointments at the study center. If they had not brought the preparations with them, attempts were made to obtain the relevant information during a telephone call after the visit to the study center. Furthermore, the participants and their parents were interviewed on medicine and supplement use and on sociodemographic and socioeconomic data during their visit to the study center. Associations of medicine and supplement use with age, sex, and socioeconomic status were analyzed using multivariate binary logistic regressions to obtain adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Furthermore, the number of the respective visit was included as possible confounder in the multivariate model. We included 3602 participants who visited the study center 11,906 times. The intake of 9759 medicines and supplements was recorded. Based on the evaluation of all study visits, 49% of the children and adolescents took at least one medicine or supplement. Self-medication accounted for 28% of the medicines and supplements. The prevalence of overall intake increased from 45% in 2014 to 53% in 2019 (aOR 2.63, 95% CI 2.23, 3.09). The prevalence was the highest (77%) in children aged 0– < 3 years, owing mainly to vitamin D. The prevalence of medicine use was higher in females (40%; aOR 1.18, 95% CI 1.10, 1.28) than in males (35%), owing mainly to the intake of ibuprofen and hormonal contraceptives in adolescent females. A high socioeconomic status was a predictor of lower medicine (aOR 0.80, 95% CI 0.68, 0.95) and higher supplement (aOR 1.47, 95% CI 1.09, 1.98) use. Conclusion: Half of all children and adolescents took at least one medicine or supplement. The intake varied depending on age and sex. Furthermore, high socioeconomic status was associated with a decreased probability of medicine intake. What is Known: • Half of all children and adolescents in Germany are exposed to medicines and supplements. • Data on the actual intake are scarce as most studies focus on prescribed medicines. What is New: • The prevalence of medicine/supplement use rose from 2014 (45%) to 2019 (53%). The prevalence was age-dependent: it was the highest in children aged < 3 years, and the lowest in children aged 6–< 9 years. Females took medicines more frequently than males. • High socioeconomic status was associated with lower medicine and higher supplement use. Self-medication accounted for 28% of all preparations. [ABSTRACT FROM AUTHOR]

What is known and objective: The recently conducted Medication Actions to Reduce hospital admissions through a collaboration between Community and Hospital pharmacists (MARCH) transitional care programme, which aimed to test the effectiveness of a transitional care programme on the occurrence of ADEs post‐discharge, did not show a significant effect. To clarify whether this non‐significant effect was due to poor implementation or due to ineffectiveness of the intervention as such, a process evaluation was conducted. The aim of the study was to gain more insight into the implementation fidelity of MARCH. Methods: A mixed methods design and the modified Conceptual Framework for Implementation Fidelity was used. For evaluation, the implementation fidelity and moderating factors of four key MARCH intervention components (teach‐back, the pharmaceutical discharge letter, the post‐discharge home‐visit and the transitional medication review) were assessed. Quantitative data were collected during and after the intervention. Qualitative data were collected using semi‐structured interviews with MARCH healthcare professionals (community pharmacists, clinical pharmacists, pharmacy assistants and pharmaceutical consultants) and analysed using thematic analysis. Results and Discussion: Not all key intervention components were implemented as intended. Teach‐back was not always performed. Moreover, 63% of the pharmaceutical discharge letters, 35% of the post‐discharge home‐visits and 44% of the transitional medication reviews were not conducted within their planned time frames. Training sessions, structured manuals and protocols with detailed descriptions facilitated implementation. Intervention complexity, time constraints and the multidisciplinary coordination were identified as barriers for the implementation. What is new and Conclusion: Overall, the implementation fidelity was considered to be moderate. Not all key intervention components were carried out as planned. Therefore, the non‐significant results of the MARCH programme on ADEs may at least partly be explained by poor implementation of the programme. To successfully implement transitional care programmes, healthcare professionals require full integration of these programmes in the standard work‐flow including IT improvements as well as compensation for the time investment. [ABSTRACT FROM AUTHOR]

Helle Håkonsen,1 Dominique Hange,1,2 Tove Hedenrud1 1School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, SE 405 30, Sweden; 2Region Västra Götaland, Education, Research and Development Primary Health Care, Skövde, 541 80, SwedenCorrespondence: Helle HåkonsenSchool of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, P.O. Box 453, Gothenburg, SE 405 30, SwedenEmail helle.hakonsen@gu.seBackground: Self-report by questionnaire is one of the main methods to collect data on drug utilization. There are several modes of data collection by questionnaire, differing in the way of delivering the questionnaire to respondents and in the administration of the questions, both influencing the recall and participation rates. The aim of this study was to compare different modes of data collection for self-reported use of non-steroidal anti-inflammatory (NSAIDs) and analgesic medicines.Methods: Data on 573 women (38 or 50 years) were retrieved from the Population Study of Women in Gothenburg. Data on medicine use were collected using two different modes: (1) a self-administered questionnaire with closed-ended medicine-specific questions; and (2) an interviewer-administered questionnaire with open-ended questions. Cohen’s kappa statistics were applied to assess the agreement of the two modes.Results: The proportion of participants that reported use of NSAIDs and analgesics was higher with the self-administered questionnaire compared with the interviewer-administered questionnaire (69.3% vs 58.5%, p < 0.001). The overall agreement between the two modes of data collection was fair (Ⱪ=0.27), ranging from none for antimigraine preparations to fair (Ⱪ=0.36) for NSAIDs. A higher proportion of the participants aged 38 years reported use of NSAIDs and analgesics compared with the 50-year olds. In the regression model using data from the self-administered questionnaire, all four categories of bodily pain were significant predictors for use of NSAIDs and analgesics. The most severe reported bodily pain was the only significant predictor in the model using data from the interviewer-administered questionnaire.Conclusion: This study showed that use of a self-administered questionnaire with closed-ended medicine-specific questions identified more users of NSAIDs and analgesic medicines compared with an interviewer-administered questionnaire with open-ended questions. Reported use according to the self-administered questionnaire was also more strongly associated with experienced pain.Keywords: analgesics, medicine use, NSAIDs, population study, questionnaire, self-report, women

Background: Oral Anticoagulants (OACs) are widely prescribed for various chronic conditions. Inappropriate prescribing has been reported in various settings. Aims: The primary aim of this study was to assess the proportion of inpatients who were prescribed OACs concordant with prescribing recommendations. The secondary aims were to assess predictors of inappropriate prescribing and evaluate the number of related hospital‐acquired complications (HAC). Method: A retrospective audit was conducted in a multisite 650‐bed Australian Hospital from January to March 2019 to fulfil the study objectives. Consecutive patients who were discharged on OAC were included. Patients' demographics, OAC prescribed and comorbidities data were collected. Appropriateness of OAC use was evaluated according to the manufacturer's recommendations. HAC data were retrieved from the hospital coding unit from January to June 2019 to evaluate the impact of inappropriate OAC prescribing. Results: A total of 322 patients were eligible to be included in the study. Of this cohort, 185 (57%) were prescribed appropriate therapy. There was a total of 78 HAC reported cases over the study period. Predictors of inappropriate prescribing included those with HASBLED scores > 3 (OR = 0.205 (0.127–0.331), p < 0.0001), discharged from surgical units (OR = 0.522 (0.312–0.875), p = 0.014) or prescribed warfarin (OR = 0.236 (0.106–0.524), p < 0.001). [Correction added on 19 April 2022: "CHA2DS2‐VASc > 3 (OR = 0.668 (0.426–1.049), p = 0.079)," was removed from before "HASBLED scores > 3..." in the preceding sentence.] Conclusion: Inappropriate OAC prescribing is prevalent among inpatients. Strategies should be developed to assist clinicians to improve OAC prescribing in an evidence‐based approach. [ABSTRACT FROM AUTHOR]

In order for healthcare professionals to better engage with patients, they need to understand and integrate the perspectives of patients into their daily work. In this project, we developed two courses for healthcare professionals on patients' perspectives on medicine. One course was an online course that introduced the patients' perspectives on medicine and explained its importance for healthcare and health policy. The second course was a blended learning course, consisting of online modules and face-to-face webinars, which specified how to explore patients' perspectives in qualitative interviews, and how to develop implementation plans. Patients participated in the development, execution, and evaluation of both courses. Overall, more than 2000 healthcare professionals enrolled in the first course and, in just over a year, 191 participants completed the online course; 57 healthcare professionals registered in the second blended learning course and six participants completed both components of the course. The relevance of knowledge gained was positively evaluated. Participants especially appreciated the participation of patients. Based on the feedback, the second blended learning course was adapted to run online and both courses continue to be freely available to all interested healthcare professionals on the Coursera platform. [ABSTRACT FROM AUTHOR]

African Americans are more likely than non-Hispanic whites to be diagnosed with and die from diabetes. A contributing factor to these health disparities is African Americans' poor diabetes medication adherence that is due in part to sociocultural barriers (e.g., medicine and illness misperceptions), which negatively affect diabetes management. In our prior work, we engaged with community stakeholders to develop and test a brief version of a culturally adapted intervention to address these barriers to medication adherence. The objective of this study was to elicit feedback to inform the refinement of the full 8-week intervention. We utilized a community-engaged study design to conduct a series of meetings with two cohorts of patient advisory boards of African Americans with type 2 diabetes who were adherent to their diabetes medicines (i.e., peer ambassadors). In total, 15 peer ambassadors were paired with 21 African American participants (i.e., peer buddies) to provide specific intervention support as peers and serve in an advisory role as a board member. Data were collected during nine board meetings with the patient stakeholders. A qualitative thematic analysis of the data was conducted to synthesize the findings. Feedback from the patient advisory board contributed to refining the intervention in the immediate-term, short-term, and long-term. The inclusion of African American community members living with type 2 diabetes on the advisory board contributed to further tailoring the intervention to the specific needs of African Americans with type 2 diabetes in the community. [ABSTRACT FROM AUTHOR]

Copyright of Alcoholism & Drug Addiction / Alkoholizm i Narkomania is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Sanming model in healthcare reform has attracted much attention due to its comprehensive and efficient exploration, while its impact on physicians' prescribing behavior remains unknown. In the present study, we aimed to evaluate the impact of Sanming reform on physicians' medicine use in county-level public hospitals. We collected outpatient prescriptions in the internal medicine and pediatric departments from nine county public hospitals in Sanming from January 2011 to December 2017. We used six prescribing indicators to analyze physicians' medicine use. The Mann-Kendall test was used to examine trends in the study outcomes. A total of 1 577 904 outpatient prescriptions were included in this study. The average prescription rate of antibiotics and combined antibiotics were 57.5% and 12.2% in 2011, respectively, which were declined to 28.2% (P = 0.007) and 2.9% (P = 0.003) in 2017, respectively. The average prescription rate of injection was 30.2% in 2011 and declined to 5.3% ( P = 0.003) in 2017. As for the subgroup analysis of the internal medicine and pediatric departments, the average prescription rate of antibiotics was 39.3% and 71.4% in 2011, respectively, which was declined to 10.2% (P = 0.003) and 47.3% (P = 0.035) in 2017, respectively. The average prescription rate of combined antibiotics was 15.9% and 9.4% in 2011, respectively, which was declined to 2.9% (P = 0.003) and 2.9% (P = 0.016), respectively. The average prescription rate of injection was 17.8% and 39.6% in 2011, respectively, which was declined to 1.9% (P = 0.003) and 9.0% (P = 0.003), respectively. Our study showed a significant decreasing trend in antibiotic use in county-level public hospitals after the Sanming healthcare reform, indicating that the reform successfully promoted the appropriate use of medicine to some extent. [ABSTRACT FROM AUTHOR]

Abstract BACKGROUND: During the COVID-19 pandemic, universities have had to adopt remote education, a strategy that caused sudden changes of routine for everyone involved in academia. OBJECTIVE: To assess the profile of medicine use by the employees of a Brazilian public university during the COVID-19 pandemic. DESIGN AND SETTING: Cross-sectional study at a Brazilian public university. METHODS: Employees were invited to answer an online self-administered questionnaire, containing questions on sociodemographic features, medicine use, mental health and lifestyle habits during the COVID-19 pandemic. The outcome variable was the use of medicines stratified according to occupation. Descriptive, bivariate and multivariate (Poisson regression) statistical analyses were performed. RESULTS: A total of 372 employees participated in the study and use of medicine was reported by 53.2%. Among professors, suicide attempts (prevalence ratio [PR], 1.81; 95% confidence interval [CI], 1.20-2.74), physical activity (PR, 1.53; 95% CI, 1.11-2.11) and poor self-rated health (PR, 1.29; 95% CI, 1.01-1.66); and among technicians, decreased workload during the COVID-19 pandemic (PR, 1.41; 95% CI, 1.00-1.99), excess body weight (PR, 1.39; 95% CI, 1.02-1.88) and poor self-rated health (PR, 1.48; 95% CI, 1.14-1.92) were positively associated with use of medicines. In addition, among technicians, engaging in physical activity (PR, 0.60; 95% CI, 0.46-0.78) was a protective factor against medicine use. CONCLUSION: The profile of medicine use among these employees was similar to that of the Brazilian population. However, some associated factors may have been influenced by the COVID-19 pandemic, thus highlighting the need to examine this topic in a longitudinal study.

Self-medication (SM) is characterized by the procurement and use of medicines by bypassing primary healthcare services and without consulting a physician, usually to manage acute symptoms of self-diagnosed illnesses. Due to the limited availability of primary healthcare services and the anxiety associated with the COVID-19 pandemic, the compulsion to SM by the public has increased considerably. The study aimed to assess the characteristics, practices, and associated factors of SM by the public during the COVID-19 pandemic in Sargodha, Pakistan. χ2-tests and univariable analyses were conducted to explore the identification of characteristics and the potential contributing factors for SM during COVID-19, while multivariable logistic regression models were run to study the effect of variables that maintained a significant association. The study was performed during July–September 2021, with n = 460 questionnaires returned overall (response rate: 99.5%). The majority of respondents were males (58.7%, n = 270) who live in the periphery of the town (63.9%, n = 294), and most of the respondents belonged to the age group of 18–28 years (73.3%, n = 339). A large number, 46.1% (n = 212), of the participants were tested for COVID-19 during the pandemic, and among them, 34.3% (n = 158) practiced SM during the pandemic; the most common source of obtaining medicines was requesting them directly from a pharmacy (25.0%; n = 127). The chances of practicing SM for medical health professionals were 1.482 (p-value = 0.046) times greater than for non-medical health personnel. The likelihood of practicing SM in participants whose COVID-19 test was positive was 7.688 (p-value < 0.001) times more than who did not test for COVID-19. Allopathic medicines, acetaminophen (23.6%), azithromycin (14,9%), and cough syrups (13%), and over the counter (OTC) pharmaceuticals, vitamin oral supplements, such as Vitamin C (39.1%), folic acid (23.5%), and calcium (22.6%), were the most commonly consumed medicines and supplements, respectively; being a healthcare professional or having a COVID-test prior showed a significant association with the usage of Vitamin C (p < 0.05 in all cases). Respondents who mentioned unavailability of the physician and difficulty in travelling/reaching healthcare professionals were found 2.062-times (p-value = 0.004) and 1.862-times (p-value = 0.021) more likely to practice SM, respectively; SM due to fear of COVID was more common in individuals who had received COVID-tests prior (p = 0.004). Practices of SM were observed at alarming levels among our participants. Consciousness and understanding about the possible adverse effects of SM must be established and validated on a continuous level; in addition, on a commercial level, collaboration from pharmacists not to sell products (especially prescription-only medicines) without a certified prescription must be developed and implemented.

As the last step in the care pathway, pharmacies can significantly impact a patient’s medication adherence and the success of treatment. The potential impact of patient’s pharmacy choice on their medication adherence has yet to be established. This study aims to review the impact a pharmacies ownership model, either independent or chain, has on its users’ medication adherence. As a generalisation, independent pharmacies offer a more personal service and chain pharmacies offer medications at lower prices. A keyword search of EMBASE and MEDLINE databases in March 2022 identified 410 studies, of which 5 were deemed to meet our inclusion criteria. The studies mostly took place in North America, measured medication adherence using pharmacy records over a 12-month period. This review was unable to substantiate a difference in the rate of medication adherence between the users of independent and chain pharmacies. However, those with a lower income, greater medication burden, and increased age appeared to use an independent pharmacy more than a chain pharmacy and to have greater medication adherence when doing so. Establishing the differences in service provision between types of pharmacies and why people choose a pharmacy to frequent should be a focus of future research.

Background: Potentially inappropriate medicines (PIM), i.e. medicines in which the potential harms may outweigh the benefits, use may be associated with e.g. hospitalization, outpatient visits and health care costs. As regional institutions are often responsible for financing pharmaceuticals, understanding the regional variation of PIM use could help to tackle the associated problems and costs.Objective: To explore regional variation in PIM use among older adults and the association with regional health-system related, patient-related and economic characteristics and the frequency of PIM use.Methods: This is a nation-wide study based on the Finnish Prescription Register. PIM use was defined according to the Finnish Meds75+ database and regional characteristics derived from national statistics.Results: Variation at the hospital district level was large, with the largest difference between the most and least PIM prescribing being 45.2%. The factors associated with high PIM prescribing were a higher share of women and a higher number of private doctor visits per inhabitant in a municipality. The factor associated to lower PIM prescribing was a higher share of Swedish-speaking population. The studied factors explained 23% of the municipal-level variation in PIM.Conclusions: Large regional differences may lead to regional inequality in prescribing and in the distribution of pharmaceutical costs. As only a small share of the variation was explained by economic, health system-related and patient-related factors, the key reasons may lie in unobserved prescribing practices. [ABSTRACT FROM AUTHOR]

What is known: Medication non‐adherence leads to negative health outcomes. Medication adherence is predicted if patients understand the necessity of medication use to control disease symptoms and progression. It could be expected then, that patients with diseases with symptoms which are managed with medications, such as chronic obstructive pulmonary disorder or gout, or diseases with high‐mortality rates, such as cancer, would have higher adherence rates than asymptomatic diseases, such as hypertension. However, poor medication adherence remains problematic in both symptomatic and asymptomatic diseases. Further work is needed to explore patient experiences of medication adherence to understand the link between adherence and symptom control. Objective: To explore patients' lived experiences of medication adherence. Methods: Participants were recruited from community pharmacies and general practices. Forty‐one semi‐structured interviews and three focus groups were used to collect data from patients with disease states that had different symptomatic and asymptomatic profiles. Inductive thematic analysis was used to identify key parts of the experience of using medications. Results: Participants reported similar experiences of medication adherence despite having different disease symptoms. Participants said that they used medications because it was an expected part of everyday life and that medications 'must be needed' because they had been supplied, rather than being used for a particular symptom. Participants reported short‐term episodes of non‐adherence were unlikely to lead to negative health outcomes but may result in negative social consequences. Discussion: The findings broaden our understanding of patient experiences of medication use by indicating patients with symptomatic and asymptomatic diseases share similar experiences of medication use. The necessity to use medications appeared to come from 'the system' of healthcare professionals, family and friends that supply and recommend medications. What is new: There were key similarities in experiences of medication adherence in patients with different disease states. The negative consequences of short‐term episodes of non‐adherence were normalized by healthcare professionals. Conclusion: Patients with symptomatic and asymptomatic diseases share similar experiences of medication adherence. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate effects of different early life transport-related factors on health, behavior, use of medicines and slaughter characteristics of veal calves. An experiment was conducted with a 2 × 2 × 2 factorial arrangement with 3 factors: (1) provision of rearing milk or electrolytes before transport, (2) transport duration (6 or 18 h), and (3) type of vehicle (open truck or conditioned truck). The study included male Holstein-Friesian and cross-bred calves (N = 368; 18 ± 4 days; 45.3 ± 3.3 kg). Data on health status of calves were collected at the collection center and at the veal farm until week 27 post-transport. Behavior of calves was recorded during transport and at the veal farm until week 13 post-transport. Use of herd and individual medical treatments was recorded at the veal farm. The prevalence of loose or liquid manure at the veal farm from day 1 until week 3 post-transport was lower in electrolyte-fed calves transported in the conditioned truck compared to electrolytes-fed calves transported in the open truck or milk-fed calves transported in both the conditioned and open truck (Δ = 11% on average; P = 0.02). In comparison with the open truck, calves transported in the conditioned truck had lower prevalence of navel inflammation in the first 3 weeks post-transport (Δ = 3 %; P = 0.05). More milk-fed calves received individual antibiotic treatments compared to electrolyte-fed calves at the veal farm (P = 0.05). In conclusion, the transport-related factors examined in the present study affected health and behavior of calves in the short-term, but there was no evidence for long-term effects. It remains unknown why no long-term effects were found in this study. Perhaps this absence of transport-related effects was due to multiple use of medical treatments in the first weeks at the veal farm. Alternatively, it might be that the collective effects of the transition from the dairy farm to the veal farm, and of the husbandry conditions during the subsequent rearing period, on the adaptive capacity of calves were so large that effects of individual transport-related factors were overruled.

Background To strengthen appropriate medicine use (AMU) including the prescribing and dispensing quality at public sector health facilities in Uganda, the Ministry of Health introduced a multipronged approach known as the Supervision, Performance Assessment, and Recognition Strategy (SPARS). This paper assesses the impact of the first year of SPARS implementation on key AMU indicators. Methods District-based health workers trained as supervisors provide in-service training in medicines management complemented by indicator-based performance assessment and targeted supervision during each SPARS facility visit. From 2010 to 2013, health facilities that started the SPARS intervention were assessed during the first and last visit during a period of 12 months of implementing SPARS. This study examines 12 AMU indicators with 57 individual outcomes covering prescribing and dispensing quality. We also explored factors influencing 1-year improvement. Results We found an overall increase in AMU indicators of 17 percentage points (p < 0.000) between the first and last visit during a period of 12 months of supervisions, which was significant in all levels of health care facilities and in both government and private not-for-profit faith-based sectors. Appropriate dispensing (25 percentage points, p < 0.005) improved more than appropriate prescribing (12 percentage points, p = 0.13). Specific facilities that reached an average score of over 75% across all AMU measures within the first year of supervision improved from 3 to 41% from the first visit (baseline). The greatest overall impact on AMU occurred in lower-level facilities; the level of improvement varied widely across indicators, with the greatest improvements seen for the lowest baseline measures. Supervision frequency had a significant impact on level of improvement in the first year, and private not-for-profit faith-based health facilities had notably higher increases in several dispensing and prescribing indicator scores than public sector facilities. Conclusions The multipronged SPARS approach was effective in building appropriate medicine use capacity, with statistically significant improvements in AMU overall and almost all prescribing and dispensing quality measures after 12 months of supervision. We recommend broad dissemination of the SPARS approach as an effective strategy to strengthen appropriate medicine use in low-income countries.

In order for healthcare professionals to better engage with patients, they need to understand and integrate the perspectives of patients into their daily work. In this project, we developed two courses for healthcare professionals on patients’ perspectives on medicine. One course was an online course that introduced the patients’ perspectives on medicine and explained its importance for healthcare and health policy. The second course was a blended learning course, consisting of online modules and face-to-face webinars, which specified how to explore patients’ perspectives in qualitative interviews, and how to develop implementation plans. Patients participated in the development, execution, and evaluation of both courses. Overall, more than 2000 healthcare professionals enrolled in the first course and, in just over a year, 191 participants completed the online course; 57 healthcare professionals registered in the second blended learning course and six participants completed both components of the course. The relevance of knowledge gained was positively evaluated. Participants especially appreciated the participation of patients. Based on the feedback, the second blended learning course was adapted to run online and both courses continue to be freely available to all interested healthcare professionals on the Coursera platform.

African Americans are more likely than non-Hispanic whites to be diagnosed with and die from diabetes. A contributing factor to these health disparities is African Americans’ poor diabetes medication adherence that is due in part to sociocultural barriers (e.g., medicine and illness misperceptions), which negatively affect diabetes management. In our prior work, we engaged with community stakeholders to develop and test a brief version of a culturally adapted intervention to address these barriers to medication adherence. The objective of this study was to elicit feedback to inform the refinement of the full 8-week intervention. We utilized a community-engaged study design to conduct a series of meetings with two cohorts of patient advisory boards of African Americans with type 2 diabetes who were adherent to their diabetes medicines (i.e., peer ambassadors). In total, 15 peer ambassadors were paired with 21 African American participants (i.e., peer buddies) to provide specific intervention support as peers and serve in an advisory role as a board member. Data were collected during nine board meetings with the patient stakeholders. A qualitative thematic analysis of the data was conducted to synthesize the findings. Feedback from the patient advisory board contributed to refining the intervention in the immediate-term, short-term, and long-term. The inclusion of African American community members living with type 2 diabetes on the advisory board contributed to further tailoring the intervention to the specific needs of African Americans with type 2 diabetes in the community.

What is known and objectives: A standard drug classification system and a fundamental measurement unit of drug consumption are prerequisites in a healthcare information system for generating quality data on drug use. Globally, the ATC/DDD (Anatomical Therapeutic Chemical Classification/Defined Daily Dose) system recommended by WHO is accepted as the international standard. However, owing to variability in body weight, it cannot be used directly in paediatric population. In our work, we aimed to develop a standard method of quantification of antibiotic consumption in paediatric population using a modified approach of the ATC/DDD system. Method: We developed a mathematical model in a simulated paediatric cohort (n = 1000) and calculated antibiotic consumption in units of days of therapy (DOT) and DDD/100 patient days (PD). We validated the model in an observational cohort (n = 38) of inpatients admitted in Paediatric Department of a tertiary care centre. Results: Model simulation showed near perfect positive correlation (R =.99‐1.00) between DOT and DDD/100 PD in discrete weight based sub‐cohorts (weight 1‐10 kg). In the validation cohort, consumption of antibiotics was 121.76 and 33.16 in terms of DOT and DDD/100 PD respectively. Strong positive correlation between the two units (R =.73) was obtained. The correlation was better in predefined age and weight categories as compared to the uncategorised consumption (R =.78‐.97). The model was proved validated when weight specific (in sub‐cohorts of patients weighing 4, 5, 7 kg) DDD/100 PD and DOT also showed near perfect positive correlation (R =.96‐.99). What is new and conclusion: Weight specific DDD/100 PD can be explored further as a tool to standardise the quantification and comparison of consumption of drugs in paediatric population. [ABSTRACT FROM AUTHOR]

Most Parkinson's Disease (PD) patients are hospitalised for reasons other than their PD. Their PD symptoms are usually under control before admission, however, too many seem to experience medication‐related problems in hospital. Hospitalised PD patients should receive their levodopa within 30 min of the scheduled time ("on time") and not miss doses ("every time"). Hospital staff should avoid prescribing and administering contraindicated dopamine antagonists to PD patients in their care. Multiple studies have shown the failure to deliver levodopa "on time" to PD patients, with less than 50% of doses being "on time" and an average 0.7 of doses missed each day. The evidence points to hospital medication administration systems (HMAS) as the likely cause of late and missed levodopa doses. PD medication administration guidelines were reviewed to find strategies that reduced late and missed doses. An integrated "on time – every time" medication administration approach is proposed. PD patients should be encouraged to self‐administer their medication in hospital. More PD nurse navigators will be needed to facilitate PD patient care in Australian hospitals. [ABSTRACT FROM AUTHOR]

What is known and objective: Community pharmacists have a key role to play in addressing drug misuse. The objective of this research was to systematically review the current evidence and investigate the attitudes and practice strategies of community pharmacists towards drug misuse management. Methods: Data were extracted from 19 studies retrieved via a three‐step search strategy using the Arksey and O'Malley methodological framework for conducting scoping reviews. Results and Discussion: The attitudes and practice strategies of pharmacists towards drug misuse management and relevance to years of practice experience were discussed in seven of the 19 studies. Pharmacists reported gaps in knowledge and insufficient education and training on drug misuse‐related topics. Barriers to the effective management of drug misuse included lack of time and staff training. The most commonly reported strategy to address drug misuse was referral back to the doctor. Eight of the studies identified the benefits of real‐time prescription monitoring systems. Pharmacists have a key role to play in addressing drug misuse. Opportunities exist in the development of new and innovative approaches for harm minimization led by pharmacists, and in the examination and evaluation of the pharmacists' role in referral services, interventions and screening. What is new and conclusion: It is important to consider the role and contribution of early career pharmacists in the delivery of primary health care. They are the future of the pharmacy profession; therefore, it is critical that they are sufficiently trained and provided with the necessary resources to ensure high quality care in the management of drug misuse. [ABSTRACT FROM AUTHOR]

Background: Standard treatment guidelines (STGs) are a critical public health tool for promoting rational use of medicines. No studies have evaluated alignment of STGs with medicine use indicators especially in low and‐middle‐income countries (LMICs) with disproportionate burden of disease and irrational medicine use. Objective: To determine the level of alignment of Namibia's STGs with WHO medicine use indicators. Methods: A descriptive policy analysis of alignment of Namibia's STGs and WHO medicine use indicators. Thirty‐two conditions/diseases prevalent and managed at primary healthcare level were included in the study of alignment of the STGs with two WHO medicine use indicators in terms of average number of medicines/condition (polypharmacy, WHO target <2) and antibiotic prescribing (WHO target <30%) after adjusting for estimated encounters per condition. Data were analyzed using (SPSSv24 software, IBM Corporation, NY) to determine frequencies, percentages and means. Key findings: Of the 32 conditions/diseases studied, 41% had three or more medicines per condition indicated in the STGs. The weighted minimum and maximum average number of medicines/condition/encounter in the STGs were 2.62 and 2.78 respectively. Antibiotics were indicated for 72% (weighted per encounter = 75%) of the 32 conditions. Conditions/diseases of the urogenital system had the highest antibiotics indicated in the STGs (100%); respiratory (80%); ENT (80%); gastrointestinal (33%) before weighting conditions for estimated patient encounters, while ENT conditions had the highest antibiotics (32%) after weighting. Conclusions: Alignment of Namibia STGs and medicine use targets is sub‐optimal. The STGs have a high indication of antibiotics and polypharmacy. Misalignment is the main contributor to sub‐optimal medicine use indicators with respect to average number of medicines and antibiotics. Countries should review their STGs and align with medicine use indicators to enhance rational medicine use and fight antimicrobial resistance. This article provides guidance for aligning STGs with medicine use indicators. [ABSTRACT FROM AUTHOR]

Introduction: Parkinson's disease is the second most common neurodegenerative disease. The disease is more prevalent in aged individuals compared to young ones. Aim: The present study aimed to investigate the factors associated with PD in the population of Khyber Pakhtunkhwa, Pakistan. Methods: In this study, the questionnaire was filled from 600 PD patients, which include 54 familial cases, and 1,200 control subjects. To study the risk of PD in familial cases, questionnaires were also filled from the cases and controls. Results: This study revealed that depression symptomology is common in PD patients. Moreover, the risk of PD was higher in patients with consanguineous marriages compare to controls (OR = 3.96, 95% Cl = 1.98–7.89). The first-degree relatives (59.3%) of PD patients are more likely to develop PD compared to a second- (29.5%) or third-degree (11.1%) relatives. Furthermore, the risk of PD is higher in individuals whose parents get married to first-cousin (OR: 4.76, 95% Cl: 1.81–12.5) than second- (OR: 1.34, 95% Cl: 0.54–3.32) or third-cousin marriages (OR = 0.18, 95% Cl: 0.06–0.49). Moreover, the use of paracetamol (OR: 0.39; 95% Cl: 0.25–0.59) and ibuprofen (OR: 0.35; 95% Cl: 0.17–0.70) were higher in control subjects. Conclusion: This study concludes that consanguineous marriages and first-degree relation with PD patients increase the risk of PD, while the use of certain medications may decrease the risk of PD. Further study is warranted in a population of Pakistan. [ABSTRACT FROM AUTHOR]

What is known and objective: As the global adoption of ENFit‐compatible syringes becomes more widespread, it is important for syringe users to understand the risk of dosing inaccuracy for both the oral and enteral routes of use. Describing the risk of dosing inaccuracy specifically related to route of use is important to the end users' understanding of the clinical impact of device changes. The objective of this study was to compare the performance of female design ENFit low dose tip (LDT) syringes when used for enteral medication administration to the syringe performance during oral administration conditions. Methods: This study was a secondary analysis of a prospective study conducted at the University of Florida Health Shands Hospital in conjunction with the University of Florida College of Pharmacy. Dosing variance (DV) up to 10% for low‐risk medications and DV up to 5% is the target for high‐risk medication administration is considered acceptable. The primary outcome was the frequency of administration volumes exceeding 10% of the expected amount when using the ENFit LDT syringe for both oral and enteral medication administration. Secondarily, the performance of standard ENFit syringes and the frequencies of DV exceeding 5 and 10% were also evaluated in the same conditions. Results and discussion: A total of 264 tests were evaluated (ENFit LDT, n = 210; ENFit standard tip, n = 54). Using the LDT syringe for the enteral route resulted in statistically significant higher rates of unacceptable dosing variance >10% when compared to the oral application (26.9% vs 12.9%, P =.01). The frequency of LDT syringe DV >5% was significantly greater than >10% variance, regardless of oral or enteral use. Standard ENFit syringes had overall fewer tests with unacceptable dosing variance and showed no difference in performance between applications. What is new and conclusions: This study raises additional clinical concerns specifically related to the enteral use of ENFit LDT syringes within commonly accepted dosing variance ranges. Enteral and oral application of LDT syringes yield unacceptably high rates of dosing variance for high risk medications with narrow therapeutic index. [ABSTRACT FROM AUTHOR]

Abstract Background Medicine use can be influenced by several factors. Health managers need specific information about irrational use of medicines, in order to identify opportunities to enhance rational use of medicines in their communities. This study aimed to assess the pattern and factors associated with household medicine use in Gondar town, northwestern Ethiopia. Methods An interviewer-administered cross-sectional survey was conducted on 771 households, carried out between 5 April and 6 May 2015. The questionnaire contained items focusing on different aspects of medicine use in the households. The analysis involved descriptive summary and binary logistic regression test, which assessed association of independent variables with medicine use. Results Of the households interviewed, 22.4% (173/771) disclosed the presence of at least one chronic disease in the family; while 49.2% reported the use of medicine in the one month prior to the study. Almost all of the households (92.6%) reported a habit of discontinuing medicines, and 17.8% disclosed a practice of sharing medicines with household members and others. Level of education, presence of health professionals, and individuals with chronic illness in the households were linked to increased likelihood of reporting medicine use. Discarding leftover medicines with garbage (56.7%) was the principal means of disposal reported by the households. Conclusions A high proportion of reported medicine use, together with problems such as sharing with other people and leaving medicines unfinished were found among the households in the study.

Background: Medicine education in Japan was introduced to junior high schools in 2012. However, the effectiveness of existing education programs is limited. In order to develop more effective programs for high school students, the present study investigated the variables that directly influence medicine use behavior and the magnitude of their influence, using a Bayesian network analysis.Methods: A national cross-sectional survey was conducted in 2017. Eighty-three public high schools across Japan were randomly selected, and questionnaires were administered to 15–16 years old 10th grade students. The number of valid responses was 17,437 (effective response rate was 98.46%). Responses were analyzed to measure students’ behavior toward, attitudes regarding, and knowledge of medicines, and awareness of their prior medicine education.Results: Students’ “attitude score” and “awareness of a class” directly influenced their “behavior score.” The “score on attitude,” which had a large influence on “score on behavior,” was directly influenced by “score on knowledge of proper use” and “awareness of class.”Conclusion: The present study argues that acquiring knowledge of appropriate medicine use leads to the acquisition of favorable attitudes, which may result in behavioral change. Therefore, for medicine education, it is expected that incorporating content related to knowledge acquisition for changing attitudes will be important for promoting behavioral change.

Aim: The aim of this article was to determine off-label (OL) use in paediatric ambulatory clinics in a South African central hospital.Patients and Methods: OL medicine events were documented in three paediatric clinics (general, highly specialized and dedicated HIV paediatric clinics) at Tygerberg Hospital, South Africa, and analysed according to South African medicine registration information.Results: There were 2167 medicine events for 658 children. Mean age was 5.6 years (interquartile range 1.8-8.8). There were 123 OL medicine events (6%). Extemporaneous OL use was most common (n = 58, 47%), followed by weight (n = 45, 37%) and lack of paediatric data (n = 38, 31%). Of note was OL use for weight for general paediatrics (n = 32, 78%, p < 0.001), lack of appropriate paediatric data for highly specialized paediatrics (n = 26, 61%, p = 0.004) and extemporaneous use for HIV-infected children (n = 34, 87%, p < 0.001), with significant less OL use for HIV-infected children (p = 0.009).Conclusions: Of note is significant extemporaneous OL use in HIV-infected children. [ABSTRACT FROM AUTHOR]

Background When women are in a condition that requires medicines during pregnancy they have to balance the health benefits of the medical treatment against the potential risk of harming their unborn child. Too high teratogenic risk perceptions among pregnant women can lead them to stop taking the medicine, worsening the symptoms for the mother and even harming their foetus. Many women today who use over-the-counter and prescribed medicines have been shown to change their medical behaviour when they become pregnant. Objective To explore in depth the perceptions of medication use among women during their pregnancy. Setting The Capital Region of Denmark. Methods Participants were recruited from social network groups on Facebook and from participants in lectures and antenatal classes for pregnant women in two hospitals. Two focus groups interviews and three individual semi-structured interviews were conducted. The interview guides were based on existing literature and relatively unstructured, with an emphasis on open-ended questions. Interview transcripts were analysed using the phenomenological approach of meaning condensation. Main Outcome measure Pregnant women's' perceptions of medicine including aspects related to their safety feeling of medicines and perceived support from health care professionals. Results The women believed that it is less safe to take medicines during pregnancy, largely due to the risk of the child getting a disease in the future, but also due to the risk of malformation. Lack of clinical tests and uncertainty about how the unborn child reacts to medications were reported causes of these concerns. Most participants were concerned about using medicines and avoided them if possible, including over-the counter medicines. Conversations with physicians had a calming effect although the physicians appeared to be unclear in their guidance regarding dietary supplements. Some women received conflicting information on the Internet. Several suggestions were made about how to reduce uncertainties about the safety of taking medicines during pregnancy. Conclusion Many pregnant women are concerned about how to use medicines. To reduce these concerns and ensure the appropriate use of medicines during pregnancy, initiatives are needed to strengthen evidence-based advice from health care professionals, especially during the first trimester. [ABSTRACT FROM AUTHOR]

Consumption of quality-assured medicines is expected to maintain or improve population health. Yet in a number of situations, what is realized is lower health benefits or magnified safety risks. Recognizing the public health implications of safety risks or medication-related harm, and that some types of harm are avoidable, the World Health Organization has initiated the third Global Patient Safety challenge on Medication Safety. Under the term "Medication Without Harm", this Challenge aims to assess the scope and nature of avoidable medication-related harm, create a framework for intervention and develop national guidance and tools to support safer medication use. The global target under the Challenge is to reduce the level of severe avoidable medication-related harm by 50% over a five-year period or within the next five years. Given a higher morbidity and mortality due to medication-related harm in low-income countries, this paper evaluates what needs to be done in low-income countries in order to achieve the global target. The ideal solution advocated requires that health planners in each low-income country determine what fraction of safety risks or harm can be prevented; and the relationship between number or frequency of avoidable harm or safety risks and the resource costs of treatment or prevention. In the absence of such information, this paper discusses a number of prevention strategies that might help; arguing that the period over which avoidable medication-related harm can be reduced by 50% will depend on whether significant continuous investments in health-system strengthening are made prior to and within that period. [ABSTRACT FROM AUTHOR]

Summary: What is known and objective: The International Organization for Standardization (ISO) created enteral device specifications to reduce tubing misconnections. The Global Enteral Device Supplier Association (GEDSA) supports a female design: standard and low dose tip (LDT). Concerns include increased complexity of use with adapters, dosing accuracy and workflow. No peer‐reviewed studies have evaluated dosing accuracy of the complete female system with adapters. The objective of this study was to compare dosing accuracy of the female design to legacy syringes. Methods: An in vitro study was conducted at the University of Florida College of Pharmacy pharmaceutics laboratory. Assessments were completed for syringe size, dispense methods and volumes, and adapters when applicable. A gravimetric scale and specific gravity were used to calculate administration volumes. The primary outcome was frequency administration volume exceeded 10% expected amount. Results and discussion: A total of 576 tests were performed. The LDT resulted in significantly higher rates of unacceptable dosing variance compared to legacy (21.2% vs 7.4%, P = 0.003). Variance exceeding 10% occurred more frequently with LDT 0.5 and 1 mL syringes, medication cup dispensing (liquid or tablet) and inappropriate LDT adapter use. Unapproved adapter processes compared to FDA‐approved processes held a higher likelihood of unacceptable dosing variance (28% vs 7.4%, P < 0.001). FDA‐approved use of adapters with prefilled syringes compared to bedside administration may result in higher rates of dosing inaccuracy (18.8% vs 5.6%, P = 0.06). What is new and conclusions: This study raises clinical concerns of dosing inaccuracies with the LDT syringes, particularly with 0.5 and 1 mL sizes. The use of adapters significantly increases the opportunity for inaccurate dosing. [ABSTRACT FROM AUTHOR]

Background: Medicine education in Japan was introduced to junior high schools in 2012. However, the effectiveness of existing education programs is limited. In order to develop more effective programs for high school students, the present study investigated the variables that directly influence medicine use behavior and the magnitude of their influence, using a Bayesian network analysis. Methods: A national cross-sectional survey was conducted in 2017. Eighty-three public high schools across Japan were randomly selected, and questionnaires were administered to 15–16 years old 10th grade students. The number of valid responses was 17,437 (effective response rate was 98.46%). Responses were analyzed to measure students' behavior toward, attitudes regarding, and knowledge of medicines, and awareness of their prior medicine education. Results: Students' "attitude score" and "awareness of a class" directly influenced their "behavior score." The "score on attitude," which had a large influence on "score on behavior," was directly influenced by "score on knowledge of proper use" and "awareness of class." Conclusion: The present study argues that acquiring knowledge of appropriate medicine use leads to the acquisition of favorable attitudes, which may result in behavioral change. Therefore, for medicine education, it is expected that incorporating content related to knowledge acquisition for changing attitudes will be important for promoting behavioral change. [ABSTRACT FROM AUTHOR]

Background: Socioeconomic variation in adolescents' medicine use behaviour is an understudied issue.Objectives: To examine the association between socioeconomic background and medicine use for headache among adolescents, and how this association changes over time.Methods: Data stem from the Danish part of the international Health Behaviour in School-aged Children (HBSC) study 1991-2014 with data about parents' occupational social class (OSC) and self-reported medicine use for headache, n = 26,685. This study examined absolute social inequality (percent difference between high and low OSC) and relative social inequality (odds ratio for medicine use by OSC).Results: In total, 40.5% used medicine for headache in the past month. There was a significant increase from 32.3% in 1991 to 42.8% in 2002 (test for trend, p < 0.0001) and very little change 2002-2014. This pattern was similar in high, middle and low OSC. The prevalence of medicine use for headache in high, middle and low OSC was 36.2%, 41.5% and 44.8% (p < 0.0001). The OR (95% CI) for medicine use was 1.25 (1.18-1.324) in middle and 1.43 (1.33-1.54) in low OSC.Conclusions: Medicine use for headache increased 1991-2002 and remained stable 2002-2014. There was increasing medicine use for headache with decreasing OSC; this social inequality was persistent 1991-2014. [ABSTRACT FROM AUTHOR]