In the present study, the effects of (a) unit-dose packaging to facilitate self-monitoring of medication-taking behavior and (b) positive verbal reinforcement to maintain the reactive effects of self-monitoring were evaluated in six psychiatric outpatients.

This diploma thesis focuses specifically on the phenomenon of self-medication with cannabis (Cannabis Sativa L.) in the Czech Republic exploring subjective perception of this treatment by ill persons and its sociocultural framework. It describes a situation when the state fails to effectively regulate medical cannabis and patients often seek practices of self-medication, which remains illegal. Theoretical part of this thesis aims to explain the self- medication and cannabis use in the sociocultural context. Practical part is based on an anthropological research, which was implemented in the Czech Republic from January 1, 2017 to May 1, 2017 in a form of the on-line qualitative questionnaire survey. The research sample consists of 107 subjects, who used cannabis and its derives for self-medication. The analysis was done by the Grounded theory method. The results demonstrate that people who seek cannabis self-medication in the Czech Republic consider current legal regulation of cannabis objectionable. Cannabis plants for self-medication are usually grown at home and people find information about specifics of the treatment on-line. Looking at experience of patients, this thesis describes specifics of the practices of cannabis self-medication and it could be useful for organizations working with...

The social anxiety literature often cites the self-medication hypothesis (SMH) to explain why socially phobic clients often present with alcohol problems. Based on some earlier hints that social anxiety and drinking might be related in a curvilinear way, we sought to examine the SMH to assess for possible non-linear relationships, and to examine whether cultural differences affect these relationships. We surveyed self-reported social anxiety, alcohol expectancies, and alcohol use in college students from Cyprus (N=127) and the United States (US) (N=697). Participants were college students with a mean age of 19.8. Results revealed that positive and negative expectations about alcohol use were predictive of drinking for students from both cultures. Cypriot students endorsed fewer positive and more negative expectancies regarding alcohol use than their US counterparts, and engaged in less binge drinking. Social anxiety in men was related to drinking via a curvilinear relationship, in which drinking peaks at moderate levels of social anxiety. Among men, those with highest levels of social anxiety in both cultures drink the least. For women, there was no relationship between social anxiety level and drinking behavior. These findings demonstrate the complexity of the relationship between social anxiety and alcohol use. Far from being a linear relationship, these two variables are related in a curvilinear fashion, for men. This should inform future research on the SMH.

Background: Irresponsible self-medication is a problem for health systems in developing countries. We aimed to estimate the frequency of self-medication and associated factors in users of drugstores and pharmacies in Peru. Methods: We performed a secondary data analysis of the 2015 National Survey on User Satisfaction of Health Services (ENSUSALUD), a two-stage probabilistic sample of all regions of Peru. Non self-medication (NSM), responsible self-medication (RSM) and irresponsible self-medication (ISM) were defined as the outcome categories. Demographic, social, cultural and health system variables were included as covariates. We calculated relative prevalence ratios (RPR) with their 95% confidence intervals (95%CI) using crude and adjusted multinomial logistic regression models for complex samples with NSM as the referent category. Results: 2582 participants were included. The average age was 41.4 years and the frequencies of NSM, RSM and ISM were 25.2%, 23.8% and 51.0%; respectively. The factors associated with RSM were male gender (RPR: 1.35; 95%CI: 1.06-1.72), being between 40 and 59 years old (RPR: 0.53; 95%IC: 0.39-0.72), being 60 or older (RPR: 0.39; 95%IC: 0.25-0.59), not having health insurance (RPR: 1.89; 95%CI: 1.31-2.71) and living in the Highlands region (RPR: 2.27; 95%CI: 1.23-4.21). The factors associated with ISM were male gender (RPR: 1.41; 95%CI: 1.16-1.72), being between 40 and 59 years old (RPR: 0.68; 95%IC: 0.53-0.88), being 60 or older (RPR: 0.65; 95%IC: 0.48-0.88) and not having health insurance (RPR: 2.03; 95%CI: 1.46-2.83). Conclusion: Around half of the population practiced ISM, which was associated with demographic and health system factors. These outcomes are the preliminary evidence that could contribute to the development of health policies in Peru. / Revisión por pares

Women with posttraumatic stress disorder (PTSD) often develop alcohol use disorders (AUD) resulting from the use of alcohol to self-medicate from negative affect. Research supports the relationship between comorbid PTSD and AUD, and studies with women additionally identify the role of rumination, or excessive thinking about distress and its causes, as a precipitating aspect leading to self-medication. Female-based data is sparse, however, regarding specific thought patterns and factors which trigger the need to self-medicate with alcohol. Numerous researchers have studied the relationship between stress, anxiety, and alcohol use, although, there exists a need for qualitative studies providing thick, rich information. Applying the self-medication model and rumination theory, the purpose of this study was to use a transcendental research framework as a lens to explore and describe the phenomenon of how women with comorbid PTSD and AUD make sense of their dual disorder. Qualitative data were gathered from in-depth interviews of 12 women who participated in Alcoholics Anonymous groups in a large Southeastern city. The women collectively described their lived experience with the phenomenon as an internally-focused strategy premised on the notion of a 'Higher Power.' They reported using this strategy to manage thoughts, feelings, and behaviors which triggered negative self-assessment and the need to self-medicate with alcohol. This research contributes to the literature by offering a more detailed understanding of comorbid PTSD and AUD. Positive social change can be achieved with a better understanding of the etiology of female trauma and the factors that trigger alcohol relapse in women with PTSD.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第18516号 / 社医博第57号 / 新制||社医||8(附属図書館) / 31402 / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 川上 浩司, 教授 横出 正之, 教授 佐藤 俊哉 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DGAM

Health can be described as both a product and a process of life, and is necessary for human wellbeing, overall quality of life and productivity. While health is generally desirable, many factors affect health and health outcomes of individuals and populations the world over. Virtually all individuals will be faced with one health problem or another during their lifetime, that requires some form of health care intervention. Whatever their reasons for seeking care, all health care consumers share a common interest – a desire to get better. In a pluralistic health care environment where different avenues exist for seeking and receiving health care, differential choice of care may be influenced by sociodemographic and related factors. To the extent that the available avenues for seeking and receiving health care do not offer the same opportunities for improving health, significantly different health outcomes may be realized for comparable conditions for which different types and volume of health care are sought and received. Understanding the factors that influence health-seeking behaviors among various populations may therefore, be an important first step in designing intervention programs that nudge health consumers toward better health-seeking behaviors with the goal to improving health and health outcomes among these populations. The purpose of this research was to develop a research instrument for studying health-seeking behaviors based on the Health Belief Model, and to use the instrument to study the factors that influence/predict health-seeking behaviors among Ghanaians. Using a convenience sample of 504 participants recruited from the Greater Accra, Ashanti, Volta and Northern Regions, analyses of the data showed that different sociodemographic characteristics such as age group, gender and health insurance status as well as selected modified constructs of the Health Belief Model such as Perceived Barriers to mainstream care, variously and collectively influence health-seeking behaviors at government and private health facilities, self-medication with herbal and pharmaceutical drugs, faith healing and care from traditional/herbal practitioners. Based on the findings of this study, the author concludes that health-seeking behaviors in Ghana are influenced by a multiplicity of factors including sociodemographic characteristics. Subsequently, recommendations for a more extensive study with a complementary qualitative enquiry are made in order to gain a more wholistic insight of the drivers of health-seeking behaviors in Ghana.

Introduction: People with Parkinson's disease require individualised medication regimens to achieve symptomatic control whilst managing complications of the treatments and the underlying disease. Patients should continue to receive their individualised regimen when they are admitted to hospital but studies have highlighted that this may not happen. There is a paucity of research about patients' perceptions of the management of anti-parkinsonian medicines during a hospital admission and the aim of this study was to explore the perceptions of Parkinson's disease patients admitted to Leeds Teaching Hospitals about the management of their anti-parkinsonian medications.Method: Grounded theory methodology was used to allow detailed exploration of patients' perceptions and to generate theory about this under-researched area. Face to face, semi-structured interviews were conducted with 13 Parkinson's disease patients during their hospital admission, fully transcribed and analysed using the constant comparative approach. Results: Categories contributing to the core category of 'patient anxiety' were identified as 'maintaining usual medication routine', 'access to anti-parkinsonian medications', 'accuracy and consistency', 'trust in healthcare professionals' and 'staff knowledge about Parkinson's disease'. Strategies used to manage the anxiety were related to the categories 'utilising expertise' in Parkinson's disease and 'patient involvement' in their care. Discussion: The theory suggests that some patients have negative perceptions about the management of their medicines during a hospital admission. Areas for practice development are presented along with areas for future research. Conclusion: This study provides new insight into the perceptions of patients with Parkinson's disease about the management of their medicines during a hospital admission.

Syftet med studien var att få fram personliga betraktelser av olika kategorier kopplat till intag av narkotika, alkohol och receptbelagda mediciner av personer med egenupplevda erfarenheter. Kategorierna missbruk och självmedicinering står i fokus men det lämnas även plats för andra kategoriseringar av intag. Detta för att undersöka hur kategoriseringar kan påverka behandlingsarbete. Sex personer intervjuas om deras upplevelser av narkotika- och alkoholintag samt hur de ser på olika kategoriseringar inom detta område. Det undersöks hur intervjupersonerna definierar sitt intag eller före detta intag av alkohol och narkotika samt hur denna kategorisering har kommit till. Studien är kvalitativ och har sex semistrukturerade intervjuer som underlag för resultatet. Studien börjar med en genomgång av olika begreppsdefinitioner gällande missbruk samt en genomgång av narkotikastrafflagen. Därefter redovisas forskning som tar upp attityder angående missbruk ur professionella behandlares perspektiv. I teoridelen tas tre teorier upp, Culture in action-teorin, självmedicinerings-hypotesen och stämplingsteorin. Resultatet visar respondenternas egna berättelser vilket är empirin som vår analys bygger på. Analysen görs ihop med de teorier som redovisats. Resultatet visar att många upplever självmedicinering som ett relevant begrepp och att den hårda kategoriseringen av missbrukare påverkar de stämplade starkt. Kategoriseringen av intag ser olika ut beroende på i vilket livsstadie personen befinner sig. Något som också spelar stor roll är i hur stor utsträckning intaget tagit över personens liv. Det framkom tankar om att den hårda kategoriseringen inom behandlingar upplevs som nedtryckande och stämplande. En mer individanpassad missbruksvård var önskad. Det framkom även vissa paralleller mellan respondenterna och självmedicinerings hypotes. / The purpose of this study was to reach personal views on categorization of the intake of natcotics, alcohol and prescription drugs by people with personal experiences on the subject. The categories drug abuse and self medication where the core categories but there where room for other categorization of intake. The purpose was to see how categorization can affect addiction treatment. Six persons where interviewed on their experiences of drugs and alcohol and their views on the categorization of these topics. The persons tell how they define their intake (or former intake) of drugs or alcohol and how this categorization came to be. This is a qualitative study the result is based on six semi structured interviews. It starts with a review on different definitions of addiction and the Swedish drug laws. Thereafter there is a presentation on research about the attitudes of professional addict treaters. The study contains three theories. The culture in action theory, the self-medication hypothesis and the labeling theory. The result shows the respondents own testimony witch is the foundation the analysis rests upon. The analysis is done together with the mentioned theories. The result shows that most respondents see self medication as a valid concept and that the harsh categorization in addict treatment has an impact on those facing it. The categorization of intake differs depending on the life situation of the person that does the categorization. Another important aspect is how much the intake is ruling the intakers life. The harsh categorization in addict treatment is seen as suppressive and labeling. A more individualized addict treatment where wanted. The study shows some parallels with the self-medication hypothesis.

Introduction: People with Parkinson's disease require individualised medication regimens to achieve symptomatic control whilst managing complications of the treatments and the underlying disease. Patients should continue to receive their individualised regimen when they are admitted to hospital but studies have highlighted that this may not happen. There is a paucity of research about patients' perceptions of the management of antiparkinsonian medicines during a hospital admission and the aim of this study was to explore the perceptions of Parkinson's disease patients admitted to Leeds Teaching Hospitals about the management of their antiparkinsonian medications.Method: Grounded theory methodology was used to allow detailed exploration of patients' perceptions and to generate theory about this under-researched area. Face to face, semi-structured interviews were conducted with 13 Parkinson's disease patients during their hospital admission, fully transcribed and analysed using the constant comparative approach. Results: Categories contributing to the core category of 'patient anxiety' were identified as 'maintaining usual medication routine', 'access to antiparkinsonian medications', 'accuracy and consistency', 'trust in healthcare professionals' and 'staff knowledge about Parkinson's disease'. Strategies used to manage the anxiety were related to the categories 'utilising expertise' in Parkinson's disease and 'patient involvement' in their care. Discussion: The theory suggests that some patients have negative perceptions about the management of their medicines during a hospital admission. Areas for practice development are presented along with areas for future research. Conclusion: This study provides new insight into the perceptions of patients with Parkinson's disease about the management of their medicines during a hospital admission.