Introduction: Various drugs are being used against the symptoms caused by COVID-19, without being approved for these purposes. Many of these drugs have small safety margin and very risky adverse effects on health, a reason why they require prescription and, above all, medical monitoring and follow-up. Unfortunately, there are many cases of self-medication in Peru and Bolivia that require prompt management. Objective: To carry out a systematic review of the scientific literature that presents evidence about the effectiveness and adverse reactions of the drugs currently used against COVID-19 in Peru and Bolivia. Methods: Qualitative research based on the systematic review of the scientific literature available in PubMed, as well as in the national regulations of Peru and Bolivia related to the etiology, epidemiology, symptoms, as well as treatments approved and discontinued by both countries since the exacerbation of the COVID-19 crisis and the completion of clinical studies to date. Conclusions: The drugs used in Peru and Bolivia for treating COVID-19 have side effects and possible risks to the health of people who unfortunately self-medicate. Greater control of these drugs is required to avoid their free acquisition, and to improve the national and regional strategy to evaluate the possible symptomatic treatments of COVID-19, taking into consideration the high probability of survival of the disease and the risk posed by using these drugs, which, in the future, could cause serious adverse effects on public health in the two countries. / Revisión por pares

Introdução: A automedicação é uma prática frequente em diferentes culturas, que pode ser usada como estratégia para resolução de pequenos problemas de saúde, especialmente em populações cujo acesso a serviços de saúde é restrito. No entanto, essa prática pode, também, ocasionar reações adversas graves, resistência microbiana, interações medicamentosas e gastos desnecessários, especialmente em grupos economicamente desfavorecidos e socialmente excluídos como ocorre com os povos ribeirinhos. Objetivo: Analisar a prática de automedicação e fatores associados entre ribeirinhos da região do Médio Solimões - Amazonas. Método: Estudo transversal de base populacional realizado nas comunidades ribeirinhas do município de Coari - Amazonas. A amostra probabilística foi composta por 492 ribeirinhos adultos. A coleta de dados foi realizada nas comunidades por meio de um questionário composto por variáveis independentes: socioeconômicas, demográficas, de acesso aos serviços de saúde, consumo de drogas lícitas, enfermidades autorrelatadas e informações sobre o consumo de medicamentos. A variável dependente automedicação foi avaliada pelo uso de pelo menos um medicamento sem prescrição médica ou de dentista, nos últimos 30 dias. Na análise dos dados utilizou-se testes do Qui-quadrado ou exato de Fischer, teste t de Student ou de Wilcoxon-Mann-Whitney e regressão logística binária hierarquizada. Resultados: A prevalência da automedicação foi de 76,3%. Dor de diferentes origens (58,1%) foi o principal motivo que levou à automedicação. Analgésicos (57,5%) e antimicrobianos (13,0%) foram os medicamentos mais utilizados. Os fatores associados à automedicação foram sexo masculino (OR=2,20; IC=1,21-4,01), faixa etária entre 18 a 39 anos (OR=2,50; IC=1,06-5,91), não procura por serviços de saúde (OR=2,90; IC=1,66-5,09), tempo de deslocamento da comunidade à zona urbana entre 1 a 4 horas (OR=2,84; IC=1,26-6,41) e maior que 4 horas (OR=5,27; IC=2,18-12,74), ter o hábito de consumo de medicamentos alopáticos por conta própria (OR=3,14; IC=1,49-6,61). Conclusões: Na população ribeirinha, a prática elevada da automedicação reflete a necessidade de busca de autocuidado pelas pessoas, sobretudo decorrente do restrito acesso aos serviços de saúde. / Introduction: Self-medication is a frequent practice in different cultures, and it can be used as a strategy to solve minor health problems, especially among populations with restricted access to health care services. However, such a practice may cause serious adverse reactions, microbial resistance, drug interactions and unnecessary expenses, mainly for economically disadvantaged and socially excluded groups like the riverside communities. Objective: To analyze the self-medication practice and its related factors among riverside communities in the region of the Middle portion of the Solimões River Amazonas State, Brazil. Method: Cross-sectional, population-based study carried out among riverside communities in the municipality of Coari Amazonas State, Brazil. The probability sampling comprised 492 adult riverside dwellers. Data collection was held in the communities by means of a questionnaire including independent variables: socioeconomic, demographic ones, access to health care services, drug therapy, self-reported illnesses, and information on medication use. Medication dependent variable was assessed by the use of at least one drug without medical or dentists prescription in the past 30 days. For the data analysis, Chi-square test or Fischers exact test, Students t or Wilcoxon-Mann-Whitney tests, and hierarchical binary logistic regression were used. Results: Self-medication prevalence was 76.3%. Pain from different origins (58.1%) was the main reason for self-medication. Painkillers (57.5%) and antimicrobial medication (13.0%) were the most used drugs. Self-medication related factors were males (OR=2.20; CI=1.21-4.01), age range between 18 and 39 years (OR=2.50; CI=1.06-5.91), not search for health care services (OR=2.90; IC=1.66-5.09), travel time from the community to the urban center between 1 and 4 hours (OR=2.84; CI=1.26-6.41), and over 4 hours (OR=5.27; CI=2.18-12.74), habit of self-medication for allopathic drugs (OR=3.14; CI=1.49-6.61). Conclusions: High self-medication practice among the riverside population reflects the need for turning to self-medication, mainly due to the restricted access to health care services.

O uso de medicamentos representa um dos recursos terapêuticos mais utilizados na resolução de grande parte dos problemas e situações em saúde. Nesse contexto, o interesse na forma como os pacientes gerem suas doenças e tratamentos farmacológicos tem crescido em importância. Esta tese objetivou compreender as dimensões da autogestão do uso de medicamentos e variáveis associadas na população brasileira. Para isso, foram analisados três comportamentos relacionados ao uso de medicamentos: a automedicação, a não-adesão intencional e as alterações das doses prescritas. Os dados analisados são provenientes da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM), estudo transversal realizado entre os meses de setembro de 2013 e janeiro de 2014 em 245 municípios brasileiros distribuídos nas cinco regiões geográficas do país. A população do estudo foram os indivíduos residentes em domicílios permanentes na zona urbana do território brasileiro. Nesta tese, foram analisados os dados de 31.573 indivíduos com idade igual ou superior a 20 anos. Modelos de Regressão de Poisson com ajuste robusto da variância foram utilizados a fim de estimar o efeito independente de cada variável nos três comportamentos estudados. Entre os entrevistados, 73,6% declararam utilizar algum medicamento sem indicação médica quando já fizeram uso do mesmo produto anteriormente, 73,8% declararam utilizar medicamentos sem prescrição médica quando já tem o medicamento em casa e 35,5% declararam utilizar algum medicamento sem prescrição quando conhecem alguém que já tomou o mesmo medicamento. As variáveis que se mostraram associadas à maior probabilidade de uso de medicamentos por automedicação foram: região geográfica do Brasil, sexo, faixa etária, renda per capita, auto avaliação da saúde, declaração de que usa medicamento sem prescrição médica quando já usou o mesmo medicamento anteriormente e declaração de que usa medicamento sem prescrição médica quando já tem o medicamento em casa. Mais da metade dos entrevistados relataram alguma situação de automedicação, enquanto que 38% relataram deixar intencionalmente de tomar medicamentos prescritos em alguma situação. Com relação às alterações nas prescrições, 8,8% dos entrevistados relataram amentar a dose dos medicamentos em alguma situação e mais de 21% relataram diminuir a dose. Nos modelos de regressão ajustados, as variáveis sexo, idade e autoavaliação de saúde mostraram-se associadas à não-adesão intencional. As alterações de dose aparecem associadas à idade, renda e autoavaliação de saúde. Os resultados indicam, portanto, que um percentual significativo da população brasileira utiliza medicamentos não exclusivamente da forma como são prescritos pelo médico. Buscando contemplar esses diferentes comportamentos cotidianos dos indivíduos em relação aos medicamentos, a presente tese propôs o conceito de “autogestão do uso de medicamentos”. Esse conceito visa ampliar a compreensão do uso de medicamentos para além da adesão às prescrições médicas como já indicado no conceito de medication self-management e de compliance. A partir dessa perspectiva, destaca-se a necessidade de adoção de outros paradigmas nos cuidados em saúde, como o dos cuidados colaborativos e da corporalidade (lived body), onde o próprio indivíduo, com a colaboração dos profissionais da saúde, tome as decisões sobre as estratégias mais adequadas de tratamento e promoção da saúde. / The use of medications represents one of the most utilized therapeutic resources to the resolution of most health problems and situations. In this context, the interest in how patients manage their diseases and pharmacological treatment has increased. This thesis had as main objective to comprehend the self-management of medications use and related variables on the Brazilian population. Three behaviors related to the use of medications were analyzed: self-medication, intentional non-adherence and prescribed doses changes. Analyzed data are part of the “Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM)”, a cross-sectional study performed between September 2013 and January 2014 in 245 Brazilian cities in the five geographic regions. Study population were individuals living permanently in the urban area of Brazil. In this thesis, data from 31.573 individuals aged 20 years or above were analyzed. Poisson Regression Models with robust variance adjustment were used to estimate independent effect of each variable on the three studied behaviors. Among the interviewed, 73.6% have declared the use of any medication without medical prescription when they have used the same product previously, 73.8% have declared the use of not prescribed drugs when the medication is available at home and, 35.5% have declared to use any drug without medical prescription when someone they know have used the same medication. Variables related to higher probability of drug use by self-medication were: geographic region, gender, age, per capita income, health self-evaluation, the use without medical prescription of the same drug used before and the use without medical prescription when the drug is available at home declarations. More than half of the interviewed reported any situation of self-medication while 38% reported to, intentionally, stop taking prescribed medications in any situation. Regarding prescription alterations, 8.8% of the interviewed reported to increase the medication dose in any situation and more than 21% reported to decrease medication dose. On the adjusted regression models variables as gender, age and health self-evaluation showed to be related to intentional nonadherence. Dose changes are related to age, income and health self-evaluation. Therefore, results show that a significant percentage of the Brazilian population uses medications not exclusively as they are prescribed by the physician. Seeking to address these different daily behaviors of individuals regarding medications, this thesis has proposed the concept of “self-management of medications use”. This concept aims to amplify the comprehension of medications use beyond medical prescriptions adherence as already indicated in the concept of medication self-management and compliance. From this perspective stands out the need of other paradigms introduction on health care, such as collaborative care and lived body, in which the individual himself, with health professionals’ collaboration, take the decisions about the most adequate treatment strategies and health promotion.

Pacientes que procuram atendimento odontológico frequentemente relatam dor de variada intensidade, principalmente aqueles que buscam atendimento em caráter de urgência. Não é incomum que os pacientes busquem alívio de seus sintomas, previamente à consulta odontológica, por meio de medidas locais e/ou automedicação. Paralelamente, a prescrição de medicamentos é comum por parte dos cirurgiões-dentistas, em especial após o atendimento em caráter de urgência. Este estudo visou avaliar a intensidade da dor dentária relatada pelos pacientes, no momento da consulta, uso de medidas locais e os principais medicamentos utilizados pelos pacientes, por meio de automedicação, previamente à consulta odontológica, o relato de efeitos adversos e a influência que diferentes mídias (televisão, jornais e revistas) exercem no momento da aquisição de medicamentos. Também foram analisados os medicamentos prescritos e os diagnósticos realizados por profissionais que atuam em serviços de urgência odontológica, além de avaliação do nível de ansiedade dos pacientes atendidos, por meio da Escala de Ansiedade Dental de Corah e questionário do Inventário de Ansiedade Traço-Estado. Para tal, foi realizado estudo observacional transversal, de caráter prospectivo, por meio de entrevista com 179 pacientes adultos, atendidos em Serviço de Urgência Odontológica da Faculdade de Odontologia da Universidade Federal do Rio Grande do Sul (UFRGS) e Unidade de Pronto Atendimento (UPA) Moacyr Scliar. A frequência de automedicação observada foi de 60,9%. Os principais medicamentos utilizados previamente à consulta foram analgésicos não opioides (54,2%). Pacientes que utilizaram antimicrobianos representaram 16,8% da amostra, sendo que 6,7% dos entrevistados utilizaram antimicrobianos por meio de automedicação. Efeitos adversos foram descritos por 21,5% dos pacientes que utilizaram medicamentos. Uso de medidas locais previamente à consulta foi descrito em 59 (33%) atendimentos. Aproximadamente um quarto dos entrevistados (25,7%) relatou se sentir influenciado por propagandas de medicamentos e já ter adquirido medicamentos por influência direta de propagandas. Houve associação estatisticamente significativa entre automedicação e relato de dores moderadas e intensas, assim como entre automedicação e o fato ser paciente muito ansioso, em avaliação realizada por meio do questionário de Inventário de Ansiedade Traço-Estado (IDATE) (Testes Exatos de Fisher P< 0,05). Quanto ao padrão de prescrição, anti-inflamatórios não esteroides foram os medicamentos indicados com maior frequência (36,9%). Antimicrobianos foram prescritos em 65 (36,3%) atendimentos. Diagnósticos envolvendo patologias pulpares e periapicais foram os mais prevalentes (59,2%), sendo abertura coronária, medicação local e selamento o tratamento realizado na maioria dos casos (48%). Concluiu-se que automedicação é prática comum entre os pacientes que buscam serviço público odontológico de urgência. Presença de dores moderadas e intensas e alto nível de ansiedade podem contribuir para esta prática. Antiinflamatórios não esteroides e antimicrobianos são os medicamentos mais frequentemente prescritos pelos cirurgiões-dentistas após o atendimento. / Patients seeking dental care often report pain of varying intensity, especially those seeking urgent care. It is not uncommon for patients to seek relief from their symptoms, prior to dental consultation, through local measures and/or self-medication. Prescription of medications is common by dental surgeons, especially after urgent care. This study aimed to evaluate the intensity of dental pain reported by the patients at the time of consultation, use of local measures and the main medications used by the patients, through self-medication, prior to dental consultation, adverse effects and influences by social media (television, newspapers, magazines) at the moment of purchase of medicines. The drugs prescribed and the diagnoses performed by professionals working in dental emergency services were also analyzed, as well as an evaluation of the level of anxiety of the patients attended, through the Corah Dental Anxiety Scale and the Trait-State Anxiety Inventory questionnaire. A prospective, crosssectional observational study was conducted through an interview with 179 adult patients, attended at the Dental Emergency Service of the Federal University of Rio Grande do Sul (UFRGS) and the Emergency Care Unit (UPA) Moacyr Scliar. The frequency of selfmedication observed was 60.9%. The main drugs used prior to the consultation were nonopioid analgesics (54.2%). Patients who used antimicrobials accounted for 16.8% of the sample, with 6.7% of those interviewed using antimicrobials by self-medication. Adverse effects were reported by 21.5% of patients using medication. Use of local measures prior to the dental appointment was described in 59 (33%) consultations. Approximately one quarter of respondents (25.7%) reported feeling influenced by drug advertisements and have already purchased drugs by direct influence of advertisements. There was a statistically significant association between self-medication prior to the consultation and reporting of moderate and severe pain, as well as between self-medication and the fact that the patient was very anxious, using the Trait-State Anxiety Inventory (STAI) questionnaire (Fisher's Exact Tests P <0.05). Regarding to the prescription pattern, non-steroidal anti-inflammatory drugs were the most frequently indicated medications (36.9%). Antimicrobials were prescribed in 65 (36.3%) dental appointments. Diagnoses involving pulp and periapical pathologies were the most prevalent (59.2%), being coronary opening, local medication and sealing the treatment performed in most cases (48%). It was concluded that self-medication is common practice among patients seeking urgent dental public service. Presence of moderate and intense pain and high level of anxiety can contribute to this practice. Non-steroidal anti-inflammatory drugs and antimicrobials are medications most frequently prescribed by dentists after care.

Submitted by Jean Medeiros (jeanletras@uepb.edu.br) on 2016-08-15T16:37:14Z No. of bitstreams: 1 PDF - Cláudia Maria Gomes de Araújo.pdf: 32534390 bytes, checksum: b1b7d1a1560b733080b283b4866e5fb0 (MD5) / Approved for entry into archive by Secta BC (secta.csu.bc@uepb.edu.br) on 2016-08-17T15:29:47Z (GMT) No. of bitstreams: 1 PDF - Cláudia Maria Gomes de Araújo.pdf: 32534390 bytes, checksum: b1b7d1a1560b733080b283b4866e5fb0 (MD5) / Made available in DSpace on 2016-08-17T15:29:47Z (GMT). No. of bitstreams: 1 PDF - Cláudia Maria Gomes de Araújo.pdf: 32534390 bytes, checksum: b1b7d1a1560b733080b283b4866e5fb0 (MD5) Previous issue date: 2002-11-13 / This work researched self-medication among university lecturers in Campina Grande – PB. Its main objectives were to look at the prevalence, main pharmacological groups used without medical guidance, and the occurrence of problems caused by self-medication. It is a cross sectional study developed with one hundred individuals of the Centre of Science and Technology of the State University of Paraiba. A questionnaire including socio-demographical characteristics, habits and aspects related to medication consumption was applied. The main results show a high prevalence of self-medication (78%) among the lecturers, being headache the major cause (41,9%), and, as a consequence, analgesic and antipyretics were the most prevalence group of drug used (64,4%). An interesting information brought about by this research was that 55% of lecturers did not associate the word drug to a bad thing, linking the word drug only to the illicit ones. Although 80% were concerned with the consequences of drug misuse and 70% had already had problems with self-medication, 81% said medication should be used without medical prescription, and 12% would use antibiotic in this condition. Considering that we dealt with a population of reasonable socio- demographical conditions with enough information, it urges the need to implement public health policies involving all the sectors related to medicine as well as the need to raise the consciousness of the citizens towards their responsibility for their own health. / O presente trabalho investigou a ocorrência da automedicação em professores universitários de Campina Grande – PB, sobretudo, no que se refere à prevalência do fenômeno entre os docentes, aos grupos farmacológicos de medicamentos utilizados com maior frequência sem orientação médica e a existência de problemas ocasionados pela automedicação. Trata-se de um estudo transversal com abordagem hipotético-dedutiva. A análise descritiva, baseou-se nos dados coletados através de um questionário, aplicado em 100 professores do Centro de Ciências e Tecnologia da Universidade Estadual da Paraíba. As perguntas envolveram a caracterização sócio-demográfica, os hábitos e práticas medicamentosas dos entrevistados. Os principais resultados da pesquisa mostraram uma alta prevalência de automedicação entre os professores pesquisados, 78,2% dos mesmos se automedicaram e a principal motivação foi a dor de cabeça 41,9% prevalecendo assim, o uso de analgésicos/antipiréticos, 64,4%. Um fato verificado pelos dados coletados apontou que a maioria dos entrevistados, 55,0% não via no medicamento a sua face negativa, associando a palavra droga apenas às substâncias consideradas ilícitas. Outro dado importante foi que, embora houvesse uma grande proporção de professores que se preocupavam com a utilização de medicamentos sem prescrição médica (80,0%) e daqueles que já haviam tido problemas decorrentes de automedicação (70,0%), contraditoriamente, 81,0% deles opinaram que o medicamento deve ser utilizado sem orientação médica e, ainda, 12,0% faziam uso de antibióticos sem prescrição. Considerando que este dados vêm de uma população com um razoável nível sócio-demográfico e com acesso à informação, percebemos ser necessária a implantação de políticas públicas de saúde que envolva todos os setores relacionados a medicamentos e, ainda, que trabalhe com a necessária conscientização dos cidadãos em direção à responsabilidade por sua própria saúde.

A esquizofrenia é um transtorno mental que provoca a desorganização de diversos processos mentais. Trata-se de uma condição crônica com expressivo impacto em termos de sobrecarga pessoal e social. O tratamento medicamentoso contínuo é necessário para evitar recaídas e manter o paciente no melhor nível de funcionamento possível. Este estudo teve como objetivo compreender o significado da terapêutica medicamentosa para a pessoa com esquizofrenia, em sua perspectiva e na de seu familiar, e formular um modelo teórico sobre o fenômeno estudado. Para tanto, foi adotado como referencial teórico o Interacionismo Simbólico e, como referencial metodológico, a Teoria Fundamentada nos Dados. A pesquisa foi desenvolvida em um Serviço Ambulatorial de Clínica Psiquiátrica de um hospital universitário, um Núcleo de Saúde Mental e um CAPS II, localizados no interior do estado de São Paulo - Brasil. Pelo processo de amostragem teórica, foram selecionados para o estudo 36 pessoas com esquizofrenia e 36 familiares. A entrevista e a observação foram as principais estratégias utilizadas para a obtenção dos dados que foram coletados no período de 2008 a 2010. Os dados coletados foram transcritos e, posteriormente, analisados em três etapas: codificação aberta, axial e seletiva. Verificou-se que, ao ser acometido pela esquizofrenia, o paciente percebe-se \"vivendo dias difíceis\" e identifica no medicamento uma possibilidade de melhora. \"Pesando o custo-benefício do medicamento\" e \"identificando obstáculos e incentivos para o tratamento\" o paciente implementa estratégias \"agindo em busca de alívio\" para o sofrimento causado pela esquizofrenia ou pelo tratamento medicamentoso. Entretanto, esse indivíduo se julga \"permanecendo em um labirinto\", pois não encontra uma saída para livrar-se do transtorno e da necessidade da farmacoterapia. A experiência descrita se centraliza no fenômeno \"CONVIVENDO COM UMA AJUDA QUE ATRAPALHA\" que representa o significado da terapêutica medicamentosa para a pessoa com esquizofrenia. A teoria aqui apresentada fornece uma compreensão abrangente, contextualizada, motivacional e empática da realidade vivenciada pelo paciente. Desse modo, o presente estudo oferece subsídios para o planejamento da assistência a essa clientela e aponta elementos a serem investigados. / Schizophrenia is a mental disorder that provokes the disorganization of several mental processes. It is a chronic condition with considerable impact in terms of personal and social burden. Continuous medication treatment is needed to avoid relapses and maintain the patient at the best possible functioning level. This study aimed to understand the meaning of medication therapy for schizophrenia patients, from their own perspective and that of their relative, and to formulate a theoretical model for the study phenomenon. Therefore, Symbolic Interactionism was adopted as the theoretical framework, and Grounded Theory as the methodological framework. The research was developed at a Psychiatric Clinical Outpatient Service of a teaching hospital, a Mental Health Center and a CAPS II located in the interior of São Paulo State - Brazil. Through a theoretical sampling process, 36 schizophrenia patients and 36 relatives were selected for the study. Interview and observation were the main strategies used for data collection, between 2008 and 2010. The collected data were transcribed and later analyzed in three phases: open, axial and selective coding. It was verified that, when the schizophrenia affects them, the patients perceive that they are \"going through difficult times\" and identify the medication as a possibility for improvement. \"Weighing the cost-benefit of the medication\" and \"identifying treatment obstacles and incentives\", the patients put in practice strategies \"acting in search of relief\" for the suffering the schizophrenia or medication treatment causes. These patients, however, consider that they \"continue in a labyrinth\", as they do not find a way out to get rid of the disorder and the need for the drug therapy. The described experience centers on the phenomenon \"LIVING WITH HELP THAT BOTHERS\", which represents the meaning of the medication therapy for schizophrenia patients. The theory presented here provides a broad, contextualized, motivational and empathetic understanding of the reality these patients experience. Thus, this study offers support to plan care for these clients and appoints elements for further research.

Mammals begin learning food preferences in utero and maternally mediated influences early in life help offspring develop their feeding habits. Mammals also learn by individual experience to ingest medicinal compounds such as polyethylene glycol (PEG), which attenuates the negative post-ingestive effects of tannins, a group of potentially toxic plant secondary compounds. The objective of this study was to investigate the transmission of acquired self-medicative behavior from mother to offspring using polyethylene glycol (PEG) as a medicine to relieve malaise caused by tannins. I hypothesized that: 1) mothers trained to associate the beneficial effects of PEG while consuming tannins will pass this information to their offspring, and 2) lambs will be more efficient at utilizing PEG as a medicine against tannins in the presence of mother than lambs which learn without the influence of the mother. This hypothesis was evaluated in four phases: in the first phase, a group of ewes (Experienced) was conditioned to associate the beneficial effects of PEG after consuming a tannin-containing diet. Ewes were offered a meal of high-tannin food and PEG and subsequently, the high-tannin food and grape pomace (GP) with little nutritional and no "medicinal" effects. In the second phase, the experienced and a naïve group of ewes (Inexperienced) were given a choice between the high-tannin food, PEG, and GP. In the third phase, experienced and inexperienced ewes with their naïve lambs, and the group of naïve lambs without their mothers, were exposed to the tannin-containing diet, PEG, and GP. Finally, in the fourth phase, lambs were separated from their mothers, and lambs from all groups were offered a choice between the tannin-containing diet, PEG, and GP. Lambs from experienced and inexperienced mothers showed a higher preference for PEG than lambs exposed without their mothers who tended to show a higher preference for GP. Thus, the presence of mother (experienced/inexperienced) was important for naïve lambs to learn about the medicinal benefits of PEG. This source of trans-generational knowledge could aid in maintaining the information in the herd, increasing the efficiency and reducing the risk of learning about foods and environments exclusively by individual experience.

Posttraumatic stress disorder (PTSD) and alcohol use problems (AUP) commonly co-occur, have shared latent genetic risk, and are associated with many negative public health outcomes. Via a self-medication framework, trauma-related drinking to cope (TRD), an unexplored construct to date, may help explain why these two disorders co-occur, thus serving as an essential target for treatment and prevention efforts. The present study aimed to create a novel measure of TRD and examine its psychometric properties, investigate its indirect influences on the association between PTSD and AUP, as well as explore its potential shared molecular genetic risk with PTSD in a genetically-informative study of college students. A sample of 1,896 students with a history of trauma and alcohol use provided genotypic data and completed an online assessment battery. First, the psychometric properties of TRD and how it relates to relevant constructs were examined using descriptive statistics and structural equation modeling. Findings demonstrated support for the external validation of TRD, both with regard to PTSD and alcohol consumption and related problems, and suggested that TRD is a more specific measure of drinking to cope motives compared to the commonly used Drinking Motives Questionnaire coping subscale. Second, results from a correlated multiple mediator model indicated that, while accounting for the effects of generalized drinking motives, TRD partially mediated the relation between PTSD and AUP and that this relationship was stronger for males than for females. Results were substantiated using longitudinal data. Third, univariate and bivariate genotypic analyses were conducted for TRD and PTSD, most of which resulted in null findings likely due to insufficient sample sizes. However, genome wide association analysis identified several significant genetic variants associated with TRD in participants of European Ancestry. Genes associated with TRD included PRAME, a protein coding gene with antithetical effects to genes commonly implicated in alcohol metabolism, as well as several genes implicated in immune system functioning (e.g., IGH, IGHE, ELK2AP). Polygenic risk for PTSD was associated with PTSD in the present sample and nominally associated with TRD. Findings are discussed in the context of limitations, clinical implications, and future directions.

Diet selection and self-medication are fundamental to the survival of all species. The abilities to choose healthy foods in response to past consequences are basic elements of evolution. This study explores self-medication regarding tannins both as a medication and as a dietary challenge. In the first study, sheep with natural parasite infections were offered a low quality supplement containing a dose of tannins considered to be therapeutic (medicine), while the control infected lambs received the same supplement without tannins (placebo). This study included a group of parasite-free lambs. The parasitized lambs ate more of the tannin containing supplement than non-parasitized lambs for the first 12 d of the study, when parasite burdens were high, but differences became smaller and disappeared towards the end of the study when parasite burdens decreased. This result indicated lambs ability to detect the presence of internal parasites and to learn to ingest tannin when followed by relief from parasite burdens.In the second study, lambs grazed on pastures with forages containing saponins (alfalfa),iiialkaloids (endophyte-infected tall fescue) and tannins (birdsfoot trefoil). I observed the foraging behavior of groups of lambs after intra-ruminal infusions of tannins (treatment). Lambs that first received intraruminal infusions of tannins and then were offered 2-way choices between varieties of forages with high and low concentrations of either saponins, alkaloids, or tannins increased their preference for the high-saponin variety of alfalfa and the high-alkaloid variety of tall fescue relative to lambs not infused with tannins (controls). Lambs infused with tannins and offered choices among the 3 forages with high concentrations of secondary compounds also manifested higher preference for the high-alkaloid variety of tall fescue than control lambs. In contrast, lambs infused with tannin reduced their preference for the high-tannin variety of birdsfoot trefoil.This research has implications for many situations where forages with secondary compounds are available but underutilized. Landscapes where such forages are available could be used effectively with little or no harm to livestock if medicinal forages or supplements are made available and offered as alternatives so animals can learn about their benefits of chemical complementarities among different plant species.

Background: Self-care is a multi-dimensional concept and has different definitions. Amongthe definitions, Orem’s definition of self-care is more consistent. Orem (1995) argues that,self-care is a personal activity to take care and maintain of own self health and illness andprevention of disease related complications. Aim: The aim of the paper was to investigate the factors that contribute to self-care behavioramong patients with Type 2 DM as argued in the literature. Method: data was collected from the following electronic databases: CINAHL, PubMed,LibHub, SweMed and Google Scholar-to find full texts. Data was analyzed through CriticalAppraisal Skill Programme. To ensure validity and reliability the author were blinded toreduce study bias and articles were selected according their quality. Result: 31 relevant studies were included in the review, among the major findings of the studywere; Age, Social support/network, high income level, high educational attainment and longType 2 DM diagnosis history had a positive predictor in Type 2 DM patients self-carecontributing factors. Conclusion: To improve a Type 2 DM patients self-care activities the present study concludedthat Demographic, Socio-Economic and Social support factors are among the positivecontributors in patients of Type 2 DM successful Self-Care activities. Key words; Blood glucose self-monitoring, self-administration, Self-care, self-medication,Type 2 Diabetes. / The aim of the paper was to investigate the factors that contribute to self-care behavior among patients with Type 2 DM as argued in the literature.