Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-05-12T12:48:49Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) LUANNA ARAUJO VERSÃO FINAL corrigida.pdf: 885561 bytes, checksum: e935406a47c78acf707661cf3e13054b (MD5) / Made available in DSpace on 2017-05-12T12:48:49Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) LUANNA ARAUJO VERSÃO FINAL corrigida.pdf: 885561 bytes, checksum: e935406a47c78acf707661cf3e13054b (MD5) Previous issue date: 2016-04-28 / A adolescência é um período caracterizado por diversas mudanças no desenvolvimento biológico, psicológico e social. Durante este período são experimentadas vivências significativas que podem trazer uma série de riscos à saúde, o que inclui o uso de substâncias lícitas de maneira exagerada ou inadequada ou até mesmo o uso de substâncias ilícitas. Estudos voltados para a população adolescente demonstram que a automedicação nesta faixa etária é frequente, sendo necessário conhecer em que medida estes indivíduos estão sujeitos a esta prática. Nesse sentido, esta pesquisa teve como objetivo de avaliar a automedicação entre adolescentes em idade escolar correlacionando esta prática aos fatores psicossociais e socioeconômicos, tratando-se de uma pesquisa do tipo corte transversal que se encontra integrada ao “Levantamento das condições de saúde bucal e psicossocial dos escolares de 15 a 19 anos do Município de São Lourenço da Mata – PE”, sendo o estudo de origem um estudo de base para uma coorte com fonte de dados primários. A pesquisa foi realizada nas escolas públicas do município de São Lourenço da Mata – PE, município escolhido por ser alvo de investimentos econômicos consideráveis nos últimos anos, fato que pode ter influência na mudança de comportamento dos jovens da comunidade local. Foram incluídos os adolescentes de 15 a 19 anos, matriculados em escolas da rede pública de São Lourenço da Mata. Os resultados apontam que um grande percentual da população adolescente local pratica a automedicação (64,7%), sendo a indicação por pais, familiares e amigos. A prevalência da automedicação é maior entre o sexo feminino (p=0,001) e a maior parte dos jovens afirma que não se sente ou se sente parcialmente segura para utilizar as medicações sem o auxílio dos pais. / Adolescence is a period characterized by several changes in the biological, psychological and social development. During this period significant experiences are experienced which can bring a number of health risks, including the use of legal substances exaggerated or improperly or even the use of illicit substances. Studies aimed at adolescents show that selfmedication in this age group is often, being necessary to know to what extent these individuals are subjected to this practice. Thus, this study aimed to evaluate the selfmedication among adolescents of school age correlating this practice to psychosocial and socioeconomic factors, in the case of a cross-sectional survey that is integrated into the "Survey of oral health status and psychosocial the school from 15 to 19 years in the city of São Lourenço da Mata - PE, "and the study of origin a baseline study for a cohort of primary data source. The survey was conducted in public schools in São Lourenço da Mata - PE, city chosen to be the target of considerable economic investments in recent years, which may have an influence on changing the behavior of young people in the local community. adolescents were included from 15 to 19 years enrolled in public schools in Sao Lourenco da Mata. The results show that a large percentage of the local teen population practice self-medication (64.7%), and the indication by parents, family and friends. The prevalence of self-medication is higher among females (p = 0.001) and most of the young people said that does not feel or feel partially safe to use medications without the help of parents.

Orientador: Fabio Bucaretchi / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T14:44:25Z (GMT). No. of bitstreams: 1 Tourinho_FrancisSolangeVieira_D.pdf: 4640374 bytes, checksum: 2b36c48e1a918184ac45857ce3838cb0 (MD5) Previous issue date: 2008 / Resumo: Este trabalho teve como objetivo determinar a prevalência da automedicação em crianças e adolescentes dos municípios de Limeira e Piracicaba (estado de São Paulo), em relação à indicadores sociodemográficos e da utilização de serviços de saúde (público ou privado) e, numa 2ª etapa, avaliar as características das farmácias domiciliares e sua relação com a automedicação. Realizou-se um estudo descritivo tipo inquérito populacional domiciliar, entre 8 de setembro de 2003 e 7 de setembro de 2004, de uma amostra aleatória simples de ambos os municípios, constituída de 772 moradores procedentes de 85 setores censitários selecionados por meio de amostragem por conglomerado. Critérios de inclusão: idade 'menor ou igual¿ 18 anos; entrevista obrigatória com um dos responsáveis legais; inventário da farmácia domiciliar; ter consumido pelo menos um medicamento nos 15 dias prévios à data da entrevista. Segundo a orientação de uso de medicamentos os participantes foram divididos em 2 grupos de estudo: automedicação (orientação leiga) e prescrição médica. Realizados análise descritiva das variáveis, testes de associação linear e regressão logística múltipla. Noventa e um virgula três por cento das famílias estocavam medicamentos no domicílio além dos prescritos para o tratamento vigente, restringindo, na 2ª etapa, a análise de 705 farmácias domiciliares. A prevalência da automedicação foi de 56,6%. Os principais responsáveis e indutores da automedicação foram as mães (51%) e funcionários de farmácia (20,1%). Os principais grupos de medicamentos administrados na automedicação foram: analgésicos/antipiréticos e antiinflamatórios não hormonais (52,9%); medicações de ação nos tratos respiratório (15,4%) e gastrintestinal (9,6%); e antibióticos sistêmicos (8,6%). As situações que mais motivaram a automedicação foram afecções respiratórias (17,2%), febre (15%) e cefaléia (14%). Indivíduos na faixa etária de 7-18 anos (razão de chances, RC= 2,81) e usuários de serviços públicos de saúde (RC= 1,52) apresentaram risco aumentado de automedicação. Em relação às farmácias domiciliares, foram identificados 3.619 medicamentos (média= 5,1/ domicílio; 79,6% especialidades farmacêuticas). Os principais cômodos de estoque foram os dormitórios (47,5%), cozinha (29,9%) e banheiros (14,6%); 76,5% em caixas de papelão e 22,4% de fácil acesso para crianças com idade < 6 anos. Considerando somente as especialidades farmacêuticas (n= 2.891), as mais freqüentes foram analgésicos/antipiréticos (26,8%) e antibióticos sistêmicos (15,3%), sendo o estoque desses medicamentos significativamente mais elevado no grupo automedicação (p < 0,01). Guardar medicamentos nos banheiros (razão de chances = 1,59) e grau de instrução dos responsáveis legais 'menor ou igual¿ 4 anos do ensino fundamental (razão de chances = 2,4) denotou maior risco de automedicação. Pôde se concluir que é comum armazenar medicamentos nos domicílios, sendo elevada a prevalência da automedicação em crianças e adolescentes / Abstract: The aim of this study was to establish the prevalence of self-medication in children and adolescents in the municipalities of Limeira and Piracicaba, state of São Paulo, and to correlate the results with sociodemographic indicators and with the use of health care services (public or private). In a second stage, we did the evaluation of home pharmacies supplies and correlate it with self-medication. This is a descriptive population-based study of a simple random sample from the two municipalities, comprised of 772 inhabitants from 85 urban census sectors selected through cluster sampling. Inclusion criteria: age = 18 years; interview with one parent/tutor; consumption of at least one drug in the previous 15 days; inventory of home pharmacies. Subjects were divided into two study groups according to their pattern of drug use: self-medication (lay advice) and medical prescription. Linear association tests, descriptive analysis of variables and multiple logistic regression tests were carried out to analyze data. It was found that 91.3% of the 772 families stored medicines at home in addition to those prescribed for treatment, restricting ¿ during the second stage ¿ the analysis to 705 home pharmacies. The prevalence of self-medication was 56.6%. Mothers (51%) and drugstore employees (20.1%) were most frequently responsible for self-medication. The main groups of self-prescribed drugs were: analgesic/antipyretic and non-hormonal anti-inflammatory drugs (52.9%); drugs acting on the respiratory tract (15.4%) and gastrointestinal drugs (9.6%); and systemic antibiotics (8.6%). The situation that most commonly motivated self-medication were respiratory diseases (17.2%), fever (15%), and headache (14%). Subjects in the age group of 7-18 years (odds ratio= 2.81) and public health care users (odds ratio = 1.52) showed increased risk for self-medication. Regarding the home pharmacies, a total of 3,619 stored medicines were identified (mean= 5.1/ home; 79.6% pharmaceutical drugs). The most frequent storage places were bedroom (47.5%), kitchens (29.9%) and bathroom (14.6%); 76.5% had been storage in cardboard boxes and 22.4% within easy children reach (< 6 yr old). Regarding only pharmaceutical drugs (n= 2,891), the main groups supplies were identified as analgesic/antipyretic (26.8%) and systemic antibiotics (15.3%), both significantly associated with self-prescription (p < 0.01). Save medicines in the bathroom (odds ratio = 1.59) and low level of education of parents/tutors (= 4 yr of elementary school; odds ratio = 2.40) showed increased risk for self-medication. We may conclude that storage medicines is a common situation and that is high the prevalence of self-medication in children and adolescents / Doutorado / Saude da Criança e do Adolescente / Doutor em Saude da Criança e do Adolescente

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.

Submitted by isabela.moljf@hotmail.com (isabela.moljf@hotmail.com) on 2017-08-29T12:12:44Z No. of bitstreams: 0 / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-08-30T14:31:02Z (GMT) No. of bitstreams: 0 / Made available in DSpace on 2017-08-30T14:31:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-07-06 / O termo desordens temporomandibulares (DTM) refere-se a um conjunto de problemas clínicos dolorosos e/ou funcionais que pode acometer o sistema estomatognático, representando uma importante causa de dor crônica na região orofacial. Muitos pacientes com queixas constantes associadas ao distúrbio consideram a automedicação como meio mais rápido e prático para aliviar suas dores e não procuram ajuda de um profissional. Atualmente não há na literatura um instrumento específico para avaliar a prática de automedicação em pacientes com DTM, sendo objetivo do presente estudo construir e validar um questionário com essa finalidade. A primeira etapa para construção do instrumento foi a fase qualitativa, na qual, para que fossem gerados itens para construção do instrumento foram realizadas uma ampla revisão da literatura sobre os temas envolvidos no estudo, entrevistas semiestruturadas com pacientes com DTM e a dinâmica do grupo focal. Após essas etapas o material gerado foi criteriosamente lido e avaliado para que se iniciasse a construção do instrumento. Elaborou-se a primeira versão do questionário, sendo as perguntas desenvolvidas com base em escala de Likert, com cinco opções de resposta. A primeira versão do instrumento resultou em 62 questões divididas em 4 dimensões: DTM/Dor orofacial, medicamentos utilizados, opinião/atitudes com relação à automedicação, atendimento/tratamento das DTM. Após a validação de face realizada por um comitê de especialistas, alguns itens foram excluídos e outros criados, assim como a ordem dos mesmos foi alterada, para facilitar a leitura do pesquisador, porém sem permitir respostas semelhantes devido à sequência de perguntas muito parecidas. A versão para pré-teste apresentava 48 perguntas, e apesar de nenhuma das questões apresentar um grau de incompreensão maior que 20%, sete questões foram excluídas, por serem consideradas repetitivas e com pouca diferença do poder explicativo, quando comparadas a outras perguntas, após avaliação inicial dos dados. A versão para validação com 41 itens, foi aplicada em uma amostra de 110 pacientes com diagnóstico de DTM de acordo com os critérios do RDC/TMD (1992). De acordo com análise fatorial, 7 questões com carga abaixo de 0,30 foram retiradas, sendo sua versão final bifatorial, composta por 34 perguntas. A análise da consistência interna e estabilidade temporal resultou em valores de 0,844 do coeficiente de Alfa de Cronbach e 0,810 do coeficiente Kappa, respectivamente, indicando que o questionário apresenta confiabilidade e capacidade de reprodutibilidade, tendo propriedades satisfatórias para o objetivo que se propõe. Como objetivo final de classificar os pacientes de acordo com o grau/intensidade de automedicação, foi proposta uma classificação que permitiu discriminar em 3 grupos distintos quanto à exposição da automedicação: leve (34-81 pontos), moderado (82-103 pontos), severo (104-170 pontos) com base na pontuação do escore bruto de automedicação. Foi verificada maior prevalência (46,4%) de casos moderados de automedicação. Em síntese, espera-se que o instrumento construído possa contribuir para o desenvolvimento de mais estudos que avaliem a automedicação associada às DTM. A partir de uma maior discussão do assunto na literatura da área, será possível difundí-lo, esclarecendo importantes questões associadas à prática estudada, visando, principalmente, a sua redução. / The term temporomandibular disorders (TMD) refers to a set of clinical problems involving pain and/or dysfunction that can affect the stomatognathic system, representing a major cause of chronic pain in the orofacial region. Many patients with constant complaints associated with such disorders consider self-medication the fastest and most convenient way to ease their pain, and do not seek help from a professional. Currently there is no specific instrument found in the literature to assess the practice of self-medication in patients with TMD, thus the objective of this study was to construct and validate a questionnaire for this purpose. The first step in constructing the instrument was the qualitative phase, in which a comprehensive review of the literature on the subjects involved in the study, semi-structured interviews with TMD patients, and focus group dynamics were carried out in order to generate items for constructing the instrument. The generated material was then carefully read and evaluated in order to begin construction of the instrument. The first version of the questionnaire was developed, with questions based on five-point Likert scale response options. The first version of the instrument resulted in 62 questions divided into four dimensions: TMD / orofacial pain, medications used, opinions / attitudes regarding self-medication, care / treatment of TMD. Aftervalidation performed by a committee of experts, some items were excluded and others created, and their order was amended as well, to facilitate reading by the researcher, but without allowing similar responses due to the sequence of very similar questions. The pre-test version had 48 questions, and although none of the questions presented a misunderstanding rate greater than 20%, seven questions were excluded for being considered repetitive, and with little difference in the explanatory power compared to the other questions, after initial assessment of the data. The version for validation, with 41 items, was administered to a sample of 110 patients diagnosed with TMD according to the criteria of the RDC/TMD (1992). According to factor analysis, 7 questions with loadings below 0.30 were taken out, with the final version consisting of 34 questions. The analysis of internal consistency and temporal stability resulted in values of 0.844 for Cronbach's alpha coefficient and 0.810 for the Kappa coefficient, respectively, indicating that the questionnaire presents reliability and reproducibility, having satisfactory properties for its proposed objective. As to the ultimate goal of classifying patients according to the degree / intensity of self-medication, a classification was proposed that allowed discrimination into three distinct groups regarding self-medication exposure: mild (34-81 points), moderate (82-103 points), severe (104-170 points), based on the total for the self-medication raw score. Highest prevalence (46.4%) was observed for moderate cases of self-medication. In summary, it is hoped that the resulting instrument will contribute to the development of further studies assessing the self-medication associated with TMD. From further discussion of the subject in the literature, it will be possible to disseminate more information, clarifying important issues associated with the practice under study, aiming mainly at its reduction.

Orientador: Priscila Maria Stolses Bergamo Francisco / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T03:11:40Z (GMT). No. of bitstreams: 1 Oliveira_MarceloAntunes_M.pdf: 1564901 bytes, checksum: f7e3ecf4821c06b1c5f43ec0e9968920 (MD5) Previous issue date: 2012 / Resumo: O padrão de utilização de medicamentos, bem como a automedicação, têm sido amplamente investigados em estudos epidemiológicos nacionais e internacionais. Considerando-se o acelerado envelhecimento populacional e a demanda por informações locais para o planejamento e a gestão em saúde, o objetivo do presente estudo foi contribuir para a investigação de fatores associados à automedicação em idosos, identificando os principais fármacos consumidos por esta população sem a prescrição de um profissional habilitado. Trata-se de um estudo transversal de base populacional realizado a partir de registros de indivíduos com 60 anos ou mais, disponíveis na amostra do Inquérito de Saúde no município de Campinas (ISACamp) realizado em 2008-2009. Dos 1.515 idosos que responderam questões sobre medicamentos, 80,4% referiram uso de ao menos um medicamento nos três dias anteriores à pesquisa. Desses, 91,1% relataram consumo exclusivo de medicamentos prescritos e o restante (8,9%), uso simultâneo de prescritos e não prescritos. Após ajuste, idade > 80 anos, hipertensão arterial, presença de doenças crônicas, procura por serviços de saúde, realização de consultas odontológicas e filiação a plano médico de saúde estiveram associadas negativamente, e renda familiar per capita, positivamente à automedicação. Os fármacos sem prescrição mais consumidos foram dipirona, ácido acetilsalicílico (AAS), diclofenaco, Ginkgo biloba, paracetamol e medicamentos homeopáticos. Principalmente entre idosos, a assistência farmacêutica deve ser priorizada para evitar o uso incorreto de medicamentos e garantir o acesso aos fármacos necessários para a prevenção de agravos, tratamento e cura das doenças / Abstract: The pattern of drug use and self-medication, have been widely investigated in national and international epidemiological studies. Considering the rapid population aging and the demand for local information for planning and management in health, the objective of this study was to contribute to the investigation of factors associated with self-medication in older adults, identifying the main drugs consumed by this population without a prescription a qualified professional. A cross-sectional population-based study with clustered two-stage sampling was conducted from records of individuals aged 60 years or more, available in the sample of Health Survey in Campinas (ISACamp - 2008/2009). Of the 1,515 elderly studied, 80.4% reported using at least one drug duringthe three days preceding the survey. Of these, 91.1% reported the use of prescription drugs only and the remainder (8.9%) reported simultaneous use of prescribed and non prescribed drugs. After adjustment, a negative association between age > 80 years, hypertension, chronic diseases, use of health services, dental consultations and adherence to a medical plan,and self-medication was found, whereas a positive association was found with per capita income. Dipyrone, acetylsalicylic acid, diclofenac, Ginkgo biloba, paracetamol and homeopathic medicines were among the most used non-prescribed drugs. Pharmaceutical assistance should be provided as a priority to the elderly, to avoid the misuse of medicines and ensure access to the correct drugs for prevention, treatment and cure of diseases / Mestrado / Mestre em Saude Coletiva

Contexte : les règlements distinguent habituellement les médicaments prescrits uniquement (prescription only medicines POM) et les médicaments en vente libre (over-the-counter OTC). Les premiers nécessitent une prescription médicale et les derniers sont disponibles pour l'automédication sans ordonnance. Au Liban comme dans les autres pays de l’Est de la Méditerranée, les médicaments théoriquement prescrits peuvent facilement être achetés sans ordonnance. Les antibiotiques sont parmi les classes de médicaments les plus fréquemment vendus sans ordonnance. L'utilisation inappropriée d'antibiotiques augmente le taux de résistance bactérienne et la fréquence de l'échec du traitement. Cette étude est menée pour déterminer le mode d'emploi des antibiotiques disponibles en tant qu'automédication au Liban, en comparaison avec leur utilisation comme médicaments uniquement prescrits en France. Méthode : Tout d'abord, une revue approfondie de la littérature publiée (1990-2015) a été menée en utilisant les bases de données : Pubmed, Web of Science, Cochrane et Google Scholar, pour abus de médicamentsdisponibles sans ordonnance au Moyen-Orient ;les antibiotiques étaient parmi les médicaments les plus mal utilisés. Une étude prospective a ensuite été menée au Liban. Les données ont été collectées auprès de patients qui achetaient des antibiotiques avec ou sans ordonnance dans les officines sur une période d’un an (septembre 2015 à septembre 2016). En France, les données ont été extraites de la base de données Echantillon Généraliste de Bénéficiaires (EGB), contenant un échantillon représentatif permanent 1/97 du système d'assurance-maladie national français, qui contient toutes les prescriptions dispensées en France. Nous y avons mené des recherchespour identifier les modes d'utilisation des 5 antibiotiques les plus utilisés au Liban. Résultats : La distribution moyenne de ces antibiotiques était plus élevée en France (18,6 DDD) qu'au Liban (10.6DDD). Cependant, le nombre moyen de dérogations au Liban était de 3,39 par an, plus élevé qu'en France (2 par an). Ce n'était pas différent entre les participants avec ou sans ordonnance. Le coamoxiclav a été largement consommé au Liban à la fois sous ordonnance et par automédication, alors que l'amoxicilline était le principal antibiotique consommé en France.62,4% des patients ont utilisé le bon antibiotique et 80,1% l'ont utilisé dans le dosage correct. Dans la suivi, la durée du traitement était inappropriée dans la majorité des cas (68,6%). Lorsque tous ces trois facteurs ont été additionnés, il s'avère que 83,6% des antibiotiques ont été utilisés de manière inappropriée. La pertinence de l'utilisation a été observée chez 27,6% et 16,4% des antibiotiques prescrits et non prescrits, respectivement. Conclusion : Il est certain que l'automédication observée ou l'utilisation médicalement non surveillée d'antibiotiques est un risque majeur. Les premières mesures à prendre pour réduire celles-ci sont éducatives, pour les patients, les pharmaciens, les prescripteurs, l'industrie pharmaceutique et les autorités réglementaires. / Background: Regulations usually distinguish between prescription-only (POM) and over-the-counter (OTC) medicines. The former requires medical prescription; the latter are available for self-medication (SM) without a prescription. In Lebanon as in other Eastern Mediterranean countries, theoretically prescription medicines can easily be purchased without a prescription. Antibiotics are among the most commonly sold drug classes without prescription. The inappropriate use of antibiotics increases the rate of bacterial resistance and the frequency of treatment failure. This study is conducted to determine the usage pattern of antibiotics available as self-medication in Lebanon, compared with their use as prescription only drugs in France. Method: First, an extensive review of the published literature (1990–2015) was conducted using Pubmed, Web of Science, Cochrane and Google Scholar databases, for OTC medicine misuse and abuse in the Middle East. Antibiotics were among the most commonly misused medications. A cross sectional prospective field study was then conducted in Lebanon. Data was collected from patients seeking antibiotics with or without prescription in community pharmacies over a 1-year period (September 2015 to September 2016). In France, data was extracted from the EchantillonGénéraliste de Bénéficiaires (EGB) database, the permanent 1/97 representative sample from the French national healthcare insurance system which contains all dispensed prescriptions in France. It was searched in 2013 to identify usage patterns of antibiotics, of 5 antibiotics most commonly used in Lebanon. Results: The average dispensing for these antibiotics was higher in France (18.6 DDD) than that in Lebanon (10.6DDD). However, the average number of dispensings in Lebanon was 3.39 per year, higher than that in France (2 per year). It was not different between participants with or without prescription. Coamoxiclav was widely consumed in Lebanon as both prescription and self-medication, whereas amoxicillin was the main antibiotic in France. 62.4% of patients used the right antibiotic and 80.1% used it in correct dosage. The duration of treatment in the follow up was inappropriate in the majority of cases (68.6%). When all of these three factors were summed together, it turned out that 83.6% of antibiotics were utilized inappropriately. Appropriateness in use was seen in 27.6% and 16.4% of the prescribed and non-prescribed antibiotics respectively. Conclusion: Misuse of antibiotics is a major driver in the development of antibiotic resistance, an issue for individuals and for public health. Obviously the observed self-medication or medically unsupervised utilization of antibiotics is a major risk. The first measures to take to reduce this are educational, for patients, pharmacists, prescribers, the pharmaceutical industry and the regulatory authorities.

Abtract Charles University Faculty of Pharmacy in Hradec Králové Department of Social and Clinical Pharmacy Title of diploma thesis: The analysis of self-medication with antibiotics in Kaliningrad region - pilote study Student: Kira Matveicheva Supervisor: prof. PharmDr. Jiří Vlček, Ph.D. Consultant: Tatiana Belkina, Ph.D. Objectives: In the theoretical part, I will focus on the self-medication with antibiotics, including its causes and consequences, and the problems associated with the emergence of antibiotic resistance. The aim of the practical part is to analyze the probability and reasons of self-medication with antibiotics in the Kaliningrad region. Methods: A study was conducted from July-August 2015 of community pharmacists and pharmaceutical assistants in Kaliningrad region, Russia. The theoretical part contains a literature research about self-medication with antibiotics and antibiotic resistance which was performed through using PubMed. The main keywords which were used were: "self- medication; antibiotics use; antimicrobial resistance". In practical part was used a self- administered questinnaire to assess antibiotic dispensing without a medical prescription by pharmacists/ pharmaceutical assistants and causes of self-medication practices. Results: Eighty questionnaires were completed, with a...

Magister Public Health - MPH / Irrational use of medicines is a global health problem. The World Health Organization has reported that more than 50% of all medicines are prescribed, dispensed and sold inappropriately, and that more than 50% of patients fail to take their medicines correctly (Holloway, 2006). The rational use of medicines is one of the core components of the National Strategic Plan for the Implementation of a Pharmaceutical Policy in Cameroon (MOH, 2000). In Cameroon, it has been noted that instead of going to the hospital when they fall sick, consumers prefer to self-medicate or visit a street vendor, traditional or faith healer or quack doctor (World Bank, 1995) and that they adjust the quantity of medicines they take based on their ability to pay for them (van der Geest, 1991). Aim and Objectives This study described the factors influencing the use of medicines by consumers in Tiko sub-division at household level, community level, health institutions level, and national level. Study Design This study used a qualitative study design to explore the factors influencing the use of medicines by consumers in Tiko-subdivision, Cameroon. Study Population and Sampling Six focus group discussions with consumers representing the different socio-economic and educational levels of Tiko sub-division were conducted. Two focus groups with members of each of the following organizations - Plantain Traders Association, Township Taxi Drivers Association and Teachers of Tiko High School. Six in-depth interviews with key informants were carried out, three with workers that sell medicines in community pharmacies and three with workers that sell medicines in the informal sector. Data Collection and Analysis Notes and observations were taken during the focus groups and key informant interviews. In addition, the proceedings were audio taped and the recordings were used to expand and clarify the notes. The data obtained was analyzed to identify recurring themes from the various influences of medicine use on consumers. Results Factors that influenced consumers’ use of medicines were categorized into household, community, health institutional and national levels. At the household level key influences were the consumers’ perceived need for medicines, the cost of medicines, the purchasing habits of consumers, the literacy level and consumers’ idea about efficacy and power of medicine, together with polypharmacy and polytherapy. At the community level, the medicine use culture, medicine supply channels and the sources of information of medicines influenced consumers’ use of medicines. At the health institutional level the influences reported were the quality of services, the cost of medicines, availability of medicines and consulting health worker. At the national level factors included, the media, lack of medicines regulation and control and medicines financing mechanisms. Discussion The study found that medicines use in Tiko sub-division was affected by a number of key factors. A number of cross-cutting themes were identified which had a critical impact on the rational use of medicines by this community. These themes were categorized as: sociocultural, economic and regulatory .Amongst the sociocultural factors was the way consumers perceived their need for medicines, their ideas about efficacy and the power of medicine and their perception of medicines as a commodity. Economic factors included user charges for health care - including medicines, and the high cost of medicines, while regulatory factors emanated from the illicit trade in pharmaceuticals, poor regulatory control and the lack of a national drug policy. Recommendations Proposals to improve the rational use of medicines by consumers in Tiko sub-division were identified to remove the sociocultural, economic and regulatory barriers to appropriate medicines use. Sociocultural strategies should focus on public education on medicines through role plays and audiovisual communication tools increase knowledge about medicines and to ensure behaviour change. Economic strategies should include the elimination of user charges and health financing strategies. Regulatory strategies proposed include amongst others, implementation of a national medicines policy and the setting up of a multisectoral task force to control sales of medicines.

This experimental study was designed to evaluate the effect of planned teaching on the self-medication practices of ambulatory cardiac patients. The sample was composed of forty male and female cardiac patients who were over the age of forty-five years, who lived at home and were of low socio-economic status. They all lived in a large urban centre and attended an outpatient clinic for medical attention. All were taking digoxin and thirty-six, 18 from each group, were also taking a diuretic. They were randomly assigned to two groups, experimental and control, when they visited the outpatient clinic. The twenty patients in the control group were given the usual routine factual information during their clinic visit. The twenty patients in the experimental group received additional planned teaching over a thirty-minute period by the researcher. The data were gathered by means of a twenty-item questionnaire designed to elicit information regarding the self-medication behavior of the study population. The questionnaire was administered in the homes of the patients ten to fourteen days following their visit to the outpatient clinic. Three hypotheses were tested in the study. Analysis of the data in relation to Hypothesis I indicated a statistically significant difference in the number of self-medication errors in digoxin and diuretics made in a twenty-four-hour period by patients in the experimental group as compared with the control group. The experimental group made significantly fewer errors. Although patients in the experimental group made fewer errors of the four types of errors studied with regard to Hypothesis II, there was not a statistically significant difference in errors related to time, dosage and non-prescribed medications made in a twenty-four-hour period by patients in the experimental group as compared with the control group. There was, however, a statistically significant difference in the fourth type of error--that of omission. The testing of Hypothesis III showed a statistically significant difference in the level of knowledge of the two groups of patients. The experimental group had a higher level of knowledge of their medications. The study concludes with consideration of implications for nursing practice and research. / Applied Science, Faculty of / Nursing, School of / Graduate

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