Over-the-counter Research Articles

Factors Associated with the Practice of Assessing Drug–Drug Interactions Among Pharmacists in Saudi Arabia

Background: Drug–drug interactions (DDIs) occur when two or more drugs are administered concomitantly, changing the pharmacokinetics or pharmacodynamics of a drug’s characteristics. Despite the advances in health technology, DDIs remain a concern to patient safety. This study aimed to (1) assess the knowledge, attitude, and practice of hospital and community pharmacists toward DDIs in Saudi Arabia and (2) examine factors associated with their practice. Methods: A cross-sectional study was conducted using an online self-administered questionnaire targeting hospital and community pharmacists working in Saudi Arabia. The study questionnaire consisted of five sections: demographics, knowledge, attitude, and practice toward DDIs, as well as pharmacy characteristics. Descriptive statistics were used to summarize the characteristics of participants as count and percentage. Chi-square tests were used to examine associations between practice variables and other independent variables. Results: A total of 131 pharmacists participated in the study. The majority were males (81.7%), aged 26–35 years (64.9%), and worked in community pharmacies (81.7%). Nearly half of the participants reported optimal practice regarding checking drug interactions before dispensing any drug. Factors associated with the practice of checking DDIs were found to be gender, perceived workload, perceived knowledge, and attitude variables. Regarding the practice of asking patients about their prescription and OTC drugs, there were statistically significant differences between hospital and community pharmacists. Conclusions: Our findings on both community and hospital pharmacists in Saudi Arabia reveal that pharmacists’ attitudes and perceived knowledge might influence the practice of pharmacists toward DDIs.

Predictive Powers of Carbon Emissions and Oil Price on Stock and Foreign Exchange (FX) Markets Using Multivariate Recurrent Neural Networks (RNN) Model

The predictive power of environmental factors such as CO2 levels and Brent oil price was evaluated on the stock market (S&P 500) and foreign exchange (FX) rates for market currency pairs (EUR/USD) and emerging market currency pairs (MXN/USD) with recurrent neural networks (RNN). The S&P 500 is a collection of well-established companies in the United States representing the macroeconomic health of the nation and the global economy. The FX market is a global decentralized over-the-counter (OTC) market used to determine the spot price of currency pairs. A highly leveraged market usually trades within a specific price range. Since stocks and FX pairs are highly correlated to macroeconomic factors, it was hypothesized that environmental factors such as CO2 levels and oil prices also have predictive power due to their close causal relationship with anthropological economic activities. To verify the predictive power, an RNN model was built, and a bi-directional neural network with an internal state was used to process data sequences. The performance of RNN was quantified by measuring the residual prediction from the true value. Although the study at its current state might need further statistical rigor, it concluded that environmental factors increased the predictive power for the S&P 500 while decreasing it for the DM FX pair and the EM FX pair showed mixed results.

Experiences of treating problematic over the counter and prescription only medication use in substance misuse services

Abstract Introduction There are growing concerns about the misuse of over the counter (OTC) and prescription only medication (POM), due to the associated negative socioeconomic and health implications1. To improve care delivery, stigma needs to be addressed and more needs to be known about the perspectives of staff who are working in substance misuse services (SMS)2. Aims To use confidential semi-structured interviews, to explore the experiences of community English SMS staff who have supported adults that have misused OTC/POM. Methods This research was conducted across five community adult English SMS operated by a national treatment provider. Individuals were eligible for participating in semi-structured interviews if they had current experience of working in a community SMS role which involved supporting adults who had misused OTC/POM, were at least 18 years of age and provided informed consent. Potential participants self-identified as being eligible and interested in being included, after receiving the participant information sheet. The interviews explored their experience of working in SMS and supporting people who have misused OTC/POM, and potential changes to current SMS provision. Thematic analysis of the audio-recording transcripts was undertaken using NVivo®. This research was funded by a Research Award from Pharmacy Research UK and the College of Mental Health Pharmacy [PRUK_CMHP-2019-2-RG]. This research was approved by Humankind/EDP and Aston University’s Life and Health Sciences Ethics Committees (ID#1655). Results Organising interviews was challenging due to pandemic-related work pressures, between October 2020 and January 2021. Thematic analyses of twenty SMS staff transcripts was undertaken and data saturation was thought to have been achieved. Three overarching themes were identified: characteristics of OTC/POM misuse; different groups of people; and negative experiences (with six sub-themes: lack of awareness of risk of harm; unmanaged health conditions; withdrawal symptoms; side-effects; problematic behaviours; and treatment pathways). Oral dependent use of opioids (especially codeine products), benzodiazepines and gabapentinoids predominated. Polypharmacy and the use of other substances sometimes occurred. OTC/POM misuse was associated with a wide range of adverse socioeconomic, physical, and psychological effects. Unmanaged withdrawal symptoms caused concern, contributed to perpetuating misuse, and sudden cessation in supplies created risks. Discussion and Conclusion This study had a unique focus on the experiences of third sector English SMS staff. OTC/POM misuse (and withdrawal symptoms) should be routinely enquired about during healthcare reviews, and tailored harm reduction, pharmacological and psychosocial interventions offered. Increased awareness, vigilance for associated safeguarding issues, and more training is required. SMS should sensitively consider how to incorporate the views of staff with lived experience to further optimise service delivery co-production. As staff were all employed by the same SMS provider, future research, conducted in SMS operated by other providers, and covering a wider geography, may enable more information to be shared, more participants to be recruited, and the results more generalisable. Repeat interviews and member-checking may improve assurance in the findings. The possible need for different SMS for those who only misuse OTC/POM without exacerbating stigma requires further exploration. Future research should identify if demographic characteristics and treatment needs differ by OTC/POM type.

Over-the-counter short-acting β2-agonist purchase and asthma-related health outcomes: a post hoc analysis of the SABINA III study

This post-hoc analysis of the SABINA III study evaluated the association of short-acting β2-agonist (SABA) prescriptions and self-reported over-the-counter (OTC) SABA purchase in the previous 12 months with asthma-related outcomes using multivariable regression models in 4556 patients (mean age, 48.9 years). Of the 2810 patients prescribed ≥3 SABA canisters, 776 (27.6%) also purchased ≥1 SABA OTC. This subset of 776 patients reported the highest disease burden; 73.2% had ≥1 severe exacerbation and 55.7% had uncontrolled asthma. Asthma-related outcomes worsened with any SABA OTC purchase, regardless of SABA prescriptions; disease burden was the highest in patients with ≥3 SABA prescriptions and ≥1 SABA OTC purchase vs 1–2 SABA prescriptions only (86% lower odds of having at least partly controlled asthma and 124% increased incidence of severe asthma (both P < 0.001). These findings emphasize the need to implement policy changes to restrict SABA purchase without prescriptions and ensure access to affordable asthma care.

Over-the-counter antibiotics compromising aminoglycoside activity.

Antimicrobial resistance (AMR) is a global issue that needs addressing. While antibiotic stewardship has improved often by restricting antibiotic use, some antibiotics that are still sold legally over the counter (OTC), notably in sore throat medications. Recent findings suggest OTC antibiotics could trigger cross-resistance to antibiotics used in clinical treatments, whether systemic or topical. Here we investigated the impact of three antibiotics contained in OTC sore throat medicines on emerging AMR in vitro. Bacterial pathogens were exposed to a bactericidal concentration of an aminoglycoside in the presence or absence of a during-use concentration of bacitracin, gramicidin or tyrothricin in a time-kill assay. Damage to the bacterial membrane was also investigated by measuring potassium leakage and membrane potential alteration post-OTC antibiotic exposure. Gramicidin (15 µg/mL) significantly decreased the bactericidal activity of amikacin, tobramycin or gentamicin in Acinetobacter baumannii. It also decreased gentamicin bactericidal activity in Enterobacter cloacae, Escherichia coli and Klebsiella pneumoniae, while tyrothricin decreased the aminoglycoside efficacy in E. cloacae and E. coli. Gramicidin significantly decreased bacterial membrane potential and caused significant potassium leakage. Gramicidin and to some extent tyrothricin impacted aminoglycoside efficacy by affecting membrane potential, which is essential for aminoglycosides uptake. Thus, some OTC antibiotics can interfere with aminoglycoside activity, which could in turn affect treatment efficacy. Although the likelihood of OTC antibiotics and aminoglycosides being used at the same time might not be common, this research highlights one potential reason for OTC antibiotics' usage to result in treatment failure and their contribution to AMR development.

Factors associated with over-the-counter drug misuse among young people: a narrative review

Abstract Background Over-the-counter (OTC) medications are sold directly to customers without requiring a doctor’s prescription. Misuse of OTC drugs is higher in adolescents and young adults than in the general population. This review is the first to narratively synthesize the factors associated with OTC drug misuse among adolescents and young adults (14-25 years old). Aim To identify the factors that are associated with OTC drug misuse among adolescents and young adults (14-25 years). Methods A comprehensive search of three electronic databases, including MEDLINE, PsycINFO and Web of Science, was conducted to retrieve publications between 1 January 1997 and 31 July 2023. The AXIS tool was used to aid critical appraisal. Papers were analysed using thematic analysis. Results Eight studies were eligible for inclusion in this narrative review We identified four key themes: motivational factors; health literacy; illicit drug use and socioeconomic status. Sensation-seeking and using OTC drugs for recreational purposes were associated with OTC misuse. Limited health literacy and lack of understanding of OTC drugs were significant factors for misusing OTC drugs. Greater use of OTC drugs at the same time as alcohol and other illicit drugs represented that they were at increased risk for misusing OTC drugs. Finally, adolescents and young adults with low income, from rural areas and with lower educational attainment were most likely to misuse OTC drugs. Conclusions Although over-the-counter medications (OTCs) encourage self-medication, their rising misuse has led to a public health problem to which nations worldwide are responding. Therefore, education and awareness among OTC drug users policy will be helpful further on strategies to prevent the misuse of OTC drugs. Key messages • This review identifies some of the factors for misusing OTC drugs, and education and awareness among OTC drug users policy may be helpful further in strategies to prevent the misuse of OTC drugs. • This review also identifies that changing the user habits and availability of OTC drugs policy may also be helpful in further strategies to prevent the misuse of OTC drugs.

Qualitative analysis of blood from patients engaging in deliberate self‐harm: Differences between prescribed and detected drugs

AbstractBackgroundWhile drugs are sometimes taken during deliberate self‐harm (DSH), no study has attempted to analyze drugs in the blood of DSH patients and compare them with prescribed medications or other drugs. In this study, drugs were analyzed from the blood of DSH patients, and the detected, prescribed, and suspected drugs were documented.MethodsPatients who practiced DSH and were transferred to the emergency sites of Fukuoka University Hospital between April 2021 and September 2022 participated in the study. Psychiatrists assessed information such as the history of psychiatric treatment and recent methods of DSH, as well as prescribed drugs within 1 month of presenting to the hospital. Blood samples were analyzed using LC–MS/MS. Participants were divided into groups according to whether or not they were prescribed psychotropics within 1 month.ResultsFifty‐five patients were enrolled in the study. Forty had been prescribed psychotropics within 1 month of hospital admission. However, non‐prescribed drugs (NPD) were detected in 42 of the 55 participants (76%). The detection of NPD was significantly high among patients with overdose of medications and OTC drugs (p = 0.036), but NPD were also detected in patients who engaged in other methods (n = 14), and in patients without prescribed medication (n = 10).DiscussionThis is the first study focused on the drug analysis of blood from patients engaging in DSH. Approximately 80% of the DSH patients in this study had taken NPD, revealing a large discrepancy between prescribed medications and those detected in the blood.

HiCorr: an influenza surveillance model using over-the-counter sales from community pharmacies

Abstract Background In large-scale community transmission, such as seasonal influenza, monitoring geographic trends and estimating the transmission intensity are critical to support public health decision-making. Previous studies have successfully used sales data from over-the-counter (OTC) products in community pharmacies to detect and monitor different epidemiological outbreaks, developing surveillance systems that are able to anticipate the load on primary care services and hospitals by up to 3 weeks. Methods The subset of OTC products sold in Portuguese community pharmacies was selected by correlating sales data to primary care attendance in previous flu seasons. This data pertained to daily coded episodes of influenza-like-illness (International Classification of Primary Care, 2nd Edition, code R80) in the Portuguese health cluster Oeste Sul. By fitting a moving epidemic method to historical sales data and then applying it to daily collected sales data, the developed index was used to anticipate the relative load to the primary care system as well as the start and the peak of epidemic activity for the current flu season. Results were compared to the public health data available on respiratory infections in Portugal. Results The model pinpointed the onset of the 2023-2024 flu epidemic in week 47 and its peak in week 52. The index curve showed a high correlation with the data published by the Portuguese national health service, with no time lag. However, the availability of consolidated public data was delayed, on average, by approximately two weeks. Discussion and conclusions Data from community pharmacies significantly enhance the early detection of seasonal flu trends, while reflecting population distribution. This underscores their invaluable contribution to public health assessments and the potential for improving the timeliness and accuracy of seasonal flu surveillance. Key messages • Community pharmacy data significantly enhance the early detection of seasonal flu trends. • Real world sales data maybe useful to support epidemic surveillance in public health.

Prevalence of potentially inappropriate medication use in the older population living in Germany

Abstract Background Potentially inappropriate medications (PIM) are medicines for which the risks for adverse events (AEs) usually outweigh the clinical benefits in older adults. PIM is associated with an increased risk of AEs, hospitalizations, mortality and higher health care costs. This analysis presents the prevalence of PIM use and associated factors in people aged 66+ years living in Germany. Methods Data from the nationally representative Study on Health of Older People in Germany (Gesundheit 65+) conducted between 2021-2023 by the Robert Koch Institute, was analyzed. All medicines used, prescribed and over-the-counter (OTC), in the 7 days before the interview were classified into anatomical therapeutic chemical codes. PIM use was identified based on the PRISCUS 2.0 list. Weighted prevalences and associated factors for PIM use are presented. Results 96% of the sample (N = 1,474) took at least 1 medication in the 7 days before the interview. The prevalence of PIM use was 29% (95% CI: 26%-32%), 23% took 1 PIM and 6% 2+. There were no sex differences but a significant increase with age: 23% in the age group 66-74, 33% in the age group 75-84, and 39% in the age group 85 + (29% 1 PIM and 10% 2+). People with a low educational level had a PIM prevalence of 32% compared to 21% in those with a high educational level. Among those reporting having chronic diseases, the PIM prevalence was 34% compared to 19% among those not reporting them. The prevalence of PIM increased with the number of medicines used: 13% in 1-4 medicines, 31% in 5-9 medicines, and 53% in 10+ medicines. The most frequently used PIM in this sample was ginkgo biloba leaf extract (plant-based antidementia drug) followed by diclofenac (non-steroidal anti-inflammatory drug), and then by tricyclic antidepressant drugs (opipramol and amitriptyline). Conclusions PIM use was higher than suggested by prescription data analysis. It was associated with higher age, chronic diseases, polypharmacy and a low educational level. Key messages • PIM use was common, affecting more people with chronic diseases, older age groups and people with a low educational level. • Strategies to promote and monitor appropriate medication use are needed.

Over-the-Counter Hearing Aids Versus Traditional Hearing Aids in Patients With Mild-to-Moderate Hearing Loss: Protocol for a Noninferiority Randomized Controlled Trial.

With the aging of society, the prevalence of hearing loss (HL) is increasing. Currently, approximately 5% of the global population has HL, and this number is projected to reach 7 million by 2050. Although hearing aids (HAs) are the primary treatment for HL, their use is limited by barriers such as high costs and social stigma. To address these limitations, over-the-counter (OTC) HAs have been introduced, but their effectiveness and drawbacks require further investigation. This study aims to conduct a noninferiority randomized controlled trial comparing OTC HAs with traditional HAs to assess the clinical effectiveness of OTC HAs. We designed a noninferiority randomized controlled trial comparing OTC HAs and traditional HAs in adults with mild-to-moderate HL. A total of 64 participants (32 per group) will be recruited. Randomization will be performed using block randomization (block sizes of 2 or 4) with an equal allocation ratio. The study will include 2 types of HAs: an OTC HA (Jabra Enhance Pro) and a traditional HA (LiNX Quattro LE561-DRW) by GN ReSound A/S. OTC HAs will be self-fitted using a smartphone app, while traditional HAs will be fitted by a licensed audiologist using the National Acoustics Laboratories-Non-Linear Prescription, second generation. Assessments, including functional gain, real-ear measurement, speech audiometry, and questionnaires, will be conducted at 6-month intervals over the course of 3 visits. Statistical analysis will compare the 2 outcomes, focusing on functional gain, to determine noninferiority. This study is scheduled to begin in August 2024 and has not yet recruited any participants. The study will be conducted over 2 years, from August 2024 to July 2026. Each participant will have 2 follow-up visits at 6-month intervals, making the total follow-up period 1 year. Since 2022, the introduction of OTC HAs has revolutionized access to these devices. Researchers, clinicians, and the general public are keen to evaluate the clinical effectiveness of OTC HAs, as more individuals will likely use them for HL. This increased usage will provide valuable real-world data to understand the benefits and limitations of OTC HAs. Monitoring the outcomes and user feedback will provide insights into their effectiveness and impact on hearing rehabilitation. PRR1-10.2196/59894.

Assessment of miligram(Mg) content of some notable analgesics used by residents of Maiduguri Metropolis: evidence from high performance liquid chromatographic technique

Diclofenac sodium and paracetamol are Over the counter (OTC) medications used as analgesic and antipyretic agents to relieve pains, fever and headaches. The aim of this work was determine the mg content of paracetamol and diclofenac sodium in selected samples across the Maiduguri metropolis using High Performance liquid chromatography (HPLC) method. For paracetamol samples an intersil ODS-3V column (150 mm × 4.6 mm; 5 μm pore size) was used at the temperature of 35oC the mobile phase was methanol: water (20:80) using isocratic elution at the flow rate of 2 mL/min, injection volume of 10 μL and a diode array detector. For diclofenac sodium samples, the chromatographic conditions were the same except the mobile phase which was methanol: water (63:37), flow rate of 0.8 mL min, injection volume of 20 μL and column temperature was set at 30 oC. A total of 45 samples were analysed; which comprised of paracetamol tablet, paracetamol syrup and diclofenac sodium tablet which were randomly selected from three different sources; hospital pharmacy, community pharmacy and drug patent stores. The percentage mg content for paracetamol tablets ranged from 48 to 83 % while that of the paracetamol syrups ranged from 72 to 120 % and finally diclofenac sodium tablets ranged from 73 to 174 %. Adopting the United State Pharmacopoeia (USP) as reference for assessment tool, it was observed that all the paracetamol tablet samples failed, 4 out of 15 paracetamol syrup samples failed, and 11 out of 15 diclofenac sodium tablet samples failed. There was statistical significance (p&lt; 0.05) between class of drug and percentage mg content but there was no significance (p&lt; 0.05) between source of drug and percentage constituent. HPLC technique was used successfully for quantitative determination of paracetamol and diclofenac sodium dosage forms.

RF pulsed plasma modified composite scaffold for enhanced anti-microbial activity and accelerated wound healing

Infected wounds present significant challenges pertaining to healing and often demand administration of strong antibiotics to patients. Also, drug resistant microbes may alter the physiology of wounds to create biofilms, frequently leading to high morbidity and mortality. In this investigation, a biodegradable, microporous composite agarose-chitosan scaffold was fabricated. Furthermore, its surface was modified with diphenyldiselenide deposition, using low pressure pulsed plasma technology. The optimized plasma parameters, viz. 5ON/15OFF (ms) of plasma pulse rate and 80 min of treatment time resulted in scaffolds having enhanced anti-bacterial activity against gram positive microbes like Staphylococcus (S.) aureus and S. epidermidis. The scaffolds were non-toxic to skin cells, as confirmed by the MTT assay. Cell proliferation through plasma treated and native scaffolds was assessed by culturing primary human dermal fibroblasts (HdaF) and human keratinocytes (HaCaT) and visualizing via confocal microscopy. Moreover, in-vivo rat model confirmed accelerated wound healing with plasma treated scaffold (100 % on day 14), as compared to the native scaffold (100 % on day 16) when compared with over-the-counter (OTC) ointment Betadine (100 % on day 12).

Assessment of knowledge, attitude and practice of over-the-counter drugs and dietary supplements among non-healthcare college students in Chitradurga

Background: The market for OTC drugs and dietary supplements is rapidly growing. However, there exists a lack of adequate awareness among the general public regarding the advantages and potential drawbacks associated with these products, particularly among the younger generation, who heavily rely on the internet for information. Therefore, this study sought to assess the knowledge, attitude and practice of college students regarding OTC drugs and dietary supplements, including prevalence and associated factors. Methods: A prospective interventional study with 306 participants was conducted. Data were collected using a self-designed and pre-validated questionnaire and analysed using Statistical Package for the Social Sciences (SPSS) version 28. Descriptive and inferential (T-test) statistics were use. Results: The prevalence of usage of OTC drugs and DSs was found to be 98.4% and 61.4% respectively. Easy accessibility (42.2%), safe and well tolerable (32.5%) were the main factors that influenced them to turn to SM with OTC drugs. The respondent’s preference for DSs was primarily driven by their desire to maintain good health (33.6%). Internet (22.2%) and healthcare professionals (21.9%) were the two most reported sources that students relied on to obtain information about DSs. The result revealed poor knowledge and a positive attitude towards OTC drugs and DSs among all participants. Conclusions: A high prevalence of self-medication with OTC drugs and dietary supplements use was highlighted. Notable issues and improper practices were recognized. The findings indicate a need for education to enhance knowledge about OTC drugs and DSs and to encourage safe practices.

OS RISCOS DO USO DE ANTI-INFLAMATÓRIOS NÃO ESTERÓIDES PELO PACIENTE DIABÉTICO NO BRASIL

Introduction: Diabetes mellitus (DM) is a chronic non-communicable disease characterized by hyperglycemia. The types of diabetes have different symptoms and treatments and can cause various chronic complications. Diabetic nephropathy and cardiovascular diseases stand out in this article. Anti-inflammatories are divided into two classifications: steroids and non-steroids (NSAIDs). NSAIDs can treat inflammation, pain, edema, osteoarthritis, rheumatoid arthritis, and musculoskeletal disorders. Still, they cause side effects, some of which can cause problems in the renal system and cardiovascular systems, systems that may already be at risk of suffering complications in diabetic patients. Despite these effects, some NSAIDs are Over-the-Counter Medications (OTC) and this facilitates self-medication and irrational use of these medications. Objective: To analyze the risks related to the use of NSAIDs by diabetics in Brazil. Methodology: The method was descriptive and quantitative research through a bibliographic review. Conclusion: Due to the prevalence of diabetics in Brazil and the common use of non-prescription NSAIDs, diabetics must avoid self-medication and be made aware and guided by health professionals.

Analysis of quality parameters and preservative concentrations in Sahacharadi Kwatha: A comparative study of three commercial brands

BackgroundSahacharadi Kwatha is traditionally employed in Ayurvedic therapy for "vata" related conditions such as back pain, herniated disc, palsy, sciatica, and paralysis. Classical Ayurvedic texts recommend the use of freshly prepared Kwatha for optimal patient benefits. However, in response to the commercialization of Ayurveda and the demand for convenient over-the-counter (OTC) formulations, various commercial preservatives have been incorporated by Ayurvedic manufacturers to facilitate OTC preparation and prolong shelf life. ObjectivesThis study aims to comprehensively analyse and compare the quality parameters and preservative content in three prominent brands of Sahacharadi Kwatha available in the Indian market. Materials and methodsOrganoleptic and physicochemical properties, phytochemical content, and microbial load of the samples were analyzed following standardized procedures. Sodium benzoate levels in the samples were determined using both titrimetric and High-Performance Liquid Chromatography (HPLC) methods. High-Performance Thin-Layer Chromatography (HPTLC) profiles were compared to discern differences among the samples. ResultsThe study revealed significant variations in organoleptic and physicochemical properties, HPTLC profiles, and microbial load among the tested samples. Sodium benzoate levels in all samples exceeded the FDA and API-approved limit. Additionally, substantial variations were noted in the phytochemical content of the samples. ConclusionThis investigation underscores noteworthy disparities in quality parameters and preservative content within the tested market variants of Sahacharadi Kwatha. The findings emphasize the existence of unregulated standards in the preparation of Ayurvedic medicines available in the market, highlighting the imperative for standardization and validation of Ayurvedic formulations. Such measures are essential for enhancing consumer acceptability and fostering the overall development and growth of the Ayurveda industry.

Benefit-Cost Analyses of Hearing Aids, Over-the-Counter Hearing Devices, and Hearing Care Services.

Limited accessibility to hearing health care threatens healthy aging in place for older adults with hearing loss. A willingness-to-pay (WTP) approach was used to determine benefits and value of prescription advanced digital technology (ADT) hearing aids, over-the-counter (OTC) hearing devices, and rehabilitative services using benefit-cost analyses. This study was a cross-sectional survey with chart review of hearing aid users at two independent audiology practices. Seventy hearing aid users (response rate: 15.6%) provided their WTP for ADT prescription hearing aids, OTC hearing devices, and hearing rehabilitative services. Benefit-cost ratios and net social benefit were calculated using deterministic and exploratory approaches. Point estimates for benefit-cost ratios and net social benefit were derived using bootstrap sampling with replacement (N = 5,000). Median WTP for ADT prescription hearing aids and rehabilitative services were $2,000 and $250, respectively. WTP was lowest for OTC devices (Mdn = $0; maximum = $500). Benefit-cost ratios and net social benefit for ADT prescription hearing aids, OTC devices, and hearing rehabilitative services favored these interventions when out-of-pocket costs remained low. Benefit-cost analyses also produced results favoring prescription ADT hearing aid intervention with costs as high as $1,530 per device. WTP results indicated that all interventions under study have a measurable consumer-perceived benefit. Results of benefit-cost analyses favored the interventions but only when costs were lower than market prices. The benefit-cost analysis results for hearing care services underscore their value when provided as part of a comprehensive rehabilitative plan that may inform future health policy changes.

Prevalence and Effect of Cannabinoids in Pain Management for Hand Pathologies.

Cannabinoids are a diverse group of compounds under investigation for various medical purposes, including analgesia. Given the evolving landscape of cannabinoid use, we aimed to analyze their prevalence and effect in pain management among urban orthopedic hand patients. An electronic survey was administered to 122 new patients presenting to the orthopedic hand clinic of a major urban academic hospital. Demographic data, numerical rating scale pain scores, cannabinoid usage, and other concomitant pain regimens were recorded. Approximately half of the new patients were dissatisfied with current pain management for their hand pathology. Prescription (Rx) and over-the-counter (OTC) pain medications were used by 58% (71/122) of patients, while cannabinoids were used by 15% (18/122) of patients. Compared with pre-usage pain scores, both cannabinoids and Rx/OTC medications induced significant reductions in pain associated with patients' hand pathologies (Cannabinoid: Δ4.4, P = .002; Rx/OTC: Δ3.0, P < .001). Cannabinoids induced a larger analgesic effect, but this difference was not statistically or clinically significant (P = .06). Subjectively, cannabinoid users either preferred their cannabinoid over Rx/OTC medications or liked both equally. Opioid use was higher among cannabinoid users (22.2% vs 12.5%), although this was not statistically significant (P = .28). Approximately 15% of new urban hand patients use cannabinoids for pain control, and these compounds have similar analgesic efficacy in hand pathologies as Rx/OTC medications. Cannabinoids are equally liked or preferred relative to traditional medications in this cohort, and they may play an important role in pain management for hand patients.

European vulnerable options pricing under sub-mixed fractional jump-diffusion model with stochastic interest rate

With the development of financial markets, the trading of financial derivatives has become more flexible. To meet the demands of investors, over-the-counter (OTC) trading of options has also become increasingly frequent, raising concerns about accurately pricing vulnerable options. This study investigates the pricing problem of European vulnerable options under the sub-mixed fractional jump-diffusion (SMFJ) model. Firstly, the underlying asset price model and the counterparty company value model are established under the SMFJ model with a sub-mixed fractional Vasicek stochastic interest rate. Then, analytical solutions for the European vulnerable options are obtained using the quasi-martingale measure transformation and the risk-neutral pricing method. Additionally, the accuracy of the pricing formula is verified through the Monte Carlo simulation method. Finally, the rationality and validity of the established model are confirmed by numerical simulations, and the influence of key parameters on the pricing models is analyzed.

9202 Characterizing The Physiological Side-Effects Of Over-The-Counter Arthritis Supplements

Abstract Disclosure: K.S. Wei: None. M.O. De La Torre: None. A. Flores: None. C.E. Chiu: None. T.E. Angell: None. Introduction: Over the counter (OTC) health supplements are commonly used by patients for a variety of ailments but may contain active ingredients that are not stated, such as glucocorticoids. Here, we present a case series of 12 patients seen by the Endocrinology Consult service at an urban safety net hospital during 2022-2023 and determined to have iatrogenic adrenal insufficiency (AI) from specific OTC supplements that surreptitiously contained glucocorticoids. Clinical Cases:12 patients using OTC arthritis supplements [Artri King (n=8), Ardosons (n=3), and Ajo Rey (n=1)] were identified. Median age was 52 years and 33.3% were female. All started using the supplements because of joint pain. Median length of use prior to cessation was 6 months. The most common presenting symptoms were nausea/vomiting (42%), fatigue (42%), abdominal pain (33%), and dizziness (17%). The most common physical exam findings of steroid excess included moon facies (66%), central adiposity (66%), abdominal striae (50%), dorsocervical fat pad (33%), and bruising (33%). 3/12 patients required ICU admission. Cortisol assessment was performed in 11/12 patients, which showed normal cortisol level in 1 patient (cortisol ≥16 mcg/dL), AI in 3 patients (cortisol ≤3 mcg/dL), and an equivocal level (cortisol 3-16 mcg/dL) in 7 patients. Cosyntropin stimulation testing in 6/7 patients with equivocal cortisol levels suggested AI in 4 (cortisol level &amp;lt;16 mcg/dL at 60 minutes after ACTH stimulation), whereas 2 showed lower but normal response (cortisol levels 18.2 mcg/dL and 18.4 mcg/dL). In total, 10/12 patients were prescribed glucocorticoid tapering replacements to avoid precipitating adrenal crisis. The most common regimens were hydrocortisone 20mg qAM/10mg qPM (33%) and hydrocortisone 5mg qAM/5mg qPM (17%). To date, 2/10 patients have successfully discontinued steroid replacement. Conclusion: These cases demonstrate possible Cushing’s syndrome and/or adrenal insufficiency after unintentional exposure to glucocorticoids in these OTC arthritis supplements, which has only previously been reported in a small number of case reports (1). This series collected over a 2-year period offers important clinical insights: Because patients may not identify or recall a supplement, possible use of OTC medications for arthritis or other anti-inflammatory purposes should be specifically assessed in patients presenting with adrenal insufficiency (especially with concomitant findings suggesting Cushing’s syndrome). For patients on such supplements, immediate discontinuation may not be possible without cortisol replacement and should be done with caution. 1)Boncompagni A.C. et al. A case of iatrogenic Cushing syndrome and subsequent adrenal insufficiency from a hidden ingredient in the supplement Artri Ajo King. J Am Coll Emerg Physicians Open. 2023;4(4):e13007. Presentation: 6/1/2024

Prospective study of risk factors for community-acquired acute kidney injury

Background and hypothesisCauses and risk factors for community-acquired acute kidney injury (CA-AKI) have not been thoroughly studied. The aim of this study was to examine the risk factors for CA-AKI. MethodsIn this prospective study, we examined serum creatinine from all individuals visiting a university hospital's emergency department (ED) over an 11-month period for the presence of AKI defined according to the KDIGO criteria. Patients with AKI were invited to participate. Randomly selected controls (1:2) were paired according to age, sex, and date of admission. Participants answered questions about their medical history and medication use, including over-the-counter (OTC) drugs. Conditional logistic regression was used to identify factors associated with AKI. ResultsOf 602 AKI cases identified, 512 participated in the study. AKI cases were significantly more likely than controls to have used nonsteroidal anti-inflammatory drugs (NSAIDs) (26.0 % vs 18.0 %, p = 0,001) in the week preceding the ED visit, particularly OTC NSAIDs (23.3 % vs 15.9 %, p < 0.001). AKI was associated with a recent history of vomiting (OR 2.52 [95 %CI 1.87–3.39]), diarrhea (1.30 [1.00–1.70]) and urinary retention (1.92 [1.36–2.72]), use of non-selective NSAIDs (1.84, [1.37–2.48]), RAAS blockers (1.63 [1.21–2.19]), and diuretics (1.53 [1.13–2.08]), and a history of diabetes (1.42 [1.04–1.94]), CKD (1.36 [1.01–1.83]) and smoking (1.72 [1.24–2.37]). ConclusionsEvents in the setting of acute illness and medication use, including OTC NSAIDs, may play a greater role in the development of CA-AKI than comorbid conditions. Frequent use of OTC NSAIDs is a concern and should be addressed in view of serious adverse effects.