Use Of Prescription Medicines Research Articles

Natural Products Inhibition of Cytochrome P450 2B6 Activity and Methadone Metabolism.

Methadone is cleared predominately by hepatic cytochrome P450 (CYP) 2B6-catalyzed metabolism to inactive metabolites. CYP2B6 also catalyzes the metabolism of several other drugs. Methadone and CYP2B6 are susceptible to pharmacokinetic drug-drug interactions. Use of natural products such as herbals and other botanicals is substantial and growing, and concomitant use of prescription medicines and non-prescription herbals is common and may result in interactions, often precipitated by CYP inhibition. Little is known about herbal product effects on CYP2B6 activity, and CYP2B6-catalyzed methadone metabolism. We screened a family of natural product compounds used in traditional medicines, herbal teas, and synthetic analogs of compounds found in plants, including kavalactones, flavokavains, chalcones and gambogic acid, for inhibition of expressed CYP2B6 activity and specifically inhibition of CYP2B6-mediated methadone metabolism. An initial screen evaluated inhibition of CYP2B6-catalyzed 7-ethoxy-4-(trifluoromethyl) coumarin O-deethylation. Hits were further evaluated for inhibition of racemic methadone metabolism, including mechanism of inhibition and kinetic constants. In order of decreasing potency, the most effective inhibitors of methadone metabolism were dihydromethysticin (competitive, K i 0.074 µM), gambogic acid (noncompetitive, K i 6 µM), and 2,2'-dihydroxychalcone (noncompetitive, K i 16 µM). Molecular modeling of CYP2B6-methadone and inhibitor binding showed substrate and inhibitor binding position and orientation and their interactions with CYP2B6 residues. These results show that CYP2B6 and CYP2B6-catalyzed methadone metabolism are inhibited by certain natural products, at concentrations which may be clinically relevant. SIGNIFICANCE STATEMENT: This investigation identified several natural product constituents which inhibit in vitro human recombinant CYP2B6 and CYP2B6-catalyzed N-demethylation of the opioid methadone. The most potent inhibitors (K i) were dihydromethysticin (0.074 µM), gambogic acid (6 µM) and 2,2'-dihydroxychalcone (16 µM). Molecular modeling of ligand interactions with CYP2B6 found that dihydromethysticin and 2,2'-dihydroxychalcone bound at the active site, while gambogic acid interacted with an allosteric site on the CYP2B6 surface. Natural product constituents may inhibit CYP2B6 and methadone metabolism at clinically relevant concentrations.

Experience of the adequacy and appropriateness of pharmaceuticals-related environmental information and preferred information channels among Finns

The normal use of medicines is the major environmental source of pharmaceuticals and a significant contributor to the chemicalization of the environment. Despite the key role of medicine users in contributing to this environmental challenge, little research has been conducted into the current state of lay people's pharmaceuticals-related environmental information, namely the information received, the information needed, the topics included in the information received, topics of interest, and previous and preferred information channels. In this study, these aspects were studied among 2,030 Finnish adults by means of an electronic survey. Of the respondents, 84.5% had received information related to pharmaceuticals in the environment (PiE). Female gender, higher age, high education level, general environmental friendliness, and use of prescription medicines were associated with a greater likelihood that information had been received. Furthermore, 39.8% of the respondents considered the amount of information received to be sufficient. Respondents had most commonly received information on 1 to 3 different topics. Proper disposal of medicines and pharmaceutical residues ending up in the environment in general were the most common topics covered by the information received. Medicines disposal and the effects of environmental pharmaceutical residues on people were the most interesting topics among the respondents. PiE-related information was most commonly obtained from traditional media (80.4%) and websites (40.5%), the least common source of PiE-related information being physicians (1.6%). The respondents were eager to receive such information in the future, preferring traditional media and medicine package leaflets as the most convenient information channels. These findings indicate a need for more diverse PiE-related information via easily accessible information channels that can vary based on sociodemographic characteristics.

Improving Self-reported Prescription Medicine Data Quality with a Commercial Database Lookup Tool and Claims Matching

Estimating prescription medicine use is challenging due to recall bias associated with surveys and coverage bias in administrative data. This study assesses how making operational improvements and combining both survey and administrative data sources can increase data quality on filled prescriptions. We use data from the Medicare Current Beneficiary Survey (MCBS) and administrative data from the Centers for Medicare and Medicaid Services (CMS). First, we investigate improvements from a prescription medicine lookup (PMLU) tool integrating a commercial medicine database into the MCBS. We then examine impacts of matching survey-reported medicines to Part D claims. We find that the PMLU improves accuracy and reduces measurement bias. Claims matching identifies additional medicines, especially for beneficiaries with more chronic conditions and medicines. This study shows that integrating a commercial database and supplementing with administrative data improves data quality and reduces sources of error.

The mental and maternal health of women in flood-affected areas in Pakistan: a call for action

The mental and maternal health of women in flood-affected areas in Pakistan: a call for action

Periodontitis may predict the use of prescription medicines later in life, a database study.

Medications used for the treatment of diseases also affect oral health. We investigated how having/not having periodontitis at baseline in 1985 was associated with purchases of medicines in the long term. The study paradigm is in the oral health-systemic health connections. We hypothesized that periodontitis links to purchases of medicines later in life. The study cohort consisted of 3,276 individuals from the greater Stockholm area, Sweden. Of them, 1,655 were clinically examined at baseline. Patients were followed-up for >35years, using the national population and patient registers. The burden of systemic diseases and purchases of medicines were statistically analyzed comparing patients with (n = 285) and without (n = 1,370) periodontitis. The results showed that patients with periodontitis had purchased more of certain medications than non-periodontitis patients. Periodontitis patients purchased significantly more drugs used in diabetes (p = 0.035), calcium channel blockers (p = 0.016), drugs acting on the renin-angiotensin system (p = 0.024), and nervous system drugs (p = 0.001). Hence, patients with periodontitis indeed had purchased specific medications statistically significantly more than the periodontally healthy ones. This indicates that periodontitis, over time, might increase the risk for systemic diseases with the subsequent need for medication.

Explanation of Socio-economic Inequality in Medicine Use: A Cross-sectional Analysis from Iran.

Despite the favorable progress in the production of medicines, there is no significant access to these important health inputs among different socio-economic groups. This study aimed to measure and explain socio-economic inequality in prescribed and non-prescribed medicine use in Iran. Data were obtained from a recent household survey on health services in Iran conducted in 2016. The Erreygers concentration index (ECI) was used to measure socio-economic inequality in the use of prescribed and non-prescribed medicines. In addition, Decomposition analysis was conducted to explain socio-economic inequality. The ECI revealed pro-rich socio-economic inequality in prescribed medicine use (ECI = 0.067, SE = 0.010), indicating that prescribed medicine use was concentrated on the better-offs. On the other hand, this index showed pro-poor inequality in non-prescribed medicine use (ECI = -0.064, SE = 0.009). Decomposition analysis showed that economic status and place of residence were the main determinants of socio-economic inequality in prescribing medicines. These factors and the number of health care needs explained the majority of socio-economic inequality in non-prescribed medicine use. Despite previous positive beliefs, we found remarkable socio-economic inequality in the use of medicines in Iran. Facilitating access to pharmaceutical services for disadvantaged households and rural residents and promoting of national essential medicines list could be recommended against socio-economic inequality in the pharmaceutical market of Iran.

Transient M-Proteins: Epidemiology, Causes, and the Impact of Mass Spectrometry: The Istopmm Study

Background: Among clinicians, it is well-known that the identification of a monoclonal(M) protein may disappear at a later timepoint (transient M protein) after certain infections, in the setting of some automimmune conditions, or other conditions. However, there is no information from a systematic study investigating patterns of transient M-proteins in a prospectively monitored cohort.The aim of this large, population-based study was to describe the epidemiology and characteristics of individuals with transient M-proteins in the prospective screening manner based on the Iceland Screens, Treats, or Prevents Multiple Myeloma (iStopMM) study. Furthermore, given the recent introduction of highly sensitive mass spectrometry (MS) based assays for the identification and quantification of M proteins, we were motivated to investigate whether transience is also related to an increased sensitivity of the assay used in a comparison with conventional serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE). Methods: The iStopMM study is an ongoing nationwide screening study for multiple myeloma precursors in Iceland. A total of 75,422 Icelanders ≥40 years old (51% of the population) were screened for M protein using SPEP and free light chains. Participants with a detectable M-protein entered a randomized controlled trial with three arms where arms 2 and 3 underwent initial testing and longitudinal follow-up. The transient M-protein cohort was defined as individuals with a positive SPEP who at a later timepoint returned a negative SPEP/IFE sample. Comorbidity data and prescription medicine use was acquired from three high-quality national disease and prescription medicine registries. MS (EXENT®, Binding Site, Birmingham, UK) analyses were performed on the original diagnostic sample and a follow-up sample with a cutoff of 0,02g/L considered as positive. We evaluated comorbidity and medication use comparing individuals with transient M protein to age- and sex-matched subjects with persistent M protein in a 4:1 matched nested case-control study. Differences between the groups were analyzed with chi square tests. Results: Overall, the iStopMM MGUS cohort comprises 3,358 individuals. Of those 2,037 underwent annual follow-up testing. A total of 198 (9.8%) individuals were identified as having transient M protein according to SPEP and IFE. In the transient M protein cohort we observed an increased prevalence of infections, autoimmune disorders, cancer, and obstructive pulmonary conditions (Table 1). We even observed increased usage of corticosteroids (17.7% vs 9.8%; p = 0.01), immunosuppressive medications (5.6% vs 2.2%; p=0.02), azithromycin (9.6% vs 4.9%; p=0.02), and diuretics (20.7% vs 13.3%; p=0.03). These drugs were found to be given between one year prior to one month after the subjects tested negative for M protein with SPEP/IFE. Among 198 individuals reported to have transient M protein according to SPEP and IFE, baseline MS samples were positive at in 183 (92%). The remaining 15 (8%) did not have an identifiable M protein on MS at baseline. Twelve (80%) of these 15 individuals had an active infection, autoimmune disorder, or active cancer at the initial measurement. Of the 183 individuals who had M protein identified at baseline by both SPEP/IFE and MS, MS identified the same M protein in 70% (129/183) of the cases at follow-up when SPEP/IFE was negative. Fifty four individuals were observed to be MS positive at baseline and negative at a follow-up testing indicating a prevalence of transient M-proteins of 2.6% within a cohort of MGUS patients when measured by MS. MS showed good concordance with IFE (Table 1), and, as expected, use of more sensitive MS in baseline samples results in additional increase by 33% in low-concentration M protein spikes, compared to conventional SPEP/IFE. Conclusion: In this large prospective study we found that M proteins were transient in almost 10% of cases. Using a more sensitive MS, the proportion of transient M proteins was only 2.6%. Thus, most of individuals with transient M proteins based on SPEP/IFE are falsely negative, when using MS as the benchmark. Our prospective cohort study provides novel insights on longitudinal patterns of abnormal serum proteins, it highlights how the use of MS results in the identification of low M proteins, and it shows that transient M proteins are often only below the limit of detection with conventional SPEP/IFE. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Medicine use in children aged under 12 years-Population survey in Finland.

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

Evaluation of the Patient Medication Counseling Services in the Philippine General Hospital Using the CIPP Model

Objectives. The patient medication counseling (PMC) services at Philippine General Hospital (PGH) started 21 years ago. While several changes have been incorporated into the program, no formal evaluation has been conducted to date. The objective of this evaluation was to assess the relevance, usefulness, responsiveness, acceptability, efficiency, impact, and sustainability of the service using the context, input, process (CIPP) model of Stufflebeam.
 Methods. The study utilized a mixed-methods study design. Interviews and surveys were conducted on pharmacist-counselors, a purposive sample of doctors, nurses, and other stakeholders. A review of records from the Department of Pharmacy of UP College of Pharmacy (UPCP) and PGH, such as patient and student satisfaction surveys and monthly reports of counseled patients served from 2015 to 2019, was conducted. The results were analyzed using descriptive statistics for quantitative data and content analysis for qualitative data.
 Results. Context evaluation revealed that the establishment of PMC resulted from informal interactions with hospitalized patients due to incorrect use of prescription medicines. Correct information was envisioned to address the irresponsible use of medicines. The input evaluation revealed that only 24% (N=75) of the pharmacists are involved in PMC, which comprise only 10% of their workload. There was also a lack of comprehensive training for counseling and insufficient physical facilities. The process evaluation identified lack of time (94%) as a significant limiting factor for the involvement of pharmacists in PMC. The interns became an additional workforce for the service, but scheduling and the consistent availability of both students and faculty-preceptors were experienced. The product evaluation revealed positive perceptions among the pharmacists, faculty, and student interns. From the patient satisfaction survey records of 5,071 patients counseled, 98 to 100% expressed high service satisfaction, and 100% were likely to recommend PMC to other patients. The pharmacists, interns, and faculty-preceptors suggested that PMC improved their confidence, communication skills, and decision-making.
 Conclusion. The PMC service is relevant and valuable to ensure patients' rational and quality use of medicines. As a value-added service to existing hospital pharmacy services, it serves as a venue for enhancing soft skills among pharmacists and students alike. However, physical and human resources and current processes need to be upgraded to improve efficiency, ensure sustainability, and expand service coverage to more patients.

Prioritizing intervention measures to prevent inappropriate self-medication practices using the Analytical Hierarchy Process

BackgroundUnited Nations Sustainable Development Goal 3 outlines the target of reducing premature mortality from non-communicable diseases by one third through prevention and treatment by 2030. In low and middle-income countries (LMICs) like Nepal, a significant number of people do not have accessible and affordable healthcare services available to them, leading to self-medication practices (SMP). Limited numbers of health professionals, ineffective regulation and easy availability of prescription medicines encourage the use of inappropriate SMP, which could result in health risks. ObjectivesThe objection of the study is to test the application of Analytical Hierarchy Process (AHP) for prioritizing the intervention measures for preventing inappropriate SMP. MethodsThe 25 experts were included in the study, out of which only 16 experts passed the consistency test. Data were collected using a structured questionnaire by the application of AHP model for ranking the intervention measures for preventing inappropriate SMP from March 2020 to May 2020. During this process, the purposively selected experts compared seven intervention measures based on three criteria: control use of prescription and non-prescription medicine, knowledge regarding the medicine and its use, and minimizing healthcare cost. ResultThe criteria, “control use of prescription and non-prescription medicine” was judged 3.58 times and 1.53 times more important than to “minimize the healthcare cost” and “knowledge regarding the medicine and its use” respectively. “Regulation of prescription and non-prescription dispensing practice” was the most prioritized intervention measure to prevent inappropriate SMP with a priority score of 20.68% followed by the “accessibility of healthcare system” (19.27%) and “awareness program for the consumers” (17.13%). ConclusionThe AHP method can be used in decision-making related to prioritizing the intervention measures to prevent inappropriate SMP. Among the seven intervention measures considered, “regulation of prescription and non-prescription dispensing practice” was the most preferred intervention measure to improve SMP followed by “access to healthcare” and an “awareness program”.

Prescribed medicine use and extent of off‐label use according to age in a nationwide sample of Australian children

BackgroundMedicine prescribing for children is impacted by a lack of paediatric‐specific dosing, efficacy and safety data for many medicines.ObjectivesTo estimate the prevalence of medicine use among children and the rate of ‘off‐label’ prescribing according to age at dispensing.MethodsWe used population‐wide primarily outpatient dispensing claims data for 15% of Australian children (0–17 years), 2013–2017 (n = 840,190). We estimated prescribed medicine use and ‘off‐label’ medicine use according to the child's age (<1 year, 1–5 years, 6–11 years, 12–17 years) defined as medicines without age‐appropriate dose recommendations in regulator‐approved product information. Within off‐label medicines, we also identified medicines with and without age‐specific dose recommendations in a national prescribing guide, the Australian Medicines Handbook Children's Dosing Companion (AMH CDC).ResultsThe overall dispensing rate was 2.0 dispensings per child per year. The medicines with the highest average yearly prevalence were systemic antibiotics (435.3 per 1000 children), greatest in children 1–5 years (546.9 per 1000). Other common medicine classes were systemic corticosteroids (92.7 per 1000), respiratory medicines (91.2 per 1000), acid‐suppressing medicines in children <1 year (47.2 per 1000), antidepressants in children 12–17 years (40.3 per 1000) and psychostimulants in children 6–11 years (27.0 per 1000). We identified 12.2% of dispensings as off‐label based on age, but 66.3% of these had age‐specific dosing recommendations in the AMH CDC. Among children <1 year, off‐label dispensings were commonly acid‐suppressing medicines (35.5%) and topical hydrocortisone (33.1%); in children 6–11 years, off‐label prescribing of clonidine (16.0%) and risperidone (13.1%) was common. Off‐label dispensings were more likely to be prescribed by a specialist (21.7%) than on‐label dispensings (7.5%).ConclusionsPrescribed medicine use is common in children, with off‐label dispensings for medicines without paediatric‐specific dosing guidelines concentrated in classes such as acid‐suppressing medicines and psychotropics. Our findings highlight a need for better evidence to support best‐practice prescribing.

The extent to which off-patent registered prescription medicines are used for off-label indications in Australia: A scoping review.

AimThe aim of this scoping review was to determine the extent of off-patent prescription medicine use beyond registered indications in various Australian clinical settings.MethodThe review followed the Joanna Briggs Institute approach and reported using PRISMA Extension for Scoping Reviews. Online databases were used to identify published literature about off-patent registered prescription medicines used for off-label indications in Australian public hospital, community and primary healthcare settings. In addition, empirical data from the Queensland and the South Australian state-wide medicine formularies were screened for the same medication/off-label indication dyads identified in the literature, and other locally approved uses.ResultsOverall, fourteen studies were included, conducted in public hospitals (n = 11), palliative care units (n = 2) and the community setting (n = 1). There were 213 reports extracted from the literature describing off-patent registered prescription medicines used for off-label indications, representing 128 unique medication/off-label indication dyads and 32 different medicines. Of these, just five medication/off-label indication dyads were approved for use on both the Queensland and South Australian state-wide medicine formularies, with 12 others only approved for use in Queensland and 16 others only approved for use in South Australia. Further examination of these state-wide formularies demonstrated that the use of off-patent registered prescription medicines beyond registered indications is more extensive than has been reported to date in the literature. There were 28 additional medication/off-label indication dyads approved on the Queensland state-wide medicine formulary and 14 such examples approved for use in South Australia. Of these, just two medication/off-label indication dyads were approved for use on both formularies.ConclusionThe extent to which off-patent registered prescription medicines have been repurposed in clinical settings for off-label indications in Australia is greater than previously reported in the literature. Usage and funded availability of certain medication/off-label indication dyads, varies across Australia. These results further expose the two tiered system of medicines regulation in Australia, and its impact on equity of access to medicines. Further research is required to support policy change to encourage submission of registration updates for off-patent prescription medicines.

Attitudes and Considerations towards Pharmaceuticals-Related Environmental Issues among Finnish Population

A number of policy recommendations identify the general public as a key participant in environmentally sustainable pharmaceutical policies. However, research into pharmaceuticals-related environmental issues from the population perspective is scarce. We studied the awareness among Finnish adults (n = 2030) of pharmaceutical residues in Finnish waterways, their perceived environmental sources, views on pharmaceuticals-related environmental issues, and their association with background characteristics. Of the respondents, 89.5% were aware of the presence of pharmaceuticals in Finnish waterways. Wastewaters from the pharmaceutical industry were most frequently, and pharmaceuticals excreted by humans least frequently, considered a major environmental source of pharmaceuticals. The vast majority of the respondents were worried about the environmental and health impact of pharmaceutical residues and emphasized issues such as the importance of environmentally sustainable actions by pharmaceutical companies and the recyclability of the pharmaceutical packaging materials. Age, education, use of prescription medicines, and environmental attitude were associated with awareness of pharmaceutical residues, while gender, age, education level, and environmental attitude were associated most frequently with pharmaceuticals-related environmental considerations. These results indicate a need for improved communication about the environmental effects of pharmaceuticals and the significance of different pharmaceutical emission sources in order to promote a more environmentally friendly, effective pharmaceutical policy.

Effect of frailty on initiation of statins following incident acute coronary syndromes in patients aged ≥75 years

IntroductionStatin use for preventing recurrent acute coronary syndromes (ACS) is low in older people due to many clinical factors, including frailty. Using the recently developed hospital frailty risk score, which allows ascertainment of frailty from real-world data, we examined the association between frailty and initiation of statin treatment following incident ACS in patients aged ≥75 years. Our secondary aim was to determine whether non-initiation of statins was associated with more conservative treatment, defined as non-receipt of evidence-based medicines and/or coronary artery procedures. MethodsWe used person-linked hospital administrative and Pharmaceutical Benefits Scheme data to identify incident ACS admissions between 2005 and 2008 in Western Australia and prescription medicine use, respectively. Outcomes were receipt of any statin, high-dose statin, beta-blockers, renin-angiotensin system inhibitors (RASI), antiplatelets and coronary artery procedures within six months of the incident ACS and were analysed using multivariable generalised linear regression models. ResultsIn 1,558 patients (52.4% female, mean age 82.6 years), initiation of any statin or high-dose statin decreased with increasing frailty. The adjusted risk ratios for any statin were 0.89 (95% CI: 0.82-0.97) and 0.67 (95% CI: 0.54-0.85) for the intermediate- and high-frailty categories compared with the low-frailty category, respectively. Compared with patients who received statins, those not receiving statins were less likely (p<0.001) to receive beta-blockers (80.8% vs 51.5%), RASI (86.9% vs 62.1%), antiplatelets (90.9% vs 65.1%) or a coronary artery procedure (65.9% vs 21.1%). ConclusionsIncreasing frailty is inversely associated with initiation of statins and generally leads to a more conservative approach to treatment of older patients with ACS.

Medication Adherence Improvement of Patients with Type 2 Diabetes Mellitus

Type 2 Diabetes Mellitus (DM) is a degenerative disease with long-term medication which needs home care service to enhance patients' obedience to medication compliance. The study aimed to investigate the effect of home care counseling on patients' medication adherence in prescribed medicine use. Methods: The research design was quasi-experimental using pre-test post-test without control group approach. A total of 43 patients with type 2 DM at the outpatient unit of Sari Mutiara General Hospital were selected through consecutive sampling techniques. The patients were given counseling in medicine using home care visits over 24 times in July 2017 and September 2017. Results: Patient adherence evaluation on disease medication was carried out through questionnaire administration before the patient received counseling (pre-test) and received counseling (post-test). Data from the Questionnaire were analyzed using the Wilcoxon test with a confidence level was 95%. Before counseling, the average score of patients was 3.26. However, after counseling was carried out to the patients, the average score was 0.72. In conclusion, there was an increase in patient adherence, i.e., 2.54. It was also obtained that there was a significant difference in patients' adherence to medication use before and after receiving counseling in-home care, with a significance value of 0.000 (p<0.05). It indicated that home care counseling was effective in enhancing their medication adherence. It is suggested that healthcare practitioners carry out monitoring, particularly during therapy, to prevent diabetic complications

The use of complementary and alternative medicine among hypertensive and type 2 diabetic patients in Western Jamaica: A mixed methods study.

The simultaneous or intermittent use of alternative treatments and prescription medications for hypertension and type 2 diabetes mellitus can have adverse health effects. To identify beliefs and practices associated with the use of alternative treatments for hypertension and type 2 diabetes mellitus among patients. A mixed-methods study including an investigator-administered survey and focus group discussion sessions using convenience sampling was conducted among patients aged ≥18 years during May to August 2018. Descriptive statistics were used to describe and compare demographic characteristics among groups of survey participants using JMP Pro 14.0. Thematic analysis was conducted to analyze the qualitative data using NVivo. Most study participants (87-90%) were on prescription medication for their condition. Of survey participants, 69% reported taking their medication as prescribed and 70% felt that prescription medicine was controlling their condition. Almost all participants (98%) reported using alternative treatments, mainly herbal medications, and 73-80% felt that herbal medicines controlled their conditions. One-third believed that herbal medicines are the most effective form of treatment and should always be used instead of prescription medication. However, most participants (85%) did not believe that prescription and herbal treatments should be used simultaneously. Most (76-90%) did not discuss herbal treatments with their healthcare providers. Four themes emerged from the focus group sessions: 1) Simultaneous use of herbal and prescription medicine was perceived to be harmful, 2) Patients did not divulge their use of herbal medicine to healthcare providers, 3) Alternative medicines were perceived to be highly effective, and 4) Religiosity and family elders played key roles in herbal use. This study provides useful insights into perceptions and use of alternative treatments by patients that can be used by healthcare providers in developing appropriate interventions to encourage proper use of prescription medicines and alternative medicines resulting in improved management of these chronic diseases.

Mixed methods study of the potential therapeutic benefits from medical cannabis for patients in Florida

ObjectivesTo evaluate medical marijuana patients’ perceptions of therapeutic benefits for self-reported medical conditions. DesignThe study was a concurrent mixed methods study with adult medical marijuana patients. Survey data were collected using a web-based survey, and interviews were conducted in person or over the phone. SettingThe study recruited 196 medical marijuana patients to complete surveys and 13 patients to participate in qualitative interviews in Florida. MeasuresA validated patient survey was distributed via Florida medical marijuana social media groups to examine the therapeutic benefits of the cannabis plant for medical conditions and overall well-being. Concurrently, qualitative interviews were conducted to understand barriers and facilitators to accessing medical cannabis and explore preferences for different forms and strains, as well as any unexpected side effects. ResultsPatients used medical cannabis for relief of chronic pain or depression, followed by arthritis and nausea. Survey results indicated 89 % of patients reported “great relief” for their medical condition. Over 76 % of patients reported a score of 8 or higher on a 10-point scale that their medical condition had improved, and over 68 % reported a score of 8 or higher that medical cannabis had reduced their pain. Interviews indicated medical cannabis was effective for pain relief and reducing the use of prescription medicines, but the drug was perceived as too expensive. ConclusionsMedical marijuana patients were positive about the health benefits they received and the fact they were able to reduce or eliminate many prescription medications; however, there were concerns about the costs.

Maternal risk factors for congenital limb deficiencies: A population-based case-control study.

Risk factors for congenital limb deficiencies are poorly understood. To investigate risk factors for congenital limb deficiencies. We conducted a nationwide population-based case-control (1:5) study in Finland, using national registers on congenital anomalies, births, and induced abortions, cross-linked with data on maternal prescription medicine use obtained from the registers on Reimbursed Drug Purchases and Medical Special Reimbursements. Five hundred and four children with limb deficiencies (241 isolated, 181 syndromic, and 82 other associated anomalies) were identified, and 2,520 controls were matched to cases on residence and year of pregnancy. Non-syndromic cases (n=323) were subdivided into longitudinal (n=120), transverse (n=123), intercalary (n=24), mixed (n=18), and unknown (n=38) deficiencies. Pregestational diabetes was associated with all limb deficiencies (adjusted odds ratio [OR] 12.71, 95% confidence interval [CI] 2.37, 68.25) and with isolated (OR 11.42, 95% CI 2.00, 64.60) deficiencies. Primiparity was associated with increased risk of congenital limb deficiencies among all cases (OR 1.49, 95% CI 1.15, 1.93), isolated cases (OR 1.46, 95% CI 1.09, 1.96), and among cases with longitudinal (OR 1.90, 95% CI 1.24, 2.90) and transverse deficiencies (OR 1.75, 95% CI 1.13, 2.70). Young maternal age (<25 years) was associated with all congenital limb deficiencies (OR 1.40, 95% CI 1.02, 1.90) and transverse deficiencies (OR 1.76, 95% CI 1.05, 2.96). Advanced maternal age (≥35 years) was associated with syndromic (OR 1.82, 95% CI 1.19, 2.78) and transverse deficiencies (OR 1.94, 95% CI 1.06, 3.57). Maternal antiepileptic medication was associated with all (OR 5.77, 95% CI 1.75, 19.04) and with isolated cases (OR 3.83, 95% CI 1.02, 14.34). It is important that pregnant women taking medications, especially antiepileptics, or women with pregestational diabetes are carefully monitored with regard to the occurrence and risk of limb deficiencies in the fetus.

Health Beliefs Regarding Medicine Use of Mothers Whose Children Are Hospitalized in a University Hospital and Knowledge and Practices of Mothers Towards Rational Use of Medicines in Their Children

Aim: This study was carried out to determine the health beliefs of mothers with children hospitalized at a university hospital regarding medicine use and their knowledge and practices towards rational use of medicines in the children. Methods: This is a descriptive and cross-sectional study. The study was conducted between 15 July and 15 October 2018 at the Karabük University Research and Training Hospital with 260 mothers. A Participant Information Form and the Drug Use Health Beliefs Scale were used as the data collection tools. Results: It was determined that only 10.8% (n=28) of the mothers had knowledge about rational use of medicines. The mothers’ Drug Use Health Beliefs Scale total mean score was 150.91 ± 15.13. 93.5% (n=243) of the mothers used antipyretics, whereas only 17.7% (n=43) of them used antipyretics recommended by a doctor. The mothers who read the package inserts of medicine had a significantly higher mean scale score than those who did not. Conclusion: The mothers had insufficient knowledge on rational use of medicines, but their health beliefs related to prescription medicine use were high. However, the mothers used antipyretic, analgesic, antibiotic and cough medicines in their children without consulting a doctor, whereas the majority of them used particularly antipyretics without a doctor’s recommendation. Keywords: rational use of medicines, Drug Use Health Beliefs Scale, children, mothers

Medication use and polypharmacy in patients referred to a tertiary gastroenterology practice.

Introduction. Commonly prescribed medications are associated with various gastrointestinal (GI) side effects but few data are available on prescription medication use and polypharmacy in a gastroenterology outpatient practice. We aimed to examine the prevalence of polypharmacy, defined as the simultaneous use of 5 or more medications.Methods. A descriptive correlational study of consecutive outpatient consultations in 988 patients referred to a tertiary gastroenterology practice. Main outcome measurements were frequency of prescription medication use and polypharmacy.Results. The most common GI symptoms were abdominal pain (72%), nausea (57%), and constipation (53%). The frequency of polypharmacy was 10%. Eighty percent of patients took at least one medication and 60% took two or more. The most frequently used medication classes were proton pump inhibitors (43%), followed by benzodiazepines (30%), selective serotonin-reuptake or norepinephrine-reuptake inhibitors (28%), non-steroidal anti-inflammatory drugs (27%), and opioids (21%).Conclusion. There was a higher use of prescription medicine including antidepressants, and a lower frequency of polypharmacy in our study cohort compared to the general population. The use of medications may have contributed to the symptoms leading to our study's population GI consultation.