Self-medication among inhabitants of Yaounde, Cameroon: Pull and push factors

The rampant practice of self-medication is indicative of very strong existing push and pulls factors. These factors could be economic, social or systemic. Despite having some beneficial effects, selfmedication has life-threatening consequences. This study was aimed to determine the factors which push users to medicine sources or factors at the sources which pull users. A pre-validated questionnaire was administered to participants. Data were collected and analyzed using Microsoft Excel and the results expressed as frequencies and percentages. From the total of 650 respondents, poverty was found to be the major push factor for 360 participants (55.39%), followed by unprofessionalism, friends' advice, previous use of medicine, lack of time, and poor price regulation as others. Low cost of medicines was found to pull 402 (61.8%) users to sources of medicines for self-medication. More than 300 of the respondents found easy access to medicine and advertising as strong pull factors. Other important pull factors include quick and time-saving, proliferation of medicine vendors, hospital crowds, and inadequate prescription checks at sources of medication. Poverty is a major push factor for self-medication, further compounded by quick access to illicit sources of medication. Consequently, users get pulled to cheaper sources, which unfortunately sell poor quality medicines, lack the expertise, or do not check prescription. Price control is required to ensure that quality medicines are accessible to users. Imposing physician prescription at all medicine sales points is a crucial step to fight the deleterious consequences of self-medication. Although self-medication has some positive elements, its practice needs to be put under control to avoid grappling with long term health complications.

El proceso de enfermar de los médicos y sus consecuencias en el profesionalismo / The process of physicians falling ill and consequences for their professionalism / O processo de adoecimento dos médicos e as suas consequências acerca do profissionalismo

Resumen: La idiosincrasia de la profesión médica, los rasgos de personalidad característicos del médico y la falta de formación específica para reconocer y tratar adecuadamente la propia vulnerabilidad, predisponen a este colectivo a padecer más patología mental y, probablemente, un deficiente tratamiento de otras enfermedades. La mayoría de los estudios realizados hasta el momento se centran en la patología mental y adictiva del médico, desde el punto de vista del riesgo para la mala praxis y la seguridad de sus pacientes. La revisión narrativa de la literatura científica realizada (MEDLINE, EMBASE e IME 1985-2016) ha mostrado que, en el entorno hispanoparlante, apenas disponemos de información actualizada sobre el médico como paciente, a pesar de ser un tema de indudable relevancia desde el punto de vista de la seguridad asistencial, del profesionalismo y del propio bienestar de los profesionales. La situación del médico que enferma es compleja y poco conocida, con conflicto de roles y con repercusiones en la ética profesional y la calidad asistencial.

Abstract: The idiosyncrasy of the medical profession, the characteristic personality traits of the physician and the lack of specific training to properly recognize and treat one's own vulnerability dispose this group to suffer more mental pathology and probably worse control of other medical diseases. Most of the studies promoted so far focus on the psychiatric and addictive concerns of the physician, from the point of view of the sick doctor as being at risk for malpractice and to guarantee the safety of their patients. The narrative review of scientific literature (MEDLINE, EMBASE and IME 1985-2016) has shown that we do not have in the Spanish-speaking environment updated information about the doctor as a patient, despite being a topic of incipient media repercussion and undoubtedly relevant from the point of view of patient safety, professionalism and medical ethics and as well as the welfare of professionals. The characteristic of a sick doctor are more complex than the rest of patients with a conflict of roles and repercussions on professional ethics and the quality of care.

Resumo: A idiossincrasia da profissão médica, as características de personalidade característica do médico e a falta de formação específica para reconhecer e, corretamente, tratar a própria vulnerabilidade, predispõem esse grupo a sofrer mais patologias mentais, e provavelmente tratamento deficiente de outras doenças. A maioria dos estudos realizados até agora tem como foco a patologia mental e o comportamento aditivo do médico, do ponto de vista do risco por negligência e segurança de seus pacientes. A revisão narrativa da literatura científica realizada (MEDLINE, EMBASE e IME 1985-2016) tem mostrado que no ambiente de idioma hispânico temos apenas informações atualizadas sobre o médico como paciente, apesar de ser uma questão de relevância inquestionável do ponto de vista da segurança assistencial, do profissionalismo e do próprio bem-estar dos profissionais. A situação do médico enfermo é complexa e pouco conhecida, com conflito de papéis e impacto sobre a ética profissional e a qualidade dos cuidados médicos. São necessários mais estudos, tanto quantitativos como qualitativos, que permitam compreender o processo do adoecimento dos médicos em cada um dos seus estágios profissionais (desde a graduação até a aposentadoria) para ser capaz de considerar estratégias para a melhoria na atenção da saúde desses profissionais.

Evaluation on the effect of self-treatment in patients with Keshan disease by echocardiography / 中华超声影像学杂志

Objective To evaluate the effect of self-treatment and observe the change of heart morphology and function in patients with Keshan disease by echocardiography.Methods The left atrium diameter(LAd),left ventricular end-diastolic diameter(LVEDd),the thickness of interventricular septum in end diastolic(IVSTd),the thickness of left ventricular posterior wall in end-diastolic(LVPWTd),the left ventricular mass(LVM),the left ventricular mass index(LVMI),the relative wall thickness(RWT),the left ventricular ejection fraction(LVEF)and the mitral valve flow E/A ratio(E/A)were measured before the self treatment by echocardiography,and also measured on the 3rd month and 6th month after self-treatment with the same method,and observed the change of the parameters above.Results The LAd,LVEDd,IVSTd,LVPWTd,LVM,LVMI and RWT decreased on the 3rd month after self-treatment compared with prior self-treatment,and decreased on the 6th month further.There was significant difference between the prior self-treatment and post self-treatment(P＜0.05).The mitral valve flow E/A ratio and LVEF increased on the post self-treatment compared with the prior self-treatment slightly,but there was no statistical difference(P＞0.05).Conclusions Left ventricular hypertrophy and remodeling in patients with Keshan disease were prevented and reversed,and the cardiac function were improved after the self-treatment.Echocardiography can be used to evaluate the effect of self-treatment on patients with Keshan disease and can provide direction for clinical treatment.