Surveying over the counter and prescription only medication misuse in treatment services during COVID-19

Background: A greater understanding of Over the Counter (OTC) and Prescription Only Medication (POM) misuse amongst adults accessing substance misuse services (SMS) during COVID-19 is required to identify how SMS can better meet the needs of the people who require treatment. Aim: To use a questionnaire to explore OTC/POM misuse during COVID-19 in adults accessing community SMS in England. Methods: In 2020 to 2021 anonymous self-administered online/paper questionnaires which collated quantitative and qualitative data were completed. They were piloted for suitability and ethical approval was obtained. Thematic analysis was conducted for qualitative data and chi-square tests used to assess the relationship between quantitative variables. Results: Participants were Caucasian (94.6% British), majority male (58.9%), aged 18 to 61 years. Most were prescribed medication for problematic substance use, with a 92.5% self-reported adherence rate. The misuse of benzodiazepines (22.2%) codeine products (30.8%) and pregabalin (14.5%) predominated and 37.5% misused 2 or more medicines. Administration was usually oral and concomitant use of other substances was common: alcohol 44.6% (52% daily), tobacco/vaping 73.2% and illicit substances 58.9%. There were statistically significant associations identified, including between changes during COVID-19 to OTC/POM misuse and illicit use. Only 56 questionnaires were included in the analysis: we believe this low number was because of infection control measures, limited footfall in services, pressures on staff limiting their capacity to distribute the paper questionnaires and reliance upon telephone consultations limiting online distribution. Increasing OTC/POM misuse and obtaining illicit supplies were reported when access to usual supplies were restricted;however, changes to doses/dispensing arrangement liberalisation in response to COVID-19 were positively viewed. Conclusion: OTC/POM misuse, including polypharmacy and concomitant use of other substances occurred during COVID-19: SMS need to be vigilant for these issues and mitigate the associated risks for example with harm reduction interventions. Further qualitative research is required to explore the issues identified. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Innovations in infectious disease testing: Leveraging COVID-19 pandemic technologies for the future.

Innovations in infectious disease testing have improved our abilities to detect and understand the microbial world. The 2019 novel coronavirus infectious disease (COVID-19) pandemic introduced new innovations including non-prescription "over the counter" infectious disease tests, mass spectrometry-based detection of COVID-19 host response, and the implementation of artificial intelligence (AI) and machine learning (ML) to identify individuals infected by the severe acute respiratory syndrome - coronavirus - 2 (SARS-CoV-2). As the world recovers from the COVID-19 pandemic; these innovative solutions will give rise to a new era of infectious disease tests extending beyond the detection of SARS-CoV-2. To this end, the purpose of this review is to summarize current trends in infectious disease testing and discuss innovative applications specifically in the areas of POC testing, MS, molecular diagnostics, sample types, and AI/ML.

Examining the effects of COVID-19 on pharmacy dispensing of naloxone and syringes sales across Massachusetts and New Hampshire.

BACKGROUND: Coronavirus disease 2019 (COVID-19) lockdowns disrupted access to harm reduction supplies and services known to be effective in overdose prevention and contributed to a worsening of the opioid crisis. However, because pharmacies can provide naloxone and sell over-the-counter (OTC) sterile syringes, their continued operation throughout the pandemic potentially reinforced a public health role as a distribution hub for safer use supplies. OBJECTIVES: The objective of this analysis was to examine patterns of naloxone and OTC syringe sale volume at 463 community pharmacies in 2 states with high overdose rates during the COVID-19 pandemic. METHODS: We analyzed weekly pharmacy-level dispensing data from January 5, 2020, to December 31, 2020, from one corporate community pharmacy chain in Massachusetts (n = 415 pharmacies) and New Hampshire (n = 48 pharmacies). Descriptive statistics and visualizations over the analytical period were generated as initial explorations of the outcome. Zero-inflated Poisson and negative binomial models were used to analyze distribution data along with county-level COVID-19 case rates and store-level COVID-19 testing location status during the same time. Interactions tested the effect of COVID-19 case rates on naloxone and OTC syringe sales. RESULTS: Pharmacies that reported selling nonprescription syringes and dispensing naloxone during the study period averaged 210.13 OTC syringes sold and 0.53 naloxone prescriptions per week. Pharmacies in communities that experienced greater COVID-19 case burden also exhibited higher naloxone dispensing and OTC syringe sales during this period. The odds of selling OTC syringes increased over time but naloxone dispensing remained constant over the pandemic year. Pharmacies hosting COVID-19 testing tended to have lower OTC syringe sales and naloxone provision than nontesting sites. CONCLUSION: During the COVID-19 pandemic, pharmacies provided harm reduction services and dispensed lifesaving medications by quickly adapting to fulfill community needs without disrupting co-located services for COVID-19 response.

Modulation of transient receptor potential (TRP) channels by plant derived substances used in over-the-counter cough and cold remedies.

BACKGROUND: Upper respiratory tract infections (URTIs) impact all age groups and have a significant economic and social burden on society, worldwide. Most URTIs are mild and self-limiting, but due to the wide range of possible causative agents, including Rhinovirus (hRV), Adenovirus, Respiratory Syncytial Virus (RSV), Coronavirus and Influenza, there is no single and effective treatment. Over-the-counter (OTC) remedies, including traditional medicines and those containing plant derived substances, help to alleviate symptoms including inflammation, pain, fever and cough. PURPOSE: This systematic review focuses on the role of the major plant derived substances in several OTC remedies used to treat cold symptoms, with a particular focus on the transient receptor potential (TRP) channels involved in pain and cough. METHODS: Literature searches were done using Pubmed and Web of Science, with no date limitations, using the principles of the PRISMA statement. The search terms used were 'TRP channel AND plant compound', 'cough AND plant compound', 'cough AND TRP channels AND plant compound', 'cough AND P2X3 AND plant compound' and 'P2X3 AND plant compound' where plant compound represents menthol or camphor or eucalyptus or turpentine or thymol. RESULTS: The literature reviewed showed that menthol activates TRPM8 and may inhibit respiratory reflexes reducing irritation and cough. Menthol has a bimodal action on TRPA1, but inhibition may have an analgesic effect. Eucalyptus also activates TRPM8 and inhibits TRPA1 whilst down regulating P2X3, aiding in the reduction of cough, pain and airway irritation. Camphor inhibits TRPA1 and the activation of TRPM8 may add to the effects of menthol. Activation of TRPV1 by camphor, may also have an analgesic effect. CONCLUSIONS: The literature suggests that these plant derived substances have multifaceted actions and can interact with the TRP 'cough' receptors. The plant derived substances used in cough and cold medicines have the potential to target multiple symptoms experienced during a cold.

Impact of COVID-19 pandemic on medicine supply chain for patients with chronic diseases: Experiences of the community pharmacists.

Problem considered: Coronavirus disease(COVID-19) outbroke towards the end of December 2019 in China, soon it started spreading rapidly to various countries leading to an outburst of pandemic. Due to the restrictions imposed to control the spread of the infection, globally the manufacturing, import and export of medicine and the healthcare services to patients with chronic illness had been affected. This study aimed to explore the perspectives of the pharmacists on the medicine supply chain for patients with chronic diseases during COVID-19 pandemic in India. Methods: This study is a prospective, qualitative research involving telephonic, semi-structured in-depth interviews. An interview guide for pharmacists was prepared and validated using "Interview Protocol Refinement" method. Purposive sampling method was used to recruit the pharmacists; a telephonic oral consent was obtained. The interview session was audio recorded and the recordings were transcribed verbatim. Further, transcripts were validated and later analysed using NVivo software. Results: A total of 8 participants were interviewed during our study. Thematic analysis of the transcripts resulted in seven main themes. The study showed that there was deficiency in medicine supply during the COVID-19 pandemic and the pharmacists faced several challenges in procuring and storing the medication, arranging for unavailable medicines, medication dispensing and provision of the services such as medicine delivery, patient counselling. There was also scarcity of manpower leading to extra workload and working overtime. Conclusion: Uninterrupted supply of essential medicine is the backbone of health care system. An effective plan and appropriate strategies are vital to combat such future emergencies.

Surveying Over the Counter and Prescription Only Medication Misuse in Treatment Services During COVID-19.

Background: A greater understanding of Over the Counter (OTC) and Prescription Only Medication (POM) misuse amongst adults accessing substance misuse services (SMS) during COVID-19 is required to identify how SMS can better meet the needs of the people who require treatment. Aim: To use a questionnaire to explore OTC/POM misuse during COVID-19 in adults accessing community SMS in England. Methods: In 2020 to 2021 anonymous self-administered online/paper questionnaires which collated quantitative and qualitative data were completed. They were piloted for suitability and ethical approval was obtained. Thematic analysis was conducted for qualitative data and chi-square tests used to assess the relationship between quantitative variables. Results: Participants were Caucasian (94.6% British), majority male (58.9%), aged 18 to 61 years. Most were prescribed medication for problematic substance use, with a 92.5% self-reported adherence rate. The misuse of benzodiazepines (22.2%) codeine products (30.8%) and pregabalin (14.5%) predominated and 37.5% misused 2 or more medicines. Administration was usually oral and concomitant use of other substances was common: alcohol 44.6% (52% daily), tobacco/vaping 73.2% and illicit substances 58.9%. There were statistically significant associations identified, including between changes during COVID-19 to OTC/POM misuse and illicit use. Only 56 questionnaires were included in the analysis: we believe this low number was because of infection control measures, limited footfall in services, pressures on staff limiting their capacity to distribute the paper questionnaires and reliance upon telephone consultations limiting online distribution. Increasing OTC/POM misuse and obtaining illicit supplies were reported when access to usual supplies were restricted; however, changes to doses/dispensing arrangement liberalisation in response to COVID-19 were positively viewed. Conclusion: OTC/POM misuse, including polypharmacy and concomitant use of other substances occurred during COVID-19: SMS need to be vigilant for these issues and mitigate the associated risks for example with harm reduction interventions. Further qualitative research is required to explore the issues identified.

Factors Associated with Self-Medication during the COVID-19 Pandemic: A Cross-Sectional Study in Pakistan.

Self-medication (SM) is characterized by the procurement and use of medicines by bypassing primary healthcare services and without consulting a physician, usually to manage acute symptoms of self-diagnosed illnesses. Due to the limited availability of primary healthcare services and the anxiety associated with the COVID-19 pandemic, the compulsion to SM by the public has increased considerably. The study aimed to assess the characteristics, practices, and associated factors of SM by the public during the COVID-19 pandemic in Sargodha, Pakistan. χ2-tests and univariable analyses were conducted to explore the identification of characteristics and the potential contributing factors for SM during COVID-19, while multivariable logistic regression models were run to study the effect of variables that maintained a significant association. The study was performed during July-September 2021, with n = 460 questionnaires returned overall (response rate: 99.5%). The majority of respondents were males (58.7%, n = 270) who live in the periphery of the town (63.9%, n = 294), and most of the respondents belonged to the age group of 18-28 years (73.3%, n = 339). A large number, 46.1% (n = 212), of the participants were tested for COVID-19 during the pandemic, and among them, 34.3% (n = 158) practiced SM during the pandemic; the most common source of obtaining medicines was requesting them directly from a pharmacy (25.0%; n = 127). The chances of practicing SM for medical health professionals were 1.482 (p-value = 0.046) times greater than for non-medical health personnel. The likelihood of practicing SM in participants whose COVID-19 test was positive was 7.688 (p-value < 0.001) times more than who did not test for COVID-19. Allopathic medicines, acetaminophen (23.6%), azithromycin (14,9%), and cough syrups (13%), and over the counter (OTC) pharmaceuticals, vitamin oral supplements, such as Vitamin C (39.1%), folic acid (23.5%), and calcium (22.6%), were the most commonly consumed medicines and supplements, respectively; being a healthcare professional or having a COVID-test prior showed a significant association with the usage of Vitamin C (p < 0.05 in all cases). Respondents who mentioned unavailability of the physician and difficulty in travelling/reaching healthcare professionals were found 2.062-times (p-value = 0.004) and 1.862-times (p-value = 0.021) more likely to practice SM, respectively; SM due to fear of COVID was more common in individuals who had received COVID-tests prior (p = 0.004). Practices of SM were observed at alarming levels among our participants. Consciousness and understanding about the possible adverse effects of SM must be established and validated on a continuous level; in addition, on a commercial level, collaboration from pharmacists not to sell products (especially prescription-only medicines) without a certified prescription must be developed and implemented.

Misleading Advertising of Health-Related Products in Ecuador during the COVID-19 Pandemic.

Background Media coverage of the COVID-19 pandemic increased tuning ratings during this time. The aim of this study was to identify misleading advertising of health-related products on Ecuadorian television during the COVID-19 pandemic. Methods Television channels were monitored for 111 h in the months of June and October 2020. Verbal, nonverbal and context content were analyzed from each advertising spot according to ethical standards for the promotion of products for human health Results A total of 667 spots were analyzed. Most, 90%, involved misleading advertising of health-related products. Products for gastrointestinal conditions were the most publicized (17.8%) during the period analyzed. Newscasts most often advertised products intended to improve sexual potency (22.9%) and to a lesser degree those intended to prevent and treat respiratory problems (1.8%); this relationship was reversed when compared to general programming (p < 0.05). Conclusions Most of the health-related products advertised on Ecuadorian television are advertised misleadingly, with news programs having the highest number of such advertisements per hour of programming.

Misuse of prescription and over-the-counter drugs to obtain illicit highs: how pharmacists can prevent abuse

There have been increasing reports of misuse of a range of prescription and over-the-counter (OTC) drugs for recreational purposes. The use of psychoactive pharmaceuticals and 'pharming' are new, widespread phenomena involving the non-medical use of prescription and OTC drugs, which are recreationally used to achieve psychoactive effects either on their own or in combination with other substances. This article provides an overview of the topic, focusing on a range of medicines (e.g. prescription medicines such as quetiapine, gabapentinoids, Z-drugs, bupropion, venlafaxine and over-the-counter medicines such as loperamide, dextromethorphan, benzydamine, promethazine, chlorphenamine, diphenhydramine and hyoscine butylbromide) that have emerged as misused and diverted, or are already described through the literature, as well as recorded by drug users' online websites reporting new trends and experimentations of drug abuse. This rapidly changing drug scenario represents a challenge for pharmacy, psychiatry, public health and drug control policies. Moreover, possibly resulting from the COVID-19 pandemic, drug use habits and availability have changed, causing a shift in behaviours relating to both prescription and OTC medicines. Healthcare professionals should be aware of potential prescription drugs diversion, recognise misuse cases, consider the possibility of polydrug misuse, and prevent it where possible. Pharmacists can prevent and reduce drug abuse, and should be involved in evidence-based actions to detect, understand and prevent drug diversion activities and the adverse effects of drug misuse. Copyright © 2020 Pharmaceutical Press. All rights reserved.

Complementing RNA Detection with Pharmaceutical Monitoring for Early Warning of Viral Outbreaks through Wastewater-Based Epidemiology

Wastewater-based epidemiology using viral nucleic acids to predict community viral outbreaks has many challenges, including differences in viral shedding of infected individuals and interference from the wastewater matrix. In this study, we demonstrate that monitoring pharmaceutical residues in untreated sewage provides complementary information that correlates with future occurrences of viral outbreaks. We monitored 63 pharmaceutically active compounds, including antivirals used to treat COVID-19 and influenza and over-the-counter drugs commonly used to relieve the symptoms of infection. Weekly sampling was conducted at four municipal sewage treatment plants in Western New York. Residues of drugs associated with managing COVID-19 symptoms were detected, including azithromycin (1.99-5.00 μg/L), chloroquine (0.01-33.00 μg/L), hydroxychloroquine (0.05-30.54 μg/L), and lopinavir (13.75-181.20 μg/L). A significant correlation (p < 0.001) was observed between the total COVID-19-related drugs detected and the 5-day rolling averages of reported cases. Acetaminophen concentrations spiked approximately 2.5 weeks before a spike in SARS-CoV-2 RNA copies in all wastewater treatment plants sampled. The results suggest over-the-counter analgesic concentrations, in particular, acetaminophen in raw sewage to be used to complement viral RNA data as an early warning system for effective management of viral outbreaks at the community level. © 2022 American Chemical Society.

ANALYSIS OF THE FACTORS INFLUENCING CONSUMER BEHAVIOR IN CHOOSING OF OTC MEDICINES

The COVID-19 pandemic, the burden on the health system, and reduced access to health services have led to an increase in the purchase of over-the-counter (OTC) medicines. The research was conducted in the Benu pharmacy in Belgrade, with 200 users of pharmacy services. The questionnaire for patients through 25 questions grouped into 5 dimensions provided an overview of the influence of various factors on the decision to purchase OTC medicines: the price of a medical examination, pharmacist recommendations, the influence of family and friends, previous experiences, and advertising. The analysis revealed a statistically significant difference between the scores in the claims of the respondents before and during the COVID-19 pandemic in the domains: the price of a medical examination (t = 2.592;df = 198;p < 0.05) and information on OTC medicines (t = 2.549;df=198;p < 0.05). The Questionnaire for patients defines the factors that influence the choice of OTC medicines for the self-medication process and is a good guideline for considering the shortcomings in the trade of OTC medicines.

Over the counter drugs and self-medication: A worldwide paranoia and a troublesome situation in India during the COVID-19 pandemic.

Self-medication is the use of drugs to treat self-diagnosed ailments without the use of a formal prescription. Self-medication is defined by the World Health Organization as the use of medications to address self-diagnosed diseases or symptoms. Over-the-counter (OTC) pharmaceuticals are medications that can be sold without a prescription directly to the client in accordance with the laws of each nation. During the COVID-19 pandemic, an increasing tendency in the use of OTC and self-medication was seen, with the situation in India particularly deteriorating due to lax regulatory restrictions. This has resulted in a slew of problems, ranging from a lack of drugs to severe responses due to overdosage and drug-drug combinations. There is an urgent need for more tangible regulatory control over self-medication and OTC medications to safeguard the uninformed populace from harm.

Egyptian perspectives on potential risk of paracetamol/acetaminophen-induced toxicities: Lessons learnt during COVID-19 pandemic.

Paracetamol/Acetaminophen was widely used as a first-line antipyretic and analgesic for COVID-19 patients without giving any attention to the potential risk of related toxicities. A survey was conducted on 176 Egyptians using an online survey portal to assess their knowledge, and attitude regarding potential risk of paracetamol toxicities and whether COVID-19 pandemic affected their practices regarding safe use of paracetamol. The self-administered questionnaire was developed by the researchers and was validated by expert opinions. A pilot testing of the questionnaire was done. Alpha Cronbach test used to assess the internal consistency reliability of the survey revealed good reliability. Overall percent-score revealed that only 24.4% of participants had good knowledge about paracetamol and its related potential toxicities. 62.5% of participants considered paracetamol safer than other medications of the same indications. 42.6% of participants could advise others to use paracetamol without prescription. According to the participants' responses, physicians were less concerned to give instructions about possibility of overdosage. Our results also revealed that participants' administration of paracetamol without physician prescription was more during COVID-19. Practice of paracetamol administration more than the allowed number of tablets/day was significantly more evident during the pandemic. We concluded that the unsupervised use of paracetamol is an alarming sign that should be addressed as this could lead to a high rate of accidental paracetamol toxicity. A lesson learnt from COVID-19 pandemic is the need to implement behavior change measures to mitigate the risk of accidental paracetamol toxicity.

Healthcare Providers' Perspectives Toward the Integration of over the Counter Supplements During COVID-19 Pandemic: A Cross-Sectional Study from Jordan.

Objective: During COVID-19 pandemic, healthcare providers (HCPs) have been inundated with consultations related to over the counter (OTC) dietary supplements' protective role. Thus, the present study focused on assessing HCPs perceptions toward OTC products integration during the COVID-19 outbreak. Methods: Pertinent data was collected using validated-online survey comprising four sections: demographics, OTC supplementation perceptions, awareness related to safety of OTC supplements, confidence in recommending dosage and counseling to patients regarding OTC supplements' safety, and some health-related behaviors. Quantified perception score represented by corrected confidence-concern ratio was used in assessing perceptions, and associations between demographics with perception and awareness were explored. Results: A total of 600 responses were included in the final analysis. Vitamin C, zinc, and vitamin D were the most popularly recommended OTC supplements. Most respondents indicated positive perceptions toward dietary supplementation while around 60% of respondents reported reluctance about the protective role of COVID-19 vaccination. Bachelor's degree holders (AOR = 4.39, 95% CI = 2.25-10.33), pharmacists (AOR = 2.17, 95% CI = 1.5-9.5), and junior HCPs (<1 year experience) had improved perceptions compared to college graduates, physicians, and senior practitioners (AOR = .17, 95% CI = .04-.78 and AOR = .15, 95% CI = .02-.93), respectively. Conclusion: Suboptimal knowledge among HCPs toward the safety and hazards associated with integration of different OTC supplements during the COVID-19 pandemic dictates further education to ensure the safe integration of OTC supplements.

Sustainable liquid chromatographic determination and purity assessment of a possible add-on triple-action over-the-counter pharmaceutical combination in COVID-19.

Nowadays, all researchers are focused on combating the pandemic COVID-19. According to recent statistics, most patients are managed at home. An over-the-counter (OTC) triple action formula containing paracetamol (PAR), aspirin (ASP), and diphenhydramine (DIPH) is widely prescribed for pain, fever and as night-time sleep aid. For COVID-19 patients, this combination is now suggested as part of symptomatic therapy and prophylaxis. In this work, two simple liquid chromatographic approaches were designed for simultaneous determination of PAR, ASP, and DIPH in Excedrin® PM caplets, beside three specified official toxic impurities, namely, p-aminophenol, p-nitrophenol, and salicylic acid. The first method comprised high-performance thin-layer chromatographic separation coupled with densitometric quantification, on silica gel HPTLC 60 F254 aluminium sheets as the stationary phase, ethyl acetate-methanol-aqueous ammonium hydroxide (10.0: 2.0: 0.1, by volume) as the developing system and scanning was performed at 210.0 nm. The second one is a high-performance liquid chromatography coupled with diode array detector. Successful separation of the six components was performed on XTerra C18 column with isocratic elution of mobile phase 0.1% triethylamine acidified water: methanol (70:30, v/v) adjusted with o-phosphoric acid to pH 3.0 and methanol (90:10, v/v) with flow rate programming and detection at 210.0 nm. Validation of the proposed methods was performed according to ICH guidelines. Both methods were successfully used for quality control of the cited drugs in their marketed formulation. Moreover, the in-vitro release study was monitored using the proposed HPLC-DAD method. The greenness profile of the proposed methods was assessed and comparatively evaluated through various assessment tools, specifically; the analytical eco-scale system, national environmental method index (NEMI), green analytical procedure index (GAPI) and analytical greenness (AGREE) metric.

Over-the-Counter Medication Prescribing in a Pediatric Emergency Department: Health Records Review.

OBJECTIVE: The purpose of this project was to describe patterns in over-the-counter medication prescribing for nonacute patients with Medicaid in a pediatric emergency department. Differences were also tested in visit time and charges between patients with and without over-the-counter medication prescriptions. METHODS: Retrospective chart review of children with Missouri Medicaid presenting to a single site between January 1, 2018 and December 31, 2018 was conducted. Low-acuity patients with common diagnoses were included. Over-the-counter medications prescribed, the cost of prescriptions, the time spent in the emergency department, provider care time, patient age, and the month of visit were extracted. Data were analyzed with descriptive statistics and t tests. RESULTS: Approximately 37% of children were prescribed over-the-counter medications, most commonly antipyretics. When comparing visits in which an over-the-counter medication was prescribed to visits without an over-the-counter medication prescription, we found no significant difference in the associated charges, total time in the department, and provider care time. CONCLUSION: Over-the-counter medications were prescribed for more than one-third of children cared for in the pediatric emergency department for low-acuity presentations. These visits may represent a substantial area for Medicaid access barriers, system redesign, and cost savings.

Accuracy of self-assessment of gestational duration among people seeking abortion.

BACKGROUND: Mifepristone, used together with misoprostol, is approved by the United States Food and Drug Administration for medication abortion through 10 weeks' gestation. Although in-person ultrasound is frequently used to establish medication abortion eligibility, previous research demonstrates that people seeking abortion early in pregnancy can accurately self-assess gestational duration using the date of their last menstrual period. OBJECTIVE: In this study, we establish the screening performance of a broader set of questions for self-assessment of gestational duration among a sample of people seeking abortion at a wide range of gestations. STUDY DESIGN: We surveyed patients seeking abortion at 7 facilities before ultrasound and compared self-assessments of gestational duration using 11 pregnancy dating questions with measurements on ultrasound. For individual pregnancy dating questions and combined questions, we established screening performance focusing on metrics of diagnostic accuracy, defined as the area under the receiver operating characteristic curve, sensitivity (or the proportion of ineligible participants who correctly screened as ineligible for medication abortion), and proportion of false negatives (ie, the proportion of all participants who erroneously screened as eligible for medication abortion). We tested for differences in sensitivity across individual and combined questions using McNemar's test, and for differences in accuracy using the area under the receiver operating curve and Sidak adjusted P values. RESULTS: One-quarter (25%) of 1089 participants had a gestational duration of >70 days on ultrasound. Using the date of last menstrual period alone demonstrated 83.5% sensitivity (95% confidence interval, 78.4-87.9) in identifying participants with gestational durations of >70 days on ultrasound, with an area under the receiver operating characteristic curve of 0.82 (95% confidence interval, 0.79-0.85) and a proportion of false negatives of 4.0%. A composite measure of responses to questions on number of weeks pregnant, date of last menstrual period, and date they got pregnant demonstrated 89.1% sensitivity (95% confidence interval, 84.7-92.6) and an area under the receiver operating curve of 0.86 (95% confidence interval, 0.83-0.88), with 2.7% of false negatives. A simpler question set focused on being >10 weeks or >2 months pregnant or having missed 2 or more periods had comparable sensitivity (90.7%; 95% confidence interval, 86.6-93.9) and proportion of false negatives (2.3%), but with a slightly lower area under the receiver operating curve (0.82; 95% confidence interval, 0.79-0.84). CONCLUSION: In a sample representative of people seeking abortion nationally, broadening the screening questions for assessing gestational duration beyond the date of the last menstrual period resulted in improved accuracy and sensitivity of self-assessment at the 70-day threshold for medication abortion. Ultrasound assessment for medication abortion may not be necessary, especially when requiring ultrasound could increase COVID-19 risk or healthcare costs, restrict access, or limit patient choice.

Waterborne outbreak in a rural area in Greece during the COVID-19 pandemic: contribution of community pharmacies.

INTRODUCTION: On 15 June 2020, the National Public Health Organization was informed about the identification of two cases of Escherichia coli Ο157 infection in a small town in the Peloponnese Region in Greece and we suspected an outbreak. METHODS: We asked the local pharmacist to assist us to verify the outbreak by providing the daily number of over-the-counter anti-diarrheal drugs sold from 20 May 2020 onwards. The pharmacist asked customers with gastroenteritis to submit stool samples at the local hospital. Samples were tested for 22 pathogens. We conducted a 1 : 1 case-control study. Cases and controls were retrieved from the pharmacy client list. Chlorination records of the water supply system were retrieved, and water samples were tested for microbiological indicators and viruses. RESULTS: The increased number of sales of anti-diarrheal drugs verified the outbreak. Overall, 58 cases and 57 controls were recruited for the study. Tap water consumption (odds ratio (OR)=10.9, 95% confidence interval (CI)=3.1-38.0, p<0.001) and consumption of ice cubes made from tap water (OR=39.3, 95%CI=10.3-150.9, p<0.001) were independently associated with gastroenteritis occurrence. Eleven stool samples were tested; one was positive for shigatoxin-producing E. coli, one for enteropathogenic E. coli, four for E. coli Ο157 and one for Salmonella spp. Four samples tested negative. Five water samples collected on 18 June tested negative. The residual chlorine on 5 and 14 June ranged from 0.12 mg/L to 0.14 mg/L. CONCLUSION: This was the first investigation of a waterborne outbreak in Greece performed with the collaboration of a local pharmacy. The COVID-19 pandemic favored the use of alternative resources and channels of communication with the local population, which can also be used in the future, especially in remote areas of the country.

The potential roles of pharmacy medication sales data to augment the syndromic surveillance system in response to COVID-19 and preparedness for other future infectious disease outbreaks in Indonesia.

BACKGROUND: Indonesia faces a continuous threat from communicable disease outbreaks. The current COVID-19 outbreak, the previous one of SARS, and many other infectious outbreaks encountered in the country warn of the need to develop comprehensive early warning systems to enable timely health responses in the long run. In this article, we argue that over the counter medication sales data at community pharmacies in Indonesia can potentially augment and increase the detection power of the current syndromic surveillance system, particularly in dealing with COVID-19 and other future infectious disease outbreaks in the country. MAIN BODY: This article discusses the experience of other countries in employing pharmacy medication sales data to serve as potential syndromic surveillance platform and contribute to pandemic responses. We argue why it is worth considering utilising medication sales data from pharmacies in Indonesia to support the current surveillance system which enables the provision of early warnings of disease outbreaks. We then discuss the potential challenges of operationalising these data and suggest a way forward for the development and implementation of the syndromic surveillance system at community pharmacy settings in Indonesia. CONCLUSION: While there are several challenges in developing a workable system in Indonesia that need to be addressed, introducing a syndromic surveillance system using pharmacy-setting medication sales data is worth investigating in the country.

Knowledge, Attitude, Practices and Viewpoints of Undergraduate University Students towards Self-Medication: An Institution-Based Study in Riyadh.

Rational and responsible self-medication (SM) is not only the key to better health outcomes, but also key to limiting adverse drug events. This institution-based cross-sectional study utilized seven- and four-item scales to assess the knowledge and attitude towards SM. Similarly, SM practices were measured using eight scale questions consisting of SM practice during the last six months, type of drug consumed, reason and frequency of SM, and so on. Statistical analyses were performed using SPSS. Overall, 371 students completed the questionnaire. The students with a good level of knowledge and positive attitude towards SM were 60.64% and 66.8%, respectively. About 55.5% of students practiced SM during the last six months using antipyretics (37.7%), multivitamins (36.4%), sleeping aids (20.2%), and anti-histamines (18.6%). Headache (79.2%), fever (37.7%), pain (25.9%), and colds and coughs (25.3%) were the illnesses for which they sought SM. The students admitted that drug side effects (75%), drug resistance (33.7%), drug interaction (41.5%), and poor treatment outcome (28.3%) were the consequences of irrational SM practice. Students (87.6%) propose that extending SM awareness through the Ministry of Health (83%) and pharmaceutical companies (48%) as major platforms would improvise the rational practice. Since AlMaarefa University students will be future healthcare professionals, their perception must be considered and accordingly educated to practice rational SM.