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

PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

A population-based study of prescribing trends in a potentially vulnerable paediatric population from 1999 to 2012.

OBJECTIVES: There is a limited understanding of paediatric medication prescribing trends and patterns, thus poorly positioning decision-makers to identify quality and safety concerns related to medication use. The objective of this study was to determine overall medication prescribing trends and patterns among children receiving Ontario Drug Benefits over a thirteen-year period in the province of Ontario, Canada. METHODS: Administrative health databases housed within the Institute for Clinical Evaluative Sciences (ICES), Ontario, Canada, were used to identify outpatient prescriptions dispensed from 1999 to 2012 through a publicly funded programme to children ≤18 years of age. Medications were classified according to the American Hospital Formulary Service Pharmacologic-Therapeutic Classification system. Descriptive statistics were used to summarize prescribing patterns. KEY FINDINGS: This study identified 457 037 children who were dispensed a new prescription between 1999 and 2012. About 56% received their first prescription before 6.5 years of age, and 85% of the children in this study were from families who received social assistance. The most commonly prescribed drugs were antiinfectives (56.1%). Prescriptions for several central nervous system agents, including antipsychotics and agents for attention-deficit/hyperactivity disorder, increased across the study period. Changes in prescribing patterns within opioids, hormones and autonomic agents were noted. The results suggest that historically, prescribing trends have shifted with public policy, pharmaceutical marketing and diagnostic patterns, thus identifying them as a possible tool to measure the impact of policydriven practice changes. Anti-infective prescribing increased markedly with the global H1N1 pandemic. Pharmaceutical marketing, formulary decisions and diagnostic trends may affect the prescribing of ADHD medications globally. The prescribing of codeine-containing products and medroxyprogesterone appeared to fluctuate in response to important publications in the medical literature, and the use of epinephrine syringes increased after public policy changes in the province of Ontario. The steady rise in the use of medications whose long-term effects in children are unknown, such as antipsychotics and proton pump inhibitors, identifies areas in need of future research. CONCLUSIONS: This study presents the first overview of Canadian prescribing trends for children, the majority of which are of low socioeconomic status and represent a potentially vulnerable population. Our analysis suggests that future research is required to determine whether prescribing trends could be used as indicators of policy effectiveness, pharmacovigilance and diagnostic trends.

Per-Prescription Drug Expenditure by Source of Payment and Income Level in the United States, 1997 to 2015.

OBJECTIVES: To evaluate expenditures and sources of payment for prescription drugs in the United States from 1997 to 2015. METHODS: The Medical Expenditures Panel Survey (MEPS) was used for this analysis. Individuals with one or more prescription medicines were eligible for inclusion. Outcomes were the inflation-adjusted cost per prescription across all payment sources (self or family, public, private, and other sources) before and after the Medicare Part D benefit and the Affordable Care Act. RESULTS: The cost per prescription increased from $38.56 in 1997 to $73.34 in 2015. Nevertheless, consumers' out-of-pocket expenditures decreased from $18.19 to $9.61, whereas public program expenditures per prescription increased from $5.61 to $34.43 over this time. Out-of-pocket expenditures of individuals in the low-income group and near-poor group had larger declined percentages from 51.4% to 20.4% and 46.5% to 17.2% relative to individuals in higher-income groups before and after implementation of the Medicare Part D, respectively. Over 90% prescription purchases were covered by medical insurance by 2015. The per-prescription cost for medications consumed by uninsured individuals increased at a lower rate from $31.83 to $54.96 versus $40.12 to $75.58 for privately insured and $36.00 to $70.96 for publicly insured (P < .001). CONCLUSIONS: Prescription drugs expenditures have increased over the past 2 decades, but public sources now pay for a growing proportion of prescription drugs cost regardless of health insurance coverage or income level. Out-of-pocket expenditures have significantly decreased for persons with lower incomes since the implementation of Medicare Part D and the Affordable Care Act.

Assessment of patients’ knowledge to their dispensed medications at Port Moresby General Hospital, Papua New Guinea

@#Limited information on drug use indicates that medicines are not optimally used. Inadequate knowledge of medication uses may lead to overuse of medicines or patient non-compliance with a medicine regimen, and result in serious outcomes. The aim of this study was to assess the patients’ knowledge on dispensed medications in pharmacy at Port Moresby General Hospital (PMGH). This was a descriptive cross-sectional study utilizing a self-administered questionnaire adapted from the WHO “Guide to Good Prescribing Practical Manual”. The questionnaire sought to elicit major classes of medicines prescribed, knowledge of patients on indications, how to use the medicines, precautions and possible adverse events. A total of 130 patients from PMGH participated in this study. Although majority of patients (94.6%) knew the instructions on the use of the dispensed medicines in terms of route of administration, dosage and frequency of usage; only 74.6% of them knew the duration of medicines use. Further, 19.2% of participants did not know the indications for which their medicines were prescribed. Knowledge on adverse effects was also significantly low i.e 34.7%. Lack of understanding of warnings and precautions was rated at 42.3%. These figures may contribute to poor patient compliance and cause possible harm to the patients. The results demonstrated lack of adequate information given to patients on their prescribed medicines. It is recommended that prescribers be re-trained on the importance of giving adequate information on medications given to patients, particularly to patients with low educational background.

Children/young people taking long-term medication: a survey of community pharmacists' experiences in England.

OBJECTIVES: To determine whether community pharmacists undertake medication reviews with children/their carers and to identify the type of medication-related experiences presented to them when a child is taking long-term medication. METHODS: A 13 question semi-structured survey was posted to 354 England-based community pharmacists with telephone follow-up/repeat mailing of non-responders. Participants were asked about their practice as a community pharmacist over the preceding 12 months to children/young people, or their carers, taking long-term medication. The questionnaire covered: medication review, reported adherence, information requests, adverse effects, administration and obtaining medication supplies. The data were analysed using SPSS version 22 and NVivo version 10. RESULTS: The response rate was 76/354 (21.5%). Eighteen (23.7%) respondents had undertaken a Medicines Use Review (MUR) and 22 (28.9%) a New Medicines Service (NMS) medication review with a child/their carer. Participants reported that patients/their carers had presented to them with non-adherence including stopping medication (24, 31.6%) and changing the dose (28, 36.8%). Respondents were directly asked about the indication (59, 77.6%), dose regimen (63, 82.9%), administration (64, 84.2%) and adverse effects (58, 76.3%) of prescribed medication. Respondents reported patients/carers experiencing difficulties obtaining medication from their community pharmacy (47, 61.8%) and patients' family doctors declining to prescribe a medication recommended by a specialist (27, 35.5%). CONCLUSIONS: Medicines Use Review and NMS reviews are utilised by community pharmacists in children/their carers. The medication-related experiences presenting to community pharmacists could fall within the purview of a medication review (MUR or NMS). There is scope to further extend this service to this group of patients/carers.

Real world data of a veterinary teaching hospital in Japan: a pilot survey of prescribed medicines.

The prescription data from a digital accounting system of a veterinary teaching hospital collected between 2008 and 2011 in Japan were downloaded, stored in a database and analysed using a statistical analysis software, SAS. Seventy-six per cent of all prescriptions were drugs approved for human beings. The most frequently prescribed category was 'Agents against pathogenic organisms', such as antibiotics and chemotherapeutic agents, followed by 'Cardiovascular agents'. Seventy-five per cent of prescribed oral formulations in the category 'Agents against pathogenic organisms' were drugs approved for human beings, while 78 per cent of the injectable prescriptions were those for veterinary. A total of 36 oral antipathogenic products were prescribed, and among them amoxicillin was prescribed the most, followed by cephalexin for human beings and enrofloxacin for veterinary. The pattern of cyclosporin prescription, which is the most prescribed product other than 'Agents against pathogenic organisms', was surveyed. The capsule formulation was primarily used for dogs, while oral solutions were preferably used for cats. This pilot study is the first analytical data of real prescription in hospitals in Japan and one of the longest surveys in veterinary world.

Prevalence and pattern of self-medication in Karachi: A community survey.

OBJECTIVE: To study the prevalence and pattern of self-medication among adult males and females in Karachi, Pakistan. METHODS: This cross-sectional community- based survey was carried out at five randomly selected towns of Karachi (Defence, Gulshan-e-Iqbal, North Nazimabad, Malir, Orangi town) over a period of 3 months (October, November & December 2012). A sample size of 500 adult cases (250 males & 250 females), with systemic random selection from different towns of Karachi were inducted in this study. The city was divided in 5 zones and one town from each zone was selected by systemic randomization. First available male and female from each randomly selected house were included in the study. After consent and confidentiality assurance they were interviewed on semi-structured Performa designed for this purpose. Results were analyzed and tabulated through SPSS v14.0. RESULT: The prevalence of self-medication in males and females in Karachi is found to be 84.8% (males 88.4% and females 81.2%). The most frequent symptoms for which self-medication used were headache (32.7%), fever (23.3%) and the medicines used were painkillers (28.8%), fever reducer medicines (19.8%). The most common reason 33.3% was previous experience with similar symptom. CONCLUSION: Self-medication is highly prevalent (84.8%) in Karachi. It was frequently used for headache followed by fever. Predominantly painkillers, fever reducer and cough syrups were used in the form of tablets and syrups. Main source of medicines for males were friends and for females were relatives.

Clinical Features of Drug-induced Liver Injury According to Etiology.

Drug-induced liver injury (DILI) is an increasingly common cause of acute hepatitis. We examined clinical features and types of liver injury of 65 affected patients who underwent liver biopsy according DILI etiology. The major causes of DILI were the use of herbal medications (43.2%), prescribed medications (21.6%), and traditional therapeutic preparations and dietary supplements (35%). DILI from herbal medications, traditional therapeutic preparations, and dietary supplements was associated with higher elevations in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels than was DILI from prescription medications. The types of liver injury based on the R ratio were hepatocellular (67.7%), mixed (10.8%), and cholestatic (21.5%). Herbal medications and traditional therapeutic preparations were more commonly associated with hepatocellular liver injury than were prescription medications (P = 0.002). Herbal medications and traditional therapeutic preparations induce more hepatocellular DILI and increased elevations in AST and ALT than prescribed medications.

Pharmacoepidemiology at Nordic School of Public Health NHV: Examples from 1999 to 2014.

BACKGROUND: Pharmacoepidemiology is a branch of public health and had a place at the Nordic School of Public Health. Courses, Master's theses and Doctorates of Public Health (DrPH) in Pharmacoepidemiology were a relatively minor, but still important part of the school's activities. METHODS: This paper gives a short background, followed by some snapshots of the activities at NHV, and then some illustrative case-studies. These case-studies list their own responsible co-authors and have separate reference lists. RESULTS: In the Nordic context, NHV was a unique provider of training and research in pharmacoepidemiology, with single courses to complete DrPH training, as well as implementation of externally-funded research projects. CONCLUSIONS: With the closure of NHV at the end of 2014, it is unclear if such a comprehensive approach towards pharmacoepidemiology will be found elsewhere in the Nordic countries.

Characterisation of patient encounters in community pharmacies (with special focus on self-medication).

OBJECTIVES: To characterise patient encounters during routine drug dispensing in community pharmacies. METHODS: Cross-sectional survey in community pharmacies (Belgium). KEY FINDINGS: Fifty-four per cent of all encounters (N = 1650) concerned patients carrying a prescription, of which 39% were prescriptions for new medication and 61% were repeat prescriptions. In 62% of all encounters, patients asked for non-prescribed medication. Almost one-third of self-medication requests related to special patient populations (mainly children and elderly). CONCLUSIONS : Many encounters related to self-medication, and a substantial number of these self-medication requests concerned vulnerable patient populations.

Clinical Features of Drug-induced Liver Injury According to Etiology

Drug-induced liver injury (DILI) is an increasingly common cause of acute hepatitis. We examined clinical features and types of liver injury of 65 affected patients who underwent liver biopsy according DILI etiology. The major causes of DILI were the use of herbal medications (43.2%), prescribed medications (21.6%), and traditional therapeutic preparations and dietary supplements (35%). DILI from herbal medications, traditional therapeutic preparations, and dietary supplements was associated with higher elevations in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels than was DILI from prescription medications. The types of liver injury based on the R ratio were hepatocellular (67.7%), mixed (10.8%), and cholestatic (21.5%). Herbal medications and traditional therapeutic preparations were more commonly associated with hepatocellular liver injury than were prescription medications (P = 0.002). Herbal medications and traditional therapeutic preparations induce more hepatocellular DILI and increased elevations in AST and ALT than prescribed medications.

Significance of pharmaceutical excipients in prescribed medicines: a case report.

KEY CLINICAL MESSAGE: Pharmaceutical excipients need careful observation as they play a significant role in treatment outcomes. It is imperative for a physician to collect complete patient profile before prescribing new medications for current treatment. We present a case report on the significance of pharmaceutical excipients in prescribed medicines.

Encuesta sobre abuso de alcohol y medicamentos en adolescentes de cuatro escuelas del conurbano bonaerense / Survey on alcohol and medicine abuse among adolescents at four schools in Greater Buenos Aires

Introducción. El consumo de alcohol y medicamentos no prescritos en los adolescentes es un problema creciente en los servicios de toxicología. La "jarra loca" es una mezcla de bebidas alcohólicas y medicamentos que utilizan los jóvenes como modalidad de abuso. En los últimos años, además de psicofármacos, los jóvenes mezclan hipoglucemiantes, lo cual puede generar secuelas neurológicas o producir la muerte, dependiendo de la dosis ingerida y el tiempo de duración de la hipoglucemia. Objetivo. Estimar la prevalencia de consumo de alcohol y medicamentos en adolescentes de 12 a 18 años de edad que concurren a cuatro escuelas del partido de Tres de Febrero, de la provincia de Buenos Aires. Material y métodos. Estudio observacional, descriptivo y transversal. Se realizó una encuesta autoadministrada sobre consumo de alcohol y medicamentos en adolescentes de 12 a 18 años, de cuatro escuelas de la provincia de Buenos Aires. Se realizaron talleres para intercambio de conocimientos y experiencias con los alumnos y se entregó material gráfico informativo. Resultados. Se realizaron 977 encuestas. El 49% de los alumnos encuestados refirió consumir bebidas alcohólicas al salir con sus amigos. El 8% (n= 78) de los alumnos refirieron consumir "jarra loca" y el 49% refirieron que sus amigos lo hacían. Veintiún alumnos requirieron atención médica, al menos, en una oportunidad luego de haber tomado bebidas alcohólicas y 17 de estos habían consumido "jarra loca". El 55% de los alumnos desconocían el uso de las pastillas que mezclan en la "jarra loca". El 48% de los padres desaprueba el consumo de alcohol. Conclusión. El 49% refirió tomar bebidas alcohólicas. En nuestro trabajo, el 8% de los alumnos encuestados consumieron o probaron alguna vez "jarra loca", aunque el 49% afirmaron que sus amigos sí lo hacían.

Introduction.The use of alcohol and prescription drugs acquired without a prescription among adolescents has become an increasing problem at departments of toxicology. The "jarra loca" is a mix of alcoholic beverages and medicines abused by teens. In the past years, in addition to psychotropic drugs, adolescents have also added hypoglycemic drugs to the mix, which may cause neurological sequelae or even death, depending on the dose used and the duration of hypoglycemia. Objective.To estimate the prevalence of alcohol and medicine use among 12 to 18 year-old adolescents attending four schools in the district of Tres de Febrero, province of Buenos Aires. Material and Metfcods.Observational, descriptive and cross-sectional study. A survey on alcohol and medicine use was self-administered by 12 to 18 year-old adolescents from four schools in the province of Buenos Aires. During workshops, knowledge and experience were exchanged with students and infographic material was provided. Results.Nine hundred and seventy-seven surveys were completed. Of all surveyed students, 49% indicated that they have alcoholic beverages while out with their friends; 8% (n= 78) admitted drinking the "jarra loca" while 49% stated that their friends did. Twenty-one students required medical care at least once following alcohol consumption, and seventeen of them had drunk the "jarra loca." Fifty-five percent of students did not know what medicines are mixed in the "jarra loca" Forty-eight percent of parents discourage alcohol consumption. Conclusion.Forty-nine percent of students indicated that they have alcoholic beverages. In our study, 8% of surveyed students had consumed or tried the "jarra loca" once, although 49% referred that they friends did.

Encuesta sobre abuso de alcohol y medicamentos en adolescentes de cuatro escuelas del conurbano bonaerense / Survey on alcohol and medicine abuse among adolescents at four schools in Greater Buenos Aires

Introducción. El consumo de alcohol y medicamentos no prescritos en los adolescentes es un problema creciente en los servicios de toxicología. La "jarra loca" es una mezcla de bebidas alcohólicas y medicamentos que utilizan los jóvenes como modalidad de abuso. En los últimos años, además de psicofármacos, los jóvenes mezclan hipoglucemiantes, lo cual puede generar secuelas neurológicas o producir la muerte, dependiendo de la dosis ingerida y el tiempo de duración de la hipoglucemia. Objetivo. Estimar la prevalencia de consumo de alcohol y medicamentos en adolescentes de 12 a 18 años de edad que concurren a cuatro escuelas del partido de Tres de Febrero, de la provincia de Buenos Aires. Material y métodos. Estudio observacional, descriptivo y transversal. Se realizó una encuesta autoadministrada sobre consumo de alcohol y medicamentos en adolescentes de 12 a 18 años, de cuatro escuelas de la provincia de Buenos Aires. Se realizaron talleres para intercambio de conocimientos y experiencias con los alumnos y se entregó material gráfico informativo. Resultados. Se realizaron 977 encuestas. El 49% de los alumnos encuestados refirió consumir bebidas alcohólicas al salir con sus amigos. El 8% (n= 78) de los alumnos refirieron consumir "jarra loca" y el 49% refirieron que sus amigos lo hacían. Veintiún alumnos requirieron atención médica, al menos, en una oportunidad luego de haber tomado bebidas alcohólicas y 17 de estos habían consumido "jarra loca". El 55% de los alumnos desconocían el uso de las pastillas que mezclan en la "jarra loca". El 48% de los padres desaprueba el consumo de alcohol. Conclusión. El 49% refirió tomar bebidas alcohólicas. En nuestro trabajo, el 8% de los alumnos encuestados consumieron o probaron alguna vez "jarra loca", aunque el 49% afirmaron que sus amigos sí lo hacían.(AU)

Introduction.The use of alcohol and prescription drugs acquired without a prescription among adolescents has become an increasing problem at departments of toxicology. The "jarra loca" is a mix of alcoholic beverages and medicines abused by teens. In the past years, in addition to psychotropic drugs, adolescents have also added hypoglycemic drugs to the mix, which may cause neurological sequelae or even death, depending on the dose used and the duration of hypoglycemia. Objective.To estimate the prevalence of alcohol and medicine use among 12 to 18 year-old adolescents attending four schools in the district of Tres de Febrero, province of Buenos Aires. Material and Metfcods.Observational, descriptive and cross-sectional study. A survey on alcohol and medicine use was self-administered by 12 to 18 year-old adolescents from four schools in the province of Buenos Aires. During workshops, knowledge and experience were exchanged with students and infographic material was provided. Results.Nine hundred and seventy-seven surveys were completed. Of all surveyed students, 49% indicated that they have alcoholic beverages while out with their friends; 8% (n= 78) admitted drinking the "jarra loca" while 49% stated that their friends did. Twenty-one students required medical care at least once following alcohol consumption, and seventeen of them had drunk the "jarra loca." Fifty-five percent of students did not know what medicines are mixed in the "jarra loca" Forty-eight percent of parents discourage alcohol consumption. Conclusion.Forty-nine percent of students indicated that they have alcoholic beverages. In our study, 8% of surveyed students had consumed or tried the "jarra loca" once, although 49% referred that they friends did.(AU)