Knowledge of appropriate acetaminophen doses and potential toxicities in an adult clinic population.

OBJECTIVE: To evaluate the knowledge of appropriate doses and potential toxicities of acetaminophen and assess the ability to recognize products containing acetaminophen in an adult outpatient setting. DESIGN: Cross-sectional, prospective study. SETTING: University adult general internal medicine (AGIM) clinic. PATIENTS: 104 adult patients presenting to the clinic over consecutive weekdays in December 2003. INTERVENTIONS: Three-page, written questionnaire. MAIN oUTCOME MEASURES: Ability of patients to identify maximum daily doses and potential toxicities of acetaminophen and recognize products that contain acetaminophen. RESULTS: A large percentage of participants (68.3%) reported pain on a daily or weekly basis, and 78.9% reported use of acetaminophen in the past 6 months. Only 2 patients correctly identified the maximum daily dose of regular acetaminophen, and just 3 correctly identified the maximum dose of extra-strength acetaminophen. Furthermore, 28 patients were unsure of the maximum dose of either product. Approximately 63% of participants either had not received or were unsure whether information on the possible danger of high doses of acetaminophen had been previously provided to them. When asked to identify potential problems associated with high doses of acetaminophen, 43.3% of patients noted the liver would be affected. The majority of the patients (71.2%) recognized Tylenol as containing acetaminophen, but fewer than 15% correctly identified Vicodin, Darvocet, Tylox, Percocet, and Lorcet as containing acetaminophen. CONCLUSION: Although nearly 80% of this AGIM population reported recent acetaminophen use, their knowledge of the maximum daily acetaminophen doses and potential toxicities associated with higher doses was poor and appeared to be independent of education level, age, and race. This indicates a need for educational efforts to all patients receiving acetaminophen-containing products, especially since the ability to recognize multi-ingredient products containing acetaminophen was likewise poor.     

Knowledge and attitude of school children in Amman/Jordan toward the appropriate use of medicines: A cross-sectional study

ObjectivesThe aim of this study is to examine the knowledge, practice, and attitude toward medications of different primary school children at age group (7–9) years.MethodsThis cross sectional study adopted the form of structured interviewing technique using a validated and pre-piloted questionnaire. The questionnaire consisted of a mixture of multiple choice and open-ended questions, 15 USP pictograms and six dosage form demos. A randomized stratified target sample of 200 students (n = 100 of each gender), of the first, second and third grades from the four Amman Education Directorates was recruited. School children were interviewed regarding their knowledge, attitude and the way they think medicines should be used.ResultsThe mean score value achieved by children in all the knowledge questions was 23.26 ± 0.25 out of 32, which was considered as satisfactory knowledge by the research team. The most significant factors affecting children’s knowledge (including: multiple choice questions, pictograms and dosage forms) were: age, school/area of residency, and the presence of a first-degree relative working in a medical job. The majority of participants (79%) stated that the taste of the medication was the main factor to prevent them from taking their medication.ConclusionIn general, school children in our sample have satisfactory knowledge and a generally positive attitude toward medicines. However, school curricula in Jordan should include more education regarding the effective and safe use of medicines.     

Self-Medication: A survey of nonprescription drug use

A sample of adults (n = 148) which reflected age, gender, and race characteristics of the 1980 U.S. Census was surveyed on the incidence of obtaining over the counter (OTC) drugs during the previous year and the nature of the drugs used. Most (78%) reported obtaining OTC drugs, and of 15 categories, headache or pain remedies, cold or flu remedies, and vitamins were most frequently (>50%) reported as used. No gender or race effects were found for obtaining OTC drugs or for the nature of OTC drugs used. Identified patterns of OTC drug use were related to previous research and have implications for drug development, health care, and marketing concerns. © 1993 Wiley-Liss, Inc.     

Principles of appropriate antibiotic use

Many antibiotics, including macrolides and quinolones, are used incorrectly in the treatment of presumed respiratory tract infections. The use of broad-spectrum antibiotics increased considerably in the 1990s, but often this use is inappropriate. Guidelines, such as those for community-acquired pneumonia, encourage rational therapy and more prudent prescribing. There are strong links between appropriate use, compliance and resistance as well as between regimen complexity and compliance. These issues provide a platform for thinking about a short-duration, high-compliance drug therapy with good clinical efficacy. Such therapy will need to be combined with programs to promote rational antibiotic use, particularly targeting inappropriate prescribing for viral infections and use of agents with a broader antimicrobial spectrum than is necessary.     

Initial exposure to nicotine in college-age women smokers and never-smokers: a replication and extension.

Recent research suggests that people who become smokers may be more sensitive to the positive effects of nicotine upon initial exposure than those who do not take up smoking. The present study was designed to extend these findings to a sample of college-age women never-smokers and light smokers. Subjects were asked to rate pleasurable and displeasurable sensations upon first smoking and to indicate the presence or absence of pleasurable rush or buzz, relaxation, dizziness, nausea, and cough. Pleasurable sensations were marginally greater in smokers; pleasurable rush or buzz and dizziness were significantly more likely to be reported by smokers. Relaxation, displeasurable sensations, nausea, and cough did not differ significantly between groups. Fagerstrom Test for Nicotine Dependence scores significantly predicted pleasurable but not displeasurable sensations; Center for Epidemiological Studies-Depression scores predicted neither. These findings lend further support to the following conclusions: (1) people who become cigarette smokers experience more pleasurable sensations upon initial exposure to tobacco than their never-smoking counterparts; and (2) unpleasant reactions to the first cigarette do not protect against subsequent smoking.     

The appropriate use of psychotropic drugs

The history of psychiatric services and treatment is reviewed from the sedatives and psychotherapy of the 1930s, through electroconvulsive therapy in the 1940s, Rauwolphia and Chlorpromazine in the 1950s, followed by barbiturates then benzodiazepines in more recent times. The move to treatment in the community rather than in institutional settings is discussed, as is the need for care in the use of psychotropic drugs.     

Childhood asthma and use during pregnancy of acetaminophen. A critical review

The possible association between acetaminophen use during pregnancy and childhood asthma has been a subject of interest based on the theory that acetaminophen metabolism may deplete glutathione in the developing lung, leading to oxidative damage and inflammation. Epidemiology studies from eight centers have reported conflicting results. In some cases, end points of these studies have included wheezing in very young children, which is a poor predictor of asthma. Other study problems have included the common use of acetaminophen as the analgesic and antipyretic of choice during pregnancy. Because acetaminophen use may be a marker for infectious or inflammatory disorders, the results of the epidemiology studies may be influenced by confounding by indication. A placebo-controlled randomized trial of acetaminophen use during pregnancy would be helpful in resolving the question of whether acetaminophen use causes childhood asthma. At present, the evidence is inconclusive that any such association is causal.     

Review article: appropriate use of corticosteroids in Crohn's disease

BACKGROUND: Corticosteroids are a well-established treatment for active Crohn's disease and have been widely used for decades. It has become apparent, however, that a proportion of patients either fails to respond to corticosteroids or is unable to withdraw from them without relapsing. Furthermore, their use is associated with a range of side effects, such that long-term treatment carries unacceptable risk. AIM: To review the evidence regarding the appropriate use of corticosteroids in Crohn's disease, along with their side effects, safety and alternatives. METHODS: To collect relevant articles, a PubMed search was performed from 1966 to November 2006 using the terms 'steroid', 'corticosteroid', 'glucocorticoid', 'prednisolone', 'prednisone', 'methylprednisolone', 'hydrocortisone', 'dexamethasone' and 'budesonide' in combination with 'Crohn(s) disease'. Relevant articles were reviewed, as were their reference lists to identify further articles. RESULTS: When used correctly, corticosteroids are a highly effective, well tolerated, cheap and generally safe treatment for active Crohn' disease. Nevertheless, approximately 50% of recipients will either fail to respond (steroid-resistant) or will be steroid dependent at 1 year. Newer alternatives to corticosteroids are not, however, without risk themselves and, moreover, are not necessarily available universally. CONCLUSIONS: Steroids are used widely to treat Crohn's disease, a situation that is unlikely to change in the near future. Accordingly, efforts should be made to ensure that they are used correctly and that their side effects are minimized. Reference is made to recently published guidelines and a simplified 'users guide' is presented.     

Assessment of difference in dimensions of sexual orientation: implications for substance use research in a college-age population

OBJECTIVE: The present research examines the associations between three distinct dimensions of sexual orientation and substance use in a random sample of undergraduate students. METHOD: A Web-based survey was administered to students attending a large, midwestern research university in the spring of 2003. The sample consisted of 9,161 undergraduate students: 56% female, 68% white, 13% Asian, 6% black, 4% Hispanic and 9% other racial categories. Using multivariate logistic regression analyses, several measures of alcohol and other drug use were compared across three dimensions of sexual orientation: sexual identity, sexual attraction and sexual behavior. RESULTS: All three dimensions of sexual orientation were associated with substance use, including heavy episodic drinking, cigarette smoking and illicit drug use. Consistent with results of several other recent studies, "nonheterosexual" identity, attraction or behavior was associated with a more pronounced and consistent risk of substance use in women than in men. CONCLUSIONS: Study findings suggest substantial variability in substance use across the three dimensions of sexual orientation and reinforce the importance of stratifying by gender and using multiple measures to assess sexual orientation. Study results have implications for future research and for interventions aimed at reducing substance use among college students.     

Fetal programming of mental health by acetaminophen? Response to the SMFM statement: prenatal acetaminophen use and ADHD

Introduction: A number of studies indicate that acetaminophen taken during pregnancy may have a programming effect on the fetal brain development. The potential adverse consequences may only surface to clinical detection years later. Should we act on these findings now or do we wait for additional evidence?

Areas covered: We argue for action inspired by these well analyzed studies that are based on five prospective cohorts data collected from different countries. Several analytical options have been employed especially to address confounding, and all analyses have consistently suggested that confounding alone is an unlikely explanation for this disturbing observation.

Expert opinion: Acetaminophen is often used for minor symptom or discomfort where the treatment has no strong indication and carries little, if any risk for the pregnant women. The harm of doing nothing may well exceed the harm for taking precautionary actions considering the consequences at stake.     

A survey of pharmacokinetic data from pregnant women

Published results of pharmacokinetic studies (terminal half-life, t 1/2 beta, elimination constant, kappa e1; apparent volume of distribution in beta-phase, Vd beta and plasma clearance, CLp) in pregnant and non-pregnant women have been compiled and compared. Most of the data relate to the results of pharmacokinetic studies with 20 drugs in women at full-term pregnancy, i.e. about 40 weeks gestation. A review of these data failed to reveal any consistent overall trend in any of the pharmacokinetic parameters listed and no generally applicable changes in the disposition of the drugs as a result of pregnancy can be characterised. However, pregnancy associated changes appear to be discernible in the elimination patterns of certain drugs, for example, ampicillin, caffeine, diazepam, phenytoin and thiopentone, but the factors producing these changes can still only be suggested.     

Knowledge,attitudes and use of anabolic-androgenic steroids among male gym users: A community based survey in Riyadh,Saudi Arabia

Recreational use of anabolic-androgenic steroids (AAS) is a growing worldwide public health concern. However, studies assessing the level of awareness and knowledge of its effects on health are fairly limited, especially in developing countries, including Saudi Arabia. This community-based cross-sectional study was conducted to assess knowledge, attitudes and practices among male gym members toward AAS in Riyadh (Saudi Arabia) from March to October 2016. Twenty gyms were randomly selected from four different geographical regions (clusters) within Riyadh. In total, 482 participants responded to the self-administered anonymous questionnaire, which covered socio-demographic data, data assessing knowledge, attitude and behavior related to AAS use. The mean (±standard deviation) age of study participants was 27.2 (±6.9) years. Among these, 29.3% of participants reported having used AAS, while the majority (53.5%) reported hearing of AAS use, mostly through friends. Most study participants reported awareness of the effects of AAS on muscle mass, body weight and muscles strength (53.2%, 51.1% and 45.5%, respectively). In contrast, a higher proportion of study participants were unaware of the side-effects of AAS use. A high proportion of study participants (43.2%) reported that they had been offered AAS and 68.7% believed that AAS are easily accessible. Most of the gym users (90.1%) reported never having used any narcotics or psychoactive drugs. Regression analysis revealed that use of anabolic-androgenic steroids is significantly associated with “weight lifting practice” OR [95%CI]?=?1.9[1.02???3.61], P?=?0.044; “using supplementary vitamins, OR [95%CI]?=?7.8[4.05???15.03], P?<?0.0001, knowing anyone using anabolic-androgenic steroids’ OR [95%CI]?=?7.5[3.78???14.10], P?<?0.0001, and someone advised Gym users to take anabolic-androgenic steroids” OR [95%CI]?=?2.26[1.23???4.14], P?<?0.008. Our findings suggest that the level of awareness regarding the possible side-effects of AAS is fairly limited. Thus, efforts directed toward educating the public and limiting access to AAS as well as health policy reforms are crucial to reduce future negative implications of AAS use.