西部城乡药店抗生素不凭处方销售情况研究——以西安市为例

目的:调查以西安为代表的西部城乡药店抗生素不凭处方销售状况。方法:采用神秘顾客法模拟成人急性上呼吸道感染和儿童腹泻两类病症,随机调查西安市102家药店凭处方销售抗生素的情况。结果:大多数药店不凭处方出售抗生素,药店药学服务情况堪忧,无法确保用药对症与否。结论:西安市药店违规销售抗生素行为普遍,建议深入推进医药卫生体制改革,加强药店监管,普及抗生素知识,以确保抗生素用药安全。     

陕西省药店凭处方销售抗生素现状研究

目的：调查陕西省药店抗生素凭处方销售情况,为完善药店抗生素管理提供建议。方法：采用神秘顾客法,分别模拟儿童腹泻和成人急性上呼吸道感染患者,调查陕西省213家药店凭处方销售抗生素情况和药店工作人员药学服务行为。结果：大多数药店不凭处方出售抗生素,儿童腹泻和成人急性上呼吸道感染病症不凭处方获得抗生素的比例分别为72．8％和95．8％;对两类病症能提供完整药学服务的药店仅占0．9％,药店药学服务缺位;大部分患者未能得到正确的用药指导,难以确保抗生素合理使用。结论：陕西省药店抗生素销售行为亟待规范。建议加强零售药店抗生素销售的监管,提升药店工作人员规范化服务水平,加强药师队伍建设,广泛开展抗生素合理使用知识的宣传教育,加快推进医药卫生体制改革,根本提升社区抗生素用药安全水平。     

Assessing mobile food vendors (a.k.a. street food vendors)—methods,challenges, and lessons learned for future food-environment research

Objectives

Mobile food vendors (also known as street food vendors) may be important sources of food, particularly in minority and low-income communities. Unfortunately, there are no good data sources on where, when, or what vendors sell. The lack of a published assessment method may contribute to the relative exclusion of mobile food vendors from existing food-environment research. A goal of this study was to develop, pilot, and refine a method to assess mobile food vendors.

Study design

Cross-sectional assessment of mobile food vendors through direct observations and brief interviews.

Methods

Using printed maps, investigators canvassed all streets in Bronx County, NY (excluding highways but including entrance and exit ramps) in 2010, looking for mobile food vendors. For each vendor identified, researchers recorded a unique identifier, the vendor's location, and direct observations. Investigators also recorded vendors answers to where, when, and what they sold.

Results

Of 372 identified vendors, 38% did not answer brief-interview questions (19% were ‘in transit’, 15% refused; others were absent from their carts/trucks/stands or with customers). About 7% of vendors who ultimately answered questions were reluctant to engage with researchers. Some vendors expressed concerns about regulatory authority; only 34% of vendors had visible permits or licenses and many vendors had improvised illegitimate-appearing set-ups. The majority of vendors (75% of those responding) felt most comfortable speaking Spanish; 5% preferred other non-English languages. Nearly a third of vendors changed selling locations (streets, neighbourhoods, boroughs) day-to-day or even within a given day. There was considerable variability in times (hours, days, months) in which vendors reported doing business; for 86% of vendors, weather was a deciding factor.

Conclusions

Mobile food vendors have a variable and fluid presence in an urban environment. Variability in hours and locations, having most comfort with languages other than English, and reluctance to interact with individuals gathering data are principal challenges to assessment. Strategies to address assessment challenges that emerged form this project may help make mobile-vendor assessments more routine in food-environment research.     

Smokers' beliefs and attitudes about purchasing cigarettes on the Internet

OBJECTIVES: Our objectives were to explore qualitatively how smokers find out about Internet cigarette sales and what factors motivate them to purchase cigarettes on-line, and to quantitatively describe the Internet cigarette purchasing behaviors and attitudes of Internet cigarette buyers. METHODS: Qualitative in-depth telephone interviews were conducted with 21 adult smokers who had purchased or contemplated purchasing cigarettes online. Findings from the qualitative study were used to develop a survey module on Internet cigarette purchasing behavior that was administered to 187 New Jersey adult smokers. RESULTS: Smokers who purchased cigarettes on-line were primarily motivated by lower prices, which occur because Internet vendors generally sell cigarettes without paying excise taxes for the destination state. Most Internet cigarette buyers first learned about on-line cigarette sales from interpersonal sources who had purchased on-line. New Jersey adult smokers who purchased cheaper cigarettes from the Internet and other lower-taxed sources significantly increased their consumption over time, compared to smokers who reported paying full-price at traditional bricks-and-mortar retail stores. CONCLUSIONS: Policies that have the effect of equalizing Internet cigarette prices with those at retail stores will likely deter smokers from purchasing cigarettes on-line. Internet cigarette vendors should be required to comply with the same provisions that apply to bricks-and-mortar retail vendors and charge appropriate state and local cigarette excise taxes. In the absence of such policies, the sales of cheaper, tax-free cigarettes on-line will undermine the public health benefit of raising cigarette prices.     

Developing Public Health Regulations for Marijuana: Lessons From Alcohol and Tobacco

Until November 2012, no modern jurisdiction had removed the prohibition on the commercial production, distribution, and sale of marijuana for nonmedical purposes—not even the Netherlands. Government agencies in Colorado and Washington are now charged with granting production and processing licenses and developing regulations for legal marijuana, and other states and countries may follow. Our goal is not to address whether marijuana legalization is a good or bad idea but, rather, to help policymakers understand the decisions they face and some lessons learned from research on public health approaches to regulating alcohol and tobacco over the past century.Marijuana legalization is no longer an abstract notion. In November 2012, voters in Colorado and Washington passed initiatives that not only made it legal to possess up to an ounce of marijuana for nonmedical purposes but also allow for-profit firms to supply the market. Colorado’s initiative additionally allows home production. Although marijuana remains illegal under federal law, policymakers in these states are now developing regulatory regimes that will allow licensees to produce and sell marijuana and other cannabis products, including infused candies and other edibles, to anyone who is aged 21 years or older. (“Marijuana” is an American term, customarily applied to the dried leaves and flowers of the cannabis plant. There are other cannabis plant products, including resin, which is referred to in the United States as “hashish.” The majority of cannabis consumed in the United States is in the form of marijuana, which is probably why initial state legalization statutes that have passed are specifically about “marijuana” although even these laws do not mean to be restrictive in their terms. For example, Washington speaks of “marijuana-infused” drinks and edibles, and Colorado’s Amendment 64 defines “marijuana” to be all possible products of the plant except industrial hemp.) Bills to legalize marijuana are being introduced in other states, and we will likely see more ballot initiatives in future elections.Although many jurisdictions have experimented with alternatives to strict marijuana prohibition, including decriminalization, medical marijuana, and the Dutch “coffee shops,” no industrialized nation has legalized the cultivation, processing, distribution, and supply of marijuana for recreational purposes in the modern era—not even the Netherlands. In the Netherlands, de facto legalization extends only to retail sales of up to 5 grams; wholesale distribution of marijuana to coffee shops remains illegal and is actively enforced. That is not to say that it has never been legal; in fact, marijuana was a legal commodity in the United States until the early 1900s. But regulatory policy on the cultivation, processing, distribution, and sale of marijuana and its derivative products is unprecedented in the modern era.Because there are no modern examples of marijuana regulation, policymakers are confronting many new questions about how to manage a marijuana market. Should the number of licensees be restricted, and, if so, how should those scarce licenses be allocated? Should vertical integration be allowed, or should there be separate licenses for growing, processing, and selling marijuana? What product safety requirements should be considered (in terms of specific ingredients allowed or disallowed), and who will be responsible for testing the product? How restrictive should licenses be in terms of permitted quantity and potency? Should taxes be assessed per unit weight, as a percentage of value (ad valorem), or on some other basis, such as Δ-9-tetrahydrocannabinol (THC) content? Should marijuana be sold in conventional stores alongside other products or only in specialized venues? What about within-state Internet sales? Although the questions are new for marijuana, policymakers have grappled with similar questions pertaining to alcohol and tobacco, raising the question of what lessons can be learned from these 2 substances and applied to marijuana policy.We have summarized insights and ideas that grew out of a meeting of alcohol, tobacco, and illicit drug policy experts hosted by the RAND Drug Policy Research Center on February 11, 2013, to foster discussions about how one might regulate marijuana to promote public health objectives assuming a decision to legalize has already been made. The arguments here do not necessarily reflect the opinions of every coauthor but, instead, reflect a general consensus of ideas that grew out of those discussions. The conference was filmed by C-SPAN.1     

Family self-medication and antibiotics abuse for children and juveniles in a Chinese city

To identify the determinants of self-medication and antibiotics abuse by parents treating their children aged between 2 and 18 over the previous year, an investigation was conducted in Hefei City, China in April, 1995. A total of 1596 students from a kindergarten, a primary school and a high school were included in the study, and 1459 completed questionnaires were collected (the response rate: 91.4%). The results showed the rate of parental self-medication for their children in the sample was 59.4%. It increased with children's age; about 51% of children had received parental self-medication on six or more occasions during the 1-year period and 32.8% on four to five occasions; there were associations between parental self-prescribers and sources of medicine and severity of disease. The rate of antibiotics abuse was 35.7%. Logistic regression analysis showed that there were significant associations between self-medication and payment of the mother's medical fees by employers, severity of diseases as well as the mother's educational level.     

Economics of self-medication: theory and evidence

A pervasive phenomenon in developing countries is that self-prescribed medications are purchased from drug vendors without professional supervision. In this article we develop a model of self-medicating behavior of a utility-maximizing consumer who balances the benefits and risks of self-medication. The empirical investigation focuses on the role of income and health insurance on the use of self-medication. Our data are from the World Bank's Living Standards Measurement Survey of Vietnam, 1997-1998. The results show that self-medication is an inferior good at high income levels and a normal good at low income levels, and it shows a strong and robust negative insurance effect.     

Problems of venereal disease in Nigeria. 1. Gonococcal resistance to antibiotics and treatment of gonorrhoea

Venereal disease is becoming an increasingly serious problemin developing countries. The availability of antibiotics inchemists' shops has encouraged self-medication with sub-therapeuticdoses and inadequate treatment regimens. At a health centrein Nigeria, a diagnosis of gonococcal urethritis was made in159 out of 429 men presenting with urethritis. Neisseria gonorrhoeaewas cultured in 141 cases and the sensitivity pattern to a numberof antibiotics freely available at chemists was determined.The organisms were highly resistant to penicillin (84%), ampicillin(80%), tetracycline (68%), streptomycin (78%) and co-trimoxazole(83%). These were the cheapest of the drugs available, leavingonly erythromycin and the more expensive drugs gentamicin andcefotaxime still effective for general use in treatment programmes.