Every week, we will provide a brief summary and a link to the published abstract of newly published papers selected from the worldwide literature as being of particular interest to the SelfCare community.
CLINICAL STRATEGIES TO ENHANCE THE EFFICACY OF NICOTINE REPLACEMENT THERAPY FOR SMOKING CESSATION: A REVIEW OF THE LITERATURE.
By: Carpenter MJ, Jardin BF, Burris JL, Mathew AR, Schnoll RA, Rigotti NA, Cummings KM.
Drugs (2013) 73(5):407–426.
Summary: A number of smoking cessation pharmacotherapies have led to increases in quitting and thus to significant benefits to public health. Among existing medications, nicotine replacement therapy (NRT) has been available the longest, has the largest literature base in support, and is the only option for over-the-counter access. While the short-term efficacy of NRT is well documented in clinical trials, long-term abstinence rates associated with using NRT are modest, as most smokers will relapse. This literature review examines emerging clinical strategies to improve NRT efficacy and concludes with a brief discussion of emergent NRT products (e.g., oral nicotine spray, among others), which may ultimately offer greater efficacy than current formulations. In order to further lower the prevalence of smoking, novel strategies designed to optimize NRT efficacy are needed.
NON-PRESCRIPTION MEDICINES FOR PAIN AND FEVER-A COMPARISON OF RECOMMENDATIONS AND COUNSELING FROM STAFF IN PHARMACY AND GENERAL SALES STORES.
By: Bardage C, Westerlund T, Barzi S, Bernsten C.
Health Policy 2013 Apr 110(1): 76-83.
Summary: The purpose of this study is to map and analyze the content and quality of the encounter when customers buy non-prescription medicines for pain and fever, in 297 pharmacies and 801 general sales stores (GSS) in Sweden. In two out of three visits to GSS, the staff proposed a medicine for a heavily pregnant woman. In 9% of the visits the staff suggested a medicine that is inappropriate in late pregnancy. The corresponding percentage in pharmacies was 1%. Both pharmacies and GSS proposed, in 6% a medicine that is inappropriate for babies to a feverish child. Only 16% of the pharmacists and 14% of the staff in GSS asked for the age of the child. General sales staff recommended in 10% ibuprofen and in 4% an acetylsalicylic acid product when an acetaminophen preparation was requested. The corresponding percentage in the pharmacy were 4% ibuprofen, 2% diclofenac, and 1% an acetylsalicylic acid product. Conclusions: The staff in GSS and pharmacies do not pay sufficient attention to the heterogeneity of painkillers, which lead to inappropriate recommendations.
OVER-THE-COUNTER AND OUT-OF-CONTROL: LEGAL STRATEGIES TO PROTECT YOUTHS FROM ABUSING PRODUCTS FOR WEIGHT CONTROL.
By: Pomeranz JL, Taylor LM, Austin SB.
American journal of public health 103. 2 (Feb 2013): 220-5.
Summary: Abuse of widely available, over-the-counter drugs and supplements such as laxatives and diet pills for weight control by youths is well documented in the epidemiological literature. Many such products are not medically recommended for healthy weight control or are especially susceptible to abuse, and their misuse can result in serious health consequences. We analyzed the government’s role in regulating these products to protect public health. We examined federal and state regulatory authority, and referred to international examples to inform our analysis. Several legal interventions are indicated to protect youths, including increased warnings and restrictions on access through behind-the-counter placement or age verification. The authors suggest future directions for governments internationally to address this pervasive public health problem.
EFFICACY OF OTC ANALGESICS.
By: Moore RA, Derry C.
Int J Clin Pract, January 2013, 67 (Suppl. 178), 21–25.
Summary: For many ‘over-the-counter’ (OTC) analgesics, there is little information available about their relative efficacy. We have examined information available in a series of Cochrane reviews of single doses of analgesic drugs in acute pain and migraine for its relevance for analgesic products commonly available without prescription, at doses generally equivalent to two tablets. For acute pain, data from third molar extraction studies showed that several OTC products were highly efficacious, principally non-steroidal anti-inflammatory drugs (ibuprofen, naproxen, diclofenac) and combination products based on ibuprofen; aspirin and paracetamol-based products were less efficacious. Fixed-dose combinations, especially those with ibuprofen, provided high levels of analgesia. For migraine headache, the outcome used was pain initially moderate or severe becoming no worse than mild pain (no pain, mild pain) at 2 h. Single-dose ibuprofen 400 mg was better than aspirin and paracetamol.
WAS THE EXPANSION OF THE MARKETING LICENSE FOR NICOTINE REPLACEMENT THERAPY IN THE UNITED KINGDOM TO INCLUDE SMOKING REDUCTION ASSOCIATED WITH CHANGES IN USE AND INCIDENCE OF QUIT ATTEMPTS?
By: Beard E, Bruguera C, Brown J, et al.
Nicotine & Tobacco Research 2013 Apr 10. [Epub ahead of print]
Summary: In December 2009 and January 2010, the UK Medicines and Healthcare Products Regulatory Agency expanded the marketing license for a number of nicotine replacement therapies (NRTs) to include smoking reduction without an intention to stop completely. This study examined whether this was associated with a change in incidence of use of NRT for harm reduction (i.e., smoking reduction and/or temporary abstinence) and in smoking cessation activity. Expansion of the UK marketing license for NRT to include smoking reduction without the intention of quitting was not associated with an increase in use of NRT for this purpose. It was followed by a reduction in the incidence of quit attempts (but not their success) although this may have been a continuation of a pre-existing decline.
IBUPROFEN: FROM INVENTION TO AN OTC THERAPEUTIC MAINSTAY.
By: Rainsford KD.
Int J Clin Pract, January 2013, 67 (Suppl.178),9-20.
Summary: The discovery of ibuprofen’s anti-inflammatory activity 50 years ago represented a milestone in the development of anti-inflammatory analgesics. Subsequent clinical studies were the basis for ibuprofen being widely accepted for treating painful conditions at high anti-rheumatic doses, with lower doses for mild-moderate acute pain. The use of the low-dose, non-prescription, over-the-counter (OTC) drug was based on marketing approval in 1983 (UK) and 1984 (USA); and it is now available in over 80 countries. The relative safety of OTC ibuprofen has been supported by large-scale controlled studies. It has the same low gastro-intestinal (GI) effects as paracetamol (acetaminophen) and fewer GI effects than aspirin. Future developments include novel gastro-tolerant forms for ‘at risk’ patients, and uses in the prevention of neuro-inflammatory states and cancers.
USE OF AND FACTORS ASSOCIATED WITH SELF-TREATMENT IN CHINA.
By: Yuefeng L, Keqin R, Xiaowei R.
BMC public health 2012 (Nov) 12: 995.
Summary: When an individual is ill or symptomatic, they have the options of seeking professional health care, self-treating or doing nothing. In China, some studies suggest that the number of individuals opting to self-treat has been rapidly increasing in recent years. Therefore, the aim of this study was to analyze the trends of, and factors related to, self-treatment in China, using data from the China National Health Survey (CNHS), which covers 802,454 individuals. Self-treatment was significantly higher in urban compared with rural areas (31.2% vs 14.9% in 1993, 43.5% vs 21.4% in 1998, 47.2% vs 31.4% in 2003, 31.0% vs 25.3% in 2008) in China. Economic and individual factors, as well as accessibility to drugs had a positive association with the probability of self-treating. Different illness symptoms, severity, and duration show a negative association with the probability of self-treating, showing a degree of rationality in decision-making. Different insurance systems were also found to have an effect on self-treatment decision-making. Self-treatment and professional medical services have shared the incremental medical needs of residents in recent years in China. Self-perceived illness status, economic circumstances, and education play important roles in health care decision-making.
LONG TERM EFFECT OF REDUCED PACK SIZES OF PARACETAMOL ON POISONING DEATHS AND LIVER TRANSPLANT ACTIVITY IN ENGLAND AND WALES: INTERRUPTED TIME SERIES ANALYSES.
By: Hawton K, Bergen H, Simkin S et al.
BMJ 2013;346:f403.
Summary: This study was to assess the long term effect of United Kingdom legislation introduced in September 1998 to restrict pack sizes of paracetamol on deaths from paracetamol poisoning and liver unit activity. Following the legislation there was an estimated average reduction of 17 deaths per quarter in England and Wales involving paracetamol alone (with or without alcohol) that received suicide or undetermined verdicts, a 43% reduction or an estimated 765 fewer deaths over the 11¼ years after the legislation. A similar effect was found when accidental poisoning deaths were included. There was a 61% reduction in registrations for liver transplantation for paracetamol induced hepatotoxicity, but no reduction was seen in actual transplantations. UK legislation to reduce pack sizes of paracetamol was followed by significant reductions in deaths due to paracetamol overdose, with some indication of fewer registrations for transplantation at liver units during the 11 years after the legislation. The continuing toll of deaths suggests, however, that further preventive measures should be sought.
GASTROINTESTINAL SAFETY OF NSAIDS AND OVER-THE-COUNTER ANALGESICS.
By: Bjarnason I.
Int J Clin Pract, January 2013, 67 (Suppl. 178), 37–42.
Summary: It is well recognized that NSAID may adversely cause damage throughout the gastrointestinal tract and aggravate pre-existing disease. Short-term use (less than 14 days) demonstrates dose-dependent damage of prescribed NSAIDs; the damage is proportional to the acidity of the drugs and not seen with Cyclooxygenase-2 (COX-2) selective inhibitors that have a pKa over 7.0.
Long-term (3 months or more) endoscopy studies in patients show ulcer rates from 15%– 35% with the various NSAIDs, but serious outcomes are exceedingly rare. Ibuprofen is consistently at the lower end of toxicity rankings, whereas ketorolac and azapropazone are the worst. The risk of bleeding is increased with advancing age, presence of HP, previous history of bleeding, anticoagulant use, etc. The mega-trials show that COX-2 selective agents halve the bleeding episodes, but NSAID-induced gastric bleeding is very rare, usually less than 1 in 200 subjects taking them for a year. Seventy percent of patients develop NSAID-enteropathy, which is associated with intestinal blood and protein loss and rarely strictures. Over-the-counter (OTC) use of ibuprofen and diclofenac is associated with symptomatic gastrointestinal side effects comparable with placebo. Ibuprofen is shown to be remarkably well tolerated at OTC doses in a number of studies.