High use of over-the-counter analgesic; possible warnings of reduced quality of life in adolescents - a qualitative study

Background Use of over-the-counter analgesics among adolescents has increased markedly. High consumption of over-the-counter analgesics among adolescents is associated with frequent pain, lower self-esteem, reduced sleep, lower educational ambition, binge drinking, higher caffeine consumption, and part-time employment. Knowledge about life experiences of adolescents who frequently use over-the-counter analgesics may be useful to prevent health problems. The purpose of the study was to increase knowledge about adolescents who suffer from frequent pain and have a high consumption of over-the-counter analgesics. Methods A qualitative study, employing one-on-one, in-depth interviews using a thematic interview guide. Data were collected in Norway in 2013–2014. Three boys and sixteen girls; aged 14–16 years, who continuously consumed over-the-counter analgesics were recruited from ten high schools in urban and suburban districts. Candidate participants were excluded if they were medically diagnosed with an acute or chronic illness, requiring extended use of over-the-counter analgesics within the last year. The interviews were taped, transcribed and analysed as text according to Kvale’s three contexts of interpretation: self-understanding, common sense and theory. Results All participants disclosed unresolved physical and psychosocial distress characterized as pain. Frequent pain from various body parts made everyday life challenging. Methods of pain self-appraisal and over-the-counter analgesics use often mimicked maternal patterns. Participants reported being raised under unpredictable circumstances that contributed to long lasting family conflicts and peer-group problems. Participants wanted to feel appreciated and to be socially and academically successful. However, pain reduced their ability to manage everyday life, hampered experienced possibilities for success, and made social settings difficult. Conclusions Childhood experiences influence how adolescents experience pain and use over-the-counter analgesics. Coping with difficult situations or attempting to mask symptoms with over-the-counter analgesics can perpetuate and amplify underlying problems. High consumption of over-the-counter analgesics and frequent pain may be warning signs of adolescents with possible health threatening conditions and reduced quality of life. These adolescent might be in need of support from school nurses and General Practitioners. This study identifies new perspectives that may lead to novel approaches to identify, guide, and support adolescents with frequent pain and high consumption of over-the-counter analgesics

The doctor-patient relationship and the management of asthma

General practitioners (GP) differ in views on how to relate to their patients, diagnose asthma and update their knowledge. By understanding the doctors' attitudes within these domains it is possible to design a better information strategy and improve disease management. In order to get insight in the doctors' experiences and ways of thinking regarding asthma, 20 GPs were interviewed. A phenomenographic analysis was applied in describing the doctors' opinions. The doctors' opinions about who was in charge of the asthma management defined four doctor-patient relationships: I will manage it, you will manage it, we will manage it and I do not know whether I will manage it. The GPs differed markedly in how much they trusted the patients' descriptions and the physiological measurements of the disease. Three opinions on how to acquire knowledge were described. Knowledge should be acquired either from experts or from peers. Another belief did not give weight to a defined source but expressed the necessity of using all opportunities at hand. Doctors holding this belief, "the bricoleurs", seemed to be more interested in a "how to do it" than a "why to do it" information. We conclude that strategies for improving asthma management should consider the importance of both patients' accounts and physiological measures, the degree of co-operation between doctors and their patients and eventually the ways and styles of acquiring new knowledge about asthma.asthma doctor-patient relationship continual medical education

Prevalence and risk factors for postpartum depressive symptoms in Argentina - a cross sectional study

Introduction: Postpartum depression is a prevalent disorder with negative consequences for women, infants, and the family as a whole. Most studies of this disorder have been conducted in Western countries, and studies from developing countries are few. In this paper, we report the first – as far as we are aware – study of the prevalence and risk factors associated with postpartum depressive symptoms in Argentina. Materials and methods: The study participants were 86 women attending 6 week check-ups, (range 4–12 weeks) postpartum at a private health care center in the metropolitan area of Buenos Aires. The women completed the Edinburgh Postnatal Depression Scale (EPDS) and a questionnaire collecting demographic and obstetric data. Data were described as proportions (percentages). Differences between proportions were assessed with chi-squared tests. To control for possible confounders, we fitted bivariate logistic regression models in which the dependent variable was an EPDS sum score of ,10 versus a score of $10. Results: We found a high prevalence of depressive symptoms. A total of 32 women (37.2$10, 16 (18.6%) had a score between 10 and 12, and 16 (18.6%) had a score of $13. In our sample, an EPDS score of$10 was significantly associated with multiparity (odds ratio [OR] =3.58; 95% confidence interval [CI]: 1.13–11.30; P=0.030), pregnancy complications (OR =3.40; 95% CI: 1.03–11.26; P=0.045), labor complications (OR =11.43; 95% CI: 1.71–76.61; P=0.012), cesarean section (OR =4.19; 95% CI: 1.10–16.01; P=0.036), and incomplete breast-feeding (OR =5.00; 95% CI: 1.42–17.54; P=0.012). Conclusion: Our results indicate that postpartum depression may be prevalent in Argentina, and may be associated with incomplete breast-feeding, cesarean section, perinatal complications and multiparity. The prevalence and risk factors for postpartum depression has not been described previously and is a considerable health-related problem among women. Argentinian health professionals should be aware of the high prevalence rate and possible risk factors so that these women and families can be identified and receive adequate support and treatment

Prevalence and risk factors for postpartum depressive symptoms in Argentina - a cross sectional study

Introduction: Postpartum depression is a prevalent disorder with negative consequences for women, infants, and the family as a whole. Most studies of this disorder have been conducted in Western countries, and studies from developing countries are few. In this paper, we report the first – as far as we are aware – study of the prevalence and risk factors associated with postpartum depressive symptoms in Argentina. Materials and methods: The study participants were 86 women attending 6 week check-ups, (range 4–12 weeks) postpartum at a private health care center in the metropolitan area of Buenos Aires. The women completed the Edinburgh Postnatal Depression Scale (EPDS) and a questionnaire collecting demographic and obstetric data. Data were described as proportions (percentages). Differences between proportions were assessed with chi-squared tests. To control for possible confounders, we fitted bivariate logistic regression models in which the dependent variable was an EPDS sum score of ,10 versus a score of $10. Results: We found a high prevalence of depressive symptoms. A total of 32 women (37.2$10, 16 (18.6%) had a score between 10 and 12, and 16 (18.6%) had a score of $13. In our sample, an EPDS score of$10 was significantly associated with multiparity (odds ratio [OR] =3.58; 95% confidence interval [CI]: 1.13–11.30; P=0.030), pregnancy complications (OR =3.40; 95% CI: 1.03–11.26; P=0.045), labor complications (OR =11.43; 95% CI: 1.71–76.61; P=0.012), cesarean section (OR =4.19; 95% CI: 1.10–16.01; P=0.036), and incomplete breast-feeding (OR =5.00; 95% CI: 1.42–17.54; P=0.012). Conclusion: Our results indicate that postpartum depression may be prevalent in Argentina, and may be associated with incomplete breast-feeding, cesarean section, perinatal complications and multiparity. The prevalence and risk factors for postpartum depression has not been described previously and is a considerable health-related problem among women. Argentinian health professionals should be aware of the high prevalence rate and possible risk factors so that these women and families can be identified and receive adequate support and treatment

How adolescents experience and cope with pain in daily life: A Qualitative study on ways to cope and the use of over-the-counter analgesics

Objective The aim of this study was to describe how different adolescents experience and manage pain in their daily life, with a focus on their use of over-the-counter analgesics. More specifically, the aim was to explore different patterns among the adolescents in pain descriptions, in the management of pain, in relationships with others, and in their daily life. Design Qualitative semistructured interviews on experiences with pain, pain management and involvement of family and friends during pain. Pain and stress management strategies and attachment theory will be in focus for interpretations. Participants and setting 25 participants aged 15–16-years from six different junior high schools, both genders, with and without immigrant background were interviewed at their local schools in Norway. Results We identified 4 groups of adolescents with similarities in attitudes and management strategies to pain: ‘pain is manageable’, ‘pain is communicable’, ‘pain is inevitable’ and ‘pain is all over’. The participants within each group differed in how they engaged their parents in pain; how they perceived, communicated and managed pain; and how they involved emotions and used over-the-counter analgesics. Conclusions The adolescents’ different involvement with the family during pain related to their pain perception and management. Knowledge of the different ways of approaching pain is important when supporting adolescents and may be a subject for further research on the use of over-the-counter analgesics in the family

Pain and development of identity in adolescents who frequently use over-the-counter analgesics: a qualitative study

Aims and objectives: This study aims to describe conditions that may influence the development of identity in adolescents frequently using over-the-counter analgesics (OTCAs). Background: Frequent self-medication with analgesics among adolescents is associated with several physical pain points, low self-esteem and low ambitions for the future. Continuous use of OTCAs can keep adolescents from learning healthier coping strategies. Design: Qualitative individual interviews with adolescents and their mothers were conducted and transcribed. Further, they were analyzed as dyads. Setting and participants: Students aged 14–16 years in 9th and 10th grades in 10 Norwegian junior high schools self-reporting at least weekly use of analgesics were asked to participate. Those who wanted to take part took a consent letter to their parents, also inviting the parent to participate. Results: Six girls, two boys and their mothers were included. The teenagers were highly dependent on their mothers. They had often been bullied, lacked good relationships with peers, avoided conflicts and strived to be accepted. Their mothers felt solely responsible for their upbringing and showed great concern for all the pain experienced by their child. A close relationship between mother and child influenced how the adolescent managed their pain, including their use of OTCAs. Three main themes were identified in the stories of mother and child: “Vulnerable adolescents,” “Mother knows best” and “Pain is a shared project.” Conclusions: Pain among adolescents may be amplified by a difficult family situation and insecure relationships with peers. Strategies within the family may sustain pain as a shared project keeping the adolescent and main caregiver close together, and this might be hampering identity development. To help adolescents with pain and high consumption of OTCAs, the adolescents’ relationship with parents must be considered in designing an intervention. Guidance on pain assessment, pain management, including appropriate use of OTCAs, should be included

Effect of vitamin D3 supplementation on glycated hemoglobin (HbA1c), fructosamine, serum lipids, and body mass index: a randomized, doubleblinded, placebo-controlled trial among healthy immigrants living in Norway

Objective Despite the suggested role of vitamin D in the prevention of diabetes and cardiovascular disease or its risk factors, the evidence is not consistent and there is a paucity of randomized controlled trials in this field. We aimed to investigate the effect of 16-week daily vitamin D3 supplementation on glycated hemoglobin (HbA1c), fructosamine, body mass index (BMI), and serum lipids. Design Double-blind, randomized, placebo-controlled trial. Setting Immigrant community centers in Oslo, Norway. Participants 251 healthy adults aged 18–50 years with a non-Western immigrant background. All participants performed the baseline test and 215 (86%) returned to the follow-up test. Intervention 16 weeks of daily oral supplementation with either 10 µg vitamin D3, 25 µg vitamin D3, or placebo. Main outcome measures Difference in absolute change during the 16-week intervention between the intervention groups combined (10 or 25 µg of vitamin D3/day) and placebo, in HbA1c, fructosamine, serum lipids (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides), and BMI. Results A total of 215 (86%) participants completed the study. Serum 25-hydroxyvitamin D increased from 29 nmol/L at baseline to 49 nmol/L after intervention, with little change in the placebo group. However, there was no difference in change of HbA1c between those receiving vitamin D3 compared with placebo (mean difference: 0.01% (95% CI -0.04 to 0.06, p=0.7)). Neither did the vitamin D3 supplementation have any effect on the other end points: fructosamine, serum lipids, and BMI. Conclusions 16-week vitamin D3 supplementation to healthy immigrants from South Asia, the Middle East, or Africa and now living in Norway with low vitamin D status did not improve HbA1c, fructosamine, lipid profiles, or BMI. An updated meta-analysis of similar published trials showed that our results were generally consistent with those of other studies