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Several studies investigated the risks of neurological conditions in patients with inflammatory bowel disease IBD , with some variability in findings. We aimed to perform a systematic review and meta-analysis of available evidence to elucidate the association between IBD and the risks of common neurological disorders. In total, 22 cohort studies were included, of which 9 studies reported stroke events in IBD patients, 5 studies reported all-cause dementia diagnoses in IBD patients, 7 studies reported PD diagnoses in IBD patients, and 1 study reported 6 MS events in 35 IBD patients. Inflammatory bowel disease may be modestly associated with increased risks of stroke, all-cause dementia, and PD. This systematic review and meta-analysis of cohort studies aimed to clarify association between inflammatory bowel disease and risks of common neurological disorders. Access to content on Oxford Academic is often provided through institutional subscriptions and purchases. 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Oxford Academic. Google Scholar. Forough Ebrahimtabar, MD. Shaghayegh Alizadeh-Tabari, BSc. Department of Neurology, University of Pennsylvania. Tenzin Choden, MD. David T Rubin, MD. Reza Malekzadeh, MD. Editorial decision:. Corrected and typeset:. Select Format Select format. Permissions Icon Permissions. Abstract Background. Lay Summary This systematic review and meta-analysis of cohort studies aimed to clarify association between inflammatory bowel disease and risks of common neurological disorders. You do not currently have access to this article. Download all slides. Sign in Get help with access. Institutional access Sign in through your institution Sign in through your institution. Get help with access Institutional access Access to content on Oxford Academic is often provided through institutional subscriptions and purchases. 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PDF version. This cross-sectional study in south-east Islamic Republic of Iran in aimed to determine where householders kept their medicines and to assess the frequency and determinants of self-medication. Analgesics were the most common medicines stored at home, followed by adult cold remedies and antibiotics. The refrigerator was the most common place for storing medicines Most householders did not consult the package inserts. Many householders There was a significant association between self-medication and educational level but not with age, sex, martial status, occupation and type of insurance. Better public knowledge and information about storage and risks of reuse of prescription medications is needed. Foroutan: This e-mail address is being protected from spambots. You need JavaScript enabled to view it. Self-medication is a global concern, in both developed and developing countries 1—9 including those of the Middle East 10— This is a practice in which individuals utilize any types and dosages of medication for treating themselves, without professional supervision, to control an illness or an abnormal condition 14, Concerns about self-medication include sharing prescription medicines with other members of the family, using leftovers from previous prescriptions or disrespecting the medical prescription by prolonging or interrupting the dosage and the administration period prescribed 1. Inappropriate storage and use of medicines at home could have a direct influence on public health, the environment and the health-care services and it increases the risk of self-medication Previous studies have identified a link between medicine storage and self-medication practices This includes medications stored intentionally while they remain in use or medications that are incompletely used. Storing medicines at home might increase the risk of self-medication, and some authors have reported a high frequency of exchange of self-medication between family members One of the main reasons for self-medication is often the financial burden of consulting a doctor. In economically deprived communities, most episodes of illnesses are treated by self-medication 19 , which provides a low-cost alternative for people who cannot afford the high cost of clinical services and also as many medicines in developing countries are dispensed over-the-counter. The present study in a city in the south-east of the Islamic Republic of Iran aimed to find out where medicines were kept at home, to investigate the frequency and determinants of self-medication among family members and to explore whether or not the medication package inserts were used. The study would inform strategies such as educational programmes aiming to promote public knowledge about medicines. These strategies would help householders to pay more attention to storing medicines at home and raise awareness of self-medication practices. The study was conducted in March in the city of Birjand, south-east of Islamic Republic of Iran. A sample of householders were recruited by stratifying the local regions of the city north, south, east, west and central into different sections to cover families of different socioeconomic status. Householders from each section were selected through a systematic, random sampling technique to cover all parts of the city. Local authorities were contacted to obtain formal permission to conduct the study and householders were informed in advance about the study to ensure their agreement to participate in the study. Selected households were visited and the data collection supervisors explained the objectives of the study. Heads of households were asked to consent for their home to be included in the study and for them to participate in filling the questionnaires. They were told that their names and those of their families would not be recorded. Each household was given a code and considered as a unit. The survey was conducted by 2 students who were trained by the researcher by conducting several household visits in the presence of the researcher before the actual start of the study. The questionnaire contained both open-ended questions and questions with a list of possible answers. We defined leftover medicines as medications prescribed by the doctor over the previous 3 months and kept by the householder. Medicine names, strength, dosage form, expiry date and quantity were recorded. Educational status was analysed in 2 categories: no formal education or primary school only; and secondary school or higher. The data were reviewed, organized, tabulated and analysed using Microsoft Excel, version. Descriptive analysis was conducted by calculating means and standard deviation SD and proportions for continuous and discrete data respectively. The chi-squared and t-tests were used to analyse statistical significance. A total of householders completed the questionnaires: Table 1 shows their demographic characteristics. Of the householders, Most of the participants One-third All the households reported that they kept medicines at home. Table 2 shows the places where medicines were kept at home. The most common place was the refrigerator None of the households kept medicines in the bathroom. Only 6. Overall, Table 2 also shows the most commonly reported therapeutic categories used for self-medication. Analgesics e. The number of times within the last 3 months that householders had self-medicated themselves and their families with analgesics were as follows:. Adult cold remedies were used for self-medication by In answer to the question related to reuse of antibiotics prescribed by the doctor, one-third reported that they reused them. Of those who reused antibiotics, The results also showed that tablets were the most commonly used formulation for self-medication There was no significant association between self-medication and age, sex, marital status, occupation or type of insurance. Our study revealed that nearly half of households stored medicines in the refrigerator, whether this was the correct place or not. The correct place for storage depends on the medicine; for example, after preparation of antibiotic suspensions they must be kept cool but not frozen, whereas adult cold remedies should be kept at room temperature in a kitchen or bedroom cupboard. The kitchen cupboard was the second most common storage place. This finding contrasts with that of other countries. In a study in Qatar, for example, most medicines were kept in the bedroom 20, Our findings raise concerns about how medications are stored and disposed of in the community. None of the participants said that they returned unused medicines to a local pharmacy and keeping them in their home could be a risk of potential harm. The refrigerator is not a suitable place for all medicines, and even if, based on the recommendations of the package inserts, those medicines should be kept in a refrigerator, freezing must be avoided. Also it is necessary to ensure that children are not able to get access to medicines that are kept in a refrigerator. Most medicines are sensitive to light and heat, and may need to be destroyed earlier than the expiry date, or even become toxic, especially antibiotics. Places such as cabinets and kitchen cupboards might be suitable although humidity should also be considered. Pharmaceutical companies in the Islamic Republic of Iran are required to include a leaflet with medication packages which briefly explains about the drug, its indications and side-effects. This covers most outpatient prescription and some non-prescription medicines and medical supplies. Even if medicines are stored correctly, it does not mean that these medicines would be suitable for a family member to start self-medication and reuse them. None of the householders in our study reported routinely returned unwanted medications to a pharmacy for proper disposal. Furthermore, a high prevalence of self-medication was noted among householders Muras et al. Previous studies have documented the link between medicine storage places at home and frequency of self-medication 23, Finding unused prescription medicines in homes in the Islamic Republic of Iran is not surprising because self-medication practices are common among people of all educational levels 11,12,25— Other research has found that the majority of householders keep unused medicines at home either to use them in the future or to give them to someone else who has similar symptoms Furthermore, leftover medications may be a result of non-completion to treatment regimens There was a significant association between self-medication and educational level. Lower educated householders were more likely to self-medicate. Self-medication provides a lower cost alternative for people who cannot afford the cost of clinical services 30, The results showed that stored medicines belonged mostly to 3 categories: analgesics, adult cold remedies and antibiotics. In the Islamic Republic of Iran, analgesics are the most commonly procured over-the-counter medicines and self-medication with them is frequent. They are usually the first-line of medicines used by community members in event of illness Adult cold formulations a combination of phenylephrine, chlorpheniramine maleate and paracetamol are also widely consumed products in the Islamic Republic of Iran. It should be noted that this study refers to antibiotics originally prescribed by the doctor and then kept and reused, as antibiotics are not sold over-the counter in the Islamic Republic of Iran. This may be in order to save money because antibiotics are expensive to buy. In Saudi Arabian households Abou-Auda found that respiratory medicines, followed closely by central nervous system CNS agents and antibiotics, were the most common reused medicines In contrast, a British study revealed that among medicines returned to pharmacies, Tablets were the formulations most commonly used for self-medication However, it should be emphasized that tablets might be the most frequently used dosage form in self-medication simply because most medicines for self-medication come in tablet form. Self-medication with herbal preparations is likely to be frequent in south-east Islamic Republic of Iran because people in this area are proud of their background related to traditional medicine. Previous studies in the Islamic Republic of Iran show that people take herbs as supplements to promote health, prevent illness especially the common cold , boost the immune system, prevent stress and to supplement regular nutrition and they believe that use of herbs is part of a healthy lifestyle 36, One of the strengths of the present study was that it was carried out in the community and was not based on a specific target group. However, an absence of a standard definition of self-medication and the study design which did not include a comparison group mean the results should be interpreted with caution. There is a need for more patient awareness about the safe handling and storage of medicines at home. A high prevalence of self-medication was also noted among householders, especially those who were less well-educated. Doctors have to take into account that their patients are likely to keep several prescription medicines in their homes. These patients are potential providers to their friends and relatives of medicines that are potentially unsafe for self-medication. Better public knowledge and information about the risks of reuse of prescription medications is needed. The authors would like to express their gratitude towards all the respondents for showing concern towards this issue and also to thank Mr Javadinia for his contribution to data collection. Subscribe via RSS. Volume 30, number 8 August WHO Bulletin. Pan American Journal of Public Health. Main Search Contact. YouTube Rss feeds Twitter Facebook. Eastern Mediterranean Health Journal. Household storage of medicines and self-medication practices in south-east Islamic Republic of Iran. PDF version B. Foroutan 1 and R. Data collection The survey was conducted by 2 students who were trained by the researcher by conducting several household visits in the presence of the researcher before the actual start of the study. Data analysis The data were reviewed, organized, tabulated and analysed using Microsoft Excel, version. Results A total of householders completed the questionnaires: The number of times within the last 3 months that householders had self-medicated themselves and their families with analgesics were as follows: 1 time Conclusions Keeping medicines at home and self-medication are important health issues. Acknowledgements The authors would like to express their gratitude towards all the respondents for showing concern towards this issue and also to thank Mr Javadinia for his contribution to data collection. Funding : None. Competing interests : None declared. Responsible self-medication: perceived risks and benefits of over-the-counter analgesic use. Int J Pharm Pract. Benefits and risks of self medication. Drug Saf. Help-seeking behavior and self-medication of a population in an urban area in Turkey: cross sectional study. Croat Med J. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. Self-medication with antibiotics in Europe: a case for action. Curr Drug Saf. Determinants of self-medication with antibiotics in Europe: the impact of beliefs, country wealth and the healthcare system. J Antimicrob Chemother. South Africa: self-medication. Asia Pac Fam Med. Prior knowledge, older age, and higher allowance are risk factors for self-medication with antibiotics among university students in southern China. PLoS One. Patterns and attitudes of self-medication practices and possible role of community pharmacists in Palestine. Int J Clin Pharmacol Ther. Self-medication and storage of drugs at home among the clients of drugstores in Tabriz. Evaluation of self-medication prevalence, diagnosis and prescription in migraine in Kerman, Iran. Neurosciences Riyadh. Self-medication practices with antibiotics and antimalarials among Sudanese undergraduate university students. Ann Pharmacother. Pharmacovigilance de l'automedication. Geneva: World Health Organization; Statistical abstract of the United States —05 at 93 tbl. Cameron KA. Comment on medication management models and other pharmacist interventions: implications for policy and practice. Home Health Care Serv Q. Antibiotic use and knowledge in the community in Kalamoon, Syrian Arab Republic: a cross-sectional study. East Mediterr Health J. Appropriateness of self-medication: method development and testing in urban Indonesia. J Clin Pharm Ther. An exploratory study on medications in Qatar homes. Drug Healthc Patient Saf. Oman Med J. A survey of patient behaviours and beliefs regarding antibiotic self-medication for respiratory tract infections in Poland. Arch Med Sci. Poirier S, Barbeau G. An in-home medication inventory among elderly receiving home care services. J Geriatr Drug Ther. Thompson S, Stewart K. Prescription medication use practices among non-institutionalised older persons. Illicit methylphenidate use among Iranian medical students: prevalence and knowledge. Drug Des Devel Ther. Dispensing drugs without prescription and treating patients by pharmacy attendants in Shiraz, Iran. Am J Public Health. Are older women likely to use medicines than older men? Results from AHAP study. Caspian J Intern Med. A survey on the extent of medication storage and wastage in urban Iranian households. Clin Ther. Drugs at home in Qazvin, Iran: community based participatory research. Eur J Sci Res. Self-medication patterns in Amman, Jordan. Pharm World Sci. Prevalence of self-medication in rural areas of Portugal. Profile of drug use in urban and rural India. Prevalence of potential drug interactions in an Iranian general hospital. Indian J Pharm Sci. An economic assessment of the extent of medication use and wastage among families in Saudi Arabia and Arabian Gulf countries. A systematic review of the efficacy and safety of herbal medicines used in the treatment of obesity. World J Gastroenterol. A systematic review of the potential herbal sources of future drugs effective in oxidant-related diseases. Inflamm Allergy Drug Targets. Current issue Volume 30, number 8 August

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