Background In spite of many benefits for individuals and community, self-medication has a number of potential risks. Objective To identify predictors of self-medication with over-the-counter and prescription (Rx) medicines without doctor's prescription. Setting Serbian population of 15 years of age and over. Method This was crosssectional, epidemiological study. Data have been drawn from Serbian National Health Survey 2013 database. Predictors of self-medication were determined among sociodemographic, health related and health services related factors, using multivariate logistic regression models. Main outcome measure Prevalence and predictors of selfmedication. Results The study included 14,623 participants. The prevalence of selfmedication was 27.1 and 24% after exclusion of vitamins, minerals and herbal preparations. Medicines for pain relief were the mostly used medicines without doctors' prescription in 18.4% of participants. A relatively high prevalence of self-medication with Rx medicines, (1) tranquilizers and sleeping pills, (2) antibiotics and (3) antihypertensives, was found, 4, 2.5 and 1.9%, respectively. Socio-demographic factors (middle age, female gender, higher level of education), health related factors (chronic disease, stress, physical pain), and health service related factors (nonrealized healthcare needs due to long waiting, dissatisfaction with publicly funded health services) have been found as significantly associated with self-medication. Conclusion Self-medication in Serbia is predicted by socio-demographic and health related factors, unmet needs for healthcare and dissatisfaction with publicly funded healthcare services. Improvements in healthcare system, particularly, shortening of long waiting for healthcare services and improvements in pharmaceutical services, particularly better control of Rx medicines dispensing, could contribute in improvement of responsible self-medication.
Background Adverse childhood experiences (ACE) are a risk factor for mental health disorders and serious somatic illnesses. There is a need for preventing ACE and using mental health care by youth who experienced them. Aims of this study were to examine which ACE are related to mental health service use and to identify a scope of unrecognized needs for these services among students who had experienced abuse/neglect in childhood. Methods Descriptive cross-sectional study was performed on a sample of 2.381 first-year students from six universities in Serbia in 2014. The survey instrument was a questionnaire developed by WHO and CDC. Thirteen ACE (covering household dysfunctionalities, abuse, neglect, peer and collective violence) and using of mental health services at least once during lifetime were assessed. Data were analyzed by univariate and multivariate logistic regression. Results Compared to respondents without particular ACE, odds (±95% CI) of mental health service use were higher only in those with next adversities: parental divorce, OR = 2,26 (1,53-3,33); suicidal/mentally ill family member, OR = 2,21 (1,42-3,44); witnessing partner violence, OR = 1,51 (1,04-2,18); peer violence, OR = 2,14 (1,51-3,03); collective violence OR = 1,48 (1,05- 2,10). Among respondents who had experienced emotional neglect, 81% have never used professional help. For physical neglect, physical and psychological abuse this percentage was 83%. Conclusions The study highlights ACE associated with mental health service use and shows a significant presence of unrecognized needs for these services. There is need for: determining barriers in this area and formulation of effective health promotion strategies; more consistent application of legislation; conducting screening on child abuse/neglect in families with a higher risk for them. Key messages High share of youth with childhood adversities remains without help of mental health specialists.It opens the issue of barriers on the side of youth as well as on the side of health system and society Considering consequences of adverse childhood experiences, there is need for comprehensive public health interventions in order to increase mental health service use among young people with ACE.
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