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1.  Self-medication with antibiotics for the treatment of menstrual symptoms in southwest Nigeria: a cross-sectional study 
BMC Public Health  2010;10:610.
Self-medication with antibiotics is an important factor contributing to the development of bacterial antibiotic resistance. The purpose of this study was to evaluate the prevalence of self-medication with antibiotics for the treatment of menstrual symptoms among university women in Southwest Nigeria.
A cross-sectional survey was administered to female undergraduate and graduate students (n = 706) at four universities in Southwest Nigeria in 2008. The universities were selected by convenience and the study samples within each university were randomly selected cluster samples. The survey was self-administered and included questions pertaining to menstrual symptoms, analgesic and antibiotic use patterns, and demographics. Data were analyzed using descriptive statistics and logistic regression.
The response rate was 95.4%. Eighty-six percent (95% CI: 83-88%) of participants experienced menstrual symptoms, and 39% (95% CI: 36-43%) reported using analgesics to treat them. Overall, 24% (95% CI: 21-27%) of participants reported self-medicated use of antibiotics to treat the following menstrual symptoms: cramps, bloating, heavy bleeding, headaches, pimples/acne, moodiness, tender breasts, backache, joint and muscle pain. Factors associated with this usage were: lower levels of education (Odds Ratio (OR): 2.8, 95% CI: 1.1-7.1, p-value: 0.03); non-science major (OR: 1.58, 95% CI: 1.03-2.50, p-value: 0.04); usage of analgesics (OR: 3.17, 95% CI: 2.07-4.86, p-value: <0.001); and mild to extreme heavy bleeding (OR: 1.64, 95% CI: 1.01-2.67, p-value: 0.05) and pimples/acne (OR: 1.57, 95% CI: 0.98-2.54, p-value: 0.06). Ampicillin, tetracycline, ciprofloxacin and metronidazole were used to treat the most symptoms. Doctors or nurses (6%, 95% CI: 4-7%), friends (6%, 95% CI: 4-7%) and family members (7%, 95% CI: 5-8%) were most likely to recommend the use of antibiotics for menstrual symptoms, while these drugs were most often obtained from local chemists or pharmacists (10.2%, 95% CI: 8-12%).
This is the first formal study to report that approximately 1 out of 4 university women surveyed in Southwest Nigeria self-medicate with antibiotics to treat menstrual symptoms. This practice could provide monthly, low-dose exposures to antibiotics among users. Further studies are necessary to evaluate the impacts of self-medication on student health.
PMCID: PMC2965722  PMID: 20946686
2.  Self-medication and related health complaints among expatriate high school students in the United Arab Emirates 
Pharmacy Practice  2013;11(4):211-218.
Self-medication, often without adult guidance, has been reported to be a common practice during adolescence. Similar to other preventable health-risk behaviors initiated in early adolescence, it has become a cause for concern universally.
This study examines the prevalence of self-medication with both prescribed and non-prescribed (OTC) medications, related health complaints, sources of drugs, and sources of drug recommendation, and gender differences related to self-medication among expatriate high school students in the United Arab Emirates (UAE).
A cross-sectional survey was conducted among 324 expatriate students through a validated, self-administered questionnaire and data was analyzed using SPSS 19 version. Means and proportions were calculated and Pearson Chi-square test of significance was used to analyze association among variables.
Majority of the participating students, almost equally distributed by gender, was aged 16 to 17 years. The period prevalence rate of self-medication with prescribed and OTC medications were 89.2%, which did not vary with age, gender, ethnicity or parents’ educational level. The most common sources of drug and drug recommendation were community pharmacies and parents respectively. Headache and fever were the common self-medicated conditions and consequently, analgesics and antipyretics were most commonly used both in the previous two weeks and the previous year prior to the survey. A high prevalence of self-medication with antibiotics (53%) and sedative/hypnotics (27%) was also observed. A female excess emerged for certain health complaints and use of medicines except for the use of anti-allergic and herbal/homeopathic drugs.
This is the first study to explore self-medication practices among high school students in UAE and provides baseline data critical in creating awareness about the risks and benefits of self-medication. Health care providers, educators and parents should be actively involved in health education strategies for inculcating responsible self-medication practices in the adolescent population of UAE.
PMCID: PMC3869637  PMID: 24367461
Self Medication; Adolescent; Prevalence; Patient Medication Knowledge; Patient Education as Topic; United Arab Emirates
3.  Self-medication patterns among medical students in South India 
The Australasian Medical Journal  2012;5(4):217-220.
Self-medication results in wastage of resources, increases resistance of pathogens and generally causes serious health hazards such as adverse drug reactions, prolonged suffering and drug dependence. This study was undertaken to determine the reasons for self-medication and the pattern of self-medication among medical students.
This cross-sectional descriptive study was conducted at the K.S. Hegde Medical Academy, Mangalore. The participants were medical students from first to final year. Medical students were selected through convenience sampling. The data was collected using a pre-tested semi-structured questionnaire. The data was analysed using SPSS version 16 and the results expressed as proportions.
A total of 200 students, 121 (60.5%) female and 79 (39.5%) male, were included in the study. Of the medical students surveyed, self-medication was reported among 92%. The respondents who used self-medication found it to be time- saving in providing relief from minor ailments. The most common ailments for which self-medication were used were: the common cold (69%), fever (63%) and headache (60%). The students consulted their textbooks (39%) and seniors or classmates (38%) for the medications. Antipyretics (71%), analgesics (65%), antihistamines (37%) and antibiotics (34%) were the most common self- medicated drugs. Of the respondents, 33% were unaware of the adverse effects of the medication and 5% had experienced adverse reactions. The majority (64%) of students advised medications to others, more often to family and friends.
The prevalence of self-medication among medical students is high, facilitated by the easy availability of drugs and information from textbooks or seniors. A significant number of students are unaware of the adverse effects of the medication that they themselves take and suggest to others. Therefore, potential problems of self-medication should be emphasised to the students.
PMCID: PMC3395275  PMID: 22848313
Self-medication; Medical students
4.  Nonmedical use of opioid analgesics among Ontario students 
Canadian Family Physician  2010;56(3):256-262.
To explore the prevalence and the demographic predictors of nonmedical use of opioid analgesics in the Canadian adolescent population.
Data are based on self-reports derived from the 2007 Ontario Student Drug Use and Health Survey, which is an anonymous, in-school, cross-sectional survey.
Schools in Ontario.
A total of 2914 students in grades 7 to 12.
Demographic predictors of nonmedical use of opioid analgesics during the past year and the sources of opioid analgesics.
Students ranged in age from 12 to 19 years (mean 15.0, SD 1.9) and 52% were male. Of the students surveyed, 20.6% (95% confidence interval [CI] 18.9% to 22.3%) reported using opioid analgesics at least once nonmedically during the past year, with 6.2% using exclusively nonmedically and 14.4% using nonmedically and medically. Female students (16.6%, CI 14.1% to 19.6%) were more likely than male students (12.0%, CI 10.0% to 14.2%) to have used opioid analgesics both nonmedically and medically in the past year, although exclusive nonmedical use was similar between female (6.7%, CI 5.3% to 8.5%) and male (5.8%, CI 4.5% to 7.3%) students. Among students who reported using opioid analgesics nonmedically, 72% reported obtaining them from home and only 6% reported obtaining them from friends. Nonmedical opioid analgesic users had higher past-year prevalences for alcohol use, daily smoking, and other illicit drug use compared with nonusers.
Nonmedical use of opioids is common among Ontario students. The motivation for using these medications without prescriptions or without medical supervision is not known. Students might have used these medications recreationally or for pain relief. Regardless of motivation, these medications are being used without medical supervision. It is important to note that the home is the main source for opioid analgesics in the absence of a prescription. Parents should be vigilant and educate themselves and their children about these medications, ensuring that prescription opioids are stored properly and avoiding casual sharing of these medications among family members.
PMCID: PMC2837694  PMID: 20228312
5.  Medication storage and self-medication behaviour amongst female students in Malaysia 
Pharmacy Practice  2010;8(4):226-232.
The aims of this study are to determine the prevalence, attitudes and behaviours of medication storage and self-medication amongst female students at Universiti Sains Malaysia (USM).
A cross-sectional survey was conducted and cluster random sampling technique was used for respondent selection. A pre-piloted questionnaire was administered to female respondents so as to collect the data. Data was analyzed using SPSS version 12 and analysis was conducted using descriptive analysis procedures.
Of the 481 participants (mean age; SD was 22.1; 3.3), 93.1% (n=448) students stated that they stored medicine in their rooms, while 70.7% (n=340) stated that they stopped taking a prescribed medicine without consulting a doctor. The prevalence of self-medication was 80.9% (n=389). The most common reasons for self-medication were related to their knowledge of their ailment and its treatment (58.0%), 14.4% thought it saved time and 8.5% mentioned that medication given by provider was not effective. The most common symptoms were otorhinolaryngology problems (22.5%), followed by respiratory disease (19.6%), Gastro Intestinal Tract (GIT) disease (18.1%) and headache/fever (16.8%). Commonly used medicines were analgesics & antipyretics (30.2%), ear, nose & throat drugs (10.8%), vitamins & minerals (10.8%), GIT drugs (8.5%), anti-infections (7.3%) and herbal medicines (3.5%). Prevalence of medicine storage and self-medication practice is high among educated female students in USM.
There is a need to educate the students to ensure safe practice by increasing their awareness. Strict policies need to be implemented on the unrestricted availability of medicines so as to prevent the wastage of medicines.
PMCID: PMC4127060  PMID: 25126145
Self Medication; Health Knowledge; Attitudes; Practice; Malaysia
6.  Predictive factors of self-medicated analgesic use in Spanish adults: a cross-sectional national study 
Analgesics are among the most commonly consumed drugs by the world populations. Within the broader context of self-medication, pain relief occupies a prominent position. Our study was to ascertain the prevalence of self-medication with analgesics among the Spanish population and to identify predictors of self-medication, including psychological disorders, psychological dysfunction, mental health status, and sociodemographic and health-related variables.
We used individualized secondary data retrieved from the 2009 European Health Interview Survey (EHIS) for Spain to conduct a nationwide, descriptive, cross-sectional pharmacoepidemiology study on self-medication with analgesics among adults (individuals aged at least 16 years) of both genders living in Spain. A total of 7,606 interviews were analysed. The dichotomous dependent variables chosen were the answers “yes” or “no” to the question In the last 2 weeks have you taken the medicines not prescribed for you by a doctor for joint pain, headache, or low back pain?” Independent variables were sociodemographic, comorbidity, and healthcare resources.
A total of 7,606 individuals reported pain in any of the locations (23.7%). In addition, analgesic consumption was self-prescribed in 23.7% (1,481) of these subjects. Forty percent (40.1%) of patients self-medicated for headache, 15.1% for low back pain, and 6.7% for joint pain. The variables significantly associated with a greater likelihood of self-medication of analgesics, independently of pain location were: age 16–39 years (2.36 < AOR < 3.68), higher educational level (1.80 < AOR <2.21), psychological disorders (1.56 < AOR < 1.98), and excellent/good perception of health status (1.74 < AOR < 2.68). In subjects suffering headache, self-prescription was associated with male gender (AOR 2.13) and absence of other comorbid condition (AOR 4.65).
This pharmacoepidemiology study constitutes an adequate approach to analgesic self-medication use in the Spanish population, based on a representative nationwide sample. Self-prescribed analgesic consumption was higher in young people with higher educational level, higher income, smoker, and with psychological disorders and with a good perception of their health status independently of the location of pain.
PMCID: PMC4105781  PMID: 25001259
7.  Patterns of analgesic use, pain and self-efficacy: a cross-sectional study of patients attending a hospital rheumatology clinic 
Many people attending rheumatology clinics use analgesics and non-steroidal anti-inflammatories for persistent musculoskeletal pain. Guidelines for pain management recommend regular and pre-emptive use of analgesics to reduce the impact of pain. Clinical experience indicates that analgesics are often not used in this way. Studies exploring use of analgesics in arthritis have historically measured adherence to such medication. Here we examine patterns of analgesic use and their relationships to pain, self-efficacy and demographic factors.
Consecutive patients were approached in a hospital rheumatology out-patient clinic. Pattern of analgesic use was assessed by response to statements such as 'I always take my tablets every day.' Pain and self-efficacy (SE) were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Arthritis Self-Efficacy Scale (ASES). Influence of factors on pain level and regularity of analgesic use were investigated using linear regression. Differences in pain between those agreeing and disagreeing with statements regarding analgesic use were assessed using t-tests.
218 patients (85% of attendees) completed the study. Six (2.8%) patients reported no current pain, 26 (12.3%) slight, 100 (47.4%) moderate, 62 (29.4%) severe and 17 (8.1%) extreme pain. In multiple linear regression self efficacy and regularity of analgesic use were significant (p < 0.01) with lower self efficacy and more regular use of analgesics associated with more pain.
Low SE was associated with greater pain: 40 (41.7%) people with low SE reported severe pain versus 22 (18.3%) people with high SE, p < 0.001. Patients in greater pain were significantly more likely to take analgesics regularly; 13 (77%) of those in extreme pain reported always taking their analgesics every day, versus 9 (35%) in slight pain. Many patients, including 46% of those in severe pain, adjusted analgesic use to current pain level. In simple linear regression, pain was the only variable significantly associated with regularity of analgesic use: higher levels of pain corresponded to more regular analgesic use (p = 0.003).
Our study confirms that there is a strong inverse relationship between self-efficacy and pain severity. Analgesics are often used irregularly by people with arthritis, including some reporting severe pain.
PMCID: PMC2777148  PMID: 19903350
8.  Cultural Intelligence and Social Adaptability: A Comparison between Iranian and Non-Iranian Dormitory Students of Isfahan University of Medical Sciences 
Materia Socio-Medica  2013;25(1):40-43.
At the modern age, to acquire knowledge and experience, the individuals with their own specific culture have to enter contexts with cultural diversity, adapt to different cultures and have social interactions to be able to have effective inter-cultural relationships.To have such intercultural associations and satisfy individual needs in the society, cultural intelligence and social adaptability are deemed as inevitable requirements, in particular for those who enter a quite different culture. Hence, the present study tries to compare the cultural intelligence and its aspects and social adaptability in Iranian and non-Iranian dormitory students of Isfahan University of Medical Sciences in 2012.
The study was of descriptiveanalytical nature. The research population consisted of Iranian and non-Iranian students resided in the dormitories of Isfahan University of Medical Sciences which are 2500, totally. For Iranian students, two-stage sampling method was adopted. At the first stage, classified sampling and at the second stage, systematic random sampling was conducted. In this way, 441 students were selected. To form non-Iranian students’ sample, consensus sampling method was applied and a sample of 37 students were obtained. The research data was collected by using Earley & Ang’s Cultural Intelligence Questionnaire with the Cronbach’s coefficient α of 76% and California Social Adaptability Standard Questionnaire with the Cronbach’s coefficient α of over 70%. Then, the data were put into SPSS software to be analyzed. Finally, the results were presented by descriptive and inferential statistics methods.
The study findings revealed that there was no statistically significant difference between cultural intelligence and cognitive aspect of cultural intelligence in Iranian and non-Iranian students (P≥0/05). However, Iranian and non-Iranian students statistically differed in terms of the following aspects of cultural intelligence: meta-cognitive aspect (61.8% for Iranian students vs. 47.6% for non-Iranians), motivational aspect (59.0% vs. 42.6%), behavioral aspect (31.8% vs. 41.2%) as well as social adaptability as the other variable in question ( 68.9% vs. 56.2%) (p<0.001).
The comparison of the mean scores gained for meta-cognitive and motivational aspects of cultural intelligence as well as social adaptability in Iranian and non-Iranian students resided in the dormitories of Isfahan University of Medical Sciences revealed that the Iranian students had the higher rank. On the other hand, the mean score acquired for the behavioral aspect in Iranian and non-Iranian students were comparable, with non-Iranian students having the higher mean scores. Therefore, it can be said that the meta-cognitive and motivational aspects of cultural intelligence and social adaptability of non-Iranian students and the behavioral aspect of Iranian students’ cultural intelligence may be promoted by educational planning, thereby, taking effective steps towards their achievement in contexts with inter-cultural interaction . In this way, their mental health will be enhanced, as well.
PMCID: PMC3633545  PMID: 23678339
culture; intelligence; cultural intelligence; social adaptability.
9.  Self-medication among undergraduate medical students in Kuwait with reference to the role of the pharmacist 
The practice of self-medication is growing world-wide. It is associated with problems that may lead to potentially life-threatening complications represent a priority to be investigated. The aim of this study was to estimate the prevalence of self-medication among undergraduate medical students and to evaluate the possible role of the pharmacist in self-medication in Kuwait.
A descriptive cross-sectional study was performed, using the questionnaire on a sample of 900 male and female students randomly selected from three health faculties in Kuwait. The prevalence of self-medication, as well as the contribution of pharmacist in self-medication was assessed. In addition, the role of the pharmacist as drug consultant for the students after getting the medication was evaluated.
The overall prevalence of self-medication was 97.8%. The age was significantly inversely proportional to self-medication. There was a significant difference between male and female students in self-medication practice. Headache was the highest health conditions that most frequently motivated self-medication with 90.1% prevalence, followed by 84.7% for dysmenorrhea and 60.3% for constipation. Contribution of the pharmacist as a part of self-medication care was low totally, with the highest rate for cough conditions 40.1%. However, the role of the pharmacist as a drug consultant was more noticeable after obtaining the drug, not before. Around 80.1% of the students request information from the pharmacist about doses, duration of treatments and side-effects.
The prevalence of self-medication among undergraduate students in Kuwait is high and there were significant differences for age and gender. The contribution of the pharmacist was low in self-medication, while it was high after getting the drugs for obtaining drug related information. The practice of self-medication is alarming. Improved awareness about the role of pharmacist as a drug consultant for careful and cautious use of medicines available for self-medication would be strongly recommended.
PMCID: PMC4078651  PMID: 24991632
Kuwait; medical student; pharmacist; self-medication; undergraduate
10.  Evaluation of Female Youth Educational Needs about Reproductive Health in Non-Medical Students in the City of Qom 
To evaluate reproductive health education which is essential to the prevention of sexual risk behavior and its associated adverse outcomes of unwanted pregnancy, AIDS and other sexually transmitted disease in adolescents. Little is known about youth educational needs about reproductive health in Iran. The aim of this study is evaluation of female youth educational needs about reproductive health in non-medical universities in the city of Qom, north central of Iran.
Materials and methods
The study was descriptive-analytical type conducted in nine non-medical universities (400 students). A questionnaire was constructed to meet the purpose of the study based on similar studies of knowledge and attitude in different countries, yet it was modified according to Iranian culture and social norms.
The findings showed that a majority of participants have moderate knowledge about all components of reproductive health. Approximately, one - third of the participants reported difficulties to discuss about sexual health with mothers. The most of the participants believed insufficient female youth reproductive health services and low knowledge about reproductive health were the main barriers for female youth reproductive health aims.
The participants in this study are representatives of an important subgroup in Iran in order to evaluate female youth reproductive health educational needs. The study identified many misconception and negative attitude that need to be addressed. A health education program through parents, peers, mass media campaign and more comprehensive family planning curriculum in universities are recommended to overcome misconception and spread awareness.
PMCID: PMC4064772  PMID: 24971106
Youth; Reproductive health; Knowledge; Attitude
11.  Self-Medication Practices and Risk Factors for Self-Medication among Medical Students in Belgrade, Serbia 
PLoS ONE  2014;9(12):e114644.
Self-medication among future health care professionals can represent a serious threat to professionalism in medicine and it has potential to put at risk public trust into this profession. The aim of this research was to investigate prevalence and risk factors for self-medication among population of medical students, because it was previously shown that their attitudes towards pharmacotherapy could affect the way they could prescribe medication in the future.
Material and Methods
Research was performed as a cross-sectional study and it included 1296 (84.1%) 1st, 3rd and 6th year students of School of Medicine, University of Belgrade. Students filled out a demographic and self-medication questionnaire created for the purpose of this research and the Physical Health Questionnaire – 9 (PHQ-9). Questions about self-medication were related to the period of the previous year.
Self-medication was reported by 79.9% students. The most frequently self-prescribed medications were analgesics (55.4%). Independent risk factors for self-medication were possession of home-pharmacies (OR = 5.3, CI 95% 3.89–7.23), lower level of father's education (OR = 1.6, CI 95% 1.18–2.25), consumption of alcoholic beverages (OR = 1.5, CI 95% 1.13–2.08), less than 1 hour spent in physical activity per week (OR = 1.4, CI 95% 1.00–2.02), female gender (OR = 1.4, CI 95% 1.02–1.89), older age (OR = 1.1, CI 95% 1.07–1.21) and higher PHQ-9 score (OR = 1.09, CI 95% 1.05–1.12).
Self-medication is an important issue among population of medical students. Prevalence of self-medication could be controlled through regulatory authorities and further education.
PMCID: PMC4263675  PMID: 25503967
12.  Current analgesic use predicts low emotional quality of life in youth: A cross-sectional survey among university students in Sikkim, North East India 
The Indian Journal of Medical Research  2013;137(6):1199-1203.
Background & objectives:
Occurrence of chronic physical pain is increasingly identified among youth, and medically unsupervised analgesic use is a possible risk factor for opioid dependence and other mental diseases in later life. Therefore, the present study was carried out in young student population in Sikkim, India, to explore predictors (including current chronic pain and current analgesic use) of low QoL in youth to identify a subset of population vulnerable to substance use and mental diseases in later life.
The study was conducted in a health university setting in Sikkim, North East India. In this cross-sectional study, 156 participants were enrolled with almost equal number of males and females. Generic instruments for demographics and current analgesic use and SF - 36, for assessment of quality of life (QoL), were used. QoL was measured in general, physical and emotional domains. Presence of chronic physical pain during past four weeks was captured using SF - 36.
Almost two-third participants reported presence of current physical pain (69%, n=108); and (14%, n=22) reported current analgesic use for pain. In logistic regression model controlled for age, ethnicity, gender and residence, higher body mass index (BMI) (β=-0.16, P=0.02) and current analgesic use (β=1.6, P=0.006) predicted low QoL in emotional domain (less accomplishment due to emotional problem). Current analgesic use also predicted low QoL in another measure of emotional domain (depressed β=2.0, P=0.001).
Interpretation & conclusions:
This study identified a subset of participants in their youth with low QoL in emotional domain predicted by current analgesic use and possible overweight problem. Low QoL in more than one emotional domain also identifies possibility of later psychiatric impairment. However, chronic pain did not emerge as a significant predictor of low QoL in emotional domain.
PMCID: PMC3734726  PMID: 23852302
Analgesic; pain; predictor; quality of life; Sikkim
13.  Six-Year Follow-Up of Impact of Co-proxamol Withdrawal in England and Wales on Prescribing and Deaths: Time-Series Study 
PLoS Medicine  2012;9(5):e1001213.
A time-series study conducted by Keith Hawton and colleagues reports on the links between withdrawal of the analgesic co-proxamol and subsequent prescribing and deaths associated with analgesic poisoning.
The analgesic co-proxamol (paracetamol/dextropropoxyphene combination) has been widely involved in fatal poisoning. Concerns about its safety/effectiveness profile and widespread use for suicidal poisoning prompted its withdrawal in the UK in 2005, with partial withdrawal between 2005 and 2007, and full withdrawal in 2008. Our objective in this study was to assess the association between co-proxamol withdrawal and prescribing and deaths in England and Wales in 2005–2010 compared with 1998–2004, including estimation of possible substitution effects by other analgesics.
Methods and Findings
We obtained prescribing data from the NHS Health and Social Care Information Centre (England) and Prescribing Services Partneriaeth Cydwasanaethau GIG Cymru (Wales), and mortality data from the Office for National Statistics. We carried out an interrupted time-series analysis of prescribing and deaths (suicide, open verdicts, accidental poisonings) involving single analgesics. The reduction in prescribing of co-proxamol following its withdrawal in 2005 was accompanied by increases in prescribing of several other analgesics (co-codamol, paracetamol, codeine, co-dydramol, tramadol, oxycodone, and morphine) during 2005–2010 compared with 1998–2004. These changes were associated with major reductions in deaths due to poisoning with co-proxamol receiving verdicts of suicide and undetermined cause of −21 deaths (95% CI −34 to −8) per quarter, equating to approximately 500 fewer suicide deaths (−61%) over the 6 years 2005–2010, and −25 deaths (95% CI −38 to −12) per quarter, equating to 600 fewer deaths (−62%) when accidental poisoning deaths were included. There was little observed change in deaths involving other analgesics, apart from an increase in oxycodone poisonings, but numbers were small. Limitations were that the study was based on deaths involving single drugs alone and changes in deaths involving prescribed morphine could not be assessed.
During the 6 years following the withdrawal of co-proxamol in the UK, there was a major reduction in poisoning deaths involving this drug, without apparent significant increase in deaths involving other analgesics.
Please see later in the article for the Editors' Summary
Editors' Summary
Every year, about a million people worldwide die by suicide. Most people who take their own life are mentally ill. For some, stressful events have made life seem worthless or too painful to bear. Suicide rates can be reduced by improving the treatment of mental illness and of stress and by limiting access to common suicide methods. These methods differ from place to place. For example, in England and Wales, where 4,528 suicides were recorded in 2010, drug-related poisoning is responsible for about a fifth of all suicides. Notably, between 1997 and 1999, the prescription analgesic (pain killer) co-proxamol, which contains paracetamol and the opioid dextropropoxyphene, was implicated in a fifth of drug-poisoning suicides in England and Wales. In response to concerns about co-proxamol's widespread use for suicidal poisoning and its safety/effectiveness profile, the UK Committee on Safety of Medicines announced on January 31, 2005 that the drug would be withdrawn completely from use in the UK by December 31, 2007, and that between 2005 and 2007, doctors should not prescribe co-proxamol to any new patients and should try to move patients already taking the drug onto other medications.
Why Was This Study Done?
Public health experts need to quantify the impact of co-proxamol withdrawal on analgesic prescribing in England and Wales and on suicide rates. In particular, they need to know whether its withdrawal has increased the use of other analgesics in suicide (substitution). Reassuringly, between 2005 and 2007, there was a reduction in both co-proxamol prescribing and in co-proxamol–related suicides in England and Wales but no evidence of increased poisoning deaths involving other prescription analgesics. But what about the longer-term effects of co-proxamol withdrawal? In this interrupted time-series study, the researchers assess the impact of co-proxamol withdrawal in England and Wales by comparing data on analgesic prescribing and suicide rates collected between 1998 and 2004 and between 2005 and 2010. An interrupted time-series study uses serial measurements of events in a population before and after an intervention to look for changes in response to the intervention.
What Did the Researchers Do and Find?
The researchers obtained prescribing data from 1998 to 2010 for co-proxamol and several other analgesics from government sources in England and Wales, and data on suicides, open verdicts (poisoning of undetermined intent), and accidental poisonings involving single analgesics from the UK Office for National Statistics. They then estimated changes in levels and trends in prescribing and deaths following the 2005 announcement of co-proxamol withdrawal using interrupted time-series analysis. There was a marked reduction in co-proxamol prescribing that was accompanied by increased prescribing of several other analgesics after co-proxamol withdrawal. These changes were associated with a major reduction in suicide deaths due to poisoning that equated to 500 fewer deaths occurring between 2005 and 2010 than would have occurred had co-proxamol not been withdrawn. On average, there were 20 co-proxamol-related deaths (suicides and accidental poisonings) per year during 2008–2010 compared to more than 250 per year in the 1990s. Finally, there was little evidence of a change in the number of deaths involving other analgesics after co-proxamol withdrawal except for a small increase in the number of deaths involving the opioid oxycodone.
What Do These Findings Mean?
These findings show that, during the six years that followed the beginning of the phased withdrawal of co-proxamol in the UK, there has been a major reduction in poisoning deaths involving this drug in England and Wales. The findings provide little evidence for an increase in deaths involving other analgesics. However, because the Office of National Statistics does not distinguish between deaths due to oral and intravenous morphine or between deaths due to morphine and heroin, the researchers did not assess whether there have been any changes in deaths involving morphine since 2005. Moreover, this study did not assess suicides related to the use of multiple drugs or investigate whether suicides involving methods other than drug-related poisoning have increased since co-proxamol withdrawal. Despite these limitations, these findings suggest that the withdrawal of co-proxamol in the UK and possibly elsewhere should have major beneficial effects on suicide rates, at least in the relatively short term.
Additional Information
Please access these Web sites via the online version of this summary at
The World Health Organization provides information on the global burden of suicide and on suicide prevention (in several languages)
The US National Institute of Mental Health provides information on suicide and suicide prevention web page
The UK National Health Service Choices website has detailed information about suicide and its prevention
The University of Oxford Centre for Suicide Research provides information about co-proxamol and suicide and links to other research on suicide
The 2005 announcement of the withdrawal of co-proxamol in the UK is available through the UK Medicines and Healthcare products Regulatory Agency, which also provides a question and answer document about the risks and benefits of co-proxamol
MedlinePlus provides links to further resources about suicide (in English and Spanish)
The charity Healthtalkonline has personal stories about dealing with suicide
Help is at Hand is a resource for people bereaved by suicide
PMCID: PMC3348153  PMID: 22589703
14.  Prevalence and characteristics of migraine in medical students and its impact on their daily activities 
Migraine is a common neurological disorder with significant impact on quality of life. The aim of this study was to investigate the prevalence and characteristics of migraine headaches in medical students, to measure its impact on their life, and to assess their knowledge about the ailment. Information about lifestyle variables was also collected.
Materials and Methods:
All medical students who confirmed of having headache for more than 1 year formed the study group. Students filled a detailed questionnaire focusing on demographics, pain characteristics, accompanying factors, triggers, and family history of migraine. Lifestyle variables were enquired and migraine associated disability was assessed by MIDAS (Migraine Disability Assessment). The diagnosis of migraine was made according to the International Headache Society criteria. Results are expressed in n = numbers and percentage.
Sixty-eight percent of medical students had headache. The prevalence of migraine in the whole cohort was 28%; however, of the headache group, migraine constituted 42%. There was a female preponderance. One-fourth of the students had weekly or daily attacks with 31% students reporting increase in their headache intensity and frequency. Forty-four percent of students had severe headaches. Dizziness, allodynia, and neck stiffness were reported as accompanying symptoms. Trigger factors were identified in 99% students, predominant of which were poor sleep hygiene, environmental changes, head movements, and mental stress. Only 4% of students did regular exercise. Twenty-seven percent of students reported self-medication use of analgesics. One-fourth of the students had migraine-associated disability but only 6% realized that they had migraine.
Our study found a high prevalence of headache with migraine in medical students. The students’ awareness of the disease was very low with one-fourth of the students resorting to self-medication. Our study identified previously less-recognized triggers like head movement and accompanying symptoms like neck stiffness. Migraine-attributed burden was high in medical students.
PMCID: PMC3724079  PMID: 23956569
Impact on life; medical students; migraine
15.  Sharing and selling of prescription medications in a college student sample 
To estimate the prevalence of prescription medication diversion among college students; to compare classes of medications with respect to the likelihood of diversion; to document the most common methods of diversion; and to examine the characteristics of students who diverted medications.
A cross-sectional analysis of personal interview data collected between August 2006 and August 2007 as part of an ongoing longitudinal study. The cohort of students, who were between the ages 17 and 19 at study onset, attended a large public university in the mid-Atlantic region. Information was gathered regarding a wide variety of variables, including demographics, diversion of medically prescribed drugs, illicit drug use, and childhood conduct problems.
Among 483 students prescribed a medication, 35.8% diverted a medication at least once in their lifetime. The most commonly diverted medication classes were prescription ADHD medication, with a 61.7% diversion rate, and prescription analgesics (35.1% diversion rate). Sharing was the most common method of diversion, with 33.6% of students sharing their medication(s) and 9.3% selling in their lifetime. Comparative analyses revealed that prescription medication diverters had used more illicit drugs in the past year and had more childhood conduct problems than non-diverters.
If confirmed, these findings have important clinical implications for improved physician-patient communication and vigilance regarding prescribing analgesic and stimulant medications for young adults.
PMCID: PMC2845992  PMID: 20331930
college students; diversion; conduct problems; illicit drug use; nonmedical use of prescription drugs; alcohol use disorders; prescription stimulants; prescription analgesics
16.  Prevalence of migraine and tension-type headache among adults in Jordan 
The Journal of Headache and Pain  2009;10(4):265-270.
Here, we investigated the prevalence of headache among adults in Jordan. The study was conducted from January 2007 to November 2008. A sample of 4,836 participants were permitted to complete a self-conducted screening questionnaire. As much as 82.3% of participants complained from headache at least once per year. 36.1% were tension-type headache and 59% of the participants had other family members who suffered from headache. Headaches affected everyday activities in 51.6% of the participants; 82.7% of participants did not seek medical attention for their headaches. Among those who used analgesics (75.6%), acetaminophen was the most common (91.43%). In conclusion, headache and overuse of analgesics were prevalent in a significant part of the society. Thus, there is a need to educate the public to ensure safe practices and to make the use and selling of analgesics more stringent.
PMCID: PMC3451745  PMID: 19387792
Headache; Prevalence; Analgesics; Self-medication; Jordan
17.  Prior Knowledge, Older Age, and Higher Allowance Are Risk Factors for Self-Medication with Antibiotics among University Students in Southern China 
PLoS ONE  2012;7(7):e41314.
Self-medication with antibiotics (SMA) has been reported among university students in many countries, but little research has been done on this issue in China. The objective of this study was to evaluate knowledge and behaviors of university students and risk factors concerning SMA.
Methodology/Principal Findings
Using a novel questionnaire-based data collection instrument, an anonymous online survey was conducted with the students of Shantou University (STU), a university comprising 8 schools/colleges in eastern Guangdong, China. Of 1,300 respondents (13.8% of total eligible participants), 47.8% had self-treated with antibiotics. Logistic regression analysis identified prior knowledge of antibiotics (PKA), older age, and higher monthly allowance as independent risk factors for SMA. PKA significantly influenced students' knowledge about antibiotics, their uses, and common adverse reactions (all p<0.05). Among self-medicated students, 61.7% used antibiotics at least twice in the previous year. Community pharmacies were the major source of self-prescribed antibiotics. Reported common indications for SMA were sore throat (59.7%), fever (38.2%), cough (37.4%), runny nose (29.3%), and nasal congestion (28.7%). While 74.1% of self-medication episodes were based on students' own experiences, only 31.1% of students claimed to understand the package insert. Alteration of antibiotics and dosage during the course of self-treatment was made by 63.8% and 55.6% of students, respectively. At least two kinds of antibiotics were simultaneously taken by 82.6% of students. The majority of self-medicated students failed to complete the course of antibiotics. Adverse reactions were reported by 16.3% of students. Amoxicillin was the most common antibiotic used for self-medication.
High prevalence of SMA was noted among STU students. Presence of risk factors and risk-associated behaviors/attitudes in the study population calls for focused educational intervention and stricter governmental legislation and regulation of antibiotic use and sale in pharmacies.
PMCID: PMC3401104  PMID: 22911779
18.  Medicines in Pharmacy Students’ Residence and Self-medication Practices 
This study was aimed at identifying the types of medicines in pharmacy students’ residence and to determine if a relationship exists between keeping medicines in students’ accommodation and self-medication practices. A cross-sectional survey of a random sample of 240 undergraduate pharmacy students of the University of Jos, Jos, Nigeria, was carried out. Participating students were given a self-administered questionnaire, and only 188 students returned their filled questionnaire. The data collected were entered and analyzed using SPSS 16, and the χ2-test was used to determine associations between the variables. The results revealed that 66.0% of respondents had medicines in their room. A total of 318 medicines items (2.56 items per student's room) of which 37.1% were leftover medicines were present in respondents’ rooms. Analgesics (34.3%) and antibiotics (25.2%) were the common classes of medicines present in respondents’ rooms. Respondents reported getting these medicines on prescription (25.8%) and self-medication (56.5%) or both (17.7%). Self-medication practice was common among respondents (53.2%); however, no significant relationship (P>0.05) existed between having medicine in students’ room and self-medication practices. Common reasons given by respondents for having medicines in their rooms were that they were leftover medicines and that they were keeping them for emergency use or for use in an event of a similar illness. Most respondents (72.2%) reported disposing of their unused medicines in a trash can/dust bin. This study demonstrated that the prevalence of medicine storage in students’ room and self-medication practice is high. Analgesics and antibiotics were the most common types of medicines present in students’ residence.
PMCID: PMC3385216  PMID: 22754265
Leftover medicines; self-medication; students’ residence
19.  Primary Headache in Yemen: Prevalence and Common Medications Used 
Background and Objective. Primary headaches is a major medical concern in certain Arabic countries, for example Oman, Jordan, and Qatar. This study was aimed at increasing understanding of the prevalence of headache in Arabic countries and identifying common medications used for treatment because of the lack of research done in this field in Yemen. Methods. This is a cross-sectional observational study conducted by recruiting case-series of adults and elderly who have primary headache within the age group from 18 to 85 years. 12640 subjects received a simple explanation for the aim of the study as ethical issue. The subjects were allowed to complete a self-conducted screening questionnaire. The data were diagnosed according to the International Headache Society's diagnostic criteria (2004). Results. The results showed that 76.5% of the primary headache is prevalent at least once per year, 27.1% of the tension type headache (TTH) was the maximum percentage of type of headache, and 14.48% of the migraine headache (MH) was the minimum percentage. On the other hand, the relationship between the primary headache and age of subjects was statistically significant (P < 0.05), while between primary headache and sex was not (P > 0.05). In addition, 70.15% of the subjects said that headache attacks affected their activity of daily livings (ADL). 62.26% of the subjects used the medications without medical advice regarding their headache. 37.73% of the subjects relied on medical professionals (physicians and pharmacist) regarding analgesics use. The most common agent used among the medications was paracetamol (38.4%). Others included ibuprofen, aspirin, diclofenac sodium, naproxen, mefenamic acid, ergotamine and (11.45%) were unknown agents. Conclusion. We concluded that absence of health attention from the Yemeni Community and education from the health system in the country regarding analgesics use and their potential risk led to abuse of such medications and could be a reason beyond high prevalence of headache in Yemen.
PMCID: PMC4236899  PMID: 25538854
20.  Attitudes of undergraduate medical students of Addis Ababa University towards medical practice and migration, Ethiopia 
BMC Medical Education  2012;12:68.
The health care system of Ethiopia is facing a serious shortage of health workforce. While a number of strategies have been developed to improve the training and retention of medical doctors in the country, understanding the perceptions and attitudes of medical students towards their training, future practice and intent to migrate can contribute in addressing the problem. This study was carried out to assess the attitudes of Ethiopian medical students towards their training and future practice of medicine, and to identify factors associated with the intent to practice in rural or urban settings, or to migrate abroad.
A cross-sectional study was conducted in June 2009 among 600 medical students (Year I to Internship program) of the Faculty of Medicine at Addis Ababa University in Ethiopia. A pre-tested self-administered structured questionnaire was used for data collection. Descriptive statistics were used for data summarization and presentation. Degree of association was measured by Chi Square test, with significance level set at p < 0.05. Bivariate and multivariate logistic regression analyses were used to assess associations.
Only 20% of the students felt ‘excellent’ about studying medicine; followed by ‘very good’ (19%), ‘good’ (30%), ‘fair’ (21%) and ‘bad’ (11%). About 35% of respondents responded they felt the standard of medical education was below their expectation. Only 30% of the students said they would like to initially practice medicine in rural settings in Ethiopia. However, students with rural backgrounds were more likely than those with urban backgrounds to say they intended to practice medicine in rural areas (adjusted OR = 2.50, 95% CI = 1.18-5.26). Similarly, students in clinical training program preferred to practice medicine in rural areas compared to pre-clinical students (adjusted OR = 1.83, 95% CI = 1.12-2.99). About 53% of the students (57% males vs. 46% females, p = 0.017) indicated aspiration to emigrate following graduation, particularly to the United States of America (42%) or European countries (15%). The attitude towards emigration was higher among Year IV (63%) and Internship (71%) students compared to Year I to Year III students (45-54%). Male students were more likely to say they would emigrate than females (adjusted OR = 1.57, 95% CI = 1.10-2.29). Likewise, students with clinical training were more likely to want to emigrate than pre-clinical students, although the difference was marginally significant (adjusted OR = 1.58, 95% CI = 1.00-2.49).
The attitudes of the majority of Ethiopian medical students in the capital city towards practicing medicine in rural areas were found to be poor, and the intent to migrate after completing medical training was found to be very high among the study participants, creating a huge potential for brain drain. This necessitates the importance of improving the quality of education and career choice satisfaction, creating conducive training and working conditions including retention efforts for medical graduates to serve their nation. It follows that recruiting altruistic and rural background students into medical schools is likely to produce graduates who are more likely to practice medicine in rural settings.
PMCID: PMC3492144  PMID: 22867022
21.  Effect of Dill (Anethum graveolens) on the severity of primary dysmenorrhea in compared with mefenamic acid: A randomized, double-blind trial 
Dysmenorrhea has negative effects on women's life. Due to side-effects of chemical drugs, there is growing trend toward herbal medicine. The aim of this study was to assess the effect of Dill compared to mefenamic acid on primary dysmenorrhea.
Materials and Methods:
This double-blind, randomized, clinical trial study was conducted on 75 single female students between 18 and 28 years old educating in Nursing and Midwifery School and Paramedical Faculty of Qom University of Medical Sciences of Iran in 2011. They were allocated randomly into one of the three groups: In Dill group, they took 1000 mg of Dill powder q12h for 5 days from 2 days before the beginning of menstruation for two cycles. Other groups received 250 mg mefenamic acid or 500 mg starch capsule as placebo, respectively. Dysmenorrhea severity was determined by a verbal multidimensional scoring system and a visual analog scale (VAS). Students with mild dysmenorrhea were excluded. Data were analyzed by SPSS using the descriptive statistic, paired-samples t-test, Wilcoxon signed-rank test, Mann-Whitney test, and Kruskal-Wallis test.
There were no significant differences between three groups for demographic or descriptive variables. Comprising the VAS showed that the participants of Dill and mefenamic acid groups had lower significant pain in the 1st and the 2nd months after treatment, whereas in the placebo group this was only significant in the 2nd month (P < 0.05).
Dill was as effective as mefenamic acid in reducing the pain severity in primary dysmenorrhea. Further studies regarding side-effects of Dill and its interactivity are recommended.
PMCID: PMC4115348  PMID: 25097605
Dill (Anethum graveolens); dysmenorrhea; mefenamic acid; pain; placebo
22.  Self-medication in university students from the city of Rio Grande, Brazil 
BMC Public Health  2012;12:339.
Self-medication is the use of medication without prescription, orientation, or supervision of a physician or dentist. Self-medication might become a serious health problem. The purpose of this study was to identify the prevalence and factors associated with self-medication among first and last-year students enrolled in healthcare and non-healthcare programs.
A cross-sectional study was conducted at Universidade Federal do Rio Grande (FURG), state of Rio Grande do Sul, Brazil. Of 830 students in the sample, 95% answered the questionnaire – 789 students enrolled in 10 undergraduate programs. Mean age was 22 ± 6.17 years. The students answered a questionnaire covering socio-economic and demographic variables, use of medication, and medication knowledge. Information was collected on the conditions treated with medication, the medications used, and attitude towards self-medication.
Of 789 students, 86.4% self-medicated (88.5% of 446 healthcare students). There were no significant differences in self-medication between healthcare and non-healthcare students, nor between first and last-year students. Bivariate and multivariate analyses showed a significant association between self-medication and having children (p = 0.01), having a home pharmacy (p < 0.001) and adequate medication knowledge (p = 0.01). The most frequently used active ingredients were acetaminophen (paracetamol), dipyrone, aspirin, phytotherapic compounds, and tea. Illicit drug use was significantly associated with self-medication in the multivariate analysis.
The fact that being a healthcare student was associated with higher medication knowledge, but not with less self-medication, suggests that medication knowledge might contribute to increase self-medication. This should be taken into account when designing educational interventions relating to self-medication.
PMCID: PMC3444910  PMID: 22568959
23.  Prevalence of medication overuse headache in an interdisciplinary pain clinic 
Medication overuse headache (MOH) has been recognized as an important problem in headache patients although the pathophysiological mechanisms remain unclear. The diagnosis of MOH is based on clinical characteristics defined by the International Headache Society. The aim was the evaluation of the diagnostic criteria of MOH in a mixed population of chronic pain patients to gain information about the prevalence and possible associations with MOH.
Data of all patients referred to the interdisciplinary pain clinic at the University Hospital of Zurich between September 2005 and December 2007 were retrospectively analyzed. Demographic data (age, sex, history of migration), as well as data about duration of pain disease, category of pain disease (neurological, psychiatric, rheumatologic, other), use of medication, history of trauma, and comorbidity of depression and anxiety have been collected.
Totally 178 of 187 consecutive chronic pain patients were included in the study. A total of 138 patients (78%) used analgesics on 15 or more days per month. Chronic headache was more prevalent among patients with analgesic overuse (39.8%) than without analgesic overuse (18%). The prevalence of MOH was 29%. The odds ratio (OR) for a patient with medication overuse to have chronic headache was 13.1 if he had a history of primary headache, compared to a patient without a primary headache syndrome. Furthermore, history of headache (OR 2.5, CI [1.13;5.44]), history of migration (OR 2.9, CI [1.31;6.32]) and comorbid depression (OR 3.5, CI [1.46;8.52]) were associated with overuse of acute medication, in general.
Primary headaches have a high risk for chronification in patients overusing analgesics for other pain disorders. Whereas history of headache, history of migration and comorbidity of depression are independentely associated with analgesic overuse in this group of patients.
PMCID: PMC3606964  PMID: 23565761
Medication overuse; Headache; Interdisciplinary pain management; Chronic pain
24.  Psychological and Drug Abuse Symptoms Associated with Non-medical Use of Opioid Analgesics among Adolescents 
This exploratory study examined the psychological and substance abuse symptoms and motivations associated with adolescents’ medical and nonmedical use of opioid analgesics. We compared three groups of adolescents: 1) those who never used an opioid analgesic; 2) those who used a prescribed opioid analgesic (medical users); and 3) those who used someone else’s opioid analgesics (nonmedical users). Nonmedical use was defined as using someone else’s opioid analgesic medication. Comparisons among the groups were made on psychological and substance abuse symptoms as well as motivations to engage in nonmedical use.
A web-based survey, the Secondary Student Life Survey (SSLS) was administered to a sample of students who attended one of five secondary schools in southeastern Michigan. The sample included 2,627 respondents and was evenly distributed by sex and grade. Sixty-five percent (65.0%) were White/Caucasian and 29.5% African-American. The average age was 14.8 years (SD=1.9).
Seventy percent (70.4%, n=1850) reported never using opioid analgesics in their lifetimes. Of the remaining 24.5% (n=644) of opioid analgesic users, most were medical users. However, 3.5% (n=92) were classified as nonmedical users who used someone else’s medication for pain relief only, and 1.6% (n=41) were classified as nonmedical users for reasons other than for pain relief (e.g. to get high). In contrast to never users, both medical users and nonmedical users reported more substance abuse symptoms and symptoms associated with pain. Further, those nonmedical users who used opioids to sensation seek had greater odds of having psychological symptoms.
These data: 1) provide additional support for the existence of distinct subgroups of adolescent opioid analgesic users; 2) provide evidence of psychological symptoms associated with nonmedical use; and 3) highlight the psychological differences among nonmedical users who self-treat for pain versus nonmedical users who use for other reasons (e.g. experiment or get high).
PMCID: PMC4243924  PMID: 24905351
prescription drug misuse; opioid use; motives; adolescents; substance abuse; problem behaviors
25.  Menstrual problems and associated factors among students of Bahir Dar University, Amhara National Regional State, Ethiopia: A cross-sectional survey 
Menstrual problems are the most common gynecologic complaints. The prevalence is highest in the 20 to 24-year-old age group and decreases progressively thereafter. They affect not only the woman, but also family, social and national economics as well. However, Population studies on Menstrual problems and associated factors were very little for university students in Ethiopia.
Institutional based quantitative cross-sectional study was employed at Bahir Dar University from October 14 to 20, 2010, Ethiopia. Stratified sampling technique was used and 491 study subjects were randomly selected from faculties. Only 470 respondents had given complete response for the self-administered questionnaire and were included in the final analysis. Data was entered and analyzed with SPSS version 16.0 windows. The main statistical method applied was logistic regression (unconditional) and both the classical bivariate and the multivariate analyses were considered.
The prevalence of dysmenorrhea and premenstrual syndrome were 85.1% and 72.8%, respectively. The most contributing factors remained to be statistically significant and independently associated with dysmenorrhea were having menstrual cycle length of 21-35 days (AOR=0.16, 95%CI: 0.04, 0.71), family history of dysmenorrhea (AOR=3.80, 95%CI: 2.13, 6.78) and circumcision (AOR=1.84, 95%CI: 1.001, 3.386) while with premenstrual syndrome were educational status of mothers being certified in certificate and beyond (AOR=0.45, 95%CI: 0.25, 0.83), living in Peda campus (AOR=2.11, 95%: 1.30, 3.45), having irregular menstruation (AOR=1.87, 95%CI: 1.17, 2.99) and family history of premenstrual syndrome (AOR=4.19, 95%CI: 2.60, 6.74).
The prevalence of menstrual problems among students of Bahir Dar University was very high. Menstrual cycle length, family history of dysmenorrhea and circumcision were the most contributing factors associated with dysmenorrhea while educational status of mothers, regularity of menstruation, and family history of premenstrual syndrome were for premenstrual syndrome. Health education, appropriate medical treatment and counseling, should be accessible and persistently provided to the affected students by Bahir Dar University. Maximum effort is needed to eliminate circumcision by all levels and further steps that would enable females to join their college education should be applied.
PMCID: PMC4189866  PMID: 25309646
Dysmenorrhea; menstruation; premenstrual syndrome

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