Consumer Health

WHO defines self-care as “the ability of individuals, families and communities to promote health, prevent disease, maintain health, and cope with illness and disability with or without the support of a health worker”.

Self-care recognises individuals as active agents in managing their own health care, in areas including:

• health promotion,
• disease prevention and control,
• self-medication,
• providing care to dependent persons,
• rehabilitation,
• palliative care.

In Europe, the estimated prevalence of self medication is 34.3%.

Increasing patient knowledge from recommendations by non-medical professionals, access to information via the Internet and the promotion of healthy lifestyles and medicines lead to an increase in self-medication.

Factors which contribute to the frequency of self medication are:

• Inaccessibility of health care due to long waiting times,
• high costs,
• long distances,
• Potential time,
• need for immediate care,
• perception of current symptoms and illnesses as mild and not serious,
• lack of recognition of symptoms by a doctor,
• negative experiences in healthcare,
• self-diagnosis and management of symptoms and illnesses.

• Self medication prevalence is greater in women than in men in all European countries, totaling 39.7% and 28.5%, respectively.
• Self medication prevalence is highest in the 25–44 group (36.1%).
• Women display much greater propensity to self-medicate than men in the 45–64 bracket.
• A higher percentage of patients with higher education self medicate (39.6%), compared to those without formal education (15.2%)
• Self medication is more frequent amongst those who possess a long-standing health problem versus those who do not (38.9% vs. 30.3%).

Appropriate self-medication offers several benefits:

• It empowers individuals to take responsibility for their health.
• It encourages active prevention of health issues.
• It enhances the quality of life for patients by saving time and reducing costs.
• It helps alleviate physical discomfort associated with both chronic and acute conditions.
• It reduces the strain on healthcare systems, thereby improving the quality and availability of treatment for those with serious health conditions.

However, self medication can also increase the risk for adverse drug reactions, with nearly 1 in 5 European patients admitted to the emergency rooms for having self-medicated via formerly prescribed medications and over the counter (OTC) medication.

A headache is a painful and disabling feature of primary headache disorders, namely migraine, tension-type headache and cluster headache.

Migraine is a primary headache disorder, in most cases episodic, that usually lasts 4-72 hours, accompanied by nausea, vomiting and/or photophobia and phonophobia. It is sometimes preceded by a short-lasting aura of unilateral, reversable visual, sensory or other symptoms.

Tension-type headache is described as pressure or tightness, often like a band around the head, sometimes spreading into of from the neck. It may be stress related or associated with musculoskeletal problems in the neck.

Cluster headache is a primary headache disorder characterized by frequently recurring (up to several times a day), brief but extremely severe headache, usually focused in or around one eye, with tearing and redness of the eye.

Headache disorders are among the most common disorders of the nervous system.¹

The prevalence of migraine in Europe is 11.4%.²

Migraine most often begins at puberty and generally affects people around 35-45 years.¹

It is more common in women.¹

It is the second leading cause of disability worldwide as measured by years lived with disability (YLDs), and the first among young women based on disability-adjusted life years (DALYs).²

• Impact on parents and children: 38.6% of parents with migraine declared that migraine affected their parenting while 8.7–13.1% of children reported that parental migraine affected their academic performance.
• Relationships: 49.0% of people with migraine indicated that they would be a better partner if they did not have headaches.
• Family planning: 3.2% subjects indicated that they chose not to have children, delayed having children, or had fewer children because of migraine.
• Career Occupation and Employment: 32.7% of people with migraine reported that headaches had affected their career, while 22.8% were worried about losing their job because of migraine.

Migraine is comorbid with a variety of conditions and diseases, such as:

• depression and anxiety disorders,
• neck and low back pain,
• cardiovascular events (eg, ischaemic heart disease or stroke), mainly in people suffering migraine with aura,
• epilepsy,
• obesity.

Indirect costs constitute most of the economic burden in Europe.

Direct costs inform health-care policies and allow for estimations of expenses incurred by health-care services.

In Europe, financial costs attributed to migraine are estimated at €50 billion to €111 billion, of which direct costs accounted for 7% and indirect costs for 93%.

In Europe, direct healthcare costs attributed to migraine were €1222 per person in 2011.

Although the vulva and the vagina are distinct organs with different characteristics, the two terms are mistakenly often used interchangeably:

• the vagina forms part of the internal female genitalia,
• the vulva describes the anatomical structures comprising the outer female genitalia.

In addition, posterior to the vulva, the perineal skin and microbiota are underappreciated modulators of genital health.

The perineal area is vulnerable to contamination by microbes of faecal origin.

Women must consider the vulva, the vagina and the perineum as distinct but synergistically acting players in the maintenance of their intimate health.

The vulva is the first line of defence to protect the genital tract from infections.

Vulvar skin differs from other skin sites in:

• hydration
• friction
• permeability
• visually discernible irritation
• higher susceptibility to topical agents compared to forearm skin because of its increased hydration, occlusion, and frictional properties.¹

Supported by international guidelines, daily gentle cleansing of the vulva is an important aspect of feminine hygiene and overall intimate health.

Women should be encouraged to choose a carefully formulated and clinically tested external wash that provides targeted antimicrobial and other health benefits without negatively affecting the natural vulvovaginal microbiota.¹

The normal vaginal flora, acidic vaginal pH, and vaginal discharge are all components of the innate defence mechanisms that protect against vulvovaginal infections.²

Resident bacteria help maintain an acidic pH and compete with exogenous pathogens to adhere to the vaginal mucosa. ²

The importance of vaginal lactic acid needs to be emphasized as it correlates with vaginal health, inhibits the growth of bacteria associated with bacterial vaginosis and possibly plays a role in the local immune defence. ²

• The vulvar microbiome differs from the vaginal microbiome.¹
• Similar to the vaginal microbiome, the vulvar microbiome may also affect the proliferation of exogenous pathogens that cause vaginal and urinary tract infections. ¹
• There is wide diversity in intra- and inter-individual vulvar microbiomes, with no single species common to all women. ¹

Many factors may upset the normal flora and facilitate infections, such as:1

• immune deficiency
• hormonal changes
• stress

The vulva is susceptible to dermatitis and other dermatological conditions, particularly when the barrier function of the skin is compromised by factors that constitute the normal vulvar environment, namely, moisture (urine, vaginal discharge), enzymes (stool residue), friction, and heat.²

The predominant bacterial species comprising the healthy vaginal microbiota are lactobacilli which protect the intimate areas by different mechanisms: ¹

• producing lactic acid, which maintains an acidic environment and inhibits the growth of pathogenic bacteria,
• binding to the surface of vaginal epithelial cells and competing with other microorganisms to prevent them from attaching to, and infecting, these cells,
• releasing soluble components that inhibit other bacteria from associating with the epithelial cell membrane

Dysbiosis has been consistently associated with increased risk of human immunodeficiency virus (HIV), human papilloma virus (HPV), herpes simplex virus-type 2 (HSV-2), and Trichomonas vaginalis infections.²

Postpartum women (the 6- to 8-week time period beginning an hour following birth1), may be more concerned with feminine hygiene than younger women.³

Postpartum women have specific hygiene needs due to the anatomical and functional changes associated with vaginal delivery. ³

During childbirth, the perineum is frequently subject to trauma, making perineal hygiene even more critical for these women. ³

In addition, vaginal delivery can lead to dramatic shifts in the vaginal microbiota which in turn can predispose postpartum women to developing bacterial vaginosis . ³

Appropriate genital hygiene via gentle vulvar cleansing can help reducing: ³

• itching,
• burning,
• oedema,
• erythema,
• bacterial vaginosis.

Upper respiratory tract infections (URTIs) are the most common infections in the population. They are the leading cause of people missing work or school and, thus, have important social implications.

The term “upper respiratory tract” covers several mutually connected anatomical structures: nose, paranasal sinuses, middle ear, pharynx, larynx, and the proximal part of trachea.²

Most acute URTIs are caused by viruses, especially rhinovirus, coronavirus, adenovirus, parainfluenza virus, respiratory syncytial virus, and enterovirus. They are responsible for more than 80% of all common colds.²

• rhinitis (inflammation of the nasal mucosa)
• rhinosinusitis or sinusitis (inflammation of the nares and paranasal sinuses)
• nasopharyngitis (rhinopharyngitis or the common cold)
• pharyngitis (inflammation of the pharynx, hypopharynx, uvula, and tonsils)
• epiglottitis (inflammation of the superior portion of the larynx and supraglottic area)
• laryngitis (inflammation of the larynx)
• laryngotracheitis (inflammation of the larynx, trachea, and subglottic area)
• tracheitis (inflammation of the trachea and subglottic area).²

In most cases, these diseases are self-limiting and can be managed at home.² However, some may cause severe complications.²

Patients with URTIs typically present with:

• runny nose
• sneezing
• congestion
• clear-to-mucopurulent nasal discharge
• an altered sense of smell
• postnasal drip with cough
• low-grade fever²

A fever of moderate-to-high grade suggests a secondary bacterial infection.¹

Fever is a normal physiological response to illness that facilitates and accelerates recovery.¹ Although fevers are often a presenting symptom of a self-limiting viral infection, they are also associated with serious bacterial infections, such as meningitis and pneumonia, and other non-infective illnesses.¹ However, in children, timely identification of those at risk of serious illness allows rapid referral and appropriate management.¹ Antipyretics should be used to make the child more comfortable and not used routinely with the sole aim of reducing the temperature.²