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Aim: To investigate the epidemiological characteristics of patients presenting to the emergency department with an overdose of over-the-counter (OTC) drugs. Methods: A questionnaire survey was conducted to examine the sociodemographic characteristics of patients with OTC drugs overdoses visiting emergency departments at eight sites across the country. The patients were divided into "habitual" and "nonhabitual" groups according to their history of OTC drugs overdose. Student's t-test or Welch's t-test was performed for numerical variables, and Pearson's χ 2 test was performed for dichotomous and nominal variables between the two groups. Results: Of the 124 patients included in this study, 79% were women. The habitual (26.6%) and the nonhabitual (73.4%) groups showed no differences in sex, occupation, cohabitants, history of mental illness, or history of alcohol consumption or smoking; however, those in the habitual group were significantly younger. The proportion of OTC drugs obtained from physical stores was higher in the habitual group, whereas the nonhabitual group used more household medicines. Suicide and self-harm were more common reasons for overdose in the nonhabitual group. Antipyretic analgesics were significantly more common in the nonhabitual group, whereas antitussive expectorants and antihistamines were significantly more common in the habitual group. Conclusion: This is the first multicenter study to determine the status of OTC drugs overdose patients treated at emergency departments of medical facilities in Japan. To prevent new overdoses of OTC drugs, continued detailed epidemiologic studies of patient backgrounds and drug acquisition routes, and investigation of the components of OTC drugs that cause dependency are necessary.

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Social media now has emerged as one of the most widely used communication channels. The objective of this work is to verify the factors that influence the compulsive use of TikTok, as well as the mediating role of algorithm awareness, and to identify the predictors of well-being related to the use of TikTok. In the present work, the relevance of the study of PSRs and FoMO that affect the compulsive use of TikTok in young people is discussed. A total of 379 young university students (56.7 % girls) between 15 and 25 years old (M = 19.80; S.D. = 1.49) were surveyed using self-reports. Data treatment followed serial mediation through structural equation modeling. The results showed that exist significant relationships between these variables. Likewise, they reinforce the understanding of the diversity of the mechanisms of social and parasocial motivations on compulsive use and well-being. The results highlight the need to strengthen the training and education of young people in the appropriate and regulated use of TikTok in the university setting.

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Background: Multimodal approach of psychotherapy has been found to be effective for managing the excessive use of technology. Yoga, a holistic mind-body therapy, has been observed to be a useful adjuvant in managing substance use disorders. Yoga is also known to reduce stress and enhance overall well-being. The aim of this study was to examine whether yoga as an adjuvant treatment to psychotherapy is better than psychotherapy alone in reducing dysfunction and severity due to excessive technology use. Methods: A two-arm randomized controlled prospective study design was followed with assessor blinding and allocation concealment. Thirty consenting young adults (22 males), scoring above 36 on the Internet Addiction Test, were randomly allocated to either: Group A = psychotherapy + yoga or Group B = psychotherapy alone. Both groups received 8 sessions of psychotherapy in the 1st month. In addition, Group A received additional 10 sessions a specific yoga program (by trained professionals). After that, monthly booster sessions (supervised yoga sessions performed with direct one-on-one contact with the yoga therapist) were organized and post-assessment was conducted at 12 weeks. Each subject was assessed using the Internet Addiction Test-Short Form, Internet Gaming Disorder Scale-Short Form, Smartphone Addiction Scale-Short Version, and Kessler Psychological Distress Scale at baseline and after 12 weeks. Results: As compared to Group B, Group A had significantly reduced Internet use (F = 5.61, P = 0.02, ηp 2 = 0.17), smartphone use (F = 4.76, P = 0.03, ηp 2 = 0.15), psychological distress (F = 7.71, P = 0.01, ηp 2 = 0.22), and weekday use (Z = -2.0, P = 0.05, ηp 2 = 0.15) along with enhanced treatment adherence and retention. Conclusion: Yoga as an adjuvant therapy with multimodal psychological intervention for excessive use of technology was found to be effective. This carries clinical implications for mental health professionals.

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Over the past decade, the world population has experienced rapid and widespread adoption of smartphones due to their usefulness and convenience. However, researchers have identified a range of adverse behaviours associated with the adoption of smartphones and their higher use. These behaviours are collectively described as Problematic Smartphone Use and Dependence (PSUD). Despite growing research, the underlying processes and drivers leading to these behaviours are inadequately understood. This can partly be attributed to the absence of developed statistical tools and measures that allow researchers to build a comprehensive conceptual understanding of PSUD. To address this issue, this study proposes and evaluates a validated extension to the Problematic Use of Mobile Phones (PUMP) scale. The extension of this tool incorporates factors associated with substance dependence outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), including additional items to measure PSUD accurately, referred to as the modified problematic use of mobile phones (MPUMP) scale. The newly developed tool was used in a cross-sectional online survey during September and October 2022, drawing on 1018 adult Australian participants. Principal Component Analysis (PCA) and Exploratory Factor Analysis (EFA) were conducted to derive the underlying factors. The EFA revealed two distinct factors: Distraction and Dysregulation. Both factors exhibited high internal consistency, with Cronbach's Alpha coefficients of 0.92 and 0.86, respectively. A one-way analysis of variance (ANOVA) revealed significant variations inthe identified factors' mean scores across different socio-demographic characteristics. The study provides evidence that the MPUMP scale is a validated and reliable measure for accurately assessing PSUD. The study findings offer novel insights into the psychosocial and physical aspects of PSUD, providing a foundation for exploring the causes and potential interventions for PSUD.

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Today, adolescents tend to accept smartphones more quickly than adults and spend more time with these devices since they are members of the first generation born and living in environments where smartphones and the internet are common. However, when they use smartphones excessively and become addicted to smartphones, this may cause them to suffer from various psychological, emotional, and physical health problems from an early age. Therefore, this study systematically examines the articles on smartphone addiction in adolescents. For this purpose, the related articles were screened using the Web of Science database and 188 studies by the search criteria were subjected to a systematic review. In this sense, methodological tendencies, variables and main findings of the studies included in the present study were examined. This study revealed that the quantitative research method was primarily used. The studies mainly investigated smartphone use, social relations, demographic characteristics, depression, personal characteristics, and sleep variables. Moreover, the studies were primarily conducted in China, and large sample groups were preferred. The factors that triggered the smartphone addiction of adolescents were family problems, and especially females were more addicted to smartphones than males. Moreover, smartphone addiction causes depressive symptoms, sleep problems, and decreased academic achievement in adolescents. Finally, various suggestions were presented based on the findings of this study.

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Adolescents and young adults have progressively become smartphone and internet-dependent. Its addiction is affecting them mentally and physically. Due to its overutilization, it is causing a detrimental effect on them. These dilemmas need to be acknowledged. Furthermore, the goal is to reduce overutilization and overreliance, and the task is to reduce the heavy toll on their mental and psychological condition. We need to review the evidence linking smartphone and social media use with psychological morbidities among adolescents and young adults. The aim of this study is to summarize the present situation and the correlation between smartphones and mental health. Cognitive, emotional difficulties, poor cognitive function, impulsivity, shyness, social networking addiction, low self-esteem, and some medical issues like insomnia, anxiety, depression, and a lack of cognitive control have been linked to excessive smartphone use.

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Acute bronchitis is a self-limiting disease, characterized by mild constitutional symptoms and a cough lasting two to three weeks. The disease usually occurs secondary to viruses; therefore, only symptomatic and supportive care is advised for the patients. Despite the recommended guidelines, most patients are prescribed antibiotics. Here, we present a case of a 38-year-old female who presented to the hospital with a sudden onset of severe epigastric pain. The patient recently started a 10-day course of doxycycline for acute bronchitis. She was admitted, evaluated, and diagnosed with doxycycline-induced esophagitis, and managed accordingly. This report highlights how excessive use of antibiotics is leading to adverse effects, antibiotic resistance, increased health care costs, and invasive testing. It also emphasizes the importance of antibiotic stewardship.

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The pervasive nature of social media can result in excessive use and addiction, but whether excessive use of social media is good or bad for individuals' creativity is unclear. This study explored the direct and indirect impact of excessive use of WeChat on individuals' creativity in workplace, focusing on how excessive use of WeChat promotes or restrains creativity through knowledge sharing and psychological strain. Based on the person-environment fit model and motivation theory, this study examined the three paths of excessive WeChat use affecting individuals' creativity in workplace. We used the structural equation model to test our research model. A survey of 364 employees revealed that excessive WeChat use directly promotes creativity and indirectly improves creativity via knowledge sharing, but excessive WeChat use does not lead to psychological strain. These findings, obtained by theoretically and empirically investigating the positive outcomes of excessive WeChat use, suggest an upside to excessive WeChat use. The implications and limitations of this study and future research on excessive-use behavior are also discussed.

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BACKGROUND: Although excessive use of social networking site (SNS) is related to undesired effects on healthy individual's psychological well-being, there is a huge gap in studies performed with individuals who suffer from various mental disorders. AIM: The main goal of this study is to examine the association between problematic utilization of SNSs and depressive symptoms across patients diagnosed with major depressive disorder (MDD). METHODS: 111 patients diagnosed with MDD (diagnoses confirmed via the Structured Clinical Interview for DSM-5-Clinician Version (SCID-5/CV)) and 108 healthy controls (HCs) were recruited for the study. Montgomery-Asberg Depression Rating Scale (MADRS) and Bergen Social Media Addiction Scale (BSMAS) were administered by both MDD and HC groups. Group comparisons were estimated with multivariate analysis of covariance (MANCOVA) analyses. To identify the relationship between SNS addiction and depressive symptoms, the Pearson correlations were performed, and finally, we computed the multiple linear regression analyses to determine whether SNS addiction predicts depressive symptoms. RESULTS: The results revealed that MDD group is more addicted to SNS relative to HC. In addition, depressive symptoms were significantly predicted by 'relapse' subdimension and the overall score of SNS addiction in the MDD group. CONCLUSION: Our study illustrated the detrimental effects of excessive SNSs usage on depressive symptoms in MDD particularly for the individuals in 'relapse' state of SNS addiction. The mental health workers should consider the usage patterns of SNSs in patients diagnosed with MDD during their clinical observation and management.

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Desde uma perspectiva crítica e de enfrentamento à problemática da sobremedicalização, a prevenção quaternária (P4) emergiu como um conceito inovador, propondo alternativas para prevenir os eventos iatrogênicos e otimizar os custos da saúde. O presente ensaio foi elaborado a partir de uma revisão histórico-conceitual da P4 e dos modelos de educação médica, visando compreender como a P4 poderia se constituir como um elemento estratégico para remodelar a educação médica. O artigo aprofunda aspectos conceituais da P4; aborda a educação médica a partir de uma perspectiva histórica; aponta as interligações dinâmicas entre a P4, as práticas de saúde e a educação médica; e, por fim, expõe os motivos pelos quais a P4 pode se tornar um elemento central da educação médica.(AU)

From a critical perspective that tackles the problem of overmedicalization, quaternary prevention (P4) emerged as an innovative concept, proposing alternatives to prevent iatrogenic events and to optimize healthcare costs. This essay provides a historical-conceptual review of P4 and of medical education models, aiming to understand how P4 can become a strategic element to remodel medical education. The article addresses conceptual aspects of P4, approaches medical education from a historical perspective, and shows the dynamic interconnections between P4, health practices and medical education. Finally, it explains the reasons why P4 can become a central element of medical education.(AU)

Desde una perspectiva crítica y de enfrentamiento a la problemática de la sobremedicalización, la prevención cuaternaria (P4) surgió como un concepto innovador, proponiendo alternativas para prevenir los efectos iatrogénicos y optimizar los costos de la salud. El presente ensayo se elaboró a partir de una revisión histórico-conceptual de la P4 y de los modelos de educación médica, con el objetivo de entender cómo la P4 podría constituirse como un elemento estratégico para remodelar la educación médica. El artículo profundiza aspectos conceptuales de la P4, aborda la educación médica a partir de una perspectiva histórica, señala las interconexiones dinámicas entre la P4, las prácticas de salud y la educación médica. Finalmente, expone los motivos por los cuales la P4 puede convertirse en un elemento central de la educación médica.(AU)

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The present study investigates how excessive smartphone use predicts users' stress and loneliness while taking the moderating role of online self-disclosure into account. We conducted a two-wave panel survey with a quota sample of smartphone users (n = 461 at time 2 [T2]). We found no direct effects of excessive smartphone use on stress or loneliness. However, our results showed that online self-disclosure moderates the postulated relationships. That is, excessive smartphone use (time 1 [T1]) predicts increased stress (T2), for those smartphone users who do engage in little online self-disclosure. However, for those who communicate their feelings, anxieties, and problems online, excessive smartphone use (T1) can even reduce loneliness (T2) and relieve stress (T2).

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BACKGROUND: Digital rectal examination (DRE) is one of the most common strategies for prostate cancer early detection. However, the use for screening purposes has a controversial benefit and potential harms can occur due to false-positive results, overdiagnosis and overtreatment. The objective of this study is to calculate the prevalence and identify factors associated with the receipt of DRE in Brazilian men. METHODS: We selected men older than 40 from a nationwide population-based survey (13,625 individuals) excluding those with prostate cancer diagnosis. Information was extracted from the most recent database of the Brazilian National Health Survey (PNS 2013). Statistical analysis was carried out to calculate incidence rate ratios, with 95% confidence intervals and p values, through multivariate analysis with Poisson regression and robust variance. RESULTS: Men having private health insurance (63.3%; CI = 60.5-66.0) presented higher prevalence of DRE than those in the public health system (41.6%; CI = 39.8-43.4). The results show a positive association between DRE and men having private health insurance, aged 60-69, living with a spouse, never smokers, and living in urban areas. Among public health services users, this positive association was observed among men aged 70-79, living with a spouse, having bad/very bad health self-perception, abstainers, ex-smokers, with undergraduate studies, presenting four or more comorbidities, and residing in urban areas. CONCLUSIONS: Prostate cancer screening with DRE is quite frequent in Brazil, specially among men with private health plans and better access to health services, healthier lifestyle and at more advanced ages, characteristics which increase the risk of overdiagnosis and overtreatment.

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Inhibitory control is a core executive function module that monitors and suppresses inappropriate behavior. Inhibitory deficits have been observed in different addiction types (e.g., smoking, alcohol, drug and gambling). The excessive use of social networking sites (SNSs) has attracted increasing attention; however, it is unknown whether inhibitory control is impaired in excessive SNS users. This study used event-related potentials in an SNS-related Go-Nogo task to investigate inhibitory control in excessive SNS users. Although the behavioral data did not show any significant differences between groups, the N1 amplitude was larger following SNS images than control images in excessive SNS users. Furthermore, excessive users showed larger N2 amplitude and smaller Nogo-P3 amplitude than non-excessive users irrespective of stimuli. These findings suggested that excessive SNS users are inefficient in allocating monitoring resources in the Go-Nogo task (reflected by enhance N2) and show difficulty in late inhibitory control procedure (reflected by reduced Nogo-P3) compared to non-excessive users. Also, excessive SNS users pay more attention to SNS-related images compared to non-SNS-related images (reflected by the N1). Interventions for this specific population should focus on limiting exposure to SNS cues and enhancing inhibitory control.

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INTRODUCTION: Problematic use of video games, social media, and Internet-related activities may be associated with sleep deprivation and poor work performance. The Internet Addiction Test was given to military medical and nursing students and housestaff to assess problematic Internet use. METHODS: Medical and nursing students at the Uniformed Services University of the Health Sciences and residents from Naval Medical Center San Diego were contacted via email (n = 1,000) and given a survey that included the Internet Addiction Test (IAT) and questions asking about other specific lifestyle variables. Individuals who received an Internet Addiction Score (IAS) ≥50 were identified as likely experiencing harmful effects of Internet addiction (IA). RESULTS: Of 399 surveys submitted, 68 were omitted due to gross incompletion or failing to finish the entirety of the IAT. Of the participants included, 205 (61.1%) were male and 125 (37.9%) were female. The mean age was 28.6 years old (S.D. = 5.1 years). In regards to training status, completed surveys were assessed for 94 medical residents, 221 School of Medicine students, and 16 Graduate School of Nursing students. Our survey showed 5.5% of the participants (n = 18) indicated problems with Internet use that are concerning for IA. CONCLUSIONS: The study results indicated that our population showed problematic Internet use in the lower range of global estimates of IA. Rates of IA further decreased between medical students and residents. Multiple lifestyle variables were significantly associated with IA score and may serve as indicators of a higher score. Interestingly, the use of social media during sleeping hours was most significantly associated with increased IAS. This paper discusses IA among military medical and nursing trainees and how problematic Internet use may affect work performance and force readiness.

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Online social networking sites (SNSs), such as Facebook, provide frequent and copious social reinforcers (e.g., "likes") delivered at variable time intervals. As a result, some SNS users display excessive, maladaptive behaviors on these platforms. Excessive SNS users, and typical users alike, are often aware of their intense use and psychological dependence on these sites, which may lead to elevated stress. In fact, research has demonstrated that use of SNSs alone induces elevated stress. Other research has begun to investigate the effects of short periods of SNS abstinence, revealing beneficial effects on subjective wellbeing. We aligned these two lines of research and hypothesized that a short period of SNS abstinence would induce a reduction in perceived stress, especially in excessive users. The results confirmed our hypothesis and revealed that both typical and excessive SNS users experienced reduction in perceived stress following SNS abstinence of several days. The effects were particularly pronounced in excessive SNS users. The reduction in stress was not associated with academic performance increases. These results indicate a benefit-at least temporarily-of abstinence from SNSs and provide important information for therapists treating patients who struggle with excessive SNS use.

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CONTEXT: Smartphone use is being investigated as a potential behavioral addiction. Most of the studies opt for a subjective questionnaire-based method. This study evaluates the psychological correlates of excessive smartphone use. It uses a telemetric approach to quantitatively and objectively measure participants' smartphone use. METHODOLOGY: One hundred forty consenting undergraduate and postgraduate students using an Android smartphone at a tertiary care teaching hospital were recruited by serial sampling. They were pre-tested with the Smartphone Addiction Scale-Short Version, Big five inventory, Levenson's Locus of Control Scale, Ego Resiliency Scale, Perceived Stress Scale, and Materialism Values Scale. Participants' smartphones were installed with tracker apps, which kept track of total smartphone usage and time spent on individual apps, number of lock-unlock cycles, and total screen time. Data from tracker apps were recorded after 7 days. RESULTS: About 36 % of participants fulfilled smartphone addiction criteria. Smartphone Addiction Scale score significantly predicted time spent on a smartphone in the 7-day period (ß = 0.234, t = 2.086, P = 0.039). Predictors for time spent on social networking sites were ego resiliency (ß = 0.256, t = 2.278, P = 0.008), conscientiousness (ß = -0.220, t = -2.307, P = 0.023), neuroticism (ß = -0.196, t = -2.037, P = 0.044), and openness (ß = -0.225, t = -2.349, P = 0.020). Time spent gaming was predicted by success domain of materialism (ß =0.265, t = 2.723, P = 0.007) and shopping by ego resiliency and happiness domain of materialism. CONCLUSIONS: Telemetric approach is a sound, objective method for evaluating smartphone use. Psychological factors predict overall smartphone usage as well as usage of individual apps. Smartphone Addiction Scale scores correlate with and predict overall smartphone usage.

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This study aims to investigate the gray matter volume (GMV) of key neural systems possibly associated with Excess Social Media Use (ESMU) in the general user population. It employs a sex-balanced case (relatively high ESMU scores) - control (relatively low ESMU scores) design with 50 random university students who have reported varying levels of ESMU. The case and control groups included 25 subjects each. Brain volumes were calculated with Voxel-Based Morphometry techniques applied to structural MRI scans. Results based on voxel-wise and region-of-interest (ROI) analyses showed that the case group had reduced GMV in the bilateral amygdala and right ventral striatum. The GMV of the bilateral amygdala and right ventral striatum negatively correlated with ESMU scores in the voxel-wise analysis. No differences or correlations in relation to prefrontal regions were observed. Using the ROI analysis, the bilateral amygdala volumes correlated with ESMU scores, and insufficient evidence regarding the ventral striatum and ESMU was obtained. It is concluded that excess social media use in the general population is associated in part with GMV reduction in the bilateral amygdala, and possibly the striatum, but not in volumetric differences in prefrontal regions.

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Facebook is notably the most widely known and used social network worldwide. It has been described as a valuable tool for leisure and communication between people all over the world. However, healthy and conscience Facebook use is contrasted by excessive use and lack of control, creating an addiction with severely impacts the everyday life of many users, mainly youths. If Facebook use seems to be related to the need to belong, affiliate with others and for self-presentation, the beginning of excessive Facebook use and addiction could be associated to reward and gratification mechanisms as well as some personality traits. Studies from several countries indicate different Facebook addiction prevalence rates, mainly due to the use of a wide-range of evaluation instruments and to the lack of a clear and valid definition of this construct. Further investigations are needed to establish if excessive Facebook use can be considered as a specific online addiction disorder or an Internet addiction subtype.

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OBJECTIVE: To identify risk factors for becoming an excessive user over time. SETTING: Prescription database study over five years. SUBJECTS AND METHOD: Norwegians between 30 and 60 years with a first dispensation of a benzodiazepine during 2006, encompassing 23 227 individuals. A Cox hazard regression model was defined, initially stratifying on gender, age, county, previous relevant drug dispensations, household income, education level, and vocational rehabilitation support. MAIN OUTCOME MEASURE: The time from the first redemption until excessive use was defined as using more than two DDDs per day on average within a three-month period. RESULTS: Women's risk was lower than men's for excessive use (HR = 0.42, CI 0.35-0.51). Initial oxazepam, alprazolam, or nitrazepam/flunitrazepam use indicated higher risk compared with diazepam (HR = 1.51, CI 1.24-1.85, HR = 2.75, CI 1.54-4.91, HR = 1.67, CI 1.29-2.16). Previous antidepressants or lithium, antipsychotics or opioids, anti-alcohol and smoke cessation treatment indicated a higher risk compared with no such use (HR = 1.4, CI 1.16-1.69, HR = 1.92, CI 1.54-2.4, and HR = 2.88, CI 2-4.15). Higher education and average or high household income were associated with a low risk compared with low education and income (HR = 0.68, CI 0.57-0.81, HR = 0.58, CI 0.46-0.73, and HR = 0.37, CI 0.26-0.54). Working in the private or public sector was associated with a low risk compared with no registered work (HR = 0.53, CI 0.4-0.71 and HR = 0.57, CI 0.45-0.74). CONCLUSION: The prevalence of excessive use over a five-year observation period was 2.34%. Risk factors were indications of psychiatric illness, first benzodiazepine choice, low income, and education. Excessive users were also characterized by a more severe disease, indicated by having prescription fulfilments by a psychiatrist and by switching benzodiazepines. Key points Guidelines state that benzodiazepines should be used for a short time and excessive use indicates drug dependency. Of all new benzodiazepine users 2.34% became excessive users, defined as consuming above two defined daily doses (DDDs) per day on average over three months, within a five-year period. Previous use of other psychotropic drugs, opioids and anti-alcohol and smoke cessation drugs, first benzodiazepine prescribed, low household income, and low education were risk factors for excessive use. Excessive users were characterized by switching benzodiazepines and having prescription fulfilments by a psychiatrist suggesting a more severe disease.

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