Medicines For Children Research Articles

7P pediatrics — Medicine of Development and Health Programming

The transition to personalized, predictive, preventive and participatory medicine, due, among other things, to the achievements of fundamental science, digitalization and the development of information and communication technologies, naturally demanded changes in childrens health care. New organizational, methodological and technological changes that have taken place to ensure a highly dynamic, adapted, and, at the same time, permanent provision of the medical process anywhere and at any time, have led to the need for specialists of a new formation a pluriexpert team ready to work in new conditions: how to participate in research in fundamental science, and to the introduction of innovative methods in clinical practice, medical and social support and the educational process. In these conditions, the strategic goal set for pediatrics to analyze absolutely all aspects of health: somatic, neuropsychic, emotional and psycho-social, in the process of growth and development of a child from conception/birth to adolescence / adulthood was implemented in a new direction of clinical and fundamental medicine developmental pediatrics and child health programming. 7P-pediatrics: Programming the development and health of the child, Preventive, Predictive, Personalized, Participatory, Polyprofessional (Pluriexpert), Progressive medicine for children, in which the results of scientific work based on fundamental data and ideas of neurosciences about progressive development and modern methodology of educational support of the entire medical process are fully translated into a clinical practice.

Factors affecting disclosure time of sexual abuse in children and adolescents.

The aim of this study is to determine the factors affecting early and delayed disclosure time of child sexual abuse (CSA). Early disclosure of CSA is considered to be crucial for child protection. A total of 125 sexually abused children and adolescents, who had been evaluated by child adolescent psychiatry and forensic medicine specialists, were enrolled in this study. Files of medical and criminal data were analyzed retrospectively and synchronously by child adolescent psychiatrist and forensic medicine specialist authors who had evaluated victims using the standard procedures of Düzce University Faculty of Medicine Child Abuse Assessment Council. Univariate and multivariate logistic regression analyses were conducted to evaluate predictors. Delayed disclosers were found to be younger than early disclosers. Among the delayed disclosers, there were also more victims of intrafamilial CSA, fewer victims of penetration, and fewer voluntary disclosures. Multivariate logistic regression revealed that "younger age" and "intrafamilial CSA" were independent predictors of delayed disclosure of CSA. The results of our study contribute to an understanding of the factors related to delayed disclosure and underline the need for age-appropriate education and prevention programs targeted to increase the awareness of sexual abuse, particularly intrafamilial abuse, and to promote voluntary disclosure in children and adolescents, especially for younger age groups. The education of potential recipients of CSA and further education of professionals is extremely important in order to support children and adolescents' voluntary disclosure of CSA.

WHO includes fluoride preparations on children's medicine list

WHO includes fluoride preparations on children's medicine list

Observation on the Effect of Clinical Nursing Path of Traditional Chinese Medicine in Children with Pneumonia and Cough

Observation on the Effect of Clinical Nursing Path of Traditional Chinese Medicine in Children with Pneumonia and Cough

Access to medicines for children

Abstract Background Access to medicines for children remains a serious public health problem worldwide. The World Health Organization (WHO) has developed a Model List of Essential Medicines for Children (EMLc). However, many essential medicines are still not covered by National EMLc and not available in some countries. The objective of this work was to examine the current situation with access to essential medicines for children in Armenia and identify changes if compare with the situation in 2013. Methods The Armenian EMLc (AEMLc) of 2013 and 2018, the Lists of medicines authorized in Armenia (for 2013 and the current data), pricelists of main wholesalers and national clinical guidelines for children were analyzed. Results 81.2% of all the active ingredients from WHO EMLc were included in the AEML, 61.5% were authorized and only 56.1% were available on the pharmaceutical market. In 2013, 74.1% of all the active ingredients from WHO EMLc were included in the AEML, 62.0% were authorized and only 56.1% were available on the pharmaceutical market. The results of comparing the new data with those received in 2013 showed that the percentage of essential medicines for children recommended by WHO, which were covered by AEML, has increased; however the percentage of those which are authorized in the country stayed almost unchanged. The percentage of medicines from WHO EMLc (with taking into account pharmaceutical form and dose recommended by WHO), which were included in the current AEML was 57.7%; and authorized in the country - 68.5%. Conclusions Essential medicines for children recommended by WHO, are covered by a medicines supply system for children in Armenia, yet not in full. Political will is important. Development and approval of Armenian EMLc can be considered to be the first step in improving access to medicines for children. Draft of Armenian EMLc is developed and will be submitted to the Ministry of Health together with appropriate recommendations. Key messages Access to essential medicines for children remains a serious problem in Armenia. There is an urgent need in improving the situation, and introducing a National EMLc would be an important strategy aimed to increase supply of essential medicines for children.

The Biobehavioral Family Model: An Evidence-Based Approach to Biopsychosocial Research, Residency Training, and Patient Care.

Engel's biopsychosocial model, based in systems theory, assumes the reciprocal influence of biological, psychological, and social factors on one another and on mental and physical health. However, the model's application to scientific study is limited by its lack of specificity, thus constraining its implementation in training and healthcare environments. The Biobehavioral Family Model (BBFM) is one model that can facilitate specification and integration of biopsychosocial conceptualization and treatment of illness. The model identifies specific pathways by which family relationships (i.e., family emotional climate) impact disease activity, through psychobiological mechanisms (i.e., biobehavioral reactivity). Furthermore, it is capable of identifying positive and negative effects of family process in the same model, and can be applied across cultural contexts. The BBFM has been applied to the study of child health outcomes, including pediatric asthma, and adult health, including for underserved primary care patients, minoritized samples, and persons with chronic pain, for example. The BBFM also serves as a guide for training and clinical practice; two such applications are presented, including the use of the BBFM in family medicine residency and child and adolescent psychiatry fellowship programs. Specific teaching and clinical approaches derived from the BBFM are described in both contexts, including the use of didactic lecture, patient interview guides, assessment protocol, and family-oriented care. Future directions for the application of the BBFM include incorporating temporal dynamics and developmental trajectories in the model, extending testable theory of family and individual resilience, examining causes of health disparities, and developing family-based prevention and intervention efforts to ameliorate contributing factors to disease. Ultimately, research and successful applications of the BBFM could inform policy to improve the lives of families, and provide additional support for the value of a biopsychosocial approach to medicine.

CBDPS 1.0: A Python GUI Application for Machine Learning Models to Predict Bitter-Tasting Children’s Oral Medicines

Bitter tastes are innately aversive and are thought to help protect animals from consuming poisons. Children are extremely sensitive to drug tastes, and their compliance is especially poor with bitter medicine. Therefore, judging whether a drug is bitter and adopting flavor correction and taste-masking strategies are key to solving the problem of drug compliance in children. Although various machine learning models for bitterness and sweetness prediction have been reported in the literature, no learning model or bitterness database for children's medication has yet been reported. In this study, we trained four different machine learning models to predict bitterness. The goal of this study was to develop and validate a machine learning model called the "Children's Bitter Drug Prediction System" (CBDPS) based on Tkinter, which predicts the bitterness of a medicine based on its chemical structure. Users can enter the Simplified Molecular-Input Line-Entry System (SMILES) formula for a single compound or multiple compounds, and CBDPS will predict the bitterness of children's medicines made from those XGBoost-Molecular ACCess System (XgBoost-MACCS) model yielded an accuracy of 88% under cross-validation.

Clinical characteristics and successful treatment outcomes of children and adolescents with Kaposi sarcoma in Southwestern Tanzania

The HIV/AIDS epidemic has driven the rise in cases of Kaposi sarcoma (KS) among children and adolescents living with HIV in countries with high Human gammaherpesvirus 8 (HHV-8) seroprevalence, such as Tanzania, where specialized oncology programs are sparse. Consequently, descriptions of successful treatment of KS in children and adolescents by general pediatricians are important. A retrospective analysis was performed of children and adolescents diagnosed with KS and treated with chemotherapy and combination antiretroviral therapy (cART) at the Baylor College of Medicine Children’s Foundation Tanzania Center of Excellence – Mbeya between 2011 and 2017. Sixty-one patients were diagnosed with KS with a median age of 12.6 years (interquartile range (IQR) 9.4 − 15.5). Diagnosis was confirmed by histopathology in 36% (22/61). Among HIV positive patients (59/61), 78% (46/59) were on cART at KS diagnosis. Severe immunosuppression was present in 63% (35/56) of those with CD4 data and 44% (27/61) had SAM. Advanced-stage T1 disease was present in 64% (39/61), including 28% (17/61) with visceral/disseminated KS. Two-year estimated overall survival (OS) was 72% (95% Confidence Interval (CI): 58%–82%) and median follow up for survivors was 25.7 months (IQR 14.2–53.8). No patients were lost to follow up. Two-year OS was 63% (95% CI: 44%–77%) in patients with severe immune suppression and 60% (95% CI: 37%–76%) in patients with SAM. Among patients with visceral/disseminated KS, 53% (9/17) survived. This retrospective analysis demonstrated favorable outcomes in a complex cohort of children and adolescents with KS treated with chemotherapy by general pediatricians in Tanzania.

Successful Use of Multidisciplinary Palliative Care in the Outpatient Treatment of Disseminated Histoplasmosis in an HIV Positive Child

Histoplasmosis is an uncommon opportunistic infection in human immunodeficiency virus (HIV) positive children. The most common form is primary disseminated histoplasmosis, characterized by persistent fever and failure to thrive. A 10-year-old HIV positive girl presented to the Baylor College of Medicine Children’s Foundation—Tanzania Mbeya Center of Excellence (COE) with ulcerated skin lesions and a violaceous facial rash. She also had persistent fevers, severe acute malnutrition, and severe anemia. At diagnosis, the patient was failing first line antiretroviral therapy (ART) with a cluster of differentiation 4 immune cells (CD4) of 24 cells/µL and an HIV viral load (VL) of 196,658 cp/mL. The patient was changed to a second line ART regimen (abacavir, lamivudine, and ritonavir-boosted lopinavir) and received nutritional support, blood transfusions, multiple antibiotics, and meticulous wound care. She also received comprehensive symptom management, psychosocial support, and emergency housing through the COE’s palliative care program. Biopsy of a lesion showed intracytoplasmic organisms consistent with Histoplasmosis capsulatum var capsulatum. The patient was treated with conventional amphotericin B and oral itraconazole and she achieved wound healing as well as immune reconstitution and HIV viral suppression. Amphotericin infusions were given as an outpatient despite the resource constraints of the setting in southwestern Tanzania. Histoplasmosis should be considered in the differential diagnosis of the immunocompromised host with unusual skin manifestations and persistent fever.

Pediatric Emergency Department Challenges and Response to COVID-19.

Severe acute respiratory syndrome coronavirus 2, the virus causing the pandemic illness coronavirus disease 2019, was first detected in the United States in January 2020. As the illness spread across the country, all aspects and venues of health care were significantly impacted. This article explores the challenges and response of one children's emergency medicine division related to surge planning, personal protective equipment, screening, testing, staffing, and other operational challenges, and describes the impact and implications thus far. [Pediatr Ann. 2021;50(4):e172-e177.].

The conect4children (c4c) Consortium: Potential for Improving European Clinical Research into Medicines for Children.

The need for information about new and existing drugs used in children was recognized in the European Union (EU) with the implementation of the Paediatric Regulation in 2007. In 2017, the 10-year review of the Paediatric Regulation identified barriers to the conduct of clinical trials, including delays in setting up and completing paediatric trials. Across Europe, the difficulties with clinical research are compounded by variation within countries and between countries. Ethics and regulatory review have national specificities. This paper describes the Collaborative Network for European Clinical Trials for Children (conect4children, c4c), which addresses selected difficulties in the design and conduct of paediatric clinical trials. c4c is a time-limited public–private consortium funded by the Innovative Medicines Initiative (IMI2). The elements of c4c are as follows: expert advice providing input on study design and/or paediatric development programmes (including patient involvement activities); a network of sites following harmonised procedures coordinated by National Hubs and a single point of contact for Europe; a facility for education and training for sites and trial teams; and support for managing data used by the network and a common paediatric data dictionary. c4c does not sponsor trials. c4c is taking a phased approach with careful piloting through industry and non-industry studies intended to demonstrate the viability of the network (proof-of-viability studies). c4c uses a co-design approach involving industry and academics within a clearly defined scope. A sustainable, successor organization open to all potential service users will be open for business before the end of IMI2 funding in 2024.

Legal Aspects of Child Protection

Legal Aspects of Child Protection Several legal codes (e. g. family, social and criminal law) are of importance in child protection cases in Germany. The intention of legal codes differs between family law (relations between family members), social law (support for families) and criminal law (penal aspects). Mental health professionals have to know the prevailing legal norms concerning child-welfare. Collaborative work between medicine and youth welfare and child protection services (CPS) requires a weighing of data protection issues and the risk for the child. German child protection law provides a stepped model for health care professionals to inform CPS. This includes a careful weighing of the risk for child abuse and own competences to provide support. Medical personnel should be aware of several further legislative regulations concerning child protection issues.

The Use of Complementary and Alternative Medicine in Children Followed by Asthma Diagnosis and Attitudes of Families

The Use of Complementary and Alternative Medicine in Children Followed by Asthma Diagnosis and Attitudes of Families

Psychiatric Follow-up of Adolescents with Gender Dysphoria: Marmara University Faculty of Medicine Child Psychiatry Clinic Experience

Psychiatric Follow-up of Adolescents with Gender Dysphoria: Marmara University Faculty of Medicine Child Psychiatry Clinic Experience

Mothers’ Attitudes toward the Use of Complementary and Alternative Medicine in Children with Cancer

Background: Children who have cancer suffer from a wide range of symptoms and side-effects of disease and treatment, and such conditions have harmful effects on the quality of life of a child and family. So, the families of such children turn to complementary and alternative medicine treatments for children with cancer. Objectives: Therefore, this study aimed at determining the mothers’ attitudes toward the use of complementary and alternative medicine in children with cancer. Methods: This cross-sectional research was conducted from January 2018 to January 2019 in the oncology section of Yazd Shahid Sadooghi Hospital in a nonrandom and convenience sampling method on 150 mothers of children with cancer. The instruments of data collection include demographic information questionnaires and a 6-part questionnaire to evaluate mothers’ performance. To investigate the face and content validity of the questionnaire, the opinions of 10 experts were considered, and to investigate the reliability of the questionnaire, the test-retest method was used, and the intraclass correlation coefficient (ICC) was reportedly 0.80. After completing the questionnaires, the collected data were analyzed, using SPSS 23 by utilizing descriptive statistics, including mean, standard deviation (SD), frequency, and percent. Results: Overall, 83.34% of mothers mentioned praying as a way of complementary and alternative medicine, 67.34% used complementary and alternative medicine to increase child recovery chance, 74% reported general child recovery, 20% reported the occurrence of side-effects following the use of complementary and alternative medicine, 67.33% introduced their friends as their information source, 33.6% avoided informing the physician regarding the use of complementary and alternative medicine, and 76% maintained that due to the objection of physicians, they avoided informing him/her. Conclusions: The use of complementary and alternative medicine is common among mothers but due to the occurrence of side-effects, using invalid information sources and hiding it from a physician, the oncologists must provide a suitable opportunity for asking and answering to guide mothers for correct performance in the use of complementary and alternative medicine.

P66 Standardising strengths of unlicensed medicines in a large London hospital trust

BackgroundA UK national position statement on standardised strengths of unlicensed liquid medicines recommend that when children require unlicensed liquid medications, they should receive the recommended strength. By standardising strengths of these medicines, the risk of errors being made in the doses given to children will be reduced and prevent accidental under and overdoses.1 Our Trust has 4 hospital sites since merging in 2012, we found the process of switching to a standard strength far from simple.MethodsThe strengths of unlicensed liquid medicines listed in the position statement available on the pharmacy dispensing system (JAC) were identified, along with the speciality users. Pharmacy and clinical leads were consulted for agreement to switching to the standardised strengths. Pharmacy procurement identified new products in standardised strengths and products were reviewed for suitability by paediatric pharmacist. A cost impact analysis was carried out. Communication was sent to stakeholders including, doctors, nurses, pharmacy and primary care.Results and DiscussionWe found the standardised strengths of azathioprine, clonazepam, ethambutol, isoniazid, melatonin, omeprazole, phenobarbitone and pyrazinamide strengths were on formulary. Clopidogrel, hydrocortisone, sertraline and tacrolimus liquids are not used. Different strengths of the listed unlicensed liquid medicines were used by different sites and specialties. Lead speciality pharmacists agreed with the standardisation. We identified use of unlicensed products where licensed products are available (sildenafil 20 mg/5 mL and furosemide 5 mg/5 mL). We added the use of these items to our review. We were not able to agree on a single standard strength for some items; the neonatal intensive care unit (NICU) have babies under 500 g who may require furosemide, spironolactone and sildenafil in doses that measure less than 0.1 mL using the recommended strengths. This volume is deemed less than satisfactory to be measured safely1. It has been agreed with the neonatal lead pharmacist that additional strengths of the sildenafil (unlicensed 20 mg/5 mL), spironolactone (unlicensed 10 mg/5 mL) and furosemide (20 mg/5 mL) be available for inpatient NICU use only. The potential for patients to be discharged on the non-standard strength is reduced by specifying ‘Not for discharge - inpatient use only’ on the pharmacy system as well as having them only as NICU stock from medicines distribution. Patients admitted on other strengths will be switched (with consent); to minimise risk pharmacists will ensure carers are aware of the change & correct dose volume to administer and endorse TTAs noting the change in concentration for the GP. Primary care have been engaged with the switch and invited the consultant pharmacist to discuss this at the interface meeting. We were not able to source the recommended midazolam 10 mg/5 mL. The switch to chloral hydrate to 1 g/5 mL was calculated to have a significant cost pressure therefore it was agreed that that we would not change from chloral hydrate 500 mg/5 mL at this time as it is mainly used in the in-patient setting within our Trust. Based on current usage there is an estimated cost saving of over £5 k based on the switch of sodium chloride, sildenafil, furosemide and spironolactone. The impact will be reviewed in 6 months.ConclusionA successful switch requires a team approach but will benefit patient safety and save money.ReferenceThe Neonatal and Paediatric Pharmacists Group (NPPG) and Royal College of Paediatric and Child Health (RCPCH). Position statement 18–01 Using Standardised Strengths of Unlicensed Liquid Medicines in Children. Version 2. May 2019.

História da saúde no Brasil

História da saúde no Brasil

Abstract A03: Prevalence and spectrum of germline mutations in children with high-risk cancer

Abstract Introduction: Zero Childhood Cancer’s National Precision Medicine for Children with Cancer Study (PRISM) utilizes novel technologies to guide individualized management of children with high-risk cancer (expected overall survival less than 30%). Germline DNA is utilized to distinguish cancer-specific somatic variants from constitutional variants or polymorphisms, allowing identification of clinically relevant germline mutations. The prevalence of cancer predisposition syndromes in pediatric cancer may range from 8.5% to as high as 33%. Method PRISM combines molecular genomic analysis (WGS and RNASeq) with in vitro high-throughput drug screening and patient-derived xenograft drug efficacy testing. A Molecular Tumour Board (MTB) of Oncology and Genetics professionals convenes to determine the significance of genomic analysis as curated by bioinformaticians, molecular scientists, and clinicians. Results: Between September 2017 and June 2019, 218 children aged under 21 years have been recruited in PRISM (37% with central nervous system tumors, 47% with non-CNS solid tumors, and 16% with hematologic malignancies), and results are available for 208 after discussion at MTB meeting. Forty-two reportable germline variants were detected in 35 participants (detection rate: 16.8%), comprising 28 pathogenic and 14 likely pathogenic variants, across 22 cancer predisposition genes. The most frequently affected gene was CHEK2 (n=7), followed by SMARCB1 (n=5) and BRCA2 (n=3) and NF1 (3). In one out of three participants with germline mutations, somatic analysis revealed a double hit in the same gene altered in the germline. Distributions of participants with germline mutation per group were 16% of patients with CNS tumors (12/77), 19% of patients with non-CNS solid tumors (18/96), and 15% of patients with hematologic malignancies (5/34). Conclusion: Germline mutation detection rate in cancer predisposition genes was higher than expected, 16.8%; however, it may result from selection bias (i.e., cohort of high-risk cancers). Although genomic sequencing has expanded our understanding of pediatric cancer predisposition and presented opportunities for genetics-mediated care, identifying underlying germline mutations with potential clinical implications remains a clinical challenge for pediatric oncologists. Citation Format: Paulette Barahona, Alexandra Sherstyuk, Mark Cowley, Paul Ekert, Judy Kirk, Dong-Anh Khuong-Quang, Amit Kumar, Loretta Lau, Chelsea Mayoh, Glenn Marshall, Emily Moud, Tracey O’Brien, Mark Pinese, David Thomas, Vanessa Tyrell, David Ziegler, Michelle Haber, Katherine Tucker, Noemi Auxiliadora Fuentes-Bolanos, Meera Warby. Prevalence and spectrum of germline mutations in children with high-risk cancer [abstract]. In: Proceedings of the AACR Special Conference on the Advances in Pediatric Cancer Research; 2019 Sep 17-20; Montreal, QC, Canada. Philadelphia (PA): AACR; Cancer Res 2020;80(14 Suppl):Abstract nr A03.

The Evaluation of the Use of Traditional and Complementary Medicine in Children and the Level of Knowledge of Families in Bağcılar Region of Istanbul

The Evaluation of the Use of Traditional and Complementary Medicine in Children and the Level of Knowledge of Families in Bağcılar Region of Istanbul

Use of Complementary and Alternative Medicine in Children With Tourette Syndrome.

Tourette syndrome is a neuropsychiatric condition defined by motor and phonic tics with onset in childhood. Many families have concerns regarding potential side effects of pharmacologic treatments, and often have difficulty accessing comprehensive behavioral intervention for tics. Patients and caregivers may turn to complementary and alternative medicine (CAM) as they perceive these as "natural" and therefore "safe." Although there are anecdotal reports of an increased use of CAM in Tourette syndrome patients, the exact prevalence is unknown. The purpose of this study was to identify commonly used CAM therapies for children with Tourette syndrome at Penn State Hershey Medical Center. A questionnaire was administered to the caregivers of children (<18 years old) via telephone. The data pertaining to demographics, type of CAM use, duration of use, adverse effects, and caregiver's perception of the effectiveness were collected. A total of 110 patients participated in this survey. When inquired about the different CAM methods, 69.1% of the participants reported using 1 or more CAM therapies, and 58% of those who used CAM informed the doctor about their use. Ninety-three percent of those who used CAM therapy reported a decrease in tic frequency. The most commonly used CAM therapies were stress management (44.6%), herbal medicine (18.2%), homeopathy (12.7%), and meditation (9.1%). In total, 46% of the participants said that CAM helped more than medication. The majority of patients interviewed were using CAM therapies, and a significant portion reported benefit greater than medication. More than half of all participants discussed CAM therapies with their physicians, and 63% of participants felt that their physicians would support their use of CAM therapies.