scholarly journals WHO essential medicines for children 2011–2019: age-appropriateness of enteral formulations

2021 ◽  
pp. archdischild-2021-321831
Author(s):  
Ebiowei Samuel F Orubu ◽  
Jennifer Duncan ◽  
Catherine Tuleu ◽  
Mark A Turner ◽  
Anthony Nunn
Keyword(s):  
Age Groups ◽  
Essential Medicine ◽  
Access To Medicines ◽  
Essential Medicines ◽  
Older Children ◽  
Efficacy Evaluation ◽  
7Th Edition ◽  
Age Related ◽  
Age Appropriate ◽  
Medicines For Children

IntroductionThe WHO Essential Medicine List for children (EMLc) is used for promoting access to medicines. The age-appropriateness of enteral (oral and rectal) formulations for children depend on their adaptability/flexibility to allow age-related or weight-related doses to be administered/prescribed and the child’s ability to swallow, as appropriate. There is scant information on the age-appropriateness of essential enteral medicines for children.ObjectiveTo evaluate the age-appropriateness of enteral essential medicines.Materials and methodsAge-appropriateness of all enteral formulations indicated and recommended in the EMLc 3rd to 7th (2011–2019) editions were determined by assessing swallowability and/or dose adaptability for children under 12 years, stratified into five age groups.ResultsEnteral formulations in the EMLc were more age-appropriate for older children aged 6–11 years than for younger children. In the 3rd edition, for older children, 77%, n=342, of formulations were age-appropriate. For younger children, age-appropriateness decreased with age group: 34% in those aged 3–5 years, 30% in those aged 1–2 years, 22% among those aged 28 days to 11 months and 15% in those aged 0–27 days. Overall, similar proportions were found for the 7th edition. In contrast, the majority of medicines in the 7th list were age-appropriate in targeted diseases like HIV and tuberculosis.ConclusionMost recommended enteral essential medicines in EMLc 2011 and 2019 were not age-appropriate for children <6 years. Medicines which are not age-appropriate must be manipulated before administration, leading to potential issues of safety and efficacy. Evaluation of the age-appropriateness of formulations for medicines to be included in EMLc could improve access to better medicines for children in the future.

scholarly journals Young Children's Exposure to and Ability to Eat Different Food Textures, as Reported by Parents (P11-119-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Sarah Smith-Simpson ◽  
Lisa Fries ◽  
Carolyn Ross
Keyword(s):  
Online Survey ◽  
Age Groups ◽  
Age Group ◽  
Older Children ◽  
Research Issues ◽  
Funding Sources ◽  
Food Texture ◽  
Age Related ◽  
Group Data ◽  
Age Appropriate

Abstract Objectives The objective was to identify the age at which parents expose their children to different food textures and how challenging the textures were for their child to eat. It was hypothesized that older children would be exposed to a wider variety of food textures and that parents would consider a larger proportion of these textures to be easy to eat. Methods Parents (n = 365) in Grand Rapids, MI, USA with a child aged 6–36 months completed an online survey. The survey had 37 questions, including 15 unique food texture categories with food examples (Table 1). Parents were asked how difficult each texture category was for their child to eat using a 5-point scale ranging from “Very Easy” to “Very Difficult”, plus an option for “My child hasn't tried this yet”. Children were divided into 5 age groups (6-8 months, 9–12 months, 13–18 months, 19–24 months, 25–36 months) for analysis. Across texture category and age group, data were analyzed using analysis of variance, with mean separation accomplished using Fisher's LSD (P < 0.05). Results A majority of children in the youngest age group (6-8 months) had only eaten foods described as creamy, dissolvable, or pureed. All of the texture categories had been served to a majority of 9–12 month-old children, except for “hard” and “tough meat”. By 18 months of age, a majority of children had tried all food texture categories except “hard”. Across all age groups, creamy, dissolvable, and puree were rated as easy and “tough meat” was rated as difficult. The other textures showed age-related differences, with parents of older children reporting the textures as easier to eat than those of younger children. Food textures were compared within the 9–12 and 13–18 month age groups, when most new food textures are introduced, and similar trends were observed. The easiest textures were creamy, dissolvable, puree and soft, followed by lumpy and juicy, then slippery, chewy, rubbery, and sticky. The most difficult textures were leafy, with skin, hard, tough meat and combination of textures. Conclusions When considering textures of the foods that comprise a well-balanced, healthy diet, many foods are difficult for children to eat. Preparing foods such as green vegetables specifically to have age-appropriate textures could improve consumption. Funding Sources Washington State Univ College of Agricultural, Human and Natural Resource Emerging Research Issues Grant.

Transparency and Accountability in Public Procurement of Essential Medicines in Developing Countries

2011 ◽  
Vol 1 (4) ◽  
pp. 15-30
Author(s):  
Anita Kotwani
Keyword(s):  
Developing Countries ◽  
Public Procurement ◽  
Essential Medicine ◽  
Access To Medicines ◽  
Lessons Learned ◽  
Essential Medicines ◽  
Political Commitment ◽  
International Agencies ◽  
High Level ◽  
Procurement System

Pharmaceuticals are an integral component of a health care system; any weakness in governance of the pharmaceutical system negatively impacts health outcomes, especially in developing countries. It is believed that procurement on the concept of essential medicine list and transparency leads to improved efficiency and access to medicines, as has been described for the Delhi model. However, transparency is only the first step; accountability and sustainability are also needed. Information systems create opportunities for transparency and openness through the disclosure of information and improve decision-making and efficiency along the medicine supply chain. With the lessons learned from experiences of many developing countries, technical guidance and tools developed by international agencies, a transparent, accountable, sustainable public procurement system is possible but high-level political commitment is needed to mandate and enforce the system.

scholarly journals Gain-loss framing enhances mnemonic discrimination in preschoolers

2018 ◽  
Author(s):  
Chi Ngo ◽  
Nora Newcombe ◽  
Ingrid R. Olson
Keyword(s):  
Age Groups ◽  
Memory Task ◽  
Older Children ◽  
Fine Grain ◽  
Age Related ◽  
Gain Loss ◽  
Loss Frame ◽  
Gain Frame ◽  
Loss Framing ◽  
Gain Loss Framing

Episodic memory relies on discriminating among similar elements of episodes. Mnemonic discrimination is relatively poor at age 4, and then improves markedly. We investigated whether motivation to encode items with fine grain resolution would change this picture of development, using an engaging computer-administered memory task in which a bird ate items that made the bird healthier (gain frame), sicker (loss frame), or led to no change (control condition). Using gain-loss framing led to enhanced mnemonic discrimination in 4- and 5-year-olds, but did not affect older children or adults. Despite this differential improvement, age-related differences persisted. An additional finding was that loss framing led to greater mnemonic discrimination than gain framing across age groups. Motivation only partially accounts for development in mnemonic discrimination.

Transparency and Accountability in Public Procurement of Essential Medicines in Developing Countries

2012 ◽  
pp. 1437-1452 ◽  
Author(s):  
Anita Kotwani
Keyword(s):  
Developing Countries ◽  
Public Procurement ◽  
Essential Medicine ◽  
Access To Medicines ◽  
Lessons Learned ◽  
Essential Medicines ◽  
Political Commitment ◽  
International Agencies ◽  
High Level ◽  
Procurement System

Pharmaceuticals are an integral component of a health care system; any weakness in governance of the pharmaceutical system negatively impacts health outcomes, especially in developing countries. It is believed that procurement on the concept of essential medicine list and transparency leads to improved efficiency and access to medicines, as has been described for the Delhi model. However, transparency is only the first step; accountability and sustainability are also needed. Information systems create opportunities for transparency and openness through the disclosure of information and improve decision-making and efficiency along the medicine supply chain. With the lessons learned from experiences of many developing countries, technical guidance and tools developed by international agencies, a transparent, accountable, sustainable public procurement system is possible but high-level political commitment is needed to mandate and enforce the system.

Right Idea, Wrong Result—Canada's Access to Medicines Regime

2008 ◽  
Vol 34 (4) ◽  
pp. 567-584 ◽  
Author(s):  
Paige E. Goodwin
Keyword(s):  
Low Income ◽  
Essential Medicine ◽  
Developed Countries ◽  
Access To Medicines ◽  
Production Costs ◽  
Essential Medicines ◽  
World Health ◽  
Low Income Countries ◽  
Brand Name ◽  
Middle Income

In 2007, an estimated 33.2 million people were living with HIV, 2.5 million had become infected, and 2.1 million died from the virus. The majority of infected individuals reside in Africa, where in some countries as many as 33.4% of adults have HIV. In developed countries, effective drug therapies have reduced AIDS-related deaths by over seventy percent each year. These drugs have been so effective that over the last two years the global number of individuals dying from AIDS-related illness has actually declined. These therapies, however, are currently sold for $10,000 USD a year, a purchase price that is not feasible for low income countries where the annual health expenditure may be only $29 per person. A lack of essential medicine is not only a problem for those suffering from AIDS. Low and middle-income countries are disproportionately burdened by many additional chronic and infectious illnesses. The World Health Organization (“WHO”) estimates that one third of the world's population cannot regularly access essential medicines. The WHO cites the high cost of drugs as one of the major hurdles countries face in obtaining access to medication. However, the high cost of these brand-name medications does not reflect their minimal production costs. Drug manufacturers can produce generic versions of these drugs for as little as 1/30th of the cost of their brand-name counterparts.

scholarly journals Age-Related Changes in Neural Networks Supporting Complex Visual and Social Processing in Adolescence

2019 ◽  
Author(s):  
Yulia Lerner ◽  
K. Suzanne Scherf ◽  
Mikhail Katkov ◽  
Uri Hasson ◽  
Marlene Behrmann
Keyword(s):  
Neural Development ◽  
Age Groups ◽  
Critical Question ◽  
Fine Grained ◽  
Age Related ◽  
Brain Responses ◽  
Adolescent Groups ◽  
Age Appropriate ◽  
Almost All ◽  
The Brain

AbstractDespite our differences, there is much about the natural visual world that almost all observers apparently perceive in common. This coherence across observers is evidenced by the finding that, across adults, approximately 30% of the brain is activated in a consistent fashion in response to viewing naturalistic input. The critical question addressed here is how does this consistency emerge and is this pattern of coherence apparent from early in development or does it evolve with time and/or experience? We focused our investigation at a key developmental juncture that might bridge the child and adult patterns, namely, the period of adolescence. We acquired fMRI BOLD data evoked by an 11-minute age-appropriate movie in younger (age 9-14 years) and older adolescents (age 15-19 years) and in adults. Using an intra-subject correlation approach, we characterized the consistency of the neural response within-individual (across two separate runs of the movie), and then, using an inter-subject correlation approach, evaluated the similarity of the response profile within individuals of the same age group and between age-groups. In primary sensory areas (A1+, V1) the response profiles in both groups of adolescents were highly similar to those of the adults, suggesting that these areas are functionally mature at earlier stages of the development. In contrast, some other regions exhibited higher within-age correlations in the adolescent groups than in the adult group. Last, we evaluated the brain responses across the whole cortex and identified the different patterns of maturation as reflected in different inter-subject correlations across the age groups. Together, these findings provide a fine-grained characterization of functional neural development. The approach offers the potential for careful tracking of the development of widespread cortical networks that support the emerging stereotypical responses to naturalistic visual and social stimuli and has important implications for future studies of cortical development.

scholarly journals Serotype patterns of pneumococcal disease in adults are correlated with carriage patterns in older children

2019 ◽  
Author(s):  
Anne L. Wyllie ◽  
Joshua L. Warren ◽  
Gili Regev-Yochay ◽  
Noga Givon-Lavi ◽  
Ron Dagan ◽  
...  
Keyword(s):  
Invasive Pneumococcal Disease ◽  
Pneumococcal Disease ◽  
Age Groups ◽  
Deviance Information Criterion ◽  
Information Criterion ◽  
Older Children ◽  
Disease Patterns ◽  
Pneumococcal Carriage ◽  
Age Related ◽  
Carriage Prevalence

ABSTRACTBackgroundThe importance of specific serotypes causing invasive pneumococcal disease (IPD) differs by age. Data on pneumococcal carriage in different age groups, along with data on serotype-specific invasiveness, could help to explain these age-related patterns and their implications for vaccination.MethodsUsing pneumococcal carriage and disease data from Israel, we evaluated the association between serotype-specific IPD in adults and serotype-specific carriage prevalence among children in different age categories, while adjusting for serotype-specific invasiveness. We used a sliding window approach to estimate carriage prevalence using different age groupings. Deviance Information Criterion was used to determine which age groupings of carriage data best fit the adult IPD data. Serotype-specific disease patterns were further evaluated by stratifying IPD data by comorbidity status.ResultsThe relative frequency of serotypes causing IPD differed between adults and children, and also differed between older and younger adults and between adults with and without comorbidities. Serotypes over-represented as causes of IPD in adults were more commonly carried in older children as compared to younger children. In line with this, the serotype-specific frequency of carriage in older children (aged 36-59 months), rather than infants, best correlated with serotype-specific IPD in adults.ConclusionsThese analyses suggest that older children, rather than infants, are the main drivers of disease patterns in adults. These insights could help in optimizing vaccination strategies to reduce disease burden across all ages.40-word summary of the article’s main pointSerotype-specific rates of invasive pneumococcal disease in adults are better correlated with serotype-specific carriage patterns in older children (36-59 months of age) than those in infants.

Age-Related Response to Lidocaine-Prilocaine (EMLA) Emulsion and Effect of Music Distraction on the Pain of Intravenous Cannulation

PEDIATRICS ◽  
1994 ◽  
Vol 93 (5) ◽  
pp. 797-801 ◽  
Author(s):  
S. E. Arts ◽  
H. H. Abu-Saad ◽  
G. D. Champion ◽  
M. R. Crawford ◽  
K. H. Juniper ◽  
...  
Keyword(s):  
Therapeutic Effect ◽  
Local Anesthetic ◽  
Age Groups ◽  
Self Report ◽  
Age Group ◽  
Older Children ◽  
Double Blind ◽  
Group 4 ◽  
Age Related ◽  
Lidocaine Prilocaine

Objective. To compare the efficacy of a local anesthetic cream and music distraction in reducing or preventing pain from needle puncture (intravenous cannulation) in children. A secondary aim was to examine the influence of age on the pain report and behavior and on the therapeutic outcome. Methodology. Children aged 4 to 16 years (N = 180) who were to undergo surgery under general anesthesia via intravenous cannulation were randomly allocated to one of three interventions. The comparison of lidocaine-prilocaine emulsion (EMLA, Astra) and a placebo emulsion was double-blind. Stratification by age group (4 to 6, 7 to 11, 12 to 16) ensured an equal number of children (20) in each intervention/age group category. A global assessment of the behavioral reaction to the procedure was made by the principal investigator, taking into account vocal, verbal, facial, and motor responses. The child was asked to assess pain severity on the Faces Pain Scale (FPS) and a visual analogue toy (VAT). The scales were applied conservatively as ordinal scales: FPS 0 to 6; VAT 0 to 10. Results. Children who received lidocaine-prilocaine emulsion reported less pain (mean FF5 score = 1.42) compared with placebo emulsion (mean FPS score = 2.58) and with music distraction (mean FPS = 2.62). There was a highly significant therapeutic effect (P &lt; .001) on the self-report and behavioral scores. Younger children, regardless of intervention, reported significantly more pain than the older children (mean FPS scores: 2.85, 2.33, 1.43 for age groups 4 to 6, 7 to 11, and 12 to 16 respectively; P &lt; .001). The superiority of the local anesthetic emulsion was maximal in the youngest age group (4 to 6) almost eliminating pain-related behavior, and multiple regression analysis confirmed significant age and treatment effects and revealed interaction between therapeutic effect and age. Although a trend favoring the active emulsion was evident in the older children (7 to 11, 12 to 16) the differences were not significant. The pain scores were influenced by the type (gauge) of cannula, but this did not affect the conclusion regarding therapeutic and age effects. There was no influence of sex, experience with venipuncture, or whether the child was anxious on arrival in the operating room. Conclusions. The results show that lidocaine-prilocaine emulsion is highly effective in preventing pain from venipunctures in young children the group in most need of prevention.

scholarly journals Feasibility of using touch screen technology for early cognitive assessment in children

2018 ◽  
Vol 103 (9) ◽  
pp. 853-858 ◽  
Author(s):  
Deirdre M Twomey ◽  
Conal Wrigley ◽  
Caroline Ahearne ◽  
Raegan Murphy ◽  
Michelle De Haan ◽  
...  
Keyword(s):  
Working Memory ◽  
Cognitive Assessment ◽  
Assessment Tool ◽  
Age Groups ◽  
Touch Screen ◽  
Task Demands ◽  
Cognitive Capacity ◽  
Task Completion ◽  
Older Children ◽  
Age Related

ObjectiveTo explore the feasibility of using a touch screen assessment tool to measure cognitive capacity in toddlers.Design112 typically developing children with a median age of 31 months (IQR: 26–34) interacted with a touch screen cognitive assessment tool. We examined the sensitivity of the tool to age-related changes in cognition by comparing the number of items completed, speed of task completion and accuracy in two age groups; 24–29 months versus 30–36 months.ResultsChildren aged 30–36 months completed more tasks (median: 18, IQR: 18–18) than those aged 24–29 months (median: 17, IQR: 15–18). Older children also completed two of the three working memory tasks and an object permanence task faster than their younger peers. Children became faster at completing the working memory items with each exposure and registered similar completion times on the hidden object retrieval items, despite task demands being twofold on the second exposure. A novel item required children to integrate what they had learnt on preceding items. The older group was more likely to complete this item and to do so faster than the younger group.ConclusionsChildren as young as 24 months can complete items requiring cognitive engagement on a touch screen device, with no verbal instruction and minimal child–administrator interaction. This paves the way for using touch screen technology for language and administrator independent developmental assessment in toddlers.

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