Pediatric Medication Noninitiation in Spain

OBJECTIVES To estimate medication noninitiation prevalence in the pediatric population and identify the explanatory factors underlying this behavior. METHODS Observational study of patients (<18 years old) receiving at least 1 new prescription (28 pharmaceutical subgroups; July 2017 to June 2018) in Catalonia, Spain. A prescription was considered new when there was no prescription for the same pharmaceutical subgroup in the previous 6 months. Noninitiation occurred when a prescription was not filled within 1 month or 6 months (sensitivity analysis). Prevalence was estimated as the proportion of total prescriptions not initiated. To identify explanatory factors, a multivariable multilevel logistic regression model was used, and adjusted odds ratios were reported. RESULTS Overall, 1 539 003 new prescriptions were issued to 715 895 children. The overall prevalence of 1-month noninitiation was 9.0% (ranging from 2.6% [oral antibiotics] to 21.5% [proton pump inhibitors]), and the prevalence of 6-month noninitiation was 8.5%. Noninitiation was higher in the youngest and oldest population groups, in children from families with a 0% copayment rate (vulnerable populations) and those with conditions from external causes. Out-of-pocket costs of drugs increased the odds of noninitiation. The odds of noninitiation were lower when the prescription was issued by a pediatrician (compared with a primary or secondary care clinician). CONCLUSIONS The prevalence of noninitiation of medical treatments in pediatrics is high and varies according to patients’ ages and medical groups. Results suggest that there are inequities in access to pharmacologic treatments in this population that must be taken into account by health care planners and providers.

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The Role of Obesity in Motor Vehicle Injuries and Fatalities in the Pediatric Population: A Systematic Review

Journal of Intensive Care Medicine ◽

10.1177/0885066621992738 ◽

2021 ◽

pp. 088506662199273

Author(s):

Zana Alattar ◽

Shelby Hoebee ◽

Eyal Ron ◽

Paul Kang ◽

Eric vanSonnenberg

Keyword(s):

Systematic Review ◽

Risk Factor ◽

Motor Vehicle ◽

Pediatric Population ◽

Extremity Injury ◽

Obese Children ◽

Patients Âgés ◽

Vehicle Accidents ◽

Increased Risk ◽

Extremity Injuries

Purpose: A systematic review done to evaluate obesity as a risk factor for injuries and mortality in motor vehicle accidents (MVAs) in the pediatric population, as there has not been a systematic review done in over 10 years. This study aims to update the literature regarding obesity as a risk factor for injuries in MVAs in the pediatric population. Materials and Methods: A systematic review was conducted according to the PRISMA guidelines with strict inclusion and exclusion criteria, resulting in the use of 3 total articles to analyze obesity as a risk factor for overall injury and mortality in the pediatric population. Results: Zaveri et al demonstrated a statistically significant, but weak, decrease in the odds of extremity injury in overweight patients ages 2 to 17 years old (odds ratio [OR] = 0.6, 95% confidence interval [CI] = 0.4-1.0, P ≤ 0.05). On the other hand, Pollack et al and Haricharan et al found an increase in extremity injury in the obese population, in ages 9 to 15 years (OR = 2.54, 95% CI = 1.15-5.59, P ≤ 0.05), and 10 to 17 years (Age 10-13: OR = 6.06, 95% CI = 2.23-16.44, P ≤ 0.05, Age 14-17 OR = 1.44, 95% CI = 1.04-2.00, P ≤ 0.05), respectively. Haricharan et al also found an increase in thoracic injuries in obese children, ages 2 to 13 and increased risk of head/face/neck injury in obese children ages 2 to 5 (OR = 3.67, 95% CI = 1.03-13.08, P ≤ 0.05), but a decreased risk of head injury in obese children ages 14 to 17 (OR = 0.33, 95% CI = 0.18-0.60, P ≤ 0.05). Conclusions: There are sparse data that are conflicting, regarding the effect of obesity on extremity injuries in the pediatric population. Obesity is not protective against thoracic, head, or abdominal injuries. However, it was found to be a risk factor for trunk injuries in ages 2 to 13, as well as head/face/neck injuries for ages 2 to 5. Since the literature is so sparse, further research is warranted in these areas.

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Robotic adrenalectomy in the pediatric population: initial experience case series from a tertiary center

BMC Urology ◽

10.1186/s12894-020-00727-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Anirban P. Mitra ◽

Evalynn Vasquez ◽

Paul Kokorowski ◽

Andy Y. Chang

Keyword(s):

Hospital Stay ◽

Pediatric Patients ◽

Pediatric Population ◽

Operating Time ◽

Case Series ◽

Length Of Hospital Stay ◽

Open Approach ◽

Invasive Approach ◽

Patients Âgés ◽

Tertiary Center

Abstract Background Laparoscopic resection is the most well described minimally-invasive approach for adrenalectomy. While it allows for improved cosmesis, faster recovery and decreased length of hospital stay compared with the open approach, instrument articulation limitations can hamper surgical dexterity in pediatric patients. Use of robotic assistance can greatly enhance operative field visualization and instrument control, and is in the early stages of adoption in academic centers for pediatric populations. Case presentation We present a single-institution series of pediatric adrenalectomy cases. The da Vinci Xi surgical system was used to perform adrenalectomies on three consecutive patients (ages, 2–13 years) at our center. Final pathology revealed ganglioneuroblastoma (n = 2) and pheochromocytoma (n = 1). Median operating time was 244 min (range, 244–265 min); median blood loss was estimated at 100 ml (range, 15–175 ml). Specimens were delivered intact and all margins were negative. Median post-operative hospital stay was 2 days (range, 1–6 days). All patients remain disease-free at median follow-up of 19 months (range, 12–30 months). Conclusion Our experience continues to evolve, and suggests that robotic surgery is safe, feasible and oncologically effective for resection of adrenal masses in well-selected pediatric patients.

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Practice guideline update summary: Pharmacologic treatment for pediatric migraine prevention

Neurology ◽

10.1212/wnl.0000000000008105 ◽

2019 ◽

Vol 93 (11) ◽

pp. 500-509 ◽

Cited By ~ 17

Author(s):

Maryam Oskoui ◽

Tamara Pringsheim ◽

Lori Billinghurst ◽

Sonja Potrebic ◽

Elaine M. Gersz ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Children And Adolescents ◽

Behavioral Therapy ◽

Pediatric Population ◽

Cognitive Behavioral ◽

Headache Frequency ◽

Pharmacologic Treatment ◽

Migraine Prevention ◽

Pediatric Migraine ◽

Pharmacologic Treatments

ObjectiveTo provide updated evidence-based recommendations for migraine prevention using pharmacologic treatment with or without cognitive behavioral therapy in the pediatric population.MethodsThe authors systematically reviewed literature from January 2003 to August 2017 and developed practice recommendations using the American Academy of Neurology 2011 process, as amended.ResultsFifteen Class I–III studies on migraine prevention in children and adolescents met inclusion criteria. There is insufficient evidence to determine if children and adolescents receiving divalproex, onabotulinumtoxinA, amitriptyline, nimodipine, or flunarizine are more or less likely than those receiving placebo to have a reduction in headache frequency. Children with migraine receiving propranolol are possibly more likely than those receiving placebo to have an at least 50% reduction in headache frequency. Children and adolescents receiving topiramate and cinnarizine are probably more likely than those receiving placebo to have a decrease in headache frequency. Children with migraine receiving amitriptyline plus cognitive behavioral therapy are more likely than those receiving amitriptyline plus headache education to have a reduction in headache frequency.RecommendationsThe majority of randomized controlled trials studying the efficacy of preventive medications for pediatric migraine fail to demonstrate superiority to placebo. Recommendations for the prevention of migraine in children include counseling on lifestyle and behavioral factors that influence headache frequency and assessment and management of comorbid disorders associated with headache persistence. Clinicians should engage in shared decision-making with patients and caregivers regarding the use of preventive treatments for migraine, including discussion of the limitations in the evidence to support pharmacologic treatments.

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Laparoscopic Cholecystectomy for Treatment of Biliary Dyskinesia is Safe and Effective in the Pediatric Population

The American Surgeon ◽

10.1177/000313480807401106 ◽

2008 ◽

Vol 74 (11) ◽

pp. 1069-1072 ◽

Cited By ~ 7

Author(s):

Matthew Hofeldt ◽

Bryan Richmond ◽

Kristy Huffman ◽

Jennings Nestor ◽

Damian Maxwell

Keyword(s):

Laparoscopic Cholecystectomy ◽

Ejection Fraction ◽

Perioperative Complications ◽

Pediatric Population ◽

Biliary Dyskinesia ◽

Quadrant Pain ◽

Gallbladder Ejection Fraction ◽

Patients Âgés ◽

History Of

Experience with laparoscopic cholecystectomy for biliary dyskinesia in children remains limited. The aim of this study was to examine the results of a single institution's experience with laparoscopic cholecystectomy for the treatment biliary dyskinesia in the pediatric population. Medical records were reviewed on all patients younger than age 18 who underwent laparoscopic cholecystectomy at our institution from July 2004 to December 2006. Patients undergoing surgery for biliary dyskinesia, as evidenced by a preoperative gallbladder ejection fraction of 40 per cent or less, comprised the study group. Of the 51 pediatric laparoscopic cholecystectomies, 30 (58.8%) were performed for biliary dyskinesia. The patients’ ages ranged from 7 to 17 (mean, 12.67 years; SD, 2.75). Symptoms consisted of chronic right upper quadrant pain (96.67%), nausea/vomiting (73.33%), back pain (30.0%), weight loss (13.33%), and a history of pancreatitis (6.66%). The amount of time between onset of symptoms and surgery was as follows: 1 to 3 months (34.62%), 4 to 6 months (30.77%), 7 to 12 months (7.69%), and greater than 1 year (26.92%). Gallbladder ejection fraction ranged from 1 to 36 per cent (mean, 14.7%). Seven of the 30 (26.67%) underwent endoscopic evaluation as part of their preoperative workup (six upper endoscopy, one colonoscopy), all of which were noncontributory. Pathology revealed chronic cholecystitis in 26 of 30 (93.3%), no abnormalities in three of 30 (10.0%), and unexpected cholelithiasis in one of 30 (3.33%). No perioperative complications were encountered. Twenty-nine of the 30 patients were available for follow up and all but one reported relief of symptoms (96.55%). This study supports the use of laparoscopic cholecystectomy as a safe and effective treatment for biliary dyskinesia in the pediatric population. The success rate in our study was substantially higher than that reported in previous series. Routine preoperative endoscopy was not used and was reserved for investigation of ambiguous or unrelated complaints.

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Once-Daily Enoxaparin for the Treatment of Pediatric Thromboembolic Disease — A Pilot Study.

Blood ◽

10.1182/blood.v108.11.880.880 ◽

2006 ◽

Vol 108 (11) ◽

pp. 880-880

Author(s):

Sarah O’Brien ◽

Arthur K. Ritchey

Keyword(s):

Ischemic Stroke ◽

Pilot Study ◽

Pediatric Population ◽

Central Venous Line ◽

Arterial Ischemic Stroke ◽

Final Dose ◽

Once Daily ◽

Patients Âgés ◽

Long Term Treatment ◽

Starting Dose

Abstract Background & Aim: The current recommended starting dose of enoxaparin in children is 1 mg/kg/dose administered twice-daily. Studies in adults, however, have demonstrated similar safety and efficacy between once-daily enoxaparin (1.5 mg/kg/dose) and twice-daily (1 mg/kg/dose) in the initial and long-term treatment of venous thromboembolism. Due to known differences in heparin clearance between adults and young children, recommendations for once-daily enoxaparin dosing should not simply be extrapolated from adult literature. Our objective was to perform a pilot study to describe the pharmacodynamics of once-daily enoxaparin in children, and to gather preliminary data regarding safety and feasibility. Methods: 15 patients, ages 3 months to 16 years, with newly diagnosed thromboembolism were enrolled. All began therapy with 1.5 mg/kg enoxaparin administered once-daily. Initial peak anti-Xa levels were drawn 4–6 hours after the second dose of enoxaparin. Dose adjustments were made according to a study nomogram to achieve peak anti-Xa levels between 1–2 U/ml, as recommended by the American College of Pathologists for once-daily enoxaparin dosing. Once therapeutic levels were achieved, a subgroup of 8 patients underwent 24–hour pharmacodynamic (PD) monitoring, with anti-Xa levels drawn at Hours 0, 2, 4, 8, 12, 18, and 24. Results: 14 patients completed the study. 8 of 14 children required a final dose of >2 mg/kg to achieve target peak anti-Xa levels (Table). Only one participant (age 15 years) achieved target levels with the original dose. In PD studies, 7 of 8 children had subtherapeutic anti-Xa levels by Hour 12, and 4 of 8 had unmeasurable levels by Hour 18 (Figure). These results differ from adult studies in which therapeutic levels (0.5–1.0 U/ml) have been measurable 13–18 hours after administration, and prophylactic levels (0.1–0.3 U/ml) have been measurable at 24 hours. There were no new or recurrent thrombotic events. One patient was removed from the study on Day 2 because anticoagulation was permanently discontinued after a post-surgical bleed (anti-Xa 0.23 at time of event). Conclusion: Our pilot data suggests faster clearance of once-daily enoxaparin in the pediatric population as compared to adults. The appropriate starting dose of once-daily enoxaparin in young pediatric patients is likely higher than 1.5 mg/kg. Dose adjustments needed to achieve target peak anti-Xa activity (1–2 IU/ml) Patient Age Weight (kg) Indication for enoxaparin Dose changes Final dose (mg/kg) DVT, deep venous thrombosis; CVL, central venous line 1 3 months 6.5 DVT with CVL 4 3.8 2 10 months 10 DVT with CVL 4 4 3 14 months 13 DVT with CVL 2 2.3 4 2 years 14 DVT with CVL 4 2.7 5 3 years 14 DVT 2 2.7 6 8 years 83 DVT with CVL 1 1.7 7 9 years 37 Arterial ischemic stroke 1 1.9 8 13 years 67 DVT with CVL 2 2.1 9 14 years 65 DVT with CVL 2 2.2 10 14 years 68 DVT 1 1.8 11 15 years 60 DVT with CVL 1 1.9 12 15 years 60 Arterial ischemic stroke 1 1.6 13 15 years 77 DVT with CVL 0 1.5 14 16 years 45 DVT 3 2.9 Figure Figure

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Oral Management for Pediatric Lyme Meningitis

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piy072 ◽

2018 ◽

Vol 8 (3) ◽

pp. 272-275

Author(s):

Santiago M C Lopez ◽

Brian T Campfield ◽

Andrew J Nowalk

Keyword(s):

Oral Therapy ◽

Chart Review ◽

Clinical Presentation ◽

Pediatric Population ◽

Case Series ◽

Parenteral Therapy ◽

Oral Antibiotics ◽

Serious Adverse Events ◽

Parenteral Route

Abstract Background Guidelines for pediatric Lyme meningitis recommend treatment with parenteral therapy [1, 2]. Adult studies suggest that Lyme meningitis can be successfully treated with oral therapy. Our objective was to evaluate the clinical response, side effects and outcome of oral therapy for Lyme meningitis in the pediatric population compared with parenteral therapy in an area endemic for Lyme disease. Methods We conducted a case series chart review from January 2012 to May 2017 of pediatrics patient diagnosed and treated for Lyme meningitis. We recorded clinical presentation, laboratory values, antimicrobial therapy and follow up after therapy to compare the efficacy of oral versus parenteral route of therapy. Results We identified 38 patients diagnosed with Lyme meningitis. Thirty-two patients were discharge with exclusively oral therapy with: doxycycline and amoxicillin. We had only 2 patients developed potential adverse effects from oral doxycycline therapy. All patients treated with oral antibiotics had resolution of symptoms on follow up appointments. Conclusions Oral therapy for Lyme meningitis yields no serious adverse events, was well tolerated and showed resolution of symptoms.

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Pediatric Crohn's Disease

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0037-1609022 ◽

2018 ◽

Vol 31 (02) ◽

pp. 080-088 ◽

Cited By ~ 2

Author(s):

Daniel von Allmen

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Older Patients ◽

Pediatric Patients ◽

Clinical Presentation ◽

Surgical Intervention ◽

Clinical Course ◽

Pediatric Population ◽

Medical Treatments ◽

Course Of Disease

AbstractThe incidence of Crohn's disease in the pediatric population is increasing. While pediatric patients with Crohn's disease exhibit many of the characteristics of older patients, there are important differences in the clinical presentation and course of disease that can impact the clinical decisions made during treatment. The majority of children are diagnosed in the early teen years, but subgroups of very early onset and infantile Crohn's present much earlier and have a unique clinical course. Treatment paradigms follow the traditional laddered approach, but growth and development represent special considerations that must be given to pediatric-specific complications of the treatment and disease. Surgical intervention is an important component of Crohn's management and is often employed to allow improved nutritional intake or decrease reliance on medical treatments that compromise growth.

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Recognition of Crohn Disease on Incidental Gastric Biopsy in Childhood

Pediatric and Developmental Pathology ◽

10.1007/s10024-002-0601-0 ◽

2003 ◽

Vol 6 (3) ◽

pp. 209-214 ◽

Cited By ~ 18

Author(s):

Judy Mae Pascasio ◽

Susan Hammond ◽

Stephen J. Qualman

Keyword(s):

Crohn Disease ◽

Pediatric Population ◽

Gastric Biopsy ◽

Patients Âgés ◽

Negative Stain ◽

Gastric Biopsies ◽

Hematoxylin And Eosin ◽

H Pylori ◽

Granulomatous Diseases

The role of gastric biopsy in the diagnosis of Crohn disease (CD) in the pediatric population has not been well described. We assessed the use of gastric biopsies in the diagnosis of CD using specific histopathologic parameters: granulomata, focal gland injury with neutrophils (glandulitis or glandular abscesses), and/or focal concomitant eosinophilic infiltrates. Multiple (438) consecutive pediatric biopsies with inflammation spanning a 5-year period were identified from archival material in patients ages 2 months to 16 years. A total of 56 CD cases were confirmed using colon biopsies and clinical and radiologic data as the gold standards of diagnosis. Review of hematoxylin and eosin (H&E) slides and Diff-Quik stained slides (negative for Helicobacter pylori) isolated 53 cases which suggested CD on gastric biopsy: 20 cases with granulomata, 14 cases with focal glandulitis and glandular abscesses, and 19 cases of focal glandulitis/glandular abscesses with eosinophilic infiltrates. Seventy-seven percent (43/56) were correctly identified as patients with CD. Twenty-three percent (13/56) of CD cases were not identified primarily because of concurrent H. pylori infection identified on Diff-Quik stain with a superimposed nonspecific diffuse gastritis. The use of Diff-Quik stain to identify H. pylori cases after all other factors are considered was significant ( P = 0.0145); a negative stain, combined with the identified histopathologic features indicative of CD, significantly increased the accuracy of CD diagnosis. CD was mimicked by other gastric granulomatous diseases (actinomyces, 1 case; chronic granulomatous disease of childhood, 1 case). Gastric biopsy can be used to identify or support the diagnosis of CD in children in the appropriate clinicopathologic setting.

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Investigation of Food and Relative Risk Probability of Having Five Different Diseases, Including Diabetes Using Collected Food Data Over A 6.5-Year Period Based on GHMethod: Math-Physical Medicine (No. 492)

Journal of Clinical & Experimental Immunology ◽

10.33140/jcei.06.06.02 ◽

2021 ◽

Vol 6 (6) ◽

Keyword(s):

Food Quality ◽

Kidney Diseases ◽

Physical Object ◽

Food Category ◽

Medical Treatments ◽

Average Value ◽

Food Quantity ◽

External Causes ◽

Original Strength ◽

External Forces

The author is a professionally trained mathematician, physicist and engineer. His view of health and medicine is similar to his past experience on designing a physical object, such as a building structure or a working machine, which he calls an “object”. The object’s strength or its expected lifespan is similar to the health conditions and longevity of a human being based on the following three key factors: (1) The original strength of the object’s material which is similar to the genetic factors of a human body. (2) The engineering design and site construction of this object are similar to the fundamental influential causes, including lifestyle details, life-long habits, and environmental factors, on the human health. Among those external causes, if the author has to pick up one category which has the most influence above of all that is the “food”. (3) The object endures different operational problems due to external forces or impacts which are similar to various diseases suffered by humans. After the object experiences external forces or impacts, we use some structural reinforcements to fix the building’s damaged cracks or replace the malfunctioned part of the machine. These engineering actions are similar to the “medical treatments” doctors provide patients. The medical treatments, including medication interventions (oral drugs or biochemical injections), necessary surgeries, or certain organ transplants are similar to the engineering repair of the damaged object. This article emphasizes the relationship between causes and results such as symptoms of diseases. It particularly addresses the inter-relationship of 5 selected diseases: cancers, cardiovascular diseases (CVD), chronic kidney diseases (CKD), diabetic retinopathy (DR), and type 2 diabetes (T2D), where the most important cause for most diseases is “food”. This food category in his study contains 25 defined elements include input data of food are collected via the developed iPhone APP. There are 5 elements for “Food Quantity”: breakfast amount, lunch amount, dinner amount, amount of between-meals snacks and fruits, and the average daily food consumption amount. In addition, there are 20 selected elements for “Food Quality” (see Figure 1). The combined Food score is the average value of both food quantity score and food quality score.

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Malignant orbital tumors in children: A series of 4 cases

International Journal of Medicine and Surgery ◽

10.15342/ijms.v1i2.6 ◽

2014 ◽

Vol 1 (2) ◽

pp. 44-48

Author(s):

Fadoua Alami ◽

Imane Imdary ◽

Abdellah El Hassan ◽

Moulay Cherif Chefchaouini ◽

Amina Berraho

Keyword(s):

Clinical Symptoms ◽

Malignant Tumors ◽

Pediatric Population ◽

Diagnostic Tools ◽

Orbital Tumors ◽

Adequate Treatment ◽

Patients Âgés ◽

The Common ◽

Orbital Imaging ◽

Remarkable Progress

Introduction: Malignant tumors in children are rare but serious conditions as they can impair function and survival. Tumors in pediatric patients can originate from the orbit. Rarely, the tumor spreads to the adjacent areas and occasionally it may metastasize. Objectives: The objective of this study is to present the common symptoms and the clinical and radiological characteristics of most common malignant orbital tumors in children. Materials and methods: Through the discussion of 4 clinical cases of children presenting with exophthalmos due to a tumor, the authors highlight that clinical symptoms are usually less specific, and that imaging has an important role in diagnosis, determining location, and local and regional expansion of the tumor in order to find the adequate therapy. Results: Our patients' ages ranged from 2 to 5 years. The revealing sign in each case was a unilateral exophthalmos due to a tumor, which could only be reduced minimally or not at all. Its evolution has been rapidly progressive. Orbital imaging and histologic study, if biopsy was possible, allowed guiding the positive diagnosis of the malignant nature and its local and regional spreading, as well as the adequate treatment. Conclusion: Orbital tumors are rare in the pediatric population. However, due to recent remarkable progress obtained through both complimentary diagnostic tools and treatments, these malignancies deserve the attention of both the ophthalmologists and the pediatricians.

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