Anti-asthmatic drugs dosage forms in children: a cross-sectional study

Objective: To describe the choice of drugs as well as the dosage forms of anti-asthmatic drugs in children with regard to different age groups.Methods: Cross-sectional study based on computerized pharmacy dispensing records of 1999 for children aged 0–16 years in the north of the Netherlands. All children were selected and divided in the following age groups: 0–1, 2–5, 6–11 and 12–16-year-olds.Results: Inhaled beta2-agonists and inhaled corticosteroids were the most widely used anti-asthmatic drugs in all age groups (respectively 59 and 58 users per 100 anti-asthmatic using 0–16 year-olds). Cromones were rarely used. Up to four years of age the use of treatment with aerosol inhalers increased simultaneously with a decrease of oral dosage forms. The use of dry powder inhalers started at the age of approximately 4 years old and increased to about 85% of the users at the age of 11, with the strongest increase around the age of 6 and 7.Conclusion: The choice of drugs and dosage forms corresponds with what might be expected based on guidelines for the treatment of asthma in children, except for the high use of deptropine in the youngest age group. Anti-asthmatic drugs for preventive treatment are used so frequently without beta2-agonists that questions about possible overtreatment need to be raised.     

Treatment modalities among US children diagnosed with attention-deficit hyperactivity disorder: 1995-99

The objective of this study was to determine the prevalence of single and combination treatment modalities among US children aged 5-18 years who were diagnosed with attention-deficit hyperactivity disorder (ADHD). Treatments included: (i) stimulant pharmacotherapy alone; (ii) psychotherapy and/or mental health counselling alone; (ii) a combination; or (iv) no treatment. Data from the US National Ambulatory Medical Care Survey (NAMCS) for the years 1995-99, were used for this analysis. Office-based physician-patient visits documenting a recorded diagnosis of ADHD (ICD-9-CM codes 314.00 or 314.01) were extracted from the NAMCS. Findings are presented for children diagnosed with ADHD with or without comorbid mental illness, for children diagnosed with ADHD without comorbid mental illness, by gender, and by age groups. Over the timeframe 1995-99, an estimated 14 402 090 office-based visits documented a diagnosis of ADHD, with (24%) or without (76%) comorbid mental illness, among children aged 5-18 years. Overall, the most frequent treatment was stimulant medication alone (42.0%). This was followed by the combination treatment of stimulant medication plus psychotherapy and/or mental health counselling (32.1%). Only 10.8% of the children received psychotherapy and/or mental health counselling alone; 15.1% received no treatment beyond the office-based visit. This pattern was consistent for boys and girls; however, a larger proportion of boys (11.7%) were receiving psychotherapy and/or mental health counselling alone than girls (8.2%). More girls (18.7%) were receiving no treatment option compared to boys (13.9%). The percentage of children receiving psychotherapy and/or mental health counselling alone increased with each age group (6.7%, 5-8 years; 11.3%, 9-12 years; 13.6%, 13-18 years), as did the combination treatment of stimulant medication plus psychotherapy and/or mental health counselling (28.2%, 31%, 37.3%, respectively). Only 8.2% of children age 13-18 years were receiving no treatment option compared to 16.9% of children age 9-12 years, and 19.5% of those aged 5-8 years. The reasons for the gender and age group differences discerned in this study require further investigation, as does the reason why 15.1% of children were receiving no treatment beyond the office-based visit.     

Distal forearm fractures in New Zealand children: annual rates in a geographically defined area

AIMS: To estimate the annual incidence of distal forearm fractures in New Zealand children and to describe circumstances associated with this fracture. METHODS: The ages and dates of fracture of all girls and boys aged three to fifteen years with distal forearm fractures treated at Fracture Clinic, Dunedin Public Hospital in one calendar year were recorded. RESULTS: The age-standardised annual incidence rates for Dunedin girls and boys aged three to fifteen years were 10.4 per 1000 (95% CI 8.3-12.4 per 1000), and 10.4 per 1000 (95% CI 8.3-12.6 per 1000), respectively. The peak incidence in girls was observed at ten years of age (23.5 fractures per 1000) and for boys at thirteen years of age (25.3 fractures per 1000). Extrapolation of these rates to all New Zealand suggest that in children aged three to fifteen years, 3659 (95% CI 2906-4413) distal forearm fractures occur per year in girls, and 3845 (95% CI 3087-4603) per year in boys, representing about 20 fractures per day. Many of the fractures for the girls and boys resulted from apparently slight trauma (62.2% and 61.6%, respectively). CONCLUSIONS: Distal forearm fractures are very common events in New Zealand children and adolescents, and are usually caused by apparently slight trauma.     

Cost considerations of therapeutic options for children with asthma

Asthma is a prevalent health condition in children, with economic implications for the individual and their family, as well as for societies with nationalized healthcare. Pharmaceutical cost is the main driver of healthcare expenditure in asthma. Existent explicit guidelines are meant to guide asthma management across all age groups, but they are failing. Pharmacologic management of asthma consists of a stepwise treatment approach to achieve symptom control. Various studies suggest a significant number of medical practitioners are prescribing inhaled corticosteroids (ICS) and ICS/long-acting beta agonist (LABA) combination inhalers inappropriately, including prescribing high doses of ICS without specialist consultation. ICS/LABA combination inhalers should only be used in persistent asthmatics, which account for approximately 5% of all children with asthma. Despite this, there is an increase in prescribing rates of ICS/LABA combination inhalers in the context of a decrease in the prevalence of asthma. Furthermore, there is inappropriate prescribing of ICS/LABA combination inhalers in children under 5 years of age, and initiation of relatively more expensive ICS/LABA combination inhalers in patients who have not previously been prescribed ICS. There is evidence to suggest that cost is a significant barrier to asthma management, especially for the more expensive ICS/LABA combination inhalers. Hence, prescribing cost-effective asthma medications appropriately is one of the most important strategies in reducing the morbidity and mortality associated with asthma. It is incumbent on every medical practitioner to not prescribe expensive medications if not indicated, both for the sake of the patient and for society.     

Medications prescribed to asthmatic children: an historical cohort study comparing clinical practice with NIH recommendations

Purpose — NIH guidelines recommend maintenance treatment of persistent moderate or severe childhood asthma with preventive anti‐inflammatory medication (inhaled corticosteroids, cromolyn or nedocromil). The objective was to determine if the NIH guidelines for the treatment of childhood asthma were implemented by examining the prevalence of prescribing preventive medication. Methods — This was a non‐concurrent cohort study of 311 children (aged 2 to 19 years) who were treated for asthma between January and December 1994 by nine Medicaid managed care plans in the northeastern USA. Results — Preventive medications were prescribed at least once to 61.1% of the children with moderate or severe asthma and to 27.1% of the children with mild asthma. Logistic regression analyses indicated prescribing preventive medication was associated with moderate or severe asthma (aOR 5.34, 95% CI 3.22 – 8.83) and age 5 to 19 years (aOR 2.11, 95% CI 1.19 – 3.72). Prescribing preventive medication was also associated with a prior emergency department visit (aOR 2.27, 95% CI 1.24 – 4.16), after adjusting for age. Conclusions — Prescribing preventive medications is related to sentinel clinical events and the NIH recommendations are not routinely implemented for all children with moderate or severe asthma during this study period. Copyright © 2000 John Wiley & Sons, Ltd.     

全国儿童期单纯性肥胖流行病学调查济南市区报告

目的了解济南市区儿童期单纯性肥胖症流行病学特点。方法采取随机整群抽样方法,调查0～17岁儿童6758名,儿童肥胖判定标准按WHO的身高标准体重值,标准差记分法,体重高于中位数一个标准差为超重,两个标准差为肥胖。测量体重、身长/身高,3岁以上肥胖儿童以1∶1比例配对测量腰围、臀围、大腿围及血压;然后进行统计学分析。结果肥胖总检出率11.36%,超重总检出率14.95%,其中男童肥胖、超重检出率分别为14.26%、16.55%,女童肥胖与超重分别为7.96%、13.14%。3岁前男女儿童BMI平均值分别为17.10、16.65,3～6岁略降低,6岁后上升,12岁分别为20.52、19.69。肥胖儿童收缩压与舒张压高于第95百分位数比例分别为8.58%、11.15%,明显高于正常体重儿童的比例1.72%、4.46%。结论济南市区儿童单纯性肥胖检出率增加,随年龄增长快速上升趋势,肥胖者已具有心血管损害指标,预防控制重点应在学龄前期。     

Patterns of excess alcohol consumption among school children in two English comprehensive schools

BackgroundThe patterns of excess alcohol consumption among children aged 11–15 years are not routinely assessed in England and neither are the alcohol consumption patterns of adolescents aged 16–18 years. The aim of the present research was to examine patterns of excess alcohol consumption among English school children aged 11–18 years.Methods1230 children and adolescents, aged 11–18 years were surveyed about their alcohol consumption, and specifically their hazardous drinking, binge drinking and problem drinking.ResultsSixteen per cent of 11 year olds and 71% of 18 year olds reported having drunk any alcohol in the previous seven days. Thirty-two per cent (n = 199) of girls and 24% (n = 142) of boys gave an affirmative answer to at least one of the CAGE questions, indicating possible problem drinking. Hazardous drinking was associated with norms and age; binge drinking and problem drinking were associated with norms, age and gender.ConclusionsThe study provides further evidence to support the case that excessive alcohol consumption among girls now exceeds that of boys. It would be valuable to collect data on patterns of excess alcohol consumption routinely to enable policy makers to target information and resources appropriately.     

Pattern of asthma medication use among children from a large urban center in Brazil

Purpose  

Despite the advances in asthma therapeutics, there are few data on the use and determinants of anti-asthmatic drugs in the general population of children. This study describes the use of asthma medications among children in the general population and in children with current asthma, living in a large urban center in Brazil.     

Alcohol use among Australian secondary students in 1996

This research estimates the prevalence of alcohol use among Australian secondary students in 1996 and examines trends in alcohol prevalence over a 12-year period. A national randomly selected representative sample of 434 secondary schools participatedin the 1996 study.Eighty students were selected randomly fromeach school and completed a questionnaire anonymously. Current drinking (drinking alcohol in the week before the survey) increased with age from 17% of boys and 10% of girls aged 12 to 56% of boys and 50% of girls aged 17. Comparisons with data collected by similar surveys in 1984, 1987, 1990 and 1993 showed that while fewer 12-15-year-olds were current drinkers in 1996 than in 1984 or 1987, the 1996 proportion was no different from the 1993 proportion. In 1996, there were more hazardous drinkers among male current drinkers aged 12-15 than in any other survey period. Among 16- and 17-year-olds, there were more current drinkers in 1996 than in 1993 or 1990, and more male and female current drinkers were drinking at hazardous levels in 1996 than in 1987 and 1990. Extrapolating from the 1996 findings, nearly 424 000 students aged 12-17 years were current drinkers. [White VM, Hill DJ, Letcher TR. Alcohol use among Australian secondary students in 1996. Drug Alcohol Rev 2000;19:371-379]     

Corticosteroid-sparing options in the treatment of childhood asthma

During the last 30 years, a significant rise in wheezing illness has occurred in the child population. Despite its high prevalence there is no clear definition of the disease, which includes a heterogeneous group of syndromes ranging from transient wheezing in infancy to atopic asthma with persistence into adult life. Molecular advances and further epidemiological information from well characterised individuals and their families are likely to clarify the different subtypes of wheezing illness and inform therapeutic options. With the recognition that chronic airway inflammation is a feature of persistent disease, at least in adults, there has been a trend towards the early introduction of anti-inflammatory treatment and particularly inhaled corticosteroids (ICS). However, the natural resolution of much wheezing illness, particularly in young children and in children with viral-induced episodes, suggests that newly presenting children should remain on symptomatic therapy alone while the severity of the disease is being assessed. Although ICS have become a cornerstone of management of chronic persistent disease, their ability to protect against exacerbations in young and mildly affected children is questionable. Alongside concerns about long term use of ICS and possible systemic adverse effects, there remains a need for alternative approaches to the control of the disease in children. Extrapolation of the findings of large multicentre adult studies into childhood, particularly for doubling the doses of ICS and long-acting beta2-agonists, may be unsound. Other approaches include the early introduction of inhaled cromones, use of second generation antihistamines, low dose theophyllines and, more recently, leukotriene modifiers. As the majority of preschool children will become asymptomatic by mid-childhood, there is an urgent need to identify those in whom chronic airway inflammation is developing, as it is in this group that early introduction of ICS may be of maximum benefit. In the remainder, other approaches, including use of corticosteroid-sparing longacting P2-agonists and leukotriene modifying drugs, may be more appropriate. Safe and effective oral preparations such as leukotriene modifying drugs are likely to establish a significant role in the management of symptoms in children of all ages and with all types of asthma and wheezing illness.     

Alcohol use among Australian secondary students in 1993

The prevalence of alcohol consumption among Australian secondary students in 1993 was estimated from a survey of 22 696 students aged between 12 and 17 years. A random, representative sample of schools from all education systems (government, Catholic and independent) was selected and a sample of 80 students from each school was randomly selected from predetermined year levels. Students completed an anonymous, self-administered survey on their drinking behaviours. Results showed that drinking was common, with 46% of female and 50% of male 17-year-olds having drunk on at least one of the 7 days prior to the survey (defined as current drinkers). Among 12-17-year-olds who were current drinkers, 27% of males had five or more alcoholic drinks on at least one drinking ("heavy drinking") while 43% of girls had had three or more drinks ("heavy drinking"). Among current drinkers aged 12-15 years, 10% of boys and 12% of girls had "binged" (for boys drinking eight or more drinks in one session, for girls having six or more drinks at one session) while among current drinkers aged 16 and 17 years the corresponding proportions were 33% of boys and 30% of girls. After controlling for age, sex, school type and state, the proportion of 12-15-year-olds who were current drinkers rose from 24% to 26% between 1990 and 1993. Among 16 and 17-year-olds, the proportion of current drinkers in 1993 (47%) was the same as that found in 1990, although there were more heavy drinkers and binge drinkers in 1993 than in 1990.