Drug Use in Outpatient Children: Epidemiological Evaluations

Background: Pharmacoepidemiology can be a useful tool for evaluating the appropriateness of drug prescriptions and for estimating therapeutic needs. In particular, pharmacoepidemiology can be valuable in the paediatric setting, which is characterized by the availability of only limited information on the safety and effectiveness of drug use. Methods: Data collected in regional and multiregional administrative prescription databases were analysed. Prevalence data by sex and age were calculated by dividing the number of drug users by the total number of male and female residents in each age group. The number of packages of medications (boxes) was used as indicator of drug consumption. Univariate and multivariate analyses were performed with the aim to identify the determinants of drug prescriptions. Results: Drug utilization studies reported quantitative and qualitative differences between countries in drug prescription to children and adolescents. In particular, Italian children have a threefold greater chance of receiving an antibiotic or an anti-asthmatic compared with children living in the Netherlands. Large differences also were found within Italy between different geographical settings, with prevalence ranging between 57.3% in northern Italy and 68.3% in southern Italy. Prevalence varied also between the local health units (LHUs) of a single region and between district of a single LHU. In the Lombardy Region prevalence ranged between 38.4% in Milan and 54.8% in Brescia, and the residence of the child was one of the main determinant of drug exposure. Conclusions: The studies described in this thesis suggest that pharmacoepidemiology is a valuable tool for monitoring the appropriateness of drug prescribing. However, the epidemiological evaluation of drug prescriptions in children should be improved with regards to the methodological quality of studies

Using a social communication intervention to improve the social interactions and employment experiences of adolescents with High Functioning Autism Spectrum Disorders

This study evaluated the effectiveness of cognitive-behavioral social communiction intervention on improving the social reciprocity and employment experiences of adolescents with High Functioning Autism Spectrum Disorders (HFASD). Four youth diagnosed with a HFASD participated in this study. A multiple baseline across skills design provided targeted measurement of the intervention, which included conversation supported language techniques, peer model role plays, social behavior mapping, and review and feedback. Conversational data were collected in the analogue and employment settings on the use of: (a) supportive comments, (b) follow-up questions, and (c) bridging comments or questions. The four participants were enrolled in a community-based work experience program as part of the school curriculum. The analogue training occurred in the high school setting once to twice a week, and observational data were collected once a week in the employment setting on conversations between coworkers and participants. The employer also rated the participants weekly on their employability and social skills.. In both settings, some improvements occurred in the use of supportive comments by three of the four participants in both settings. Some impact occurred on follow-up questions for three of the four participants. No significant findings occurred for bridging comments or questions. The researcher developed a threshold that compared the target skill use among non-disabled peers and determined that during intervention the participants demonstrated skill use commensurate with their non-disabled peers. As well, social validity interviews of participants, teachers, and employers supported the usefulness of the intervention. Furthermore, employability ratings indicated that workplace social interactions and social skills necessary for employment settings improved for the participants over the course of the study

Spirometry testing in a population of Italian children: Age and gender differences

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In Vitro Permeation Screening of a New Formulation of Thiocolchicoside Containing Various Enhancers

Thiocolchicoside, a muscle relaxant agent with anti-inflammatory and analgesic actions, also is used topically for the treatment of muscular spasms and for rheumatologic, orthopedic, and traumatologic disorders. In this study, thiocolchicoside was formulated to use as foam to avoid contact with the afflicted area during the spreading phase. To enhance drug penetration, various enhancers were added to the base formulation. The tested enhancers were ethoxyethylendiglycol (Transcutol), highly purified phosphatidylcholine (Lipoid S20), capsaicin, propylene glycol dipelargonate (DPPG), and glycolysed ethoxylated glycerides (Labrafil M1944 CS). The transdermal absorption of the tested formulations containing enhancers, in comparison with base formulation, was evaluated in vitro through rat skin using standard Franz diffusion cells. Base formulation was found to have a higher permeation profile than the simple aqueous and hydroalcoholic solutions of the drug, meaning that the base formulation by itself enhances the drug permeation. Among the tested formulations, only the formulation containing DPPG/ethanol was found to be statistically different, showing an enhancement factor of 3.58. In the same experimental session, Muscoril ointment, the commercially available pharmaceutical product containing the same thiocolchicoside concentration (0.25%), also was tested. The formulation containing DPPG/ethanol showed a 4.86 times increase of permeability constant in comparison with Muscoril ointment. The formulation containing DPPG/ethanol as an enhancer could be a good candidate for a new topical foam, considering its good characteristics of permeability and compliance

Using Prescription Patterns in Primary Care to Derive New Quality Indicators for Childhood Community Antibiotic Prescribing.

BACKGROUND: To describe patterns of antibiotic outpatient use in three European countries, including two new pediatric-specific quality indicators (QIs). METHODS: A cohort study was conducted, 2001-2010, using electronic primary care records of 2,196,312 children up to 14 (Pedianet, Italy) or 18 years (THIN, UK; IPCI, the Netherlands) contributing 12,079,620 person-years. Prevalence rates of antibiotic prescribing per year were calculated and antibiotics accounting (drug utilization) for 90% of all antibiotic prescriptions were identified (DU90% method). The ratio between users of broad to narrow-spectrum penicillins, cephalosporins and macrolides (B/N ratio) and two pediatric-specific quality indicators (QIs): the proportion of amoxicillin users (amoxicillin index, AI) and the ratio between users of amoxicillin to broad-spectrum penicillins, cephalosporins and macrolides (A/B ratio) were determined. RESULTS: The overall annual prevalence of antibiotic prescriptions was 18.0% in the Netherlands, 36.2% in the UK and 52.0% in Italy. Use was maximal in the first years of life. The number of antibiotics accounting for the DU90% was comparable. The B/N ratio varied widely from 0.3 to 74.7. The AI was highest in the Netherlands and the UK (50-60%), lowest in Italy (30%) and worsened over time in the UK and Italy. The A/B ratio in 2010 was 0.3 in Italy, 1.7 in the Netherlands and 5.4 in the UK. CONCLUSIONS: The patterns of antibiotic prescribing varied highly with age and country. The pediatric-specific QIs combined with the total prevalence rate of use provide a clear picture of the trends of community childhood antibiotic prescribing, allowing monitoring of the impact of policy interventions

Anti-asthma medication prescribing to children in the Lombardy Region of Italy: chronic versus new users

<p>Abstract</p> <p>Background</p> <p>Although anti-asthma medications are amongst those most frequently under or over prescribed it is generally accepted that prescriptions for such agents can be used as a proxy for disease prevalence. The aims of this study were to estimate prevalence and incidence of childhood asthma in a representative Italian area by analysing three years of anti-asthmatic prescriptions and hospitalizations of subjects with chronic or first time treatment, and to underline appropriateness of therapeutic choices.</p> <p>Methods</p> <p>The analysis involved prescriptions given to 6-17 year olds between 2003 and 2005 in Italy's Lombardy Region. The youths were classified as potential asthmatics, based on the different degree of drug utilization: occasional, low or high users, and grouped as 'new onset' or 'chronic' cases based on the duration of therapy dispensed. The analysis of prescriptions and hospitalization rate of these groups provided an estimate of the 2005 asthma prevalence and incidence and allowed an estimation of the level of appropriateness of treatments.</p> <p>Results</p> <p>During 2005, the estimated incidence of potential asthmatics was 0.8% and the estimated prevalence was 3.5%. When viewed retrospectively for two years, records showed that 47% of potential asthmatics received prescriptions also during 2004 and 30% also during 2003. During the three years considered, 7.5%, 2.8%, and 1.5% of high, low, and occasional users, respectively, were hospitalized for asthma. The most important inappropriateness found was the prescription of long acting beta adrenergics as first time treatment.</p> <p>Conclusions</p> <p>This study allowed a proxy of asthma incidence, prevalence, and severity. The analyses highlighted a low compliance with the guidelines, suggesting that educational interventions are needed to obtain a more rational management of childhood asthma, especially in subjects starting therapy.</p

Antidepressant and antipsychotic use in an Italian pediatric population

<p>Abstract</p> <p>Background</p> <p>The safety and effectiveness of psychotropic drug use in the paediatric population is widely debated, in particular because of the lack of data concerning long term effects.</p> <p>In Italy the prevalence of psychotropic drug prescriptions increased in the early 2000s and decreased afterwards. In such a context, a study with the aim to estimate the incidence and prevalence of psychotropic drug prescription in the paediatric population and to describe diagnostic and therapeutic approaches was performed.</p> <p>Methods</p> <p>The study population was composed of 76,000 youths less than 18 years and living in the area covered by the local health unit of Verona, Italy. The data source was the Verona local health unit's administrative prescription database. Prevalence and incidence of antidepressant and/or antipsychotic drug prescriptions in the 2004-2008 period were estimated. Children and adolescents receiving antidepressant and/or antipsychotic drug prescriptions between 1 January 2005 and 31 December 2006 were identified and questionnaires were sent to the prescribers with the aim to collect data concerning diagnostic and therapeutic approaches, and care strategies.</p> <p>Results</p> <p>The prevalence of psychotropic drug prescriptions did not change in the 2004-2008 period, while incidence slightly increased (from 7.0 in 2005 to 8.3 per 10,000 in 2008). Between 1 January 2005 and 31 December 2006, 111 youths received at least one psychotropic drug prescription, 91 of whom received antidepressants. Only 28 patients attended child and adolescent psychiatry services. Information concerning diagnostic and therapeutic approaches, and care strategies was collected for 52 patients (47%). Anxiety-depressive syndrome and attention disorders were the diseases for which psychotropic drugs were most commonly prescribed. In all, 75% youths also received psychological support and 20% were prescribed drugs for 2 or more years.</p> <p>Conclusions</p> <p>Despite the low drug prescription prevalence, the finding that most children were not cared for by child and adolescent psychiatric services is of concern and calls for a systematic, continuous monitoring of psychopharmacological treatments.</p

A small satellite design for deep space network testing and training

With the continuing exploration of the Solar System and the reemphasis on Earth focused missions, the need for faster data transmission rates has grown. Ka-band could allow a higher data delivery rate over the current X-band, however the adverse effects of the Earth's atmosphere on Ka are as yet unknown. The Deep Space Network and Jet Propulsion Lab have proposed to launch a small satellite that would simultaneously transmit X and Ka signals to test the viability of switching to Ka-band. The Mockingbird Design Team at the University of Texas at Austin applied small satellite design principles to achieve this objective. The Mockingbird design, named BATSAT, incorporates simple, low-cost systems designed for university production and testing. The BATSAT satellite is a 0.64 m diameter, spherical panel led satellite, mounted with solar cells and omni-directional antennae. The antennae configuration negates the need for active attitude control or spin stabilization. The space-frame truss structure was designed for 11 g launch loads while allowing for easy construction and solar-panel mounting. The communication system transmits at 1 mW by carrying the required Ka and X-band transmitters, as well as an S band transmitter used for DSN training. The power system provides the 8.6 W maximum power requirements via silicon solar arrays and nickel-cadmium batteries. The BATSAT satellite will be lofted into an 1163 km, 70 deg orbit by the Pegasus launch system. This orbit fulfills DSN dish slew rate requirements while keeping the satellite out of the heaviest regions of the Van Allen radiation belts. Each of the three DSN stations capable of receiving Ka-band (Goldstone, Canberra, and Madrid) will have an average of 85 minutes of view-time per day over the satellites ten year design life. Mockingbird Designs hopes that its small satellite design will not only be applicable to this specific mission scenario, but that it could easily be modified for instrument capability for university, government, and/or commercial research

Temporal Patterns of Medications Dispensed to Children and Adolescents in a National Insured Population

This study aimed to comprehensively describe prevalence and temporal dispensing patterns for medications prescribed to children and adolescents in the United States. Participants were 1.6 million children (49% female) under 18 years old enrolled in a nation-wide, employer-provided insurance plan. All medication claims from 1999–2006 were reviewed retrospectively. Drugs were assigned to 16 broad therapeutic categories. Effects of trend over time, seasonality, age and gender on overall and within category prevalence were examined. Results: Mean monthly prevalence for dispensed medications was 23.5% (range 19.4–27.5), with highest rates in winter and lowest in July. The age group with the highest prevalence was one-year-old children. On average each month, 17.1% of all children were dispensed a single drug and 6.4% were dispensed two or more. Over time, prevalence for two or more drugs did not change, but the proportion of children dispensed a single drug decreased (slope -.02%, p = .001). Overall, boys had higher monthly rates than girls (average difference 0.9%, p = .002). However, differences by gender were greatest during middle childhood, especially for respiratory and central nervous system agents. Contraceptives accounted for a large proportion of dispensed medication to older teenage girls. Rates for the drugs with the highest prevalence in this study were moderately correlated (average Pearson r.66) with those from a previously published national survey. Conclusion: On average, nearly one quarter of a population of insured children in the United States was dispensed medication each month. This rate decreased somewhat over time, primarily because proportionally fewer children were dispensed a single medication. The rate for two or more drugs dispensed simultaneously remained steady