Antibiotics represent the most widely prescribed therapeutic agents. The prevalence of drug prescription differs across age, with preschool children being most exposed to antibiotic drugs, especially ...in the community setting. A review with the aim to compare the profile of antibiotic drug prescription at the multinational, national and regional levels was performed. This overview of drug-utilisation studies found quantitative and qualitative differences in the antibiotic prescription profile between and within countries. Moreover, differences exist also at the local level and between prescribers. In general, second-choice antibiotic drugs (eg, cephalosporins) were more commonly prescribed in settings characterised by a high prevalence of antibiotic prescription. Geographical differences should be taken into account when monitoring antimicrobial drug resistance and when planning educational interventions for health professionals and parents with the aim to improve the rational use of antibiotic drugs.
Introduction: Attention-deficit hyperactivity disorder (ADHD) is a common neurobehavioral disorder in children and adolescents that comprises core symptoms of developmentally inappropriate levels of ...inattention and/or hyperactivity and impulsivity. Stimulant (methylphenidate, amphetamines) and non stimulant (atomoxetine, clonidine and guanfacine) are the treatment usually prescribed for ADHD.
Area covered: This review covers the safety of ADHD medications in children and adolescents.
MEDLINE, EMBASE and PsycINFO databases were searched with the aim to retrieve prospective studies that monitored the incidence of adverse events (AEs) in children receiving drug therapy for ADHD. Many of the studies investigated the risk of specific AEs. In particular, the cardiovascular safety, the impact on growth and on sleep pattern, the risk of substance use disorders and of suicidal ideation are among the topics more studied.
Expert opinion: Effective drugs for ADHD appears to be safe and well tolerated. Most of the adverse events reported in the randomised controlled trials are mild and transient. Decreased appetite, growth decrease and the impact on sleep (insomnia for stimulants and somnolence for alpha2-agonists) are among the most common events. Concerns exist about cardiovascular and psychiatric AEs, even if the available evidence does not support an association with medications.
Free education has resulted in Cuba having one of the highest number of medical doctors per head of population (84.8 per 10 000).1 Despite having a large number of doctors, Cuba is training over 60 ...000 medical students, with 8–10 000 students anticipating graduating each year.1 This includes the 8000 overseas students training at the Latin American School of Medicine.1 Universal healthcare and an excellent primary healthcare system have ensured that health indices are excellent in Cuba, comparable with high-income countries.2 For example, child mortality is lower in Cuba than in the USA.2 It is also lower than in all other countries in Latin America and the Caribbean.2 The Cuban healthcare system has trained thousands of foreign doctors, offered free services and responded to health crises around the globe, as during the Ebola epidemic or the current COVID-19 pandemic. The disinformation is exposed in the documentary ‘The War on Cuba–Episode 3’.6 The USA has played a major role in disinformation during the COVID-19 pandemic.7 An example of Cuba’s approach to solidarity is illustrated by South Africa, where Cuba has trained doctors for over 20 years and is currently training 700 South Africans each year.8 Other examples of collaboration lasting more than a decade include Timor-Leste and the Pacific Islands (Fiji, Kiribati, Nauru, Solomon Islands, Tonga, Tuvalu and Vanuatu).9 Initially, Cuba covered all the costs of their health professionals working overseas.6 However, as international collaboration increased, it became apparent that some countries could contribute financially. In August, the head of WHO, Dr Margaret Chan, contacted Cuba to see if they could help.13 Cuba already had over 4000 health professionals working in 32 different countries in Africa.13 Cuba responded by launching an appeal to health professionals to volunteer to work in West Africa.14 Over 10 000 volunteered, of whom 465 were selected for training at the Pedro Kouri Institute of Tropical Medicine in Havana.14 They were trained in the management of Ebola. The offer to send 165 health professionals to Sierra Leone was welcomed by the WHO.15 The first brigade arrived in Sierra Leone on 2 October 2014.16 The financial agreement between Cuba and the WHO was that WHO would cover the expenses of the Cubans working in the brigades against Ebola, but that Cuba would not receive any financial payment for their services.14Table 1 Timeline of Cuba’s response to the Ebola outbreak in West Africa 2014 Action Reference 13 August UN calls for global response 13 p45 29 August Letter from president of Sierra Leone requesting help from Cuba 13 p45 9 September Phone call from UN secretary general to several world leaders requesting help (presidents of USA, France, EU, Cuba and prime minister of UK) 13 p37–38 13 September Press conference by Cuba’s health minister and Dr Chan (WHO) announcing decision to send 62 doctors and 103 nurses to Sierra Leone 15 15 September Requests for help from presidents of Liberia and Guinea 13 p48–50 16 September Cuba announces it will send 53 health professionals to Liberia and 38 to Guinea 13 p48–50 2 October Cuban brigade arrives in Sierra Leone 16 EU, European Union; UN, United Nations.
Purpose To evaluate the drug prescription pattern in outpatient children. Methods A systematic literature search was performed in MEDLINE and EMBASE to identify studies published between 1994 and ...2008 evaluating drug prescriptions to outpatient children. Results A total of 128 drug utilisation studies were identified, 107 of which were focused on a specific drug class, in particular psychotropic drugs (49 studies) and antibiotics (32 studies). The 21 studies that evaluated all drug prescriptions involved 21 countries, mainly from Europe (13 studies). Large differences were found between studies concerning data source, sample size and age range. A prevalence ranging from 51% in Denmark to 70% in Greenland and a prescription rate (number of drugs per children) ranging from 0.8 in Norway to 3.2 in the United States were reported in the 11 studies that monitored the overall paediatric population. The prevalence rate was higher in preschoolers, with a peak between 72 and 90%, and decreased in children >6 years. Antibiotics were the most prescribed drugs (20-33% of the prescriptions) followed by antiasthmatics (10-25%). According to the results of four studies comparable in terms of data source and children's age, the overall prevalence estimate was 60%. Conclusion A large heterogeneity was found between studies, making a comparative evaluation often difficult or incomplete. The epidemiological evaluation of drug use in children should therefore be improved, in particular in terms of methodological quality of studies, and prospective multinational collaborative studies aimed at collecting valid and comparable data should be performed to improve the rational use of drugs.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
Many hospitalizations for asthma could potentially be avoided with appropriate management. The aim of this study was to analyze data on disease management of a paediatric population with a ...hospitalization for asthma. The study population comprised 6-17 year old subjects belonging to three local health units of the Lombardy Region, northern Italy. Regional administrative databases were used to collect data on: the number of children with an incident hospitalization for asthma during the 2004-2006 period, anti-asthma therapy, specialist visit referrals, and claims for spirometry, released in the 12 months before and after hospitalization. Each patient's asthma management profile was compared with GINA guideline recommendations. Among the 183 hospitalized subjects, 101 (55%) received therapy before hospitalization and 82 (45%) did not. 10% did not receive any therapy either before or after hospital admission and in 13% the therapy was discontinued afterward. Based on GINA guidelines, asthma management adhered to recommendations only for 55% of subjects. Results may suggest that for half of hospitalized subjects, inaccurate diagnosis, under-treatment/scarce compliance with asthma guidelines by physicians, and/or scarce compliance to therapy by patients/their parents occurred. In all these cases, hospitalization would be a proxy indicator of preventable poor control of disease, rather than a proxy indicator of severity.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Treatment and prophylaxis of sepsis in very low birth weight neonates is a matter of concern and research is being undertaken with the aim to give rise to shared approaches based on solid evidence. ...As part of a European initiative, a survey was set up to describe the use of two drugs in this area. The Italian national practices concerning neonatal sepsis, as well as calls for related guidance, are described.
A standardized and previously tested questionnaire was submitted online to all Italian level III NICUs. A 5-point Likert scale was used to analyze attitudinal replies. Categorical variables were compared by χ2 analysis and 2-tailed P-values are reported.
Data was provided by 38 Italian NICUs (36% of the country's level III centers), 53% of which have 1-10 cases of bacterial sepsis monthly and 90% a prevalence of <1% fungal infections. Ciprofloxacin and fluconazole treatment for neonatal sepsis are scantly used in Italian NICUs (13% and 45%, respectively). Major concerns are related to the safety of ciprofloxacin and the efficacy of fluconazole. On the contrary, prophylaxis of fungal infections is a routine approach in many Italian NICUs. The use of both ciprofloxacin and fluconazole is characterized by a large inter-NICU variability in dose and scheme of use. The lack of adequate, shared evidence is a common consideration made by the survey participants.
Common approaches are needed to standardize and update a national drug strategy for the prevention and treatment of sepsis in very low birth weight newborns. This can be achieved through collaborative initiatives aimed at setting up guidelines, based on available data, and multicenter trials to produce new evidence that will address the knowledge gaps.
Migrate to be equal. Campi, Rita; Bonati, Maurizio
Recenti progressi in medicina
114, Issue:
9
Journal Article
Peer reviewed
Equitable access to healthcare is crucial to ensure the fundamental human right to health for all. However, the possibility to use in appropriate manner medical services (e.g., to access hospital) ...differs substantially across Italian regions. It is a situation, source of inequality, that has been known for some time and has not found a solution to date. In 2020, the pandemic year, 7.6% of hospital admissions occurred for patients residing in regions other than that of hospitalization. The starting regions with the highest mobility rate were Molise, Basilicata, Calabria and Abruzzo with a flight index of 28.1 (Molise)-16.1 (Abruzzo) for a total of 86,787 hospitalizations (16.8% of total national hospitalizations outside the region of residence). 58.7% of hospitalizations are for patients traveling from one of the regions bordering their residence, while 13.9% are for those who have crossed 2 regions and 27.4% at least 3 regions. The main cause of hospitalization is attributable to surgery for the replacement of major joints or reimplantation of the lower limbs with 124,860 discharges for hospitalized residents in their own region (16.1%), 16,996 hospitalized in a neighbouring region (20.4 %) and 8,019 hospitalized in a region far from their own (17.7%). The phenomenon of medical migration undermines the principles of universality, equality and fairness and it is therefore necessary to intervene to guarantee an unfulfilled right in its entirety.
Part 1 of the review “
Back to the Future
” examines the historical evolution of the medico-legal autopsy and microscopy techniques, from Ancient Civilization to the Post-Genomic Era. In the section ...focusing on “
The Past
”, the study of historical sources concerning the origins and development of the medico-legal autopsy, from the Bronze Age until the Middle Ages, shows how, as early as 2000 BC, the performance of autopsies for medico-legal purposes was a known and widespread practice in some ancient civilizations in Egypt, the Far East and later in Europe. In the section focusing on “
The Present
”, the improvement of autopsy techniques by Friedrich Albert Zenker and Rudolf Virchow and the contemporary development of optical microscopy techniques for forensic purposes during the 19th and 20th centuries are reported, emphasizing, the regulation of medico-legal autopsies in diverse nations around the world and the publication of international guidelines or best practices elaborated by International Scientific Societies. Finally, in “The Future” section, innovative robotized and advanced microscopy systems and techniques, including their possible use in the bio-medicolegal field, are reported, which should lead to the improvement and standardization of the autopsy methodology, thereby achieving a more precise identification of natural and traumatic pathologies.
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