Health-care professionals who prescribe medicines have the professional duty to choose medicines that are in the best interest of their individual patient, irrespective if that patient is an adult or ...a child. However, the availability of medicines with an appropriate label for pediatric use is lagging behind those for adults, and even available pediatric drugs are sometimes not suitable to administer to children. Consequently, health-care professionals often have no other option than to prescribe off-label medicines to children. An important reason for use of off-label medicines is to improve access to (innovative) treatments or to address medical needs and preferences of patients, especially when no other options are available. However, off-label use of medicines is in general not supported by the same level of evidence as medicines licensed for pediatric use. This may result in increased uncertainty on efficacy as well as the risk for toxicity and other side effects. In addition, liability may also be of concern, counterbalanced by professional guidelines.
Conclusion:
The purpose of this joint EAP/ESDPPP policy statement is to offer guidance for HCPs on when and how to prescribe off-label medicines to children and to provide recommendations for future European policy.
Respiratory distress syndrome (RDS) frequently necessitates respiratory support. While non-invasive methods are typically the preferred approach, mechanical ventilation becomes necessary for patients ...with insufficient response. Our study aimed to compare two common respiratory support modes, volume-targeted mechanical ventilation and non-invasive ventilation continuous positive airway pressure (CPAP) and high-flow nasal cannula (HFNC), using electrical impedance tomography.
: Infants with very low birth weight and gestational ages of less than 32 weeks were eligible for inclusion in the study. All enrolled infants were beyond the transitional period (>72 h of age). The infants were divided into two groups: infants receiving invasive respiratory support through an endotracheal tube and infants receiving non-invasive respiratory support. We used electrical impedance tomography to assess end-expiratory lung impedance (EELZ), DeltaZ, heterogeneity, and regional ventilation distribution. Patients were evaluated at 0, 30, and 60 min after assuming the supine position to examine potential time-related effects.
: Our study initially enrolled 97 infants, and the final analysis included a cohort of 72 infants. Ventilated infants exhibited significantly larger EELZ compared to their non-invasive counterparts (
= 0.026). DeltaZ was also greater in the invasive respiratory support group (
< 0.001). Heterogeneity was higher in the non-invasive group and did not change significantly over time. The non-invasive group demonstrated significantly greater ventilation in the dependent lung areas compared to intubated patients (
= 0.005). Regional distribution in the left lung was lower than in the right lung in both groups; however, this difference was significantly more pronounced in intubated patients (
< 0.001).
: Our study revealed that volume-targeted mechanical ventilation results in higher EELZ and DeltaZ compared to spontaneously breathing infants receiving non-invasive respiratory support. However, lung heterogeneity was lower during mechanical ventilation. Our study also reaffirmed that spontaneous breathing promotes greater involvement of the dependent lung compared to mechanical ventilation.
The school environment is crucial for the child’s health and well-being. On the other hand, the data about the role of school’s aerosol pollution on the etiology of chronic non-communicable diseases ...remain scarce. This study aims to evaluate the level of indoor aerosol pollution in primary schools and its relation to the incidence of doctor’s diagnosed asthma among younger school-age children. The cross-sectional study was carried out in 11 primary schools of Vilnius during 1 year of education from autumn 2017 to spring 2018. Particle number (PNC) and mass (PMC) concentrations in the size range of 0.3–10 µm were measured using an Optical Particle Sizer (OPS, TSI model 3330). The annual incidence of doctor’s diagnosed asthma in each school was calculated retrospectively from the data of medical records. The total number of 6–11 years old children who participated in the study was 3638. The incidence of asthma per school ranged from 1.8 to 6.0%. Mean indoor air pollution based on measurements in classrooms during the lessons was calculated for each school. Levels of PNC and PMC in schools ranged between 33.0 and 168.0 particles/cm
3
and 1.7–6.8 µg/m
3
, respectively. There was a statistically significant correlation between the incidence of asthma and PNC as well as asthma and PMC in the particle size range of 0.3–1 µm (
r
= 0.66,
p
= 0.028) and (
r
= 0.71,
p
= 0.017) respectively. No significant correlation was found between asthma incidence and indoor air pollution in the particle size range of 0.3–2.5 and 0.3–10 µm.
Conclusion
: We concluded that the number and mass concentrations of indoor air aerosol pollution in primary schools in the particle size range of 0.3–1 µm are primarily associated with the incidence of doctor’s diagnosed asthma among younger school-age children.
What is Known:
• Both indoor and outdoor aerosol pollution is associated with bronchial asthma in children.
What is New:
• The incidence of bronchial asthma among younger school age children is related to indoor air quality in primary schools.
• Aerosol pollutants in the size range of 0.3–1 µm in contrast to larger size range particles can play major role in the etiology of bronchial asthma in children.
The growing public health concern caused by non-communicable diseases in urban surroundings cannot be solved by health care alone; therefore a multidisciplinary approach is mandatory. This study ...aimed to evaluate the airborne aerosol pollution level in primary schools as possible factor influencing origin and course of the diseases in children.
Seasonal aerosol particle number concentration (PNC) and mass concentration (PMC) were studied in the randomly selected eleven primary schools in the Lithuanian capital, Vilnius, as model of a middle-size Eastern European city. Total PNC in the size range from 0.01 to >1.0 μm in diameter was measured using a condensation particle counter. Using an optical particle sizer, PNC was measured and PMC estimated for particles from 0.3 to 10.0 μm. A descriptive statistics was used to estimate the aerosol pollution levels.
During all seasons, local cafeterias in the absence of ventilation were the main sources of the elevated levels of indoor PMC and PNC (up to 97,500 particles/cm). The other sources of airborne particulates were the children's activity during the lesson breaks with PMC up to 586 μg/m. Soft furniture, carpets in the classrooms and corridors were responsible for PMC up to 200 μg/m. Outdoor aerosol pollution (up to 18,170 particles/cm) was higher for schools in city center. Elevated air pollution in classrooms also resulted from intermittent sources, such as construction work during classes (200-1000 μg/m) and petrol-powered lawn trimmers (up to 66,400 particles/cm).
The results of our survey show that even in a relatively low polluted region of Eastern Europe there are big differences in aerosol pollution within middle-sized city. Additional efforts are needed to improve air quality in schools: more frequent wet cleaning, monitoring the operation of ventilation systems, a ban on construction works during school year, on a use of sandblasting mechanisms in the neighborhood of schools.
Aerosol particle number (PNC) and mass concentrations (PMC) were studied in 11 primary schools during the 2017–2018 school years (from September to May) in Vilnius, Lithuania, with the aim to ...evaluate the main aerosol pollution sources and its levels. Expeditious information on the total aerosol particle concentration over the full range of sizes (from 0.01 to > 1 μm) was estimated using a condensation particle counter (CPC). Particle number and mass concentrations in the size range of 0.3–10 μm were measured and estimated using an optical particle sizer (OPS). The use of aerosol particle size spectra (OPS) in school lodgements facilitated the identification of the main sources of indoor air pollution. The main sources responsible for the elevated levels of indoor PN and PM aerosol concentrations were determined: local canteens in the absence of ventilation (particle concentrations up to 97,500 part/cm
3
(CPC)), the school-grader activity during the lesson breaks (275–586 μg/m
3
), soft furniture and carpets in the classrooms and corridors (~ 200 μg/m
3
), and in some cases (city center) elevated outdoor aerosol pollution levels (16800–18,170 part/cm
3
). Elevated aerosol pollution levels were also due to the occasional sources: construction works during lessons (200–1000 μg/m
3
), scraping the exterior walls of buildings near schools (up to 1600 μg/m
3
), and the use of petrol-powered trimmers during cutting of green plantings (22500–66,400 part/cm
3
(CPC)).
Studies and initiatives such as the “Choosing wisely” (CW) campaign emphasise evidence-based investigations and treatment to avoid overdiagnosis and overtreatment. The perception of the extent of ...medical overactivity among professionals and drivers behind are not well studied in the paediatric field.
Aim
We aimed to investigate the physicians‘ opinion and clarify the main drivers regarding medical overactivity in member countries of the European Academy of Paediatrics (EAP).
Methods
In this study, paediatricians, paediatric residents, primary care paediatricians, and family doctors treating children were surveyed in Norway, Lithuania, Ukraine, Italy, and Switzerland. Over-investigation was defined as “diagnostic work-up or referral that is unlikely to provide information which is relevant for a patient” and overtreatment was defined as “treatment that does not benefit or can harm more than benefit the patient.” The original questionnaire was developed in 2018 by a working group from the Norwegian Paediatric Association.
Results
Overall, 1,416 medical doctors participated in the survey, ranging from 144 in Lithuania to 337 in Switzerland. 83% stated that they experienced over-investigation/overtreatment, and 81% perceived this as a problem. The majority (83%) perceived expectations from family and patients as the most important driver for overtreatment in their country. Other drivers for overuse were use of national guidelines/recommendations, worry for reactions, and reduction of uncertainty.
Conclusion
This is the first study investigating knowledge and attitude toward medical overactivity in European countries. Despite different cultural and economic environments, the patterns and drivers of increased investigations and medicalisation are similar.
It has been reported that the disease-initiated and disease-mediated effects of aerosol pollutants can be related to concentration, site of deposition, duration of exposure, as well as the specific ...chemical composition of pollutants.
To investigate the microelemental composition of dust aggregates in primary schools of Vilnius and determine trace elements related to acute upper respiratory infections among 6-to 11-year-old children.
Microelemental analysis of aerosol pollution was performed using dust samples collected in the classrooms of 11 primary schools in Vilnius from 2016 to 2020. Sites included areas of its natural accumulation behind the radiator heaters and from the surface of high cupboards. The concentrations of heavy metals (Pb, W, Sb, Sn, Zr, Zn, Cu, Ni, Mn, Cr, V, and As) in dust samples were analyzed using a SPECTRO XEPOS spectrometer. The annual incidence rates of respiratory diseases in children of each school were calculated based on data from medical records.
The mean annual incidence of physician-diagnosed acute upper respiratory infections (J00-J06 according to ICD-10A) among younger school-age children was between 25.1 and 71.3% per school. A significant correlation was found between vanadium concentration and the number of episodes of acute upper respiratory infections during each study year from 2016 to 2020. The lowest was r = 0.67 (
= 0.024), and the highest was r = 0.82 (
= 0.002). The concentration of vanadium in the samples of dust aggregates varied from 12.7 to 52.1 parts per million (ppm). No significant correlations between the other trace elements and the incidence of upper respiratory infections were found, which could be caused by a small number of study schools and relatively low concentrations of other heavy metals found in the samples of indoor dust aggregates.
A significant and replicable correlation was found between the concentration of vanadium in the samples of natural dust aggregates collected in primary schools and the incidence of acute upper respiratory infections in children. Monitoring the concentration of heavy metals in the indoor environment can be an important instrument for the prevention and control of respiratory morbidity in children.
Two weeks have passed since the beginning of the invasion of Ukraine. Despite 141 countries voting in the UN General Assembly for the Russian army to stop fighting and withdraw from another sovereign ...country, Ukraine, the fighting is increasingly bloody and brutal. The war has led to 2.5 million people including about 1 million children fleeing from their homes and becoming refugees. There are 79 children confirmed killed including 18 months old infant in Mariupol. Most of child fatalities result from attacks from the air or with rockets. We stand together with Ukrainian children, families and the heroic medical and nursing staff calling for the action now: • we ask the governments of our countries to do more to ensure the safety of children in Ukraine, to stop the war and first of all to stop rockets and bombs attacks on civil infrastructure of Ukraine; • we ask Russian paediatricians and especially leaders of paediatric organizations in Russia to express clear and loud position against the war in Ukraine and to do everything in their power to stop the war; • we confirm once again solidarity and professionalsupport for children’s doctors and nurses in Ukraine. Our voices are stronger than rockets and bombs! Slava Ukraine!
There is still lack of knowledge of drug allergy in children. Proper knowledge and management of drug hypersensitivity reactions is important to physicians.
To evaluate the approach of primary care ...doctors regarding drug allergy in children.
A total of 195 primary care doctors were questioned in various parts of Lithuania from 2015 to 2016. An original questionnaire was used. The incidence of a suspected drug allergy, culprit drugs, the clinical pattern and management of the suspected drug hypersensitivity were analysed.
The majority of primary care doctors (74.4%) reported a suspected drug allergy. The main suspected drugs were antibiotics (95.2%) and nonsteroidal anti-inflammatory drugs (32.4%). Skin symptoms (skin rash (100%) and itching (82.1%)) were the main symptoms of the suspected drug allergy. The vast majority of doctors (93.8%) withdrew the use of a suspected drug and 68.3% of respondents prescribed an alternative drug. The fact that skin tests, blood tests and provocation tests could be used in a drug allergy workup were indicated by 43.6% of doctors. Most doctors (69.2%) knew about the opportunity to test children for drug allergy in Lithuania and 41.4% of doctors referred patients for the further drug allergy workup.
The majority of primary care doctors reported a suspected drug allergy in children. The most common suspected drugs were antibiotics and skin symptoms were the main symptoms. Most doctors knew about the possibility to test for the drug allergy but only less than half of them referred patients for the drug allergy workup.
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