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Arias D, So E, Chen TF, Moles RJ. The information seeking behaviors of caregivers in the management of childhood fever - A systematic literature review. Res Social Adm Pharm 2024; 20:559-575. [PMID: 38609816 DOI: 10.1016/j.sapharm.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/05/2023] [Accepted: 02/23/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION Parents' and caregivers' non-evidence-based childhood fever management 'fever phobic' practices have remained relatively stable over more than 34 years despite successful educational interventions. This systematic review aimed to assess the information seeking behavior of caregivers managing fever in their children, as well as to compile the fever management practices undertaken by caregivers by investigating underlying factors influencing them. METHODS The electronic databases Pubmed, CINAHL, Medline, and International Pharmaceutical Abstracts were searched using key terms including, fever, child, caregiver, and management. Studies were included if they were written in English, published between January 1980 and January 2021, explored generalized childhood fever management practices of caregivers, and factors which influence fever management. Data extracted included study year and design, location, dimensions of fever management explored (i.e., knowledge, beliefs, detection, and/or treatment of fever), factors influencing management, and information sources used by caregivers. RESULTS In total, 36 studies were eligible for inclusion in the study. Twenty-nine of the studies were designed as a cross-sectional survey, six studies were interviews and the remainder were pre-post studies. The review of studies found that parents and caregivers sourced childhood fever management information most commonly from friends and family or their own personal experiences, however, participants most commonly sourced doctors/general practitioners as their first line of information when required. Over the years, trends showed that doctors as well as the internet were more frequently being used as a first line source of information by caregivers. CONCLUSIONS Despite decades of research, education and development of evidence-based guidelines caregivers continue to exhibit 'fever phobia' when caring for febrile children. This is demonstrated by their continued use of non-evidence-based methods and increasing reliance on, and incorrect use of antipyretics, alternating antipyretics if fever is not sufficiently reduced or returns. There is an increasing need for the development of easy to access digital resources for caregiver as internet use is rising which mirrors best practice taught to professionals.
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Affiliation(s)
- Daniel Arias
- School of Pharmacy, The University of Sydney, Australia
| | - Esther So
- School of Pharmacy, The University of Sydney, Australia
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Sakr F, Toufaili Z, Akiki Z, Akel M, Malaeb D, Dabbous M, Salameh P. Fever among preschool-aged children: a cross-sectional study assessing Lebanese parents' knowledge, attitudes and practices regarding paediatric fever assessment and management. BMJ Open 2022; 12:e063013. [PMID: 36198469 PMCID: PMC9535157 DOI: 10.1136/bmjopen-2022-063013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study investigated parental knowledge, attitudes and practices towards fever in preschool children to help address gaps in public health and provide information with the aim of supporting clinical reports for parental education. DESIGN A cross-sectional study design was used to explore parental experiences with fever. SETTING Participants were recruited randomly from schools all over Lebanon targeting the preschool divisions. PARTICIPANTS Parents of children aged 5 years or less. INTERVENTIONS An electronic self-administered questionnaire was sent to the parents through the schools' emails and e-learning mobile applications. PRIMARY AND SECONDARY OUTCOMES The primary outcome measure was to assess parental knowledge about the precise definition of fever, correct use of medications and to evaluate the impact of sociodemographic factors on this knowledge. The secondary outcome measures were to assess parental attitudes and practices of fever management, sources of information and reasons to seek primary medical attention. RESULTS A total of 733 parents were included in the study. Only 44% identified fever correctly according to the recognised definition by international guidelines. A significant association between parents' knowledge of antibiotics and years of parenting experience was found (adjusted OR, ORa=4.23, 95% CI 1.41 to 12.68, p=0.01). Other sociodemographic factors that were significantly associated with parents' knowledge of antibiotics were age (ORa=3.42, 95% CI 1.09 to 10.73, p=0.036) and education level (ORa=7.99, 95% CI 3.71 to 17.23, p<0.001). Greater than 75% usually give their children antipyretics without consulting a doctor. Approximately one-quarter of parents (26.3%) consulted different doctors at the same time, of which more than half (58.4%) had received different medical information. CONCLUSIONS This research determines deficiencies in parents' knowledge of fever with some malpractices in its management particularly regarding antipyretic use. It provides insight for healthcare providers to empower parental experiences by offering the necessary information to enhance general outcomes of febrile sickness.
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Affiliation(s)
- Fouad Sakr
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- INSERM U955, Institut Mondor de Recherche Biomédicale, University Paris-Est Créteil, Creteil, France
- École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est Créteil, Créteil, France
| | - Zeinab Toufaili
- Department of Operations, Primary Health Care Corporation, Doha, Qatar
| | - Zeina Akiki
- Faculty of Public Health, Lebanese University, Fanar, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
| | - Marwan Akel
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- International Pharmaceutical Federation, The Hague, Netherlands
| | - Diana Malaeb
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- School of Pharmacy, Gulf Medical University, Ajman, UAE
| | - Mariam Dabbous
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- School of Education, Lebanese International University, Beirut, Lebanon
| | - Pascale Salameh
- Faculty of Public Health, Lebanese University, Fanar, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- School of Medicine, Lebanese American University, Byblos, Lebanon
- University of Nicosia Medical School, Nicosia, Cyprus
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Seth S, Dubey AK, Maheshwari N. Parent-Directed use of Over-the-Counter Medications and Complementary and Alternative Medicine Therapies among Pediatric Patients: A Cross-Sectional Study. J Res Pharm Pract 2022; 11:151-161. [PMID: 37969617 PMCID: PMC10642586 DOI: 10.4103/jrpp.jrpp_15_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/04/2022] [Indexed: 11/17/2023] Open
Abstract
Objective The use of over-the-counter (OTC) drugs and complementary and alternative medicines (CAM) as initial options by parents is common in the pediatric population. Despite the widespread use of parent-directed medication (PDM) among the pediatric population, we have scarce data in the Indian context. This study was done to assess the PDM practices and its determinants in the Indian population. Methods It was a descriptive cross-sectional study assessing a representative sample of 284 parents of pediatric patients visiting the pediatrics department of a tertiary care hospital. Findings Majority (64.08%; 182 out of 284) of the parents agreed to have used some form of PDM in the past 3 months. While higher socioeconomic status and having 2 or more children were associated with higher practice of PDM (P < 0.05), it was similar between educated or uneducated parents, rural or urban backgrounds, and nuclear or joint families (P > 0.05). CAM was the most commonly used option (58.12%; 161 out of 277), followed by OTC conventional allopathic medications (41.88%; 116 out of 277). Homeopathic medicines were the most preferred alternative therapy under the Alternative Medical System Category of National Centre for Complementary and Alternative Medicine. Majority of parents (71.43%; 130 out of 182) were confident that the treatment chosen could not harm the health of their children and they attributed time constraints or availability of prior prescriptions as reasons for such practice. Conclusion PDM is a widespread phenomenon in the Indian pediatric population. The parents as well as the prescribers need to take a more balanced, practical, and judicious approach toward medications given to a child.
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Affiliation(s)
- Shreyasi Seth
- Department of Pharmacology, School of Medical Science and Research, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Ashok Kumar Dubey
- Department of Pharmacology, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India
| | - Nidhi Maheshwari
- Department of Pharmacology, School of Medical Science and Research, Sharda University, Greater Noida, Uttar Pradesh, India
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Bloukh S, Wazaify M, Matheson C. Paracetamol: unconventional uses of a well-known drug. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:527-540. [PMID: 34455434 DOI: 10.1093/ijpp/riab058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/04/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To describe and map what is known about unconventional uses of paracetamol through a scoping review of published literature by adopting adopted a PRISMA systematic approach methodology. KEY FINDINGS Four themes for unconventional uses of paracetamol emerged: (a) use of paracetamol in sleep (a-1) positive effect of paracetamol on sleep (n = 9) or (a-2) neutral or negative effect of paracetamol on sleep (n = 9); (b) use of paracetamol in sport (n = 13); (c) mixing paracetamol with drinks, waterpipe and illicit drugs (n = 5); and (d) miscellaneous uses (n = 4). Forty records were reviewed and charted. Available literature supports concern around the potential of harmful or non-medical use of paracetamol, especially among patients with a history of substance use, parents of young children or athletes. SUMMARY Paracetamol (acetaminophen) is one of the most popular and widely used drugs for the treatment of pain and fever. It is considered remarkably safe if used within instructions. However, there is growing evidence that paracetamol, is sometimes used outside approved indications or abused (i.e. used for non-medical reasons). This review highlights the need for enhanced pharmacovigilance and surveillance of non-medical paracetamol use and raising general public awareness of its potential dangers especially in higher than recommended doses.
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Affiliation(s)
- Sarah Bloukh
- School of Pharmacy, The University of Jordan (UJ), Amman, Jordan
| | - Mayyada Wazaify
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan (UJ), Amman, Jordan
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Daifallah A, Jabr R, Al-Tawil F, Elkourdi M, Salman Z, Koni A, Samara A, Al-Jabi SW, Zyoud SH. An assessment of parents' knowledge and awareness regarding paracetamol use in children: a cross-sectional study from Palestine. BMC Public Health 2021; 21:380. [PMID: 33602192 PMCID: PMC7890973 DOI: 10.1186/s12889-021-10432-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/12/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Paracetamol, also known as acetaminophen, is one of the most common antipyretic and analgesic over-the-counter (OTC) medicines administered to children due to its efficacy, safety, and availability in many pharmaceutical forms, including suppositories, syrup, and drops. Parents frequently administer the wrong dose of paracetamol by mistake for their children, as reported by many previous studies. We aimed in this study to assess parents' knowledge, attitudes, and practice regarding paracetamol dosing and toxicity, as well as their awareness regarding paracetamol-containing products. METHODS This was a cross-sectional study that targeted parents of children seeking healthcare services at primary health care centers in the Nablus area in the West Bank, Palestine. We used questionnaire-based interviews with parents for data collection. RESULTS A total of 300 parents were included in the study. Most of the caregivers surveyed were (87%) females (mothers). About half the parents (50.9%) reported previously using paracetamol as an antipyretic in children under the age of six. A quarter (25.4%) preferred the syrup forms, while 33.8% preferred the suppository dosage form. Medical personnel was the primary source of information for half the caregivers (51.2%). The mean knowledge score about paracetamol was 2.1 (SD = 1.4) out of 6, and the median was 2.0 with an interquartile range of 1.0-3.0. Two hundred seventy-four (95.5%) of the participants scored less than 80% and were considered to have insufficient knowledge. Only 50.9% of parents recognized that paracetamol overdose could result in serious harm. CONCLUSIONS We found a serious lack of knowledge regarding paracetamol dosing, administration, and potential toxicity among Palestinian parents. We recommend raising awareness regarding this problem among healthcare providers and authorities and working on plans that aim to provide caregivers with accurate and adequate information on dosing, formulation, side effects, and other aspects of paracetamol use, as well as developing effective educational plans targeting healthcare providers, as well as the public.
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Affiliation(s)
- Aiman Daifallah
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Ruba Jabr
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Faraj Al-Tawil
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Moutaz Elkourdi
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Ziad Salman
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Amer Koni
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Ahmad Samara
- grid.11942.3f0000 0004 0631 5695Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Samah W. Al-Jabi
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Sa’ed H. Zyoud
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- Clinical Research Center, An-Najah National University Hospital, Nablus, 44839 Palestine
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Utilising a content analysis approach to assess measurement tools used in the management of general feverish illness in children. Res Social Adm Pharm 2020; 16:949-957. [DOI: 10.1016/j.sapharm.2019.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 10/14/2019] [Accepted: 10/14/2019] [Indexed: 11/30/2022]
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Thompson AP, Nesari M, Hartling L, Scott SD. Parents' experiences and information needs related to childhood fever: A systematic review. PATIENT EDUCATION AND COUNSELING 2020; 103:750-763. [PMID: 31668490 DOI: 10.1016/j.pec.2019.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/18/2019] [Accepted: 10/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To synthesize current evidence about experiences and information needs of parents/caregivers managing pediatric fever. METHODS We used systematic review methodology with an a priori protocol. We searched Medline, Embase, PsycINFO, CINAHL and ProQuest Dissertations and Theses Global, from 2000 to May 2018. RESULTS We included thirty-six studies (n = 29 quantitative, n = 7 qualitative; 15,727 participants). Quantitative data contained four themes; 1) caregivers seek information about pediatric fever, 2) low knowledge is coupled with misconceptions and anxiety, 3) fever assessment and management practices vary, 4) demographic factors (e.g., ethnicity, age, socioeconomic status, education) influence information needs and health practices. Qualitative data contained three themes; 1) tension between logic and emotion, 2) responsibility contrasted with sense of vulnerability, 3) seeking support and information to build confidence. CONCLUSION Parents often overestimate the risks associated with pediatric fever and struggle to make decisions during a child's febrile illness - leading to caregiving actions that may not reflect current clinical recommendations. Parents seek knowledge about how to care for a febrile child at home and what indicators should prompt them to seek medical attention. PRACTICE IMPLICATIONS In addition to providing clear, reliable information, interventions that address educational, pragmatic, and emotional domains may be effective in supporting parents.
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Affiliation(s)
- Alison P Thompson
- Faculty of Nursing, 5-187 Edmonton Clinic Health Academy, 11405-87 Avenue, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada.
| | - Maryam Nesari
- Faculty of Nursing - Level 3, Edmonton Clinic Health Academy, 11405-87 Avenue, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada.
| | - Lisa Hartling
- Department of Pediatrics, Division of Pediatric Emergency Medicine, 4-472 Edmonton Clinic Health Academy, 11405-87 Avenue, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada.
| | - Shannon D Scott
- Faculty of Nursing, 5-187 Edmonton Clinic Health Academy, 11405-87 Avenue, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada.
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Haidar MK, Vogt F, Takahashi K, Henaff F, Umphrey L, Morton N, Bawo L, Kerkula J, Ferner R, Porten K, Baud FJ. Suspected paracetamol overdose in Monrovia, Liberia: a matched case-control study. BMC Pediatr 2020; 20:139. [PMID: 32228536 PMCID: PMC7104478 DOI: 10.1186/s12887-020-2008-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 02/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background A cluster of cases of unexplained multi-organ failure was reported in children at Bardnesville Junction Hospital (BJH), Monrovia, Liberia. Prior to admission, children’s caregivers reported antibiotic, antimalarial, paracetamol, and traditional treatment consumption. Since we could not exclude a toxic aetiology, and paracetamol overdose in particular, we implemented prospective syndromic surveillance to better define the clinical characteristics of these children. To investigate risk factors, we performed a case–control study. Methods The investigation was conducted in BJH between July 2015 and January 2016. In-hospital syndromic surveillance identified children with at least two of the following symptoms: respiratory distress with normal pulse oximetry while breathing ambient air; altered consciousness; hypoglycaemia; jaundice; and hepatomegaly. After refining the case definition to better reflect potential risk factors for hepatic dysfunction, we selected cases identified from syndromic surveillance for a matched case–control study. Cases were matched with in-hospital and community-based controls by age, sex, month of illness/admission, severity (in-hospital), and proximity of residence (community). Results Between July and December 2015, 77 case-patients were captured by syndromic surveillance; 68 (88%) were under three years old and 35 (46%) died during hospitalisation. Of these 77, 30 children met our case definition and were matched with 53 hospital and 48 community controls. Paracetamol was the most frequently reported medication taken by the cases and both control groups. The odds of caregivers reporting supra-therapeutic paracetamol consumption prior to admission was higher in cases compared to controls (OR 6.6, 95% CI 2.1–21.3). Plasma paracetamol concentration on day of admission was available for 19 cases and exceeded 10 μg/mL in 10/13 samples collected on day one of admission, and 4/9 (44%) collected on day two. Conclusions In a context with limited diagnostic capacity, this study highlights the possibility of supratherapeutic doses of paracetamol as a factor in multi-organ failure in a cohort of children admitted to BJH. In this setting, a careful history of pre-admission paracetamol consumption may alert clinicians to the possibility of overdose, even when confirmatory laboratory analysis is unavailable. Further studies may help define additional toxicological characteristics in such contexts to improve diagnoses.
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Affiliation(s)
- Mohamad K Haidar
- Epicentre, 8 Rue Saint Sabin, 75011, Paris, France. .,UMR 8257, Université Paris Descartes, Paris, France.
| | - Florian Vogt
- Epicentre, 8 Rue Saint Sabin, 75011, Paris, France
| | | | - Fanny Henaff
- Médecins sans Frontières - Operational Center Paris, Paris, France
| | - Lisa Umphrey
- Médecins sans Frontières - Operational Center Paris, Paris, France
| | - Nikola Morton
- Médecins sans Frontières - Operational Center Paris, Paris, France
| | - Luke Bawo
- Ministry of Health and Social Welfare, Monrovia, Liberia
| | - Joseph Kerkula
- Ministry of Health and Social Welfare, Monrovia, Liberia
| | - Robin Ferner
- Institute of Clinical Sciences, University of Birmingham, Birmingham, England
| | | | - Frederic J Baud
- Médecins sans Frontières - Operational Center Paris, Paris, France.,Assistance Publique - Hôpitaux de Paris, Paris, France.,University Paris Diderot, Paris, France.,EA7323, Evaluation of prenatal and paediatric therapeutics and pharmacology, Université Paris Descartes, Paris, France
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Postnatal Acetaminophen and Potential Risk of Autism Spectrum Disorder among Males. Behav Sci (Basel) 2020; 10:bs10010026. [PMID: 31906400 PMCID: PMC7017213 DOI: 10.3390/bs10010026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/30/2019] [Accepted: 12/30/2019] [Indexed: 12/13/2022] Open
Abstract
Some evidence from the literature suggests that postnatal acetaminophen exposure may be associated with increased risk of autism spectrum disorder (ASD). Using a data set obtained from a previous study that was derived from an Internet-based survey among parents on 1515 children from the US, an adjusted odds ratio (aOR) and gender-specific aORs for doses of postnatal acetaminophen provided before age two were calculated against the outcome of ASD. Separately, parental uncertainty on the number of doses of acetaminophen provided was analyzed. A population attributable fraction (PAF) associated with postnatal acetaminophen exposure before age two for ASD among males was also estimated. Postnatal acetaminophen exposure, measured in doses before age two, was found to be associated with ASD among male children (aOR 1.023, CI 1.005–1.043, p = 0.020*), and parental uncertainty on the number of doses of acetaminophen provided before age two was also found to be associated with ASD. Using this data set, the PAF associated with postnatal acetaminophen was estimated to be about 40% of the risk of ASD among male children in the US. These results suggest the possibility that postnatal acetaminophen may be a significant contributor to the risk of ASD among males in the US.
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de Bont EGPM, Bohnen JMHA, Verhoeven R, Dinant GJ, Cals JWL. Childhood fever: Parental paracetamol administration after consulting out-of-hours general practice. Eur J Gen Pract 2019; 26:21-25. [PMID: 31617769 PMCID: PMC7034021 DOI: 10.1080/13814788.2019.1676415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Current guidelines emphasise prudent use of paracetamol in febrile children without pain. Little evidence is available on paracetamol administration by parents in general and post-GP-consultations. Objectives: To investigate if and how often parents of febrile children administer paracetamol to their child after consulting a GP during out-of-hours care. To explore if condition (painful or not), socio-economic status and age influenced this behaviour. Methods: This was a pre-planned secondary study, attached to an RCT (n = 25,355) that studied the effect of an illness-focused interactive booklet on antibiotic prescriptions in febrile children between three months and 12 years, at 20 GP out-of-hours centres across the Netherlands. Baseline data and ICPC codes were retrieved from the GP out-of-hours centre database. During a telephone survey two weeks after consulting a GP out-of-hours centre, a random sample of parents was asked if and how often they had given their child paracetamol. Results: Parents of 548 children participated. Most parents administrated paracetamol for two weeks after consulting (83.8%). Children received 11 doses on average during follow-up (maximum 72 doses). Paracetamol administration increased with age. Age three to six months received paracetamol in 68% (17/25) of the cases versus 89.6% (121/135) in children aged five to twelve years. Frequency of paracetamol administration was similar for most common infections, regardless of being painful or painless. Conclusion: Most children who consulted out-of-hours general practice for fever and common infections received paracetamol at home during their illness episode, regardless of a painful condition being present. Paracetamol administration increased with age.
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Affiliation(s)
- Eefje G P M de Bont
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Jolijn M H A Bohnen
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Rachèl Verhoeven
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Geert-Jan Dinant
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Jochen W L Cals
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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Wigmore BC, Collins JC, Schneider CR, Arias D, Moles RJ. Ability of Pharmacy Students, Pharmacists and Pharmacy Support Staff to Manage Childhood Fever via Simulation. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2018; 82:6445. [PMID: 30643307 PMCID: PMC6325453 DOI: 10.5688/ajpe6445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 11/16/2017] [Indexed: 06/09/2023]
Abstract
Objective. To ascertain how pharmacy students (novices) and pharmacy staff (experts) respond to a childhood fever scenario. Methods. Data were collected from 65 second year students and 51 fourth (final) year students in an over-the-counter fever scenario during assessment tasks. Data from pharmacy staff were collected via mystery shopping conducted over nine weeks between March and October 2015. All encounters were immediately scored by the trained simulated client, and immediate feedback was provided for pharmacy staff and fourth year students. Questioning scores and proportions of competent participants were collected in all groups. Statistical comparative analyses were made between fourth year students and pharmacy staff. Pharmacy staff scores were also tracked over time. Results. Second year students performed well, achieving a median questioning score of 100%. Conversely, pharmacy staff scored 22%. A large proportion of the fourth year students and pharmacy staff achieved appropriate outcomes (92% and 65%, respectively); however, a smaller proportion of second year students performed well (52%). The pharmacy staff achieved statistical improvements over time for median questioning scores. Conclusion. Protocol compliant questioning appears to decline with experience. However, experienced counselors are more likely to provide appropriate patient advice. Further improvements in outcomes can also occur when staff are provided feedback and coaching. Mystery shopping simulations can be used as a valuable educational tool.
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Affiliation(s)
- Beatrice C. Wigmore
- King’s College, London, United Kingdom
- The University of Sydney, Sydney, Australia
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Kelly M, Sahm LJ, Shiely F, O’Sullivan R, de Bont EG, Mc Gillicuddy A, Herlihy R, Dahly D, McCarthy S. Parental knowledge, attitudes and beliefs on fever: a cross-sectional study in Ireland. BMJ Open 2017; 7:e015684. [PMID: 28694348 PMCID: PMC5541503 DOI: 10.1136/bmjopen-2016-015684] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/03/2017] [Accepted: 04/26/2017] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Fever is a common symptom of mostly benign illness in young children, yet concerning for parents. The aim of this study was to describe parental knowledge, attitudes and beliefs regarding fever in children aged ≤5 years of age. DESIGN A cross-sectional study using a previously validated questionnaire. Results were analysed using descriptive statistics and multivariable logistic regression. SETTING Purposively selected primary schools (n=8) in Cork, Ireland, using a paper-based questionnaire. Data were collected from a cross-sectional internet-based questionnaire with a convenience sample of parents via websites and web pages (n=10) previously identified in an interview study. PARTICIPANTS Parents with at least one child aged ≤5 years were invited to participate in the study. MAIN OUTCOME MEASURES Parental knowledge, attitudes and beliefs when managing fever in children. RESULTS One thousand one hundred and four parents contributed to this research (121 parents from schools and 983 parents through an online questionnaire). Almost two-thirds of parents (63.1%) identified temperatures at which they define fever that were either below or above the recognised definition of temperature (38°C). Nearly two of every three parents (64.6%) alternate between two fever-reducing medications when managing a child's fever. Among parents, years of parenting experience, age, sex, educational status or marital status did not predict being able to correctly identify a fever, neither did they predict if the parent alternated between fever-reducing medications. CONCLUSIONS Parental knowledge of fever and fever management was found to be deficient which concurs with existing literature. Parental experience and other sociodemographic factors were generally not helpful in identifying parents with high or low levels of knowledge. Resources to help parents when managing a febrile illness need to be introduced to help all parents provide effective care.
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Affiliation(s)
- Maria Kelly
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
- HRB Clinical Research Facility, Mercy University Hospital, Cork, Ireland
| | - Laura J Sahm
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Frances Shiely
- HRB Clinical Research Facility, Mercy University Hospital, Cork, Ireland
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Ronan O’Sullivan
- School of Medicine, University College Cork, Cork, Ireland
- National Children’s Research Centre, Dublin, Ireland
| | - Eefje G de Bont
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Aoife Mc Gillicuddy
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Roisin Herlihy
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Darren Dahly
- HRB Clinical Research Facility, Mercy University Hospital, Cork, Ireland
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Suzanne McCarthy
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
- Department of Pharmacy, Cork University Hospital, Cork, Ireland
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Drivers for inappropriate fever management in children: a systematic review. Int J Clin Pharm 2016; 38:761-70. [PMID: 27315082 DOI: 10.1007/s11096-016-0333-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/06/2016] [Indexed: 11/27/2022]
Abstract
Background Fever is one of the most common childhood symptoms and accounts for numerous consultations with healthcare practitioners. It causes much anxiety amongst parents as many struggle with managing a feverish child and find it difficult to assess fever severity. Over- and under-dosing of antipyretics has been reported. Aim of the review The aim of this review was to synthesise qualitative and quantitative evidence on the knowledge, attitudes and beliefs of parents regarding fever and febrile illness in children. Method A systematic search was conducted in ten bibliographic databases from database inception to June 2014. Citation lists of studies and consultation with experts were used as secondary sources to identify further relevant studies. Titles and abstracts were screened for inclusion according to pre-defined inclusion and exclusion criteria. Quantitative studies using a questionnaire were analysed using narrative synthesis. Qualitative studies with a semi-structured interview or focus group methodology were analysed thematically. Results Of the 1565 studies which were screened for inclusion in the review, the final review comprised of 14 studies (three qualitative and 11 quantitative). Three categories emerged from the narrative synthesis of quantitative studies: (i) parental practices; (ii) knowledge; (iii) expectations and information seeking. A further three analytical themes emerged from the qualitative studies: (i) control; (ii) impact on family; (iii) experiences. Conclusion Our review identifies the multifaceted nature of the factors which impact on how parents manage fever and febrile illness in children. A coherent approach to the management of fever and febrile illness needs to be implemented so a consistent message is communicated to parents. Healthcare professionals including pharmacists regularly advise parents on fever management. Information given to parents needs to be timely, consistent and accurate so that inappropriate fever management is reduced or eliminated. This review is a necessary foundation for further research in this area.
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Sharif MR, Haji Rezaei M, Aalinezhad M, Sarami G, Rangraz M. Rectal Diclofenac Versus Rectal Paracetamol: Comparison of Antipyretic Effectiveness in Children. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e27932. [PMID: 26889398 PMCID: PMC4753024 DOI: 10.5812/ircmj.27932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 07/01/2015] [Accepted: 07/28/2015] [Indexed: 01/03/2023]
Abstract
Background Fever is the most common complaint in pediatric medicine and its treatment is
recommended in some situations. Paracetamol is the most common antipyretic drug, which
has serious side effects such as toxicity along with its positive effects. Diclofenac is
one of the strongest non-steroidal anti-inflammatory (NSAID) drugs, which has received
little attention as an antipyretic drug. Objectives This study was designed to compare the antipyretic effectiveness of the rectal form of
Paracetamol and Diclofenac. Patients and Methods This double-blind controlled clinical trial was conducted on 80 children aged six
months to six years old. One group was treated with rectal Paracetamol suppositories at
15 mg/kg dose and the other group received Diclofenac at 1 mg/kg by rectal
administration (n = 40). Rectal temperature was measured before and one hour after the
intervention. Temperature changes in the two groups were compared. Results The average rectal temperature in the Paracetamol group was 39.6 ± 1.13°C,
and 39.82 ± 1.07°C in the Diclofenac group (P = 0.37). The average rectal
temperature, one hour after the intervention, in the Paracetamol and the Diclofenac
group was 38.39 ± 0.89°C and 38.95 ± 1.09°C, respectively (P =
0.02). Average temperature changes were 0.65 ± 0.17°C in the Paracetamol group
and 1.73 ± 0.69°C in the Diclofenac group (P < 0.001). Conclusions In the first one hour, Diclofenac suppository is able to control the fever more
efficient than Paracetamol suppositories.
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Affiliation(s)
- Mohammad Reza Sharif
- Autoimmune Diseases Research Center, Kashan University of
Medical Sciences, Kashan, IR Iran
- Trauma Research Center, Kashan University of Medical
Sciences, Kashan, IR Iran
| | - Mostafa Haji Rezaei
- Trauma Research Center, Kashan University of Medical
Sciences, Kashan, IR Iran
| | - Marzieh Aalinezhad
- Department of Radiology, Isfahan University of Medical
Sciences, Isfahan, IR Iran
- Medical Student Research Center, Isfahan University of
Medical Sciences, Isfahan, IR Iran
| | - Golbahareh Sarami
- Department of Pediatrcis, Kashan University of Medical
Sciences, Kashan, IR Iran
| | - Masoud Rangraz
- Department of Pediatrcis, Kashan University of Medical
Sciences, Kashan, IR Iran
- Corresponding Author: Masoud Rangraz, Department of
Pediatrcis, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3155540021,
Fax: +98-3155540111, E-mail:
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Sahm LJ, Kelly M, McCarthy S, O'Sullivan R, Shiely F, Rømsing J. Knowledge, attitudes and beliefs of parents regarding fever in children: a Danish interview study. Acta Paediatr 2016; 105:69-73. [PMID: 26280909 DOI: 10.1111/apa.13152] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/24/2015] [Accepted: 07/30/2015] [Indexed: 11/27/2022]
Abstract
AIM Fever and febrile illness are some of the most common conditions managed by parents. The aim of this study was to examine the knowledge, attitudes and beliefs of parents around fever in children under five years of age. METHODS Between July and August 2014, a convenience sample of parents was invited to participate in this study in Copenhagen, Denmark. Results were analysed thematically using a constant comparison method. RESULTS Twenty-one parents participated in the study. Five themes emerged from the data: parental concern, help-seeking behaviour, parental knowledge, parent fever management practices and initiatives. Parents used a range of information sources to obtain their knowledge on management of fever; however, due to issues of trust with these sources, reassurance was often sought from healthcare practitioners. There was a desire amongst most parents for initiatives to be introduced which provide general information on how to manage fever in children. CONCLUSION Parents were very concerned when their child was febrile and instigated practices obtained from accessible information sources. This study has identified a need for specific and reliable information initiatives to be introduced as a means of reducing parental concern and ensuring evidence-based strategies for managing a child with fever.
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Affiliation(s)
- Laura J. Sahm
- Pharmaceutical Care Research Group; School of Pharmacy; University College Cork; Cork Ireland
- Department of Pharmacy; Mercy University Hospital; Cork Ireland
| | - Maria Kelly
- Pharmaceutical Care Research Group; School of Pharmacy; University College Cork; Cork Ireland
| | - Suzanne McCarthy
- Pharmaceutical Care Research Group; School of Pharmacy; University College Cork; Cork Ireland
- Department of Pharmacy; Cork University Hospital; Cork Ireland
| | - Ronan O'Sullivan
- School of Medicine; University College Cork; Cork Ireland
- National Children's Research Centre; Dublin Ireland
| | - Frances Shiely
- HRB Clinical Research Facility & Department of Epidemiology and Public Health; University College Cork; Cork Ireland
| | - Janne Rømsing
- Department of Drug Design and Pharmacology; University of Copenhagen; Copenhagen Denmark
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Tolaymat A, Nayak A, Geyer JD, Geyer SK, Carney PR. Diagnosis and management of childhood epilepsy. Curr Probl Pediatr Adolesc Health Care 2015; 45:3-17. [PMID: 25720540 DOI: 10.1016/j.cppeds.2014.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 01/01/2023]
Abstract
Epilepsy is a relatively common neurologic disorder in children that has important implications for development, parents, and society. Making the correct diagnosis starts with an accurate and complete history that consequently leads to a directed diagnostic workup. This article outlines a diagnostic and management approach to pediatric seizures and epilepsy syndromes. Making the correct diagnosis of epilepsy or nonepileptic imitators allows the practitioner to prescribe appropriate therapy. Initial management for typical epileptic syndromes and seizures and potential adverse effects are discussed. Alternative treatment options for pharmacologically resistant patients such as ketogenic diet, vagal nerve stimulation, and surgery are also discussed. While most children favorably respond to antiepileptic medications, early identification of medication failure is important to ensure optimal neurodevelopment.
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Affiliation(s)
- Abdullah Tolaymat
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL; Department of Neurology, University of Florida College of Medicine, Gainesville, FL
| | - Anuranjita Nayak
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL; Department of Neurology, University of Florida College of Medicine, Gainesville, FL
| | - James D Geyer
- Alabama Sleep Medicine, University of Alabama, Tuscaloosa, AL; Alabama Neurology and Sleep Medicine, Tuscaloosa, AL
| | - Sydney K Geyer
- Alabama Sleep Medicine, University of Alabama, Tuscaloosa, AL; Alabama Neurology and Sleep Medicine, Tuscaloosa, AL
| | - Paul R Carney
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL; Department of Neurology, University of Florida College of Medicine, Gainesville, FL
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Jensen JF, Gottschau M, Siersma VD, Graungaard AH, Holstein BE, Knudsen LE. Association of maternal self-medication and over-the-counter analgesics for children. Pediatrics 2014; 133:e291-8. [PMID: 24394687 DOI: 10.1542/peds.2013-1107] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Self-medication with over-the-counter (OTC) analgesics, such as paracetamol (PCM), among children and adolescents is increasing and constitutes an important public health issue internationally. Reasons for this development are unclear; parental influence is suggested. Our objective was to examine whether self-medication with OTC analgesics among school-aged children is influenced by maternal self-reported health and medicine use, taking the child's frequency of pain into account. METHODS A quantitative cross-sectional survey was conducted on 131 children aged 6 to 11 years and their mothers in the framework of the Demonstration Of A Study To Coordinate And Perform Human Biomonitoring On A European Scale (DEMOCOPHES) European project. Participants were selected from 1 urban and 1 rural area of Denmark, and equally distributed in age and gender. Data were collected through structured interviews with all children and self-report questionnaires for mothers regarding health, pain, and medicine use. RESULTS After adjusting for several sociodemographic and health parameters, maternal use of OTC analgesics was significantly associated with self-medication with OTC analgesics, particularly PCM, in our population of schoolchildren, even when the child's pain was adjusted for (odds ratio 3.00, P = .008). A clear association between child pain and OTC analgesic use was not found. Additionally, maternal health (self-rated health, chronic pain, chronic disease, daily medicine intake) did not significantly influence child use of OTC analgesics. CONCLUSIONS Maternal self-medication with OTC analgesics is associated with self-medication of OTC analgesics, predominantly PCM, among school-aged children, perhaps more than the child's pain. Maternal health seems of less importance. Information to parents about pain self-management is important to promote appropriate PCM use among schoolchildren.
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Goldman RD. Acetaminophen in children: an old drug with new warnings. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2013; 59:1065-e450. [PMID: 24130280 PMCID: PMC3796971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
QUESTION I frequently suggest to parents to use acetaminophen to treat their children's fever and pain. Recently, I had a child in my office who presented with a target-lesion skin rash a day after receiving acetaminophen. The rash resolved after 3 days and after stopping administration of acetaminophen. Does acetaminophen carry a risk of adverse events such as this? ANSWER Like any other medication or active substance, acetaminophen preparations might carry a risk of adverse events. In recent years a potential association between acetaminophen and asthma was investigated, and the US Food and Drug Administration recently published a warning about potential severe but rare skin reactions associated with acetaminophen. Although acetaminophen is mostly a safe medication, health care providers should be alert and advise parents about the possibility of rare but severe adverse events.
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Affiliation(s)
- Ran D Goldman
- BC Children's Hospital, Department of Pediatrics, Room K4-226, Ambulatory Care Bldg, 4480 Oak St, Vancouver, BC V6H 3V4.
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Bauer AZ, Kriebel D. Prenatal and perinatal analgesic exposure and autism: an ecological link. Environ Health 2013; 12:41. [PMID: 23656698 PMCID: PMC3673819 DOI: 10.1186/1476-069x-12-41] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 04/02/2013] [Indexed: 05/04/2023]
Abstract
BACKGROUND Autism and Autism Spectrum Disorder (ASD) are complex neurodevelopmental disorders. Susceptibility is believed to be the interaction of genetic heritability and environmental factors. The synchronous rises in autism/ASD prevalence and paracetamol (acetaminophen) use, as well as biologic plausibility have led to the hypothesis that paracetamol exposure may increase autism/ASD risk. METHODS To explore the relationship of antenatal paracetamol exposure to ASD, population weighted average autism prevalence rates and paracetamol usage rates were compared. To explore the relationship of early neonatal paracetamol exposure to autism/ASD, population weighted average male autism prevalence rates for all available countries and U.S. states were compared to male circumcision rates - a procedure for which paracetamol has been widely prescribed since the mid-1990s. Prevalence studies were extracted from the U.S. Centers for Disease Control and Prevention Summary of Autism/ASD Prevalence Studies database. Maternal paracetamol usage and circumcision rates were identified by searches on Pub Med. RESULTS Using all available country-level data (n = 8) for the period 1984 to 2005, prenatal use of paracetamol was correlated with autism/ASD prevalence (r = 0.80). For studies including boys born after 1995, there was a strong correlation between country-level (n = 9) autism/ASD prevalence in males and a country's circumcision rate (r = 0.98). A very similar pattern was seen among U.S. states and when comparing the 3 main racial/ethnic groups in the U.S. The country-level correlation between autism/ASD prevalence in males and paracetamol was considerably weaker before 1995 when the drug became widely used during circumcision. CONCLUSIONS This ecological analysis identified country-level correlations between indicators of prenatal and perinatal paracetamol exposure and autism/ASD. State level correlation was also identified for the indicator of perinatal paracetamol exposure and autism/ASD. Like all ecological analyses, these data cannot provide strong evidence of causality. However, biologic plausibility is provided by a growing body of experimental and clinical evidence linking paracetamol metabolism to pathways shown to be important in autism and related developmental abnormalities. Taken together, these ecological findings and mechanistic evidence suggest the need for formal study of the role of paracetamol in autism.
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Affiliation(s)
- Ann Z Bauer
- Department of Work Environment, School of Health and Environment, University of Massachusetts- Lowell, 1 University Avenue, Lowell, MA, 01854, USA
| | - David Kriebel
- Department of Work Environment, School of Health and Environment, University of Massachusetts- Lowell, 1 University Avenue, Lowell, MA, 01854, USA
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20
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Association between parental attitudes and self-medication of their children. Int J Clin Pharm 2012; 35:113-20. [PMID: 23100184 DOI: 10.1007/s11096-012-9715-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 10/08/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The association between parental attitudes and medication administered to their children has been studied mainly regarding specific diseases and ailments, e.g. asthma, fever and pain. Little is known about how parental attitudes toward medicines in general are associated with how they medicate their children using self-medication. OBJECTIVE The aim of this study was to identify how parental attitudes toward medicines are associated with how they medicate their children with self-medication including the use of over-the-counter (OTC) medicines and complementary and alternative medicines (CAMs). SETTING A cross-sectional population-based study was conducted in the spring of 2007. The study sample consisted of a random sample of Finnish children under 12 years of age (n = 6,000). METHOD A questionnaire was sent to parents, and the parent who usually takes responsibility for the child´s medication was instructed to answer the questionnaire. MAIN OUTCOME MEASURE The responding parent was asked to report the child's use of OTC medicines and CAMs during the preceding 2 days. The parent's attitude toward medicines was measured by 18 statements using a 5-item Likert scale. RESULTS CAM use was least likely among children whose parent had a positive view of prescription medicines. In contrast, a positive attitude toward OTC medicines by a parent was associated with both, OTC medicine and CAM use among children, whereas, parental worry about the risks of medicines predicted the use of CAMs among children. CONCLUSION This study showed that parental attitudes toward medicines have an impact on how they medicate their children, especially with CAMs. This finding highlights the fact that health care professionals should negotiate a child's treatment, taking into account parental views toward medicines, and previous use of self-medication.
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Gonzalez-Barcala FJ, Pertega S, Perez Castro T, Sampedro M, Sanchez Lastres J, San Jose Gonzalez MA, Bamonde L, Garnelo L, Valdes L, Carreira JM, Moure J, Lopez Silvarrey A. Exposure to paracetamol and asthma symptoms. Eur J Public Health 2012; 23:706-10. [PMID: 22645237 DOI: 10.1093/eurpub/cks061] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Paracetamol is one of the factors that have been associated with the observed increase in asthma prevalence in the last few years. The influence of environmental or genetic factors in this disease may be different in some countries than in others. The purpose of this study was to analyse the relationship between the paracetamol consumption and asthma prevalence in our community. METHODS A cross-sectional study was conducted on more than 20,000 children and adolescents in Galicia, Spain. The International Study of Asthma and Allergies in Childhood methodology was used to collect the information on asthma symptoms in children, paracetamol consumption, body mass index (BMI), pets in the home, education level of the mother and parental asthma and smoking habits. The influence of paracetamol consumption on the prevalence of asthma symptoms was calculated using logistic regression, adjusted for the other parameters included in the study. RESULTS After adjusting for gender, BMI, having a cat or dog, maternal education, parental asthma and smoking, in 6- to 7-year-old children, the consumption of paracetamol during the first year of life is associated with asthma [odds ratio (OR) 2.04 (1.79-2.31) for wheezing at some time]. Paracetamol consumption in the previous year leads to a significant increase in the probability of wheezing at some time [OR 3.32 (2.51-4.41)] in young children and adolescents [OR 2.12 (1.68-2.67)]. CONCLUSIONS Paracetamol consumption is associated with a significant increase in asthma symptoms. The effect is greater the more often the drug is taken.
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Watts R, Robertson J. Non-pharmacological Management of Fever in Otherwise Healthy Children. ACTA ACUST UNITED AC 2012. [DOI: 10.11124/jbisrir-2012-43] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Watts R, Robertson J. Non-pharmacological Management of Fever in Otherwise Healthy Children. ACTA ACUST UNITED AC 2012; 10:1634-1687. [PMID: 27820389 DOI: 10.11124/01938924-201210280-00001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Fever is a common childhood problem faced in both hospital and community settings. In many cases the fever is associated with mild to moderate self-limiting illnesses. There has been a rapid increase in antipyretic use as the means of managing or treating this adaptive physiological response to infection. The use of alternative means of caring for a febrile child could minimise the amount of antipyretics administered to children and thereby reduce the potential risks. OBJECTIVE The objective of this systematic review was to establish what non-pharmacological practices are effective in managing fever in children, three months to 12 years of age, who are otherwise healthy. INCLUSION CRITERIA Interventions for inclusion were physiological e.g. maintenance of hydration and rest, and external cooling, either direct e.g. sponging, clothing, or environmental e.g. fans, ambient temperature. Outcomes of interest were effect on fever, increase in comfort, decrease in parental anxiety and reduction in unnecessary use of health services. SEARCH STRATEGY The search sought English, Spanish, Portuguese, Mandarin and Italian language studies, published 2001-2011 in 12 major databases. CRITICAL APPRAISAL, DATA EXTRACTION AND DATA SYNTHESIS Critical appraisal of and data extraction from eligible studies were undertaken using standardised tools developed by the Joanna Briggs Institute. As statistical pooling of data was precluded, the findings are presented in narrative form. RESULTS Twelve randomised controlled trials were included, involving 986 children in total. Only one intervention identified in the review protocol - direct external cooling measures - was addressed by the studies. Eleven studies included sponging as an intervention while one also included clothing (unwrapping). No studies investigated physiological interventions, (e.g. hydration or rest), or environmental cooling measures, (e.g. fans or ambient temperature) as separate interventions. Three of these interventions (encouragement of fluid intake, rest and fans) were reported as part of the standard care provided to participants in several studies or were controlled in the study (ambient temperature). Only two of the four outcomes identified in the review protocol were examined (effect on fever (all 12 studies) and patient comfort). Although tepid sponging alone resulted in an immediate decrease in temperature, this response was of short duration, with antipyretics or antipyretics plus sponging having a more lasting effect. In addition, the observed levels of discomfort of the sponged children were higher than the other groups. For both measures, this effect was not statistically significant in every case. CONCLUSION The care of a febrile child needs to be individualised, based on current knowledge of the effectiveness and risks of interventions. The administration of antipyretics should be minimised, used selectively and with caution, even in otherwise healthy children. The results of this systematic review support previous findings that routine tepid sponging does not have an overall beneficial effect. However measures such as encouraging fluid intake and unwrapping the child should be encouraged. IMPLICATIONS FOR PRACTICE The two foci of care should be the child and the parents/primary caregiver. For the child, care should aim to support the body's physiological responses i.e. maintain hydration, minimise use of antipyretics. Support the parents to reduce anxiety e.g. by involving them in care and providing appropriate education, particularly in respect to correct dosages of antipyretics. IMPLICATIONS FOR RESEARCH Given the now well demonstrated discomfort engendered by tepid sponging, its use in treating febrile children is no longer advocated and does not warrant further research. However aspects of other non-pharmacological interventions have not been so well researched e.g. parental response to advice on fluid intake and appropriate clothing.
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Affiliation(s)
- Robin Watts
- 1. WACEIHP, Curtin University of Technology Bentley WA Australia and Princess Margaret Hospital for Children Subiaco, WA Australia, a Collaborating Centre of the Joanna Briggs Institute
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Ertmann RK, Siersma V, Reventlow S, Söderström M. Infants' symptoms of illness assessed by parents: impact and implications. Scand J Prim Health Care 2011; 29:67-74. [PMID: 21591836 PMCID: PMC3347950 DOI: 10.3109/02813432.2011.576863] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES. Some parents with a sick infant contact a doctor, while others do not. The reasons underlying such parental decisions have not been thoroughly studied. The purpose of this study was to explore how the actual symptoms in the infant were associated with parent-rated illness, illness severity, and the probability of the parents contacting a doctor. DESIGN. A retrospective questionnaire and a prospective diary study covering 14 months of the participating infants' lives. SETTING AND SUBJECTS. The 194 participating infants were followed for three months prospectively from the age of 11 to 14 months using diary cards, and retrospectively from birth until the age of 11 months by a questionnaire. RESULTS. During the three months of the diary card prospective follow-up, the infants had symptoms on average every second day, and the vast majority (92%) had 10 or more days with at least one symptom; 38% of the infants were reported to have had five or more symptoms for more than five days. Fever, earache, and vomiting were the symptoms most likely to cause parents to rate their infant as ill. Earache was the symptom that triggered doctor contact most immediately. The parent-rated illness severity was strongly related to the tendency to contact a doctor. However, this association was markedly weaker when adjustment was made for the infant not eating normally, having a cough, or running a fever. CONCLUSION. Specific symptoms such as fever, earache, and vomiting were strongly associated with the probability of parents rating the infant as ill. An earache would cause the parents to contact a doctor. Fever and vomiting were other symptoms triggering doctor contacts. First, these symptoms could cause the parents to want a doctor's expert evaluation of the infant's illness; second, the parents could expect medication to be necessary; or third, it could just be difficult for the parents to handle the ill infant.
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Affiliation(s)
- Ruth K Ertmann
- Department of General Practice and the Research Unit for General Practice in Copenhagen, University of Copenhagen, Denmark
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