Medication use in Australian children with asthma: user's perspective.

BACKGROUND AND OBJECTIVES: Medication use-related issues remain problematic in childhood asthma despite effective treatment strategies and public investment into improved asthma management strategies in industrialized countries. This study aimed to carry out an in-depth exploration of the views of parents/carers and children with asthma on medication use. METHODS: Semi-structured qualitative interviews were conducted with a purposive convenience sample of children with asthma and their parents recruited from general practices in Sydney. Interviews were tape-recorded, transcribed verbatim, and thematically analyzed. RESULTS: A total of 52 interviews (26 parents/carers and 26 children with asthma) were conducted. Major themes which emerged from the children's interviews included issues such as self-image, resistance to medication use, and lack of responsibility in medication taking. Parental or carer issues included lack of clear understanding of how medications worked, as well as administration difficulties, cost constraints, and beliefs about medications contrary to quality use. DISCUSSION: This is one of the few research studies exploring the viewpoint of children with asthma about their medications in Australia. Despite investment in dissemination of professional, targeted evidence-based asthma management strategies in healthcare, there seems to be a lack of depth in terms of what parents understand about their child's asthma. Effective communication about medication usage, especially the inclusion of the child in the consultation to empower them to be involved in their own asthma care, may be the answer.

Medication use in Indian children with asthma: the user's perspective.

BACKGROUND AND OBJECTIVE: Despite the high prevalence of asthma in children, there has been limited research into patient perception of medication use, particularly in the developing world. This study therefore aimed to carry out an in-depth exploration of the views of carers and children with asthma on asthma medication use. METHODS: Grounded theory approach was used to conduct semistructured qualitative interviews in a purposive convenience sample of parents and children with asthma. The participants were recruited from two specialty hospitals in New Delhi, India. Interviews were tape-recorded, transcribed verbatim and thematically analysed. RESULTS: Twenty children (7-12 years old) with asthma and their parent or carer were interviewed in July 2011. Major reported issues included poor parent and child understanding of disease and medications. Fears, misinformed beliefs and lack of self-management skills were apparent. Child self-image, resistance to medication use and lack of responsibility in medication taking were themes that emerged from child interviews. CONCLUSIONS: This is one of the first research studies exploring the viewpoint of children with asthma about their medications. Resource constraints dictate a pragmatic paternalistic approach by physicians which, in contrast to patients in westernized nations, seems to be acceptable and satisfactory to Indian patients (carers).

Medication use in children with asthma: not a child size problem.

OBJECTIVE: The global burden of pediatric asthma is high. Governments and health-care systems are affected by the increasing costs of childhood asthma--in terms of direct health-care costs and indirect costs due to loss of parental productivity, missed school days, and hospitalizations. Despite the availability of effective treatment, the current use of medications in children with asthma is suboptimal. The purpose of this review is to scope the empirical literature to identify the problems associated with the use of pediatric asthma medications. The findings will help to design interventions aiming to improve the use of asthma medications among children. METHODS: A literature search using electronic search engines (i.e., Medline, International Pharmaceutical Abstracts (IPA), PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL)) and the search terms "asthma," "children," and "medicines" (and derivatives of these keywords) was conducted. RESULTS: The search terms were expanded to include emergent themes arising out of search findings. Content themes relating to parents, children themselves, health-care professionals, organizational systems, and specific medications and devices were found. Within these themes, key issues included a lack of parental knowledge about asthma and asthma medications, lack of information provided to parents, parental beliefs and fears, parental behavioral problems, the high costs of medications and devices, the child's self-image, the need for more child responsibility, physician nonadherence to prescribing guidelines, "off-label" prescribing, poor understanding of teachers, lack of access to educational resources, and specific medications. CONCLUSION: These key issues should be taken into account when modifying the development of educational tools. These tools should focus on targeting the children themselves, the parent/carers, the health-care professionals, and various organizational systems.

Evaluation of calcium ion release and change in pH on combining calcium hydroxide with different vehicles.

INTRODUCTION: Intracanal medicaments have traditionally been used in endodontics to disinfect root canals between appointments. Calcium hydroxide is widely used as an intracanal medicament for disinfection and to promote periapical healing. It is stable for long periods, harmless to the body, and bactericidal in a limited area. The efficacy of calcium hydroxide as a disinfectant is dependent on the availability of the hydroxyl ions in the solution that depends on the vehicle in which the calcium hydroxide is carried. In general, three types of vehicles are used: Aqueous, viscous or oily. Some in vitro studies have shown that the type of vehicle has a direct relationship with the concentration and the velocity of ionic liberation as well as with the antibacterial action when the paste is carried into a contaminated area. AIM OF THE STUDY: To evaluate the calcium ion release and measure the change in pH of the environment that occurred when calcium hydroxide was combined with different vehicles (distilled water, propylene glycol, calcium hydroxide containing gutta-percha points and chitosan) over different time periods. MATERIALS AND METHODS: Forty single rooted mandibular first premolar teeth were decoronated for this study. Working length was established and the root canals were enlarged and irrigation accomplished with 2 ml of NaOCl solution after every file. The teeth were then randomly divided into four groups. The canals were then packed with different preparations of calcium hydroxide using the following vehicles-distilled water, propylene glycol, gutta-percha points and chitosan. Calcium ion release in different groups was analyzed using an ultraviolet spectrophotometer at 220 nm. The change in pH of was determined using a pH meter. Results were statistically evaluated using one-way ANOVA test. RESULT: For calcium ion release, Group 2 showed cumulative drug release of 81.97% at the end of 15 days, whereas Group 1, 3 and 4 showed a release of 99.53, 17.98, 74.93% respectively with a significant difference among all groups. Group 1 reached the highest Ca(2+) level (39.79%) at the end of 1 day but showed almost complete release of calcium hydroxide at the end of 15 days. Group 3 showed least calcium ion release (17.98%) at 15 days. Group 4 showed a sustained release of Ca(+2) ions from 74% at 15 days to 95% at the end of 30 days. After the 1(st) h; Group 1 showed the highest pH level (11.8). However, pH reduced to 7.8 at the end of 30 days in this group. Group 2 showed the highest pH value (10.35), followed by Group 4 (10.32) after 30 days. CONCLUSION: Chitosan can be used as a promising vehicle for calcium hydroxide to maintain an alkaline pH and to allow sustained release of calcium ions in the root canal system.