Archives of disease in childhood
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Review
Children's access to treatment for epilepsy: experience from the Lao People's Democratic Republic.
Epilepsy affects an estimated 10.5 million children worldwide, of whom 80% live in developing countries. The treatment gap is estimated at around 90% in the Lao People's Democratic Republic (Lao PDR). The present work analyses some of the reasons that could explain the low access to antiepileptic drugs (AED) for children with epilepsy in the Lao PDR. ⋯ Traditional beliefs, fear and stigma are common among the general population and shared by 40% of health staff. Poor knowledge of the disease and its treatment, low trust in modern treatment, restricted access to AED and ignorance of long-term treatment explain the low access to AED. Improving understanding of epilepsy and its treatment, will improve the treatment gap for epileptic children in the Lao PDR.
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Randomized Controlled Trial
Randomised controlled trial of thermostatic mixer valves in reducing bath hot tap water temperature in families with young children in social housing.
To assess the effectiveness of thermostatic mixing valves (TMVs) in reducing bath hot tap water temperature, assess acceptability of TMVs to families and impact on bath time safety practices. ⋯ TMVs and accompanying educational leaflets are effective at reducing bath hot tap water temperatures in the short and longer term and are acceptable to families. Housing providers should consider fitting TMVs in their properties and legislators should consider mandating their use in refurbishments as well as in new builds.
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Intravenous paracetamol (acetaminophen) has recently been registered for treatment of pain in neonates but the pharmacodynamics, including effects on body temperature, have not been reported. ⋯ Administration of intravenous paracetamol does not result in hypothermia in normothermic neonates. In those with fever, maximal temperature reduction is achieved within 2 h following paracetamol administration.
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Most of the epilepsies that occur in children are relatively straightforward to manage, including suppression of the seizures. However, in at least 30% of children, seizures will not be fully controlled by one or two antiepileptic drugs (AEDs); these children may also have additional physical, educational or behavioural problems. ⋯ The approach to these children must always begin with ensuring that the diagnosis of epilepsy is accurate, that the correct seizure type or types and epilepsy syndrome have been identified and that an underlying cause has been considered. Treatment must be holistic, considering the child as a person and not just someone having seizures; the AED regimen must be appropriate and not excessive; and surgery must always be considered a viable option.
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To evaluate the safety and efficacy of a sedation protocol based on intranasal lidocaine spray and midazolam (INM) in children who are anxious and uncooperative when undergoing minor painful or diagnostic procedures, such as peripheral line insertion, venipuncture, intramuscular injection, echocardiogram, CT scan, audiometry testing and dental examination and extractions. ⋯ This study has shown that the combined use of lidocaine spray and atomised INM appears to be a safe and effective method to achieve short-term sedation in children to facilitate medical care and procedures.