儿童健康学之儿童药品的使用
07-09, 2014
摘要
为儿童提供卫生保健是非常重要的。它依赖于医疗专业人员和父母对待疾病的态度。孩子有权利接受科学的和安全性的药物。不幸的是假冒伪劣药品导致许多世界各地的孩子们的死亡。有二甘醇被用作溶剂在假冒药品的特殊问题。它也被发现在受污染的不合格的药品中。它一直引起全世界许多不同国家的儿童死亡。我回顾了所有已发表的二甘醇中毒例文献。我所描述的症状，希望这些发现增强儿童二甘醇中毒的临床表现的认识。这是众所周知的，在英国，在提供健康和卫生保健服务是不平等的。这种不公平现象已经特别在某些少数民族中注意到。儿童“风险”的群体，如寻求庇护者和难民，和吉普赛人和流浪者被确认为在提供医疗保健和药品上有可能会受到阻碍。我进行了一项研究，研究在在英国东米德兰地区儿童药品的使用情况。在确定卫生保健方面的研究同时还希望了解父母在接受治疗疼痛，哮喘和癫痫的态度。
ABSTRACT
Access to health care for children is important. It is dependent on access to health professionals and also parental attitudes towards illness.
Children have the right to receive medicines that are scientifically evaluated for both efficacy and safety. Counterfeit and substandard medicines unfortunately result in the death of many children worldwide. There have been particular problems with diethylene glycol which has been used as a solvent in counterfeit medicines. It has also been found in contaminated substandard medicines. It has been responsible for the death of many children in different countries throughout the world. I performed a literature review of all cases of diethylene glycol poisoning that have been published. I have described the clinical signs and symptoms and hope that these findings increase the awareness of diethylene glycol poisoning in children.
It is well known that there are clear inequalities in health and access to health care in the UK. This inequity has been particularly noticed amongst certain minority groups. Children of “at risk” groups, such as Asylum Seekers and Refugees, and Gypsies and Travellers, were recognised as having possible barriers in accessing health care and medicines.
I conducted a study to explore children‟s access to medicines in the East Midlands area in the UK. Alongside determining accessibility to health care the study also wished to explore parental attitudes towards receiving treatment for pain, asthma and epilepsy.
II
Both quantitative and qualitative research methodology was used in this study. The research data was gathered with the aid of semi-structured interviews with parents from the “at risk” groups and control parents. Fifty parents from each group were selected and interviewed regarding their children‟s health and their access to health care and medicines. The semi-structured interviews allowed participating parents to state their opinions about any barriers they had encountered to their children receiving medicines.#p#分页标题#e#
Parents from both “at risk” groups and children from the Traveller group had mo re health problems than the controls. The attitude of some Gypsy and Traveller parents (11%) not to immunise their children was a significant probliem. One in six Refugee parents reported difficulties while obtaining medicines. The two main barriers were language/communication problems and financial difficulties. Both Refugee and Traveller children received fewer OTC medicines than the children of the control group. It was not clear from the interviews whether this was due to financial difficulties or reluctance to use medicines without a doctor having seen the child first.
Parents from both “at risk” groups were less likely to give analgesics for treating earache than those in the control group. Parents of Refugee children were more reluctant to tell others about their child‟s epilepsy.
Access to health care is an essential human right. Children are dependent upon both their parents and the health system for ensuring access to health care. This study has identified problems both within the system and also in relation to parental beliefs that may affect the access to health care and treatment for children. It is important that both of these
III potential barriers are addressed in order to improve the health of children of “at risk” groups. It is hopeful that the findings in this study will help to identify ways of improving access to health care and medicines for these groups.
IV ACKNOWLEDGEMENTS
Praise be to Allah, most Gracious, most Merciful without whose gift of life and knowledge, among other things, this thesis would not have been.
I wish to thank profusely my sponsors, the government of the Kingdom of Saudi Arabia.
I am firstly indebted to my inspirational supervisor, Professor Imti Choonara for his invaluable support, advice, understanding and thoughtfulness especially at the most demanding periods. It would be impossible to overstate my gratitude to him.
It is a pleasure to thank Dr. Helen Sammons, my co-supervisor, for her guidance and critical advice throughout the study.
My thanks, too, to Dr. Sharon Conroy for encouragement and advice during my first year; all the staff at the Academic Division of Child Health at the University of Nottingham, especially Janine Cherrill for her invaluable help with the interviews; and to all the administrative staff at the Medical School in Derby.
My gratitude goes to Refugee Action in Nottingham, and the Derbyshire Gypsy Liaison Group.
No words can express my gratitude to my mother and father, my wife and my three sons and the rest of my extended family. For all their love, emotional support and the sacrifices they have made. May Allah bless them, Amen.
I thank all my friends, and my PhD student colleagues who made my stay here more comfortable.
Without the support of all these people, I would not have been able to complete this work. Thank you
V PUBLICATIONS ARISING FROM THIS THESES
The following publications and presentations are based on the research and findings from this thesis:
Journal article and Abstract
Publication:
Alkahtani S, Sammons H, Choonara I. Epidemics of Acute Renal Failure in Children (diethylene glycol toxicity). Arch Dis Child 2010; 95: 1062-1064.
Published abstract:
Alkahtani S, Sammons H, Choonara I. Children‟s Access to Medicines. Arch Dis Child 2012, 97:5,e19,doi 10.1136/archdischild-2012-301728.39
Conference proceedings
Alkahtani S. (2011, November). Children‟s Access to Medicines. Paper reviewed and presented at the 17th Annual Conference and Exhibition of the NPPG, Bristol, UK.
.
Alkahtani S. (2011, June). Children‟s Access to Medicines. Paper reviewed and presented at the 5th Annual Saudi International Conference , University of Warwick, Coventry, UK.
Alkahtani S. (2011, June). Children‟s Access to Medicines. Paper reviewed and presented at the 13th ESDPP Congress, Oslo, Norway.
Alkahtani S. (2011, May). Children‟s Access to Medicines. Paper presented at the Annual National workshop of Paediatric Clinical Pharmacology and Child Health, Royal Derby Hospital, Derby, UK.
VI
Alkahtani S. (2010, July). Epidemics of Acute Renal Failure in Children (diethylene glycol toxicity). Paper reviewed and presented at the 4th Annual Saudi International Conference, University of Manchester, Manchester, UK.
Alkahtani S. (2010, May). Children‟s Access to Medicines. Paper presented at the Annual National workshop of Paediatric Clinical Pharmacology and Child Health, Royal Derby Hospital, Derby, UK.
Alkahtani S. (2009, June). Epidemics of Acute Renal Failure in Children (diethylene glycol toxicity). Paper presented at the Annual National workshop of Paediatric Clinical Pharmacology and Child Health, Royal Derby Hospital, Derby, UK.
World Health Organisation
The World Health Assembly
United Nations High Commission for Refugees
United Nations International Children's Emergency Fund
Non-Governmental Organisations
Food and Drug Administration
Food and Drug Administration Modernisation Act
National Institute of Health
Paediatric Committee
National Health Service
European Medicines Agency
Good Manufacturing Practice
World Trade Organisation
Trade-Related Aspects of Intellectual Property Rights
International Covenant on Economic, Social and Cultural Rights
Medecins Sans Frontieres
Intellectual Property
Medicines and Healthcare Products Regulatory Agency
Defective Medicines Report Centre
International Federation of Pharmaceutical Manufacturers Association#p#分页标题#e#
Diethylene glycol
European Union
United Kingdom
United States of America
United Nations
Indefinite Leave to Remain
Post-Traumatic Stress Disorder
General Practices
Anti-Social Behaviour Orders
Institute for Public Policy Research
Research Ethics Committee
Good Clinical Practice
Qualitative Research Review Guidelines
Over-The-Counter
Inter Quartile Range
Anti Epileptic Drug
Adverse Drug Reactions
为儿童提供卫生保健是非常重要的。它依赖于医疗专业人员和父母对待疾病的态度。孩子有权利接受科学的和安全性的药物。不幸的是假冒伪劣药品导致许多世界各地的孩子们的死亡。有二甘醇被用作溶剂在假冒药品的特殊问题。它也被发现在受污染的不合格的药品中。它一直引起全世界许多不同国家的儿童死亡。我回顾了所有已发表的二甘醇中毒例文献。我所描述的症状，希望这些发现增强儿童二甘醇中毒的临床表现的认识。这是众所周知的，在英国，在提供健康和卫生保健服务是不平等的。这种不公平现象已经特别在某些少数民族中注意到。儿童“风险”的群体，如寻求庇护者和难民，和吉普赛人和流浪者被确认为在提供医疗保健和药品上有可能会受到阻碍。我进行了一项研究，研究在在英国东米德兰地区儿童药品的使用情况。在确定卫生保健方面的研究同时还希望了解父母在接受治疗疼痛，哮喘和癫痫的态度。
ABSTRACT
Access to health care for children is important. It is dependent on access to health professionals and also parental attitudes towards illness.
Children have the right to receive medicines that are scientifically evaluated for both efficacy and safety. Counterfeit and substandard medicines unfortunately result in the death of many children worldwide. There have been particular problems with diethylene glycol which has been used as a solvent in counterfeit medicines. It has also been found in contaminated substandard medicines. It has been responsible for the death of many children in different countries throughout the world. I performed a literature review of all cases of diethylene glycol poisoning that have been published. I have described the clinical signs and symptoms and hope that these findings increase the awareness of diethylene glycol poisoning in children.
It is well known that there are clear inequalities in health and access to health care in the UK. This inequity has been particularly noticed amongst certain minority groups. Children of “at risk” groups, such as Asylum Seekers and Refugees, and Gypsies and Travellers, were recognised as having possible barriers in accessing health care and medicines.
I conducted a study to explore children‟s access to medicines in the East Midlands area in the UK. Alongside determining accessibility to health care the study also wished to explore parental attitudes towards receiving treatment for pain, asthma and epilepsy.
II
Both quantitative and qualitative research methodology was used in this study. The research data was gathered with the aid of semi-structured interviews with parents from the “at risk” groups and control parents. Fifty parents from each group were selected and interviewed regarding their children‟s health and their access to health care and medicines. The semi-structured interviews allowed participating parents to state their opinions about any barriers they had encountered to their children receiving medicines.#p#分页标题#e#
Parents from both “at risk” groups and children from the Traveller group had mo re health problems than the controls. The attitude of some Gypsy and Traveller parents (11%) not to immunise their children was a significant probliem. One in six Refugee parents reported difficulties while obtaining medicines. The two main barriers were language/communication problems and financial difficulties. Both Refugee and Traveller children received fewer OTC medicines than the children of the control group. It was not clear from the interviews whether this was due to financial difficulties or reluctance to use medicines without a doctor having seen the child first.
Parents from both “at risk” groups were less likely to give analgesics for treating earache than those in the control group. Parents of Refugee children were more reluctant to tell others about their child‟s epilepsy.
Access to health care is an essential human right. Children are dependent upon both their parents and the health system for ensuring access to health care. This study has identified problems both within the system and also in relation to parental beliefs that may affect the access to health care and treatment for children. It is important that both of these
III potential barriers are addressed in order to improve the health of children of “at risk” groups. It is hopeful that the findings in this study will help to identify ways of improving access to health care and medicines for these groups.
IV ACKNOWLEDGEMENTS
Praise be to Allah, most Gracious, most Merciful without whose gift of life and knowledge, among other things, this thesis would not have been.
I wish to thank profusely my sponsors, the government of the Kingdom of Saudi Arabia.
I am firstly indebted to my inspirational supervisor, Professor Imti Choonara for his invaluable support, advice, understanding and thoughtfulness especially at the most demanding periods. It would be impossible to overstate my gratitude to him.
It is a pleasure to thank Dr. Helen Sammons, my co-supervisor, for her guidance and critical advice throughout the study.
My thanks, too, to Dr. Sharon Conroy for encouragement and advice during my first year; all the staff at the Academic Division of Child Health at the University of Nottingham, especially Janine Cherrill for her invaluable help with the interviews; and to all the administrative staff at the Medical School in Derby.
My gratitude goes to Refugee Action in Nottingham, and the Derbyshire Gypsy Liaison Group.
No words can express my gratitude to my mother and father, my wife and my three sons and the rest of my extended family. For all their love, emotional support and the sacrifices they have made. May Allah bless them, Amen.
I thank all my friends, and my PhD student colleagues who made my stay here more comfortable.
Without the support of all these people, I would not have been able to complete this work. Thank you
V PUBLICATIONS ARISING FROM THIS THESES
The following publications and presentations are based on the research and findings from this thesis:
Journal article and Abstract
Publication:
Alkahtani S, Sammons H, Choonara I. Epidemics of Acute Renal Failure in Children (diethylene glycol toxicity). Arch Dis Child 2010; 95: 1062-1064.
Published abstract:
Alkahtani S, Sammons H, Choonara I. Children‟s Access to Medicines. Arch Dis Child 2012, 97:5,e19,doi 10.1136/archdischild-2012-301728.39
Conference proceedings
Alkahtani S. (2011, November). Children‟s Access to Medicines. Paper reviewed and presented at the 17th Annual Conference and Exhibition of the NPPG, Bristol, UK.
.
Alkahtani S. (2011, June). Children‟s Access to Medicines. Paper reviewed and presented at the 5th Annual Saudi International Conference , University of Warwick, Coventry, UK.
Alkahtani S. (2011, June). Children‟s Access to Medicines. Paper reviewed and presented at the 13th ESDPP Congress, Oslo, Norway.
Alkahtani S. (2011, May). Children‟s Access to Medicines. Paper presented at the Annual National workshop of Paediatric Clinical Pharmacology and Child Health, Royal Derby Hospital, Derby, UK.
VI
Alkahtani S. (2010, July). Epidemics of Acute Renal Failure in Children (diethylene glycol toxicity). Paper reviewed and presented at the 4th Annual Saudi International Conference, University of Manchester, Manchester, UK.
Alkahtani S. (2010, May). Children‟s Access to Medicines. Paper presented at the Annual National workshop of Paediatric Clinical Pharmacology and Child Health, Royal Derby Hospital, Derby, UK.
Alkahtani S. (2009, June). Epidemics of Acute Renal Failure in Children (diethylene glycol toxicity). Paper presented at the Annual National workshop of Paediatric Clinical Pharmacology and Child Health, Royal Derby Hospital, Derby, UK.
World Health Organisation
The World Health Assembly
United Nations High Commission for Refugees
United Nations International Children's Emergency Fund
Non-Governmental Organisations
Food and Drug Administration
Food and Drug Administration Modernisation Act
National Institute of Health
Paediatric Committee
National Health Service
European Medicines Agency
Good Manufacturing Practice
World Trade Organisation
Trade-Related Aspects of Intellectual Property Rights
International Covenant on Economic, Social and Cultural Rights
Medecins Sans Frontieres
Intellectual Property
Medicines and Healthcare Products Regulatory Agency
Defective Medicines Report Centre
International Federation of Pharmaceutical Manufacturers Association#p#分页标题#e#
Diethylene glycol
European Union
United Kingdom
United States of America
United Nations
Indefinite Leave to Remain
Post-Traumatic Stress Disorder
General Practices
Anti-Social Behaviour Orders
Institute for Public Policy Research
Research Ethics Committee
Good Clinical Practice
Qualitative Research Review Guidelines
Over-The-Counter
Inter Quartile Range
Anti Epileptic Drug
Adverse Drug Reactions
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