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Cyprus College
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The college was founded in 1961 with the purpose to provide a well rounded education of high calibre where students can acquire the necessary academic knowledge.
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Wroclaw University
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Founded in 1702 by Leopold I Habsburg. Since the beginning of 20th century the university has produced 9 Nobel Prize winners.
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Volyn University
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The history dates back to 1940. At present, the university includes 4 institutes, 14 faculties and 73 departments.
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Berkeley College
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Through the power of internet, Berkeley college online brings the classroom to you anywhere in the world with the same high level of support as On-Campus classes.
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AIS
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New Zealand's largest international degree provider. The programmes are focused on the global marketplace.
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WORLD UNIVERSITY DIRECTORY
Medical Education Archives of Disease in Childhood current issue
<sec id="s1"><st>3<sup>rd</sup> May 1891</st> <p>There it was, the summary in black and white: a record for her own family physician whose suggestions for appropriate remedies for the chronic cough had hit the doldrums. Salt of tartar, usually so reliable, even after combining with cochineal had simply not made a dent in its density – and so another opinion was sought. ‘I regretfully must inform you that Ms X, 15 years of age, whom you referred with such alacrity on 21st April has a classic case of pulmonary consumption. She understands the implications of this diagnosis but is cognisant of and has been educated about the benefits of prophylaxis. Daily exercise, posture and, she informs me her family has the means, an annual Alpine sojourn. Should these fail to bring symptomatic relief, piercing the diseased lobe to induce a pneumothorax would be the next consideration.’</p> </sec> <sec id="s2"><st>Unmisslabelling the misslabelled</st>...
<sec id="s1"><st>Challenges in rare disease trials</st> <p>Rare diseases are defined in the European Union as ones that affect fewer than one person in 2000. Although individually rare, there are more than 6000 rare diseases with more than half of them starting in childhood. As a result, there are approximately 3.5 million individuals with rare diseases in the UK. These rare diseases have significant impact on children and their families with more than 30% of children dying before the age of 5 years.<cross-ref type="bib" refid="R1">1</cross-ref></p> <p>Rare diseases in children generally lack focused development of new treatments. One of the important reasons behind this is the difficulty in doing clinical trials using traditional design: the number of patients available to recruit is often too limited to do well-powered randomised controlled trials (RCTs). Paediatric trials have significant complexities and very few patients/parents are keen on placebo controlled trials.<cross-ref type="bib" refid="R2">2</cross-ref></p> <p>With methodological developments...
<p>One in 10 children are labelled as ‘penicillin allergic’, the majority before starting school.<cross-ref type="bib" refid="R1">1</cross-ref> Most are viral exanthema mislabelled as ‘allergy’. Confirming true allergy is further confounded because around 80% of young children with ‘true’ penicillin allergy will outgrow the allergy within 10 years.<cross-ref type="bib" refid="R2">2</cross-ref> As a result, around 95% of penicillin allergy labels are found to be incorrect at formal investigation (<cross-ref type="fig" refid="F1">figure 1</cross-ref>).<cross-ref type="bib" refid="R3">3</cross-ref></p> <p>The British Society for Allergy and Clinical Immunology (BSACI) published a guideline in 2022 to assist UK clinicians (who do not have formal allergy training) to develop a penicillin allergy delabelling service for their patients.<cross-ref type="bib" refid="R3">3</cross-ref> The guideline builds on over 10 years of evidence that direct oral ‘challenge’ or drug provocation testing (DPT) without initial specialist assessment is safe.<cross-ref type="bib" refid="R4">4</cross-ref></p> <p>Penicillin allergy delabelling needs to be a priority for UK paediatricians.<cross-ref type="bib" refid="R5">5</cross-ref> The National...
<p>Parents smuggle antipyretics into their feverish infants. At the other end of this continuum, the clandestine administration of any drug to a competent or capacitous person who is oblivious to such treatment, whose consent is absent, is unlawful. It is not a battery, since no touch was involved ... but it is a serious interference with an individual’s right to respect for their private life under Article 8 of the European Convention of Human Rights 1948 (ECHR).</p> <p>While it is simple for a capable person to object, on discovery, that their rights have been trampled upon ... the incompetent or incapacitated may have no such remedy. It was, in part, to give that group of citizens a voice through a legal right, that the Convention was established.</p> <p>There are remarkably few reported common law decisions relating to covert medication in England and Wales; none concerning children. Guidance published by...
<p>Obesity is a significant public health problem. Prevalence is rising in children and young people, with lifelong health impacts and implications for paediatric clinical practice. Obesity stigma is increasingly acknowledged as a problem within health services. Health professionals can inadvertently contribute to this stigma, which is harmful and in itself can promote weight gain. A complex web of factors contributes to obesity, and a simplistic approach exclusively focused on personal responsibility, diet and exercise is unhelpful. A more nuanced, sensitive and informed approach is needed, with careful use of language and non-judgemental partnership working.</p>
<p>More than 10 million children have been born with assisted reproductive technology (ART) as we begin to enter the third generation of individuals conceived by ART. Here we summarise key messages from an enlarging body of literature regarding their health. Earlier research had pointed towards increases in perinatal, neonatal and neurological risks, such as preterm birth, low birth weight, congenital malformations and cerebral palsy. Many of these risks have continued to persist in most recent work but have shown reduction. Newer research proposes long-term cardiometabolic and endocrine concerns. Fortunately, most reports conclude there is little or no risk of increased childhood malignancy or abnormal neurodevelopment. Moving forward, new research may benefit from changes in comparator groups and a better understanding of infertility per se in ART, and the confounding role it probably plays in many of the known risk associations, to reliably scan the horizon for health threats for individuals born after ART.</p>
<p>Between July 2023 and June 2024, there were 540 publications from randomised controlled trials (RCTs) in child and adolescent health in low- and middle-income countries (LMICs), identified using a standardised process that has been in use for 21 years. This year, trials addressed a wide range of diseases and conditions impacting the health, development and well-being of children, newborns, adolescents and mothers. The RCTs reflected old, new and neglected problems, the rapidly changing epidemiology and the evolving social and economic circumstances in many countries. They also highlighted local and global priorities in LMICs, as well as environmental factors contributing to poor child health and inequities. The trials tested new and refined treatments, diagnostics, vaccines, holistic management and prevention approaches, and explored many outcomes, including mortality, nutrition, psychosocial measures and development. The studies were conducted in hospitals and primary healthcare clinics, schools and communities. Some studies are of the highest quality, while others fall short. The implications are many, including the need for greater capacity for discriminating synthesis and translation of evidence at a national and local level in many LMICs. This involves resourcing and educational components, with implications for healthcare worker training in research translation, quality improvement and learning health systems. Paediatricians and child health nurses everywhere have a role to play.</p>
<sec><st>Objective</st>
<p>To evaluate the use of a questionnaire-based decision-making algorithm to triage children with reported antibiotic allergies to proceed directly to an oral provocation challenge.</p>
</sec>
<sec><st>Design</st>
<p>Cohort study.</p>
</sec>
<sec><st>Setting</st>
<p>Children aged 2–16 years attending paediatric emergency department over 1 year (1 June 2018 till 31 May 2019) or identified from four primary care centres in Sheffield with a recorded antibiotic allergy and no previous testing.</p>
</sec>
<sec><st>Participants</st>
<p>313 children with 325 recorded antibiotic allergies.</p>
</sec>
<sec><st>Exposure</st>
<p>Clinical decision-making algorithm used to either exclude, directly delabel or stratify children to oral antibiotic challenge in outpatient department or primary care practice.</p>
</sec>
<sec><st>Main outcome measures</st>
<p>To assess the safety of using the questionnaire-based algorithm for proceeding to a direct oral provocation challenge.</p>
<p>The secondary outcomes were to look for associations and predictive factors in positive challenges and to assess parent/carer acceptability of the service by using Likert Scale.</p>
</sec>
<sec><st>Results</st>
<p>Successful contact was made with 200 children, of which 153 children could be evaluated based on inclusion criteria, engagement and availability of medical records.</p>
<p>15 children were directly delabelled based on history and records. 138 children underwent challenges in outpatient and primary care. 6% of challenges were reactive with a mild, delayed reaction. Overall, a delabelling rate of 91% was achieved. There were no clear predictors for a positive challenge.</p>
</sec>
<sec><st>Conclusion</st>
<p>Our questionnaire-based algorithm for stratifying children with antibiotic allergies to proceed directly to an oral outpatient or primary care challenge was found to be safe, feasible and acceptable.</p>
</sec>
<sec><st>Objective</st>
<p>To evaluate the implementation of an antimicrobial stewardship programme-led inpatient beta-lactam allergy de-labelling programme using a direct oral provocation test (OPT).</p>
</sec>
<sec><st>Design</st>
<p>One-year quality improvement study using a before–after design.</p>
</sec>
<sec><st>Setting</st>
<p>Free-standing tertiary care paediatric hospital.</p>
</sec>
<sec><st>Patients</st>
<p>Patients with a reported beta-lactam allergy admitted to the paediatric medicine inpatient unit.</p>
</sec>
<sec><st>Interventions</st>
<p>Following standardised assessment and risk stratification of reported symptoms, patients with a low-risk history were offered an OPT. Beta-lactam allergy labels were removed if a reported history was considered non-allergic or after successful OPT.</p>
</sec>
<sec><st>Main outcome measures</st>
<p>Removal of inappropriate beta-lactam allergy labels.</p>
</sec>
<sec><st>Results</st>
<p>80 patients with 85 reported beta-lactam allergies were assessed. Median age was 8.1 years (IQR 4.8–12.9) and 34 (42%) were female. The majority (n=55, 69%) had an underlying medical condition. Amoxicillin was the most reported allergy (n=25, 29%). Reported reactions were primarily dermatological (n=65, 77%). Half of participants (n=40) were ineligible for OPT, with equal proportions due to clinical reasons or the nature of the reported reaction. Of the 40 eligible patients, 28 patients (70%) were de-labelled either by history alone (n=10) or OPT (n=18). All OPTs were successful. De-labelling allowed five additional patients (11% of those receiving antibiotics) to receive the preferred beta-lactam. Including patients who were subsequently assessed in the allergy clinic, almost half of all evaluated patients were de-labelled (n=37, 46%).</p>
</sec>
<sec><st>Conclusions</st>
<p>An antimicrobial stewardship programme-led programme using a direct OPT was feasible and safe for expanding beta-lactam allergy de-labelling to paediatric patients admitted to the paediatric medicine inpatient unit.</p>
</sec>
<sec><st>Objective</st>
<p>Beta-lactam antibiotic allergies are reported in 5%–10% of children; however, up to 90% do not have any reaction at oral challenge test (OCT). This study aimed to determine the frequency and identify predictors of positive in-hospital graded beta-lactam OCTs in children with a beta-lactam antibiotic allergy label (AAL).</p>
</sec>
<sec><st>Design</st>
<p>This is a retrospective study conducted over 7 years, including children aged 0–19 years who underwent a beta-lactam OCT. The OCT comprised an in-hospital graded challenge followed by a 5-day outpatient antibiotic course. Univariate and multivariate logistic regression analyses were performed to identify predictors of a positive in-hospital graded OCT.</p>
</sec>
<sec><st>Results</st>
<p>Overall, 1259 beta-lactam OCTs were included: median age at time of OCT was 6.3 years (range 8.8 months to 19.2 years). Of these, 18 (1.4%) in-hospital graded OCTs were positive and 10 (0.8%) were equivocal, with only 4 children (0.3%) having an immediate, severe reaction to their in-hospital graded OCT. Factors associated with a positive in-hospital graded OCT on univariate analysis were: history of other drug allergy (OR 2.7, 95% CI 1.0 to 7.2; p 0.05), an index reaction which was severe (OR 2.9, 95% CI 1.1 to 7.6; p 0.035), immediate and severe (OR 5.85, 95% CI 1.7 to 20.0; p 0.005) or that required epinephrine (OR 9.65, 95% CI 1.7 to 53.6; p 0.01).</p>
</sec>
<sec><st>Conclusion</st>
<p>Of the children referred with a beta-lactam AAL, only 1.4% had a positive in-hospital graded OCT. Risk factors for a positive in-hospital graded OCT were history of other drug allergy, an index reaction which was severe, immediate and severe or required epinephrine.</p>
</sec>
<p>In most cases, a reproductive couple will only become aware of their increase chance of their offspring having an autosomal recessive or X-linked condition, when a child is born into that family with one of these rare genetic diseases. There is screening available for specific conditions where there is a strong family history. Can or should this screening be offered to the general population? We certainly have the genomic sequencing technology via mass expanded reproductive carrier screening. Would it be acceptable? The Mackenzie’s Mission Investigators, Kirk E <I>et al</I> (<I>N Engl J Med</I> 2024;391:1877–1889. DOI: 10.1056/NEJMoa2314768), have asked these questions and several other questions such as : What genes and conditions should be included in a screening programme? How is screening best offered to the general population? Who would take up the offer of screening? How should laboratories determine which variants to report? What reproductive decisions are made by...
<sec><st>Objective</st>
<p>To assess natural history of otitis media with effusion (OME)-related hearing loss and OME causing hearing loss in children under 12 years.</p>
</sec>
<sec><st>Methods</st>
<p>Embase, MEDLINE, CINAHL, INAHTA database, CENTRAL, CDSR, Epistemonikos and PsycINFO were searched to identify observational single group studies, and comparative studies with untreated control arms published in English up to June 2022, reporting natural history of OME-related hearing loss and OME causing hearing loss. Risk of bias and overall quality of evidence were assessed using the JBI (Joanna Briggs Institute (JBI) checklist and GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, respectively.</p>
</sec>
<sec><st>Results</st>
<p>Thirteen studies with 24–639 children were included. Resolution of OME-related hearing loss was 50% by 3 months, 60% by 6 months and 61–77% by 12 months. Resolution of OME causing hearing loss (OME of <1 month, >3 months, >6 months or unknown duration before follow-up) was 23–55% by 3 months, 20–50% by 6 months, 31% by 9 months and 21–93% by 12 months, depending on population and how resolution was defined. Resolution of chronic OME (OME of >12 months duration before follow-up) was only 7% by 1 month, 12% by 6 months and 6% by 12 months. Resolution was only 42% by 57 months in children with primary ciliary dyskinesia.</p>
</sec>
<sec><st>Conclusions</st>
<p>There was greater resolution of OME-related hearing loss over longer follow-up periods. Resolution of OME causing hearing loss also showed a trend towards greater resolution over longer follow-up periods; however, this did not follow a linear pattern, potentially due to differences in populations and definitions of resolution across studies.</p>
</sec>
<p>The International Study of Asthma and Allergies in Children (ISAAC) questionnaire was developed in the 1990s and has been used throughout the world to assess the prevalence of asthma, eczema and hay fever. <I>Archivist</I> was particularly impressed by the size and participation rate of the study published by Oyenuga VO <I>et al</I> [The Lancet Child & Adolescent Health 2024;8: 859–871. <A HREF="https://doi.org/10.1016/">https://doi.org/10.1016/</A> S2352-4642(24)00232-3]. They caried out a cross sectional, two-phase, multi-country (Malawi, South Africa, Zimbabwe, Ghana and Nigeria) study in 149 secondary schools involving 27, 407 adolescents who were screened with the ISAAC questionnaire with a 99·5% (27 272) participation rate. A total of 3236 (11·9% [95% CI 11·5–12·3]) reported a twelve-month period prevalence of wheeze and 644 (19·9%) of 3236 had a formal clinical diagnosis of asthma. There were 2146 (66·3%) of those 3236 adolescents who reported severe wheeze (impacting the ability to talk), the majority of whom...
<sec><st>Objective</st>
<p>To systematically assess the modifiable risk factors for developing otitis media with effusion (OME) in children under 12 years.</p>
</sec>
<sec><st>Methods</st>
<p>We searched Embase, MEDLINE, INAHTA database, CENTRAL, CDSR and Epistemonikos for cohort studies with ≥40 children per arm/prognostic factor, published in English from 2000 to November 2022. We assessed risk of bias using the Quality in Prognosis Studies checklist, and overall evidence quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Outcomes were analysed as risk ratio (RR), OR or Peto OR.</p>
</sec>
<sec><st>Results</st>
<p>Seven studies totalling 2 760 292 children were included. The evidence was very low quality. Fluid or pus discharge from ears (OR 2.1, 95% CI 1.01 to 4.35) and exposure to other children (RR 2.79, 95% CI 1.98 to 3.93) (OR 5.21, 95% CI 2.9 to 9.36) were strongly associated with development of OME. Coughs/colds ≥5 times (OR 1.91, 95% CI 1.22 to 2.99), breathing problems ≥5 times (RR 1.78, 95% CI 1.26 to 2.53) and ear infections (RR 1.95, 95% CI 1.39 to 2.72) in past year were associated with development of OME. Adenoid hypertrophy was strongly associated with development of fluctuating OME (recurrent OME) (OR 9.96, 95% CI 5.17 to 19.19). There was scare evidence for some potential modifiable risk factors, including breast feeding, household smoking, gastro-oesophageal reflux, dummy use and swimming.</p>
</sec>
<sec><st>Conclusions</st>
<p>Upper respiratory tract infection, ear infection, adenoid hypertrophy and exposure to other children could be the predictors for development of OME. Further observational studies are needed to investigate other potential modifiable risk factors.</p>
</sec>
<sec><st>Background</st>
<p>The widespread use of pneumococcal conjugate vaccines (PCV) has changed the epidemiology of invasive pneumococcal disease (IPD) in children globally.</p>
</sec>
<sec><st>Methods</st>
<p>Multicentre prospective audit of IPD episodes from five paediatric hospitals in Australia over 5.5 years between 2016 and June 2021. Children (<18 years) with <I>Streptococcus pneumoniae</I> isolated from a sterile site were included.</p>
</sec>
<sec><st>Results</st>
<p>There were 377 IPD episodes in 375 children: 338 (90%) had received ≥3 PCV doses; 42 (11%) had IPD risk factors. The most common presentations were complicated pneumonia (254, 67%), bacteraemia (65, 17%) and meningitis (29, 8%). Five (1%) children died.</p>
<p>Serotype information was available for 230 (61%) episodes; 140 (61%) were 13vPCV vaccine serotypes (VTs). The majority (85%) of episodes of complicated pneumonia were due to a VT; predominantly 3, 19A, 19F. Children with risk factors were more likely to present with bacteraemia ± sepsis (42% vs 12%) and to have a non-vaccine serotype (NVT) (74% vs 32%). Resistance to ceftriaxone (meningitis cut-off) occurred in 17% of 23B isolates (n=12) and accounted for 22% (5/23) of meningitis cases.</p>
</sec>
<sec><st>Conclusions</st>
<p>Complicated pneumonia is the most common IPD presentation. NVTs account for the majority of bacteraemia and meningitis episodes. High rates of ceftriaxone resistance for NVT 23B support the addition of vancomycin for empiric treatment of suspected meningitis.</p>
</sec>
<sec><st>Objective</st>
<p>To explore associations between maternal body mass index (BMI) in early pregnancy and childhood infections.</p>
</sec>
<sec><st>Design</st>
<p>Birth cohort study linked to primary care records.</p>
</sec>
<sec><st>Setting</st>
<p>Bradford, UK.</p>
</sec>
<sec><st>Participants</st>
<p>Live singleton births within the Born in Bradford cohort study between 2007 and 2011.</p>
</sec>
<sec><st>Exposures</st>
<p>Maternal BMI in early pregnancy.</p>
</sec>
<sec><st>Main outcome measures</st>
<p>The total number of infections between birth and ~14 years of age with subgroup analysis by infection type and age.</p>
</sec>
<sec><st>Results</st>
<p>A total of 9037 mothers and 9540 children were included in the main analysis. 45% of women were of Pakistani ethnicity and 6417 women (56%) were overweight or obese. There was an overall trend for an increasing infection rate with increasing maternal BMI. In adjusted models, only those with obesity grade 2–3 had offspring with significantly higher rates of infection during the first year of life (RR 1.12 (95% CI 1.05 to 1.20)) compared with women of healthy weight. However, by age 5 to <15 years, children born to overweight women (RR 1.09 (95% CI 1.02 to 1.16)), obese grade 1 women (RR 1.18 (95% CI 1.09 to 1.28)) or obese grade 2 women (RR 1.31 (95% CI 1.16 to 1.48)) all had significantly higher rates of infection compared with those born to healthy weight mothers. Respiratory tract and skin/soft tissue infections made up the majority of excess infections.</p>
</sec>
<sec><st>Conclusions</st>
<p>Maternal BMI was positively associated with rates of offspring infection in this study cohort, and suggests that we should be supporting women to achieve a healthy weight for pregnancy. Future research should investigate whether this is replicated in other populations, whether there is a causal association and the potential mechanisms and areas for intervention.</p>
</sec>
<sec><st>Objective</st>
<p>IgA vasculitis (IgAV) is the most frequently experienced subtype of vasculitis seen in children. Most children fully recover, however, complications including chronic kidney disease are recognised. The aim of this project was to use a best available evidence, group agreement, based approach to develop national recommendations for the initial management of IgAV and its associated complications.</p>
</sec>
<sec><st>Methods</st>
<p>A fully representative multiprofessional guideline development group (GDG), consisting of 28 members, was formed and met monthly. Graded recommendations were generated using nationally accredited methods, which included a predefined scope, open consultation, systematic literature review, evidence appraisal, review of national or international guidelines and a period of open consultation. Audit measures and research priorities were incorporated.</p>
</sec>
<sec><st>Results</st>
<p>The IgAV GDG met over a 14-month period. A total of 82 papers were relevant for evidence synthesis. For the initial management, four topic areas were identified with five key questions generating six graded recommendations related to classification, specialist referral and musculoskeletal involvement. For the associated complications, five topic areas with 12 key questions generated 15 graded recommendations covering nephritis, gastrointestinal and testicular involvement, atypical disease and follow-up. Open consultation feedback was incorporated. The guidelines were endorsed by the UK Kidney Association and Royal College of Paediatrics and Child Health and are available online.</p>
</sec>
<sec><st>Conclusion</st>
<p>Despite IgAV being a rare disease with limited evidence, a national standardised approach to the clinical management for children and young people has been achieved. This should unite approaches to care and act as a foundation for improvement.</p>
</sec>
<p>In paediatric medical research, across jurisdictions, parental consent and the assent of their child will usually come from a shared conversation between the researcher and family. This is how a study is introduced, information delivered, uncertainties addressed and understanding confirmed. Evidence indicates the crucial importance of the dialogue<cross-ref type="bib" refid="R1">1</cross-ref> yet it currently goes unguided, undocumented, and often unchecked as review and research design continue to focus on the Participant Information Sheets (PIS).<cross-ref type="bib" refid="R2">2</cross-ref> We propose that it’s time to move our focus on to this conversation to help families make their decision and in this viewpoint we suggest how this can be realised working within the constraints that researchers face. We address consent to research, but would contend that this idea has equal applicability in clinical practice.</p> <sec id="s1"><st>An assent and consent information decision aid</st> <p>Recognising the importance of this dialogue, the UK Oxford ‘A’ Research Ethics...
<sec id="s1"><st>Scenario</st> <p>A 6-week-old girl is admitted with fevers, vomiting and a urine dipstick suggestive of a urinary tract infection (UTI). Inflammatory markers and blood culture are sent to the laboratory, and she is commenced on empirical intravenous antibiotics. The following day, her blood culture flagged positive. It is known that the risk of meningitis in well-appearing infants and children (>4 weeks old) with UTI is low, and a routine lumbar puncture (LP) is not required. But, in the setting of bacteraemia, is an LP now warranted?</p> </sec> <sec id="s2"><st>Clinical question</st> <p>In infants with bacteraemic UTI, is an LP required to exclude meningitis?</p> </sec> <sec id="s3"><st>Search</st> <p>A literature search was conducted on OVID MEDLINE up to 26 December 2023 using the following strategy: (paediatric* or paediatric* or child* or infan* or newborn or neonat*) AND (UTI or urinary tract adj4 infec* or urinary adj3 infec* or bacteriuria or urinalysis...
<sec><st>Partial truth</st> <p>There is an unfortunate tendency in our clinical questions to follow the patient, intervention, comparison, outcome (PICO) model as though it was actually only made of four boxes. We have discussed before how sometimes it is useful to have a PIIICO<cross-ref type="bib" refid="R1">1</cross-ref> if there is a few different treatments that need to be stacked against each other, and even that we might need a PICOOO too ... but it is time to get stronger.</p> <p>We always need a PICOO. At minimum.</p> <p>If we only think of the one outcome we want to modify, even if it is as overwhelming as ‘overall mortality’, we might end up doing more harm (if the patient is alive, but with the most intolerable side effects and comorbidities). We always, always need to consider and look for the costs our treatments come with. Those costs can be as simple as the...
<sec id="s1"><st>Cannabinoids for children and adolescents: do you use them? Be careful!</st> <p>Cannabinoids are being used more frequently in the adult world. How about use in children and adolescents? Are they safe? Chhabra <I>et al</I> (<I>JAMA Pediatr</I> 2024;178:1124–1135.doi:10.1001/jamapediatrics.2024.3045) have completed a systematic review and meta-analysis. They have examined randomised clinical trials (RCTs), with their team of two reviewers who independently performed the title, abstract, full-text review, data extraction and quality assessment. They examined any RCTs with children less than 18 years of age, who have used a natural or pharmaceutical cannabinoid to manage any medical condition and had an active comparator or placebo. Of 39175 citations, there were 23 RCTs with 3612 participants that included female (635 (17.6%). Only 11 trials (47.8%) included children and adolescents only, and the other 12 trials (52.2%) included children, adolescents and adults. It is interesting to see what interventions are being used: purified...
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