E. Kimland - Academia.edu (original) (raw)

Papers by E. Kimland

European Child & Adolescent Psychiatry

Sleep disturbances are common in the pediatric population and should primarily be treated non-pha... more Sleep disturbances are common in the pediatric population and should primarily be treated non-pharmacologically. Most medicines for sleep disturbances are not approved for pediatric use and data on long-term safety is scarce. In Sweden, melatonin is classified as a prescription medicine. The aim of the present study was to characterize the prevalence and incidence of dispensed melatonin prescriptions, long-term treatment, concomitant dispensation of psychotropic medication, and psychiatric comorbidity, in children and adolescents aged 0–17 years living in Sweden during 2006–2017. Data was retrieved by linking the national population-based registers, the Swedish Prescribed Drug register and the National Patient register. In 2017, nearly 2% of the pediatric population 0–17 years was dispensed at least one prescription of melatonin, which was more than a 15-fold increase for girls and a 20-fold increase for boys, when compared to 2006. Among the children in the age group 5–9 who initia...

Acta Paediatrica, 2011

To perform a nationwide investigation of paediatric drug use at Swedish hospitals, including an a... more To perform a nationwide investigation of paediatric drug use at Swedish hospitals, including an analysis of off-label drug use. Methods: All paediatric hospitals in Sweden were invited to register all prescriptions to children, aged between 0 and 18, during two separate 2-day-periods in 2008. Data were reported and analysed with respect to licence status and proportion of and reasons for offlabel drug use. Results: Data on 11 294 prescriptions to 2947 paediatric patients were received. Drugs associated with pain relief, infection, prematurity, nutrition and surgery or anaesthesia were most commonly used. Paracetamol was the most frequently used drug on-label and also among the most commonly used off-label drugs. Nearly half (49%) of all administered prescriptions concerned unlicensed drugs, off-label drugs or extemporaneously prepared drugs. The corresponding rate among neonates was 69%. Lack of paediatric information in the Summary of Product Characteristics was the main reason for off-label classification. Conclusions: Paediatric off-label drug use is common at Swedish hospitals, and nearly half of all prescriptions were not documented for use in children. The findings emphasize a need for paediatric clinical studies as well as compilation of existing clinical experience and scattered evidence, particularly for drug treatment in infants and neonates.

Clinical pharmacology and therapeutics, 2012

Reviews, 1996

ABSTRACT The aim of drug treatment for epilepsy is to prevent seizures without causing adverse ef... more ABSTRACT The aim of drug treatment for epilepsy is to prevent seizures without causing adverse effects. To achieve this, drug dosages need to be individualised. Measuring antiepileptic drug levels in body fluids (therapeutic drug monitoring) is frequently used to optimise drug dosage for individual patients. To review the evidence regarding the effects of therapeutic drug monitoring upon outcomes in epilepsy. We searched the Cochrane Epilepsy Group Specialised Register (September 2006), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 4), MEDLINE (January 1966 to April 2005) and EMBASE (1974 to May 2005). No language restrictions were imposed. We checked the reference lists of retrieved articles for additional reports of relevant studies. Randomised controlled trials comparing the outcomes of antiepileptic drug monotherapy guided by therapeutic drug monitoring with drug treatment without the aid of therapeutic drug monitoring. We based this review on published aggregate data. The main outcomes measured were the proportions of patients achieving a 12-month remission from seizures, reporting adverse effects, and being withdrawn from the treatment they had been randomised to receive. Only one study met the inclusion criteria for the review. In this open study, 180 patients with newly-diagnosed, untreated epilepsy were randomised to treatment with the antiepileptic drug selected by their physician either with or without therapeutic drug serum level monitoring as an aid to dosage adjustments. The antiepileptic drugs used were carbamazepine, valproate, phenytoin, phenobarbital and primidone. A 12-month remission from seizures was achieved by 60% of the patients randomised to therapeutic drug monitoring (intervention group) and by 61% in the control group. A total of 56% in the intervention group and 58% in the control group were seizure free during the last 12 months of follow up. Adverse effects were reported by 48% in the intervention group and 47% of the control group patients. Of those randomised to therapeutic drug monitoring, 62% completed the two-year follow up compared with 67% of the control group. We found no clear evidence to support routine antiepileptic drug serum concentration measurement with the aim of reaching predefined target ranges for the optimisation of treatment of patients with newly-diagnosed epilepsy with antiepileptic drug monotherapy. However, this does not exclude the possible usefulness of therapeutic drug monitoring of specific antiepileptic drugs during polytherapy, in special situations or in selected patients, although evidence is lacking.

European Journal of Pediatrics, 2011

We have used three different sources to estimate the use of drugs sold over the counter (OTC) by ... more We have used three different sources to estimate the use of drugs sold over the counter (OTC) by the Swedish paediatric population during 2007-2008 as part of a European evaluation initiated by the European Medicines Agency. An estimation of the paediatric use from the total numbers of over-the-counter drugs (OTCD) packages sold by Swedish pharmacies and analyses of two separate questionnaires directed towards a population of 11- to 14-year-old children and another towards visitors to one of the paediatric emergency wards in Stockholm County were included in the study. In Sweden, 1.25 OTC packages are sold quarterly per child (0-18 years), and the children in both questionnaire studies use, on average, 0.9 OTC substances. Sixty-five percent of the children visiting an emergency ward and 67% of the 13-year-old Stockholm inhabitants had used at least one OTCD. OTCD use among children is common. Interpretation of OTCD data must be done carefully since questions with regard to OTCD use is subject to recall bias and the number of packages sold to children is hypothesised through a conversion factor.

European Journal of Clinical Pharmacology, 2011

We performed a systematic analysis of which drugs, prescribed, over the counter (OTC), and/or nat... more We performed a systematic analysis of which drugs, prescribed, over the counter (OTC), and/or natural remedies, children had used prior to visiting a pediatric emergency room (ER), and to compare this information with the documentation of drug use in the medical records. A questionnaire study was performed at a pediatric ER in a Swedish university hospital during 3 weeks in April 2008. The questionnaire was validated through an interview with a subgroup of participants. Only drug use associated with the time of that hospital visit was requested. Information was compared with information in medical records related to the same visit. Two hundred and seventy-four children aged 0-18 (median 2) years were enrolled, representing 28% of the total number of patients visiting the ER within the time frame. Forty% (n = 109) of participants reported use of prescribed drugs, 65% (n = 172) OTC drugs, and 8% (n = 17) natural remedies prior to the ER visit. The most common drugs in the three groups were salbutamol, paracetamol, and omega fatty acids, respectively. In the medical records, no more than 50% of the reported drug intake could be found, representing 74% of prescribed drugs but only 34% of OTC drugs and 27% of natural remedies. The majority of children had used drugs, both prescribed and OTC, before coming to the ER , but this drug intake, and especially that of nonprescribed drugs, was often not documented in the medical records.

Acta Paediatrica, 2012