Pediatrics

Adherence to medication is an issue in adults but in children, there is the added difficulty of child refusal of medication. Researchers at the university, led by Dr Angela MacAdam have been investigating the issue of child refusal of medication as this may impact on the health outcome for the child, cause distress to parents/carers attempting to give the medicine as well as the cost to the health service.

There are three components to child refusal of medication being investigated by researchers, namely, the roles of the child, the medication and the parent/carer. Dr Angela MacAdam and Dr Sian Williams are interested in the role of child where evidence suggests that there is a link to child who refuse medication and those that are fussy eaters. Professor Paul Gard and Dr Angela MacAdam are looking at how the organoleptic properties of the medicines affect child refusal and therefore adherence in studies being conducted at the AldeyHey Hospital. In addition, there are some exciting new areas being pursued by Dr Matt Ingram and Dr Angela MacAdam of individualising medication where the child can design their dose form with the view of increasing acceptability of the medicine and therefore adherence. The final component under investigation is the role of the parent/carer where the influence of parenting style on child refusal is being researched.

Professor Paul Gard is interested in fetal alcohol. In Europe, one per cent of children are affected by exposure to alcohol before birth, leading to learning difficulties. This research investigates the neurochemistry underlying this disease and explores the use of drugs, designed for use in elderly patients with dementia, in children in order to reverse the cognitive deficits.

The Oral Contraceptive (OC) remains the most popular form of contraception among adolescent girls in the UK. As with all medicines, efficacy of the OC depends on regular and adherent use however research suggests non-adherence to OCs reported as one of the main causes of unintended pregnancies in young women, there is a clear need to develop effective interventions to increase adherence. Dr Sian Williams, Dr Angela MacAdam and Claire May are investigating the use of Mobile technologies for OCs as a way of personalising messages to users that target specific beliefs that are known to influence adherence. In addition these technologies can promote behavioural control and planning by allowing the user to schedule when and how to receive the reminder. OC use lends itself well to this type of intervention as users are typically not regularly being seen by a healthcare provider.

Rates of teenage births are five times those in the Netherlands, double those in France and more than twice those in Germany

Family planning association

There has been considerable debate over the optimum age of introduction of solid foods in infants and particularly its effect on nutrient and iron adequacy for growth and development as well as its impact on eating behaviours, such as feeding difficulties, dietary variety and food preferences. Dr Angela MacAdam has been part of a research group looking at into this and results show that a higher number of parents/carers are waiting until six months before weaning their infants compared to a UK 2010 infant feeding survey, highlighting a trend towards the government recommendations.

Food preferences and perceived fussy eating did not differ significantly at nine months between infants who were introduced to solids before or after six months.

Baby-weaning

Dr Alison Lansley is part of the Brighton and Sussex Medical School paediatrics research group looking into how we can optimize inhaled beta-agonist dose as a “reliever” medicine for wheezy pre-school children. The study is investigating the average dose required to produce maximal bronchodilatation in wheezy preschool children and whether some children are so unresponsive to beta-agonists that alternative therapy (eg anticholinergics, antileukotrienes) should be used. This variable responsiveness to beta-agonists is thought to be due to the genetic make-up of the child and researchers are looking to whether this lack of responsiveness can be predicted by a simple genetic test.

Dr Alison Lansley is also lead PhD supervisor for Saikat Ray (other supervisors are Professor Tony Metcalfe and Mr Baljit Dheansa) who’s studying novel delivery mechanisms for the application of autologous keratinocytes to reduce scarring and wound contraction in children with scald and burn injuries. The research is based at the Blond McIndoe Research Institute. 

An estimated 75 per cent of hospital admissions for asthma are avoidable and as many as 90 per cent of the deaths from asthma are preventable.

Asthma UK

Morphine delivery

Medication errors are the second largest cause of iatrogenic (healthcare associated) injury in the UK. Incidents involving errors in the intravenous administration of morphine to neonates are frequently reported. Dr Greg Scutt and Dr Bhavik Patel, in collaboration with Dr Heike Rabe and Mr Mike Pettit (Brighton and Sussex University Hospitals NHS Trust) are developing and testing a point-of-care analytical device with the ability to identify intravenous medication errors prior to administration to neonates.

Skeletal development: Growth plate physiology

Long bones lengthen from birth through to skeletal maturity at about 20 years of age. This process is termed endochondral ossification, and describes the creation of bone from an expanding cartilage template. In long bones, the cartilage that is responsible for an increase in length is called the growth (or epiphyseal) plate. The cartilage cells, chondrocytes, of the growth plate undergo an explosive increase in their volume. It is the rate of volume increase and final volume reached by these cells that is the major determinant of final bone length. Despite the importance of this process to the growth and development of a healthy skeleton, the mechanisms responsible for cell volume increase are poorly understood.

The cell volume increase was believed to be driven by cell swelling alone, but Dr Bush’s research was the first to show that hypertrophy is also an important component.

Further work has identified the Sodium-Potassium-Chloride Cotransporter (NKCC), a protein found in the cell membrane as a key contributor to growth plate chondrocyte volume increase. Experiments revealed that the specific inhibitor of NKCC, bumetanide (a loop diuretic), had a dramatic effect reducing bone lengthening. This is a key observation, especially as the closely related drug furosemide is one of the most commonly used drugs in paediatrics. There are anecdotal reports of children exposed to loop diuretics are of shorter stature; this was previously explained by the effects of the conditions suffered – and not the chronic medication prescribed.

Further work has identified the Sodium-Potassium-Chloride Cotransporter (NKCC), a protein found in the cell membrane as a key contributor to growth plate chondrocyte volume increase. Experiments revealed that the specific inhibitor of NKCC, bumetanide (a loop diuretic), had a dramatic effect reducing bone lengthening. This is a key observation, especially as the closely related drug furosemide is one of the most commonly used drugs in paediatrics. There are anecdotal reports of children exposed to loop diuretics are of shorter stature; this was previously explained by the effects of the conditions suffered – and not the chronic medication prescribed.

Further investigation is warranted to determine the regulatory control of NKCC in the mammalian growth plate and to the possible detrimental effect with chronic exposure to loop diuretics in children

Yearbook of Pediatric Endocrinology 2010

Research team

Professor Paul Gard (Professor of Experimental Therapeutics)
Dr Angela MacAdam (Principal lecturer in Pharmacy Practice)
Dr Greg Scutt (Principal Lecturer in Medicines Optimisation)
Dr Matt Ingram (Principal Lecturer in Medicinal Chemistry)
Dr Alision Lansley (Principal Lecturer in Biopharmaceutics)
Dr Sian Williams (Senior lecturer in Health Psychology)
Dr Peter Bush (Senior lecturer in Physiology)
Dr Bhavik Patel (Senior Lecturer in Pharmaceutical Chemistry)
Claire May (Senior Lecturer in Pharmacy Practice)
Elaine Sharp (Senior Lecturer in Pharmacy Practice)
Antiopi Ntouva (PhD Student)
Simon Bryson (PhD Student)
Saikat Ray (PhD Student)
Joyce Bols (MRes Student)

Output

Bush, P. G., A. C. Hall, et al. (2008). "New insights into function of the growth plate: clinical observations, chondrocyte enlargement and a possible role for membrane transporters." J Bone Joint Surg Br 90(12): 1541-1547.

Bush, P. G., C. A. Parisinos, et al. (2008). "The osmotic sensitivity of rat growth plate chondrocytes in situ; clarifying the mechanisms of hypertrophy." J Cell Physiol 214(3): 621-629.

Bush, P. G., M. Pritchard, et al. (2010). "A key role for membrane transporter NKCC1 in mediating

Huntley, J. S., P. G. Bush, et al. (2003). "Looking at the living human growth plate." CMAJ 168(4): 459-460.

Loqman, M. Y., P. G. Bush, et al. (2010). "A cell shrinkage artefact in growth plate chondrocytes with common fixative solutions: importance of fixative osmolarity for maintaining morphology." Eur Cell Mater 19: 214-227.

Whately, B., Williams, S., Gard, P.R., MacAdam, A.B. (2012) Healthy children’s identification and risk perception of medicines in England. Social and Administrative Pharmacy 8 478-483

Whately B,  Williams SE, Gard PR and MacAdam AB (2011) Children's Identification and Risk Perception of Medicines in the UK. Research in Social & Administrative Pharmacy 2012 Sep-Oct;8(5):478-83

Weaning practices and iron status of exclusively breast fed infants. Ntouva, A. ; Rogers, I. ; MacAdam, A. ; Emmett, P.

Journal of Human Nutrition and Dietetics - 2011 ; VOL 24, NUMB 3 ; Page(s): 297-298

McGraw, M., Fellows, S., Long, A., Millar, H., Muir, G., Thomson, A., Uddin, S., Watt, J. & Williams, S. (2011). Feedback on doctors’ performance from parents and carers of children: a national pilot study. Archives of Disease in Childhood, published online 26th May 2011 DOI: 10.1136/adc.2010.203174

Sooriakumaran, R. and Williams, S.E. (2009). Neonatal practitioners’ use and appraisal of reference sources in finding information about the use of medicines. International Journal of Pharmacy Practice, 17(1): A14-A15.

June 2013 “Parents’/carers’ views and decisions about the human papillomavirus vaccine” A Macadam, K Curley and S Williams International Association for Adolescent Health: 10th World Congress

Leggo E, MacAdam A.B and Bayliss J (2009) Community pharmacists' experiences in supplying paediatric medicines. Int. J. Pharm. Pract. 17(1);  A4-5

MacAdam A and Marfo-Mensah O. (2010) What factors influence a pharmacist’s decision whether or not to supply or sell medicines to children under the age of 16. Int. J. Pharm. Pract. 18 (1); A29

2013 SRCD Biennial Meeting to be held April 18-20, 2013 in Seattle, Washington, USA.

Is there a relationship between fussy eaters and medication adherence in children? A MacAdam, S Williams

Fidalgo S, Bol J and Gard P.R (2014) Acute administration of angiotensin IV increases brain-derived neurotrophic factor in mice.

Gard P.R, Fidalgo S, Skipper C and Onaji V (2014) Effect of acute administration of angiotensin IV in a mouse model of Foetal Alcohol syndrome.

Sources/links

PeReNE Project

Collaborations

Professor Paul Gard & Professor Ilse Smolders, Vrije University, Brussels
Professor Paul Gard & Professor D Vardy, University of Rouen, France

Professor Helena Lutéscia L Coelho from the University of Fortaleza in Brazil

The Infant & Toddler Forum

Funding

Novel delivery mechanisms for the application of autologous keratinocytes to reduce scarring and wound contraction in children with scald and burn injuries. Funded by SPARKS the Children’s Medical Research Charity (£211,402).

Interreg (EU) (2012): Equal partner amongst 13 collaborators of Peptide Research Network of Excellence (PeReNe), (Principal investigator for University of Brighton component.) €2.9 million

Department of Health (Research for patient benefit project grant). A pragmatic randomised controlled trial of an allergy intervention for children with asthma and rhinitis in General Practice (Lead by Professor Somnath Mukhopadhyay with Helen Smith, Brighton and Sussex Medical School). 2009-2012:  £250K

Auralis Pharmaceuticals (2007 - 2014) 5-year part-time research studentship to study: Formulation of medications for improved paediatric compliance. (Co-investigator in association with Dr A.B. MacAdam). £50,000 

2009 Wellcome Trust Biomedical Vacation Scholarships How English primary school children recognise and perceive medicines £720

2013 The development of a novel intervention to improve adherence to oral contraceptives funded by  Leverhulme Pharmacy Research Fellowship £13,075

2013 Wellcome Trust Biomedical Vacation Scholarship Adolescents’ knowledge and beliefs about contraception £1440

Awards, recognition, impact

A MacAdam reviews for International Journal of Pharmacy Practice & Wellcome Trust
S Williams is a reviewer for International Journal of Pharmacy Practice