Browsing by Subject "Pediatrics"

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  • Venäläinen, Tuomas (Helsingin yliopisto, 2020)
    Lisämunuaiskuoren vajaatoiminnan lapsuudenaikaisia syitä ei olla aikaisemmin tutkittu Suomessa. Kansainvälisiä tutkimuksia etiologioiden yleisyyksistä on tehty vähän. Tässä rekisteritutkimuksessa olen selvittänyt lisämunuaiskuoren vajaatoiminnan syitä lapsuudessa sekä eri etiologioiden yleisyyden ajallista muuttumista. Aineisto koostuu potilaista, joilla oli vähintään yksi hoitokäynti Helsingin yliopistollisen keskussairaalan (HYKS) Lastenklinikalla tammikuun 1985 ja maaliskuun 2016 välisenä aikana. Lisämunuaiskuoren vajaatoimintaa sairastavat potilaat haettiin HYKSin sähköisestä potilastietojärjestelmästä ICD-9 ja -10-tautiluokitusten koodeilla. Sisäänottokriteerit täyttivät kliinistä ja kroonista lisämunuaiskuoren vajaatoimintaa sairastavat lapsena diagnosoidut potilaat. Potilaat saivat diagnoosinsa vuosina 1958-2016. Tutkimuksessa löytyi 170 lisämunuaiskuoren vajaatoimintaa (AI) sairastavaa potilasta. Kaksi yleisintä syytä AI:lle olivat synnynnäinen lisämunuaishyperplasia, jota sairasti 65 potilasta, sekä tyypin 1 autoimmuunipolyendokrinopatia (APECED eli APS-1) 47 potilaalla. Muut tautietiologiat olivat aivolisäkkeen vajaatoiminta (16 potilasta), isoloitunut autoimmuuniadrenaliitti (11), keskushermoston leikkaukset (9), tyypin 2 autoimmuunipolyendokrinopatia (5), adrenoleukodystrofia (4), isoloitunut adrenokortikotropiinivaje (4), määrittelemätön lisämunuaislama (4), lääkkeiden sivuvaikutus (4) sekä synnynnäinen lisämunuaisten hypoplasia (1). Vain kolme uutta APECED-tapausta diagnosoitiin vuosina 2000-2016. Synnynnäinen lisämunuaishyperplasia oli suurin etiologinen AI-ryhmä, mikä vahvistaa aiempien tutkimusten tuloksia. Sen suurta osuutta voi selittää tyttöjen virilisaation korjausleikkausten keskittyminen HYKSiin. APECEDin osuus oli suurempi kuin aiemmissa tutkimuksissa. Taustalla voivat olla taudin kuuluminen suomalaiseen tautiperintöön sekä muiden sairaanhoitopiirien potilaiden tutkimuskäynnit Lastenklinikalla. Primaarinen lisämunuaisen vajaatoiminta oli yleisempää kuin sekundaarinen, kuten kansainvälisissä lasten vajaatoimintaa selvittäneissä tutkimuksissakin on todettu. Osasyynä voi olla myös hoitavien lääkärien käyttämien sekundaarisen vajaatoiminnan ICD-koodien vaihtelevuus.
  • Afzelius, Pehr von (Uppsala, 1803)
  • Bodén, A. E. (1845)
  • Abelin (Uppsala, 1882)
  • Leppänen, Marja H.; Sääksjärvi, Katri; Vepsäläinen, Henna; Ray, Carola; Hiltunen, Pauliina; Koivusilta, Leena; Erkkola, Maijaliisa; Sajaniemi, Nina; Roos, Eva (2020)
    Screen time is increasing rapidly in young children. The aim of this study was to examine associations of long-term stress and temperament with screen time in Finnish preschool children and the moderating role of socioeconomic status. Cross-sectional DAGIS data were utilized. Long-term stress was assessed using hair cortisol concentration, indicating values of the past 2 months. Temperament was reported by the parents using the Children's Behavior Questionnaire (the Very Short Form), and three broad temperament dimensions were constructed: surgency, negative affectivity, and effortful control. Screen time was reported by the parents over 7 days. The highest education level in the household was used as an indicator of socioeconomic status. In total, 779 children (mean age, 4.7 +/- 0.9 years, 52% boys) were included in the study. Of the temperament dimensions, a higher effortful control was associated with less screen time (B = - 6.70, p = 0.002). There was no evidence for an association between hair cortisol concentration and screen time nor a moderating role of socioeconomic status in the associations (p > 0.05). Conclusion: Our findings indicate that preschool children with a higher score in effortful control had less screen time. Because effortful control reflects general self-regulatory abilities, promoting these skills may be effective in reducing screen time in young children.What is Known: center dot Screen time has increased rapidly during the last decades, and higher screen time has been linked with numerous adverse health consequences in children. center dot There are no previous studies investigating associations of long-term stress and temperament with screen time in young children.What is New: center dot Of the temperament dimensions, effortful control was associated with higher screen time in preschool children, but there was no association found between long-term stress and screen time. center dot Since effortful control reflects general self-regulatory abilities, promoting these skills may be effective in reducing screen time in young children.
  • Kaipio, Johanna; Karisalmi, N.; Hiekkanen, K.; Stenhammar, H.; Lahdenne, P. (IOS PRESS, 2019)
    Studies in Health Technology and Informatics
    Patient experience (PX) is an important evaluation criterion for quality in healthcare. Compared to patient satisfaction, however less research has focused on the development of instruments to measure experiences of patients and their families. In the article, we describe the process of developing a PX questionnaire for the parents of pediatric patients in the context of children's hospital and illustrate the questionnaire items for measuring PX. The phases of the development process included retrospective interviews, description of the themes influencing PX and the metrics for measuring PX, as well as iterative development of three versions of questionnaires including data gathering and factor analysis. The final versions of the surveys suggested for implementation at the hospitals include eight PX statements for the outpatient clinic and five statements for the ward. Compared to satisfaction surveys, the developed surveys emphasize the aspects of parent's attitude towards the illness, support for families, and daily arrangements with a child patient. © 2019 American Psychological Association Inc. All rights reserved.
  • Bekker, Vincent; Zwittink, Romy D.; Knetsch, Cornelis W.; Sanders, Ingrid M. J. G.; Berghuis, Dagmar; Heidt, Peter J.; Vossen, Jaak M. J. J.; de Vos, Willem M.; Belzer, Clara; Bredius, Robbert G. M.; van't Hof, Peter J.; Lankester, Arjan C.; Kuijper, Ed J. (2019)
    Bloodstream infections and graft-versus-host disease are common complications after hematopoietic stem cell transplantation (HSCT) procedures, associated with the gut microbiota that acts as a reservoir for opportunistic pathogens. Selective gut decontamination (SGD) and total gut decontamination (TGD) during HSCT have been associated with a decreased risk of developing these complications after transplantation. However, because studies have shown conflicting results, the use of these treatments remains subject of debate. In addition, their impact on the gut microbiota is not well studied. The aim of this study was to elucidate the dynamics of the microbiota during and after TGD and to compare these with the dynamics of SGD. In this prospective, observational, single center study fecal samples were longitudinally collected from 19 children eligible for allogenic HSCT (TGD, n=12; SGD, n=7), weekly during hospital admission and monthly after discharge. In addition, fecal samples were collected from 3 family stem cell donors. Fecal microbiota structure of patients and donors was determined by 16S rRNA gene amplicon sequencing. Microbiota richness and diversity markedly decreased during SGD and TGD and gradually increased after cessation of decontamination treatment. During SGD, gut microbiota composition was relatively stable and dominated by Bacteroides, whereas it showed high inter- and intraindividual variation and low Bacteroides abundance during TGD. In some children TGD allowed the genera Enterococcus and Streptococcus to thrive during treatment. A gut microbiota dominated by Bacteroides was associated with increased predicted activity of several metabolic processes. Comparing the microbiota of recipients and their donors indicated that receiving an SCT did not alter the patient's microbiota to become more similar to that of its donor. Overall, our findings indicate that SGD and TGD affect gut microbiota structure in a treatment-specific manner. Whether these treatments affect clinical outcomes via interference with the gut microbiota needs to be further elucidated. (C) 2019 American Society for Blood and Marrow Transplantation.
  • Hukkinen, Maria; Pakarinen, Mikko Petteri; Merras-Salmio, Laura; Koivusalo, Antti; Rintala, Risto; Kolho, Kaija-Leena (2016)
    Background: Fecal calprotectin (FC) correlates with endoscopic recurrence of Crohn's disease (CD) in adults but has not been studied among children postoperatively. We aimed to analyze whether FC relates with postoperative CD recurrence in children. Methods: Altogether 51 postoperative endoscopies and FC measurements from 22 patients having undergone surgery for CD at age Results: Ileocecal resection (n = 15), small bowel resection (n = 6), or left hemicolectomy (n = 1) was performed at median age of 15.1 (interquartile range 14.4-17.6) years. Following surgery, FC decreased significantly (659 vs. 103 mu g/g, p = 0.001). During median follow-up of 5.7 (4.2-7.7) years, either endoscopic or histological recurrence occurred in 17 patients (77%). FC > 139 mu g/g at time of endoscopy or FC increase of 79 mu g/g compared to first postoperative value was suggestive of endoscopic recurrence (Rutgeerts score i2-i4), while FC > 101 mu g/g or increase of 21 mu g/g indicated histological recurrence. Best accuracy for prediction of recurrence was obtained by combining FC at endoscopy and the postoperative increase of FC. The corresponding AUROC values were 0.74 (95% 0.58-0.89) for endoscopic recurrence whereas 0.81 (95% CI 0.67-0.95) for histological recurrence. Conclusion: FC is a useful surrogate marker of postoperative recurrence also in pediatric CD patients. (C) 2016 Elsevier Inc. All rights reserved.
  • Afzelius, Pehr von (Uppsala, 1803)
  • Evanson, R.T.; Mansell, H. (Berlin, 1838)
  • Jörg, J. Ch. G. (Leipzig, 1826)
  • Henke, A. (Frankfurt am Main, 1821)
  • Hamalainen, Anssi; Sipponen, Taina; Kolho, Kaija-Leena (2011)
  • Leimi, Lilli (Helsingfors universitet, 2010)
    Tutkielma kuvaa lapsuusiän kantasolusiirtojen merkittävimmät tulokset ja komplikaatiot keskeisissä tautiryhmissä modernin hoidon aikakaudella HUS:ssä. Aineistona on HUS:n Lasten ja nuorten sairaalan veri- ja syöpätautien sekä kantasolusiirtoyksikön potilaista kerätty, vuonna 1993 perustetun ProLapsi-rekisterin sisältämä kliininen kantasolusiirtoaineisto vuosilta 1993-2006. Aineisto sisältää runsaat 90% Suomessa tehdyistä lasten allogeenisista kantasolusiirroista (n=233) sekä kaikki HUS:in autologiset siirrot (n=117) ko. aikajaksolla. Tutkielma on toteutettu kvantitatiivisia tutkimusmenetelmiä käyttäen. Suurin allogeenisen kantasolusiirron saaneiden potilaiden diagnoosiryhmä oli akuutti lymfoblastileukemia, ja suurin autologisen kantasolusiirron saaneiden ryhmä neuroblastoomapotilaat. Allogeenisista kantasolusiirroista 38% tehtiin HLA-identtiseltä sukulaisluovuttajalta ja 53% rekisteriluovuttajan soluilla. Kumulatiivinen kokonaisselviytyminen oli merkitsevästi parempaa sukulaisluovuttajan soluilla tehdyissä siirroissa kuin rekisteriluovuttajan (p=0,003). Allogeenisen kantasolusiirron saaneista potilaista 71% sai jonkin asteisen akuutin ja 42% kroonisen käänteishyljinnän (GVHD). Sekä akuutin että kroonisen GVHD:n vaikeus puolestaan korreloi kuolleisuuteen. Allogeenisen kantasolusiirron pitkäaikaisvaikutusta arvioitiin seurantatietojen perusteella. 58%:lla elämänlaatu arvioitiin normaaliksi, 35%:lla hieman rajoittuneeksi ja 7%:lla heikoksi.
  • Soini, Tea (2018)
  • Int Liaison Comm Resuscitation; Buick, Jason E.; Wallner, Clare; Aickin, Richard; Meaney, Peter A.; de Caen, Allan; Maconochie, Ian; Skrifvars, Markus B.; Welsford, Michelle (2019)
    Introduction: The International Liaison Committee on Resuscitation prioritized the need to update the review on the use of targeted temperature management (TTM) in paediatric post cardiac arrest care. In this meta-analysis, the effectiveness of TTM at 32-36 degrees C was compared with no target or a different target for comatose children who achieve a return of sustained circulation after cardiac arrest. Methods: Electronic databases were searched from inception to December 13, 2018. Randomized controlled trials and non-randomized studies with a comparator group that evaluated TTM in children were included. Pairs of independent reviewers extracted the demographic and outcome data, appraised risk of bias, and assessed GRADE certainty of effects. A random effects meta-analysis was undertaken where possible. Results: Twelve studies involving 2060 patients were included. Two randomized controlled trials provided the evidence that TTM at 32-34 degrees C compared with a target at 36-37.5 degrees C did not statistically improve long-term good neurobehavioural survival (risk ratio: 1.15; 95% CI: 0.69-1.93), long-term survival (RR: 1.14; 95% CI: 0.93-1.39), or short-term survival (risk ratio: 1.14; 95% CI: 0.96-1.36). TTM at 32-34 degrees C did not show statistically increased risks of infection, recurrent cardiac arrest, serious bleeding, or arrhythmias. A novel analysis suggests that another small RCT might provide enough evidence to show benefit for TTM in out-of-hospital cardiac arrest. Conclusion: There is currently inconclusive evidence to either support or refute the use of TTM at 32-34 degrees C for comatose children who achieve return of sustained circulation after cardiac arrest. Future trials should focus on children with out-of-hospital cardiac arrest.