Browsing by Subject "child"

Sort by: Order: Results:

Now showing items 1-20 of 48
  • Janket, Sok-Ja; Meurman, Jukka; Diamandis, Eleftherios P. (2020)
    We teach and practice ethical behavior with all clinical and research activities. Notably, we are well educated to treat the subjects participating in research studies with high ethical standards. However, the ethics of interacting with colleagues, or with junior faculty members, are neither well defined nor taught. Dealing with junior faculty has parallels to dealing with vulnerable research subjects such as children, mentally or physically challenged groups, prison inmates or army recruits. Like any other vulnerable population, lower-ranking faculty members are often at the mercy of department chairs or other higher-ranked faculty members. Herein we present some potentially unethical or unfair examples related to academic research. Our goal is to educate the academic community of conceptual paths and to prevent similar untoward occurrences from happening in the future. Unethical behaviors related to sexual misconduct have already been described elsewhere and are not included in this manuscript. © 2020 Janket SJ et al.
  • DIABIMMUNE Study Grp; Seppälä, Elina M.; Oikarinen, Sami; Lehtonen, Jussi P.; Neupane, Subas; Honkanen, Hanna; Tyni, Iiris; Siljander, Heli; Ilonen, Jorma; Sillanpää, Saara; Laranne, Jussi; Knip, Mikael; Hyöty, Heikki (2020)
    Background. Human rhinoviruses (HRVs), human enteroviruses (HEVs) and human parechoviruses (HPeVs) have been linked to acute otitis media (AOM). We evaluated this association in a prospective birth cohort setting. Methods. A total of 324 healthy infants were followed up from birth to age 3 years. Nasal swab samples were collected at age 3, 6, 12, 18, 24, and 36 months and screened for HRV and HEV using real-time reverse-transcription quantitative polymerase chain reaction. Stool samples were collected monthly and analyzed for HRV, HEV, and HPeV. AOM episodes diagnosed by physicians were reported by parents in a diary. The association of viruses with AOM was analyzed using generalized estimation equations, and their relative contributions using population-attributable risk percentages. Results. A clear association was found between AOM episodes and simultaneous detection of HEV (adjusted odds ratio for the detection of virus in stools, 2.04; 95% confidence interval, 1.06-3.91) and HRV (1.54; 1.04-2.30). HPeV showed a similar, yet nonsignificant trend (adjusted odds ratio, 1.44; 95% confidence interval, .81-2.56). HRV and HEV showed higher population-attributable risk percentages (25% and 20%) than HPeV (11%). Conclusions. HEVs and HRVs may contribute to the development of AOM in a relatively large proportion of cases.
  • Luotonen, Silja; Railo, Henry; Acosta, Henriette; Huotilainen, Minna; Lavonius, Maria; Karlsson, Linnea; Karlsson, Hasse; Tuulari, Jetro J. (2022)
    Maternal depression symptoms are common in pregnant women and can have negative effects on offspring's emotional development. This study investigated the association between prenatal maternal depression symptoms (assessed with the Edinburgh Postnatal Depression Scale at 24 weeks of gestation) and auditory perception of emotional stimuli in 3-year-olds (n = 58) from the FinnBrain Birth Cohort Study. Using electroencephalography (EEG), we examined mismatch responses for happy, sad, and angry sounds presented among neutral stimuli. A positive association between maternal depression symptoms and the emotional mismatch responses in an early time window (80-120 ms) was found, indicating that brain responses of children of mothers with depressive symptoms were weaker to happy sounds, though the results did not survive Bonferroni correction. There were no clear associations in the sad and angry emotional categories. Our results tentatively support that the 3-year-old children of mothers with depression symptoms may be less sensitive to automatically detect happy sounds compared to children whose mothers do not display symptoms of depression.
  • Pelkonen, Tuula; Roine, Irmeli; Bernardino, Luis; Jahnukainen, Kirsi; Peltola, Heikki (2022)
    Sickle cell disease (SCD) was found in 10% of children with bacterial meningitis (BM) in Luanda, 5-fold more than in the general population. BM children with SCD versus BM children without SCD had higher inflammatory markers, more often had pneumococcal meningitis (71% vs. 39%), and either died (39% vs. 22%) or had a longer hospital stay (15 vs. 11 days).
  • Utriainen, Pauliina; Niinimäki, Tuukka T.; Huurre, Anu J.; Vepsäläinen, Kaisa L.; Mäkitie, Outi M.; Niinimäki, Riitta A. (2021)
    Background: Osteonecrosis (ON) is a recognized complication of childhood ALL, but its optimal management remains unestablished. This study evaluated the effect of bisphosphonate (BP) treatment on the evolution of ON lesions in childhood ALL. Material and Methods: We included a national cohort of ALL patients diagnosed with symptomatic ON before 18 years of age and treated with BPs (N = 10; five males). Patients were followed both clinically and with serial MRIs. ON lesions were graded according to the Niinimaki classification. Results: The 10 patients had a total of 55 ON lesions. The median age was 13.3 years at ALL diagnosis and 14.8 years at ON diagnosis. Four patients had received HSCT before the ON diagnosis. BPs used were pamidronate (N = 7), alendronate (N = 2) and ibandronate (N = 1). The duration of BP treatment varied between 4 months and 4 years. In 4/10 patients, BP treatment was given during the chemotherapy. BPs were well-tolerated, with no severe complications or changes in kidney function. At the end of follow up 13/55 (24%) ON lesions were completely healed both clinically and radiographically; all these lesions were originally graded 3 or less. In contrast, ON lesions originally classified as grade 5 (joint destruction; N = 4) remained at grade 5. All grade 5 hip joint lesions needed surgical treatment. During BP treatment, the pain was relieved in 7/10 patients. At the end of follow-up, none of the patients reported severe or frequent pain. Conclusion: BP treatment was safe and seemed effective in relieving ON-induced pain in childhood ALL. After articular collapse (grade 5) lesions did not improve with BP treatment. Randomized controlled studies are needed to further elucidate the role of BPs in childhood ALL-associated ON.
  • Buechner, Jochen; Caruana, Ignazio; Kuenkele, Annette; Rives, Susana; Vettenranta, Kim; Bader, Peter; Peters, Christina; Baruchel, Andre; Calkoen, Friso G. (2022)
    Chimeric antigen receptor T-cell therapy (CAR-T) targeting CD19 has been associated with remarkable responses in paediatric patients and adolescents and young adults (AYA) with relapsed/refractory (R/R) B-cell precursor acute lymphoblastic leukaemia (BCP-ALL). Tisagenlecleucel, the first approved CD19 CAR-T, has become a viable treatment option for paediatric patients and AYAs with BCP-ALL relapsing repeatedly or after haematopoietic stem cell transplantation (HSCT). Based on the chimeric antigen receptor molecular design and the presence of a 4-1BB costimulatory domain, tisagenlecleucel can persist for a long time and thereby provide sustained leukaemia control. "Real-world" experience with tisagenlecleucel confirms the safety and efficacy profile observed in the pivotal registration trial. Recent guidelines for the recognition, management and prevention of the two most common adverse events related to CAR-T - cytokine release syndrome and immune-cell-associated neurotoxicity syndrome - have helped to further decrease treatment toxicity. Consequently, the questions of how and for whom CD19 CAR-T could substitute HSCT in BCP-ALL are inevitable. Currently, 40-50% of R/R BCP-ALL patients relapse post CD19 CAR-T with either CD19(-) or CD19(+) disease, and consolidative HSCT has been proposed to avoid disease recurrence. Contrarily, CD19 CAR-T is currently being investigated in the upfront treatment of high-risk BCP-ALL with an aim to avoid allogeneic HSCT and associated treatment-related morbidity, mortality and late effects. To improve survival and decrease long-term side effects in children with BCP-ALL, it is important to define parameters predicting the success or failure of CAR-T, allowing the careful selection of candidates in need of HSCT consolidation. In this review, we describe the current clinical evidence on CAR-T in BCP-ALL and discuss factors associated with response to or failure of this therapy: product specifications, patient- and disease-related factors and the impact of additional therapies given before (e.g., blinatumomab and inotuzumab ozogamicin) or after infusion (e.g., CAR-T re-infusion and/or checkpoint inhibition). We discuss where to position CAR-T in the treatment of BCP-ALL and present considerations for the design of supportive trials for the different phases of disease. Finally, we elaborate on clinical settings in which CAR-T might indeed replace HSCT.
  • Lamminsalo, Anni; Lundqvist, Annamari; Virta, Lauri J.; Gissler, Mika; Kaila, Minna; Metsälä, Johanna; Virtanen, Suvi M. (2021)
    Bakground: It is suggested that early intake of cow's milk could be a risk factor for type 1 diabetes (T1DM). Further, the different immunological background, gives a suggestion of an inverse relationship for the occurrence of these diseases. The aim of this study was to explore the association between cow's milk allergy (CMA) and the risk of T1DM in a register-based case-cohort study. Methods: Data were obtained from Finnish nationwide health registers. The study included all children born in Finland between January 01, 1986 and December 31, 2008 and diagnosed with T1DM before the age of 16 years (n = 7754). A 10% random sample from each birth year cohort was selected as a reference cohort (n = 137,798). T1DM, CMA, and asthma were defined based on valid special reimbursements for the costs of drugs/special formulas needed in the treatment of the diseases. Child's sex, birth decade, asthma, maternal diabetes and asthma, smoking during pregnancy, and previous deliveries were considered as confounding factors. Time-dependent, weighted Cox regression was applied for statistical analyses. Results: Children with CMA had an increased risk of developing T1DM in fully adjusted model (HR = 1.17; 95% CI 1.02-1.34), but the association was no longer observed when including the use of special infant formulas in the definition of CMA in the sensitivity analysis (HR = 1.11; 95% CI 0.92-1.32). CMA was associated with an increased risk of T1DM in children without asthma (HR = 1.27; 95%CI 1.10-1.47), but not in children with asthma (HR = 0.80; 95% CI 0.92-1.27). Conclusion: Children with CMA may have an increased risk of T1DM.
  • 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.
  • Lepola, P.; Wang, Siri; Tötterman, A.M.; Gullberg, Ninna; Harboe, Kristine Moll; Kimland, Elin E. (2020)
    Objective The aim of this study was to assess the marketing status of the new paediatric medicinal products listed in the 10-year report as initially authorised between 2007 and 2016, reflecting the product availability in four Nordic countries. Design This is a cross-sectional study. Setting Analysis of the national medicine agency's databases in Denmark, Finland, Norway and Sweden. Data source New medicinal products with paediatric indications and new paediatric formulations listed in the Annex of European Medicines Agency's EU Paediatric Regulation 10-year report. Data analysis The products were classified according to national marketing status between January 2019 and March 2019, whether a product was authorised and whether the product was marketed. Main outcome measures The percentages of the new medicinal products with paediatric indications and new paediatric formulations having a valid marketing authorisation and being marketed, both in terms of the sums of all countries and separately for each country. Results Across the four countries, 21%-32% (16/76-24/76) of the new medicinal products were not marketed. Of the new formulations relevant to children, 29%-50% (16/56-28/56) were not marketed, and a significant proportion of these products had never been marketed. Conclusions This study reflects the reality of the implementation of the Paediatric Regulation. The results show that several new paediatric medicines and new formulations are not marketed. This affects the product availability. Similar data from other countries are needed to evaluate the overall European status to find remedies to current situation and increase the availability of the medicines for children. ©
  • Saari, Antti; Pokka, Jari; Mäkitie, Outi; Saha, Marja-Terttu; Dunkel, Leo; Sankilampi, Ulla (2021)
    Context Development of the typical growth phenotype in juvenile acquired hypothyroidism (JHT), the faltering linear growth with increasing weight, has not been thoroughly characterized. Objective To describe longitudinal growth pattern in children developing JHT and investigate how their growth differs from the general population in systematic growth monitoring. Design Retrospective case-control study. Setting JHT cases from 3 Finnish University Hospitals and healthy matched controls from primary health care. Patients A total of 109 JHT patients aged 1.2 to 15.6 years (born 1983-2010) with 554 height and weight measurements obtained for 5 years preceding JHT diagnosis. Each patient was paired with 100 healthy controls (born 1983-2008) by sex and age. Longitudinal growth pattern was evaluated in mixed linear models. Growth monitoring parameters were evaluated using receiver operating characteristics analysis. Results At diagnosis, JHT patients were heavier (mean adjusted body mass index-for-age [BMISDS] difference, 0.65 [95% CI, 0.46-0.84]) and shorter (mean adjusted height-for-age deviation from the target height [(THSDS)-S-DEV] difference, -0.34 [95% CI, -0.57 to -0.10]) than healthy controls. However, 5 years before diagnosis, patients were heavier (mean BMISDS difference, 0.33 [95% CI, 0.12-0.54]) and taller (mean (THSDS)-S-DEV difference, 0.29 [95% CI, 0.06-0.52]) than controls. JHT could be detected with good accuracy when several growth parameters were used simultaneously in screening (area under the curve, 0.83 [95% CI, 0.78-0.89]). Conclusions Abnormal growth pattern of patients with JHT evolves years before diagnosis. Systematic growth monitoring would detect abnormal growth at an early phase of JHT and facilitate timely diagnosis of JHT.
  • Komulainen, K; Pulkki-Raback, L; Jokela, M; Lyytikäinen, LP; Pitkänen, N; Laitinen, T; Hintsanen, M; Elovainio, M; Hintsa, T; Jula, A (2018)
    Objectives:The life-course development of body mass index (BMI) may be driven by interactions between genes and obesity-inducing social environments. We examined whether lower parental or own education accentuates the genetic risk for higher BMI over the life course, and whether diet and physical activity account for the educational differences in genetic associations with BMI.Subjects/Methods:The study comprised 2441 participants (1319 women, 3-18 years at baseline) from the prospective, population-based Cardiovascular Risk in Young Finns Study. BMI (kg/m 2) trajectories were calculated from 18 to 49 years, using data from six time points spanning 31 years. A polygenic risk score for BMI was calculated as a weighted sum of risk alleles in 97 single-nucleotide polymorphisms. Education was assessed via self-reports, measured prospectively from participants in adulthood and from parents when participants were children. Diet and physical activity were self-reported in adulthood.Results:Mean BMI increased from 22.6 to 26.6 kg/m 2 during the follow-up. In growth curve analyses, the genetic risk score was associated with faster BMI increase over time (b=0.02, (95% CI, 0.01-0.02, P
  • Pajunen, T.; Vuori, E.; Lunetta, P. (2018)
    Background: Post-mortem (PM) ethanol production may hamper the interpretation of blood alcohol concentration (BAC) in victims of drowning. Different exclusion criteria (e.g. cases with low BAC or with protracted interval between death and toxicological analysis) have been proposed with no factual figures to reduce the potential bias due to PM ethanol production when examining the prevalence rates for alcohol-related drowning. The aim of this study is to verify the extent to which PM alcohol production may affect the accuracy of studies on drowning and alcohol. Findings: Unintentional fatal drowning cases (n = 967) for which a full medico-legal autopsy and toxicological analysis was performed, in Finland, from 2000 to 2013, and relevant variables (demographic data of the victims, month of incident, PM submersion time, blood alcohol concentration, urine alcohol concentration (UAC), vitreous humour alcohol concentration (VAC) were available. Overall, out of 967 unintentional drownings, 623 (64.4%) were positive for alcohol (BAC > 0 mg/dL), 595 (61.5%) had a BAC ≥ 50 mg/dL, and 567 (58.6%) a BAC ≥ 100 mg/dL. Simultaneous measurements, in each victim, of BAC, UAC, and VAC revealed PM ethanol production in only 4 victims (BAC: 25 mg/dL – 48 mg/dL). These false positive cases represented 0.4% of drownings with BAC > 0 mg/dL and 14.3% of drownings with BAC > 0 mg/dL and <50 mg/dL. Conclusions: The present study suggests that PM ethanol production has a limited impact on research addressing the prevalence rate for alcohol-related drowning and that the use of too rigorous exclusion criteria, such as those previously recommended, may led to a significant underestimation of actual alcohol-positive drowning cases. © 2018, The Author(s).
  • Karppinen, Mariia; Bernardino, Luis; dos Anjos, Elizabete; Pätäri-Sampo, Anu; Pitkäranta, Anne; Peltola, Heikki; Pelkonen, Tuula (2019)
    Background: In resource-poor settings, otorrhea causes a significant burden of disease in children. Etiologic studies and structured data on otorrhea and chronic otitis media among African children remain scarce. Methods: Here, we reviewed 678 bacteriologically analyzed otorrhea samples from Luanda Children's Hospital from children Results: Overall, 32 different bacteria were identified among 542 isolates from 654 children in Luanda. Gram-negative bacteria constituted the majority of all isolates (85%), whereby Pseudomonas spp. was the most common (n = 158; 29%), followed by Proteus spp. (n = 134; 25%). Among Staphylococcus aureus (n = 54; 10%), 69% of tested isolates were Methicillin-resistant S. aureus, and among Enterobacteriaceae, 14% were expanded-spectrum beta-lactamase isolates. Resistance to quinolones was rare. Furthermore, in a review of the literature, we found a high occurrence of otorrhea and chronic suppurative otitis media in children as well as possible gaps in existing knowledge. Conclusions: In Angola, Gram-negative rods emerged as common causative agents of otorrhea in children followed by S. aureus. The magnitude of chronic otorrhea in Africa represents a cause for public health concern.
  • Mateos, Marion K.; Tulstrup, Morten; Quinn, Michael C. J.; Tuckuviene, Ruta; Marshall, Glenn M.; Gupta, Ramneek; Mayoh, Chelsea; Wolthers, Benjamin O.; Barbaro, Pasquale M.; Ruud, Ellen; Sutton, Rosemary; Huttunen, Pasi; Revesz, Tamas; Trakymiene, Sonata S.; Barbaric, Draga; Tedgard, Ulf; Giles, Jodie E.; Alvaro, Frank; Jonsson, Olafur G.; Mechinaud, Francoise; Saks, Kadri; Catchpoole, Daniel; Kotecha, Rishi S.; Dalla-Pozza, Luciano; Chenevix-Trench, Georgia; Trahair, Toby N.; MacGregor, Stuart; Schmiegelow, Kjeld (2020)
    Symptomatic venous thromboembolism (VTE) occurs in five percent of children treated for acute lymphoblastic leukemia (ALL), but whether a genetic predisposition exists across different ALL treatment regimens has not been well studied. Methods: We undertook a genome-wide association study (GWAS) meta-analysis for VTE in consecutively treated children in the Nordic/Baltic acute lymphoblastic leukemia 2008 (ALL2008) cohort and the Australian Evaluation of Risk of ALL Treatment-Related Side-Effects (ERASE) cohort. A total of 92 cases and 1481 controls of European ancestry were included. Results: No SNPs reached genome-wide significance (p <5 x 10(-8)) in either cohort. Among the top 34 single-nucleotide polymorphisms (SNPs) (p <1 x 10(-6)), two loci had concordant effects in both cohorts: ALOX15B (rs1804772) (MAF: 1%; p = 3.95 x 10(-7)) that influences arachidonic acid metabolism and thus platelet aggregation, and KALRN (rs570684) (MAF: 1%; p = 4.34 x 10(-7)) that has been previously associated with risk of ischemic stroke, atherosclerosis, and early-onset coronary artery disease. Conclusion: This represents the largest GWAS meta-analysis conducted to date associating SNPs to VTE in children and adolescents treated on childhood ALL protocols. Validation of these findings is needed and may then lead to patient stratification for VTE preventive interventions. As VTE hemostasis involves multiple pathways, a more powerful GWAS is needed to detect combination of variants associated with VTE.
  • Global Burden of Disease Self-Harm Collaboration; Orpana, H.M.; Doku, D.T.; Meretoja, T.J.; Shiri, R.; Vasankari, T. (2019)
    Objectives To use the estimates from the Global Burden of Disease Study 2016 to describe patterns of suicide mortality globally, regionally, and for 195 countries and territories by age, sex, and Socio-demographic index, and to describe temporal trends between 1990 and 2016. Design Systematic analysis. Main outcome measures Crude and age standardised rates from suicide mortality and years of life lost were compared across regions and countries, and by age, sex, and Socio-demographic index (a composite measure of fertility, income, and education). Results The total number of deaths from suicide increased by 6.7% (95% uncertainty interval 0.4% to 15.6%) globally over the 27 year study period to 817 000 (762 000 to 884 000) deaths in 2016. However, the age standardised mortality rate for suicide decreased by 32.7% (27.2% to 36.6%) worldwide between 1990 and 2016, similar to the decline in the global age standardised mortality rate of 30.6%. Suicide was the leading cause of age standardised years of life lost in the Global Burden of Disease region of high income Asia Pacific and was among the top 10 leading causes in eastern Europe, central Europe, western Europe, central Asia, Australasia, southern Latin America, and high income North America. Rates for men were higher than for women across regions, countries, and age groups, except for the 15 to 19 age group. There was variation in the female to male ratio, with higher ratios at lower levels of Socio-demographic index. Women experienced greater decreases in mortality rates (49.0%, 95% uncertainty interval 42.6% to 54.6%) than men (23.8%, 15.6% to 32.7%). Conclusions Age standardised mortality rates for suicide have greatly reduced since 1990, but suicide remains an important contributor to mortality worldwide. Suicide mortality was variable across locations, between sexes, and between age groups. Suicide prevention strategies can be targeted towards vulnerable populations if they are informed by variations in mortality rates. © Published by the BMJ Publishing Group Limited.
  • Lempinen, Laura; Laulajainen-Hongisto, Anu; Aarnisalo, Antti A.; Bernardino, Luis; Peltola, Heikki; Pitkäranta, Anne; Pelkonen, Tuula; Jero, Jussi (2022)
    Aim Bacterial meningitis (BM) is a common cause of hearing loss in childhood. Our aim was to investigate bacterial aetiology, hearing impairment and outcome in childhood BM with vs. without otitis media (OM) in Angola. Methods Hearing was tested by auditory brainstem response in 391 (76%) children with confirmed BM. The bacteria identified from the ear discharge were compared to those from cerebrospinal fluid (CSF). The hearing findings were compared among children with vs. without OM on days 1 and 7 of hospitalization, and at follow-ups of 1, 3 and 6 month(s). Results No correlation was found in bacteriology between the ear discharge and CSF. On day 7 in hospital, hearing impairment (>40 dB) was common, regardless of whether concomitant OM or not (in 27% vs. 30%, respectively). Any hearing deficit on day 7 was associated with a higher risk of complicated or fatal clinical course (OR 2.76, CI95% 1.43-5.29, p = 0.002). Conclusion No significant difference prevailed in hearing thresholds between children with or without OM in hospital on day 7 or at later follow-ups. Any hearing impairment during hospital stay associated with a higher risk for complicated clinical course or death.
  • Litwin, Linda; Sundholm, Johnny K. M.; Meinilä, Jelena; Kulmala, Janne; Tammelin, Tuija H.; Rönö, Kristiina; Koivusalo, Saila B.; Eriksson, Johan G.; Sarkola, Taisto (2021)
    Background: Heredity and family-shared lifestyle contribute to cardiovascular risk, but the magnitude of their influence on arterial structure and function in early childhood is unknown. We aimed to assess associations between child and maternal ideal cardiovascular health, maternal subclinical atherosclerosis, and child arterial phenotype. Methods: Cross-sectional analysis of 201 mother-child pairs originating from the Finnish Gestational Diabetes Prevention Study (RADIEL) longitudinal cohort was done at child age 6.1 +/- 0.5 years with assessments of ideal cardiovascular health (BMI, blood pressure, fasting glucose, total cholesterol, diet quality, physical activity, smoking), body composition, very-high frequency ultrasound of carotid arteries (25 and 35 MHz), and pulse wave velocity. Results: We found no association between child and maternal ideal cardiovascular health but report evidence of particular metrics correlations: total cholesterol (r=0.24, P=0.003), BMI (r=0.17, P=0.02), diastolic blood pressure (r=0.15, P=0.03), and diet quality (r=0.22, P=0.002). Child arterial phenotype was not associated with child or maternal ideal cardiovascular health. In the multivariable regression explanatory model adjusted for child sex, age, systolic blood pressure, lean body mass, and body fat percentage, child carotid intima-media thickness was independently associated only with maternal carotid intima-media thickness (0.1 mm increase [95% CI 0.05, 0.21, P=0.001] for each 1 mm increase in maternal carotid intima-media thickness). Children of mothers with subclinical atherosclerosis had decreased carotid artery distensibility (1.1 +/- 0.2 vs 1.2 +/- 0.2%/10 mmHg, P=0.01) and trend toward increased carotid intima-media thickness (0.37 +/- 0.04 vs 0.35 +/- 0.04 mm, P=0.06). Conclusion: Ideal Cardiovascular Health metrics are heterogeneously associated in mother-child pairs in early childhood. We found no evidence of child or maternal Ideal Cardiovascular Health effect on child arterial phenotype. Maternal carotid intima-media thickness predicts child carotid intima-media thickness, but the underlying mechanisms remain unclear. Maternal subclinical atherosclerosis is associated with local carotid arterial stiffness in early childhood.
  • Salmi, Asta; Holmström, Miia; Toiviainen-Salo, Sanna; Kanerva, Jukka; Taskinen, Mervi (Helsingin yliopisto, 2020)
    Punasolusiirrot ovat tärkeä osa leukemiahoitoon ja kantasolusiirtoon liittyviä tukihoitoja. Runsaat punasolusiirrot altistavat rautaylimäärälle, jonka pitkäaikaisvaikutuksia kantasolusiirretyillä lapsilla on tutkittu suhteellisen vähän. Tutkimuksen tarkoituksena oli selvittää rautaylimäärän esiintyvyyttä sekä sen yhteyttä elinvaurioihin ja lapsuusiän pituuskasvuun potilailla, jotka olivat saaneet allogeenisen kantasolusiirron lapsuusiässä akuutin lymfaattisen leukemian vuoksi. Tutkimukseen osallistui 23 potilasta, jotka olivat mediaani-iältään 12.6 (vaihteluväli 7.5-21.4) vuotta. Kehon rautalastin suuruutta arvioitiin laboratoriokokeilla, sydämen ja maksan magneettikuvantamisella sekä laskemalla punasolusiirroista saadun raudan määrä. Käytimme monimuuttuja-analyysiä tutkiaksemme yhteyttä kehon rautalastin ja sydämen toiminnan, maksaentsyymitasojen, insuliiniresistenssin ja pituuskasvun välillä. Plasman ferritiini oli mediaaniarvoltaan 344 (vaihteluväli 40-3235) ng/ml ja ylitti tason 1000 ng/ml kolmella potilaalla (13%). Magneettikuvauksessa yhdellätoista potilaalla (48%) todettiin rautaylimäärä maksassa ja yhdellä potilaalla (4%) rautaylimäärä sydämessä. Sydämen magneettitutkimuksessa ejektiofraktio oli subkliinisesti alentunut kahdeksalla potilaalla (35%), mutta sydämen toiminta ei assosioitunut kehon rautalastiin. Maksaentsyymitaso korreloi punasolusiirroista saadun rautamäärän kanssa (p=0.001), mutta potilailla ei esiintynyt kohonneita maksaentsyymiarvoja tai merkkejä maksavauriosta mediaaniltaan 4.5 vuoden seurannan jälkeen. Rautalasti ei korreloinut pituuskasvun tai insuliiniresistenssin kanssa. Rautaylimäärä on yleinen akuutin leukemian vuoksi kantasoluriirretyillä lapsilla, mutta rautalastiin liittyviä elinvauriota ei esiinny nuorella iällä. Suosittelemme rautalastin arvioimista kaikille potilaille ainakin kerran kantasolusiirron jälkeisen seurannan aikana.
  • Huhtanen, Miika (Helsingin yliopisto, 2021)
    Lasten kallon murtuminen on harvinainen tapahtuma, joka voi johtaa monenlaisiin komplikaatioihin. Kuulo voi vaurioitua etenkin temporaaliluun murtumassa. Kuuloluiden tai tärykalvon vaurio tai esimerkiksi veri välikorvassa voivat aiheuttaa johtumistyyppistä kuulovikaa, jolla on melko hyvä spontaani paranemistaipumus. Mikäli sisäkorva vaurioituu, voi seurata sensorineuraalinen kuulovika. Tutkimuksessamme selvitimme alle 18-vuotiaiden kallonmurtumapotilaiden korva- ja kuulolöydöksiä. Selvitimme potilaskertomustekstejä läpikäymällä, kuinka yleinen kallonmurtuman komplikaatio kuulovaurio on ja minkä tyyppisiä kuulovikoja potilailla ilmeni. Selvitimme myös eri korvalöydösten esiintyvyyttä, kuten aivo-selkäydinnesteen vuotoa tai verenvuotoa korvasta. Vertasimme kliinisiä löydöksiä radiologisiin murtumalöydöksiin. Tässä 97 potilaan aineistossa kuulovaurio ilmeni vain niillä 51 potilaalla, joilla oli temporaaliluun murtuma. Pysyvä kuulovaurio todettiin kuudella potilaalla, joista kolmella oli OCV-tyyppinen eli sisäkorvan rakenteisiin ulottuva temporaaliluun murtuma. Näillä OCV-murtumapotilailla oli sisäkorvavaurioon sopien sensorineuraalinen tai sekamuotoinen kuulovika. Kuulo oli tutkittu 22 potilaalta, joten on mahdollista, että kaikki kuulovauriot eivät ole tulleet ilmi. Myös kliinisiä korvalöydöksiä oli lähes pelkästään temporaaliluun murtumien yhteydessä. Yleisin korvalöydös oli verenvuoto korvakäytävässä, jota oli 18 potilaalla. Huimaus ja tinnitus ovat tutkimuksemme perusteella harvinainen kallonmurtuman komplikaatio, sillä näitä ilmeni vain muutamilla potilailla ja kaikki tapaukset olivat lieviä eivätkä vaatineet hoitoa. Tutkimuksen perusteella pysyvä kuulovaurio ei ole kovin yleinen komplikaatio lasten kallonmurtuman yhteydessä. Voitaneen kuitenkin tulosten perusteella pitää perusteltuna kuulon tutkimista kertaalleen kaikilta temporaaliluun murtuman saaneilta lapsipotilailta, mutta vasta noin 1-2 kuukauden kuluttua murtumasta, jolloin merkittävä osa väliaikaisista kuulonvajauksista ehtii korjaantua seurannassa.
  • Laivuori, Tove (Helsingfors universitet, 2010)
    Tutkimuksen tarkoituksena oli kartoittaa Helsingin ja Uudenmaan sairaanhoitopiirin (HUS) sairaaloissa hoidettujen lasten kroonisten B- ja C-hepatiittien tartuntareittejä ja tartunnan riskitekijöitä sekä selvittää, miten hepatiittien seuranta ja hoito on HUS-piirissä toteutunut. Tutkimusaineisto kerättiin retrospektiivisesti strukturoitua tiedonkeruulomaketta käyttäen HUS-piirin sairaaloiden ja HUSLAB:n arkisto- ja sairauskertomustiedostoja. Potilaiden valintakriteereinä olivat alle 16 vuoden ikä ja laboratoriotutkimuksin varmennettu krooninen B- tai C-hepatiitti vuosien 1996-2006 aikana. B-hepatiittia sairastavista lapsista 61/66 oli syntynyt Suomen ulkopuolella, ja valtaosa heidän tartunnoistaan todettiin maahantulotarkastuksen yhteydessä. C-hepatiittia sairastavista lapsista 28/40 oli syntynyt Suomessa. Maahantulotarkastus sekä päihteiden käyttöön liittyvä seulonta olivat tärkeimmät diagnoosiin johtaneet tutkimustilanteet. Antiviraalisesta lääkehoidosta hyötyi 6/13 B-hepatiittia ja 2/4 C-hepatiittia sairastavista lapsista. HUS-piirissä B-hepatiittia esiintyy lähinnä maahanmuuttajataustaisilla lapsilla. Krooninen C-hepatiitti liittyi lapsen tai hänen vanhempiensa huumeiden käyttöön. Tutkimus korostaa lasten B- ja C-hepatiitin seulonta-, seuranta- ja hoitokäytäntöjä selkeyttävän ohjeistuksen tarvetta.