Browsing by Subject "children"

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  • EFSA Panel Dietetic Products Nutri; Heinonen, Marina (2017)
    Following an application from H.J. Heinz Supply Chain Europe B.V., submitted for authorisation of a health claim pursuant to Article 14 of Regulation (EC) No 1924/2006 via the Competent Authority of the Netherlands, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver an opinion on the scientific substantiation of a health claim related to 'Nutrimune (R)' and immune defence against pathogens in the gastrointestinal (GI) tract and upper respiratory tract (URT). The food 'Nutrimune (R)' (a pasteurised cow's skim milk fermented with Lactobacillus paracasei CBA L74) which is the subject of the health claim is sufficiently characterised. The Panel considers that immune defence against pathogens in GI tract and URT is a beneficial physiological effect. One human intervention study from which conclusions can be drawn showed an effect of 'Nutrimune (R)' on immune defence against pathogens in the GI tract and the URT, and the results from one animal study could support an effect of 'Nutrimune (R)' on defence against pathogens in the GI tract. However, there were inconsistencies in the reporting of the process and criteria used for the diagnosis of URTI in the human intervention study, the results of this study have not been replicated, and no evidence was provided for a plausible mechanism by which 'Nutrimune (R)' could exert the claimed effect in vivo in humans. The Panel concludes that the evidence provided is insufficient to establish a cause and effect relationship between the consumption of 'Nutrimune (R)' and immune defence against pathogens in the gastrointestinal and upper respiratory tracts. (C) 2017 European Food Safety Authority. EFSA Journal published by John Wiley and Sons Ltd on behalf of European Food Safety Authority.
  • ARIA Working Grp; Bousquet, J; Pfaar, O; Togias, A; Haahtela, T; Toppila-Salmi, S (2019)
    Allergen immunotherapy (AIT) is a proven therapeutic option for the treatment of allergic rhinitis and/or asthma. Many guidelines or national practice guidelines have been produced but the evidence-based method varies, many are complex and none propose care pathways. This paper reviews care pathways for AIT using strict criteria and provides simple recommendations that can be used by all stakeholders including healthcare professionals. The decision to prescribe AIT for the patient should be individualized and based on the relevance of the allergens, the persistence of symptoms despite appropriate medications according to guidelines as well as the availability of good-quality and efficacious extracts. Allergen extracts cannot be regarded as generics. Immunotherapy is selected by specialists for stratified patients. There are no currently available validated biomarkers that can predict AIT success. In adolescents and adults, AIT should be reserved for patients with moderate/severe rhinitis or for those with moderate asthma who, despite appropriate pharmacotherapy and adherence, continue to exhibit exacerbations that appear to be related to allergen exposure, except in some specific cases. Immunotherapy may be even more advantageous in patients with multimorbidity. In children, AIT may prevent asthma onset in patients with rhinitis. mHealth tools are promising for the stratification and follow-up of patients.
  • Hou, Kathy (Helsingin yliopisto, 2021)
    Antidepressant use among children and adolescents has become more common in many countries. The prevalence of antidepressants is higher for boys but during adolescence girls’ have a higher antidepressant prevalence. In previous studies, the prevalence of selective serotonin re-uptake inhibitors (SSRI) has increased. The aim of this study was to investigate antidepressant use among Finnish children and adolescents aged 1–17 years during 2008–2019. The differences of antidepressant use in different age groups and genders were investigated. Furthermore, the secondary objective was to examine the trends in prevalence and costs of the five most commonly used antidepressant agents. This was a nation-wide register study. The data for this study was from Kelasto which is a statistical database maintained by the Social Insurance Institution of Finland. The extracted data was from 2008–2018 and included each persons’ age, gender, dispensed drug and costs. The data extracted was for 1–17-year-olds who had been dispensed reimbursed antidepressants from community pharmacies. The data was analyzed with Microsoft Office’s Excel program. The results were transferred in to tables and reported as prevalences by age groups, genders, antidepressants and costs. The prevalence of antidepressant use among children and adolescents was 5,0 per 1000 in 2008 and it increased to 10,3 by 2018. In the youngest age group of 1–6-year-olds, antidepressant use decreased. Antidepressant use increased slightly among 7–12-year-olds. Antidepressant use increased the most among 13–17-year-olds. 13–17-year-old girls had the higher antidepressant use prevalence throughout the study. The same group had a 2,4-fold increase in prevalence during the study period which accounted for the biggest increase in the study. The most used group of antidepressants was SSRIs. The total cost for antidepressants among children and adolescents increased by 73,7 % during the study period. The most commonly used antidepressant agents were fluoxetine, sertraline, escitalopram, mirtazapine, and venlafaxine, respectively. Fluoxetine was the most used agent throughout the study. In 2014, sertraline surpassed escitalopram and became the second most used antidepressant agent. Escitalopram and venlafaxine’s cost per user decreased during the study. The cost per user stayed stable for mirtazapine. Fluoxetine and sertraline’s cost per user increased. The Kelasto database does not include data on indications for prescriptions. The prevalence of antidepressants does not necessarily correlate directly to depression among children and adolescents because antidepressants can be used to treat other diseases. More studies need to be conducted on different off-label uses for antidepressants among children and adolescents. This study only investigated the trends on cost for the five most commonly used antidepressants. Further studies on antidepressant costs among children and adolescents are needed. Additionally, it is essential to investigate the reasons for the increase in antidepressant use among children and adolescents.
  • Chaput, Jean-Philippe; Weippert, Madyson; LeBlanc, Allana G.; Hjorth, Mads F.; Michaelsen, Kim F.; Katzmarzyk, Peter T.; Tremblay, Mark S.; Barreira, Tiago V.; Broyles, Stephanie T.; Fogelholm, Mikael; Hu, Gang; Kuriyan, Rebecca; Kurpad, Anura; Lambert, Estelle V.; Maher, Carol; Maia, Jose; Matsudo, Victor; Olds, Timothy; Onywera, Vincent; Sarmiento, Olga L.; Standage, Martyn; Tudor-Locke, Catrine; Zhao, Pei; Sjodin, Anders M.; ISCOLE Res Grp (2016)
    In order to verify if the full moon is associated with sleep and activity behaviors, we used a 12-country study providing 33,710 24-h accelerometer recordings of sleep and activity. The present observational, cross-sectional study included 5812 children ages 9-11 years from study sites that represented all inhabited continents and wide ranges of human development (Australia, Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, United Kingdom, and United States). Three moon phases were used in this analysis: full moon (4 days; reference), half moon (5-9 days), and new moon (+10-14 days) from nearest full moon. Nocturnal sleep duration, moderate -to vigorous physical activity (MVPA), light-intensity physical activity (LPA), and total sedentary time (SED) were monitored over seven consecutive days using a waist -worn accelerometer worn 24 h a day. Only sleep duration was found to significantly differ between moon phases (-5 min/night shorter during full moon compared to new moon). Differences in MVPA, LPA, and SED between moon phases were negligible and non-significant (
  • PASTURE EFRAIM Study Grp; Metzler, Stefanie; Frei, Remo; Schmausser-Hechfellner, Elisabeth; Pekkanen, Juha; Karvonen, Anne M.; Kirjavainen, Pirkka V.; Roduit, Caroline (2019)
    Background: Allergies are a serious public health issue, and prevalences are rising worldwide. The role of antibiotics in the development of allergies has repeatedly been discussed, as results remain inconsistent. The aim of this study was to investigate the association between pre-and post-natal antibiotic exposure and subsequent development of allergies (atopic dermatitis, food allergy, asthma, atopic sensitization and allergic rhinitis). Methods: A total of 1080 children who participated in a European birth cohort study (PASTURE) were included in this analysis. Data on antibiotic exposure during pregnancy and/or first year of life and allergic diseases were collected by questionnaires from pregnancy up to 6 years of age and analysed by performing logistic regressions. To take into account reverse causation, we included models, where children with diagnosis or symptoms of the respective disease in the first year of life were excluded. Results: Antibiotic exposure in utero was significantly and positively associated with atopic dermatitis and food allergy. The strongest effect was on diseases with onset within the first year of life (for atopic dermatitis: aOR 1.66, 95% CI 1.11-2.48 and for food allergy: aOR 3.01, 95% CI 1.22-7.47). Antibiotics in the first year of life were positively associated with atopic dermatitis up to 4 years (aOR 2.73, 95% CI 1.66-4.49) and also suggested a dose-response relationship. A tendency was observed with asthma between 3 and 6 years (aOR 1.65, 95% CI 0.95-2.86). Conclusions: Our findings show positive associations between exposure to antibiotics and allergies, mainly atopic dermatitis and food allergy within the first year of life, after prenatal exposure, and atopic dermatitis and asthma after post-natal exposure to antibiotics in children born in rural settings.
  • Nyman, Maria (Helsingin yliopisto, 2019)
    The material that has been analyzed for this study consists of video recordings from Natur & Språk’s [Nature & Language’s] multilingual summer camps. The aim was to study the children’s interactions and conversations at the camps, focusing on their stances towards other languages. A further aim was to study the results in relation to the National Core Curriculum for Basic Education 2014. The research questions focus on how the children in their conversations express their stances and positions towards other languages, and how this can be related to the views on language stated in the national core curriculum. The respondents were between 8 and13 years old and spoke either Swedish or Finnish while some were bilingual. The video recordings of the conversations between the children were transcribed and analyzed through thematic analysis. The transcripts were additionally analyzed through a sociolinguistic perspective by studying the children’s stance. The theoretical framework of this study was based upon stance. As a result of the analysis, four main categories were found that represented the children’s varied ways of expressing their stances towards other languages, as well as other people’s language choices and backgrounds. The children categorized themselves and others in relation to languages and/or language groups. They showed expectations regarding their own and/or other’s competence. They expressed comments or whishes about language choice and showed orientation towards language learning. These results demonstrate that multilingual practices with language encounters create opportunities for children to challenge themselves and develop their language awareness, their stances and interests in other languages. In relation to this, parallels were drawn to the views on language stated in the National Core Curriculum, with its aims concerning language awareness and cultural diversity. Therefor this study can contribute with insight in regard to the potential that multilingual practices and activities have to offer in different educational contexts. This study is written in collaboration with the project Natur & Språk [Nature & Language], a collaboration between the Finnish Society for Nature and Environment, the Finnish Nature League and the Faculty of Educational Sciences at the University of Helsinki.
  • Rautamo, Maria M; Kvarnström, Kirsi; Siven, Mia; Airaksinen, Marja; Lahdenne, Pekka Olavi; Sandler, Niklas (2020)
    The utilization of three-dimensional (3D) printing technologies as innovative manufacturing methods for drug products has recently gained growing interest. From a technological viewpoint, proof-of-concept on the performance of different printing methods already exist, followed by visions about future applications in hospital or community pharmacies. The main objective of this study was to investigate the perceptions of healthcare professionals in a tertiary university hospital about oral 3D-printed medicines for pediatric patients by means of focus group discussions. In general, the healthcare professionals considered many positive aspects and opportunities in 3D printing of pharmaceuticals. A precise dose as well as personalized doses and dosage forms were some of the advantages mentioned by the participants. Especially in cases of polypharmacy, incorporating several drug substances into one product to produce a polypill, personalized regarding both the combination of drug substances and the doses, would benefit drug treatments of several medical conditions and would improve adherence to medications. In addition to the positive aspects, concerns and prerequisites for the adoption of 3D printing technologies at hospital settings were also expressed. These perspectives are suggested by the authors to be focus points for future research on personalized 3D-printed drug products.
  • Oulasvirta, Elias; Koroknay-Pál, Päivi; Hafez, Ahmad; Elseoud, Ahmed Abou; Lehto, Hanna; Laakso, Aki (Helsingin yliopisto, 2017)
    BACKGROUND: Population-based long-term data on pediatric patients with cerebral arteriovenous malformations (AVMs) are limited. OBJECTIVE: To clarify the characteristics and long-term outcome of pediatric patients with AVM. METHODS: A retrospective analysis was performed on 805 consecutive brain AVM patients admitted to a single center between 1942 and 2014. The patients were defined as children if they were under 18 yr at admission. Children were compared to an adult cohort. Changing patterns of presentation were also analyzed by decades of admission. RESULTS: The patients comprised 127 children with a mean age of 12 yr. The mean follow-up time was 21 yr (range 0-62). Children presented more often with intracerebral hemorrhage (ICH) but less often with epilepsy than adults. Basal ganglia, cerebellar, and posterior paracallosal AVMs were more common in pediatric than in adult patients. Frontal and temporal AVMs, in contrast, were more common in adult than in pediatric patients. As the number of incidentally and epilepsy-diagnosed AVMs increased, ICH rates dropped in both cohorts. In total, 22 (82%) pediatric and 108 (39%) adult deaths were assessed as AVM related. After multivariate analysis, small AVM size and surgical treatment correlated with a favorable long-term outcome. CONCLUSION: Hemorrhagic presentation was more common in children than in adults. This was also reflected as lower prevalence of epileptic presentation in the pediatric cohort. Lobar and cortical AVM locations were less frequent, whereas deep and cerebellar AVMs were more common in children. Hemorrhagic presentation correlated negatively with incidentally and epilepsy-diagnosed AVMs. In children, AVM was a major cause of death, but in adults, other factors contributed more commonly to mortality.
  • Lyly, Annina; Kontturi, Antti; Salo, Eeva; Nieminen, Tea; Nokso-Koivisto, Johanna (2020)
    Objective Cervicofacial lymphadenitis caused by nontuberculous mycobacteria (NTM) is commonly treated with surgery or antimicrobial therapy. The aim of this study was to analyze the utility of our new blood-based diagnostic method and the treatment protocol, surgery or observation alone, in NTM lymphadenitis in children. Methods All patients under 16 years of age with cervicofacial NTM lymphadenitis diagnosed and treated at Children’s Hospital or at the Department of Otorhinolaryngology, Helsinki University Hospital (Helsinki, Finland) in 2007-2017 were retrospectively reviewed. Results Fifty-two patients, 33 (63%) of whom were girls, were included in the study. The median age at initial presentation of the NTM lymphadenitis was 2.9 years. The novel blood-test had been performed on 49 (94%) of the patients and in all of them it was indicative of NTM infection. A sample for mycobacterial culture was available from 34 patients, and Mycobacterium avium was the most common species detected. Most patients (n=33, 63%) were treated conservatively with observation alone. Of these, nine patients (27%) did not develop a skin fistula, and the lymphadenitis resolved without drainage. Conclusions The novel blood test is clinically feasible method for diagnosing childhood cervicofacial NTM lymphadenitis noninvasively. Observation alone is a good alternative to surgery, without the risk of complications.
  • Lommi, Sohvi; Viljakainen, Heli T.; Weiderpass, Elisabete; de Oliveira Figueiredo, Rejane Augusta (2020)
    Purpose To validate the Children's Eating Attitudes Test (ChEAT) in the Finnish population. Materials and methods In total 339 children (age 10-15 years) from primary schools in Southern Finland were evaluated at two time points. They answered the ChEAT and SCOFF test questions, and had their weight, height and waist circumference measured. Retesting was performed 4-6 weeks later. Test-retest reliability was evaluated using intra-class correlation (ICC), and internal consistency was examined using Cronbach's alpha coefficient (C-alpha). ChEAT was cross-calibrated against SCOFF and background variables. Factor analysis was performed to examine the factor structure of ChEAT. Results The 26-item ChEAT showed high internal consistency (C-alpha 0.79), however, a 24-item ChEAT showed even better internal consistency (C-alpha 0.84) and test-retest reliability (ICC 0.794). ChEAT scores demonstrated agreement with SCOFF scores (p <0.01). The mean ChEAT score was higher in overweight children than normal weight (p <0.001). Exploratory factor analysis yielded four factors (concerns about weight, limiting food intake, pressure to eat, and concerns about food), explaining 57.8% of the variance. Conclusions ChEAT is a valid and reliable tool for measuring eating attitudes in Finnish children. The 24-item ChEAT showed higher reliability than the 26-item ChEAT.
  • Kähkönen, Kaisa; Sandell, Mari; Rönkä, Anna; Hujo, Mika; Nuutinen, Outi (2021)
    Children’s preference for fruit and vegetables must emerge during childhood. At children’s homes, mothers and fathers influence children’s developing food preferences with their own preferences and actions. The purpose of the study was to reveal the association parents have with their children’s fruit and vegetable preferences. The study was conducted in a sample of Finnish mothers and fathers of 3–5-year-old children. The participants were recruited, and questionnaires distributed through early childhood education and care centers in 2014 and 2015. The results showed considerable variance in the children’s preferences, and were more similar with their father’s, than their mother’s preference. There was an association between mother’s and children’s preference for “strong-tasting vegetables and berries“ (p = 0.005), “sweet-tasting fruit“ (p < 0.001) and “common vegetables“ (p = 0.037). Fathers preferences associated with children’s preferences for “strong-tasting vegetables and berries“ (p = 0.003). Food neophobia decreased children’s “strong-tasting vegetables and berries“ (p < 0.001) and “sweet-tasting fruit“ (p < 0.001) preferences. The father’s more relaxed attitude towards eating decreased children’s preferences for “strong-tasting vegetables and berries“ (p = 0.031) and “sweet-tasting fruit“ (p = 0.003). These findings indicate a need for more targeted strategies for increasing children’s preferences for fruit and vegetables and highlight the importance of taking both parents equally into account.
  • Korkalainen, Milla (Helsingin yliopisto, 2018)
    Tutkielmassa tarkastellaan läheisensä menettäneiden lasten suhdetta menetettyyn sururyhmän kontekstissa. Tutkielman tehtävänä on ymmärtää, miten lasten suhde ja side menetettyyn rakkaaseen tulee esiin heidän piirustuksissaan ja kertomuksissaan, ja toisaalta, mikä rooli sururyhmällä on lasten surussa. Lapsen ja kuolleen läheisen suhdetta tutkielmassa tarkastellaan jatkuvan tunnesiteen paradigmaa soveltaen. Tunnesiteen katsotaan jatkuvan kuoleman jälkeen läheisen menettäneen ja kuolleen välillä. Suhde läheisen menettäneen ja kuolleen läheisen välillä kuitenkin muuttuu elämän mittaan, sillä surun ajatellaan olevan elämänmittainen kokemus. Tutkielman aineisto koostuu neljästä eri materiaalista: visuaalisesta (piirustukset), kirjoitetusta (lasten taustatiedot), puhutusta (haastattelut) ja osallistuvasta havainnoinnista sururyhmässä. Tutkimusaihetta lähestytään sekä visuaalis-narrativiisella otteella viiden latenssi-ikäisen (9−11 vuotiaan) lapsen piirustuksien ja kertomusten kautta sekä temaattisnarratiivisella näkökulmalla sururyhmän ohjaajien haastattelun perusteella. Visuaalis-narratiivisen analyysin pohjalta nousee esiin kolme erilaista suhdetta ja sidettä menetettyyn: erottamaton side, muuttuva side ja tunnusteleva side. Nämä erilaiset tunnesiteet vaikuttavat olevan jatkuvan neuvottelun alla. Ne voivat muuttua ajan mittaan lapsen kasvaessa ja kehittyessä, ja ovat sidoksissa elämän sosiaaliseen ja kulttuuriseen kontekstiin latenssi-ikäisen lapsen tunnustellessa omaa rooliaan yhteiskunnassa. Temaattis-narratiivisesta analyysistä nousevien teemojen perusteella sururyhmässä menetetyt läheiset tulevat muistelun kautta näkyviksi ja muistelun pohjalta rakentuu side menetettyyn, vaikkakaan tuonpuoleisuuden ajatukset eivät ryhmässä nouse esiin. Sururyhmä antaa apukeinoja ja voimavaroja erityisesti ryhmän tarjoaman vertaistuen kautta surun kohtaamiseen, joka saattaa olla monelle ammattilaiselle haasteellista. Lopulta, surun sanoittaminen ja surun kokonaisvaltaisuuden käsittäminen sekä tulevaisuuden näkeminen merkityksellisenä tarjoavat surun kanssa eläville lapsille voimavaroja tulevaan. Näin ollen tutkielman tulokset osoittavat sururyhmän olevan tarpeellinen surun käsittelyssä. Tutkimuksen perusteella vaikuttaa siltä, että jatkotutkimuksena olisi hyödyllistä yhdistää kriisikeskusten ja seurakunnan lasten sururyhmätoiminta sekä tehdä pitkittäistutkimusta, sillä se mahdollistaisi suhteen ja tunnesiteen tarkastelun pidemmällä aikavälillä.
  • Lassmann-Klee, Paul G.; Lehtimäki, Lauri; Lindholm, Tuula; Malmberg, Leo Pekka; Sovijärvi, Anssi R. A.; Piirilä, Päivi Liisa (2019)
    In clinical practice, assessment of expiratory nitric oxide (F-ENO) may reveal eosinophilic airway inflammation in asthmatic and other pulmonary diseases. Currently, measuring of F-ENO is standardized to exhaled flow level of 50 ml s(-1), since the expiratory flow rate affects the F-ENO results. To enable the comparison of F-ENO measured with different expiratory flows, we firstly aimed to establish a conversion model to estimate F-ENO at the standard flow level, and secondly, validate it in five external populations. F-ENO measurements were obtained from 30 volunteers (mixed adult population) at the following multiple expiratory flow rates: 50, 30, 100 and 300 ml s(-1), after different mouthwash settings, and a conversion model was developed. We tested the conversion model in five populations: healthy adults, healthy children, and patients with COPD, asthma and alveolitis. F-ENO conversions in the mixed adult population, in healthy adults and in children, showed the lowest deviation between estimated FENO from 100 ml s(-1) and measured F-ENO at 50 mL s(-1): -0 center dot 28 ppb, -0 center dot 44 ppb and 0 center dot 27 ppb, respectively. In patients with COPD, asthma and alveolitis, the deviation was -1 center dot 16 ppb, -1 center dot 68 ppb and 1 center dot 47 ppb, respectively. We proposed a valid model to convert F-ENO in healthy or mixed populations, as well as in subjects with obstructive pulmonary diseases and found it suitable for converting F-ENO measured with different expiratory flows to the standard flow in large epidemiological data, but not on individual level. In conclusion, a model to convert F-ENO from different flows to the standard flow was established and validated.
  • Burman, Janne; Elenius, Varpu; Lukkarinen, Heikki; Kuusela, Tom; Mäkelä, Mika J.; Kesti, Olli; Väätäinen, Katri; Maunula, Maria; Remes, Sami; Jartti, Tuomas (2020)
    Background and Aim The eucapnic voluntary hyperventilation (EVH) testing is a diagnostic tool for diagnostics of exercise-induced bronchoconstriction; while the testing has become more common among children, data on the test's feasibility among children remain limited. Our aim was to investigate EVH testing feasibility among children, diagnostic testing cut-off values, and which factors affect testing outcomes. Methods We recruited 134 patients aged 10-16 years with a history of exercise-induced dyspnoea and 100 healthy control children to undergo 6-min EVH testing. Testing feasibility was assessed by the children's ability to achieve >= 70% of the target minute ventilation of 30 times forced expiratory volume in 1 s (FEV1). Bronchoconstriction was assessed as a minimum of 8%, 10%, 12%, 15% or 20% fall in FEV1. Patient characteristics were correlated with EVH outcomes. Results Overall, 98% of the children reached >= 70%, 88% reached >= 80%, 79% reached >= 90% and 62% reached >= 100% of target ventilation in EVH testing; of children with a history of exercise-induced dyspnoea, the decline percentages were as follows: 24% (>= 8% fall), 17% (>= 10% fall), 10% (>= 12% fall), 6% (>= 15% fall) and 5% (>= 20% fall) in FEV1, compared to 11%, 4%, 3%, 1% and 0% among the healthy controls, respectively. Healthy controls and boys performed testing at higher ventilation rates (p <.05). Conclusion Eucapnic voluntary hyperventilation testing is feasible among children aged 10-16 years and has diagnostic value in evaluating exercise-induced dyspnoea among children. A minimum 10% fall in FEV1 is a good diagnostic cut-off value. Disease status appears to be important covariates.
  • Vuorio, Alpo; Kovanen, Petri T. (2018)
    This review covers the current knowledge about plant stanol esters as a dietary treatment option for heterozygous familial hypercholesterolemia (he-FH) children. The current estimation of the prevalence of he-FH is about one out of 200-250 persons. In this autosomal dominant disease, the concentration of plasma low-density lipoprotein cholesterol (LDL-C) is strongly elevated since birth. Quantitative coronary angiography among he-FH patients has revealed that stenosing atherosclerotic plaques start to develop in he-FH males in their twenties and in he-FH females in their thirties, and that the magnitude of the plaque burden predicts future coronary events. The cumulative exposure of coronary arteries to the lifelong LDL-C elevation can be estimated by calculating the LDL-C burden (LDL-C level x years), and it can also be used to demonstrate the usefulness of dietary stanol ester treatment. Thus, when compared with untreated he-FH patients, the LDL-C burden of using statin from the age of 10 is 15% less, and if he-FH patients starts to use dietary stanol from six years onwards and a combination of statin and dietary stanol from 10 years onwards, the LDL-C burden is 21% less compared to non-treated he-FH patients. We consider dietary stanol treatment of he-FH children as a part of the LDL-C-lowering treatment package as safe and cost-effective, and particularly applicable for the family-centered care of the entire he-FH families.
  • Walsh, Hanna (Helsingin yliopisto, 2020)
    Introduction Kenya has recently acquired lower-middle income country status and is facing the triple burden of malnutrition. There is a shortage of data on food intake habits of children and adolescents especially in the rapidly changing urban environments. To be able to reliably measure food intake, one must be able to accurately estimate food portion sizes. Children’s ability to recall portion sizes consumed can vary widely. When a photographic food atlas designed for children with applicable portions is used, it can improve children’s estimation of food portions. Objectives The aim of this study was to develop a photographic food atlas to be used in assessing portion sizes among Kenyan adolescents aged 9-14 years living in urban areas, to support a quantitative 7-day food frequency questionnaire. The second aim was to assess the usability of the atlas amongst 9-14-year-olds and professionals working in the field of nutrition. Methodology A steering group of Finnish and Kenyan nutritionists was formed to oversee the development of the atlas. Literature and other official documents were reviewed to identify the most commonly consumed foods among 9-14-year-old Kenyans. To obtain weighed portion size data, participants were recruited in Nairobi sub-counties Embakasi Central and Langata to represent low- and middle-socioeconomic status respectively. Twenty-one participants aged 9-14 years participated in the weighing of portion sizes, food portions from street markets were also weighed. Three portion sizes (A, B, C) were calculated for most of the 88 food items in the photographic food atlas. Portion B was the average of all weighed portion sizes, portion A was half of B, and portion C was one and half times B. Cooking demonstrations were arranged with the families of participants and the food portions were weighed out and photographed. A photographic food atlas was compiled, and its usability was tested amongst eight adolescents and four nutrition professionals. The usability survey consisted of Likert scale and open-end questions to ascertain acceptability of the atlas. Verbal feedback and observations were also recorded. Results Based on the usability survey, the photographic food atlas received the Usability Score of “OK” and “Good” from adolescents and nutrition professionals respectively. All eight adolescents agreed that the atlas helped them recall portion sizes, but half disagreed and one was unsure whether they could use the atlas on their own. All four professionals agreed they would use the atlas in their work, but all found the quality of photographs poor. Two adolescents disagreed when asked if the portion sizes were small enough and one disagreed when asked if the portion sizes were large enough. However, all professionals agreed that portion sizes were reasonable for the age group. Professionals gave verbal suggestions on improvements, for example, which foods were missing, how to adjust layout as well as the shapes of portion sizes. Conclusion An atlas consisting of 88 most commonly consumed Kenyan foods was developed based on weighed portion sizes of 9-14-year-old Kenyans. The shapes of portion sizes as well as range of portion sizes were crucial for its usability. Poor picture quality hampered recognition of pictures. Clear instructions and explanation of the purpose of the atlas were crucial. A second version of the atlas was developed based on the feedback. The updated atlas, including 173 food items, was used in a cross-sectional study in Nairobi. Further research is recommended to validate the photographic food atlas in order to identify the possible bias it may introduce to portion size estimation.
  • Lammi, Anne; Arikoski, Pekka; Hakulinen, Arja; Schwab, Ursula; Uusitupa, Matti; Heinonen, Seppo; Savilahti, Erkki; Kinnunen, Tuure; Ilonen, Jorma (2016)
    Objective. The development of gliadin-specific antibody and T-cell responses were longitudinally monitored in young children with genetic risk for celiac disease (CD). Material and methods. 291 newborn children positive for HLA-DQB1*02 and -DQA1*05 alleles were followed until 3-4 years of age by screening for tissue transglutaminase autoantibodies (tTGA) by using a commercial ELISA-based kit and antibodies to deamidated gliadin peptide (anti-DGP) by an immunofluorometric assay. Eighty-five of the children were also followed for peripheral blood gliadin-specific CD4(+) T-cell responses by using a carboxyfluorescein diacetate succinimidyl ester-based in vitro proliferation assay. Results. The cumulative incidence of tTGA seropositivity during the follow-up was 6.5%. CD was diagnosed in nine of the tTGA-positive children (3.1%) by duodenal biopsy at a median 3.5 years of age. All of the children with confirmed CD were both IgA and IgG anti-DGP positive at the time of tTGA seroconversion and in over half of the cases IgG anti-DGP positivity even preceded tTGA seroconversion. Peripheral blood T-cell responses to deamidated and native gliadin were detected in 40.5% and 22.2% of the children at the age of 9 months and these frequencies decreased during the follow-up to the levels of 22.2% and 8.9%, respectively. Conclusions. Anti-DGP antibodies may precede tTGA seroconversion and thus frequent monitoring of both tTGA and anti-DGP antibodies may allow earlier detection of CD in genetically susceptible children. Peripheral blood gliadin-specific T-cell responses are relatively common in HLA-DQ2-positive children and are not directly associated with the development of CD.
  • Suomi, J.; Tuominen, P.; Niinistö, S.; Virtanen, S.M.; Savela, K. (2019)
    AIMS Agriculture and Food 2019: Vol.4, No. 3, p. 778 - 793
    The exposure of Finnish 1-year-olds to cadmium, lead and inorganic arsenic via food and drinking water was determined. The food consumption data consisted of 3-day records from 1010 children aged 12 months, collected during 2002 to 2005 in Southwest Finland. One fifth of these children were still breastfed when the consumption data were collected and their exposure was assessed separately from the non-breastfed children. The heavy metal concentration data in foodstuffs were mainly analysis results from national authorities and they were mostly from the years 2005 to 2012. Dietary exposure assessment was performed probabilistically using the online program MCRA. With middle bound estimates, 89% of the non-breastfed and 56% of the breastfed children exceeded the tolerable weekly intake of cadmium. The benchmark dose (BMDL01) for neurological damage caused by lead was exceeded by 60% of the non-breastfed and by 50% of the breastfed children, while the lowest BMDL01 for cancer risk increase caused by inorganic arsenic was exceeded by 77% of the non-breastfed and by 61% of the breastfed children. The assessment did not include the unknown heavy metal exposure from breast milk. Heavy metal exposure differences between the boys and the girls were also assessed. Breastfed girls had significantly higher heavy metal exposure relative to their bodyweight than the breastfed boys, while in the non-breastfed group there were no differences by sex.
  • Kohva, E.; Miettinen, P. J.; Taskinen, S.; Hero, M.; Tarkkanen, A.; Raivio, T. (2018)
    Background: We describe the phenotypic spectrum and timing of diagnosis and management in a large series of patients with disorders of sexual development (DSD) treated in a single pediatric tertiary center. Methods: DSD patients who had visited our tertiary center during the survey period (between 2004 and 2014) were identified based on an ICD-10 inquiry, and their phenotypic and molecular genetic findings were recorded from patient charts. Results: Among the 550 DSD patients, 53.3% had 46,XY DSD; 37.1% had sex chromosome DSD and 9.6% had 46,XX DSD. The most common diagnoses were Turner syndrome (19.8%, diagnosed at the mean age of 4.7 +/- 5.5 years), Klinefelter syndrome (14.5%, 6.8 +/- 6.2 years) and bilateral cryptorchidism (23.1%). Very few patients with 46,XY DSD (7%) or 46,XX DSD (21%) had molecular genetic diagnosis. The yearly rate of DSD diagnoses remained stable over the survey period. After the release of the Nordic consensus on the management of undescended testes, the age at surgery for bilateral cryptorchidism declined significantly (P <0.001). Conclusions: Our results show that (i) Turner syndrome and Klinefelter syndrome, the most frequent single DSD diagnoses, are still diagnosed relatively late; (ii) a temporal shift was observed in the management of bilateral cryptorchidism, which may favorably influence patients' adulthood semen quality and (iii) next-generation sequencing methods are not fully employed in the diagnostics of DSD patients.
  • Pöllänen, Petra M.; Ryhänen, Samppa J.; Toppari, Jorma; Ilonen, Jorma; Vähäsalo, Paula; Veijola, Riitta; Siljander, Heli; Knip, Mikael (2020)
    Context: We set out to characterize the dynamics of islet autoantibodies over the first 15 years of life in children carrying genetic susceptibility to type 1 diabetes (T1D). We also assessed systematically the role of zinc transporter 8 autoantibodies (ZnT8A) in this context. Design: HLA-predisposed children (N = 1006, 53.0% boys) recruited from the general population during 1994 to 1997 were observed from birth over a median time of 14.9 years (range, 1.9-15.5 years) for ZnT8A, islet cell (ICA), insulin (IAA), glutamate decarboxylase (GADA), and islet antigen-2 (IA-2A) antibodies, and for T1D. Results: By age 15.5 years, 35 (3.5%) children had progressed to T1D. Islet autoimmunity developed in 275 (27.3%) children at a median age of 7.4 years (range, 0.3-15.1 years). The ICA seroconversion rate increased toward puberty, but the biochemically defined autoantibodies peaked at a young age. Before age 2 years, ZnT8A and IAA appeared commonly as the first autoantibody, but in the preschool years IA-2A- and especially GADA-initiated autoimmunity increased. Thereafter, GADA-positive seroconversions continued to appear steadily until ages 10 to 15 years. Inverse IAA seroconversions occurred frequently (49.3% turned negative) and marked a prolonged delay from seroconversion to diagnosis compared to persistent IAA (8.2 vs 3.4 years; P = .01). Conclusions: In HLA-predisposed children, the primary autoantibody is characteristic of age and might reflect the events driving the disease process toward clinical T1D. Autoantibody persistence affects the risk of T1D. These findings provide a framework for identifying disease subpopulations and for personalizing the efforts to predict and prevent T1D.