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.
  • Hilska, Matias; Leppänen, Mari; Vasankari, Tommi; Aaltonen, Sari; Raitanen, Jani; Räisänen, Anu M.; Steffen, Kathrin; Forsman, Hannele; Konttinen, Niilo; Kujala, Urho M.; Pasanen, Kati (2021)
  • 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.
  • Palmu, Tiina; Lehtonen, Jussi; Korhonen, Laura; Virtanen, Suvi M.; Niemelä, Onni; Toppari, Jorma; Ilonen, Jorma; Veijola, Riitta; Knip, Mikael; Laitinen, Olli H.; Lönnrot, Maria; Hyöty, Heikki (2021)
    Background Enterovirus (EV) infections, being among the most prevalent viruses worldwide, have been associated with reduced risk of allergic diseases. We sought to determine the association between EVs and allergic sensitization and disease in early childhood. Methods The study was carried out in a nested case-control setting within a prospective birth cohort in Finland. We included 138 case children who had specific IgE (s-IgE) sensitization at the age of 5 years and 138 control children without s-IgE sensitization. Allergic disease was recorded at study visits and identified with the ISAAC questionnaire. We screened for the presence of serotype-specific antibodies against 41 EVs at 1-5 years of age and assessed their association with allergic sensitization and disease. Results The overall number of EV infections did not differ between s-IgE-sensitized children and non-sensitized control children. However, there was a tendency of case children with an allergic disease having less EV infections than their controls. This observation was statistically significant for species A EVs in case children with atopic dermatitis vs. control children: OR 0.6 (95% CI 0.36-0.99), p = .048. Conclusion This study supports the evidence that EV exposure and development of allergic disease are inversely associated. Interestingly, the inverse association was not observed for bare atopic IgE sensitization, but for IgE sensitization coupled with clinical atopic disease. This suggests that environmental factors influencing IgE sensitization may differ from those influencing progression to clinical allergic disease.
  • Haapala, Eero A.; Gao, Ying; Lintu, Niina; Väistö, Juuso; Vanhala, Anssi; Tompuri, Tuomo; Lakka, Timo A.; Finni, Taija (2021)
    We investigated the associations of motor competence (MC) with peak oxygen uptake (V.O-2peak), peak power output (W-max), and body fat percentage (BF%) and whether measures of cardiorespiratory fitness (CRF) modify the associations between MC and BF%. Altogether, 35 children (aged 7-11 years) in the CHIPASE Study and 297 in PANIC Study (aged 9-11 years) participated in the study. MC was assessed using KTK and modified Eurofit tests. V.O-2peak and W-max were measured by maximal exercise test on a cycle ergometer and scaled by lean mass (LM) or body mass (BM). BF% was assessed either by bioimpedance (CHIPASE) or DXA (PANIC). MC was not associated with V.O-2peak/LM (standardized regression coefficient beta = 0.073-0.188, P > .083). V.O-2peak/BM and W-max/LM and BM were positively associated with MC (beta = 0.158-0.610, P < .05). MC ( = -0.186 to -0.665, P < .01), but not V.O-2peak/LM ( = -0.169-0.035, P > .381), was inversely associated with BF%. Furthermore, the associations of MC with BF% were not modified by CRF. These results suggest that the positive associations between MC and CRF scaled by BM are a function of adiposity and not peak aerobic power and that CRF is not modifying factor in the associations of MC and BF%.
  • Niinistö, Sari; Miettinen, Maija E.; Cuthbertson, David; Honkanen, Jarno; Hakola, Leena; Autio, Reija; Erlund, Iris; Arohonka, Petra; Vuorela, Arja; Härkönen, Taina; Hyöty, Heikki; Krischer, Jeffrey P.; Vaarala, Outi; Knip, Mikael; Virtanen, Suvi M. (2022)
    AimsAltered immune functions as well as fatty acid intake and status have been associated with the development of type 1 diabetes. We aimed to study the relationship between fatty acids and immunological markers in young children with increased genetic risk for type 1 diabetes in order to define putative mechanisms related to development of islet autoimmunity. MethodsSerum samples for fatty acid and immunological marker measurements were obtained in the Trial to Reduce IDDM in the Genetically at Risk (TRIGR) ancillary study (Divia) from children born between 2002 and 2007 in 15 countries. Case children (n = 95) were defined as having repeated positivity for at least two out of four diabetes-associated autoantibodies. For each case child, control children were selected matched for country and date of birth (n = 173). Serum fatty acids and immunological markers were measured from cord serum and at the age of 6 and 12 months. Spearman correlation coefficients were calculated between fatty acids and immunological markers. ResultsCorrelations between circulating fatty acids and immunological markers were different in case children who developed islet autoimmunity than in control children already at birth continuing across the first year of life. In case children, saturated fatty acids (SFAs) showed stronger correlations with immunological markers, while in controls, polyunsaturated fatty acids (PUFAs) showed stronger correlations. ConclusionsIn cases, SFAs were associated with several immunological markers (CXCL10, IL-6, IL-9, IL-17, and CM-CSF) previously linked to the type 1 diabetes disease process. Findings indicate that fatty acids could have immunomodulatory potential in the early phase of the disease development, although causality between fatty acids and the immunological pathways remains to be explored. Trial registry numberNCT00179777
  • 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.
  • Leppänen, Marja H.; Lehtimäki, Aku-Ville; Roos, Eva; Viljakainen, Heli (2022)
    Body image dissatisfaction is a concern for adolescents' mental and physical well-being, and the role of body mass index (BMI) and physical activity (PA) in it is still unclear. This study investigates the associations of BMI and PA with body image, separately for boys and girls, in a large sample of Finnish adolescents. We also examine the associations of BMI with body image in varying PA levels. A total of 10,496 adolescents (girls 52.6%) were included in the analyses. Body image was assessed using a pictorial tool, and categorized as wishing for a smaller body, being satisfied, and wishing for a bigger body. BMI (kg/m(2)) was categorized as thin, normal weight, and overweight/obese. Self-reported PA was divided into three similar-sized categories as low, moderate, and high PA levels. Adjusted ordinal regression analyses were conducted. Our results show that adolescents with thinness had higher odds of wishing for a bigger body compared to their normal-weight peers, while adolescents with overweight/obesity had smaller odds of wishing for a bigger body. Adolescents in low and middle PA levels had lower odds of wishing for a bigger body compared to adolescents in the high PA level. Yet, the PA level modified the associations between BMI and body image, especially in adolescents with thinness and more so in girls than in boys. These findings highlight the need to pay attention to healthy weight gain and PA in adolescents to support their body image satisfaction.
  • 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.
  • Byman, Jenny; Kumpulainen, Kristiina; Wong, Chin-Chin; Renlund, Jenny (2022)
    In this study, we investigate how digital storying creates opportunities for children to attend to their emotional experiences in and about nature. Following relational ontology and socio-cultural theorising, we focus our analysis on the temporal–spatial entanglements of children's emotional experiences. Our inquiry draws on a case study of two children at a Finnish primary school. Liam and Vera engaged in digital storying in their local forest using an augmented storycrafting app, MyAR Julle. The data were collected during two storying workshops by means of observational field notes, video recordings, interviews with the children and digital artefacts. The results illustrate how engaging in the narrative plot of a fictitious augmented character invited the children to create necessary open-endedness in the activity which further stimulated their storying. The children's experiences were imbued with emotions and distributed across human and non-human actors. The children's digital storying not only communicated their personal emotional experiences in local surroundings, but was also grounded in broader societal narratives, such as climate change and forest conservation, with considerations of the future of the planet. The results suggest how digital storying offers a pedagogical method for early environmental education that builds on children's emotional experiences.
  • 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.
  • Lezo, Antonella; Diamanti, Antonella; Marinier, Evelyne M.; Tabbers, Merit; Guz-Mark, Anat; Gandullia, Paolo; Spagnuolo, Maria I.; Protheroe, Sue; Peretti, Noel; Merras-Salmio, Laura; Hulst, Jessie M.; Kolacek, Sanja; Ee, Looi C.; Lawrence, Joanna; Hind, Jonathan; D'Antiga, Lorenzo; Verlato, Giovanna; Pukite, Ieva; Di Leo, Grazia; Vanuytsel, Tim; Doitchinova-Simeonova, Maryana K.; Ellegard, Lars; Masconale, Luisa; Maiz-Jimenez, Maria; Cooper, Sheldon C.; Brillanti, Giorgia; Nardi, Elena; Sasdelli, Anna S.; Lal, Simon; Pironi, Loris (2022)
    Background: The European Society for Clinical Nutrition and Metabolism database for chronic intestinal failure (CIF) was analyzed to investigate factors associated with nutritional status and the intravenous supplementation (IVS) dependency in children. Methods: Data collected: demographics, CIF mechanism, home parenteral nutrition program, z-scores of weight-for-age (WFA), length or height-for-age (LFA/HFA), and body mass index-for-age (BMI-FA). IVS dependency was calculated as the ratio of daily total IVS energy over estimated resting energy expenditure (%IVSE/REE). Results: Five hundred and fifty-eight patients were included, 57.2% of whom were male. CIF mechanisms at age 1-4 and 14-18 years, respectively: SBS 63.3%, 37.9%; dysmotility or mucosal disease: 36.7%, 62.1%. One-third had WFA and/or LFA/HFA z-scores < -2. One-third had %IVSE/REE > 125%. Multivariate analysis showed that mechanism of CIF was associated with WFA and/or LFA/HFA z-scores (negatively with mucosal disease) and %IVSE/REE (higher for dysmotility and lower in SBS with colon in continuity), while z-scores were negatively associated with %IVSE/REE. Conclusions: The main mechanism of CIF at young age was short bowel syndrome (SBS), whereas most patients facing adulthood had intestinal dysmotility or mucosal disease. One-third were underweight or stunted and had high IVS dependency. Considering that IVS dependency was associated with both CIF mechanisms and nutritional status, IVS dependency is suggested as a potential marker for CIF severity in children.
  • Rehn, Marius; Chew, Michelle S.; Olkkola, Klaus T.; Sigurosson, Martin Ingi; Yli-Hankala, Arvi; Moller, Morten Hylander (2021)
    Background The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. The guideline can serve as a useful decision aid for clinicians managing children with suspected and confirmed septic shock and sepsis-associated organ dysfunction.
  • 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.