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Age at the introduction of solid foods during the first year and allergic sensitization at age 5 years.

https://arctichealth.org/en/permalink/ahliterature146877
Source
Pediatrics. 2010 Jan;125(1):50-9
Publication Type
Article
Date
Jan-2010
Author
Bright I Nwaru
Maijaliisa Erkkola
Suvi Ahonen
Minna Kaila
Anna-Maija Haapala
Carina Kronberg-Kippilä
Raili Salmelin
Riitta Veijola
Jorma Ilonen
Olli Simell
Mikael Knip
Suvi M Virtanen
Author Affiliation
Tampere School of Public Health, University of Tampere, Finland. bright.nwaru@uta.fi
Source
Pediatrics. 2010 Jan;125(1):50-9
Date
Jan-2010
Language
English
Publication Type
Article
Keywords
Age Factors
Breast Feeding
Cohort Studies
Confidence Intervals
Female
Finland
Follow-Up Studies
Food Hypersensitivity - immunology - prevention & control
Humans
Immunization
Immunoglobulin E - analysis - immunology
Infant
Infant Food
Infant, Newborn
Logistic Models
Male
Nutritional Requirements
Odds Ratio
Probability
Prospective Studies
Respiratory Hypersensitivity - immunology - prevention & control
Risk assessment
Time Factors
Abstract
The goal was to examine the relationship between age at the introduction of solid foods during the first year of life and allergic sensitization in 5-year-old children.
We analyzed data from the Finnish Type 1 Diabetes Prediction and Prevention nutrition study, a prospective, birth cohort study. We studied 994 children with HLA-conferred susceptibility to type 1 diabetes mellitus for whom information on breastfeeding, age at the introduction of solid foods, and allergen-specific immunoglobulin E levels at 5 years was available. The association between age at the introduction of solid foods and allergic sensitization was analyzed by using logistic regression.
The median duration of exclusive breastfeeding was 1.8 months (range: 0-10 months). After adjustment for potential confounders, late introduction of potatoes (>4 months), oats (>5 months), rye (>7 months), wheat (>6 months), meat (>5.5 months), fish (>8.2 months), and eggs (>10.5 months) was significantly directly associated with sensitization to food allergens. Late introduction of potatoes, rye, meat, and fish was significantly associated with sensitization to any inhalant allergen. In models that included all solid foods that were significantly related to the end points, eggs, oats, and wheat remained the most important foods related to sensitization to food allergens, whereas potatoes and fish were the most important foods associated with inhalant allergic sensitization. We found no evidence of reverse causality, taking into account parental allergic rhinitis and asthma.
Late introduction of solid foods was associated with increased risk of allergic sensitization to food and inhalant allergens.
PubMed ID
19969611 View in PubMed
Less detail

Agreement between parental reports and patient records in food allergies among infants and young children in Finland.

https://arctichealth.org/en/permalink/ahliterature157306
Source
J Eval Clin Pract. 2008 Dec;14(6):984-9
Publication Type
Article
Date
Dec-2008
Author
Jetta Tuokkola
Minna Kaila
Pirjo Pietinen
Olli Simell
Mikael Knip
Suvi M Virtanen
Author Affiliation
Department of Public Health, University of Helsinki, Finland. jetta.tuokkola@helsinki.fi
Source
J Eval Clin Pract. 2008 Dec;14(6):984-9
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Child, Preschool
Diabetes Mellitus, Type 1 - physiopathology
Female
Finland - epidemiology
Food Hypersensitivity - diagnosis
Humans
Infant
Infant, Newborn
Male
Parents
Questionnaires
Reproducibility of Results
Abstract
A third of parents suspect food allergy in their children. Questionnaire-based studies usually overestimate the occurrence of food allergies. The aim of the present study was to validate a study questionnaire by comparing children's use of special diets as reported by parents with patient records at the hospital.
A population-based cohort with genetic susceptibility to type 1 diabetes (15% of those screened) was recruited in the Tampere area between 1997 and 2001, and followed for development of food allergy for 3 years. Food allergies and other special diets were queried at the age of 3 years with a structured questionnaire. The hospital records of the children, whose parents had reported an elimination diet of the child, were studied to validate the parental reports of food allergies. The hospital database was also checked for the respective diagnosis codes to estimate underreporting.
Altogether, 1122 parents returned the questionnaire at the study center visit when the child was 3 years old. Food allergy was reported by 15.0% of the parents. In 10.6% of the children food allergy had been diagnosed or confirmed at the hospital. Hospital-confirmed food allergy was unreported in 0.9% of the cases. The measure of agreement between reported and hospital-confirmed food allergies, using crosstabulation with Cohen's Kappa, was within 0.71-0.88 for cow's milk allergy, 0.74-0.82 for cereal allergy and 0.66-0.86 for any reported food allergy.
We found that the validity of the questionnaire obtaining information on food allergies of infants and young children was good to excellent based on a comparison between parental reports and information obtained from patient records.
PubMed ID
18462278 View in PubMed
Less detail

Allergy from infancy to adolescence. A population-based 18-year follow-up cohort.

https://arctichealth.org/en/permalink/ahliterature149497
Source
BMC Pediatr. 2009;9:46
Publication Type
Article
Date
2009
Author
Minna Kaila
Päivi Rautava
Doris Holmberg-Marttila
Tero Vahlberg
Minna Aromaa
Matti Sillanpää
Author Affiliation
Clinical Research Centre, Turku University Hospital, Turku, Finland. minna.kaila@iki.fi
Source
BMC Pediatr. 2009;9:46
Date
2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Asthma - complications - diagnosis - epidemiology
Child
Child, Preschool
Female
Finland - epidemiology
Follow-Up Studies
Humans
Hypersensitivity - complications - diagnosis - epidemiology
Infant
Infant, Newborn
Male
Prevalence
Abstract
Anxious parents have many concerns about the future health of their atopic infants. Paediatricians and primary care practitioners need to seek knowledge on long-term outcomes in order to cope with the increasing caseload of suspected allergy and the concerns of parents. The aim of the study was to assess suspected and diagnosed allergy in infancy as predictors of allergy and asthma in adolescence.
Families expecting their first baby and making their first visit to a maternity health care clinic in 1986 were selected as the study population in a random sample. There were 1278 eligible study families. The data were provided of the children at the ages of 9 and 18 months and 3, 5, 12, 15 and 18 years by health care professionals, parents, and adolescents (themselves).
At the age of 9 months, the prevalence of allergy suspicions was distinctly higher than that of allergy diagnoses. At the age of five years suspected allergy approaches were nil, and the prevalence of diagnosed allergy was about 9%. During the adolescence, the prevalence of self-reported allergy increases steadily up to the age of 18 years, and that of asthma remains at approximately 5%. Suspected allergy at the age of 9 or 18 months and at the 5 years of age does not predict allergy at adolescence. Compared with non-allergic children, children with definite allergy at the age of 5 were over 8 times more likely to have allergy and nearly 7 times more likely to have asthma in adolescence.
An early ascertained diagnosis of allergy, but not suspicions of allergy, predicts prevailing allergy in adolescence. Efforts need to be focused on accurate diagnosis of early childhood allergies.
Notes
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PubMed ID
19630989 View in PubMed
Less detail

The association between asthma and type 1 diabetes: a paediatric case-cohort study in Finland, years 1981-2009.

https://arctichealth.org/en/permalink/ahliterature298640
Source
Int J Epidemiol. 2018 04 01; 47(2):409-416
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Date
04-01-2018
Author
Johanna Metsälä
Annamari Lundqvist
Lauri J Virta
Minna Kaila
Mika Gissler
Suvi M Virtanen
Jaakko Nevalainen
Author Affiliation
Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.
Source
Int J Epidemiol. 2018 04 01; 47(2):409-416
Date
04-01-2018
Language
English
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Asthma - complications - epidemiology
Case-Control Studies
Child
Child, Preschool
Cohort Studies
Diabetes Mellitus, Type 1 - complications - epidemiology
Female
Finland - epidemiology
Humans
Male
Proportional Hazards Models
Registries
Risk factors
Abstract
The association between asthma and type 1 diabetes, two chronic, immune-mediated diseases, has been of longstanding interest, but the evidence is still conflicting. We examined this association in a large, nationwide case-cohort study among Finnish children, using a novel statistical approach.
Among the initial cohort of all children born between 1 January 1981 and 31 December 2008, those who were diagnosed with asthma (n?=?81 473) or type 1 diabetes (n?=?9541) up to age 16 years by the end of 2009 were identified from the Central Drug Register maintained by the Social Insurance Institution of Finland. A 10% random sample from each initial birth year cohort was selected as a reference cohort (n?=?171 138). The association between asthma and type 1 diabetes was studied using a multistate modelling approach to estimate transition rates between healthy and disease states since birth. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to represent the change in the transition rate between the disease states.
After adjusting for sex and birth decade, previous diagnosis of asthma increased the risk of subsequent type 1 diabetes by 41% (95% CI: 1.28, 1.54), whereas previous diagnosis of type 1 diabetes decreased the risk of subsequent asthma by 18% (95% CI: 0.69, 0.98).
The findings of the present study imply that the association between the diseases is more complex than previously thought, and its direction depends on the sequential appearance of the diseases.
PubMed ID
29211844 View in PubMed
Less detail

Asthma programme in Finland: comparison of adult asthma referral letters in 1994 and 2001.

https://arctichealth.org/en/permalink/ahliterature168015
Source
Respir Med. 2007 Mar;101(3):595-600
Publication Type
Article
Date
Mar-2007
Author
Leena E Tuomisto
Minna Kaila
Marina Erhola
Author Affiliation
Seinajoki Central Hospital, Hanneksenrinne 7, 60220 Seinäjoki, Finland. leena.tuomisto@epshp.fi
Source
Respir Med. 2007 Mar;101(3):595-600
Date
Mar-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Asthma - epidemiology
Correspondence as Topic
Female
Finland - epidemiology
Humans
Male
Middle Aged
Program Evaluation - methods
Quality of Health Care
Referral and Consultation - standards
Abstract
The aim of the study was to evaluate the quality of asthma-related referral letters at the launch of the Asthma Programme in 1994 and 7 years later in 2001.
All referrals during 1 year (n=1121 in 1994, n=1136 in 2001) to one pulmonary department were screened in 2001. By the same inclusion criteria of asthma or suspicion of asthma, 624 letters (56% of all) from the year 1994 and 452 (40% of all) from the year 2001 were selected. The quality of study letters was assessed against the previously developed asthma referral letter criteria. Comparison of the referral letter quality in 1994 and 2001 was made.
The proportion of poor letters decreased from 63% in 1994 to 44% in 2001, while that of good letters increased from 7% to 22%. Graphics of peak flow follow-up measurements (14% vs. 40%) and spirometry with bronchodilatation test (5% vs. 32%) were included significantly more often as an attachment.
Lung functions are being measured more often in primary care, indication a more active detection of asthma. The number of asthma-related referrals in relation to all pulmonary consultation referrals decreased and their quality improved during the years of the Asthma Programme.
PubMed ID
16890421 View in PubMed
Less detail

Asthma Programme in Finland: the quality of primary care spirometry is good.

https://arctichealth.org/en/permalink/ahliterature154909
Source
Prim Care Respir J. 2008 Dec;17(4):226-31
Publication Type
Article
Date
Dec-2008
Author
Leena Tuomisto
Vesa Jarvinen
Jukka Laitinen
Marina Erhola
Minna Kaila
Pirkko Brander
Author Affiliation
Pulmonary Department, Seinajoki Central Hospital, Seinajoki, Finland. leena.tuomisto@gmail.com
Source
Prim Care Respir J. 2008 Dec;17(4):226-31
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Asthma - diagnosis - physiopathology - therapy
Female
Finland
Forced Expiratory Flow Rates - physiology
Forced Expiratory Volume - physiology
Humans
Male
Medical Audit
Middle Aged
Primary Health Care
Program Evaluation
Referral and Consultation
Reproducibility of Results
Retrospective Studies
Spirometry
Young Adult
Abstract
To assess the quality of primary care spirometry by visual inspection of the flow-volume expiratory curve and to study the quantity of clinical information provided on the spirometry report sheets.
Retrospective audit of 868 expiratory flow-volume curves referred to three pulmonary clinics assessed against five predefined quality criteria. Clinical information included on the spirometry report sheets was also collected.
Quality was good in 78% of pre-bronchodilation curves and in 80% of post-bronchodilation curves. Obtaining a sharp PEF value and full vital capacity exhalation seemed to be the critical points of measurement. Inter-rater reliability of the curve assessment was mainly good. Data on where the spirometry took place, and comments on the use of respiratory medication and patient co-operation were often lacking.
The quality of primary care spirometry was good. Adequate clinical information on the report sheets would further improve the quality of this diagnostic process.
Notes
Comment In: Prim Care Respir J. 2009 Sep;18(3):231-2; author reply 23219662322
Erratum In: Prim Care Respir J. 2009 Sep;18(3):184
PubMed ID
18830519 View in PubMed
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Attitudes toward guidelines in Finnish primary care nursing: a questionnaire survey.

https://arctichealth.org/en/permalink/ahliterature148823
Source
Worldviews Evid Based Nurs. 2009;6(4):229-36
Publication Type
Article
Date
2009
Author
Seija Alanen
Minna Kaila
Maritta Välimäki
Author Affiliation
Department of Nursing Science, University of Turku, and Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland. seija.alanen@pshp.fi
Source
Worldviews Evid Based Nurs. 2009;6(4):229-36
Date
2009
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Attitude of Health Personnel
Cross-Sectional Studies
Evidence-Based Nursing - statistics & numerical data
Female
Finland
Guideline Adherence - statistics & numerical data
Health Care Surveys
Humans
Male
Practice Guidelines as Topic
Primary Health Care - statistics & numerical data
Questionnaires
Specialties, Nursing - statistics & numerical data
Abstract
Evidence-based clinical guidelines have attracted international interest as tools for improving the quality of health care. Attitudes toward these guidelines are of great importance because attitudes are proven to be important predictors of guideline use. Attitudes are also believed to be shaped by perceptions of others, which makes the role of organizational implementation interventions interesting.
This article describes primary care nurses' attitudes toward guidelines among Finnish primary care nurses and the associations between attitudes, implementation interventions, and guideline use.
This study was a cross-sectional survey using postal questionnaires. Participants (N = 409) were primary care nurses working in outpatient services of primary health care centers in Finland. They were selected for the study from two groups of Finnish health centers representing contrasting implementation styles, for example, disseminator and implementer health centers (N = 32).
Responses were received from 327 nurses. In general, nurses' attitudes toward guidelines were positive, especially those concerning the reliability and usefulness of guidelines. The utilization of any implementation intervention included in the questionnaire was associated with more positive attitudes. In addition, nurses working in health centers that used an active implementation strategy as opposed to a disseminator strategy also felt that others in their organization rated the guidelines more positively and that guidelines were more easily available. Further, nurses who were familiar or very familiar with the guidelines had more positive attitudes toward them. Attitudes were also associated with self-reported guideline use.
The evidence-based guidelines were accepted as a reliable source of advice in patient care in Finnish primary care. It seems that implementation interventions improve attitudes toward guidelines and enhance guideline use. These interventions might also be important from another point of view; they presumably improve familiarity with guidelines, which was also associated with guideline use.
PubMed ID
19719463 View in PubMed
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Clinical decision support must be useful, functional is not enough: a qualitative study of computer-based clinical decision support in primary care.

https://arctichealth.org/en/permalink/ahliterature120106
Source
BMC Health Serv Res. 2012;12:349
Publication Type
Article
Date
2012
Author
Tiina Kortteisto
Jorma Komulainen
Marjukka Mäkelä
Ilkka Kunnamo
Minna Kaila
Author Affiliation
School of Health Sciences, University of Tampere, Tampere, 33014, Finland. tiina.kortteisto@uta.fi
Source
BMC Health Serv Res. 2012;12:349
Date
2012
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Decision Making, Computer-Assisted
Decision Support Systems, Clinical
Female
Finland
Humans
Male
Models, Theoretical
Primary Health Care
Qualitative Research
Questionnaires
Abstract
Health information technology, particularly electronic decision support systems, can reduce the existing gap between evidence-based knowledge and health care practice but professionals have to accept and use this information. Evidence is scant on which features influence the use of computer-based clinical decision support (eCDS) in primary care and how different professional groups experience it. Our aim was to describe specific reasons for using or not using eCDS among primary care professionals.
The setting was a Finnish primary health care organization with 48 professionals receiving patient-specific guidance at the point of care. Multiple data (focus groups, questionnaire and spontaneous feedback) were analyzed using deductive content analysis and descriptive statistics.
The content of the guidance is a significant feature of the primary care professional's intention to use eCDS. The decisive reason for using or not using the eCDS is its perceived usefulness. Functional characteristics such as speed and ease of use are important but alone these are not enough. Specific information technology, professional, patient and environment features can help or hinder the use.
Primary care professionals have to perceive eCDS guidance useful for their work before they use it.
Notes
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PubMed ID
23039113 View in PubMed
Less detail

Cost-effectiveness analysis of guidelines for antihypertensive care in Finland.

https://arctichealth.org/en/permalink/ahliterature160632
Source
BMC Health Serv Res. 2007;7:172
Publication Type
Article
Date
2007
Author
Neill Booth
Antti Jula
Pasi Aronen
Minna Kaila
Timo Klaukka
Katriina Kukkonen-Harjula
Antti Reunanen
Pekka Rissanen
Harri Sintonen
Marjukka Mäkelä
Author Affiliation
Tampere School of Public Health, University of Tampere, Tampere, Finland. neill.booth@uta.fi
Source
BMC Health Serv Res. 2007;7:172
Date
2007
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Antihypertensive Agents - economics - therapeutic use
Cost-Benefit Analysis
Decision Making
Drug Administration Schedule
Drug Utilization - economics - standards
Female
Finland - epidemiology
Guideline Adherence - economics
Humans
Hypertension - drug therapy - economics - epidemiology
Male
Middle Aged
Practice Guidelines as Topic
Quality-Adjusted Life Years
Registries
Abstract
Hypertension is one of the major causes of disease burden affecting the Finnish population. Over the last decade, evidence-based care has emerged to complement other approaches to antihypertensive care, often without health economic assessment of its costs and effects. This study looks at the extent to which changes proposed by the 2002 Finnish evidence-based Current Care Guidelines concerning the prevention, diagnosis, and treatment of hypertension (the ACCG scenario) can be considered cost-effective when compared to modelled prior clinical practice (the PCP scenario).
A decision analytic model compares the ACCG and PCP scenarios using information synthesised from a set of national registers covering prescription drug reimbursements, morbidity, and mortality with data from two national surveys concerning health and functional capacity. Statistical methods are used to estimate model parameters from Finnish data. We model the potential impact of the different treatment strategies under the ACCG and PCP scenarios, such as lifestyle counselling and drug therapy, for subgroups stratified by age, gender, and blood pressure. The model provides estimates of the differences in major health-related outcomes in the form of life-years and costs as calculated from a 'public health care system' perspective. Cost-effectiveness analysis results are presented for subgroups and for the target population as a whole.
The impact of the use of the ACCG scenario in subgroups (aged 40-80) without concomitant cardiovascular and related diseases is mainly positive. Generally, costs and life-years decrease in unison in the lowest blood pressure group, while in the highest blood pressure group costs and life-years increase together and in the other groups the ACCG scenario is less expensive and produces more life-years. When the costs and effects for subgroups are combined using standard decision analytic aggregation methods, the ACCG scenario is cost-saving and more effective.
The ACCG scenario is likely to reduce costs and increase life-years compared to the PCP scenario in many subgroups. If the estimated trade-offs between the subgroups in terms of outcomes and costs are acceptable to decision-makers, then widespread implementation of the ACCG scenario is expected to reduce overall costs and be accompanied by positive outcomes overall.
Notes
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PubMed ID
17958883 View in PubMed
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Cumulative prevalence of atopic eczema and related skin symptoms in a well-baby clinic: a retrospective cohort study.

https://arctichealth.org/en/permalink/ahliterature182610
Source
Pediatr Allergy Immunol. 2003 Oct;14(5):405-8
Publication Type
Article
Date
Oct-2003
Author
Elina Pia-Maria Lehtonen
Doris Holmberg-Marttila
Minna Kaila
Author Affiliation
Department of General Practice, Medical School, University of Tampere Paediatric Research Center, Tampere University Hospital and University of Tampere, Tampere, Finland. elina.pm.lehtonen@uta.fi
Source
Pediatr Allergy Immunol. 2003 Oct;14(5):405-8
Date
Oct-2003
Language
English
Publication Type
Article
Keywords
Administration, Topical
Adrenal Cortex Hormones - therapeutic use
Age Factors
Ambulatory Care
Anti-Inflammatory Agents - therapeutic use
Child Health Services
Child Welfare
Child, Preschool
Cohort Studies
Dermatitis, Atopic - diagnosis - epidemiology - therapy
Exanthema - diagnosis - epidemiology - therapy
Female
Finland - epidemiology
Food Hypersensitivity - diagnosis - epidemiology - therapy
Gestational Age
Histamine H1 Antagonists - therapeutic use
Humans
Infant
Infant Welfare
Infant, Newborn
Male
Prevalence
Retrospective Studies
Severity of Illness Index
Skin - drug effects - pathology
Treatment Outcome
Abstract
The aim of the study was to assess the frequency and treatment policy of atopic eczema (AE) and related skin symptoms including rash, redness, dryness and itch in 0- to 5-year-old children. Health records of 320 children born in 1994 were systematically studied. The main results were that 77% of children suffered from skin symptoms during their first 5 years while the cumulative prevalence of AE was 16%, and 11% of children with skin symptoms were referred to a specialist. AE and related skin symptoms were common in the first 5 years of life, and were mostly temporary and responsive to topical treatment. Well-baby clinics play a key role in the treatment of skin-symptomatic children.
PubMed ID
14641612 View in PubMed
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