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Adenoidectomy versus chemoprophylaxis and placebo for recurrent acute otitis media in children aged under 2 years: randomised controlled trial.

https://arctichealth.org/en/permalink/ahliterature30523
Source
BMJ. 2004 Feb 28;328(7438):487
Publication Type
Article
Date
Feb-28-2004
Author
Petri Koivunen
Matti Uhari
Jukka Luotonen
Aila Kristo
Risto Raski
Tytti Pokka
Olli-Pekka Alho
Author Affiliation
University of Oulu, PO Box 5000, FIN-90014, Finland. petri.koivunen@ppshp.fi
Source
BMJ. 2004 Feb 28;328(7438):487
Date
Feb-28-2004
Language
English
Publication Type
Article
Keywords
Adenoidectomy - methods
Anti-Infective Agents - therapeutic use
Comparative Study
Double-Blind Method
Female
Humans
Infant
Male
Middle Ear Ventilation - methods
Otitis Media - prevention & control - surgery
Recurrence
Research Support, Non-U.S. Gov't
Sulfisoxazole - therapeutic use
Treatment Failure
Abstract
OBJECTIVE: To evaluate the efficacy of adenoidectomy compared with long term chemoprophylaxis and placebo in the prevention of recurrent acute otitis media in children aged between 10 months and 2 years. DESIGN: Randomised, double blind, controlled trial. SETTING: Oulu University Hospital, a tertiary centre in Finland. PARTICIPANTS: 180 children aged 10 months to 2 years with recurrent acute otitis media. INTERVENTION: Adenoidectomy, sulfafurazole (sulphisoxazole) 50 mg/kg body weight, given once a day for six months or placebo. Follow up lasted for two years, during which time all symptoms and episodes of acute otitis media were recorded. MAIN OUTCOME MEASURES: Intervention failure (two episodes in two months or three in six months or persistent effusion) during follow up, number of episodes of acute otitis media, number of visits to a doctor because of any infection, and antibiotic prescriptions Number of prescriptions, and days with symptoms of respiratory infection. RESULTS: Compared with placebo, interventions failed during both the first six months and the rest of the follow up period of 24 months similarly in the adenoidectomy and chemoprophylaxis groups (at six months the differences in risk were 10% (95% confidence interval -9% to 29%) and 18% (-2% to 38%), respectively). No significant differences were observed between the groups in the numbers of episodes of acute otitis media, visits to a doctor, antibiotic prescriptions, and days with symptoms of respiratory infection. CONCLUSIONS: Adenoidectomy, as the first surgical treatment of children aged 10 to 24 months with recurrent acute otitis media, is not effective in preventing further episodes. It cannot be recommended as the primary method of prophylaxis.
PubMed ID
14769785 View in PubMed
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Aetiology of neonatal conjunctivitis evaluated in a population-based setting.

https://arctichealth.org/en/permalink/ahliterature288228
Source
Acta Paediatr. 2018 Jan 18;
Publication Type
Article
Date
Jan-18-2018
Author
Minna Honkila
Marjo Renko
Irma Ikäheimo
Tytti Pokka
Matti Uhari
Terhi Tapiainen
Source
Acta Paediatr. 2018 Jan 18;
Date
Jan-18-2018
Language
English
Publication Type
Article
Abstract
Our aim was to study prospectively the aetiology of neonatal conjunctivitis in a population-based setting.
Altogether 173 neonates with clinical conjunctivitis aged on average 20 (SD 10) days were recruited from child welfare clinics in Oulu, Finland, in 2010-2015. Conjunctival specimens were collected from 167 neonates for multiplex polymerase chain reaction to detect 16 respiratory viruses, from 163 for polymerase chain reaction to detect Chlamydia trachomatis and Neisseria gonorrhoeae and from 160 for bacterial culture studies. The cases were followed up until the age of 18 months.
Viral conjunctivitis was diagnosed in 8/167 (4.8%; 95% CI 2.1-9.2%), chlamydial or gonococcal conjunctivitis in 0/163 cases (0%; 95% CI 0-2.2%) and other bacterial conjunctivitis in 58/160 (36%; 95% CI 29-44%). Rhinovirus was found at the ocular site in 4/167 (2.4%) neonates, adenovirus in 3/167 (1.8%) and bocavirus in 1/167 (0.6%). The most commonly isolated bacteria included Staphylococcus aureus (16%), Moraxella catarrhalis (9.4%) and Streptococcus pneumoniae (3.1%). None of these pathogens was associated with the 4/173 (2.3%) cases later operated on for persistent nasolacrimal duct obstruction.
Chlamydia trachomatis was a rare pathogen in neonatal conjunctivitis in a population-based setting, but respiratory viruses were detected more frequently than indicated earlier.
PubMed ID
29345007 View in PubMed
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The changing pattern of pediatric both-bone forearm shaft fractures among 86,000 children from 1997 to 2009.

https://arctichealth.org/en/permalink/ahliterature116006
Source
Eur J Pediatr Surg. 2013 Aug;23(4):289-96
Publication Type
Article
Date
Aug-2013
Author
Juha-Jaakko Sinikumpu
Tytti Pokka
Willy Serlo
Author Affiliation
Clinic of Pediatric Surgery and Orthopedics, Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland. juha-jaakko.sinikumpu@ppshp.fi
Source
Eur J Pediatr Surg. 2013 Aug;23(4):289-96
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Child
Child, Preschool
Female
Finland - epidemiology
Follow-Up Studies
Forearm Injuries - surgery
Fracture Fixation, Intramedullary - methods
Humans
Incidence
Infant
Infant, Newborn
Male
Radius Fractures - epidemiology - surgery
Reoperation
Risk factors
Treatment Outcome
Ulna Fractures - epidemiology - surgery
Abstract
Forearm fractures are common among children. Unlike most pediatric fractures, there is a risk of unsatisfactory results in forearm shaft fractures. The healing of a tubular bone is most unlikely in the diaphysis far away from the metaphyseal zones. The treatment of forearm shaft fractures is evolving. The purpose of the study was to analyze the pattern of forearm shaft fractures and their treatment in a population of children in recent years.
All the children (from 0 to 16 years) with a both-bone forearm shaft fracture (AO-segment 22-D) during the years 1997 to 2009 in a catchment area of about 86,000 children were included in this population-based study. There were 291 fractures in all. The age-related annual incidences, background factors, seasonal variation, injury types, treatment, reoperations, and short-term outcome were determined.
The incidence of all forearm shaft fractures increased threefold in 1997 to 2009 (p
PubMed ID
23444075 View in PubMed
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Childhood Urinary Tract Infections and Pregnancy-Related Complications in Adult Women.

https://arctichealth.org/en/permalink/ahliterature305301
Source
Pediatrics. 2020 08; 146(2):
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Video-Audio Media
Date
08-2020
Author
Minna Honkila
Annukka Hannula
Tytti Pokka
Anna-Maija Hanni
Jarmo Salo
Marjo Renko
Marja Vääräsmäki
Marja Perhomaa
Elina Keskimäinen
Matti Uhari
Terhi Tapiainen
Author Affiliation
Departments of Pediatrics and Adolescent Medicine, minna.honkila@oulu.fi.
Source
Pediatrics. 2020 08; 146(2):
Date
08-2020
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Video-Audio Media
Keywords
Adult
Case-Control Studies
Child
Cohort Studies
Essential Hypertension - epidemiology
Female
Finland - epidemiology
Humans
Hypertension, Pregnancy-Induced - epidemiology
Pre-Eclampsia - epidemiology
Pregnancy
Proteinuria - epidemiology
Pyelonephritis - epidemiology
Ultrasonography
Urinary Tract - diagnostic imaging
Urinary Tract Infections - epidemiology
Young Adult
Abstract
Long-term outcomes of urinary tract infection (UTI) in childhood are not well known. Pregnancy may reveal latent renal damage caused by a UTI because of stress on the kidneys.
Our cohort included adult women with an ultrasonography taken because of a childhood UTI in 1981-1991 (N = 1175). Nine women with a severe congenital kidney malformation or urinary tract obstruction were excluded. Altogether, 260 mothers with a childhood UTI and 500 population-based control mothers without a childhood UTI matched for age, and delivery dates were compared. Our primary end point was the proportion of women with essential or gestational hypertension, preeclampsia, proteinuria, or pyelonephritis during the first pregnancy.
The pregnancy outcomes of the women with a UTI in childhood did not differ from those of the controls because 105 of 260 (40%) patients met the primary end point compared with 204 of 500 (41%) controls (relative risk [RR] 0.99; 95% confidence interval [CI] 0.82 to 1.2; P = .91). Similarly, there were no significant differences between the 2 groups in essential hypertension (RR 1.0; 95% CI 0.65 to 1.6; P = .92), gestational hypertension (RR 0.93; 95% CI 0.74 to 1.2; P = .54), preeclampsia (RR 1.5; 95% CI 0.91 to 2.5; P = .11), proteinuria (RR 1.2; 95% CI 0.81 to 1.8; P = .36) or pyelonephritis (2 controls and none of the patients; P = .55) during the first pregnancy.
Childhood UTIs did not increase the risk of pregnancy-related complications in this controlled population-based study. Thus, UTIs in childhood without severe urinary tract abnormalities appear to have a minimal effect on kidney health in early adulthood.
PubMed ID
32669403 View in PubMed
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Comparison of pressure-, flow-, and NAVA-Triggering in pediatric and neonatal ventilatory care.

https://arctichealth.org/en/permalink/ahliterature101265
Source
Pediatr Pulmonol. 2011 Aug 9;
Publication Type
Article
Date
Aug-9-2011
Author
Merja Alander
Outi Peltoniemi
Tytti Pokka
Tero Kontiokari
Author Affiliation
Department of Pediatrics, Oulu University Hospital, Oulu, Finland. merja.alander@oulu.fi.
Source
Pediatr Pulmonol. 2011 Aug 9;
Date
Aug-9-2011
Language
English
Publication Type
Article
Abstract
OBJECTIVE: To compare conventional trigger modes (pressure and flow trigger) to neurally adjusted ventilatory assist (NAVA), a novel sensing technique, and to observe the patient-ventilator interactions during these modes. METHODS: In this prospective, crossover comparison study in tertiary care pediatric and neonatal intensive care unit, 18 patients (age from 30 weeks of postconceptional age to 16 years) needing mechanical ventilation were randomized. Three patients were excluded from the analysis because of problems in data collection. Patients were ventilated with three different trigger modes (pressure, flow, NAVA), for 10?min each. Patients were randomly allocated to six groups according to the order of trigger modes used. RESULTS: The primary end point was the time in asynchrony between the patient and the ventilator. Secondary end points were peak and mean airway pressures (MAP), breathing frequency, tidal volume (TV), and vital parameters during each trigger mode. The proportion of time in asynchrony was significantly shorter in the NAVA group (8.8%) than in the pressure (33.4%) and flow (30.8%) groups (P?
PubMed ID
21830318 View in PubMed
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Continuous glucose monitoring and HbA1c in the evaluation of glucose metabolism in children at high risk for type 1 diabetes mellitus.

https://arctichealth.org/en/permalink/ahliterature278005
Source
Diabetes Res Clin Pract. 2016 Oct;120:89-96
Publication Type
Article
Date
Oct-2016
Author
Olli Helminen
Tytti Pokka
Päivi Tossavainen
Jorma Ilonen
Mikael Knip
Riitta Veijola
Source
Diabetes Res Clin Pract. 2016 Oct;120:89-96
Date
Oct-2016
Language
English
Publication Type
Article
Keywords
Blood Glucose - metabolism
Blood Glucose Self-Monitoring - methods
Case-Control Studies
Child
Child, Preschool
Diabetes Mellitus, Type 1 - complications - epidemiology - metabolism
Female
Finland - epidemiology
Glucose Tolerance Test
Hemoglobin A, Glycosylated - metabolism
Humans
Hyperglycemia - blood - diagnosis - etiology
Hypoglycemia - blood - diagnosis - etiology
Male
Monitoring, Ambulatory - methods
Risk factors
Abstract
Continuous glucose monitoring (CGM) parameters, self-monitored blood glucose (SMBG), HbA1c and oral glucose tolerance test (OGTT) were studied during preclinical type 1 diabetes mellitus.
Ten asymptomatic children with multiple (?2) islet autoantibodies (cases) and 10 age and sex-matched autoantibody-negative controls from the Type 1 Diabetes Prediction and Prevention (DIPP) Study were invited to 7-day CGM with Dexcom G4 Platinum Sensor. HbA1c and two daily SMBG values (morning and evening) were analyzed. Five-point OGTTs were performed and carbohydrate intake was assessed by food records. The matched pairs were compared with the paired sample t-test.
The cases showed higher mean values and higher variation in glucose levels during CGM compared to the controls. The time spent ?7.8mmol/l was 5.8% in the cases compared to 0.4% in the controls (p=0.040). Postprandial CGM values were similar except after the dinner (6.6mmol/l in cases vs. 6.1mmol/l in controls; p=0.023). When analyzing the SMBG values higher mean level, higher evening levels, as well as higher variation were observed in the cases when compared to the controls. HbA1c was significantly higher in the cases [5.7% (39mmol/mol) vs. 5.3% (34mmol/mol); p=0.045]. No differences were observed in glucose or C-peptide levels during OGTT. Daily carbohydrate intake was slightly higher in the cases (254.2g vs. 217.7g; p=0.034).
Glucose levels measured by CGM and SMBG are useful indicators of dysglycemia during preclinical type 1 diabetes mellitus. Increased evening glucose values seem to be common in children with preclinical type 1 diabetes mellitus.
PubMed ID
27525364 View in PubMed
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Cow's Milk Allergy in Infancy and Later Development of Juvenile Idiopathic Arthritis: A Register-Based Case-Control Study.

https://arctichealth.org/en/permalink/ahliterature285667
Source
Am J Epidemiol. 2017 Jul 15;186(2):237-244
Publication Type
Article
Date
Jul-15-2017
Author
Miika Arvonen
Lauri J Virta
Tytti Pokka
Liisa Kröger
Paula Vähäsalo
Source
Am J Epidemiol. 2017 Jul 15;186(2):237-244
Date
Jul-15-2017
Language
English
Publication Type
Article
Keywords
Adolescent
Animals
Arthritis, Juvenile - epidemiology
Case-Control Studies
Cattle
Child
Child, Preschool
Comorbidity
Female
Finland - epidemiology
Humans
Infant
Logistic Models
Male
Milk Hypersensitivity - epidemiology
Odds Ratio
Registries
Risk factors
Sex Distribution
Abstract
We examined the association between cow's milk allergy (CMA) and juvenile idiopathic arthritis (JIA). The material for this case-control study was collected from national registers of all children born in Finland between 2000 and 2010 and diagnosed with JIA (n = 1,298) and age-, sex-, and place-matched controls (n = 5,179). We identified 235 children with CMA; 66 of these children also had JIA. A conditional logistic regression analysis was performed to evaluate the association between CMA and JIA and to test whether exposure to antibiotics would be a covariate for this association. In boys (but not in girls), a diagnosis of CMA and the use of hypoallergenic formula in infancy were associated with the later development of JIA (odds ratio = 2.4, 95% confidence interval: 1.6, 3.6). The association was most evident in boys who were diagnosed with JIA before age 3 years or diagnosed with CMA with predominantly gastrointestinal symptoms. There was no statistically significant additive interaction between CMA and antibiotic exposure in the later development of JIA. These associations may reflect impaired maturation of intestinal immunity and integrity in boys with a risk of JIA. Predisposing factors related to JIA pathogenesis seem to display a sex-linked disparity.
PubMed ID
28459985 View in PubMed
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Current trends in paediatric and neonatal ventilatory care -- a nationwide survey.

https://arctichealth.org/en/permalink/ahliterature120915
Source
Acta Paediatr. 2013 Feb;102(2):123-8
Publication Type
Article
Date
Feb-2013
Author
Merja Ålander
Outi Peltoniemi
Timo Saarela
Eija Anttila
Tytti Pokka
Tero Kontiokari
Author Affiliation
Department of Pediatrics, Oulu University Hospital, Oulu, Finland. merja.alander@oulu.fi
Source
Acta Paediatr. 2013 Feb;102(2):123-8
Date
Feb-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Child
Child, Preschool
Finland
Follow-Up Studies
Guideline Adherence - statistics & numerical data
Health Care Surveys
Humans
Infant
Infant, Newborn
Intensive Care - methods - statistics & numerical data - trends
Intensive Care Units, Neonatal - statistics & numerical data - trends
Intensive Care Units, Pediatric - statistics & numerical data - trends
Outcome and Process Assessment (Health Care)
Physician's Practice Patterns - statistics & numerical data - trends
Practice Guidelines as Topic
Prospective Studies
Questionnaires
Respiration, Artificial - adverse effects - methods - statistics & numerical data - trends
Ventilator-Induced Lung Injury - prevention & control
Abstract
To assess daily practices in paediatric and neonatal ventilatory care in Finland.
All neonatal and paediatric intensive care units in Finland were sent a questionnaire on ventilatory strategies and were offered a 3-month prospective survey.
A total of 96% of units returned the questionnaire, and clinicians agreed on most of the principles of lung-protective ventilation. Seventeen hospitals (94%) joined the prospective survey. On average, 2.3 new ventilation episodes were started daily, and totally 211 episodes were monitored. Pulmonary problems (64%) were the main cause of treatment in neonates and postoperative care (68%) in older children. Synchronized intermittent mandatory ventilation with pressure support was the primary mode in 42% of episodes. Hypocapnia was observed repeatedly in all units. In adult intensive care units, children often received high oxygen fraction, leading to hyperoxia, and they were frequently sedated with propofol, which is not licensed for that purpose. A large proportion of children had only light sedation or no sedation at all. Despite the different strategies and practices, most episodes resulted in a favourable outcome.
Most of the principles of lung-protective ventilation have been well accepted by clinicians. More attention should be paid to achieving normocapnia and normoxia and to the correct use of sedatives, especially in units that only occasionally provide paediatric ventilation.
PubMed ID
22957736 View in PubMed
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Diaper-embedded urine test device for the screening of urinary tract infections in children: a cohort study.

https://arctichealth.org/en/permalink/ahliterature305085
Source
BMC Pediatr. 2020 08 11; 20(1):378
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
08-11-2020
Author
Niko Paalanne
Lotta Wikstedt
Tytti Pokka
Jarmo Salo
Matti Uhari
Marjo Renko
Terhi Tapiainen
Author Affiliation
Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland. niko.paalanne@oulu.fi.
Source
BMC Pediatr. 2020 08 11; 20(1):378
Date
08-11-2020
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Abstract
There is a need for an easy and sensitive method for screening of urinary tract infections in young children. We set out to test whether a novel diaper-embedded urine test device is feasible and reliable in screening for urinary tract infections.
This prospective cohort study consisted of young children examined due to a suspected acute urinary tract infection at the Pediatric Emergency Department of the Oulu University Hospital, Finland. We analyzed the same urine samples using three different methods: 1) a diaper-embedded test device applied to the urine pad within the diaper, 2) a urine sample aspirated from the urine pad for the conventional point-of-care dipstick test, and 3) a urine sample aspirated from the urine pad and analyzed in the laboratory with an automated urine chemistry analyzer. The gold standard for confirming urinary tract infection was quantitative bacterial culture.
Urine samples were available from 565 children. Bacterial culture confirmed urinary tract infection in 143 children. Sensitivity of the positive leukocyte screening of the diaper-embedded urine test device was 93.1% (95% CI: 87.4-96.8) and that of the point-of-care urine dipstick analysis was 95.4% (90.3-98.3) in those with both tests results available (n?=?528). The sensitivity of the positive leukocyte test of the diaper-embedded test device was 91.4% (85.4-95.5) and that of the automated analysis was 88.5% (82.0-93.3) in those with both tests available (n?=?547). The time to the test result after urination was immediate for the diaper-embedded test, 1-5?min for point-of-care dipstick, and 30-60?min for laboratory-based automated urine chemistry analyzer.
In this prospective study, the diaper-embedded urine test device was an easy and sensitive screening method for UTIs in young children. The main clinical benefit of the diaper-embedded urine test device was that the screening test result was available immediately after urination.
PubMed ID
32781982 View in PubMed
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Dietary factors protecting women from urinary tract infection.

https://arctichealth.org/en/permalink/ahliterature61636
Source
Am J Clin Nutr. 2003 Mar;77(3):600-4
Publication Type
Article
Date
Mar-2003
Author
Tero Kontiokari
Jaana Laitinen
Leea Järvi
Tytti Pokka
Kaj Sundqvist
Matti Uhari
Author Affiliation
Department of Pediatrics, University of Oulu, Oulu, Finland.
Source
Am J Clin Nutr. 2003 Mar;77(3):600-4
Date
Mar-2003
Language
English
Publication Type
Article
Keywords
Adult
Animals
Beverages
Case-Control Studies
Coitus
Confidence Intervals
Diet
Feces - microbiology
Female
Fermentation
Finland - epidemiology
Fruit
Humans
Life Style
Middle Aged
Milk - metabolism - microbiology
Multivariate Analysis
Nutrition Policy
Odds Ratio
Probiotics - administration & dosage
Questionnaires
Recurrence
Research Support, Non-U.S. Gov't
Risk factors
Urinary Tract Infections - epidemiology - etiology - prevention & control
Abstract
BACKGROUND: Because urinary tract infections (UTIs) are caused by bacteria in the stool, dietary factors may affect the risk of contracting a UTI by altering the properties of the fecal bacterial flora. OBJECTIVE: We studied dietary and other risk factors for UTI in fertile women in a case-control setting. DESIGN: One hundred thirty-nine women from a health center for university students or from the staff of a university hospital (mean age: 30.5 y) with a diagnosis of an acute UTI were compared with 185 age-matched women with no episodes of UTIs during the past 5 y. Data on the women's dietary and other lifestyle habits were collected by questionnaire. A risk profile for UTI expressed in the form of adjusted odds ratios (ORs) with 95% CIs was modeled in logistic regression analysis for 107 case-control pairs with all relevant information. RESULTS: Frequent consumption of fresh juices, especially berry juices, and fermented milk products containing probiotic bacteria was associated with a decreased risk of recurrence of UTI: the OR for UTI was 0.66 (95% CI: 0.48, 0.92) per 2 dL juice. A preference for berry juice over other juices gave an OR of 0.28 (95% CI: 0.14, 0.56). Consumption of fermented milk products > or = 3 times/wk gave an OR of 0.21 (95% CI: 0.06, 0.66) relative to consumption or = 3 times/wk compared with
PubMed ID
12600849 View in PubMed
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34 records – page 1 of 4.