Abstract: Aim: The aim was to evaluate the trends in childhood mortality in Finland from 1969 to 2004. We especially wanted to find out whether the decline in mortality is continuous and whether there are still deaths that could be prevented. Methods: We analyzed mortality data obtained from the official cause of death statistics in Finland from 1969 to 2004. Annual mortality rates were calculated in proportion to those at risk of dying. Comparison of cause specific mortality rates was conducted for neonatal group and children aged 1 month to 15 years. Results: Annual neonatal mortality declined from 11.13 per thousand in 1969 to 2.46 per thousand in 2004. The leading causes of death were perinatal disorders and congenital malformations. Mortality among children aged 1 month to 15 years declined from 0.67 per thousand in 1969 to 0.23 per thousand in 2004, with accidents the leading cause of death, although congenital malformations, tumours and haematological diseases, and infectious diseases were significant causes as well. There was a notable peak in total mortality in 2004, as 44 Finnish children died in the Asian tsunami in December of that year. Conclusion: Childhood mortality in Finland has decreased significantly during recent decades. Prevention programmes should be directed towards reducing mortality from accidents by promoting traffic safety and ensuring a safer environment. Even though child mortality is very low in Finland at present, continued reductions can still be achieved.
Abstract: BACKGROUND: Xylitol has antiadhesive effects on Streptococcus pneumoniae and inhibits its growth, and has also been found to be effective in preventing acute otitis media and has been used in intensive care as a valuable source of energy. RESULTS: We evaluated the oxidative burst of neutrophils in rats fed with and without xylitol. The mean increase in the percentage of activated neutrophils from the baseline was higher in the xylitol-exposed group than in the control group (58.1% vs 51.4%, P = 0.03 for the difference) and the mean induced increase in the median strength of the burst per neutrophil was similarly higher in the xylitol group (159.6 vs 140.3, P = 0.04). In two pneumococcal sepsis experiments rats were fed either a basal powder diet (control group) or the same diet supplemented with 10% or 20% xylitol and infected with an intraperitoneal inoculation of S. pneumoniae after two weeks. The mean survival time was 48 hours in the xylitol groups and 34 hours in the control groups (P < 0.001 in log rank test). CONCLUSION: Xylitol has beneficial effects on both the oxidative killing of bacteria in neutrophilic leucocytes and on the survival of rats with experimental pneumococcal sepsis.
Abstract: Viruses are important causes of paediatric hospital-associated infections (HAIs). We evaluated the frequency of viral HAIs during hospitalisation and after discharge in a paediatric infection ward. Data were collected prospectively for two years with follow-up questionnaires in which parents reported symptoms of new infections. Infections occurring >72 h after admission to hospital or <72 h after discharge were regarded as hospital-associated. The mean age of patients was 3.0 years and the mean hospitalisation time 3.0 days. Twenty-one out of the 1927 patients [1.1%, 95% confidence interval (CI): 0.7-1.7] developed an HAI during hospitalisation, in every case diarrhoea. A total of 1175 (61%) questionnaires were returned. In all, 86 children (7.3%, 95% CI: 5.9-9.0) had new symptoms within 72 h of discharge, most often diarrhoea (49%). Older age protected against HAI [odds ratio (OR, per year in age): 0.92; 95% CI: 0.85-0.99; P=0.02]. Among the patients hospitalised for respiratory infections, a shared room increased the risk of HAI (OR: 2.3; 95% CI: 1.1-4.8; P=0.03). Eight percent of the patients in our ward, where alcohol hand gel is actively used and single rooms are common, developed an HAI. Eighty percent of the HAIs appeared at home, which emphasises the importance of post-discharge follow-up.
Abstract: It has been suggested that a respiratory syncytial virus (RSV) infection in infancy increases the likelihood of development of asthma in childhood. The RSV epidemics have a special 2-yr pattern in Finland and this allows the evaluation of the association of RSV and asthma by epidemiological means. We evaluated whether being 0-6 months of age during an RSV epidemic has an impact on the use of asthma medication later in the childhood. The consumption of asthma medication at the age of 3-16 yr and the number of those entitled to special reimbursement for asthma medication were identified for a total of 637,922 children. These subjects were grouped in cohorts according to whether they had been aged 0-6 months (exposed) or not (unexposed) during an RSV epidemic. The means of the proportions taking asthma medication and of those receiving reimbursement were calculated for each cohort. The means of the proportions in the unexposed vs. exposed cohorts were 20.5% vs. 20.3% for consumption and 4.8% vs. 4.9% for reimbursement. These differences were insignificant. In conclusion exposure to a RSV epidemic in infancy does not increase the consumption of asthma medicines at the population level.
Abstract: BACKGROUND: Xylitol administered regularly 5 times a day after each meal is successful in preventing acute otitis media (AOM) in children, but if given only during respiratory infections it is ineffective against AOM. To find a more convenient dosing regimen, we tested whether xylitol administered 3 times a day reduces the occurrence of AOM. METHODS: In this 3-month randomized, double-blind trial, 663 healthy day care children were randomized to receive either a control product (n = 331) or xylitol (n = 332). Xylitol was given in chewing gum or in a mixture 3 times a day, the daily dose being 0.5 g in the control group and 9.6 g in the xylitol group. The occurrence of the first AOM diagnosed during any period of respiratory symptoms during the follow-up was the main outcome measure. RESULTS: At least one AOM episode was diagnosed in 98 of the 331 children who received control products (30%) and in 94 of the 332 who received xylitol products (28%). A total of 142 episodes of AOM were diagnosed in the control group compared with 156 in the xylitol group. The differences were not statistically significant. CONCLUSIONS: Xylitol given regularly 3 times a day for 3 months during the respiratory infection season failed to prevent AOM.
Abstract: BACKGROUND: We have previously found by lateral cephalometry an association between nasopharyngeal anatomy and the risk of acute otitis media (AOM). We evaluate here the association of nasopharyngeal dimensions in magnetic resonance imaging (MRI) with the occurrence of AOM in otherwise healthy children. METHODS: Sixty-one healthy children (mean age 5.7 years, range 3.9-6.9) were recruited from child care centres. The parents filled in a questionnaire on the child's history of ear infections and adenoidectomy. MRI was performed with a 4 mm slice thickness during an upper respiratory infection. Five dimensions and two angles expressing the structure of the bony nasopharynx were measured in sagittal images. RESULTS: The dimension from the caudal edge of the septum to the midpoint of the sella, reflecting the height of the nasopharynx, was on average 2.2 mm smaller in the children who had had AOM attacks during the last 12 months than those without attacks (95% confidence interval (CI) 0.9 to 3.4, p=0.001) and the nasal base angle was on average 2.1 degrees smaller (95% CI 0.7 to 3.5, p=0.004). These differences remained significant after adjustment for age, sex and previous adenoidectomy in the logistic modelling. A history of adenoidectomy did not have any effect on the dimensions. CONCLUSIONS: The nasopharynx was smaller in the children with AOM attacks during the last year. The value of this finding for predicting susceptibility to recurrent AOM and directing preventive procedures should be evaluated.
Abstract: OBJECTIVE: We carried out a prospective, randomized, controlled trial to clarify the effect of tonsillectomy on the clinical course of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome. STUDY DESIGN: Twenty-six consecutive children (mean age 4.1 years) with at least 5 PFAPA attacks were recruited from 3 tertiary care pediatric hospitals during 1999-2003 and randomly allocated to tonsillectomy or follow-up alone. They were all followed up with symptom diaries for 12 months. Tonsillectomy was allowed after 6 months in the control group if the attacks recurred. RESULTS: Six months after randomization all 14 children in the tonsillectomy group and 6/12 children in the control group (50%) were free of symptoms (difference 50%, 95% confidence interval 23% to 75%, P < .001). Tonsillectomy was performed on 5/6 of the patients in the control group who still had symptoms after 6 months. The remaining unoperated child in the control group had recurrences of the fever episodes throughout the follow-up, but the symptoms became less severe, and the parents did not choose tonsillectomy. CONCLUSION: Tonsillectomy appeared to be effective for treating PFAPA syndrome. The fever episodes ceased without any intervention in half of the control subjects. We conclude that although the mechanisms behind this syndrome are unknown, tonsillectomy can be offered as an effective intervention for children with PFAPA.
Abstract: BACKGROUND: Teaching the principles of scientific research in a comprehensive way is important at medical and dental schools. In many countries medical and dental training is not complete until the candidate has presented a diploma thesis. The objective of this study was to evaluate the nature, quality, publication pattern and visibility of Finnish medical diploma theses. METHODS: A total of 256 diploma theses presented at the University of Oulu from 2001 to 2003 were analysed. Using a standardised questionnaire, we extracted several characteristics from each thesis. We used the name of the student to assess whether the thesis resulted in a scientific publication indexed in medical article databases. The number of citations received by each published thesis was also recorded. RESULTS: A high proportion of the theses (69.5%) were essentially statistical in character, often combined with an extensive literature review or the development of a laboratory method. Most of them were supervised by clinical departments (55.9%). Only 61 theses (23.8%) had been published in indexed scientific journals. Theses in the fields of biomedicine and diagnostics were published in more widely cited journals. The median number of citations received per year was 2.7 and the range from 0 to 14.7. CONCLUSION: The theses were seldom written according to the principles of scientific communication and the proportion of actually published was small. The visibility of these theses and their dissemination to the scientific community should be improved.
Abstract: BACKGROUND: Disappearance of middle ear effusion is one of the most important outcomes in the treatment of acute otitis media (AOM). AIM: To evaluate the duration of effusion in AOM treated by antimicrobials and to find factors influencing it. METHODS: Parents of 90 children with AOM monitored daily the disappearance of effusion with tympanometry. The children were randomly allocated to be treated with either oral amoxicillin or cefuroxime-axetil for 10 d. Daily monitoring lasted for 14 d or until the tympanogram was normal (curve A or C) in both ears. Pneumatic otoscopy was carried out every 2 wk. RESULTS: Normal tympanograms were obtained after a median time of 7.5 d (range 1-58 d) among 75 successfully monitored patients. In two-thirds (69%) of them, effusion resolved in 14 d. The median duration of effusion did not differ significantly between the two treatment groups (8 vs 7 days, p=0.7). The children who had unilateral AOM cured more rapidly than those with bilateral AOM (5 vs 19 d, p<0.001). In logistic regression analysis adjusted for age, bilaterality explained treatment failure at 2 wk with an odds ratio of 28.1 (95% CI 4.6-169.5, p<0.001). CONCLUSION: The choice of antimicrobials did not influence the duration of middle ear effusion, which was much shorter than had been thought previously. Children with unilateral AOM were cured much more quickly than those with bilateral AOM.
Abstract: BACKGROUND: Respiratory syncytial virus (RSV) infection may influence the development of recurrent wheezing and atopy, but the mechanisms are unclear. OBJECTIVE: The purpose was to evaluate serum concentrations of soluble intercellular adhesion molecule-1 (sICAM-1), CD14, IgE, IL-5 and IFN-gamma in children 6-10 years after an RSV infection and their correlation with subsequent asthma and atopy. METHODS: Fifty-one subjects admitted to hospital for RSV infection during the first year of life and controls matched for birth date and sex underwent clinical examinations including lung function, skin prick and blood tests. RESULTS: The RSV subjects had significantly higher serum concentrations of IFN-gamma and sICAM-1 than the controls (for IFN-gamma 224.9 pg/mL (standard deviation (SD) 271.3) vs. 187.1 pg/mL (372.9), difference 37.8 pg/mL, 95% confidence interval (CI) -90.3 to 166.0, P = 0.05; for sICAM-1 170.2 ng/mL (SD 63) vs. 147.8 ng/mL (SD 57), difference 22.4 ng/mL, 95% CI -1.4 to 46.1, P = 0.04). The RSV subjects with asthma had significantly higher concentrations of IFN-gamma than the controls with asthma, and the RSV subjects with wheezing during the previous 12 months had significantly higher concentrations of both IFN-gamma and sICAM-1 than the controls with wheezing. CONCLUSIONS: Children hospitalized for RSV infection in infancy still differ in IFN-gamma and sICAM-1 production 6-10 years after the infection. The data suggest that the pathomechanism of asthma and wheezing after an early RSV infection may be different from that of children without an early RSV infection.
Abstract: BACKGROUND: Lectures are good for presenting information and providing explanations, but because they lack active participation they have been neglected. METHODS: Students' experiences were evaluated after exposing them to the use of voting during lectures in their paediatrics course. Questions were delivered to the students taking paediatrics course. Thirty-six students out of the total of 40 (90%) attended the opening lecture, at which the first survey concerning previous experiences of lectures was performed. Thirty-nine students (98%) answered the second series of questions at the end of the paediatrics course. RESULTS: Most of the students felt that voting improved their activity during lectures, enhanced their learning, and that it was easier to make questions during lectures than earlier. CONCLUSIONS: The students gained new, exciting insights much more often during the paediatrics course than before. We as teachers found that voting during lectures could easily overcome some of the obstacles of good lecturing.
Abstract: BACKGROUND: Respiratory syncytial virus (RSV) causes postbronchiolitic wheezing but its role in allergic sensitization is controversial. The purpose of the study was to examine the effect of an early RSV infection on allergic sensitization. METHODS: Seventy-six subjects were examined 6-10 years after hospitalization for RSV infection during the first year of life. Fifty-one subjects (68%) attended clinical studies and 25 filled in a questionnaire. The study protocol included lung function, skin-prick and blood tests. The controls were matched for birth date and sex. RESULTS: Eight per cent of the subjects and 37% of the controls had at least one positive skin-prick test (SPT) (difference -35%, 95% CI -50 to -19%, P < 0.0001). Allergic rhinitis, atopic dermatitis and asthma occurred as often in both groups, but asthma had been diagnosed significantly earlier in the subjects than in the controls [mean age 3.0 years (SD 2.6) and 5.6 years (SD 3.0), difference 2.6 years, 95% CI 0.57-4.65, P = 0.014]. In a logistic regression analysis, RSV infection was associated with negative SPTs. CONCLUSIONS: An early RSV infection results in reduction of SPT positivity but not of occurrence of atopic diseases. This finding might explain why there is less atopic sensitization in countries with a greater probability of acquiring RSV infection at an early age.
Abstract: Xylitol prevents otitis media when given to children regularly five times per day. To find a more convenient dosing schedule, an enzymatic assay was used to measure xylitol concentrations in the saliva of 65 children after giving them xylitol chewing gum or syrup in doses equal to those used in clinical trials. Although concentrations high enough to have an antimicrobial effect were attained, the xylitol disappeared from the saliva within 15 min. This finding indicates that high peak concentrations are more important for efficacy than the amount of time the xylitol concentration exceeds that needed to produce an antimicrobial effect. A schedule with the same single doses given less frequently could be clinically effective in preventing otitis media.
Abstract: Respiratory syncytial virus (RSV) is the major respiratory tract pathogen in infancy. Host-related differences in susceptibility to severe RSV infection suggest that genetic factors may play a role. In this study, a candidate-gene approach was used to study whether the surfactant protein D (SP-D) gene polymorphism associates with severe RSV infection. DNA samples from 84 infants hospitalized for the treatment of RSV bronchiolitis and 93 healthy controls were analyzed. The controls were matched with the cases on the basis of sex, hospital district, date of birth (+/-2 wk) and gestational age at birth (+/-2 wk). Three biallelic SP-D gene polymorphisms were genotyped. Significant differences were observed in the SP-D allele frequencies for amino acid 11 between the RSV infants and their matched controls. The frequency of the allele coding for Met 11 (p = 0.033) was increased in the severe RSV group. The frequency of the homozygous genotype Met/Met for amino acid 11 was increased in the RSV group relative to the controls, whereas the heterozygous genotype tended to be less frequent among the RSV cases than in the matched controls. Conditional logistic regression analysis was used to study whether the confounders, i.e. smoking and number of children in the family, influence the association between the homozygous SP-D genotype for methionine 11 and the risk of RSV bronchiolitis. The results further confirmed this association (p = 0.028). To our knowledge, the present report provides the first evidence of a specific gene associated with susceptibility to severe RSV infection.
Abstract: OBJECTIVE: As regular administration of xylitol had been effective in preventing acute otitis media (AOM) in children, we tested whether xylitol administered only at times of acute respiratory infection (ARI) reduces the occurrence of AOM. METHODS: Healthy children (N = 1277) were recruited from child care centers and randomized after screening with tympanometry to receive either control mixture (n = 212), xylitol mixture (n = 212), control chewing gum (n = 280), xylitol chewing gum (n = 286), or xylitol lozenges (n = 287) during an ARI. The trial was randomized and double blinded within the mixture and chewing gum groups. The parents began administering the products to their children at the onset of symptoms of ARI. The follow-up lasted until resolution of the symptoms or up to 3 weeks. RESULTS: A total of 1253 of the 1277 randomized children were eligible for the analysis. Altogether, 980 (78%) of 1253 children had at least 1 episode of ARI during the 4 months that the trial lasted. The occurrence of AOM during this episode was 34 (20.5%) of 166 in the xylitol mixture group, as compared with 32 (20.4%) of 157 among the children who received the control mixture. Among the older children who received control chewing gum, xylitol chewing gum, or xylitol lozenges, AOM was experienced by 24 (11.0%) of 218, 31 (14.1%) of 220, and 34 (15.5%) of 219, respectively. None of the differences between the groups was statistically significant. CONCLUSIONS: Xylitol administered only during an ARI was ineffective in preventing AOM.
Abstract: Respiratory syncytial virus (RSV) causes seasonal epidemics of bronchiolitis among susceptible infants. Surfactant protein A (SP-A), a lung C-type lectin involved in innate host defense, opsonizes RSV and enhances phagocytosis. The candidate gene approach was used to investigate association of SP-A polymorphism with susceptibility to severe RSV infection. Genotype analysis was done for 86 infants with severe RSV infection and 95 matched control subjects. A significant difference in the frequency of SP-A2 was observed. The SP-A2 allele 1A(3) was overrepresented in RSV-infected infants, compared with control subjects (5% vs. 0.5%; P =.006), whereas allele 1A was underrepresented (1% vs. 6%; P =.011). The allele pool in which lysine was amino acid 223 was overrepresented in infants with severe RSV infection (28% vs. 18%; P =.023), whereas the allele pool in which proline was amino acid 99 was underrepresented (5% vs. 16%; P =.001). These results indicate that a genetic association exists between SP-A gene locus and severe RSV infection.
Abstract: In problem-based learning (PBL) there are problems during tutorial group sessions, for example lack of participation, interaction and cohesion, and withdrawing. The authors evaluated whether these problems could be avoided with a peer consultation model. Peer consultation takes advantage of cooperation between students by encouraging them to accept more responsibility for learning from their peers. Forty-nine fifth-year students participated in three group sessions where they solved a paediatric case problem. The students were working in small groups, assuming the following roles in turn: presenters, facilitators and observers. The students reported that this consultative method forced one to actually define the problem, helped to develop communication skills and to identify problematic issues from different viewpoints and offered the possibility to evaluate personal problem-solving strategies. The method also gave an opportunity for students to learn in practice how to utilize new technology in data searching. These experiences suggest that the model of peer consultation adds new flavour, increasing enthusiasm in problem-based learning.
Abstract: OBJECTIVES: To evaluate the association between pacifier use and the increased occurrence of acute otitis media (AOM) in an intervention trial. METHODS: Fourteen well-baby clinics were selected to participate in an open, controlled cohort study. These clinics were paired according to the number of children and the social classes of the parents they served. One clinic in each pair was randomly allocated for an intervention, while the other served as a control. The nurses at the intervention clinics were trained to instruct the parents of children <18 months old to limit pacifier use during their prescheduled visits to the clinic. The intervention consisted of a leaflet explaining the harmful effects of pacifier use and instructions to restrict its use. Two hundred seventy-two children were successfully recruited from the intervention clinics and 212 from the control clinics. The data about pacifier use and the occurrence of respiratory infections and AOM were collected similarly in both groups. RESULTS: After the intervention, a 21% decrease was achieved in continuous pacifier use at the age of 7 to 18 months (P =.0001), and the occurrence of AOM per person-months at risk was 29% lower among children at the intervention clinics. The children who did not use a pacifier continuously in either of the clinics had 33% fewer AOM episodes than the children who did. CONCLUSION: Pacifier use appeared to be a preventable risk factor for AOM in children. Its restriction to the moments when the child was falling asleep effectively prevented episodes of AOM.
Abstract: It is not known how well nasopharyngeal swab culture represents pneumococcal carriage status. We tested this by comparing swab culture to quantitative culture and quantitative PCR of mucosal tissue in a rat model of pneumococcal carriage. Quantitative culture and quantitative PCR identified significantly more carriers compared to swab culture (differences 15% and 33%, 95% CI 1-28% and 16-47%, p=0.04 and 0.001, respectively). The sensitivity and specificity of swab culture was 75/92% and 63/100% compared to quantitative tissue culture and quantitative PCR, respectively. The quantitative estimates of culture and PCR were very similar (Pearson correlation coefficient 0.79, p<0.001). In conclusion, even a well-controlled swab sampling markedly underestimates pneumococcal carriage rate, and simultaneous use of quantitative culture and PCR increases the number of positive samples by about one third.
Abstract: Otitis media (OM) is one of the most common diseases of childhood, and causes both direct and indirect costs to families and to society. This study calculated the costs arising from OM among 736 day care children whose infections were prospectively monitored for up to 15 mo in 10 day care centres in the city of Oulu. The children in the survey had 1.5 attacks of acute OM per person year, made 2.1 visits to a physician (cost $US55 visit(-1)) and received 1.5 courses of antimicrobials (cost $24 course(-1)). Their parents were absent from work for 1.9 d per person year (cost $85 d(-1)). Either adenoidectomy ($890 operation(-1)) or tympanostomy ($740) was performed on 6% of the children and the overall costs of surgery were $80 per person year at risk. In total, each single attack of acute OM cost $228. The average annual costs per child younger than 2 y were $1040, those for children aged 2-3 y $283 and those for children older than 3 y $141. The cumulative costs from age 6 mo to 7 y were $2549 child(-1). When the attributable risk of OM at a day care centre is taken into account, in Finland, a country with about 5 million inhabitants, OM gives rise to total annual costs of $US138 million. OM leads to considerable expenses and even expensive preventive measures would be cost-effective.
Abstract: The care of a child in a day care center is a marked risk factor for acute otitis media. In a nationwide questionnaire survey we found that the rate of tympanostomies and adenoidectomies was 59-67% higher for the children cared for at a day care center before the age of 3 y. When the local authorities in Finland at the beginning of 1990 were obliged by law to arrange day care for all children under 3 y, the number of adenoidectomies performed on children at this age increased by 30%.
Abstract: BACKGROUND: The decision to seek medical advise for children during upper respiratory infections is largely based on the parental assumption that the child's symptoms are related to acute otitis media. The symptoms related to acute otitis media, however, are considered nonspecific. METHODS: Altogether 857 healthy day-care children (mean age, 3.7 years) were followed up for 3 months, and the symptoms of each child were compared during upper respiratory infections with and without acute otitis media. RESULTS: A total of 138 children had upper respiratory infections with and without acute otitis media. The symptom with the strongest association with acute otitis media was earache [relative risk (RR), 21.3; 95% confidence intervals (CI), 7.0 to 106, P < 0.0001] but sore throat (RR = 3.2; CI = 1.1 to 11; P = 0.027), night restlessness (RR = 2.6; CI = 1.1 to 6.9; P = 0.024) and fever (RR = 1.8; CI = 1.1 to 3.2; P = 0.025) also had significant associations. Logistic regression analysis showed 71% of the cases to be correctly diagnosed on the basis of the symptoms of earache and night restlessness. The parents were able to predict the presence of acute otitis media with a sensitivity and specificity of 71 and 80%, respectively (positive predictive value, 51%; negative predictive value, 90%). CONCLUSIONS: Despite the limited value of symptoms in differentiating acute otitis media from upper respiratory infection, the parents are able to predict acute otitis media somewhat reliably. More symptoms than have been reported earlier appeared to be associated with acute otitis media.
Abstract: BACKGROUND: Xylitol, a commonly used sweetener, is effective in preventing dental caries. As it inhibits the growth of pneumococci, we evaluated whether xylitol could be effective in preventing acute otitis media (AOM). DESIGN: Altogether, 857 healthy children recruited from day care centers were randomized to one of five treatment groups to receive control syrup (n = 165), xylitol syrup (n = 159), control chewing gum (n = 178), xylitol gum (n = 179), or xylitol lozenge (n = 176). The daily dose of xylitol varied from 8.4 g (chewing gum) to 10 g (syrup). The design was a 3-month randomized, controlled trial, blinded within the chewing gum and syrup groups. The occurrence of AOM each time the child showed any symptoms of respiratory infection was the main outcome. RESULTS: Although at least one event of AOM was experienced by 68 (41%) of the 165 children who received control syrup, only 46 (29%) of the 159 children receiving xylitol syrup were affected, for a 30% decrease (95% confidence interval [CI]: 4.6%-55.4%). Likewise, the occurrence of otitis decreased by 40% compared with control subjects in the children who received xylitol chewing gum (CI: 10.0%-71.1%) and by 20% in the lozenge group (CI: -12.9%-51.4%). Thus, the occurrence of AOM during the follow-up period was significantly lower in those who received xylitol syrup or gum, and these children required antimicrobials less often than did controls. Xylitol was well tolerated. CONCLUSIONS: Xylitol sugar, when given in a syrup or chewing gum, was effective in preventing AOM and decreasing the need for antimicrobials.
Abstract: We assessed the point prevalence of middle ear effusion among day care children in an area where acute otitis media is diagnosed, treated and followed actively. Minitympanometry was used to screen 850 day care centre attendants aged 0.6 to 6.9 years (mean 3.7 years). Tympanometry was performed by two trained nurses at the day care centres and pneumatic otoscopy was done by a paediatrician when effusion was suspected. We found 60 (7.1%) children to have middle ear effusion, which was bilateral in 23 (2.7%) cases. Of the children with bilateral effusion 13 had respiratory symptoms fulfilling the criteria of acute otitis media, 8 of them had experienced acute otitis media during the past 3 weeks and were diagnosed to have otitis media with effusion, and only 2 (0.2%) were asymptomatic children not identified earlier. Of the 37 (4.4%) children with unilateral effusion, 14 had acute otitis media and 23 otitis media with effusion, of whom 12 children (1.4%) had not been identified earlier. The point prevalence of acute otitis media was 3.2% and that of otitis media with effusion 3.9%. CONCLUSION: We conclude that active diagnosis and treatment of acute otitis media practically eliminates such middle ear effusion that could cause significant hearing impairment.
Abstract: At the baseline of this cohort study we determined risk factors for colonization of oral lactobacilli and candida in a group of children (n = 166) whose mean age was 2.5 years. The results showed that pacifier-sucking and the use of a nursing bottle at night increase the occurrence of both salivary lactobacilli and candida. In the present study these children were followed for 2 years, and the progression of caries was recorded with particular reference to the etiologic factors measured before. The results of the logistic regression analysis showed prolonged pacifier-sucking (> or = 24 months) to be a significant risk factor for caries development in children, with a rather high relative risk (RR) of 3.5 (95% confidence interval (CI), 1.5-8.2; P= 0.003). Prolonged use of a nursing bottle at night (> or = 24 months) was also a risk factor, but less significant than pacifier-sucking (RR, 2.6; CI, 1.1-6.4; P= 0.03). On the grounds of this study we conclude that prolonged pacifier-sucking (> or = 2 years) and use of a nursing bottle at night are risk factors for dental caries in children.
Abstract: We analyzed the occurrence of salivary lactobacilli and Candida in a sample of 166 children aged 1-4 years (mean, 2.5 years) in relation to possible risk factors for colonization of the microbes. The risk factors examined were sucking habits, feeding habits, symptoms of respiratory infections, and antibiotic therapy at the time of sampling. Lactobacilli occurred in 18% of the children's saliva, and Candida in 24%. In the logistic modeling the variables most strongly associated with the occurrence of lactobacilli were pacifier-sucking (relative risk (RR), 2.9; 95% confidence interval (CI), 1.1-7.0; P = 0.01) and antibiotic therapy (RR, 4.6; CI, 1.2-16.9; P = 0.01). The association between positive Candida test and use of a pacifier was also significant (RR, 4.8; CI, 2.1-10.7; P = 0.0001). The results of the study suggest that the use of a pacifier increases the occurrence of both salivary lactobacilli and Candida. It could therefore be a factor influencing caries susceptibility and activity in children.
Abstract: OBJECTIVE: To assess the time needed to perform tympanometry, the success rate and the importance of the child's cooperation for the accuracy of minitympanometry in detecting middle ear fluid, and the relation between the static admittance of the tympanogram and the weight of the middle ear fluid. STUDY DESIGN: Two series of patients were enrolled. The first consisted of 206 consecutive children (mean age 4.7 years, range 1 month to 16 years) from the Outpatient Emergency Department of Pediatrics in the University of Oulu; the second group consisted of 162 children (age range 7 months to 8 years) who were referred to the Department of Otolaryngology for adenoidectomy, tympanostomy, or both procedures. In the first series the success rate and the time needed to complete a minitympanometric examination on each ear were recorded. In the second series, the tympanograms were evaluated according to the cooperation of the children at the time of the tympanometric examination, and the weight of the middle ear fluid was measured and compared with the static admittance of the minitympanometric curve. Sensitivity and specificity values were calculated separately for cooperative and uncooperative patients. RESULTS: In the first series, the mean time needed for tympanometry was 2.1 minutes (range 0.5 to 10 minutes), and 179 (86.9%) of the patients were cooperative. In the second series, the sensitivity and specificity calculated for tympanometry in detecting middle ear fluid were 79% and 93% among the cooperative children. In the uncooperative group, sensitivity and specificity were 71% and 38%, respectively. The weight of the middle ear fluid varied from 5 mg to 695 mg. There was a significant negative correlation (r = -0.66, p < 0.001) between the static admittance in minitympanometry and the weight of the middle ear fluid. CONCLUSION: Minitympanometry can be done quickly, it fails rarely, and in cooperative patients it is a better tool than has been earlier suggested, but it is useless in uncooperative children. The amount of middle ear fluid varies notably even among young children.
Abstract: The occurrence of acute otitis media (AOM) has increased steadily during the last 15 years. The possible environmental risks associated with AOM should be well identified to prevent any further increase in its occurrence. A meta-analysis of the studies evaluating the risk factors for AOM was performed. A MEDLINE search of the medical literature from 1966 to 1994 with the key words children, risk, acute otitis media, and recurrent acute otitis media was performed, and the references of the articles that were found served as the sources for the studies used in the meta-analysis. Sixty-one studies were identified. Twenty-two (36%) of these studies were accepted for the meta-analysis. Depending on the risk factor, there were two to seven different studies from which risk ratios (RRs) could be pooled. The studies were performed in six different countries. If any other member of the family had had AOM, the risk increased (RR, 2.63; 95% confidence interval [CI], 1.86-3.72; P = .00001). The risk of AOM increased with day care outside the home (RR, 2.45; 95% CI, 1.51-3.98; P = .0003) and family day care (RR, 1.59; 95% CI, 1.19-2.13, P = .002). The risk of AOM increased with parental smoking (RR, 1.66; 95% CI, 1.33-2.06; P < .00001). Breast-feeding for at least 3 months reduced the risk of AOM (RR, 0.87; 95% CI, 0.79-0.95; P = .003). The use of a pacifier increased the risk of AOM (RR, 1.24; 95% CI, 1.06-1.46; P = .008). Child care outside the home and parental smoking were the factors that most significantly increased the occurrence of AOM
Abstract: OBJECTIVE: To examine whether xylitol, which reduces the growth of Streptococcus pneumoniae, might have clinical importance in the prevention of acute otitis media. DESIGN: A double blind randomised trial with xylitol administered in chewing gum. SETTING: Eleven day care nurseries in the city of Oulu. Most of the children had had problems with recurrent acute otitis media. SUBJECTS: 306 day care children: 149 children in the sucrose group (76 boys; mean (SD) age 4.9 (1.5) years) and 157 in the xylitol group (80 boys; 5.0 (1.4) years). INTERVENTION: Either xylitol (8.4 g a day) or sucrose (control) chewing gum for two months. MAIN OUTCOME MEASURES: The occurrence of acute otitis media and antimicrobial treatment received during the intervention and nasopharyngeal carriage of S pneumoniae. RESULTS: During the two month monitoring period at least one event of acute otitis media was experienced by 31/149 (20.8%) children who received sucrose compared with 19/157 (12.1%) of those receiving chewing gum containing xylitol (difference 8.7%; 95% confidence interval 0.4% to 17.0%; P = 0.04). Significantly fewer antimicrobials were prescribed among those receiving xylitol: 29/157 (18.5%) children had at least one period of treatment versus 43/149 (28.9%) (difference 10.4%; 0.9% to 19.9%; P = 0.032). The carriage rate of S pneumoniae varied from 17.4% to 28.2% with no difference between the groups. Two children in the xylitol group experienced diarrhoea, but no other adverse effects were noted among the xylitol users. CONCLUSION: Xylitol seems to have a preventive effect against acute otitis media.
Abstract: We carried out a prospective study to analyse if it would be possible to predict the coexistence of acute otitis media on the basis of symptoms and signs of infection. Of the 658 patients admitted to hospital during the period concerned, 197 (29.9%) had otitis media. For each child with otitis, the next patient of the same age was chosen as a control. The risk of having otitis media was increased among patients with cough, rhinitis and earache. All three variables together correctly classified 67% of those not having otitis media and 63% of those with acute otitis, compared with the 50% which would theoretically be achieved by chance alone. Prediction was worst (55%) among patients younger than 2 years of age not having otitis media and best among older patients who had otitis media, i.e. 78%. Prediction on these grounds would have caused significant over-treatment, and one-third of the otitis cases among the youngest group would have been missed. Thus it is important to always examine the ears of a child with an infection in order to reliably exclude the possibility of acute otitis media.
Abstract: OBJECTIVE. To follow up a previous retrospective analysis in which we found the use of a pacifier to be a risk factor for recurrent acute otitis media (AOM). METHOD. In the present prospective study, the occurrence of AOM and the use of a pacifier were recorded in 845 children attending day care centers during a 15-month period. RESULTS. More than three attacks of AOM occurred in 29.5% of the children younger than 2 years using pacifiers and in 20.6% of those not doing so (relative risk, 1.6; 95% confidence interval [CI], 0.6, 4.1); in children 2 to 3 years of age, the figures were 30.6% and 13.2%, respectively (relative risk, 2.9; 95% CI, 1.2, 7.3). Logistic modeling with adjustment for age and the duration of monitoring showed the occurrence of AOM to be associated with the time during which a pacifier was used. The use of a pacifier increased the annual incidence of AOM from 3.6 (95% CI, 2.5, 4.9) to 5.4 episodes (4.4, 6.6) in children younger than 2 years and from 1.9 (1.4, 2.5) to 2.7 (2.2, 3.3) in children 2 to 3 years of age. The population-attributable risk of AOM attacks due to the use of a pacifier was 176 attacks, ie, 459 to 635 attacks per year, in the youngest children and 69 attacks, ie, from 264 to 333 attacks per year, in those 2 to 3 years of age. It can be calculated that the use of a pacifier was responsible for 25% of the attacks in children younger than 3 years. Breastfeeding, parental smoking, thumb sucking, using a nursing bottle, and the social class of the family failed to show such strong associations with the occurrence of AOM. CONCLUSION. We conclude that the use of a pacifier is a significant risk factor for recurrent AOM and suggest that pacifiers should be used only during the first 10 months of life, when need for sucking is strongest, and AOM is uncommon.
Abstract: Although the symptoms of the acutely ill child are important both in the diagnosis and follow-up of acute otitis media (AOM), data about them are quite limited. We carried out a prospective survey by collecting information on 354 consecutive children visiting a pediatrician, otolaryngologist or general practitioner because of any kind of acute symptoms to compare symptoms of children with acute otitis media with those of children with other acute infectious diseases. The symptoms and signs observed at home were recorded by the parents before the visit and the findings in the physical examination were recorded later by the physician. AOM was diagnosed in 191 patients (54.0%). The most important symptoms increasing the likelihood of AOM significantly were ear-related symptoms, such as earache (relative risk (RR) 5.4; P < 0.001), rubbing of the ear (RR 5.0; P < 0.001) and feeling of blocked ear (RR 4.5; P < 0.05). However, only 67.7% of children younger than 2 years of age with AOM had any ear-related symptoms. The children with tympanostomy tubes had earache (47.8%) and rubbing of the ear (58.8%) of the same magnitude as did children without tubes. Rhinitis increased the likelihood of AOM (RR 2.3; P < 0.001) as did excessive crying in children older than 2 years of age (RR 3.0; P < 0.001). Fever, earache or excessive crying was present in 90.1% of patients with AOM but also in 72.4% of patients without AOM.(ABSTRACT TRUNCATED AT 250 WORDS)
Abstract: The purpose of the study was to examine the relationship between ear infections and dentition, sucking habits, pacifier sucking and atopic and allergic diseases in a historic cohort survey. The series comprised 944 5-year-old children representing about 3/4 of the whole age cohort. The parents completed a questionnaire that asked for details of the children's ear infections, sucking habits and atopic or allergic diseases diagnosed by a physician. The dental status was examined by the child's own local dentist. The children who had used a pacifier had a greater risk of having recurrent attacks of acute otitis media in their history than those who had not used a pacifier (risk ratio (RR), 1.43; 95% confidence interval (CI), 1.06-1.93; P = 0.02). Mouth breathing was significantly associated with acute otitis media (RR, 1.87; CI, 1.28-2.73; P = 0.01), as was open bite (RR, 1.36; CI, 1.01-1.84; P = 0.04), but no other mode of malocclusion. The population attributable risk of otitis media caused by pacifier amounted to a total of 478 attacks or 0.7 per child. The association between otitis media and the use of a pacifier remained even after adjusting for mouth breathing and the measures of malocclusion. Neither thumb sucking nor atopic eczema showed such an association.
Abstract: The purpose of this study was to evaluate the hypothesis that the nasopharyngeal anatomy has influence in the risk of recurrent acute otitis media (AOM) attacks. We analysed the occurrence of acute otitis media in 238 healthy schoolchildren who were X-rayed for orthodontic purposes. Six measurements reflecting the size and shape of the bony nasopharynx were recorded from lateral cephalograms. The means for almost all the dimensions of the bony nasopharynx measured were smaller in the children with two or more attacks of AOM in their history than in those with no attack or only one attack. Logistic multivariate modelling showed the distance from the posterior nasal spine to the sella-basion line to be a significant risk factor for recurrent otitis media in girls (difference 1.0 mm; 95 per cent confidence interval 0.1-2.0 mm; p = 0.04) and the shape of the nasopharynx (roundness) in boys (difference 1.9 mm; 95 per cent confidence interval 0.1-4.0 mm; p = 0.01). Measuring the nasopharyngeal bony dimensions may help to identify those children with a risk of recurrent otitis media, at whom prophylactic therapies should be targeted.
