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Biomedical subjects

H Peltola

Publications and source records attributed to H Peltola.

At least 55 records · Page 3Linked to original sources
PubMed1998

Physicians' opinions about the management of hypertension: changes in Finland between 1985 and 1992.

The successful management of hypertension requires an active involvement of physicians. We studied trends in Finnish physicians' opinions about the management of hypertension between 1985 and 1992. The response rates in these two random samples of physicians were 68% and 56%, respectively. Physicians who reported regularly treating hypertensive patients were included in our analyses (n1 = 319, n2 = 470). Fifty per cent of physicians used diastolic blood pressure of 100 mm Hg as a criterion for starting drug treatment and a goal blood pressure of 90 mm Hg was reported by 60% of physicians. Both levels decreased from 1985 to 1992. The variation in both of these blood pressure levels as reported by the physicians were wide both in 1985 and 1992. The activity in promoting non-pharmacological measures such as exercise and restriction of fat intake improved during this time period. The choice of drugs for anti-hypertensive therapy changed drastically from 1985 to 1992. For younger patients ACE inhibitors became the drug of choice and for older patients Ca-blockers gained popularity from diuretics. A similar shift can also be seen in the sales statistics. Whether this increased activity in starting drug therapy and using new drugs will improve the outcome of treatment remains to be seen.

Aged↗
PubMed1998

Etiology of measles- and rubella-like illnesses in measles, mumps, and rubella-vaccinated children.

The viral etiology of measles- or rubella-like illnesses after MMR (measles, mumps, and rubella) vaccination was studied prospectively in 993 acutely ill Finnish children with fever and rash in 1983-1995. Their sera were tested for adeno-, entero-, and parvovirus B19 antibodies. Sera of 300 children <4 years old were also tested for human herpesvirus 6 (HHV-6) antibodies. Measles and rubella had been excluded by previous antibody testing. Serologic diagnosis of adeno-, entero-, or parvovirus infection was based on EIA (IgM or IgG antibodies) and that of HHV-6 on indirect immunofluorescence. A viral etiology was verified in 368 cases, most commonly parvovirus (20%), followed by enterovirus (9%) and adenovirus (4%). Among young children, HHV-6 infection was found in 37 (12%). Thirty-eight children (4%) had double infections. This study confirms that measles- or rubella-like illnesses in MMR-vaccinated children are often caused by other viruses. Each suspected vaccine failure requires laboratory confirmation to maintain reliable surveillance and control and to establish the specific etiology of the disease.

Adenoviruses, Human↗
PubMed1998

Etiology of pneumonia and other common childhood infections requiring hospitalization and parenteral antimicrobial therapy. SE-TU Study Group.

The etiology of acute lower respiratory tract infections (mostly pneumonia) in children is well characterized, but these are only some of the community-acquired infections warranting parenteral antimicrobial therapy. We prospectively evaluated all such infections among children aged 3 months to 15 years by use of blood cultures, examination of nasopharyngeal aspirates, and serologies for 15 viral, 7 bacterial, and 1 protozoal agent. Immunocompromised patients and those with urinary tract infection, meningitis, or osteoarticular infection were excluded. In all, 170 children were included. The pathogenic agent was identified in 62% of the cases. Bacteria were detected in 54%, and a pneumococcus was found in 59% of the cases identified. Viruses were found in 15% overall. Sole bacterial or viral infections were detected in 47.1% and 8.1%, respectively. Since thorough screening established the etiology in less than two-thirds of patients ill enough to be hospitalized and treated parenterally, better diagnostics are needed, especially to identify those who would truly benefit from antimicrobial therapy.

Adolescent↗
PubMed1998

Haemophilus influenzae type b disease and vaccination in Europe: lessons learned.

OBJECTIVE: To scrutinize the experiences of those European countries that have played a central role in understanding the behavior of and vaccination for Haemophilus influenzae type b (Hib) diseases, to enlighten weaknesses and to explore whether lessons learned would benefit other countries in combating Hib. DESIGN: Epidemiologic and clinical data on Hib infections and vaccinations were analyzed, including all disease manifestations and all age groups. To improve reliability, sources that used active case finding were especially searched for. RESULTS: In the prevaccination era meningitis represented 40 to 70% of all classical Hib diseases. Epiglottitis was the second most common presentation, except in southern Europe (data not available from former socialist countries). The overall incidence of meningitis and of all Hib disease combined for children ages 0 to 4 years was 23 and 41 per 100000, suggesting 9900 and 17800 cases per year, respectively. Including all age groups and entities, >20000 Hib cases occurred annually. Vaccination, accomplished with two or three primary doses and a late booster, has almost eliminated Hib disease in >10 countries, and >10000 cases per year are prevented. An age analysis of Hib meningitis suggests that strong early immunogenicity is not as imperative in Europe as in some other regions. The incidence of non-type b H. influenzae infections has not increased. CONCLUSIONS: With Hib epidemiology comparable with that in Europe, good protection is achieved by various conjugate vaccines also with two primary doses only. However, active research on the whole Hib issue should be a priority, especially in southern and eastern European countries.

Child, Preschool↗
PubMed1998

Need for Haemophilus influenzae type b vaccination in Asia as evidenced by epidemiology of bacterial meningitis.

OBJECTIVE: To evaluate the role of Haemophilus influenzae type b (Hib) infections in Asia by scrutinizing data on Hib meningitis. DESIGN: A comprehensive literature search was performed in English and other languages. Special attention was paid to the age group of 0 to 4 years, in which the great majority of Hib meningitis occurs. RESULTS: Twenty studies from as many countries indicated Hib to be a major pathogen in childhood meningitis. In series comprising nearly 2000 patients, Hib was responsible for at least 50% of cases in one-third of series and for at least 25% in three-fourths of series investigated and was the leading pathogen overall. The countries in South and Southeast Asia differed from the Middle East and East Asia in having a greater incidence of meningitis during the first 6 months of life; the proportions were 50 to 60% vs. 10 to 30%, respectively (P < 0.001). CONCLUSIONS: Despite lacking data from many areas, belief in a paucity of Hib disease in Asia is not supported by the existing data; and because meningitis represents only 50 to 75% of all classical Hib manifestations and some cases occur after the age of 4 years, vaccination is warranted. The cumulative age curves suggest that conjugates with good immunogenic potential should be used, especially in South and Southeast Asia.

Asia↗
PubMed1998

Reduced incidence of septic arthritis in children by Haemophilus influenzae type-b vaccination. Implications for treatment.

In many countries Haemophilus influenzae type b (Hib) is the second most common cause of septic arthritis in children. In Finland large-scale immunisation against Hib using conjugate vaccines began in 1986, four years after a multicentre prospective study of orthopaedic infections in children had started. Since 1982, including six years before and ten after starting routine Hib vaccination, there has been a major change in the pattern of septic arthritis. From 1982 to 1988, 32 of 61 cases (53%) were caused by staphylococci, 22 (36%) by Hib and 7 (11%) by other bacteria. Since 1988, Hib infection has disappeared, and one-third of cases of childhood septic arthritis has been eliminated. This change has allowed us to reduce initial antimicrobial therapy for such children to cover only Gram-positive cocci. The more limited treatment is safer, reduces cost, and simplifies treatment.

Anti-Bacterial Agents↗
PubMed1998

Single-dose and steady-state pharmacokinetics of a new oral suspension of ciprofloxacin in children.

OBJECTIVE: Quinolones are used ever increasingly in pediatrics, although officially they are still contraindicated. Lack of evidence of arthropathic effects in human offspring favors their use, but little is known about the pharmacokinetics of oral or parenteral ciprofloxacin in children, especially those without cystic fibrosis. DESIGN: We studied 16 non-cystic fibrosis patients ranging in age from 0.3 to 7.1 years to whom the new suspension formulation of ciprofloxacin (10 mg/kg body weight) was given orally three times daily. Single-dose and steady-state pharmacokinetic parameters were elucidated. RESULTS: Ciprofloxacin was rapidly absorbed. The maximum plasma concentrations, with the means varying from 1.7 to 3.6 mg/L, were reached within 1 hour, almost regardless of whether single-dose administration or steady state. The mean oral clearance was lower in children <6 years of age than in those >/=6 years. Terminal half-life values, with the means varying only between 4.2 and 5.1, suggest that dosing recommendations based on body weight are pertinent, although caution should be exercised in small infants. No arthropathic or other adverse events attributable to ciprofloxacin suspension were observed. CONCLUSION: A dose of the suspension form of ciprofloxacin of 10 mg/kg body weight given orally three times daily seems appropriate in children, provided the drug is clearly indicated.

Administration, Oral↗
PubMed1998

Meningococcal vaccines. Current status and future possibilities.

Meningococcal disease causes great emotion and anxiety in the families and caregivers of patients. Numbers of such patients are usually small in industrialised countries, unlike those in many regions--especially in subsahelian Africa. Vaccines have been tried for more than 80 years; at present there are available polysaccharide vaccines against groups A, C, Y and W135, and a protein-based vaccine against group B. A property common to all is their relative efficacy (75 to 100%) at school age and after, and an acceptably short persistence of antibodies. Small children pose the major challenge, in whom there is essentially evidence of clinical protection only against group A and C diseases. With vaccines against other serogroups protection is possible, but not yet proven in controlled clinical studies. The search is on for help from various modifications, including the conjugation technique, to transform the independent nature of polysaccharide response towards T cell dependence, as was done earlier in Haemophilus influenzae type b vaccines. First trials along this path are encouraging although, again, group B meningococci pose special problems. The next few years will probably see a new generation of meningococcal vaccines. Generally speaking, the incidence of meningococcal disease is too low to indicate vaccinations for the whole population, or even children, but some risk groups and epidemics are important exceptions. To date, bivalent group A + C or tetravalent group A + C + Y + W135 polysaccharides, or an outer membrane protein-based group B vaccine, are the products to be used when the indications, that may vary from country to country, are considered met. A strong herd immunity effect, demonstrated with group A and C vaccinations, facilitates extinction of an epidemic since large-scale vaccinations can be restricted only in the major risk groups, children and in various schools. Prompt intervention demands, however, a functioning mechanism which detects very early on a pending epidemic. Unfortunately, such a mechanism is often lacking in countries often hit by this deadly disease.

Adolescent↗
PubMed1998

Total elimination of measles in Finland.

On average, 15,000 cases of measles occurred annually in Finland before the initiation of a vaccination programme in 1975. Because of insufficient activity, the vaccination coverage failed to reach the required level of over 90%, and cases continued to occur. The policy was revolutionized in 1982 by launching a project in which the Schwarz strain was substituted by an attenuated Enders-Edmonston strain given as a component of a trivalent live-virus measles-mumps-rubella vaccine (MMRII). This vaccine is given twice, at the ages of 14-18 months and 6 years. The impact of the vaccinations has been monitored in several prospective studies. In addition to a very favourable safety profile, good immunogenicity and excellent clinical effectiveness have also been demonstrated. Since 1996 not a single case of measles has been found in Finland, although cases have been searched actively and serological confirmation has been required. Total interruption of virus circulation has brought a new problem: the possibility of vaccinees to acquire natural boosters is so rare that waning immunity has become a reality. As there is a continuous risk of measles originating from a foreign source, the only tool against an outbreak is to maintain a high vaccination coverage and to continue the two-dose schedule as a minimum policy.

Child↗
PubMed1998

Immunoreactivation of Epstein-Barr virus due to cytomegalovirus primary infection.

Serological diagnosis of herpes virus infections is hampered by concurrent expression of IgM for heterologous members of this virus family. To assess the frequency of such multiple diagnostic findings and to understand their etiology, we sought by using IgG, IgM, and IgG avidity test serodiagnoses for Epstein-Barr virus (EBV) among immunocompetent or immune-suppressed patients with well-documented cytomegalovirus (CMV) primary infection. Controls had primary infection by EBV or had acute septic or severe respiratory infection. Among EBV-seropositive patients with CMV primary infection, a large proportion (13/56, 23%) showed antibody profiles of EBV reactivation: seroconversion of VCA IgM and/or > or = fourfold rise of VCA IgG, together with high or intermediate avidity of VCA IgG. Most of the CMV patients with EBV serodiagnosis showed also diagnostic HHV-6 antibody rises. In contrast to the frequently occurring CMV-induced EBV immunoreactivation, EBV primary infections did not appear to induce immunoreactivations of CMV (0/22). Only one (2%) CMV patient had a significant varicella zoster virus (VZV) antibody rise. The studies show that CMV is a particularly active inducer of some, but not all, members of the herpes virus family and suggest that the in vivo interplay between CMV and EBV occurs unidirectionally. The high frequency of heterologous herpes virus immunoreactivations poses demands on laboratory diagnosis.

Adolescent↗
PubMed1997

Haemophilus influenzae type b disease and vaccination in Latin America and the Caribbean.

OBJECTIVE: Conjugate vaccines are highly effective in preventing Haemophilus influenzae type b (Hib) diseases. Data on the epidemiology of Hib disease in Latin America and the Caribbean are not easily accessible, are incomplete and are deserving of critical analysis. METHODS: Relevant information in Spanish, English and Portuguese from over 20 regions in 16 countries was reviewed, with special attention to all Hib diseases and to children < 5 years because of their proneness to disease. Total number of cases and deaths were estimated from the incidence rates obtained from 10 studies. RESULTS: Taking into account variation between among countries, the overall incidence of Hib meningitis at age 0 to 4 years was estimated as 35 per 100,000, which would imply 20,000 cases annually in the region. An estimated rate of 60 per 100,000 for all Hib disease suggests 33,000 cases per annum. In all age groups at least 40,000 annual cases and 5000 deaths occurred annually. Given that the true role of Hib pneumonia is unknown because of data are much lacking for nonbacteremic cases, these figures are probably underestimations. Because large scale vaccination programs are being implemented in only 3 countries, the impact on Hib epidemiology has been minimal. CONCLUSIONS: Hib diseases are common in Latin America and the Caribbean, and use of conjugate vaccines is minor. Concurrently with better epidemiologic studies, their use should be extended, preferably in combination with other vaccines. Making Hib diseases notifiable would be one step for better recognition of their importance.

Caribbean Region↗
PubMed1997

Simplified treatment of acute staphylococcal osteomyelitis of childhood. The Finnish Study Group.

OBJECTIVE: Recommendations on treatment of acute staphylococcal osteomyelitis of children, based mostly on retrospective analyses, comprise surgical drainage, up to 6 weeks fo antimicrobials guided by the erythrocyte sedimentation rate, and the possibility of switching to the oral route only if monitoring of serum bactericidal titer is guaranteed. A prospective study was conducted to test whether the treatment could be simplified. DESIGN: Fifty pediatric cases of acute Staphylococcus aureus osteomyelitis were randomized to receive 150 mg/kg/day of cephradine divided in four doses, or 40 mg/kg/day in four doses of clindamycin. The treatment was initiated intravenously, but switched to oral administration mostly within 4 days, using the same doses. The peak antimicrobial serum inhibitory titer or bactericidal titer was not measured. The course of illness was monitored by blood leukocytes, erythrocyte sedimentation rate, and serum C-reactive protein. The follow-up was extended to 1 year posthospitalization. SETTING: Eight tertiary pediatric-orthopedic hospitals in Finland. MAIN OUTCOME MEASURE: Full recovery and remaining healthy at least 12 months from hospital discharge. RESULTS: The lower and upper extremities were affected in 72% and 8% of patients, respectively. No surgery at all or needle aspiration only was performed in 62% and drilling in 38%. C-reactive protein and the sedimentation rate normalized within 9 days and 29 days, respectively. X-ray changes developed in 68% but had no prognostic significance. The mean hospitalization time was 11 days, and the total duration of antimicrobials was 23 days. No failure has occurred nor have long-term sequelae been observed in any patient. CONCLUSIONS: Treatment of pediatric acute staphylococcal osteomyelitis can be simplified and costs reduced by keeping surgery at a minimum, shortening hospitalization and the course of antimicrobials, switching quickly to the oral route, and not monitoring serum bactericidal activity.

Acute Disease↗