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Biomedical subjects

M Uhari

Publications and source records attributed to M Uhari.

At least 91 records · Page 5Linked to original sources
PubMed1995

Risk of acute otitis media in relation to the viral etiology of infections in children.

We carried out a prospective case-control study to analyze the etiology of respiratory tract infections among children with and without acute otitis media (AOM). Of the 658 patients admitted to our hospital during the period concerned, 197 (29.9%) had AOM, and for each such child the next patient of the same age was chosen as a control. The total number of virologically positive samples was 99 (50.3%) among the patients with AOM vs. 93 (47.2%) among the controls. The only etiologic agent that was more common in the patients with AOM was respiratory syncytial virus, found in 31 cases vs. 15 controls (relative risk [2.27]; 95% confidence interval, 1.18-4.35; P < .02). Our results confirm earlier observations from uncontrolled studies regarding the fact that respiratory syncytial virus is especially liable to cause AOM. Since respiratory syncytial virus is causing predictable epidemics, this finding could be useful for the timing of efforts to prevent AOM in young infants.

Acute Disease↗
PubMed1995

Prediction of acute otitis media with symptoms and signs.

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.

Acute Disease↗
PubMed1995

Factors triggering the first febrile seizure.

The symptomatology of infections as well as immunological and virological findings were analysed using a logistic model in a survey of 58 children experiencing their first febrile seizures. These were then compared with findings in 116 age- and sex-matched controls with infections but no seizures. There were no statistically significant differences in the aetiology of infections between patients and controls. High temperature was the only variable to explain the occurrence of febrile seizures in the logistic model after adjusting for duration of symptoms (partial correlation coefficient in logistic model, r = 0.31). The duration of symptoms before hospitalization was shorter in patients than in controls (mean 1.0 and 3.6 days). With a longer duration of symptoms, the likelihood of seizures diminished (r = -0.34). Patients in the seizure group had a significantly higher temperature at home than controls before hospitalization (39.4 versus 38.8 degrees C). Our findings of higher temperatures in children with febrile seizures supports its importance as the most important triggering factor in febrile convulsions.

Bacterial Infections↗
PubMed1995

Effect of xylitol on growth of nasopharyngeal bacteria in vitro.

Xylitol is known to reduce caries by inhibiting the growth of Streptococcus mutans. We hypothesized that xylitol could also affect the growth of other nasopharyngeal bacterial flora, which could be important when considering respiratory infections caused by these bacteria. We studied this in vitro by adding xylitol to the medium and observed that 1 and 5% xylitol reduced markedly the growth of alpha-hemolytic streptococci, including S. pneumoniae. It reduced slightly the growth of beta-hemolytic streptococci but not that of Haemophilus influenzae or Moraxella catarrhalis. The inhibitory growth pattern was similar to that previously seen with S. mutans, which may indicate a similarity in the enzymatic processing of five-carbon sugars such as xylitol. This sugar alcohol is a widely used sweetener, and the concentrations used in our experiments are easily achieved in the oral cavity. If xylitol reduces the growth of S. pneumoniae in the nasopharynx, it could also reduce the carriage of this pathogen and thus have clinical significance in the prevention of pneumococcal diseases.

Bacteria↗
PubMed1995

Toothbrushing and the occurrence of salivary mutans streptococci children at day care centers.

Risk factors for the occurrence of salivary mutans streptococci (MS) were surveyed in 677 children aged 1-8 years (4.9 +/- 1.2; mean +/- SD) at 20 municipal day care centers in Oulu. As a part of an intervention program to reduce the spread of infectious diseases, toothbrushing was discontinued in 10 centers, the other 10 serving as controls. The test for MS was performed on 506 children before the 8-month intervention, on 358 at the end and on 345 on both occasions. Past caries experience was recorded from the children's dental health cards (dmf). Dental health habits were evaluated by means of questionnaires filled in by the parents. The occurrence of MS varied from 43.4 to 48.0%. Although those children who cleaned their teeth regularly at home carried less MS than those who did so irregularly (46.4 vs. 64.9%, p < 0.001), the withdrawal of toothbrushing at the day care center did not increase the incidence of MS. The occurrence of MS was increased by consumption of sweets containing sucrose (p < 0.01) and reduced by the regular use of fluoride tablets (p < 0.02). Logistic modeling showed a positive MS test to be associated significantly with older age (p < 0.01) and female sex (p < 0.05) in addition to toothbrushing at home (p < 0.001). The children with positive tests had significantly higher mean (+/- SD) dmf than those with negative ones (1.6 +/- 2.7 vs. 0.3 +/- 1.2, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1995

A review and meta-analysis of hormonal treatment of cryptorchidism.

To assess the effect of LH-releasing hormone (LHRH) and hCG in the treatment of cryptorchidism, 33 articles published in English between 1958-1990 were analyzed. Altogether, 3282 boys with 4524 undescended testes were included in the analysis; 872 boys with 1174 undescended testes were treated in randomized trials. The meta-analysis showed LHRH to be more effective than placebo; the risk ratio was 3.21 [95% confidence interval (CI) of 1.83-5.64] and 2.57 (95% CI, 1.39-4.74) in trials excluding retractile testes, respectively. In the combined randomized trials, the success rate with LHRH was 21% (95% CI, 18-24%), that with hCG was 19% (95% CI, 13-25%), and that with placebo was 4% (95% CI, 2-6%). The effect of the hormonal treatment was overestimated in nonrandomized trials. In conclusion, LHRH is effective in the treatment of cryptorchidism, and hCG is more effective than placebo, but data about the effect are scanty.

Aging↗
PubMed1995

Helicobacter pylori infection in Finnish children and adolescents. A serologic cross-sectional and follow-up study.

BACKGROUND: The purpose was to examine the epidemiology of Helicobacter pylori infection in Finnish children and adolescents. METHODS: Blood samples taken from healthy subjects (n = 461) 3-18 years old were studied cross-sectionally for the presence of H. pylori antibodies. Additionally, blood samples drawn in 1980, 1983, 1986, and 1989 from 74 children born in 1977 were tested. Serum IgG-class antibodies to H. pylori were determined by an enzyme immunoassay. RESULTS: In the cross-sectional series the mean antibody levels and the percentage of seropositive children increased with age. The overall seroprevalence was 10.2%. During the follow-up period from 3 to 12 years of age the seropositivity increased from 4.6% to 5.7%. On the basis of the seroconversions between 3 and 12 years of age the annual incidence of H. pylori infection was calculated to be only 0.3%. CONCLUSIONS: In children seropositivity for H. pylori of the IgG class is often a sign of an infection acquired in early childhood. It seems likely that the age-dependent increase in the seropositivity reflects cumulation of a chronic infection.

Adolescent↗
PubMed1995

A pacifier increases the risk of recurrent acute otitis media in children in day care centers.

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.

Acute Disease↗
PubMed1994

Medical student abuse: an international phenomenon.

OBJECTIVE: To evaluate the prevalence of physical and psychological mistreatment of medical students at two medical schools in Finland. STUDY DESIGN AND SETTING: To enable comparison between Finnish and American students, we used the American Medical Association's Office of Education Research questionnaire. RESULTS: Three of every four students surveyed reported experiencing some kind of mistreatment during their medical education. Students most commonly reported sexual mistreatment, usually as slurs and sexual discrimination, from classmates, preclinical teachers, clinical teachers, clinicians, nurses, and patients. Other forms of verbal abuse, psychological mistreatment, and physical threats were also reported. CONCLUSIONS: All forms of mistreatment were reported occurring less frequently than in the United States; still, the level of such behavior was high. The results suggest the need for more international awareness and debate regarding the habits and behavior of teaching staff in medical schools.

Female↗
PubMed1994

Pacifiers and dental structure as risk factors for otitis media.

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.

Acute Disease↗
PubMed1994

Epidemiology of Guillain-Barré syndrome in children: relationship of oral polio vaccine administration to occurrence.

Because a cluster of cases of Guillain-Barré syndrome followed a mass vaccination program using oral polio vaccine, a retrospective epidemiologic survey was carried out in southern California to examine the relationship between oral polio vaccine and Guillain-Barré syndrome. We also examined the yearly pattern of Guillain-Barré syndrome and compared rates of illness in different ethnic populations. The mean annual incidence of Guillain-Barré syndrome was 0.60 (95% confidence intervals 0.48 to 0.73) per 100,000 children under 15 years of age. There was no difference in incidence between boys and girls or between ethnic populations. The incidence was significantly higher in 2-year-old children than in any other age group (p < 0.05). The onset of Guillain-Barré syndrome was preceded by an infection in 71 (76%) of 93 children. In five children (5%) a vaccination was given within 8 weeks before illness onset. Only two children received the oral polio vaccine; the duration from vaccine administration to the onset of Guillain-Barré syndrome was 41 and 52 days, whereas the mean incubation time associated with infectious illnesses was 10.3 days. Strong evidence against a causal relationship between oral polio vaccine administration and Guillain-Barré syndrome is provided by the failure to find a correlation between the usual age of immunization with oral polio vaccine and the incidence of Guillain-Barré syndrome by age and the failure to find any children with onset of Guillain-Barré syndrome within 1 month of immunization with oral polio vaccine.

Adolescent↗
PubMed1994

Chronic sclerosing osteomyelitis of the mandible in monozygotic twins.

Identical female twins with chronic sclerosing osteomyelitis of the mandible are presented. The diagnoses of both at the age of 12 years were based on typical history, and on clinical, radiographic, and histologic findings. High concentrations of IgA and IgG were detected in the serum of both patients, but deviations were not observed in other immunologic variables. The normally commensal organism, Propionibacterium acnes grew from a bone biopsy specimen from the mandible of one twin. No oral focus of the disease was confirmed in either case. We suggest that hereditary factors must have played a role in the pathogenesis of these cases of chronic osteomyelitis.

Child↗
PubMed1994

Association of recurrent acute otitis media with nasopharynx dimensions in children.

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.

Acute Disease↗
PubMed1994

Lack of specific symptomatology in children with acute otitis media.

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)

Acute Disease↗
PubMed1994

Growth and joint symptoms in children treated with nalidixic acid.

To analyze the effects of quinolones on growth and joints in children we identified 78 patients who had been receiving nalidixic acid for 116 days on the average (range, 3 to 570 days) from a random sample of 3094 of 16,409 children treated with long term medication because of recurrent urinary tract infection. Two controls per each index case, matched for sex and the age at which the first medication for recurrent urinary tract infection occurred, were chosen. Frequency of joint symptoms and examinations or possible treatments for arthropathies were similar in the index (n = 44) and control (n = 62) cases. Detailed growth data were analyzed from 39 case-control pairs after the mean follow-up time of 19.6 years (range, 14.8 to 24.7 years), and no growth disturbances were found. The final heights (age, > 18 years) of the index and control cases were similar (n = 31 case-control pairs). We conclude that nalidixic acid does not cause arthropathies or hamper growth in children, which supports the suggestion that at least short treatment periods with quinolones are safe.

Adolescent↗