Browsing by Subject "children"

Antidepressant use among children and adolescents has become more common in many countries. The prevalence of antidepressants is higher for boys but during adolescence girls’ have a higher antidepressant prevalence. In previous studies, the prevalence of selective serotonin re-uptake inhibitors (SSRI) has increased. The aim of this study was to investigate antidepressant use among Finnish children and adolescents aged 1–17 years during 2008–2019. The differences of antidepressant use in different age groups and genders were investigated. Furthermore, the secondary objective was to examine the trends in prevalence and costs of the five most commonly used antidepressant agents. This was a nation-wide register study. The data for this study was from Kelasto which is a statistical database maintained by the Social Insurance Institution of Finland. The extracted data was from 2008–2018 and included each persons’ age, gender, dispensed drug and costs. The data extracted was for 1–17-year-olds who had been dispensed reimbursed antidepressants from community pharmacies. The data was analyzed with Microsoft Office’s Excel program. The results were transferred in to tables and reported as prevalences by age groups, genders, antidepressants and costs. The prevalence of antidepressant use among children and adolescents was 5,0 per 1000 in 2008 and it increased to 10,3 by 2018. In the youngest age group of 1–6-year-olds, antidepressant use decreased. Antidepressant use increased slightly among 7–12-year-olds. Antidepressant use increased the most among 13–17-year-olds. 13–17-year-old girls had the higher antidepressant use prevalence throughout the study. The same group had a 2,4-fold increase in prevalence during the study period which accounted for the biggest increase in the study. The most used group of antidepressants was SSRIs. The total cost for antidepressants among children and adolescents increased by 73,7 % during the study period. The most commonly used antidepressant agents were fluoxetine, sertraline, escitalopram, mirtazapine, and venlafaxine, respectively. Fluoxetine was the most used agent throughout the study. In 2014, sertraline surpassed escitalopram and became the second most used antidepressant agent. Escitalopram and venlafaxine’s cost per user decreased during the study. The cost per user stayed stable for mirtazapine. Fluoxetine and sertraline’s cost per user increased. The Kelasto database does not include data on indications for prescriptions. The prevalence of antidepressants does not necessarily correlate directly to depression among children and adolescents because antidepressants can be used to treat other diseases. More studies need to be conducted on different off-label uses for antidepressants among children and adolescents. This study only investigated the trends on cost for the five most commonly used antidepressants. Further studies on antidepressant costs among children and adolescents are needed. Additionally, it is essential to investigate the reasons for the increase in antidepressant use among children and adolescents.

Background: The effects of vegan and vegetarian diets on children's health are not yet well-understood due to limited research, and the relationship between plant-based diets and children's serum amino acid levels remains unclear. Amino acids play a vital role in growth and well-being, particularly for children. Objectives: The primary objective of this study is to investigate potential differences in serum amino acid concentrations among children following vegan, vegetarian, and omnivorous diets. The secondary objective is to explore whether the diet of a child can be inferred based on their serum amino acid profiles. Methods: Conducted as part of the MIRA2 research, the study involved 69 children from Helsinki day care centers, following vegan, vegetarian, or omnivore diets, with dietary data gathered from parents and validated by 3-day food diaries. Serum amino acid concentrations were analyzed using UHPLC in a laboratory, and group comparisons were conducted using Kruskal-Wallis tests with post-hoc analyses. A decision tree model was constructed based on amino acid concentrations to classify children as vegan or non-vegan. Results: Serum amino acid median concentrations of glycine, arginine, cysteine, conditionally indispensable amino acids, sulfur amino acids and amino acids participating in urea cycle were higher in vegans compared to omnivores. Concentrations of lysine were lower in vegans and vegetarians compared to omnivores. The decision tree model, based on amino acid concentrations, successfully classified 70,3% of children as vegan or non-vegan. Conclusions: Plant-based diets appeared to influence serum amino acid concentrations of children to some extent. Further research, especially regarding the health implications and reference values for amino acid levels, particularly in children on plant-based diets, is still needed. Tausta: Vegaani- ja kasvisruokavalioiden vaikutukset lasten terveyteen eivät ole vielä täysin ymmärrettyjä rajallisen tutkimustiedon vuoksi, ja yhteys kasvipohjaisten ruokavalioiden ja lasten seerumin aminohappopitoisuuksien välillä on epäselvä. Aminohapot ovat keskeisiä kasvun ja hyvinvoinnin kannalta, erityisesti lapsille. Tavoitteet: Tutkimuksen ensisijainen tavoite oli selvittää mahdollisia eroja seerumin aminohappopitoisuuksissa lapsilla, jotka noudattavat vegaani-, kasvis- tai sekasyöntiruokavaliota. Lisäksi tutkittiin, voiko lasten ruokavalion päätellä heidän seerumin aminohappoprofiilinsa perusteella. Menetelmät: Tutkimus tehtiin osana MIRA2-tutkimusta, ja siihen osallistui Helsingin päiväkodeissta yhteensä 69 lasta, jotka noudattivat vegaani-, kasvis- tai sekaruokavaliota. Tieto ruokavaliosta kerättiin vanhemmilta ja validioitiin 3 päivän ruokapäiväkirjoilla. Seerumin aminohappopitoisuudet analysoitiin laboratoriossa UHPLC-menetelmällä, ja ryhmävertailut suoritettiin Kruskal-Wallis -testeillä post-hoc-analyyseineen. Päätöspuumalli luotiin aminohappopitoisuuksien perusteella lasten luokittelemiseksi vegaaneiksi tai ei-vegaaneiksi. Tulokset: Vegaaneilla glysiinin, arginiinin, kysteiinin, ehdollisesti välttämättömien aminohappojen, rikkipitoisten aminohappojen ja ureasykliin osallistuvien aminohappojen mediaanipitosuudet olivat korkeammat verrattuna sekasyöjiin. Lysiinin pitoisuudet olivat alhaisemmat vegaaneilla ja kasvissyöjillä verrattuna sekasyöjiin. Aminohappopitoisuuksiin perustuva päätöspuumalli luokitteli onnistuneesti 70,3 % lapsista vegaaneiksi tai ei-vegaaneiksi. Johtopäätökset: Kasvipohjaiset ruokavaliot vaikuttivat jossain määrin lasten seerumin aminohappopitoisuuksiin. Lisätutkimusta tarvitaan erityisesti terveysvaikutusten ja aminohappopitoisuuksien viitearvojen suhteen, erityisesti kasvipohjaisilla ruokavaliolla olevilla lapsilla.

The material that has been analyzed for this study consists of video recordings from Natur & Språk’s [Nature & Language’s] multilingual summer camps. The aim was to study the children’s interactions and conversations at the camps, focusing on their stances towards other languages. A further aim was to study the results in relation to the National Core Curriculum for Basic Education 2014. The research questions focus on how the children in their conversations express their stances and positions towards other languages, and how this can be related to the views on language stated in the national core curriculum. The respondents were between 8 and13 years old and spoke either Swedish or Finnish while some were bilingual. The video recordings of the conversations between the children were transcribed and analyzed through thematic analysis. The transcripts were additionally analyzed through a sociolinguistic perspective by studying the children’s stance. The theoretical framework of this study was based upon stance. As a result of the analysis, four main categories were found that represented the children’s varied ways of expressing their stances towards other languages, as well as other people’s language choices and backgrounds. The children categorized themselves and others in relation to languages and/or language groups. They showed expectations regarding their own and/or other’s competence. They expressed comments or whishes about language choice and showed orientation towards language learning. These results demonstrate that multilingual practices with language encounters create opportunities for children to challenge themselves and develop their language awareness, their stances and interests in other languages. In relation to this, parallels were drawn to the views on language stated in the National Core Curriculum, with its aims concerning language awareness and cultural diversity. Therefor this study can contribute with insight in regard to the potential that multilingual practices and activities have to offer in different educational contexts. This study is written in collaboration with the project Natur & Språk [Nature & Language], a collaboration between the Finnish Society for Nature and Environment, the Finnish Nature League and the Faculty of Educational Sciences at the University of Helsinki.

BACKGROUND: Population-based long-term data on pediatric patients with cerebral arteriovenous malformations (AVMs) are limited. OBJECTIVE: To clarify the characteristics and long-term outcome of pediatric patients with AVM. METHODS: A retrospective analysis was performed on 805 consecutive brain AVM patients admitted to a single center between 1942 and 2014. The patients were defined as children if they were under 18 yr at admission. Children were compared to an adult cohort. Changing patterns of presentation were also analyzed by decades of admission. RESULTS: The patients comprised 127 children with a mean age of 12 yr. The mean follow-up time was 21 yr (range 0-62). Children presented more often with intracerebral hemorrhage (ICH) but less often with epilepsy than adults. Basal ganglia, cerebellar, and posterior paracallosal AVMs were more common in pediatric than in adult patients. Frontal and temporal AVMs, in contrast, were more common in adult than in pediatric patients. As the number of incidentally and epilepsy-diagnosed AVMs increased, ICH rates dropped in both cohorts. In total, 22 (82%) pediatric and 108 (39%) adult deaths were assessed as AVM related. After multivariate analysis, small AVM size and surgical treatment correlated with a favorable long-term outcome. CONCLUSION: Hemorrhagic presentation was more common in children than in adults. This was also reflected as lower prevalence of epileptic presentation in the pediatric cohort. Lobar and cortical AVM locations were less frequent, whereas deep and cerebellar AVMs were more common in children. Hemorrhagic presentation correlated negatively with incidentally and epilepsy-diagnosed AVMs. In children, AVM was a major cause of death, but in adults, other factors contributed more commonly to mortality.

Tutkielmassa tarkastellaan läheisensä menettäneiden lasten suhdetta menetettyyn sururyhmän kontekstissa. Tutkielman tehtävänä on ymmärtää, miten lasten suhde ja side menetettyyn rakkaaseen tulee esiin heidän piirustuksissaan ja kertomuksissaan, ja toisaalta, mikä rooli sururyhmällä on lasten surussa. Lapsen ja kuolleen läheisen suhdetta tutkielmassa tarkastellaan jatkuvan tunnesiteen paradigmaa soveltaen. Tunnesiteen katsotaan jatkuvan kuoleman jälkeen läheisen menettäneen ja kuolleen välillä. Suhde läheisen menettäneen ja kuolleen läheisen välillä kuitenkin muuttuu elämän mittaan, sillä surun ajatellaan olevan elämänmittainen kokemus. Tutkielman aineisto koostuu neljästä eri materiaalista: visuaalisesta (piirustukset), kirjoitetusta (lasten taustatiedot), puhutusta (haastattelut) ja osallistuvasta havainnoinnista sururyhmässä. Tutkimusaihetta lähestytään sekä visuaalis-narrativiisella otteella viiden latenssi-ikäisen (9−11 vuotiaan) lapsen piirustuksien ja kertomusten kautta sekä temaattisnarratiivisella näkökulmalla sururyhmän ohjaajien haastattelun perusteella. Visuaalis-narratiivisen analyysin pohjalta nousee esiin kolme erilaista suhdetta ja sidettä menetettyyn: erottamaton side, muuttuva side ja tunnusteleva side. Nämä erilaiset tunnesiteet vaikuttavat olevan jatkuvan neuvottelun alla. Ne voivat muuttua ajan mittaan lapsen kasvaessa ja kehittyessä, ja ovat sidoksissa elämän sosiaaliseen ja kulttuuriseen kontekstiin latenssi-ikäisen lapsen tunnustellessa omaa rooliaan yhteiskunnassa. Temaattis-narratiivisesta analyysistä nousevien teemojen perusteella sururyhmässä menetetyt läheiset tulevat muistelun kautta näkyviksi ja muistelun pohjalta rakentuu side menetettyyn, vaikkakaan tuonpuoleisuuden ajatukset eivät ryhmässä nouse esiin. Sururyhmä antaa apukeinoja ja voimavaroja erityisesti ryhmän tarjoaman vertaistuen kautta surun kohtaamiseen, joka saattaa olla monelle ammattilaiselle haasteellista. Lopulta, surun sanoittaminen ja surun kokonaisvaltaisuuden käsittäminen sekä tulevaisuuden näkeminen merkityksellisenä tarjoavat surun kanssa eläville lapsille voimavaroja tulevaan. Näin ollen tutkielman tulokset osoittavat sururyhmän olevan tarpeellinen surun käsittelyssä. Tutkimuksen perusteella vaikuttaa siltä, että jatkotutkimuksena olisi hyödyllistä yhdistää kriisikeskusten ja seurakunnan lasten sururyhmätoiminta sekä tehdä pitkittäistutkimusta, sillä se mahdollistaisi suhteen ja tunnesiteen tarkastelun pidemmällä aikavälillä.

Johdanto Alhaisen ja keskituloluokan maissa, kuten Keniassa, lasten ja nuorten ravitsemuksesta tiedetään hyvin vähän. Kun maa on siirtymässä alhaisen tuloluokan maasta keskituloluokan maaksi, virheravitsemuksen riski moninkertaistuu. Tällöin väestössä ja samassa kotitaloudessa voi esiintyä samanaikaisesti sekä ali- että yliravitsemusta ja ravinnonpuutteita. Tästä johtuen on tärkeää saada lisää tietoa lasten ja nuorten ravitsemuksesta ja ruoankäytöstä sekä niissä tapahtuvista muutoksista. Jotta lasten ja nuorten ruoankulutusta voidaan mitata tarkasti ja luotettavasti, heidän täytyy osata luotettavasti arvioida ruoka-annostensa koko. Annoskoon arviointi tarkentuu lasten käyttäessä annoskuvakirjaa, jossa on ikäryhmälle sopivia annoskuvia. Tavoitteet Tämän tutkimuksen tavoitteena oli kehittää annoskuvakirja tukemaan 9–14-vuotiaiden nairobilaisten lasten annoskokojen arviointia ruoankäyttöfrekvenssikyselyn yhteydessä. Toinen tavoite oli selvittää 9–14-vuotiaiden lasten sekä kenialaisten ravitsemustieteilijöiden näkemystä kehitetyn annoskuvakirjan hyväksyttävyydestä ja käytettävyydestä. Menetelmät Julkaisuista ja muista virallisista dokumenteista selvitettiin taustatietoa yleisimmistä kenialaisista ruokalajeista ja annosko’oista. Annoskokojen määritystä varten rekrytoitiin 21 9–14-vuotiasta lasta, joista kymmenen Nairobin Embakasi Central-alueelta ja yksitoista Nairobin Langata-alueelta. Vierailujen yhteydessä heidän annoskokonsa punnittiin ja selvitettiin yleisimmin syödyt ruokalajit. Lisäksi selvitettiin alueiden katukauppojen, ravintoloiden sekä valintamyymälöiden tarjonta ja tarjolla olevien annosten koot punnittiin. Punnittujen annoskokojen perusteella määriteltiin kolme annoskokoa (A, B, C) suurimalle osalle ruokalajeista. B-annoskoko oli punnittujen annoskokojen keskiarvo, A oli puolet B:sta ja C puolitoista kertaa B. Kyselyyn osallistuneiden lasten äideille järjestettiin ruoanvalmistustilaisuus, jossa he valmistivat annoskuvakirjaan tulevat ruoat ja annoskoot punnittiin ja kuvattiin. Lopuksi annoskuvakirja koottiin ja sen käytettävyyttä testattiin kahdeksan lapsen ja neljän ravitsemustieteilijän keskuudessa. Käytettävyyskysely sisälsi yhdeksän Likert-asteikollista väitettä sekä avoimia kysymyksiä. Tutkittavien suullinen palaute ja tutkijoiden huomiot kirjattiin ylös. Tulokset Annoskuvakirja sai käytettävyysarvioiksi lapsilta ”OK” ja ravitsemusosaajilta ”Hyvä”. Kaikki kahdeksan nuorta uskoivat annoskuvakirjan auttavan heitä annoskokojen mieleen palauttamisessa, mutta vain puolet uskoi, että osaisivat käyttää annoskuvakirjaa yksin. Kaikki neljä ravitsemusosaajaa kertoivat, että käyttäisivät annoskuvakirjaa työssään, mutta kaikki kommentoivat, että valokuvien laatu oli kehno. Kolme lapsista katsoi, ettei annoskuvakirjan annoskoot vastaa heidän tavallisia annoskokojaan, mutta kaikki ravitsemusosaajat uskoivat, että annoskoot olivat sopivia ikäryhmälle. Ravitsemusosaajat antoivat suullista palautetta liittyen siihen, mitkä ruokalajit puuttuivat, missä järjestyksessä ne tulisi esittää sekä esittivät korjauksia ruoka-annosten muotoon. Johtopäätökset Valmis kirja sisälsi 88 ruokalajia. Annoskuvakirjan käytettävyyteen vaikutti etenkin valokuvien laatu sekä ruoka-annosten muodot. Selvät käyttöohjeet olivat myös tarpeelliset. Tässä tutkimuksessa saadun palautteen perusteella tehtiin annoskuvakirjasta toinen versio, jota käytettiin myöhemmin 160 lapsen poikkileikkaustutkimuksessa Nairobissa. Jatkotoimenpiteenä annoskuvakirja tulisi validoida, jotta tutkimuksissa voidaan paremmin huomioida sen tuomia virhelähteitä annoskokojen arviointiin.

Objective. The FRIENDS programme is a group cognitive behavioural therapy (CBT) programme, developed for the prevention and treatment of child and adolescent anxiety and depression. In the context of prevention, FRIENDS has been extensively researched; however, little research has been conducted on FRIENDS in a treatment setting and with different populations. To help fill this gap, the aim of the present study was to evaluate the effectiveness of the Finnish version of FRIENDS in reducing internalising symptoms in children diagnosed with psychiatric and neuropsychiatric disorders. Methods. The present study was conducted at Helsinki University Hospital (HUS) Child Psychiatry outpatient clinics in the Helsinki metropolitan area, Finland. The participating children (n = 99, mean age = 9.45 years, range 6–13 years, 68.7 % boys) were randomly assigned to either FRIENDS (n = 52) or a waitlist control group (n = 47), which received treatment as usual for a period of 3 months before the intervention. The children’s internalising symptoms were assessed using parent- and teacher-report questionnaires (Child Behavior Checklist and Teacher’s Report Form) at referral to treatment, pre-treatment, post-treatment, and six-month follow-up. Results and conclusions. In both groups, there was a medium-sized statistically significant decrease in parent-reported internalising symptoms immediately after the intervention; however, these improvements were not retained at six-month follow-up. Teacher-reported internalising symptoms followed a similar pattern of decrease during the intervention and increase during follow-up; however, these changes were smaller in magnitude and did not reach statistical significance, possibly due to loss of statistical power caused by missing data. Neither parent- or teacher-reports showed an intervention effect, with children’s internalising symptoms exhibiting similar changes regardless of whether they belonged to the intervention group or the waitlist control group, which received treatment as usual during the wait period. These results raise questions on the durability of treatment effects and the superiority of FRIENDS over active waitlist control conditions or treatment as usual when treating children diagnosed with diverse psychiatric and neuropsychiatric disorders in a community setting where treatment adherence and integrity may not be ideal.

Numerous genome-wide association studies (GWAS), GWAS meta-analyses and mouse studies have demonstrated that Wingless-related integration site 16 (WNT16) is associated with BMD, cortical bone thickness and strength as well as fracture risk. Practically no data exists regarding the significance of WNT16 in childhood-onset osteoporosis and fractures. Mutations and genetic variation in WNT16 were hypothesized to explain the clinical characteristics of some of the patients in question. Therefore, in this study the WNT16 gene was screened by Sanger sequencing in 46 pediatric patients with early-onset osteoporosis and in 60 pediatric patients with multiple fractures. We found altogether 12 variants in WNT16, of which one was a novel change. Inspite of the large amount of genetic variation found in WNT16, no actual mutations were found. None of the changes were statistically significant. It is likely that WNT16 mutations do not play an important role in the development of childhood osteoporosis.

The current definition for dietary fibre was adopted by the Codex Alimentarius Commission (CAC) in 2009, but implementation still requires updating food composition databases with values based on appropriate analysis methods. The Finnish National Food Composition Database Fineli is among the first to be updated with CODEX-compliant values of total dietary fibre (TDF), insoluble dietary fibre (IDF), dietary fibre soluble in water but precipitated in 78 % aqueous ethanol (SDFP) and dietary fibre soluble in water and not precipitated in 78 % aqueous ethanol (SDFS). Previous data on population intakes of dietary fibre fractions is sparse. The aim of this study was to assess intakes and sources of dietary fibre and dietary fibre fractions in Finnish children based on updated values of the national food composition database Fineli. In addition, associations of sociodemographic factors with energy adjusted total dietary fibre intake were assessed. Our sample included 5206 children at increased genetic risk of type 1 diabetes from the Type 1 Diabetes Prediction and Prevention birth-cohort, born between 1996 and 2004. We assessed the intakes and sources based on 3-day food records collected at the ages of 6 months, 1, 3, and 6 years. Associations of child’s age, sex, breastfeeding status and sociodemographic factors were assessed with independent samples t-test, Mann-Whitney U-test, and univariate analysis of variance. Food sources of dietary fibre were assessed with source analysis. Older children and boys had higher intakes of absolute dietary fibre. The highest energy-adjusted intake of TDF was however observed in 1-year-olds (2.85 g/MJ in boys; 2.77 g/MJ in girls). At the age of 6 months, non-breastfed girls and boys had higher energy-adjusted intake of TDF than their breastfed counterparts, while at the age of one the setting reversed. Children of older parents, parents with a higher level of education, non-smoking mothers, and children with no older siblings had higher energy-adjusted intakes of total dietary fibre. Cereal products, fruits and berries, potatoes, and vegetables were the major food sources of total dietary fibre as well as the dietary fibre fractions. IDF was the major dietary fibre fraction followed by SDFP and SDFS. Proportions of IDF and SDFP decreased with age, while the proportion of SDFS increased. Our study based on updated CODEX-compliant food database values found that on average the TDF intake of Finnish children met the recommendations. The proportions of dietary fibre fractions as well as the roles of different foods as dietary fibre sources shifted with the child’s age, reflecting age related changes in the child’s diet.

Background and aim Limited global research is available on the nutritional status of preschool-aged children following a vegan diet. Significant disparities in the absorption of animal and plant-based iron call for an investigation into the iron status of vegan children. The aim of the study was to assess the iron status of preschool-aged children and their caregivers following vegan or vegetarian diets compared to their omnivorous counterparts using multiple iron biomarkers. An additional aim was to capture the variation of dietary intake within the diet groups by constructing a dietary variable and exploring its association with iron biomarkers. Methods In a cross-sectional MIRA 2 study 2-6-year-old children following either a vegan, vegetarian or mixed diet, and their family members, were recruited from daycare centres in Helsinki. Parents reported their own and their children's diets and completed a short screener of dietary intake. Haemoglobin, transferrin receptor and ferritin concentrations were analysed from blood samples. The data used in this study included children (N=61) and parents (N=72) who provided a blood sample and answered the background questionnaire. Diet groups were formed based on the screener. Iron biomarker distributions were examined by diet groups with the Kruskal-Wallis test and iron deficiency prevalence was examined using the Fisher’s exact test. Dietary variables were constructed by principal component analysis and linear regression models were used to assess the association between the variables and iron biomarkers. Results Compared to omnivorous children, children following a vegan diet had lower haemoglobin concentrations (median -7 g/L), and children following a vegetarian diet were found to have haemoglobin values below the reference value (<112 g/L) more often. Vegan men had lower ferritin concentrations compared to omnivorous men (median -55 µg/l). Animal-based dietary pattern was associated with higher haemoglobin concentrations in children and ferritin concentrations in men. In women, a negative linear association was found between animal-based dietary pattern and ferritin concentrations. Of all children and women, 26% and 28 % had ferritin concentrations below the reference value (<12/15 µg/L). Conclusions Iron biomarker concentrations of vegetarians and vegans were lower compared to omnivores. While the popularity of plant-based diets is increasing, studies assessing the long-term effects of childhood vegetarian diets are warranted.