Biologisten lääkkeiden käyttöönotto ja käyttö Suomessa : Terveydenhuollon käytäntöjä ja näkökulmia

Uusia biologisia lääkkeitä tulee markkinoille koko ajan enemmän, ja niiden kustannukset ovat kasvaneet huomattavasti 2000-luvulla. Näihin lääkkeisiin liittyy useita hoidollisia ja yhteiskunnallisia kysymyksiä muun muassa lääkkeiden tehosta, turvallisuudesta, kohdentamisesta, kustannusvaikuttavuudesta ja hinnasta. Tässä tutkimuksessa selvitettiin biologisten lääkkeiden käyttöönottoon ja käyttöön liittyvää päätöksentekoa. Tutkimus toteutettiin vuosina 2013–2014. Tutkimuksessa haastateltiin reuma- ja syöpälääkäreitä sekä sairaala-apteekkareita eri puolilla Suomea. Lisäksi tarkasteltiin päätöksentekoon liittyviä dokumentteja ja lääkehoidon kustannuksia. Päätettäessä uuden lääkkeen käyttöönotosta arvioidaan sen asemaa sairauden hoidossa. Päätökset tehdään organisaatioissa ja jokapäiväisessä potilastyössä. Kaksikanavainen rahoitusjärjestelmä ohjaa valitsemaan korvattavia avohoitolääkkeitä lääketieteellisesti hyväksytyissä rajoissa. Kaksikanavaisuuteen liittyvät käytännöt koetaan ongelmallisina. Päätöksenteossa voidaan päätyä erilaisiin lopputuloksiin riippuen yksilöistä, organisaatioista ja paikallisista tekijöistä. Yksilöt voivat tulkita olemassa olevaa tietoa eri tavoin. Organisaatioiden linjaukset ja paikalliset tekijät, kuten sairastavuus, hoidon järjestämisen käytännöt ja resurssit, vaikuttavat päätöksenteossa. Vaikka erot päätöksenteossa eivät automaattisesti merkitse huonompia tai parempia hoitotuloksia, nousee tutkimuksen perusteella esille tarve yhtenäisille linjauksille kalliiden lääkehoitojen käytössä. Yhtenäiset linjaukset tukevat yhdenvertaisen hoidon toteutumista. Kalliita lääkkeitä koskeva päätöksenteko on yhdistelmä lääketieteellisiä, yhteiskunnallisia ja arvoihin liittyviä tekijöitä. Päätöksentekoa yhteisistä linjauksista voidaan tukea seuraamalla ja tutkimalla lääkkeiden vaikuttavuutta. Lisäksi päätöksenteossa tarvitaan tietoa eri osapuolten näkökulmista ja intresseistä. Kalliiden lääkehoitojen järkevä käyttö yksilöä hyödyttävällä, yhdenvertaisella ja yhteiskunnallisesti kestävällä tavalla asettaa entistä suuremman haasteen päätöksentekijöille ja väestölle.25,00 euro

Dog Owners\u27 Perspectives on Canine Dental Health : A Questionnaire Study in Sweden

Periodontal disease is one of the most common diseases affecting dogs, with a reported prevalence of at least 80% in dogs over 3 years of age. However, there is a lack of studies regarding dog owners\u27 assessment of their dog\u27s dental health, and whether they perceive clinical signs often associated with periodontal disease, i.e., dental calculus, halitosis or mobile or lost teeth. A validated questionnaire survey was distributed to all Swedish dog owners with email addresses in the national registry (n = 209,263). The response rate was 32%. The survey questions concerned opinions and practices regarding canine dental health, including assessment of dental health parameters and dog owners\u27 ability to examine their dog\u27s mouth. A construct (α = 0.76) was used to investigate dog owners\u27 assessed symptoms of their dog\u27s dental health in relation to background factors. Half of the respondents rated their dog\u27s dental health as very good. However, one in four dog owners experienced difficulties when inspecting the dog\u27s teeth. The most common reason for this difficulty was stated to be an uncooperative dog. Almost half of the dog owners reported halitosis to some degree in their dog, and almost four in ten owners reported dental calculus. One in eight dogs had been previously anesthetized for dental cleaning, and one in 12 dogs had experienced problems with gum disease, according to the owners. Owners\u27 assessment varied significantly with the dog\u27s age, weight, breed, breed group, sex, and concurrent disease. Owner-related factors that influenced the assessment of the dog\u27s dental health were age, gender, education, county (urban/rural), and whether they were breeders or not. Dog owners with smaller dogs, older dogs and certain breeds predisposed to periodontal disease assessed their dog\u27s dental health as worse than their counterparts, which is in agreement with previously reported higher prevalence of dental disease in these groups. This indicates that dog owners are able to perform relative assessment of their dog\u27s dental health status. Our results also highlight the need for routine professional assessment of periodontal health, as well as education of dog owners and training of dogs to accept dental care procedures

Iron status in early childhood is modified by diet, sex and growth : Secondary analysis of a randomized controlled vitamin D trial

Background & aims: During early childhood the risk of iron deficiency (ID) is high. Serum ferritin serves as a marker of iron status. We explored prevalence of ID and iron deficiency anemia (IDA), and identified determinants of iron status in infants and toddlers. Methods: We performed a secondary analysis of the Vitamin D intervention in infants (VIDI) study in Finnish healthy term infants. According to study protocol, at 12- and 24-months of age iron status, growth and dietary intakes were evaluated. ID was defined as serum ferritin Results: ID prevalence increased from 14% in infants to 20% in toddlers. IDA prevalence was 3% at both time points. In infants, ID and IDA were more common in boys than in girls (19% vs. 9%, p = 0.001 and 5% vs. 1%, p = 0.039) but no sex-difference in toddlers was observed. Of infants, 30% had daily iron intake below average requirement of 5 mg/day. Higher daily iron intake per body weight (mg/kg) independently associated with higher infant serum ferritin (B (95% CI) 0.30 (0.04, 0.56), p = 0.026). Correlation between iron intake and ferritin was stronger in infants with ID than in infants without ID. Breastfeeding was more common (63% vs. 35%, p < 0.001) among ID infants than in infants without ID. In toddlers, frequent consumption of milk products independently associated with lower ferritin (B (95% CI) -0.03 (-0.05, -0.01), p = 0.001). Consumption of meat and fish associated with better iron status. Serum ferritin at both time points associated with duration of gestation and growth. The association of growth and ferritin was age-dependent in boys, while in girls, faster growth associated consistently with lower ferritin. Conclusions: In Northern European healthy infants and toddlers ID is common. The intake of iron remains below recommendations and food consumption and iron intake associate with iron status. Further studies are warranted to assess significance of ID on child development and clinical health outcomes. (C) 2021 The Authors. Published by Elsevier Ltd.Peer reviewe

The Effects of Vitamin D Supplementation During Infancy on Growth During the First 2 Years of Life

Context: The relationship between maternal and infant vitamin D and early childhood growth remains inadequately understood. Objective: This work aimed to investigate how maternal and child 25-hydroxyvitamin D (25[OH]D) and vitamin D supplementation affect growth during the first 2 years of life. Methods: A randomized, double-blinded, single-center intervention study was conducted from pregnancy until offspring age 2 years. Altogether 812 term-born children with complete data were recruited at a maternity hospital. Children received daily vitamin D-3 supplementation of 10 mu g (group 10) or 30 mu g (group 30) from age 2 weeks to 2 years. Anthropometry and growth rate were measured at age 1 and 2 years. Results: Toddlers born to mothers with pregnancy 25(OH)D greater than 125 nmol/L were at 2 years lighter and thinner than the reference group with 25(OH)D of 50 to 74.9 nmol/L (P .053), but group 30 had slower growth in length and head circumference between 6 months and 1 year (P 121 nmol/L) were shorter (mean difference 0.2 SD score [SDS], P = .021), lighter (mean difference 0.4 SDS, P = .001), and thinner (in length-adjusted weight) (mean difference 0.4 SDS, P = .003) compared with the lowest quartile (< 81.2 nmol/L). Conclusion: Vitamin D and early childhood growth may have an inverse U-shaped relationship.Peer reviewe

Collagen X Biomarker (CXM), Linear Growth, and Bone Development in a Vitamin D Intervention Study in Infants

Publisher Copyright: © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).Collagen X biomarker (CXM) is suggested to be a biomarker of linear growth velocity. However, early childhood data are limited. This study examines the relationship of CXM to the linear growth rate and bone development, including the possible modifying effects of vitamin D supplementation. We analyzed a cohort of 276 term-born children participating in the Vitamin D Intervention in Infants (VIDI) study. Infants received 10 μg/d (group-10) or 30 μg/d (group-30) vitamin D3 supplementation for the first 2 years of life. CXM and length were measured at 12 and 24 months of age. Tibial bone mineral content (BMC), volumetric bone mineral density (vBMD), cross-sectional area (CSA), polar moment of inertia (PMI), and periosteal circumference (PsC) were measured using peripheral quantitative computed tomography (pQCT) at 12 and 24 months. We calculated linear growth as length velocity (cm/year) and the growth rate in length (SD unit). The mean (SD) CXM values were 40.2 (17.4) ng/mL at 12 months and 38.1 (12.0) ng/mL at 24 months of age (p = 0.12). CXM associated with linear growth during the 2-year follow-up (p = 0.041) but not with bone (p = 0.53). Infants in group-30 in the highest tertile of CXM exhibited an accelerated mean growth rate in length compared with the intermediate tertile (mean difference [95% CI] −0.50 [−0.98, −0.01] SD unit, p = 0.044) but not in the group-10 (p = 0.062) at 12 months. Linear association of CXM and growth rate until 12 months was weak, but at 24 months CXM associated with both length velocity (B for 1 increment of √CXM [95% CI] 0.32 [0.12, 0.52] cm/yr, p = 0.002) and growth rate in length (0.20 [0.08, 0.32] SD unit, p = 0.002). To conclude, CXM may not reliably reflect linear growth from birth to 12 months of age, but its correlation with growth velocity improves during the second year of life.Peer reviewe

Maternal vitamin D status, gestational diabetes and infant birth size

Background: Maternal vitamin D status has been associated with both gestational diabetes mellitus (GDM) and fetal growth restriction, however, the evidence is inconsistent. In Finland, maternal vitamin D status has improved considerably due to national health policies. Our objective was to compare maternal 25-hydroxy vitamin D concentrations [25(OH)D] between mothers with and without GDM, and to investigate if an association existed between maternal vitamin D concentration and infant birth size. Methods: This cross-sectional study included 723 mother-child pairs. Mothers were of Caucasian origin, and infants were born at term with normal birth weight. GDM diagnosis and birth size were obtained from medical records. Maternal 25(OH)D was determined on average at 11 weeks of gestation in pregnancy and in umbilical cord blood (UCB) at birth. Results: GDM was observed in 81 of the 723 women (11%). Of the study population, 97% were vitamin D sufficient [25(OH)D >= 50 nmol/L]. There was no difference in pregnancy 25(OH)D concentration between GDM and non-GDM mothers (82 vs 82 nmol/L, P = 0.99). Regression analysis confirmed no association between oral glucose tolerance test results and maternal 25(OH)D (P > 0.53). Regarding the birth size, mothers with optimal pregnancy 25(OH)D (>= 80 nmol/L) had heavier newborns than those with suboptimal pregnancy 25(OH)D (P = 0.010). However, mothers with optimal UCB 25(OH) D had newborns with smaller head circumference than those with suboptimal 25(OH)D (P = 0.003), which was further confirmed as a linear association (P = 0.024). Conclusions: Maternal vitamin D concentration was similar in mothers with and without GDM in a mostly vitamin D sufficient population. Associations between maternal vitamin D status and birth size were inconsistent. A sufficient maternal vitamin D status, specified as 25(OH)D above 50 nmol/L, may be a threshold above which the physiological requirements of pregnancy are achieved.Peer reviewe

High Pregnancy, Cord Blood, and Infant Vitamin D Concentrations May Predict Slower Infant Growth

Context: The relationship of maternal and infant 25-hydroxyvitamin D concentration [25(OH)D] with infant growth is unclear. Objective: Our objective was to explore whether 25(OH)D in pregnancy, umbilical cord blood (UCB), or in infancy was associated with infant growth. Design: This study involved 798 healthy infants and their mothers in Finland. We assessed 25(OH)D during pregnancy, from UCB at birth, and from the infant at the age of 12 months. Main Outcome Measures: Infant length, weight, length-adjusted weight, and head circumference at 6 and 12 months and midupper-arm circumference at 12 months. Results: Of the mothers and infants, 96% and 99% were vitamin D sufficient [25(OH)D >= 50 nmol/L], respectively. Mothers with pregnancy 25(OH)D >125 nmol/L had the shortest, lightest (in weight), and thinnest (in length-adjusted weight) infants at 6 months (P for all <0.05). For each 10 nmol/L higher UCB 25(OH)D, the infants were 0.03 SD score (SDS) shorter at 6 months (95% CI -0.05 to -0.01), adjusted for birth size, infant 25(OH)D, and parental height. Higher UCB 25(OH)D associated with smaller head circumference at 6 and 12 months (P for all 125 nmol/L had the thinnest infants at 12 months (P = 0.021). For each 10 nmol/L higher infant 25(OH)D, the infants were 0.03 SDS lighter (-0.05 to -0.01) and 0.03 SDS thinner (-0.05 to 0.00) at 12 months. Conclusions: Our results suggest that high pregnancy, cord blood, and infant vitamin D concentration may have disadvantageous effects on infant growth.Peer reviewe

Food and Nutrient Intake and Nutrient Sources in 1-Year-Old Infants in Finland : A Cross-Sectional Analysis

The infant diet has short- and long-term health consequences. Updated data regarding the dietary intake of Finnish infants are lacking. The objectives of this study were to describe infant food and nutrient intake and to identify food sources of the nutrients. Altogether, 739 healthy infants were studied. Dietary intake and breastfeeding frequency were assessed with a three-day food record at 1 year of age. Dietary intake was calculated separately for non-breastfed and breastfed infants. One-third (36%) of the infants were partially breastfed and 95% consumed mass-produced baby foods. The infants' diet consisted mainly of infant formula, dairy milk, porridges, fruit and berry foods, and meat dishes. The mean vegetable, fruit and berry consumption was 199 g/day. Most nutrient intakes were adequate except for fat, linoleic acid, vitamin D and iron from food. Mean sucrose intake, as a percentage of total energy intake (E%), was 5-6 E%. High protein intake (>20 E%) was observed in 19% of non-breastfed infants. Overall, the infants' diet was favorable since vegetable and fruit consumption was reasonably high and nutrient intake was mostly adequate. However, the fat intake was lower, and protein intake higher than recommended. Increasing the consumption of vegetable oils and reducing the intake of red meat and dairy milk may further improve the diet of 1-year-olds.Peer reviewe

Season, dietary factors, and physical activity modify 25-hydroxyvitamin D concentration during pregnancy

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