Määrältään vähäisen tupakoinnin ominaispiirteet ja pysyvyys suomalaisessa aikuisväestössä

Tupakointitutkimukset keskittyvät perinteisesti säännöllisesti tai runsaasti tupakoiviin. Koska ei ole osoitettu mitään terveyden kannalta haitattoman tupakoinnin rajaa, määrältään vähäisenkin tupakoinnin tutkiminen on tärkeää. Tutkielman tavoitteina oli analysoida päivittäin 1-4 savuketta polttavien ominaispiirteitä, tupakointitottumusten pysyvyyttä sekä tupakointitavan muutosta ennustavia tekijöitä. Tutkimuksessa käytettiin vuosina 1975, 1981 ja 1990 kerätyn suomalaisen kaksoskohorttitutkimuksen kyselyaineistoa. Vuoden 1975 aineistossa oli 9 940 päivittäistupakoitsijaa, joista 8% poltti alle 5 ja 20% vähintään 20 savuketta päivässä. Tutkimuksessa verrattiin päivittäin vähän ja paljon polttavien ominaispiirteitä. Vähän tupakoivat olivat todennäköisemmin naisia, yksin eläviä, liikunnallisia, korkeammin koulutettuja, elämäänsä tyytyväisiä ja vähemmän stressaantuneita kuin runsaasti polttavat. Pienempi osuus vähemmän tupakoivista käytti runsaasti kahvia ja alkoholia tai tupakoidessaan hengitti savua keuhkoihin. Pitkittäistarkastelussa ikä, koulutusaste, siviilisäädyn muutos ja alkoholin käyttö ennustivat tupakointitapojen muuttumista. Yksilötasolla vähäinen tupakointi oli usein väliaikaista: seuranta-aikana valtaosa lopetti tupakoinnin tai lisäsi savukemäärää. Väestötasolla vähän tupakoivien osuus pysytteli samana: tupakoinnin aloittajia, vähentäjiä sekä aiemmin lopettaneita mutta uudelleen aloittaneita siirtyi tähän ryhmään

Smoking patterns and lung function : a longitudinal twin study

In many countries, the prevalence of smoking and smokers average cigarette consumption have decreased, with occasional smoking and daily light smoking (1-4 cigarettes per day, CPD) becoming more common. Despite these changes in smoking patterns, the prevalence of chronic obstructive pulmonary disease (COPD), a disorder characterized by a progressive decline in lung function, continues to rise globally. Smoking is the most important factor causing COPD, however, not all smokers develop the disease. Genetic factors partly explain the inter-individual differences in lung function and susceptibility of some smokers to COPD. No earlier research on the genetic and environmental determinants of lung function or on the phenomenon of light smoking exists in the Finnish population. Further, the association between low-rate smoking patterns and COPD remains partly unknown. This thesis aimed to study the prevalence and consistency of light smoking longitudinally in the Finnish population, to assess the characteristics of light smokers, and to examine the risks of chronic bronchitis and COPD associated with changing smoking patterns over time. A further aim was to estimate longitudinally the proportions of genetic and environmental factors that explain the inter-individual variances in lung function. Data from the Older Finnish Twin Cohort, including same-sex twin pairs born in Finland before 1958, were used. Smoking patterns and chronic bronchitis symptoms were consistently assessed in surveys conducted in 1975, 1981, and 1990. National registry data on reimbursement eligibilities and medication purchases were used to define COPD. Lung function data were obtained from a subsample of the cohort, 217 female twin pairs, who attended spirometry in 2000 and 2003 as part of the Finnish Twin Study on Ageing. The genetic and environmental influences on lung function were estimated by using genetic modeling. This thesis found that light smokers are more often female, well-educated, and exhibit a healthier lifestyle than heavy smokers. At individual level, light smoking is rarely a constant pattern. Light smoking, reducing from heavier smoking to light smoking, and relapsing to light smoking after quitting, are among patterns associated with an increased risk of chronic bronchitis and COPD. Constant light smoking is associated with an increased use of inhaled anticholinergics, a medication for CODP. In addition to smoking, other environmental factors influence lung function in the older age. During a three-year follow-up, new environmental effects influencing spirometry values were observed, whereas the genes affecting lung function remained mostly the same. In conclusion, no safe level of daily smoking exists with regard to pulmonary diseases. Even daily light smoking in middle-age is associated with increased respiratory morbidity later in life. Smoking reduction does not decrease the risk of COPD, and should not be recommended as an alternative to quitting smoking. In elderly people, attention should also be drawn to other factors that can prevent poor lung function.Krooninen keuhkoputkentulehdus ja keuhkoahtaumatauti voivat kehittyä muutamia savukkeita päivässä tupakoiville, eikä tupakoinnin vähentäminen suojaa sairastumiselta. Verrattuna ei koskaan tupakoineisiin, on 1-4 savuketta päivässä tupakoivilla 1,6-kertainen riski sairastua krooniseen keuhkoputkentulehdukseen ja kolminkertainen riski sairastua lääkkeillä hoidettavaan keuhkoahtaumatautiin. Enemmän tupakoivilla tupakoinnin vähentäminen ei alenna sairastumisriskiä. Vähäinen päivittäistupakointi on yksilötasolla harvoin pysyvä tapa. Kun 1-4 savuketta päivässä tupakoivia verrattiin yli 20 savuketta päivässä tupakoiviin, vähäinen tupakointi oli yleisempää naisilla sekä terveellisiä elintapoja noudattavilla ja korkeasti koulutetuilla ihmisillä. Tupakoimattomilla naisilla geneettiset tekijät selittävät noin kolmasosan ja erilaiset ympäristötekijät kaksi kolmasosaa yksilöiden välisestä keuhkotoiminnan vaihtelusta. Tutkimustulokset tukevat käsitystä siitä, että vähäinenkin tupakointi vahingoittaa keuhkoja. Vähäinen päivittäistupakointi lisää myöhemmin kehittyvien keuhkoahtaumataudin ja kroonisen keuhkoputkentulehduksen riskiä. Muutamia savukkeita päivässä tupakoivat tarvitsevat tukea tupakoinnin lopettamiseen, sillä moni heistä lisää tupakointiaan myöhemmin. Tupakoinnin vähentäminen ei pienennä keuhkoahtaumataudin kehittymisen riskiä, eikä sitä voi suositella vaihtoehtona lopettamiselle. Ikääntyvillä ihmisillä tulee kiinnittää huomiota myös muihin alentuneen keuhkotoiminnan riskitekijöihin kuin tupakointiin. Suomessa ja monessa kehittyneessä maassa tupakointi vähenee ja tupakoitsijoiden päivittäinen savukkeiden määrä pienenee, kun taas satunnaistupakointi sekä määrältään vähäinen päivittäistupakointi yleistyvät. Keuhkoahtaumataudin esiintyvyys maailmalla puolestaan kasvaa. Vähäiseen tupakointiin liittyvä keuhkosairauksien riski tunnetaan huonosti, ja epäselvänä on pidetty myös sitä, suojaako tupakoinnin vähentäminen keuhkosairauksien kehittymiseltä. Vaikka tupakointi on keuhkoahtaumataudin tärkein riskitekijä, kaikki tupakoitsijat eivät sairastu. Geneettiset tekijät vaikuttavat sairastumisalttiuteen ja selittävät osan yksilöiden välisistä eroista keuhkojen toimintakapasiteetissa. Suomalaisessa väestössä ei ole aiemmin tutkittu määrältään vähäistä tupakointia eikä geneettisten tekijöiden ja ympäristötekijöiden vaikutusta keuhkotoimintaan. Tutkimuksessa käytettiin Suomen kaksoskohorttitutkimuksen kolmea kyselyaineistoa vuosilta 1975, 1981 ja 1990. Kyselyissä on tutkittu tupakointitavat sekä kroonisen keuhkoputkentulehduksen oireet yksityiskohtaisesti ja yhtenevällä tavalla. Kansaneläkelaitoksen rekisteritietoja lääkeostoista sekä lääkkeiden erityiskorvattavuuksista käytettiin keuhkoahtaumataudin määrittelemiseksi. Keuhkotoimintamittaukset tehtiin vuosina 2000 ja 2003 kaksoskohortin alaotokselle, 217 naiskaksosparille. Geneettisten tekijöiden ja ympäristötekijöiden selitysosuudet keuhkotoiminnan yksilöiden välisestä vaihtelusta arvioitiin käyttämällä geneettistä mallinnusta

Risk factors and outcomes of tapering surgery for small intestinal dilatation in pediatric short bowel syndrome

Background: In remains unclear why in some short bowel syndrome (SBS) patients, the remaining small bowel (SB) dilates excessively leading to requirement of tapering surgery. Methods: Among SBS children, we retrospectively analyzed risk factors for tapering surgery with logistic regression and compared the outcome of operated patients (n = 16) to those managed conservatively (n = 44) with Cox proportional hazards regression. Results: SBS was caused by necrotizing enterocolitis (NEC) (n = 31), SB atresia (SBA) (n = 13), midgut volvulus (n = 12), or gastroschisis (n = 4). Patients with spontaneous symptomatic SB dilatation unable to wean parenteral nutrition (PN) underwent tapering surgery at median age of 1.04 (interquartile range 0.70-3.27) years. Missing ICV was related to an 8-fold (p = 0.003) increased risk while SBA diagnosis was related to a 13-fold risk of tapering surgery (p <0.001). Increasing SB length and NEC diagnosis were protective of tapering (p = 0.027-0.004). Of operated patients, 75% reached enteral autonomy during follow-up and their postoperative adjusted PN weaning rate was similar to nonoperated children (p = 0.842). Conclusion: SBS children with short remaining SB, missing ICV, and SBA etiology are more likely while NEC patients are less likely than others to necessitate tapering surgery. Postoperative PN weaning rates were comparable to patients who initially had more favorable intestinal anatomy and adapted without surgery. (C) 2017 Elsevier Inc. All rights reserved.Peer reviewe

Long-term outcomes of biliary atresia patients surviving with their native livers

Publisher Copyright: © 2021 The Author(s)Portoenterostomy (PE) has remained as the generally accepted first line surgical treatment for biliary atresia (BA) for over 50 years. Currently, close to half of BA patients survive beyond 10 years with their native livers, and most of them reach adulthood without liver transplantation (LT). Despite normalization of serum bilirubin by PE, ductular reaction and portal fibrosis persist in the native liver. The chronic cholangiopathy progresses to cirrhosis, complications of portal hypertension, recurrent cholangitis or hepatobiliary tumors necessitating LT later in life. Other common related health problems include impaired bone health, neuromotor development and quality of life. Only few high-quality trials are available for evidence-based guidance of post-PE adjuvant medical therapy or management of the disease complications. Better understanding of the pathophysiological mechanisms connecting native liver injury to clinical outcomes is critical for development of accurate follow-up tools and novel therapies designed to improve native liver function and survival.Peer reviewe

Small Bowel Dilatation Predicts Prolonged Parenteral Nutrition and Decreased Survival in Pediatric Short Bowel Syndrome

Objective: To analyze risk factors and prognostic significance of small bowel (SB) dilatation in children with short bowel syndrome (SBS). Background: In SBS, the remaining SB may dilate as part of intestinal adaptation. The impact of dilatation on parenteral nutrition (PN) dependence and survival has not been studied systematically. Methods: SB diameter of SBS children (n = 61) was measured in contrast SB series (n = 169, median age 0.94, range 0.32-2.7 years) during 2002 to 2015, and expressed as millimeters (SB width) and as ratio to L5 vertebra height (SB diameter ratio). Linear regression was used to examine risk factors for dilatation. PN weaning and survival were analyzed with Cox proportional hazards regression. Results: Maximal SB diameter ratio during follow-up was predicted by PN dependence and SB atresia, while maximal absolute SB width by birth weight, age, PN duration, and remaining bowel length. Weaning off PN was 14-fold more likely in patients with maximal SB diameter ratio 3.00 (P = 0.005), and 5.4-fold more likely when maximal SB width was 30mm (P = 0.023). After adjustment for age, remaining SB length, and the presence of ileocecal valve, both estimates of maximal SB dilatation remained significant independent predictors for weaning off PN. When all measurements were included, the cumulative survival was worse if SB diameter ratio exceeded 2.00 (P = 0.002-0.042). Conclusions: SB dilatation predicts prolonged PN duration and decreased survival in SBS children. Measurement of maximal SB diameter standardized to L5 vertebra height may be a valuable objective tool for patient follow-up and assessment of prognosis.Peer reviewe

Growth of children with biliary atresia living with native livers : impact of corticoid therapy after portoenterostomy

We addressed growth of biliary atresia (BA) patients living with native livers between ages 0-6 and effects of post-surgical corticosteroid treatment on growth. Growth charts of 28 BA patients born in Finland between 1987 and 2017 were retrospectively evaluated. Dosage and length of corticosteroid treatment and hydrocortisone substitution were reviewed. At birth, BA patients were shorter (median height -0.6 (interquartile range (IQR) -1.3 to -0.1) SDS, n=28, PPeer reviewe

Very low bilirubin after portoenterostomy improves survival of the native liver in patients with biliary atresia by deferring liver fibrogenesis

Background: Progression of fibrosis and ensuing complications determine the postoperative course of patients operated on for biliary atresia. We evaluated predictors of the progression of fibrosis in the native liver after operative treatment. Methods: Among patients whose bilirubin decreased to Results: After median follow-up of 5.2 years (interquartile range 1.6-10.2) after portoenterostomy, liver biopsies showed cirrhosis in 53% of patients, and the Metavir stage remained stable or decreased in 38%. The development of cirrhosis was predicted by total or conjugated bilirubin >= 170/120 mu mol/L at the time of portoenterostomy (P = 12.5/7.5 mu mol/L (P=.002) and aspartate aminotransferase-to-platelet ratio >= 0.55 at 3 months postoperatively (P=.001); and total or conjugated bilirubin >= 7.5/2.5 mu mol/L (P = 0.63 (P=.004), and gamma glutamyl transferase >= 266 U/L (P=.007) at 6 months postoperatively. In multiple regression analysis, conjugated bilirubin >= 2.5 mu mol/L at 6 months increased the risk of cirrhosis 35-fold (P=.020), and other predictors were not predictive. Total or conjugated bilirubin <12.5/7.5 mu mol/L (P = 0.55 at 3 months (P=.006), and total or conjugated bilirubin <7.5/2.5 mu mol/L at 6 months postoperatively (P Conclusion: Among patients whose serum bilirubin normalizes after portoenterostomy, its rapid decrease to very low levels prolongs the survival of their native liver by delaying the progression of fibrosis. (C) 2018 Elsevier Inc. All rights reserved.Peer reviewe

Health-related quality of life and neurodevelopmental outcomes among children with intestinal failure

Treatment results of pediatric intestinal failure have improved markedly during the last decades. With improved survival the attention is turning to other essential outcomes including quality of life and neurodevelopment. So far, relatively few studies with limited number of patients and variable methodology have addressed these issues. Based on these studies using generic health related quality of life tools, children with intestinal failure demonstrate decreased physical health, while PN-dependence is also associated with compromised emotional functioning. Impairments of social functioning are frequently observed among older children and parents. Few recent studies on neurodevelopment imply significant impairments in motor and mental skills among children with intestinal failure despite small sample sizes and limited follow-up times. Development of a disease-specific survey designed for the pediatric intestinal failure population could better reveal the health issues with greatest impact on quality of life. Robust studies with appropriate methodology on neurodevelopment in pediatric intestinal failure with extended follow-up times are urgently needed. Quality of life and neurodevelopment requires greater attention from medical professionals managing children with intestinal failure. (C) 2018 Elsevier Inc. All rights reserved.Peer reviewe

Noninvasive Evaluation of Liver Fibrosis and Portal Hypertension After Successful Portoenterostomy for Biliary Atresia

We investigated noninvasive follow-up markers for histologic liver fibrosis and portal hypertension (PH) in patients with biliary atresia after successful portoenterostomy (PE). Among children with bilirubin 11 mu mol/L in the youngest tertile (AUROC, 0.91; P 80 mu mol/L in the middle tertile (AUROC, 0.81; P = 0.009), and liver stiffness was >24 kPa in the oldest age tertile (AUROC, 0.96; P = 0.002). Conclusion: After successful PE, development of PH associates with progression of liver fibrosis and can be accurately detected by APRI and stiffness. Liver stiffness most accurately identified cirrhosis in older children, whereas biochemical markers of cholestasis closely reflected histologic cirrhosis in younger children.Peer reviewe

Fecal calprotectin in the prediction of postoperative recurrence of Crohn's disease in children and adolescents

Background: Fecal calprotectin (FC) correlates with endoscopic recurrence of Crohn's disease (CD) in adults but has not been studied among children postoperatively. We aimed to analyze whether FC relates with postoperative CD recurrence in children. Methods: Altogether 51 postoperative endoscopies and FC measurements from 22 patients having undergone surgery for CD at age Results: Ileocecal resection (n = 15), small bowel resection (n = 6), or left hemicolectomy (n = 1) was performed at median age of 15.1 (interquartile range 14.4-17.6) years. Following surgery, FC decreased significantly (659 vs. 103 mu g/g, p = 0.001). During median follow-up of 5.7 (4.2-7.7) years, either endoscopic or histological recurrence occurred in 17 patients (77%). FC > 139 mu g/g at time of endoscopy or FC increase of 79 mu g/g compared to first postoperative value was suggestive of endoscopic recurrence (Rutgeerts score i2-i4), while FC > 101 mu g/g or increase of 21 mu g/g indicated histological recurrence. Best accuracy for prediction of recurrence was obtained by combining FC at endoscopy and the postoperative increase of FC. The corresponding AUROC values were 0.74 (95% 0.58-0.89) for endoscopic recurrence whereas 0.81 (95% CI 0.67-0.95) for histological recurrence. Conclusion: FC is a useful surrogate marker of postoperative recurrence also in pediatric CD patients. (C) 2016 Elsevier Inc. All rights reserved.Peer reviewe