[Update on Current Care guidelines: obesity (children)]

Childhood obesity is an increasing health problem. There may be possibilities to prevent obesity in childhood, and efficient interventions to treat obese children have been published. Local and regional strategies to prevent and to treat childhood obesity are needed.

[Update on current care guidelines: appropriate treatment of medical problems associated with Down's syndrome]

The lifetime prognosis of people with Down's syndrome has improved. Development of the services that health care and society can offer to such people is ongoing. These guidelines are targeted at defining what is required to further increase the lifespan and quality-of-life of people with Down's syndrome.

Verbal and academic skills in children with early-onset type 1 diabetes

AIM

Basic verbal and academic skills can be adversely affected by early-onset diabetes, although these skills have been studied less than other cognitive functions. This study aimed to explore the mechanism of learning deficits in children with diabetes by assessing basic verbal and academic skills in children with early-onset diabetes and in comparison children. In addition, the incidence of dyslexia (< or =10th centile in reading speed or reading-spelling accuracy) was studied.

METHOD

The performance of 51 children with early-onset diabetes (25 females, 26 males; mean age 9y 11mo, SD 4mo; range 9-10y) was compared with that of 92 children without diabetes (40 females, 52 males; mean age 9y 10mo, SD 3mo; range 9-10y) in the tasks of phonological processing, short-term memory, rapid automatized naming, reading, spelling, and mathematics.

RESULTS

The performance of children with diabetes was poorer than that of the comparison children in phonological processing (p=0.001), spelling accuracy (p<0.001), and mathematics (p=0.024). They learned to read later (p=0.013), but reading performance and the incidence of dyslexia in the third grade (aged 9-10y) were similar in the two groups.

INTERPRETATION

Children with early-onset diabetes are prone to minor learning difficulties in their early school years as a result of deficits in phonological processing.

Healthcare professionals' intentions to use clinical guidelines: a survey using the theory of planned behaviour

Background

Finnish clinical guidelines are evolving toward integration of knowledge modules into the electronic health record in the Evidence-Based Medicine electronic Decision Support project. It therefore became important to study which factors affect professionals' intention to use clinical guidelines generally in their decision-making on patient care. A theory-based approach is a possible solution to explore determinants of professionals' behaviour. The study's aim was to produce baseline information for developers and implementers by using the theory of planned behaviour.

Methods

A cross-sectional internet-based survey was carried out in Finnish healthcare organisations within three hospital districts. The target population (n = 2,252) included physicians, nurses, and other professionals, of whom 806 participated. Indicators of the intention to use clinical guidelines were observed by using a theory-based questionnaire. The main data analysis was done by means of multiple linear regressions.

Results

The results indicated that all theory-based variables--the attitude toward the behaviour, the subjective norm, and the perceived behaviour control--were important factors associated with the professionals' intention to use clinical practice guidelines for their area of specialisation in the decisions they would make on the care of patients in the next three months. In addition, both the nurse and the physician factors had positive (p < 0.01) effects on this intention in comparison to other professionals. In the similar models for all professions, the strongest factor for the physicians was the perceived behaviour control, while the key factor for the nurses and the other professionals was the subjective norm. This means that context- and guideline-based factors either facilitate or hinder the intention to use clinical guidelines among physicians and, correspondingly, normative beliefs related to social pressures do so for nurses and other healthcare professionals.

Conclusions

The results confirm suggestions that the theory of planned behaviour is a suitable theoretical basis for implementing clinical guidelines in healthcare practices. Our new finding was that, in general, profession had an effect on intention to use clinical guidelines in patient care. Therefore, the study reaffirms the general contention that different strategies need to be in place when clinical guidelines are targeted at different professional groups.

Towards a National Health Information System evaluation

Most EU Member States have a documented policy on eHealth. Documented follow-up and evaluation strategies for assessing whether national level systems have reached their set aims and outcomes are, however, rare. Methodologies for large scale information system assessment and evaluation are poorly established. This article describes the approach used to generate the Finnish National Health Information System (NHIS) evaluation plan. The core elements of the plan are illustrated, discussing also challenges and solutions in implementation. The article is based on NHIS evaluation planning project [15] and its presentation in the MIE workshop in Sarajevo in 2009 [16], where core issues and challenges of large-scale evaluations were discussed using the Finnish NHIS evaluation plan as a frame of reference.The Finnish plan offers other countries tools with which to assess their own plans and generate national methodologies for NHIS evaluation.

[Judgment of the level of evidence and strength of recommendations in healthcare according to the GRADE working group]

Finnish doctors are pioneers in the production and utilization of evidence-based recommendations in healthcare. Doctor's databases were established by the end of the 1980s and Current Care guidelines have been devised since 1994. In evidence-based recommendations it is essential to provide the user with a description of the quality of research data used as the basis for the recommendation. Consistent, applicable and transparent methods are helpful in the judgment of the quality of studies and strength of evidence. In this article we describe the judgment of the level of evidence and the strength of recommendations according to the international GRADE working group.

Breastfeeding stimulates total and cow's milk-specific salivary IgA in infants

Breastfeeding may increase the rate of mucosal maturation and IgA production. We sought to determine the effect of breastfeeding vs. formula-feeding on the maturation of oral mucosa by measuring the salivary total antibodies and cow's milk protein-specific IgA. Fifty-eight saliva samples were collected from 39 healthy, full term infants. At the age of 3 months (n = 25) eight infants received only breast milk and seventeen formula (cow's milk based n = 10, hydrolysed n = 7) and breast milk; and at the age of 6 months (n = 33) eleven received breast milk, seventeen formula and breast milk and five were not breastfed any more (cow's milk based n = 14, hydrolysed n = 8). Total IgA, IgG, IgM and protein, and beta-lactoglobulin specific IgA were measured from saliva with enzyme-linked immunoassay (ELISA). The antibody results were proportioned to total protein. No differences in antibody levels between the feeding groups were found at 3 months of age. At 6 months, total IgA, total IgM and beta-lactoglobulin-specific IgA were higher among the breastfed infants compared to those receiving formula as supplement to breast milk or not breastfed any more (breast milk vs. any formula p = 0.029, p = 0.015, p = 0.058; breast milk vs. cow's milk formula p = 0.025, p = 0.044, p = 0.038). To conclude, breastfeeding stimulated the mucosal immune system to produce IgA to saliva, which is a marker for immunological maturation and likely provides protection against environmental antigens.

Planning for national health information system evaluation

Most EU member states have a documented policy on eHealth. Documented follow-up and evaluation policies to assess reaching of the set aims, as well as evaluating outcomes of implemented systems at a national level are, however, rare. Methodologies for large scale information system assessment and evaluation are poorly established. In the workshop, the Finnish evaluation plans for the National Health Information System (NHIS) are used as a case in the workshop to reflect on core issues and challenges in large-scale evaluation for supporting system development, implementation and positive impacts. The results of the discussions are documented to be used in further refinement of the Finnish evaluation methodology and for enhancing networking of respective parties in different countries. The results will also benefit participants including policy makers, developers and researchers of national eHealth systems in pursuit of national evaluation activities.

[Update on current care guidelines. Eating disorders in children and adolescents]

Eating disorders in childhood and adolescence are considered to involve both somatic and psychological problems. Treatment soon after diagnosis is aimed at correcting the nutritional and somatic status, including psychoeducative guidance and support for the patients and their family. Multi-professional cooperation is needed in the diagnosis and treatment of eating disorders. Once serious undernutrition is corrected, psychotherapy is indicated. Early and active treatment is associated with favourable prognosis.

Probe based manipulation and assembly of nanowires into organized mesostructures

A convenient approach to patterning inorganic and organic nanowires using a novel probe manipulator is presented. The system utilizes an electrochemically etched tungsten wire probe mounted onto a 3D actuator that is directed by a 3D controller. When it is engaged by the user, the movement of the probe and the forces experienced by the tip are simultaneously reported in real time. Platinum nanowires are manipulated into organized mesostructures on silicon chip substrates. In particular, individual nanowires are systematically removed from aggregates, transferred to a chosen location, and manipulated into complex structures in which selected wires occupy specific positions with defined orientations. Rapid prototyping of complex mesostructures, by pushing, rotating and bending conjugated polymer, i.e., polyfluorene, nanowires into various configurations, is also achieved. By exploiting the strong internal axial alignment of polymer chains within the polyfluorene nanowires, mesostructures tailored to exhibit distinctly anisotropic optical properties, such as birefringence and photoluminescence dichroism, are successfully assembled on fused silica substrates.

Lumbar bone mineral density in normal subjects aged 3-6 years: a prospective study

Longitudinal studies on bone mineral density (BMD) accrual in young children are scarce. The purpose of the present study was to evaluate prospectively the development of spinal BMD in healthy Finnish children aged 3-6 y by dual-energy x-ray absorptiometry (DXA). Lumbar spine (L2-L4) areal BMD (g/cm2) was measured by DXA (Lunar DPX) in 20 children (10M, 10F) aged 3.3-6.9 y (median 4.8 y) at baseline and after a median follow-up of 1.0y (range 0.8-1.1 y). Apparent volumetric BMD (BMDvol, g/cm3) was calculated to minimize the effect of bone size on BMD in growing spine. At baseline, lumbar areal and volumetric BMDs (mean +/- SD) for males were 0.623+/-0.087 g/cm2 and 0.270+/-0.034 g/cm3, respectively, and for females 0.620+/-0.082 g/cm2 and 0.254+/-0.035 g/cm3, respectively. During the median follow-up of 1 y, lumbar areal and volumetric BMDs (mean +/- SD) increased in males by 4.7+/-2.7% (p < 0.01) and 3.5+/-3.5% (p <0.05), respectively, and in females by 7.2+/-5.3% (p <0.01) and 3.1+/-3.1% (p <0.05), respectively. No statistically significant difference in the BMD values was observed between the sexes.

CONCLUSION

A significant increase in both areal and apparent volumetric BMD was observed in children aged 3-6 y during a follow-up of I y. The increase in volumetric BMD indicated that there was a real accrual of BMD in growing spine measured by DXA. The present study provides prospective data on BMD accrual in young children for the evaluation of bone mass development in early childhood.

A theoretical study of the77Se NMR and vibrational spectroscopic properties of SenS8–nring molecules

The structures and spectroscopic properties of SenS8–nring molecules have been studied by the use of ab initio molecular orbital techniques and density functional techniques involving Stuttgart relativistic large core effective core potential approximation with double zeta basis sets for valence orbitals augmented by two polarization functions for both sulfur and selenium. Full geometry optimizations have been carried out for all 30 isomers at the Hartree-Fock level of theory. The optimized geometries and the calculated fundamental vibrations and Raman intensities of the SenS8–nmolecules agree closely with experimental information where available. The nuclear magnetic shielding tensor calculations have been carried out by the Gauge-independent atomic orbital method at the DFT level using Becke's three-parameter hybrid functional with Perdew/Wang 91 correlation. The isotropic shielding tensors correlate well with the observed chemical shift data. The calculated chemical shifts provide a definite assignment of the observed77Se NMR spectroscopic data and can be used in the prediction of the chemical shifts of unknown SenS8–nring molecules.Key words: selenium sulfides, ab initio, DFT, effective core potentials, geometry optimization, energetics, fundamental vibrations,77Se chemical shifts.