Publications by authors named "L Pekka Malmberg"

170 Publications

Overweight and exercise-induced bronchoconstriction - is there a link?

Pediatr Allergy Immunol 2021 Mar 8. Epub 2021 Mar 8.

Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Background: The objective of this study was to evaluate the role of body mass index with regard to exercise performance, exercise-induced bronchoconstriction (EIB) and respiratory symptoms in 7-16-year-old children.

Methods: 1120 outdoor running exercise challenge test results of 7-16-year-old children were retrospectively reviewed. Lung function was evaluated with spirometry and exercise performance was assessed by calculating distance per 6 minutes from the running time and distance. Respiratory symptoms in the exercise challenge test were recorded and body mass index modified for children (ISO-BMI) was calculated for each child from height, weight, age, and gender according to the national growth references.

Results: Greater ISO-BMI and overweight were associated with poorer exercise performance (p<0.001). In addition, greater ISO-BMI was independently associated with cough (p=0.002) and shortness of breath (p=0.012) in the exercise challenge. However, there was no association between ISO-BMI and EIB or with wheeze during the exercise challenge.

Conclusion: Greater ISO-BMI may have a role in poorer exercise performance and appearance of respiratory symptoms during exercise, but not in EIB in 7-16-year-old children.
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http://dx.doi.org/10.1111/pai.13492DOI Listing
March 2021

Intra-individual dynamics of lesson-specific engagement: Lagged and cross-lagged effects from one lesson to the next.

Br J Educ Psychol 2020 Dec 25:e12404. Epub 2020 Dec 25.

Department of Teacher Education, University of Jyväskylä, Finland.

Background: Student engagement denotes active participation in academic work through commitment and involvement in learning tasks (Appleton et al., 2006, Journal of School Psychology, 44, 427). This study looks at questions such as whether engagement experiences in one lesson have an effect on the next lesson. In the present study, process-oriented analyses were conducted to examine lower secondary school students' engagement experiences and the stability of those experiences from one lesson to the next.

Aims: (1) To what extent are students' engagement experiences, in terms of behavioural and cognitive engagement, emotional engagement, and disaffection, stable from one lesson to the next (autoregressive cyclic effects)? (2) What are the cross-lagged relationships (dynamic effects) between engagement experiences from one lesson to the next?

Sample: The sample consisted of 56 Finnish lower secondary school students. The students provided ratings of their engagement experiences at the end of each lesson for one week (5 days, 975 ratings). Each student rated, on average, 17.4 lessons (SD = 5.67).

Methods: We specified multilevel dynamic structural equation models with random slopes.

Results: The models showed small significant sustainability in behavioural and cognitive engagement, emotional engagement, and disaffection from one lesson to the next, regardless of subject matter and teacher continuity. Higher behavioural and cognitive engagement in a lesson also had a self-diminishing effect on disaffection.

Conclusions: The present study provides valuable information to teachers by showing that an experience in one lesson can have an effect on subsequent ones.
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http://dx.doi.org/10.1111/bjep.12404DOI Listing
December 2020

Patient Inspiratory Maneuver Performance; Peak Lungpower, Acceleration and Volume.

J Aerosol Med Pulm Drug Deliv 2020 12 18;33(6):305-313. Epub 2020 May 18.

Allergology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Use of drug delivery devices between nebulizers, dry powder inhalers (DPIs), or metered dose inhalers (MDIs), for treating patients with asthma and chronic obstructive pulmonary disease (COPD), is based on patients' capability of coordinating the inhalation maneuver and achieving sufficient airflow. There are limited data available with regard to how patients meet the requirements of successful inhalation performance, and how the concept of inspiratory lungpower could be applied. The aim of this work was to study the patient inspiratory airflow profile performance in large data sets. We analyzed how the Kamin-Haidl inhalation criteria were met by patients with DPIs such as Easyhaler for combination therapy (EH-combi), Easyhaler for monotherapy (EH-mono), Diskus, and Turbuhaler (TH), and applied peak lungpower instead of peak inspiratory flow rate as an indicator of patient performance. Data sets gathered in two previous studies for DPIs, that is, EH-combi, EH-mono, Diskus, and TH, were used to analyze how inspiratory lungpower representing inspiratory muscle power, flow acceleration, and volume after peak met the inhalation criteria. The measured patient airflow profiles through inhalers were assessed for patients with asthma or COPD. Based on the Kamin-Haidl inhalation criteria, successful inhalation requirements were met with EH-combi in 96.1% and with EH-mono in 92.6% of patients. The success rates were 89.5% and 84.6% with Diskus and TH, respectively, ( < 0.0001 between devices). In patients with asthma or COPD, the mean lungpower was 7.51 and 6.15 W for EH-combi, 8.79 and 6.88 W for EH-mono, 7.18 and 4.36 W for Diskus, and 9.65 and 6.86 W for TH, respectively, when patients followed the manufacturer's written instructions. Lungpower applied to the Kamin-Haidl inhalation criteria concept could be an applicable method for reviewing patient performance for different DPIs despite DPIs' characteristic differences in airflow resistance. In light of these results, DPIs provide a feasible treatment option for a large majority of respiratory patients.
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http://dx.doi.org/10.1089/jamp.2019.1575DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757585PMC
December 2020

Endodontic follow-up practices, sources of knowledge, and self-assessed treatment outcome among general dental practitioners in Sweden and Norway.

Acta Odontol Scand 2020 Oct 13;78(7):547-552. Epub 2020 May 13.

Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.

To reduce the gap between what can be achieved in endodontic treatments and the observed treatment outcome among general dental practitioners, the present study set out to assess the status of the endodontic practices as regards to knowledge and self-assessed skills among general dental practitioners in Sweden and Norway. The questionnaire was sent to 1384 general dental practitioners. It contained questions regarding access to continuing education in endodontics, sources of knowledge for clinical management of patients, post-operative follow-ups, self-assessed success-rate, and the initial diagnosis impact on the outcome of endodontic treatments. The response rate was 61.4%. Almost half estimated their endodontic success-rate to be 90%. About two-thirds of the respondents did not know, or did not believe, that the initial diagnosis could affect the outcome of their endodontic treatments. Respondents who did not believe the diagnosis could impact the outcome were more likely to estimate their success rate as the highest (<.001). Less than half performed post-operative follow-ups a year after treatment. A third of the respondents had not attended any continuing endodontic education. Dentists who do not receive regular feedback on their treatments may lack insight into their own shortcomings. If this is combined with insufficient knowledge and understanding it may result in sub-par endodontic treatments being performed. It is important to have reliable ways to communicate current endodontic knowledge and to establish robust methods that may help dentists accurately assess their own performance in endodontics.
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http://dx.doi.org/10.1080/00016357.2020.1763455DOI Listing
October 2020

A Multilevel Person-Centered Examination of Teachers' Workplace Demands and Resources: Links With Work-Related Well-Being.

Front Psychol 2020 8;11:626. Epub 2020 Apr 8.

Substantive Methodological Synergy Research Laboratory, Department of Psychology, Concordia University, Montreal, QC, Canada.

Teachers' healthy and effective functioning at work is impacted by the demands they face and the resources they can access. In this study, person-centered analysis was adopted to identify distinct teacher profiles of demands and resources. We investigated teachers' experiences of two job demands (barriers to professional development and disruptive student behavior), two job resources (teacher collaboration and input in decision-making), and one personal resource (self-efficacy for teaching). Using data from the Teaching and Learning International Survey (TALIS) 2013, the study involved 6,411 teachers from 369 schools in Australia and 2,400 teachers from 154 schools in England. In phase one, latent profile analysis revealed five teacher profiles that were similar across the two countries: the Low-Demand-Flourisher (12%), Mixed-Demand-Flourisher (17%), Job-Resourced-Average (34%), Balanced-Average (15%), and Struggler (21%). The profiles were differently associated with two background characteristics (teacher gender and teaching experience) and two work-related well-being outcomes (job satisfaction and occupational commitment). In phase two, we extended our analysis to the school-level to identify school profiles based on the relative prevalence of the five teacher profiles within a school. Indeed, a yield of large scale datasets such as TALIS is that there are sufficient units at the school-level to enable institutional insights, beyond insights garnered at the individual teacher-level. Two school profiles that were similar in both countries were revealed: the Unsupportive school profile (58%) and the Supportive school profile (42%). The Supportive school profile was associated with higher school-average teacher job satisfaction and occupational commitment than the Unsupportive school profile. Taken together, the findings yield knowledge about salient teacher and school profiles, and provide guidance for possible interventions at the teacher- and school level.
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http://dx.doi.org/10.3389/fpsyg.2020.00626DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156640PMC
April 2020

Predictive value of childhood airway hyper-responsiveness to indirect stimuli: 10-year longitudinal study.

Pediatr Allergy Immunol 2020 10 27;31(7):767-773. Epub 2020 Jun 27.

Department of Allergology, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Background: Airway hyper-responsiveness (AHR) is a common feature in asthma. The use of AHR in predicting active asthma or the persistence of AHR in childhood is poorly understood. By analyzing longitudinal connections including different measures of AHR, lung function, and inflammation markers, we sought to identify the best available method for predicting persistence of AHR and identification of later active asthma.

Methods: We tested 105 asthmatic children aged 3-7 years with fractional exhaled nitric oxide (FeNO), impulse oscillometry (IOS), and AHR evaluated by indirect methods (hypertonic saline and exercise challenge). Ten years later, 64 children participated in the follow-up visit and were tested with FeNO, IOS, spirometry, and methacholine challenge. At both study visits, blood samples were collected, and a questionnaire was completed.

Results: Asthma was in remission in 66% of patients at adolescence. AHR measured by hypertonic saline challenge at preschool age was associated with asthma symptoms (OR 10.2; 95% CI 2.8, 37.3) but not with AHR estimated with methacholine challenge 10 years later. AHR measured by exercise challenge was not associated with AHR or recent asthma symptoms in adolescence. Preschool eosinophilia continued until adolescence in 87% of patients but was not associated with AHR or subjective signs of asthma 10 years later. Wheezy preschoolers with atopy had a higher risk for AHR in adolescence (OR 4.1; 95% CI 1.0, 16.2).

Conclusion: Results from hypertonic saline challenge are associated with persistent asthma symptoms even after a decade. AHR measured by indirect methods at preschool age did not predict AHR in adolescence.
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http://dx.doi.org/10.1111/pai.13248DOI Listing
October 2020

Airway hyperresponsiveness, remodeling and inflammation in infants with wheeze.

Clin Exp Allergy 2020 05 23;50(5):558-566. Epub 2020 Mar 23.

Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Background: The relationship of airway hyperresponsiveness to airway remodeling and inflammation in infants with wheeze is unclear.

Objective: To investigate airway hyperresponsiveness, remodeling and inflammation in infants with wheeze and troublesome breathing.

Methods: Inclusion criteria were as follows: full-term, 3-23 months of age; doctor -diagnosed wheeze and persistent recurrent troublesome breathing; without obvious structural defect, suspicion of ciliary dyskinesia, cystic fibrosis, immune deficiency or specified use of corticosteroids. Airway hyperresponsiveness (AHR) was evaluated by performing a methacholine bronchial challenge test combined with whole body plethysmography and rapid thoracoabdominal compression. Endobronchial biopsies were analysed for remodeling (thickness of reticular basement membrane and amount of airway smooth muscle) and for inflammation (numbers of inflammatory cells). Correlation analyses were performed.

Results: Forty-nine infants fulfilled the inclusion criteria for the present study. Median age was 1.06 years (IQR 0.6; 1.5). Lung function was impaired in 39/49 (80%) children, at the median age of 1.1 years. Methacholine challenge was successfully performed in 38/49 children. Impaired baseline lung function was correlated with AHR (P = .047, Spearman). In children with the most sensitive quartile of AHR, the percentage of median bronchial airway smooth muscle % and the number of bronchial mast cells in airway smooth muscle were not significantly higher compared to others (P = .057 and 0.056, respectively). No association was found between AHR and thickness of reticular basement membrane or inflammatory cells. Only a small group of children with both atopy and AHR (the most reactive quartile) had thicker airway smooth muscle area than non-atopics with AHR (P = .031).

Conclusions And Clinical Relevance: These findings do not support the concept that AHR in very young children with wheeze is determined by eosinophilic inflammation or clear-cut remodeling although it is associated with impaired baseline lung function. The possible association of increased airway smooth muscle area among atopic children with AHR remains to be confirmed.
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http://dx.doi.org/10.1111/cea.13598DOI Listing
May 2020

[Treatment of erectile dysfunction - from pill to implant].

Lakartidningen 2020 02 17;117. Epub 2020 Feb 17.

Örestadsklinikens vårdcentral - Malmö, Sweden Örestadsklinikens vårdcentral - Malmö, Sweden.

The article gives an overview of erectile mechanisms and erectile dysfunction (ED). Current treatment of ED is presented. Most of the patients with ED should be treated by their primary care physician. Urologists should be involved only when treatment has failed, and when erectile implants might be an option. In Skåne the waiting list for these patients has been eliminated by using the operating capacity of a smaller hospital.
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February 2020

Measurement of bronchial hyperreactivity: comparison of three Nordic dosimetric methods.

Scand J Clin Lab Invest 2020 May 7;80(3):222-229. Epub 2020 Feb 7.

Unit of Clinical Physiology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland.

Clinical testing of bronchial hyperreactivity (BHR) provides valuable information in asthma diagnostics. Nevertheless, the test results depend to a great extent on the testing procedure: test substance, apparatus and protocol. In Nordic countries, three protocols predominate in the testing field: Per Malmberg, Nieminen and Sovijärvi methods. However, knowledge of their equivalence is limited. We aimed to find equivalent provocative doses (PD) to obtain similar bronchoconstrictive responses for the three protocols. We recruited 31 patients with suspected asthma and health care workers and performed BHR testing with methacholine according to Malmberg and Nieminen methods, and with histamine according to Sovijärvi. We obtained the individual response-dose slopes for each method and predicted equivalent PD values. Applying a mixed-model, we found significant differences in the mean (standard error of mean) response-dose (forced expiratory volume in one second (FEV)%/mg): Sovijärvi 7.2 (1.5), Nieminen 13.8 (4.2) and Malmberg 26 (7.3). We found that the earlier reported cut-point values for moderate BHR and marked BHR between the Sovijärvi (PD) and Nieminen (PD) methods were similar, but with the Malmberg method a significant bronchoconstrictive reaction was measured with lower PD values. We obtained a relationship between slope values and PD (mg) between different methods, useful in epidemiological research and clinical practice.
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http://dx.doi.org/10.1080/00365513.2020.1719541DOI Listing
May 2020

Early bronchial inflammation and remodeling and airway hyperresponsiveness at school age.

Allergy 2020 07 11;75(7):1765-1768. Epub 2020 Feb 11.

Department of Allergy, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

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http://dx.doi.org/10.1111/all.14198DOI Listing
July 2020

The effect of physical education lesson intensity and cognitive demand on subsequent learning behaviour.

J Sci Med Sport 2020 Jun 17;23(6):586-590. Epub 2019 Dec 17.

Oxford University, Department of Education, United Kingdom.

Objectives: To investigate the effect of (i) physical education (PE) lesson intensity and (ii) skill complexity, and (iii) their interaction on students' on-task behaviour in the classroom.

Design: Within-subject repeated-measures.

Methods: Participants were children (N=101, age 7-11) recruited from four elementary schools in Oxfordshire, United Kingdom. The experiment consisted of manipulating the aerobic intensity (low/medium/high) and skill complexity (low/high) of PE lessons. Children participated in all six conditions of the experiment: low intensity-low complexity (flexibility), medium intensity-low complexity (health related exercise), high intensity-low complexity (sprinting games), low intensity-high complexity (bi-lateral ball skills), medium intensity-high complexity (ball games), high intensity-high complexity (aerobics). Children's behaviour in the classroom was observed every 30s for 25min before and after each PE lesson and rated as on-task or off-task.

Results: A main effect of intensity on children's on-task behaviour was found (F=11.07, p<0.001), with greater on-task behaviour following high intensity PE lessons (t=2.85, p<0.01, d=0.2). No main effect of complexity on on-task behaviour was observed (F=1.89, p=0.17). The interaction of intensity and complexity was significant (F=69.19, p<0.001).

Conclusions: These findings suggest that participation in PE lessons can improve children's on-task behaviour in the classroom. PE lessons involving high complexity and high intensity, or low complexity and medium intensity appear to have the greatest benefits for students' behaviour in the classroom.
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http://dx.doi.org/10.1016/j.jsams.2019.12.012DOI Listing
June 2020

Serum chitinase-like protein YKL-40 is linked to small airway function in children with asthmatic symptoms.

Pediatr Allergy Immunol 2019 12 2;30(8):803-809. Epub 2019 Oct 2.

Department of Allergology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Background: Lung function impairment among asthmatic children begins in early life, and biomarkers for identifying this impairment are needed. The chitinase-like protein YKL-40 has been associated with asthma and lung function in adults, but studies in children have yielded conflicting results. We evaluated the potential of YKL-40 and other systemic biomarkers for identifying lung function deficits in children with asthmatic symptoms.

Methods: We determined the levels of serum YKL-40, periostin, and high-sensitivity C-reactive protein (hs-CRP) from the blood samples of 49 children with asthmatic symptoms. Lung function was assessed with impulse oscillometry (IOS) and spirometry, combined with an exercise challenge and a bronchodilator test. Fractional exhaled nitric oxide was measured at multiple flow rates.

Results: Serum levels of YKL-40 showed significant correlations with most IOS indices at baseline (P = .008-.039), but there was no association between YKL-40 and spirometry parameters. Neither periostin nor hs-CRP were associated with baseline lung function. Children with a significant response in either the exercise challenge or the bronchodilator test had increased serum levels of YKL-40 (P = .003) and periostin (P = .035). YKL-40 correlated significantly with the blood neutrophil count (r  = .397, P = .005) but was not associated with biomarkers of eosinophilic inflammation.

Conclusion: Serum YKL-40 is a potential biomarker for lung function deficits in children with asthmatic symptoms. These deficits appear to be focused on small airways and may remain undetected with spirometry.
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http://dx.doi.org/10.1111/pai.13119DOI Listing
December 2019

Smoking and lung function among adults with newly onset asthma.

BMJ Open Respir Res 2019 25;6(1):e000377. Epub 2019 Mar 25.

Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland.

Introduction: Smoking increases the risk of asthma and reduces lung function among subjects with and without asthma. We assessed the effects of smoking on lung function reflecting both central and small airways among adults with newly onset asthma.

Methods: In a population-based study, 521 (response rate 86%) working-aged adults with clinically defined newly diagnosed asthma answered a questionnaire on personal smoking and other factors potentially influencing lung function, and performed spirometry. We applied multiple linear regression analysis to estimate the relations between smoking and lung function adjusting for confounding.

Results: Among asthmatics, FEV level was reduced significantly, on average 208 mL, related to regular smoking (adjusted effect estimate -0.208, 95% CI -0.355 to -0.061) and 245 mL in relation to former smoking, that is, among those who quit less than a year ago (-0.245, 95% CI -0.485 to -0.004). In contrast, FEV was not significantly related to occasional smoking or former smoking among those who quit over a year ago. Forced expiratory flow (FEF) levels (L/s) were also significantly reduced among regular smokers (FEF: -0.372, 95% CI -0.607 to -0.137; FEF: -0.476, 95% CI -0.750 to -0.202). An exposure-response pattern related to both daily smoking rate and lifetime cumulative smoking was seen both among men and women.

Conclusions: This study provides new evidence that among working-aged adults with new asthma, regular smoking and former smoking reduce lung function levels with a dose-response pattern. The lung function parameters applied as outcomes reflect both larger and smaller airways.
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http://dx.doi.org/10.1136/bmjresp-2018-000377DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530508PMC
April 2020

Converting F by different flows to standard flow F.

Clin Physiol Funct Imaging 2019 Sep 3;39(5):315-321. Epub 2019 Jun 3.

Unit of Clinical Physiology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.

In clinical practice, assessment of expiratory nitric oxide (F ) may reveal eosinophilic airway inflammation in asthmatic and other pulmonary diseases. Currently, measuring of F is standardized to exhaled flow level of 50 ml s , since the expiratory flow rate affects the F results. To enable the comparison of F measured with different expiratory flows, we firstly aimed to establish a conversion model to estimate F at the standard flow level, and secondly, validate it in five external populations. F measurements were obtained from 30 volunteers (mixed adult population) at the following multiple expiratory flow rates: 50, 30, 100 and 300 ml s , after different mouthwash settings, and a conversion model was developed. We tested the conversion model in five populations: healthy adults, healthy children, and patients with COPD, asthma and alveolitis. F conversions in the mixed adult population, in healthy adults and in children, showed the lowest deviation between estimated from 100 ml s and measured F at 50 mL s : -0·28 ppb, -0·44 ppb and 0·27 ppb, respectively. In patients with COPD, asthma and alveolitis, the deviation was -1·16 ppb, -1·68 ppb and 1·47 ppb, respectively. We proposed a valid model to convert F in healthy or mixed populations, as well as in subjects with obstructive pulmonary diseases and found it suitable for converting F measured with different expiratory flows to the standard flow in large epidemiological data, but not on individual level. In conclusion, a model to convert F from different flows to the standard flow was established and validated.
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http://dx.doi.org/10.1111/cpf.12574DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003879PMC
September 2019

Inspiratory and Expiratory Flow Changes, Voice Symptoms and Laryngeal Findings during Histamine Challenge Tests.

Folia Phoniatr Logop 2020 24;72(1):29-35. Epub 2019 Apr 24.

Department of Otorhinolaryngology and Phoniatrics, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Objective: The aim of this study was to analyse the associations between the spirometry parameter changes in relation to laryngeal finding changes and self-reported voice and throat symptom changes among patients undergoing a histamine challenge test.

Patients And Methods: Thirty adult patients with a chronic cough underwent a histamine challenge test. Videolaryngostroboscopy and voice and throat symptoms were assessed using a visual analogue scale immediately before and after the challenge test. Correlations between the relative changes in spirometry values in relation to the change in vocal fold oedema and redness and self-reported voice and throat symptom changes during the challenge test were assessed.

Results: A correlation between the relative change in inspiratory and expiratory air flow values and the change in voice and throat symptoms during the histamine challenge test was found. The vocal fold oedema, visible on videolaryngostroboscopy, caused by the histamine challenge did not significantly affect the spirometry air flow values.

Conclusion: The relative changes in inspiratory and expiratory air flow and voice and throat symptoms during the histamine challenge test correlated. The vocal fold oedema caused by the histamine challenge, visible on videolaryngostroboscopy, did not significantly affect the spirometry air flow values.
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http://dx.doi.org/10.1159/000495783DOI Listing
April 2019

Shedding light on the breathing difficulties of children.

Acta Paediatr 2019 08 27;108(8):1380-1381. Epub 2019 Mar 27.

Allergology, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland.

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http://dx.doi.org/10.1111/apa.14784DOI Listing
August 2019

Endodontic infection control routines among general dental practitioners in Sweden and Norway: a questionnaire survey.

Acta Odontol Scand 2019 Aug 5;77(6):434-438. Epub 2019 Mar 5.

a Faculty of Odontology, Department of Endodontics , Malmö University , Malmö , Sweden.

The purpose of this study was to investigate endodontic infection prevention and control routines among general dental practitioners in Sweden and Norway. A questionnaire was sent by email to 1384 general dental practitioners employed in Sweden and Norway. The participants were asked questions concerning different aspects of infection prevention and control during endodontic treatment; use of rubber dam, sealing of rubber dam, antibacterial solutions, and use of hand disinfectant and gloves. The response rate was 61.4% (: 819). 96.9% reported routinely using rubber dam during endodontic treatment. 88.3% reported always, or sometimes, sealing the area between rubber dam and tooth. Most disinfected the endodontic operative field, but the antibacterial solutions used varied. 11.9% did not use gloves at all during treatment, and 10.5% did not use hand disinfectant during treatment. Most of the general dental practitioners took measures to establish and maintain aseptics during endodontic treatment, which infers an awareness of the importance of endodontic infection prevention and control. But the results were self-reported and there may be a gap between claimed and actual behaviour. Further studies using observation methodologies are needed to assess how infection control routines are performed in everyday clinical practice.
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http://dx.doi.org/10.1080/00016357.2019.1584330DOI Listing
August 2019

Airway hyperresponsiveness in young children with respiratory symptoms: A five-year follow-up.

Ann Allergy Asthma Immunol 2019 May 2;122(5):492-497. Epub 2019 Mar 2.

Helsinki University Hospital, Skin and Allergy Hospital, Helsinki, Finland.

Background: Recurrent wheezing in early life is transient in most children. The significance of airway hyperresponsiveness (AHR) in persistence of respiratory symptoms from infancy to early childhood is controversial.

Objective: We evaluated whether AHR in wheezy infants predicts doctor-diagnosed asthma (DDA) or AHR at the age of 6 years.

Methods: Sixty-one wheezy infants (age 6-24 months) were followed up to the median age of 6 years. Lung function and AHR with methacholine challenge test were assessed at infancy and 6 years. The exercise challenge test was performed at the age of 6 years. Atopy was assessed with skin prick tests.

Results: At 6 years, 21 (34%) of the children had DDA. Children with DDA had higher logarithmic transformed dose-response slope (LOGDRS) to methacholine in infancy than children without DDA (0.047 vs 0.025; P = .033). Furthermore, AHR to methacholine in infancy and at 6 years were associated with each other (r = 0.324, P = .011). Children with exercise-induced bronchoconstriction (EIB) at 6 years were more reactive to methacholine in infancy than those without EIB (P = .019).

Conclusion: Increased AHR in symptomatic infants was associated with increased AHR, DDA, and EIB at median the age of 6 years, suggesting early establishment of AHR.
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http://dx.doi.org/10.1016/j.anai.2019.02.025DOI Listing
May 2019

Tidal breathing flow volume profiles during sleep in wheezing infants measured by impedance pneumography.

J Appl Physiol (1985) 2019 05 14;126(5):1409-1418. Epub 2019 Feb 14.

Department of Allergology, University Central Hospital , Helsinki , Finland.

Overnight analysis of tidal breathing flow volume (TBFV) loops, recorded by impedance pneumography (IP), has been successfully applied in the home monitoring of children with wheezing disorders. However, little is known on how sleep physiology modifies the relationship between TBFV profiles and wheeze. We studied such interactions in wheezing infants. Forty-three infants recruited because of recurrent lower airway symptoms were divided into three groups based on their risk of asthma: high (HR), intermediate (IR), or low (LR). Sedated patients underwent infant lung function testing including assessment of airway responsiveness to methacholine at the hospital and a full-night recording of TBFV profiles at home with IP during natural sleep. Overnight TBFV indexes were estimated from periods of higher and lower respiration variability, presumably belonging to active [rapid eye movement (REM)] and quiet [non-REM (NREM)] sleep, respectively. From 35 valid recordings, absolute time indexes showed intrasubject sleep phase differences. Peak flow relative to time and volume was lower in HR compared with LR only during REM, suggesting altered expiratory control. Indexes estimating the concavity/convexity of flow decrease during exhalation suggested limited flow during passive exhale in HR compared with IR and LR, similarly during NREM and REM. Moreover, during REM convexity was negatively correlated with maximal flow at functional residual capacity and methacholine responsiveness. We conclude that TBFV profiles determined from overnight IP recordings vary because of sleep phase and asthma risk. Physiological changes during REM, most likely decrease in respiratory muscle tone, accentuate the changes in TBFV profiles caused by airway obstruction. Impedance pneumography was used to investigate overnight tidal breathing flow volume (TBFV) indexes and their interactions with sleep phase [rapid eye movement (REM) vs. non-REM] at home in wheezing infants. The study shows that TBFV indexes vary significantly because of sleep phase and asthma risk of the infant and that during REM the changes in TBFV indexes caused by airway obstruction are accentuated and better associated with lung function of the infant.
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http://dx.doi.org/10.1152/japplphysiol.01007.2018DOI Listing
May 2019

Influence of mouthwashes on extended exhaled nitric oxide (F) analysis.

Scand J Clin Lab Invest 2018 Oct 22;78(6):450-455. Epub 2018 Oct 22.

a Unit of Clinical Physiology, Helsinki University Central Hospital and University of Helsinki , Helsinki , Finland.

Fractional exhaled nitric oxide (F) is used to assess eosinophilic inflammation of the airways. F values are influenced by the expiratory flow rate and orally produced NO. We measured F at four different expiratory flow levels after two different mouthwashes: tap water and carbonated water. Further, we compared the alveolar NO concentration (C), maximum airway NO flux (J') and airway NO diffusion (D) after these two mouthwashes. F was measured in 30 volunteers (healthy or asthmatic) with a chemiluminescence NO-analyser at flow rates of 30, 50, 100 and 300 mL/s. A mouthwash was performed before the measurement at every flow rate. The carbonated water mouthwash significantly reduced F compared to the tap water mouthwash at all expiratory flows: 50 mL/s (p < .001), 30 mL/s (p = .001), 100 mL/s (p < .001) and 300 mL/s (p = .004). J' was also significantly reduced (p = .017), however, there were no significant differences in C and D. In conclusion, a carbonated water mouthwash can significantly reduce oropharyngeal NO compared to a tap water mouthwash at expiratory flows of 30-300 mL/s without affecting the C and D. Therefore, mouthwashes need to be taken into account when comparing F results.
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http://dx.doi.org/10.1080/00365513.2018.1497802DOI Listing
October 2018

Small airway function in children with mild to moderate asthmatic symptoms.

Ann Allergy Asthma Immunol 2018 10 27;121(4):451-457. Epub 2018 Jul 27.

Pediatric Unit, Department of Allergy, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Background: Clinical significance of small airway obstruction in mild pediatric asthma is unclear.

Objective: To evaluate small airway properties in children with mild to moderate asthmatic symptoms and the association of small airway function with asthma control and exercise-induced bronchoconstriction (EIB).

Methods: Children (5-10 years old) with recurrent wheezing (n = 42) or persistent troublesome cough (n = 16) and healthy controls (n = 19) performed impulse oscillometry (IOS), spirometry, and a multiple-breath nitrogen washout (MBNW) test. Exhaled nitric oxide (NO) was measured at multiple flow rates to determine alveolar NO concentration (Calv). Asthma control was evaluated with the Childhood Asthma Control Test (C-ACT), short-acting β-agonist (SABA) use within the past month, and asthma exacerbations within the past year.

Results: IOS, spirometry, and exhaled NO indexes that are related to small airway function differed between children with recurrent wheezing and healthy controls, whereas only forced expiratory flow at 25% to 75% of the forced vital capacity was associated with persistent cough. The MBNW indexes showed no difference between the groups. Among symptomatic children, conducting airway ventilation inhomogeneity and Calv were associated with asthma exacerbations (P = .03 and P = .002, respectively), and lung clearance index and Calv were associated with EIB (P = .04 and P = .004, respectively). None of the proposed small airway indexes was associated with the C-ACT score or SABA use.

Conclusion: Subtle changes were observed in the proposed small airway indexes of IOS, spirometry, and exhaled NO among children with mild to moderate recurrent wheezing. Small airway dysfunction, expressed as ventilation inhomogeneity indexes and Calv, was also associated with asthma exacerbations and EIB.
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http://dx.doi.org/10.1016/j.anai.2018.07.026DOI Listing
October 2018

Nocturnal Heart Rate Variability Spectrum Characterization in Preschool Children With Asthmatic Symptoms.

IEEE J Biomed Health Inform 2018 09 17;22(5):1332-1340. Epub 2017 Nov 17.

Asthma is a chronic lung disease that usually develops during childhood. Despite that symptoms can almost be controlled with medication, early diagnosis is desirable in order to reduce permanent airway obstruction risk. It has been suggested that abnormal parasympathetic nervous system (PSNS) activity might be closely related with the pathogenesis of asthma, and that this PSNS activity could be reflected in cardiac vagal control. In this work, an index to characterize the spectral distribution of the high frequency (HF) component of heart rate variability (HRV), named peakness ($\wp$), is proposed. Three different implementations of $\wp$, based on electrocardiogram (ECG) recordings, impedance pneumography (IP) recordings and a combination of both, were employed in the characterization of a group of preschool children classified attending to their risk of developing asthma. Peakier components were observed in the HF band of those children classified as high-risk ( $p < 0.005$), who also presented reduced sympathvoagal balance. Results suggest that high-risk of developing asthma might be related with a lack of adaptability of PSNS.
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http://dx.doi.org/10.1109/JBHI.2017.2775059DOI Listing
September 2018

A randomised study of tailored toxicity-based dosage of fluorouracil-epirubicin-cyclophosphamide chemotherapy for early breast cancer (SBG 2000-1).

Eur J Cancer 2018 05 20;94:79-86. Epub 2018 Mar 20.

Department of Immunology, Genetics and Pathology, Uppsala University Hospital, Uppsala, Sweden.

Study Aim: Retrospective studies have demonstrated a worse outcome in breast cancer patients not developing leukopenia during adjuvant chemotherapy. The SBG 2000-1 is the first randomised trial designed to compare individually dosed chemotherapy without G-CSF support based on grade of toxicity to standard-dosed chemotherapy based on body surface area (BSA).

Methods: Patients with early breast cancer were included and received the first cycle of standard FEC (fluorouracil 600 mg/m, epirubicin 60 mg/m, cyclophosphamide 600 mg/m). Patients with nadir leukopenia grade 0-2 after first cycle were randomised between either 6 additional courses of tailored FEC with increased doses (E 75-90 mg/m, C 900-1200 mg/m) or fixed treatment with 6 standard FEC. Patients with grade 3-4 leukopenia were registered and treated with 6 standard FEC. Primary end-point was distant disease-free survival (DDFS).

Results: The study enrolled 1535 patients, of which 1052 patients were randomised to tailored FEC (N = 524) or standard FEC (N = 528), whereas 401 patients with leukopenia grade 3-4 continued standard FEC and formed the registered cohort. Dose escalation did not statistically significantly improve 10-year DDFS (79% and 77%, HR 0.87, CI 0.67-1.14, P = 0.32) or OS (82% and 78%, respectively, HR 0.89, CI 0.57-1.16, P = 0.38). Corresponding estimates for the registered group of patients were DDFS 79% and OS 82%, respectively.

Conclusions: The SBG 2000-1 study failed to show a statistically significant improvement of escalated and tailored-dosed chemotherapy compared with standard BSA-based chemotherapy in patients with low haematological toxicity, although all efficacy parameters showed a numerical advantage for tailored treatment.
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http://dx.doi.org/10.1016/j.ejca.2018.02.016DOI Listing
May 2018

Abnormal lung function at preschool age asthma in adolescence?

Ann Allergy Asthma Immunol 2018 05 6;120(5):520-526. Epub 2018 Mar 6.

Department of Allergology, Skin and Allergy Hospital, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland.

Background: Asthma often begins early in childhood. However, the risk for persistence is challenging to evaluate.

Objective: This longitudinal study relates lung function assessed with impulse oscillometry (IOS) in preschool children to asthma in adolescence.

Methods: Lung function was measured with IOS in 255 children with asthma-like symptoms aged 4-7 years. Baseline measurements were followed by exercise challenge and bronchodilation tests. At age 12-16 years, 121 children participated in the follow-up visit, when lung function was assessed with spirometry, followed by a bronchodilation test. Asthma symptoms and medication were recorded by a questionnaire and atopy defined by skin prick tests.

Results: Abnormal baseline values in preschool IOS were significantly associated with low lung function, the need for asthma medication, and asthma symptoms in adolescence. Preschool abnormal R5 at baseline (z-score ≥1.645 SD) showed 9.2 odds ratio (95%CI 2.7;31.7) for abnormal FEV1/FVC, use of asthma medication in adolescence, and 9.9 odds ratio (95%CI 2.9;34.4) for asthma symptoms. Positive exercise challenge and modified asthma-predictive index at preschool age predicted asthma symptoms and the need for asthma medication, but not abnormal lung function at teenage.

Conclusion: Abnormal preschool IOS is associated with asthma and poor lung function in adolescence and might be utilised for identification of asthma persistence.
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http://dx.doi.org/10.1016/j.anai.2018.03.002DOI Listing
May 2018

Standardizing dose in dosimetric bronchial challenge tests.

Clin Physiol Funct Imaging 2018 Sep 17;38(5):903-906. Epub 2018 Jan 17.

Department of Allergy, Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland.

Recent technical recommendations on bronchial challenge testing aim at standardized assessment of provocative dose of causing 20% decrease in FEV1 (PD20). The aim of this study was to investigate the effect of mode of nebulization on the output of a computerized dosimeter (APS) and to compare PD20 obtained by two different dosimetric systems in vivo. The output of the APS system was tested during continuous nebulization, and using simulated breaths, for intermittent actuations with four different durations. Using output data, a modified methacholine challenge protocol was applied for APS and compared with a standard set-up using Spira dosimeter in 14 asthmatic patients attending duplicate methacholine challenges using both systems, within median (range) 3 (1-6) days apart. The calculated output (mg min ) with all the intermittent mode settings was significantly higher (P<0·001) than in the continuous mode, and in the intermittent mode, the output was dependent of the pulse duration. The PD20 values assessed with the APS and Spira systems were significantly correlated (r = 0·69; P<0·007), without systematic difference in the geometric means (P = 0·10). A moderate to good agreement was found for assessment of significant hyperresponsiveness. The results suggest that in dosimetric systems for bronchial challenge tests, the output of the nebulizer is dependent on the mode of nebulization, and this should be considered when standardizing the dose between devices and protocols. As long as the delivered dose is determined for the specified nebulization mode of the protocol, it may be possible to obtain comparable results between different devices.
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http://dx.doi.org/10.1111/cpf.12498DOI Listing
September 2018

Small airway oscillometry indices: Repeatability and bronchodilator responsiveness in young children.

Pediatr Pulmonol 2017 10 18;52(10):1260-1267. Epub 2017 Aug 18.

Pediatric Unit of the Department of Allergy, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Introduction: The impulse oscillometry (IOS) indices absolute and relative difference between respiratory resistance at 5 and 20 Hz (R5-20 and R5-20%, respectively) and the area under the reactance curve (AX) are postulated to reflect small airway function. Data on their cutoff values to evaluate bronchodilator responsiveness (BDR) or between-visit changes after interventions are limited in young children.

Methods: We evaluated the BDR of 103 healthy children aged 2-7 years, who received either salbutamol (n = 84) or placebo (n = 19) in order to determine cutoff values for BDR of R5-20, R5-20%, and AX. We then determined the repeatability within and between two IOS measurements 7-14 days apart in young children aged 4-8 years with asthmatic symptoms (n = 43), including cutoff values for significant between-visit changes.

Results: The investigated IOS parameters showed marked BDR (fifth percentile cutoff of 75-110% of the baseline value) in healthy children, whereas no significant changes were seen after inhalation of placebo. The agreement within the triplicate IOS measurement was excellent (ICC > 0.80), and the agreement of results between visits was good (ICC > 0.60). A change in R5-20, R5-20%, and AX of 0.65, 1.08, and 0.84 z-scores, respectively, would exceed 95% confidence intervals for between-visit variability.

Conclusion: We introduce cutoff values for BDR of R5-20, R5-20%, and AX, and their repeatability indices and cutoff limits for significant between-visit changes. These IOS parameters may show greater variability than the conventional IOS indices during follow-up, but the between-visit agreement remains good, providing potentially useful endpoints for monitoring lung function in young children.
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http://dx.doi.org/10.1002/ppul.23794DOI Listing
October 2017

Vitamin D, high-sensitivity C-reactive protein, and airway hyperresponsiveness in infants with recurrent respiratory symptoms.

Ann Allergy Asthma Immunol 2017 09 28;119(3):227-231. Epub 2017 Jul 28.

Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Background: Vitamin D insufficiency might be associated with biased T-cell responses resulting in inflammatory conditions such as atopy and asthma. Little is known about the role of vitamin D in low-grade systemic inflammation and airway hyperresponsiveness (AHR) in young children.

Objective: To evaluate whether vitamin D insufficiency and increased serum high-sensitivity C-reactive protein (hs-CRP) are linked to AHR in symptomatic infants.

Methods: Seventy-nine infants with recurrent or persistent lower respiratory tract symptoms underwent comprehensive lung function testing and a bronchial methacholine challenge test. In addition, skin prick tests were performed and serum 25-hydroxyvitamin D (S-25-OHD), hs-CRP, total immunoglobulin E, and blood eosinophil levels were determined.

Results: S-25-OHD was lowest in infants with blood eosinophilia and AHR (n = 10) compared with those with eosinophilia only (n = 6) or AHR only (n = 50) or those with neither (n = 13; P = .035). Moreover, vitamin D insufficiency (S-25-OHD <50 nmol/L) was most common in infants with blood eosinophilia and AHR (P = .041). Serum hs-CRP was lower in infants with recurrent physician-diagnosed wheezing (P = .048) and in those with blood eosinophilia (P = .015) than in infants without these characteristics and was not associated with S-25-OHD or AHR. S-25-OHD levels were significantly lower (median 54 nmol/L) during the autumn-winter season than in the spring-summer season (median 63 nmol/L; P = .026).

Conclusion: Vitamin D insufficiency could underlie eosinophilia and AHR in infants with troublesome lung symptoms, whereas hs-CRP-mediated low-grade systemic inflammation is rare in early childhood wheezing.
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http://dx.doi.org/10.1016/j.anai.2017.06.014DOI Listing
September 2017

Clinical practice of BOTOX treatment for overactive bladder syndrome in Sweden: an assessment of resource use and external validity.

Scand J Urol 2017 Oct 5;51(5):397-401. Epub 2017 Jul 5.

c Department of Urology , Skåne University Hospital , Malmö , Sweden.

Objective: The objective of this study was to assess the resource use of treating overactive bladder (OAB) patients in real-world clinical practice and to evaluate whether there is external validity in the treatment of OAB in clinical practice.

Materials And Methods: The study included 55 patients suffering from OAB and treated with BOTOX at two Swedish clinics. The study was conducted as an anonymized retrospective chart review study.

Results: The estimated yearly direct cost of BOTOX treatment was €902. The mean age of patients in the study was 60 years, and 85% were women. The severity of OAB before BOTOX treatment, given by the mean number of daily leakages, equalled 4.8. The median interval between treatments was 210 days.

Conclusions: Patient characteristics in the real world were similar to those in the clinical trials, showing a high degree of external validity. Treatment intervals were longer in the real world than in clinical trials, indicating that treatment cost could be lower when patients are treated as observed in real-world clinical practice.
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http://dx.doi.org/10.1080/21681805.2017.1334697DOI Listing
October 2017