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The cost-effectiveness of hypertonic saline inhalations for infant bronchiolitis: a decision analysis

World Journal of Pediatrics 2018年第1期14卷 26-34页

作者： Paula Heikkila Minna Mecklin matti korppi Tampere Center for Child Health Research Universityof Tampere and Tampere University HospitalTampereFinland Department of Pediatrics Tampere University HospitalPOBOX200033521T ampereFinland

Background This study evaluated the cost-effectiveness of hypertonic saline (HS) inhalations for infant bronchiolitis, com-pared to normal saline inhalations or standard treatment without inhalations as controls. Methods The decision tree in the decision analysis was used to calculate the expected costs. Actual cost data were obtained from our retrospective case-control study on bronchiolitis treatment. The effectiveness of treatment, based on the hospitaliza-tion rate of those admitted to the emergency department and the length of stay (LOS) of those who were hospitalized, was collected from previous studies. For the effectiveness estimations, we made a meta-analysis summarizing the results of the meta-analysis of the Cochrane review in 2013 and the results of 10 studies published after it. Results The mean hospitalization rate was 24.7% in the HS inhalation group and 32.6% in the control group [risk ratio: 0.80, 95% confidence interval (CI) 0.67–0.96] and the mean LOS was 3.736 (HS group) and 4.292 (controls) days (mean difference: ? 0.55 days, 95% CI ? 0.96 to ? 0.15), respectively. The expected costs per patient, when both inpatients and outpatients were included, were €816 ($1111) in the HS inhalation group and €962 ($1310) in the control group. The expected costs per hospitalization, when only inpatients were included, were €2600 ($3540) in the HS inhalation group and €2890 ($3935) in the control group. Conclusions HS inhalations slightly reduced the expected hospitalization costs of infant bronchiolitis. However, the low effectiveness, rather than the cost, is the factor that will limit the use of HS inhalations in infant bronchiolitis.

关键词： Bronchiolitis Cost-effectiveness Decision analysis Hospitalization costs Hypertonic saline

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Tonsillitis in children: unnecessary laboratory studies and antibiotic use

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世界儿科杂志:英文版 2016年第1期12卷 114-117页

作者： Antti Kunnamo matti korppi Merja Helminen Pediatric Research Centre Tampere University and Univesity HospitalTampereFinland

Background:The Finnish Current Care Guidelines on diagnostics and treatment of sore throat recommend the treatment of only group A streptococcus(GAS)positive cases with *** aim of the study was to evaluate how these guidelines are followed in the pediatric emergency ***:We analyzed retrospectively the data on microbiological studies and blood tests done,and data on prescribing of antibiotics,of 200 children admitted for febrile exudative ***:After the clinical diagnosis of exudative tonsillitis,antigen test and/or culture for GAS identifi cation was done in>95%of *** the 32(16%)children with GAS infection,but also 52(38%)of the 137 children without any evidence of bacterial infection received *** laboratory studies were done in 96%of *** C-reactive concentrations or white blood cell counts were not able to separate streptococcal from non-streptococcal *** serious bacterial infection was ***:The Finnish Current Care Guidelines lead to over-treatment with *** of the 200 children returned after discharge,suggesting that undertreatment did not happen.

关键词： exudative tonsillitis streptococcal antigen test streptococcal culture

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Polymorphisms in the promoter region of IL10 gene are associated with virus etiology of infant bronchiolitis

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World Journal of Pediatrics 2018年第6期14卷 594-600页

作者： Annukka Holster Johanna Terasjarvi Juho Vuononvirta Petri Koponen Ville Peltola Merja Helminen Qiushui He matti korppi Kirsi Nuolivirta Seinajoki Central Hospital Hanneksenrinne 760220 SeinajokiFinland Department of Medical Microbiology and Immunology Turku UniversityTurkuFinland Tampere Center forChild Health Research Tampere University andU niversity HospitalTampereFinland Department of Pediatrics and Adolescent Medicine Turku University Hospital and Child and Youth Research InstituteUniversity of T urkuTurkuFinland Department of Medical Microbiology Capital Medical UniversityBeijingChina

Background Bronchiolitis is the most common infection leading to hospitalization in infancy. Interleukin-10 (IL-10) is an anti-inflammatory cytokine, and in our previous study, IL10 gene rs1800896 (-1082A/G) polymorphism was associated with viral etiology of infant bronchiolitis. The objective of this study was to evaluate the associations between IL10 single nucleotide polymorphisms (SNPs) at rs1800890 (-3575A/T), rs1800871 (-819C/T) or rs1800872 (-592C/A) either alone or combined with the SNP at rs1800896 (-1082G/A), and the etiology and severity of infant bronchiolitis. Methods Data on four IL10 SNPs were available from 135 full-term infants, hospitalized for bronchiolitis at age less than 6 months, and from 378 to 400 controls. Viral etiology was studied, and oxygen support, feeding support and the length of stay in hospital were recorded during bronchiolitis hospitalization. Results Infants with rhinovirus bronchiolitis had the IL10 rs1800890 variant AT or TT genotype less often (18.2%) than controls (63.3%, P=0.03), and likewise, had the IL10 rs1800896 variant AG or GG genotype less often (27.3%) than con-trols (65.5%, P=0.009). Twenty-eight infants with bronchiolitis had the variant–variant Grs1800896Trs1800890 haplotype, and none of them had rhinovirus infection. The IL10 rs1800871 or rs1800872 genotypes showed no associations with viruses. No association was found between any genotypes and bronchiolitis severity measures. Conclusion IL10 rs1800890 and rs1800896 polymorphisms differed between infants with rhinovirus bronchiolitis and con-trols, but not between infants with respiratory syncytial virus bronchiolitis and controls.

关键词： Bronchiolitis IL10 gene polymorphism Infant Respiratory syncytial virus

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婴儿发生喘息20年后的哮喘和肺功能:一项前瞻性随访研究

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世界核心医学期刊文摘（儿科学分册） 2005年第9期1卷 8-9页

作者： Piippo-Savolainen E. Remes S. Kannisto S. M. korppi 郭战宏 Department of Pediatrics Kuopio University Hospital FIN-70210 Kuopio Finland Dr.

Objective: To determine the outcome until adulthood after wheezing in infancy Design: An 18-to-20-year prospective cohort study. Setting: Pediatric department at a university hospital, providing primary hospital care for a defined population. Patients: Fifty-four children hospitalized for bronchiolitis and 34 for pneumonia at younger than 2 years, and 45 controls with no early-life wheezing or hospitalization, were studied at median age 19 years. Main Outcome Measures: A questionnaire on asthma symptoms and medication, physical examination, flow volume spirometry (FVS), methacholine inhalation challenge (MIC), home peak expiratory flow (PEF) monitoring, and skin prick testing (SPT) to common inhalant allergens. The 2 asthma definitions were physician-diagnosed asthma and previously diagnosed asthma with recent asthmatic symptoms (physiciandiagnosed asthma included). Results: By the 2 definitions, asthma was present in 30% (odds ratio OR , 3.37; 95% confi-dence interval CI , 1.12-10.10) and in 41% (OR 1.38; 95% CI, 0.37-5.21) in the bronchiolitis group, in 15% (OR, 5.50; 95% CI, 1.87-16.14) and in 24% (OR, 2.07; 95% CI, 0.59-7.22) in the pneumonia group, and in 11% in the control group. After bronchiolitis, the FVS values were forced vital capacity (FVC), 108% (SD, 13% ) of predicted; forced expiratory volume in 1 second, 98% (SD, 12% ); forced expiratory volume in 1 second divided by FVC, 91% (SD, 7.6% ); midexpiratory flow at 50% of the FVC, 74% (SD, 19% ); and midexpiratory flow at 25% of the FVC, 74% (SD, 22% ). Bronchial reactivity by MIC was present in 25 (48% ) of 52 subjects in the bronchiolitis group, in 13 (42% ) of 31 in the pneumonia group, and in 14 (32% ) of 44 in the control group. The prevalence of atopy (positive SPTs) was 48% to 63% in the 3 groups. In a logistic regression adjusted for atopy and smoking, infantile bronchiolitis was an independent risk factor for asthma by both definitions. Conclusion: The increased risk for asthma persists until ad

关键词：随访研究细支气管炎吸入性变应原乙酰甲胆碱过敏症年龄中位数吸入激发住院治疗前瞻性队列研究独立危险因子

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