| 1. |
- Axelsson, Irene, et al.
(författare)
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The influence of dietary nucleotides on erythrocyte membrane fatty acids and plasma lipids in preterm infants
- 1997
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Ingår i: Acta Pædiatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 86:5, s. 539-544
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The objective of this study was to evaluate whether a regular formula for premature infants supplemented with nucleotides has any influence on plasma lipids and erythrocyte membrane fatty acids. METHODS: Preterm infants fed either human milk supplemented with human milk protein (HM, n = 14), nucleotide-supplemented preterm formula (NF, n = 13), or a regular preterm formula (F, n = 13) were included in the study. The NF was supplemented with 18.2 mg cytidine monophosphate/l (CMP), 7.0 mg uridine monophosphate/l (UMP), 6.4 mg adenosine monophosphate/l (AMP), 3.0 mg inosine monophosphate/l (IMP) and 3.0 mg guanosine monophosphate/l (GMP). RESULTS: There were significantly higher concentrations of triglycerides (TG) in infants fed NF compared to those fed F (191.42 +/- 79.58 vs 108.21 +/- 43.73, p < 0.001, mean +/- SD lipid concentrations, mg/100 ml plasma). Infants fed F had significantly lower concentrations of total cholesterol (94.34 +/- 11.71 vs 115.69 +/- 39.29, p < 0.01) and TG in plasma (108.21 +/- 43.73 vs 172.27 +/- 68.19, p < 0.001, mean +/- SD lipid concentrations, mg/100 ml plasma) when compared to HM-fed infants. There were no significant differences in any of the erythrocyte membrane fatty acids and total long-chain polyunsaturated fatty acids (LC-PUFA) between NF and F during the study period (6 weeks). Furthermore, total LC-PUFA and docosahexaenoic acid (DHA) concentrations in red blood cell were not significantly different when infants fed NF were compared to those fed HM. In contrast, however, infants fed F had significantly lower concentrations of total n-3 LC-PUFA (p < 0.01) and DHA (p < 0.01) than those found in HM-fed infants. CONCLUSIONS: These results do not suggest an effect of nucleotides on the red blood cell LC-PUFA profile in preterm infants. However, the nucleotides may increase the concentrations of triglycerides in plasma.
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| 2. |
- Bernstein, Henry H., et al.
(författare)
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Comparison of the safety and immunogenicity of a refrigerator-stable versus a frozen formulation of ProQuad (measles, mumps, rubella, and varicella virus vaccine live)
- 2007
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Ingår i: Pediatrics. - : American Academy of Pediatrics (AAP). - 1098-4275 .- 0031-4005. ; 119:6, s. 1299-1305
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Tidskriftsartikel (refereegranskat)abstract
- Objective. A refrigerator-stable formulation of ProQuad has been developed to expand the utility of ProQuad to areas in which maintenance of a frozen cold chain (- 15 degrees C or colder) during storage and transport may not be feasible. The objective of this study was to demonstrate that the immunogenicity and safety profiles of a refrigerator-stable formulation of ProQuad are similar to the recently licensed frozen formulation. Methods. In this double-blind, randomized, multicenter study, healthy 12- to 23-month- old children with negative vaccination and clinical histories for measles, mumps, rubella, varicella, and zoster were vaccinated with either the refrigerator-stable formulation of ProQuad (N = 1006) or the frozen formulation of ProQuad (N = 513). Patients were followed for 42 days after vaccination for adverse experiences. Immunogenicity was evaluated 6 weeks after vaccination. Results. The refrigerator-stable formulation of ProQuad was generally well tolerated. The incidence of adverse experiences was similar between groups. No vaccine-related serious adverse experiences were reported. For both groups, the response rate was >= 97.7% for measles, mumps, and rubella, and the percentage of patients with a varicella zoster virus antibody titer of >= 5 U/mL glycoprotein antigen-based enzyme-linked immunosorbent assay after vaccination was >= 88.8%. The geometric mean titers for all antigens were numerically slightly higher in patients who received the refrigerator-stable formulation. Conclusions. The refrigerator-stable formulation of ProQuad is generally well tolerated, highly immunogenic, and noninferior in terms of postvaccination antibody responses. This refrigerator-stable formulation may improve ease of vaccine administration, increase use of the vaccine throughout the world because of its improved storage conditions, and replace the frozen formulation of ProQuad or any dose of M-M-RII and Varivax in routine practice.
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| 3. |
- Brambilla, P., et al.
(författare)
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Metabolic risk-factor clustering estimation in children: to draw a line across pediatric metabolic syndrome
- 2007
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Ingår i: International Journal of Obesity. - : Springer Science and Business Media LLC. - 1476-5497 .- 0307-0565. ; 31:4, s. 591-600
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Forskningsöversikt (refereegranskat)abstract
- Background: The diagnostic criteria of the metabolic syndrome ( MS) have been applied in studies of obese adults to estimate the metabolic risk-associated with obesity, even though no general consensus exists concerning its definition and clinical value. We reviewed the current literature on the MS, focusing on those studies that used the MS diagnostic criteria to analyze children, and we observed extreme heterogeneity for the sets of variables and cutoff values chosen. Objectives: To discuss concerns regarding the use of the existing definition of the MS (as defined in adults) in children and adolescents, analyzing the scientific evidence needed to detect a clustering of cardiovascular risk-factors. Finally, we propose a new methodological approach for estimating metabolic risk-factor clustering in children and adolescents. Results: Major concerns were the lack of information on the background derived from a child's family and personal history; the lack of consensus on insulin levels, lipid parameters, markers of inflammation or steato-hepatitis;the lack of an additive relevant effect of the MS definition to obesity per se. We propose the adoption of 10 evidence-based items from which to quantify metabolic risk-factor clustering, collected in a multilevel Metabolic Individual Risk-factor And CLustering Estimation (MIRACLE) approach, and thus avoiding the use of the current MS term in children. Conclusion: Pediatricians should consider a novel and specific approach to assessing children/adolescents and should not simply derive or adapt definitions from adults. Evaluation of insulin and lipid levels should be included only when specific references for the relation of age, gender, pubertal status and ethnic origin to health risk become available. This new approach could be useful for improving the overall quality of patient evaluation and for optimizing the use of the limited resources available facing to the obesity epidemic.
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| 4. |
- Casabona, Giacomo, et al.
(författare)
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Randomised controlled trial showed long-term efficacy, immunogenicity and safety of varicella vaccines in Norwegian and Swedish children
- 2022
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 111:2, s. 391-400
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Several countries, such as Norway and Sweden, have not implemented universal varicella vaccination. We present data for Norway and Sweden that were generated by a paediatric multi-country Phase III study over a 10-year period. This assessed the efficacy, antibody persistence and safety of two varicella vaccines containing the same Oka strain.Methods: This was an observer-blind, controlled trial conducted in 10 European countries. Children aged 12–22 months (n = 5803) were randomised 3:3:1 and vaccinated between 1 September 2005 and 10 May 2006. The two-dose group received two tetravalent measles-mumps-rubella-varicella vaccine doses. The one-dose group received one monovalent varicella vaccine dose after a measles-mumps-rubella vaccine dose. Control group participants received two measles-mumps-rubella vaccine doses. Main study outcomes were vaccine efficacy against confirmed varicella cases and incidence of adverse events.Results: Vaccine efficacy in the two-dose group was ≥92.1% in both Norwegian and Swedish children compared to 72.3% in Norway and 58.0% in Sweden in the one-dose group. Incidences of adverse events and serious adverse events were similar in the Norwegian and Swedish study populations.Conclusion: Consistent with overall study results, high efficacy against varicella and acceptable safety profiles of the two varicella vaccines were observed in Norwegian and Swedish populations. These findings highlight the benefits of varicella vaccines, particularly when administered as a two-dose schedule.
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| 5. |
- Coccia, Francesco, et al.
(författare)
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Vitamin D and Osteogenesis Imperfecta in Pediatrics
- 2023
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Ingår i: Pharmaceuticals. - 1424-8247. ; 16:5
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Forskningsöversikt (refereegranskat)abstract
- Osteogenesis Imperfecta (OI) is a heterogeneous group of inherited skeletal dysplasias characterized by bone fragility. The study of bone metabolism, in these disease, is problematic in terms of clinical and genetic variability. The aims of our study were to evaluate the importance of Vitamin D levels in OI bone metabolism, reviewing studies performed on this topic and providing advice reflecting our experience using vitamin D supplementation. A comprehensive review on all English-language articles was conducted in order to analyze the influence of vitamin D in OI bone metabolism in pediatric patients. Reviewing the studies, contradictory data were found on the relationship between 25OH vitamin D levels and bone parameters in OI, and in several studies the baseline levels of 25OH D were below the threshold value of 75 nmol/L. In conclusion, according to the literature and to our experience, we highlight the importance of adequate vitamin D supplementation in children with OI.
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| 6. |
- Eli, Karin, et al.
(författare)
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Associations between maternal sense of coherence and controlling feeding practices : The importance of resilience and support in families of preschoolers
- 2016
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Ingår i: Appetite. - : Elsevier BV. - 0195-6663 .- 1095-8304. ; 105, s. 134-143
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Tidskriftsartikel (refereegranskat)abstract
- Sense of Coherence (SOC) measures an individual's positive, or salutogenic, orientation toward her/his capacities, environment, future, and life. SOC comprises three factors: comprehensibility (the sense of one's own life as ordered and understandable); manageability (the perception of available resources and skills to manage stressors); and meaningfulness (the overall sense that life is filled with meaning and purpose). In numerous studies, SOC has been associated with resilience to stress. However, associations between parental SOC and controlling feeding practices have yet to be studied. This study examines the validity of the SOC 13-item, 3-factor questionnaire, associations between SOC and maternal and child characteristics, and associations between SOC and use of pressuring or restrictive feeding, among mothers of 4-year-olds. 565 mothers (23.5% of foreign origin, 30.3% with overweight/obesity) recruited via the Swedish population registry (response rate: 65%), completed the SOC-13, the Child Feeding Questionnaire (CFQ), and a background questionnaire. The validity of SOC-13 was examined using confirmatory factor analysis; associations with background characteristics and feeding practices were tested with structural equation modeling. SOC-13 validity testing showed acceptable fit (TLI = 0.93, CFI = 0.94, RMSEA = 0.06, SRMR = 0.04) after allowing one pair of error terms to correlate. The Cronbach's alpha for meaningfulness was 0.73, comprehensibility 0.76, and manageability 0.75. SOC increased with mothers' Swedish background and education, and decreased with higher BMI. Child gender, age, and BMI, were not associated with SOC. Lower SOC was associated with controlling practices and with concern about child weight and eating. The associations between SOC and feeding suggest that SOC-related parameters could inform childhood obesity research, and that prevention should address the socioeconomic barriers that parents face in building resilience to stress.
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| 7. |
- Ferruzzi, Alessandro, et al.
(författare)
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The influence of growth hormone on pediatric body composition : A systematic review
- 2023
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Ingår i: Frontiers in Endocrinology. - : Frontiers Media SA. - 1664-2392. ; 14
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Forskningsöversikt (refereegranskat)abstract
- Background: Growth hormone (GH) affects metabolism and regulates growth in childhood. The most prominent feature of GH deficiency (GHD) in children is diminished height velocity that eventually leads to short stature. In adult-onset GHD, lean body mass (LBM) is reduced, and visceral fat mass (FM) increased. Beneficial effects of GH treatment on body composition in adults with GHD, including an increase in muscle mass and a decrease in FM, are well established. Relatively few studies have investigated the effects of GH treatment on the body composition of pediatric patients with idiopathic or hypothalamic-pituitary disease-associated GH deficiency. This systematic review aimed to summarize available evidence relating to the effects of GH treatment on body composition in children with GHD. Methods: The PubMed, Science Direct, Cochrane Trials, and Embase databases, were searched with keywords including “GH”, “body composition”, “children”, and “growth hormone” for English-language articles, published between January 1999 and March 2021. Two reviewers independently evaluated the search results and identified studies for inclusion based on the following criteria: participants had a confirmed diagnosis of GHD (as defined in each study); participants were pediatric patients who were receiving GH or had stopped GH treatment, regardless of whether they were pre- or post-pubertal; the intervention was recombinant human GH (rhGH; somatropin); and outcomes included changes in body composition during or after stopping GH therapy. Data extracted from each study included study quality, study sample characteristics, study interventions, and body composition. Data on fat-free mass and LBM were combined into a single category of LBM. Results: Sixteen studies reporting changes in body composition (i.e., FM and LBM) associated with GH treatment in children with GHD were identified and included in the review. Collectively, these studies demonstrated that FM decreased, and LBM increased in response to GH replacement therapy. Conclusion: Despite study limitations (i.e., potential effects of diet and physical activity were not considered), we concluded that a periodic body composition assessment is required to ensure that a satisfactory body composition is achieved during GH replacement therapy in children with GHD.
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| 8. |
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| 9. |
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| 10. |
- Flodmark, Carl-Erik
(författare)
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Childhood Obesity
- 1997
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Ingår i: Clinical Child Psychology and Psychiatry. - : SAGE Publications. - 1359-1045 .- 1461-7021. ; 2:2, s. 283-295
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Tidskriftsartikel (refereegranskat)abstract
- Prevention of obesity should have the highest priority and be started as early in life as possible in high-risk families. This article covers the most promising areas of today's research aimed at finding better ways of treating obesity in the future and an overview of the treatment choices available today. The cause of obesity is genetic in approximately 40-50 percent of adults and probably to a higher degree in children. This means that it is possible to remain overweight without a calorie intake that exceeds that of those individuals of normal weight who lack the genetic susceptibility of obesity. Treatment is recommended from 10 years of age with a hypocaloric diet (1500 kcal) and a reduced fat content (30 energy-percent). Exercise is often obtained naturally by the child before this age. It is helpful to try to replace a sedentary lifestyle including television-viewing with moderate physical activities such as walking. In introducing these changes in lifestyle family therapy has been effective. Other strategies such as behavioural therapy has also been tried individually or in groups or at school with short-term benefits only. Cognitive therapy in childhood obesity gives no advantages over behavioural therapy. No reports on psychodynamic therapy have been published. Surgery is used only in rare inborn metabolic diseases. Although the treatment of children seems to give better results than does treating adults, further development of therapy for obesity is needed.
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| 11. |
- Flodmark, Carl-Erik, et al.
(författare)
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Childhood obesity: from nutrition to behaviour.
- 2008
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Ingår i: Proceedings of the Nutrition Society. - 0029-6651. ; 67, s. 356-362
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Tidskriftsartikel (refereegranskat)abstract
- Obesity in children is difficult to treat, but it seems to be easier to treat than adult obesity. The first step in treatment is to identify effective advice relating to nutrition and physical activity. In most treatment studies the macronutrient composition of the diet is not of major importance for treatment outcome. In relation to physical activity fat-utilisation strategies have been described. The second step includes appropriate approaches to lifestyle change. In Europe there are no drugs approved for children, and surgery for children is still limited to research projects. Thus, the major challenge is to develop effective ways of changing lifestyle. Family therapy may be an effective approach in preventing severe obesity from developing during puberty, and a therapeutic strategy based on treatment studies is described. The family-therapy techniques used here are intended to facilitate the family's own attempts to modify their lifestyle, and to increase their own sense of responsibility and readiness to change, i.e. these variables are the prime targets during therapy. Thus, the family, not the therapist, assumes responsibility for the changes achieved. This approach may be helpful in making the therapeutic process less cumbersome for the therapist. Instead of the therapist attempting to persuade the obese subjects to lose weight, it might be more effective to teach them to control their eating patterns through their own efforts. The treatment model includes structural family therapy and solution-focused-brief therapy. The use of such a model makes it possible to train therapists and health professionals to use an evidence-based intervention model.
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| 12. |
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| 13. |
- Flodmark, Carl-Erik
(författare)
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Familjeterapi tillämplig även i somatiska vården. Studieöversikt över medicinskt orienterad familjeterapi
- 2001
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Ingår i: Läkartidningen. - 0023-7205. ; 98:1, s. 30-34
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Tidskriftsartikel (refereegranskat)abstract
- By observing and analyzing the influence of the therapist on the family as well as interactions between family members, the encounter with a family in a medical setting can serve to improve the health of its members, by improving their ability to use their own resources. This method of focusing on the interaction between individuals in a family or other systems has been a valuable addition to medical treatment of chronic disease. Family therapy has been shown to effectively improve treatment of diabetes, asthma and obesity. A review of the literature is presented.
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| 14. |
- Flodmark, Carl-Erik, et al.
(författare)
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Fokus på fetma i familjen
- 1995
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Ingår i: Familjeterapi tillämpningar ur ett svenskt perspektiv. - 9789144469119 ; , s. 54-54
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 15. |
- Flodmark, Carl-Erik, et al.
(författare)
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Interventions to prevent obesity in children and adolescents: a systematic literature review.
- 2006
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Ingår i: International Journal of Obesity. - : Springer Science and Business Media LLC. - 1476-5497 .- 0307-0565. ; 30:4, s. 579-589
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Forskningsöversikt (refereegranskat)abstract
- Objective: Preventive measures to contain the epidemic of obesity have become a major focus of attention. This report reviews the scientific evidence for medical interventions aimed at preventing obesity during childhood and adolescence. Design: A systematic literature review involving selection of primary research and other systematic reviews. Articles published until 2004 were added to an earlier ( 2002) review by the Swedish Council on Technology Assessment in Health Care. Methods: Inclusion criteria required controlled studies with follow-up of at least 12 months and results measured as body mass index, skinfold thickness or the percentage of overweight/obesity. Children could be recruited from normal or high-risk populations. Results: Combining the new data with the previous review resulted in an evaluation of 24 studies involving 25 896 children. Of these, eight reported that prevention had a statistically significant positive effect on obesity, 16 reported neutral results and none reported a negative result ( sign test; P = 0.0078). Adding the studies included in five other systematic reviews yielded, in total, 15 studies with positive, 24 with neutral and none with negative results. Thus, 41% of the studies, including 40% of the 33 852 children studied, showed a positive effect from prevention. These results are unlikely to be a random chance phenomenon ( P = 0.000061). Conclusion: Evidence shows that it is possible to prevent obesity in children and adolescents through limited, school-based programs that combine the promotion of healthy dietary habits and physical activity.
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| 16. |
- Flodmark, Carl-Erik, et al.
(författare)
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Laser beam measurement of abdominal sagittal diameter in obese children: a validation study.
- 2013
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Ingår i: Pediatric obesity. - : Wiley. - 2047-6310 .- 2047-6302. ; 8:2, s. 112-117
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Tidskriftsartikel (refereegranskat)abstract
- What is already known about this subject Sagittal diameter (SAD), i.e. the mid height of the abdomen when lying down, has been reported to correlate to visceral fat, insulin resistance and cardiovascular risk factors in adults. SAD seems to be the best anthropometric predictor of cardiovascular risk, and also of more importance than waist circumference (WC) in adults. There has been no validation studies comparing SAD measured with anthropometric tools (e.g. ruler) to measurements made with more exact devices such as magnetic resonance imaging (MRI) in pediatric age. What this study adds This new reliable method is ideal for children due to limited body contact and no radiation. It is accurate, less expensive than MRI, and also easier to perform than measuring WC. It is easily available for screening purposes making future epidemiological studies possible evaluating health risks related to regional distribution of abdominal tissue. OBJECTIVES: Sagittal diameter (SAD) has been reported to correlate to visceral fat and cardiovascular risk factors. SAD is measured with the individual lying down, halfway between the lower rib margin and the iliac crest; it represents the mid-height of the abdomen. The aim of this study was to validate SAD measured using a recently-developed laser beam device (SAD(LDB) ) against SAD measured using MRI (SAD(MRI) ). METHODS: Of 48 obese children (25 boys, 23 girls) aged 9-11 years on the waiting list for obesity treatment, 34 agreed to a baseline measurement, which was followed by repeated measurements 6 and 12 months later in 31 and 22 children respectively. MRI was used to examine SAD(MRI) at 5 cm above (SAD(MRI) (,cra) ) and below (SAD(MRI) (,cau) ) the mid plane of the L4-5 intervertebral disc. RESULTS: Each of the differences SAD(LBD) - SAD(MRI) (,cau) and SAD(LBD) - SAD(MRI) (,cra) was subjected to a repeated-measurements ANOVA; the visit did not have a statistically significant effect in either case (p = 0.19 and p = 0.72, respectively). The difference SAD(LBD) - SAD(MRI) (,cau) was 1.50 on average (p < 0.0001; CI 1.26-1.74) while the corresponding figure for SAD(LBD) - SAD(MRI) (,cra) was 1.26 (p < 0.0001; CI 1.04-1.49). Regression of the difference on the mean gave slopes of -0.09 (p = 0.25) and -0.04 (p = 0.57) respectively. Prediction of SAD(MRI) from SAD(LDB) can be performed in different ways: by means of linear regression or by means of an additive correction. CONCLUSIONS: Thus, this laser device can be used instead of MRI to estimate SAD by using a simple correction.
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| 17. |
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| 18. |
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| 19. |
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| 20. |
- Flodmark, Carl-Erik, et al.
(författare)
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Prevention of progression to severe obesity in a group of obese schoolchildren treated with family therapy
- 1993
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Ingår i: Pediatrics. - 1098-4275. ; 91:5, s. 880-884
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Tidskriftsartikel (refereegranskat)abstract
- STUDY OBJECTIVE. To evaluate the effect of family therapy on childhood obesity. DESIGN. Clinical trial. One year follow-up. SETTING. Referral from school after screening. PARTICIPANTS. Of 1774 children (aged 10 to 11), screened for obesity, 44 obese children were divided into two treatment groups. In an untreated control group of 50 obese children, screened in the same manner, body mass index (BMI) values were recorded twice, at 10 to 11 and at 14 years of age. INTERVENTION. Both treatment groups received comparable dietary counseling and medical checkups for a period of 14 to 18 months, while one of the groups also received family therapy. RESULTS. At the 1-year follow-up, when the children were 14 years of age, intention- to-treat analyses were made of the weight and height data for 39 of 44 children in the two treatment groups and for 48 of the 50 control children. The increase of BMI in the family therapy group was less than in the conventional treatment group at the end of treatment, and less than in the control group (P = .04 and P = .02, respectively). Moreover, mean BMI was significantly lower in the family therapy group than in the control group (P < .05), and the family therapy group also had fewer children with BMI > 30 than the control group (P = .02). The reduction of triceps, subscapular, and suprailiac skinfold thicknesses, expressed as percentages of the initial values, was significantly greater in the family therapy group than in the conventional treatment group (P = .03, P = .005 and P = .002, respectively), and their physical fitness was significantly better (P < .05). CONCLUSIONS. Family therapy seems to be effective in preventing progression to severe obesity during adolescence if the treatment starts at 10 to 11 years of age.
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| 21. |
- Flodmark, Carl-Erik, et al.
(författare)
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Psychotherapy
- 2002
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Ingår i: Child and Adolescent Obesity: Causes and Consequences. Prevention and Management.. - 9780521026642 - 0521026644 ; , s. 327-327
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 22. |
- Flodmark, Carl-Erik, et al.
(författare)
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Red cell sodium-potassium adenosine triphosphatase sites and intracellular sodium increased in obese school children
- 1992
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Ingår i: Mineral and Electrolyte Metabolism. - 1423-016X. ; 18:1, s. 6-8
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Tidskriftsartikel (refereegranskat)abstract
- Principally to ascertain whether mineral metabolism is involved in weight regulation, the 40 most obese of 1,774 children, aged 10-11 years, screened for obesity were compared with 46 age-matched controls. The obese children had more 3H-Ouabain erythrocyte binding sites (p = 0.04), higher intracellular sodium (p = 0.04), and lower plasma sodium (p = 0.002). After exclusion of the non-Scandinavians, the p values were p = 0.02, p = 0.03, and p = 0.03, respectively. Analysis of variance also showed the differences to be more dependent on obesity than on gender or nationality. It is concluded that obese children have more 3H-Ouabain erythrocyte binding sites indicating an increase of the sodium-potassium adenosine triphosphatase activity. The increase of intracellular sodium may increase the risk of future hypertension.
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| 23. |
- Flodmark, Carl-Erik, et al.
(författare)
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Switching From Originator to Biosimilar Human Growth Hormone Using Dialogue Teamwork: Single-Center Experience From Sweden.
- 2013
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Ingår i: Biologics in Therapy. - : Springer Science and Business Media LLC. - 2190-9164 .- 2195-5840. ; 3:1, s. 35-43
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Tidskriftsartikel (refereegranskat)abstract
- Introduction A new treatment plan was implemented at Skåne University Hospital, on economic grounds, for children requiring recombinant human growth hormone (rhGH) treatment. This involved switching patients from treatment with originator rhGHs to treatment with a biosimilar rhGH, somatropin (Omnitrope®), using a Dialogue Teamwork approach. The feasibility of using this approach to implement the switch of treatment was assessed, as well as the impact of the switch on treatment efficacy and cost of therapy. Methods As part of the Dialogue Teamwork approach, patients/parents received several opportunities for dialogue and sources of information, including discussions with the Head of Department, the responsible physician and a specialized endocrinology nurse. Height and height standard deviation score (HSDS) data were plotted for each individual patient (N = 98). A modeling approach was also used, to predict growth after switching to biosimilar rhGH; the predictions were then compared to the actual observed height after the switch. Costs to the clinic of rhGH therapy were calculated between May–August 2009 and May–August 2012. Results Of the 102 patients offered the switch, 98 accepted. Height and HSDS data indicated there was no negative impact on growth velocity after the switch to biosimilar rhGH. Modeling demonstrated that observed growth following the switch was consistent with predicted growth based on data before patients were switched. There were no reports of serious or unexpected adverse drug reactions following the switch to biosimilar rhGH. Following the switch, the cost to the clinic of rhGH treatment decreased from approximately 6 million SEK (May–August 2009) to approximately 4 million SEK (May–August 2012). This corresponds to an annual saving of 6 million SEK (€650,000). Conclusion Patients were successfully switched from originator to biosimilar rhGH (somatropin), with no negative impact on growth, and no serious or unexpected adverse drug reactions. The switch from originator to biosimilar rhGH is associated with substantial cost savings.
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| 24. |
- Flodmark, Carl-Erik
(författare)
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The happy obese child
- 2005
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Ingår i: International Journal of Obesity. - : Springer Science and Business Media LLC. - 1476-5497 .- 0307-0565. ; 29, s. 31-33
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Firstly, is the negative psychological effect of obesity also present in the whole population of obese and overweight children? Secondly, what tools could be recommended to measure the psychological effects of obesity? DESIGN: Review. METHODS: Quality of life or self-esteem is often used in evaluating the psychological effects of obesity. Test instruments used have been instruments for measuring quality of life such as the pediatric quality of life inventory (PedsQL) or the KINDL (R) instrument, and measurements of self-esteem, such as 'ITIA' ('I think I am) and the Self-Perception Profile for Children. RESULTS: The obese child studied in community samples has better quality of life and self-esteem than obese children from clinical samples. CONCLUSION: Psychosocial factors seem to be more important than the functional limitations of obesity itself. This means that we might help the obese child better by social support to a minor part of the population than to focus on the child's obesity as a cause of psychological problems. A happy obese child might have greater resources to cope with the problem than previously thought.
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| 25. |
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