The Sydney System: Epidemiology and natural history of chronic gastritis

Chronic gastritis is a common disease which forms an important background to the pathogenesis of several gastric diseases. In most instances, gastritis seems to be a bacterial (microbial) disease. It begins as long-lasting, chronic inflammatory reaction directed against Helicobacter pylori (HP), or occasionally against other spiral bacteria, which colonize in the space between the surface epithelium and the mucous layer. Gastritis may, irrespectively of the HP-related or HP-independent origin, progress to an atrophy (chronic gastritis with atrophy) in the underlying mucosa. Prevalence of gastritis increases with increase in age, but great variations exist in the age-specific prevalence and in mean age of onset of the gastritis in different populations. A high rate and an early onset of the HP-related gastritis associates with low socio-economic status. Chronic gastritis, and the gastritis with atrophy in particular, may interfere with the function of the affected gastric mucosa, and may subsequently increase or decrease the risk of some gastric diseases, such as cancer and peptic ulcer. Both antral and corpus gastritis with coexistent severe atrophic changes have been shown to be associated with an increased risk of gastric cancer. In addition, gastritis seems to also play an important role in the pathogenesis of peptic ulcer. Virtually all patients with DU and GU have coexisting and preceding gastritis. The cumulative risk of ulcer has been estimated to be high in subjects with gastritis, but, in contrast, to be low in subjects who have normal gastric mucosa.     

Oral health programme for preschool children: a prospective, controlled study

Background.  New perspectives are needed for oral health programmes (OHPs). The aim was to evaluate the preventive effect of a risk-based OHP in comparison with a traditional programme.
Design.  An age cohort of 794 Finnish children, 446 in the intervention group and 348 in the control group, was followed from 18 months to 5 years of age. The children were screened for mutans streptococci (MS) in the dental biofilm. The main outcome measure was the proportion of children with dental caries (decayed, missing, or filled primary teeth > 0) at the age of 5 years. The intervention, targeted to MS-positive subjects in the intervention group only, was based on repeated health education to the caretakers and xylitol lozenges for the child. Dental hygienists carried out the programme.
Results.  OHP was effective in white-collar families [numbers needed to treat (NNT) = 3, 95% CI 2–11]. Factors significantly associated with caries at 5 years were MS colonization at 18 months, occupation of caretaker, but also gender when incipient carious lesions were included in the index.
Conclusion.  Early risk-based OHP, targeted to the families of MS-positive children, can reduce the risk for caries in white-collar families. For blue-collar families, different kinds of methods in caries prevention and support are needed.     

Mode of delivery directs the phagocyte functions of infants for the first 6 months of life.

Factors that direct the immune responsiveness of the newborn beyond the immediate post-natal period are not known. We investigated the influence of mode of delivery and type of feeding on the phagocyte activity during the first 6 months of life. Sixty-four healthy infants (34 delivered vaginally and 30 by elective Caesarean section) were studied at birth and at the ages of 2 and 6 months. Phagocyte functions were studied by measuring the chemiluminescence (CL) activity of whole blood and isolated leucocytes and by investigating the expression of phagocyte receptors (FcgammaRI (CD64), FcgammaRII (CD32), FcgammaRIII (CD16), CR1 (CD35), CR3 (CD11b) and FcalphaR (CD89)) on neutrophils, monocytes and eosinophils by using receptor-specific MoAbs and immunofluorescence flow cytometry. Infants born by elective Caesarean section had significantly higher CL activity than those delivered vaginally during the entire 6-month follow up. In addition, infants who received formula feeds had significantly higher CL activity at 6 months of age and higher expression of FcgammaRI-, Fcalpha- and CR3-receptors on neutrophils than infants exclusively breast-fed. We suggest that stress reaction associated with labour influences the phagocytic activity measured in the cord blood but later during infancy the intraluminal antigens, gut microflora and diet, become important determinants in immune programming of human individuals.     

Low bone mass in patients with motor disability: prevalence and risk factors in 59 Finnish children

Aim Children with motor disabilities are at increased risk of compromised bone health. This study evaluated prevalence and risk factors of low bone mass and fractures in these children. Method This cross‐sectional cohort study evaluated bone health in 59 children (38 males, 21 females; median age 10y 11mo) with motor disability (Gross Motor Function Classification System levels II–V). Bone mineral density (BMD) in the lumbar spine was measured with dual‐energy X‐ray absorptiometry; BMD values were corrected for bone size (bone mineral apparent density [BMAD]) and skeletal maturity, and compared with normative data. Spinal radiographs were obtained to assess vertebral morphology. Blood biochemistry included vitamin D concentration and other parameters of calcium homeostasis. Results Ten children (17%) had sustained in total 14 peripheral fractures; lower‐limb fractures predominated. Compression fractures were present in 25%. The median spinal BMAD z‐score was ?1.0 (range ?5.0 to 2.0); it was ?0.6 in those without fractures and ?1.7 in those with fractures (p=0.004). Vitamin D insufficiency was present in 59% of participants (serum 25‐hydroxyvitamin D <50nmol/l) and hypercalciuria in 27%. Low BMAD z‐score and hypercalciuria were independent predictors for fractures. Interpretation Children with motor disability are at high risk of peripheral and vertebral fractures and low BMD. Evaluation of bone health and prevention of osteoporosis should be included in the follow‐up.     

Mutans streptococci colonization associates with the occupation of caretaker,a practise‐based study

International Journal of Paediatric Dentistry 2010; 20: 144–150 Background. The early mutans streptococci (MS) bacteria colonization is connected to early childhood caries. The aim of this study is to examine associations between the MS‐colonization and background factors in young children, in order to enhance the oral health program in a low caries prevalence community. Subjects and Design. An age cohort of 512 children was screened for MS in the oral biofilm at the age of 18 months. The caretakers were, using a structured form, interviewed of demographical factors and habits connected to oral health: antibiotic treatments, child’s appetite, frequency of night feeding, use of sugary products or drinks, and maternal xylitol use. The associations were evaluated with logistic regression analysis. Results. Mutans streptococci colonization was significantly associated with both the occupation of the caretaker and the non‐Finnish background. Conclusion. The early MS‐colonization, in preschool children, strongly associates with the socioeconomic status of the family.     

Growth of 519 Small for Gestational Age Infants during the First Two Years of Life

ABSTRACT. The physical growth of 519 small for gestational age infants (SGA), with a birth weight below the 10th percentile on our own growth curve, born in the region of University Central Hospital of Turku during the period June 1,1981-May 31, 1982, was studied. The study population consists of 4 517 term, appropriate for gestational age (AGA) infants, 488 term SGA infants, 320 preterm AGA infants and 31 preterm SGA infants. The degree of intrauterine growth retardation (IUGR) seemed to have an effect on physical growth in term SGA infants. Those term SGA infants with a low Ponderal Index (PI) (type II) were taller and had a larger head circumference at the age of 24 months than term SGA infants with adequate PI (type I). Among the preterm SGA infants the degree of IUGR seemed to have no effect on later growth. Smoking is still one of the main risk factors associated with poor intrauterine growth. In this study we also found that smoking has an effect on later growth; the children of smoking mothers were smaller than those of non-smoking mothers in the AGA group. Among the SGA infants the infants of non-smoking mothers were bigger than those of smoking mothers. This difference could be explained by other factors associated with SGA. We found that in spite of the catch-up growth during the first months, 26% of the severely SGA infants (birth weight below the 2.5th percentile) still had a weight below the 2.5th percentile at the age of 24 months.     

Pathological Heart Rate Responses Associated with Body Movements in Neurologically Damaged Infants during Sleep

ABSTRACT. Simultaneous electrocardiogram (ECG) and static charge sensitive bed (SCSB) method recordings were carried out in fifteen healthy and twenty-one neurologically damaged infants during sleep at the age of one week, one month and three months. The SCSB method allows continuous long-term recording of body movements without electrodes connected to the subject. The heart rate response to body movements was studied. Healthy newborns had clear heart rate (HR) acceleration response to body movements. A rapid HR deceleration response occurred at the end of body movements. In the neurologically damaged infants the HR response to body movements was significantly hyperactive or delayed. The abnormal heart rate acceleration-deceleration response to body movements in damaged infants can best be explained by disturbed function of the autonomic nervous system.     

EFFECT OF EXTRADURAL ANALGESIA USING BUPIVACAINE AND 2-CHLOROPROCAINE ON INTERVILLOUS BLOOD FLOW DURING NORMAL LABOUR

The effect of lumbar extradural analgmig on intervillous bloodflow (IBF) during labour was studied in 26 healthy parturientsusing an i. v. bolus injection of xenon-133. There was a 19%decrease (n.s.) in mean IBF in six parturients (non-extraduralcontrol group). Mean IBF increased by 37.5% when 0.25% bupivacaine10 ml was used and by 35.2% when 2% 2-chloroprocaine 10 ml wasused (n.s.). When the two extradural groups were combined, themean difference between IBFi and IBF2 was 45± 112 mlmin dl^–1. This increase is statistically significant (P<0.05). The improvement in IBF after extradural block was consideredto be a result of the decreased uterine vascular resistance,as no significant changes were observed in arterial pressure,utenne activity or uterine tone.