Antti Saari

Aims: The use of automated insulin delivery (AID) systems is associated with improved glycaemic control in individuals with type 1 diabetes (T1DM). However, AID systems are more expensive than other treatment modalities for T1DM. The aim of this study was to evaluate the long‐term cost‐effectiveness of AID compared to continuous subcutaneous insulin infusion (CSII) combined with continuous glucose monitoring (CGM) in individuals with T1DM at Kuopio University Hospital, Finland. Materials and Methods: The study included 336 individuals (mean age: 26.7 years, SD: 15.9 years), with a mean duration of diabetes of 16.6 years. Outcomes were projected in the base case of 50 years using the IQVIA CORE Diabetes Model (v10.0). Clinical data were sourced from electronic health records (EHRs), including changes in glycated haemoglobin (HbA1c) and events of hypoglycaemia and ketoacidosis. Costs were expressed in 2023 Euros (EUR). Results: The AID system was associated with an improvement in quality‐adjusted life expectancy of 2.3 quality‐adjusted life‐years (QALYs) compared to CSII plus CGM. These benefits came from the delayed and reduced incidence of diabetes‐related complications. The mean HbA1c improvement was 12.1 ± 11.7 mmol/mol (3.3% ± 3.2%) in the AID group. Direct costs were estimated to be 26 076 EUR higher for AID than for CSII plus CGM, and AID was associated with an incremental cost‐effectiveness ratio (ICER) of 11 184 EUR per QALY gained. Conclusions: Based on the results of this first cost‐effectiveness study conducted in Finland, a willingness‐to‐pay (WTP) threshold of 50 000 EUR per QALY gained suggests that AID is more cost‐effective than CSII plus CGM for the treatment of T1DM in a real‐world setting.

Aim: To describe the current approaches to surveillance and use of data on children's growth in the Nordic countries and to reach consensus on how this can be improved. Methods: Members of the Promoting Healthy Weight in Children (PromoKids) network and additional public health professionals from five Nordic countries described their respective national growth surveillance systems. The various approaches to data collection and consolidation were analysed and compared. Results: In Finland, Denmark, Norway, Sweden and Iceland, all children's weight and height are measured repeatedly at different intervals from birth by child and school health services. However, the data are not consistently registered centrally in all countries for use in public health planning, policymaking and research. Finland and Denmark had the most mature systems for data collection. Conclusion: A consensus was reached that surveillance of body weight and height should be a mandatory element of national action plans to prevent and manage growth disorders including obesity, and to identify susceptible population groups. Surveillance protocols should be designed to prevent stigmatisation of children with overweight. Nordic countries should collaborate to accomplish comprehensive data coverage to uncover social inequalities and evaluate societal actions to prevent obesity in children.

Context Development of the typical growth phenotype in juvenile acquired hypothyroidism (JHT), the faltering linear growth with increasing weight, has not been thoroughly characterized. Objective To describe longitudinal growth pattern in children developing JHT and investigate how their growth differs from the general population in systematic growth monitoring. Design Retrospective case-control study. Setting JHT cases from 3 Finnish University Hospitals and healthy matched controls from primary health care. Patients A total of 109 JHT patients aged 1.2 to 15.6 years (born 1983-2010) with 554 height and weight measurements obtained for 5 years preceding JHT diagnosis. Each patient was paired with 100 healthy controls (born 1983-2008) by sex and age. Longitudinal growth pattern was evaluated in mixed linear models. Growth monitoring parameters were evaluated using receiver operating characteristics analysis. Results At diagnosis, JHT patients were heavier (mean adjusted body mass index-for-age [BMISDS] difference, 0.65 [95% CI, 0.46-0.84]) and shorter (mean adjusted height-for-age deviation from the target height [TH^DEVSDS] difference, −0.34 [95% CI, −0.57 to −0.10]) than healthy controls. However, 5 years before diagnosis, patients were heavier (mean BMISDS difference, 0.33 [95% CI, 0.12-0.54]) and taller (mean TH^DEVSDS difference, 0.29 [95% CI, 0.06-0.52]) than controls. JHT could be detected with good accuracy when several growth parameters were used simultaneously in screening (area under the curve, 0.83 [95% CI, 0.78-0.89]). Conclusions Abnormal growth pattern of patients with JHT evolves years before diagnosis. Systematic growth monitoring would detect abnormal growth at an early phase of JHT and facilitate timely diagnosis of JHT.

In recent decades, obesity has surged to epidemic proportions in the developed world, and it has become crucial that obesity’s multifactorial pathophysiology be better understood, providing a means to prevent its increasing occurrence in children and adults.1 An initial observation, made in 2008, was that antibiotic use in infancy is associated with altered microbiota, possibly causing an increased risk for weight gain.2 Since then, numerous observational studies in which this hypothesis has been elucidated and 3 separate meta-analyses have been conducted, and authors have uniformly concluded that there is a weak but significant and positive association between exposure to antibiotics during infancy and weight gain during childhood.3–5 In this issue of Pediatrics , Block et al6 use an extensive database of 362 550 children to report results that are in agreement with the findings of 3 recent meta-analyses,3–5 further confirming a reported independent association between early-life antibiotics and greater weight. However, important questions remain: (1) Is there a causal relationship between early-life antibiotic use and future weight gain? (2) What is the clinical … Address correspondence to Antti Saari, MD, PhD, Department of Paediatrics, Kuopio University Hospital, PO Box 100, 70029 KYS, Finland. E-mail: antti.saari{at}kuh.fi

In Finland, growth monitoring is a fundamental part of preventive child health care, aiming at an early detection of childhood illnesses as well as weight gain or loss. However, evidence-based studies on growth monitoring are practically lacking. Updated growth curves must be representative of the monitored population. Screening of Turner syndrome and celiac disease with novel growth monitoring methods could facilitate early diagnosis. Electronic health records provide an alternative to develop an automated growth monitoring program, which was found to be distinctly better than the manually orientated one in primary care. Systematic growth monitoring seems to be beneficial, although true population- based evidence on effectiveness is scarce.

OBJECTIVE: Antibiotics have direct effects on the human intestinal microbiota, particularly in infancy. Antibacterial agents promote growth in farm animals by unknown mechanisms, but little is known about their effects on human weight gain. Our aim was to evaluate the impact of antibiotic exposure during infancy on weight and height in healthy Finnish children. METHODS: The population-based cohort comprised 6114 healthy boys and 5948 healthy girls having primary care weight and height measurements and drug purchase data from birth to 24 months. BMI and height, expressed as z-scores at the median age of 24 months (interquartile range 24 to 26 months), were compared between children exposed and unexposed to antibiotics using analysis of covariance with perinatal factors as covariates. RESULTS: Exposed children were on average heavier than unexposed children (adjusted BMI-for-age z-score difference in boys 0.13 SD [95% confidence interval 0.07 to 0.19, P < .001] and in girls 0.07 SD [0.01 to 0.13, P < .05]). The effect was most pronounced after exposure to macrolides before 6 months of age (boys 0.28 [0.11 to 0.46]; girls 0.23 [0.04 to 0.42]) or >1 exposure (boys 0.20 [0.10 to 0.30]; girls 0.13 [0.03 to 0.22]). CONCLUSIONS: Antibiotic exposure before 6 months of age, or repeatedly during infancy, was associated with increased body mass in healthy children. Such effects may play a role in the worldwide childhood obesity epidemic and highlight the importance of judicious use of antibiotics during infancy, favoring narrow-spectrum antibiotics.

Growth-monitoring programs have been a fundamental part of preventive child health care for more than a century.¹ Ideally, screens for abnormal growth aim to detect treatable illnesses before any other symptoms of the disease appear. Early diagnosis helps to minimize the impact of the underlying condition and optimize final adult height.^2,3 During growth screening, height and weight values should be compared with the pre-established cutoff values that define normal growth.⁴ Despite the long tradition of growth monitoring, evidence-based cutoffs for clinical pediatric practice are insufficiently explored and studies that aim to define such norms are scarce.^2-5