Statines en pr��vention primaire: comment d��cider avec le patient [Statins in primary prevention: how to share the decision?].

Long-term treatment of hypercholesterolemia with statins diminishes the risk of cardiovascular events. Statins are recommended in secondary prevention of cardiovascular disease. In the absence of preexisting cardiovascular disease, the decision to start a statin or not is most often made by the general practitioner and his patient. An interactive decision aid, developed by the Mayo Clinic, has just been translated in French and adapted to the Swiss epidemiology of cardiovascular risk factors, with the aim of promoting shared decision-making. This paper reviews the conditions and potential benefits of shared decision-making about statin therapy in primary prevention.

Prevention of vascular dysfunction and arterial hypertension in mice generated by assisted reproductive technologies by addition of melatonin to culture media.

Assisted reproductive technologies (ART) induce vascular dysfunction in humans and mice. In mice, ART-induced vascular dysfunction is related to epigenetic alteration of the endothelial nitric oxide synthase (eNOS) gene, resulting in decreased vascular eNOS expression and nitrite/nitrate synthesis. Melatonin is involved in epigenetic regulation, and its administration to sterile women improves the success rate of ART. We hypothesized that addition of melatonin to culture media may prevent ART-induced epigenetic and cardiovascular alterations in mice. We, therefore, assessed mesenteric-artery responses to acetylcholine and arterial blood pressure, together with DNA methylation of the eNOS gene promoter in vascular tissue and nitric oxide plasma concentration in 12-wk-old ART mice generated with and without addition of melatonin to culture media and in control mice. As expected, acetylcholine-induced mesenteric-artery dilation was impaired (P = 0.008 vs. control) and mean arterial blood pressure increased (109.5 �� 3.8 vs. 104.0 �� 4.7 mmHg, P = 0.002, ART vs. control) in ART compared with control mice. These alterations were associated with altered DNA methylation of the eNOS gene promoter (P < 0.001 vs. control) and decreased plasma nitric oxide concentration (10.1 �� 11.1 vs. 29.5 �� 8.0 &#956;M) (P < 0.001 ART vs. control). Addition of melatonin (10(-6) M) to culture media prevented eNOS dysmethylation (P = 0.005, vs. ART + vehicle), normalized nitric oxide plasma concentration (23.1 �� 14.6 &#956;M, P = 0.002 vs. ART + vehicle) and mesentery-artery responsiveness to acetylcholine (P < 0.008 vs. ART + vehicle), and prevented arterial hypertension (104.6 �� 3.4 mmHg, P < 0.003 vs. ART + vehicle). These findings provide proof of principle that modification of culture media prevents ART-induced vascular dysfunction. We speculate that this approach will also allow preventing ART-induced premature atherosclerosis in humans.

A Randomized, Placebo-controlled Trial of Preemptive Antifungal Therapy for the Prevention of Invasive Candidiasis Following Gastrointestinal Surgery for Intra-abdominal Infections.

BACKGROUND: Patients undergoing emergency gastrointestinal surgery for intra-abdominal infection are at risk of invasive candidiasis (IC) and candidates for preemptive antifungal therapy. METHODS: This exploratory, randomized, double-blind, placebo-controlled trial assessed a preemptive antifungal approach with micafungin (100 mg/d) in intensive care unit patients requiring surgery for intra-abdominal infection. Coprimary efficacy variables were the incidence of IC and the time from baseline to first IC in the full analysis set; an independent data review board confirmed IC. An exploratory biomarker analysis was performed using logistic regression. RESULTS: The full analysis set comprised 124 placebo- and 117 micafungin-treated patients. The incidence of IC was 8.9% for placebo and 11.1% for micafungin (difference, 2.24%; [95% confidence interval, -5.52 to 10.20]). There was no difference between the arms in median time to IC. The estimated odds ratio showed that patients with a positive (1,3)-&#946;-d-glucan (��DG) result were 3.66 (95% confidence interval, 1.01-13.29) times more likely to have confirmed IC than those with a negative result. CONCLUSIONS: This study was unable to provide evidence that preemptive administration of an echinocandin was effective in preventing IC in high-risk surgical intensive care unit patients with intra-abdominal infections. This may have been because the drug was administered too late to prevent IC coupled with an overall low number of IC events. It does provide some support for using ��DG to identify patients at high risk of IC. CLINICAL TRIALS REGISTRATION: NCT01122368.

Recommandations pour le traitement et la pr��vention du zona et des douleurs associ��es chez la personne ��g��e [Recommendations for treatment and prevention of herpes zoster and associated pain in aged adults].

Initiated within the first 72hours of the rash, prescribing antiviral drugs reduces both acute neuralgia (AN) and later complications and especially postherpetic neuralgia (PHN). But their analgesic as well as preventative effect on AN and PHN is modest. Combination with analgesic drugs is more often needed for pain management. However, the pharmacological management of pain, in the context of old patients' frailty, co-morbidities and often polypharmacy, must be carefully considered. Based on analyses of the evidences from the literature, this review presents the therapeutic options we have at one's disposal and proposes a stepwise management for both AN and PHN specifically designed for aged population.

Impact of Aldosterone Antagonists on Sudden Cardiac Death Prevention in Heart Failure and Post-Myocardial Infarction Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND AND OBJECTIVES: Sudden cardiac death (SCD) is a severe burden of modern medicine. Aldosterone antagonist is publicized as effective in reducing mortality in patients with heart failure (HF) or post myocardial infarction (MI). Our study aimed to assess the efficacy of AAs on mortality including SCD, hospitalization admission and several common adverse effects. METHODS: We searched Embase, PubMed, Web of Science, Cochrane library and clinicaltrial.gov for randomized controlled trials (RCTs) assigning AAs in patients with HF or post MI through May 2015. The comparator included standard medication or placebo, or both. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Event rates were compared using a random effects model. Prospective RCTs of AAs with durations of at least 8 weeks were selected if they included at least one of the following outcomes: SCD, all-cause/cardiovascular mortality, all-cause/cardiovascular hospitalization and common side effects (hyperkalemia, renal function degradation and gynecomastia). RESULTS: Data from 19,333 patients enrolled in 25 trials were included. In patients with HF, this treatment significantly reduced the risk of SCD by 19% (RR 0.81; 95% CI, 0.67-0.98; p = 0.03); all-cause mortality by 19% (RR 0.81; 95% CI, 0.74-0.88, p&lt;0.00001) and cardiovascular death by 21% (RR 0.79; 95% CI, 0.70-0.89, p&lt;0.00001). In patients with post-MI, the matching reduced risks were 20% (RR 0.80; 95% CI, 0.66-0.98; p = 0.03), 15% (RR 0.85; 95% CI, 0.76-0.95, p = 0.003) and 17% (RR 0.83; 95% CI, 0.74-0.94, p = 0.003), respectively. Concerning both subgroups, the relative risks respectively decreased by 19% (RR 0.81; 95% CI, 0.71-0.92; p = 0.002) for SCD, 18% (RR 0.82; 95% CI, 0.77-0.88, p &lt; 0.0001) for all-cause mortality and 20% (RR 0.80; 95% CI, 0.74-0.87, p &lt; 0.0001) for cardiovascular mortality in patients treated with AAs. As well, hospitalizations were significantly reduced, while common adverse effects were significantly increased. CONCLUSION: Aldosterone antagonists appear to be effective in reducing SCD and other mortality events, compared with placebo or standard medication in patients with HF and/or after a MI.

Is Switzerland doing enough regarding the prevention of syphilis, gonorrhea and chlamydia infections ?

Sexually transmitted infections are a major problem for medicine and for public health services worldwide. More than 30 sexually transmittable pathogenic micro-organisms are known, including bacteria, viruses, fungi, protozoa and ectoparasites. According to estimates from the World Health Organisation more than 333 million of bacterial sexually transmitted infections occur worldwide per year. Sexually transmitted infections, by their nature, affect individuals, within partnerships and larger sexual networks, and in turn populations. This report focuses on three bacterial sexually transmitted infections in Switzerland that are Chlamydia trachomatis, Neisseria gonorrhea and Treponema pallidum (syphilis) in Switzerland. The prevalence of these infections has been increasing alarmingly for a decade. All three infections can be asymptomatic and their diagnosis and treatment can therefore occur too late or worse not at all, even though treatments are available. This is an important problem as untreated sexually transmitted infections may cause complications such as ascending infections, infertility, ectopic pregnancies and serious long-term neurological sequels. The consequences of these infections should not be underestimated. They constitute a significant public health burden as well as serious financial burden. The increases in chlamydia, syphilis and gonorrhea infections have also been observed in many European countries. Countries, where rising numbers of sexually transmitted infections have been observed, have reacted in different ways. Some have developed clinical guidelines or implemented screening programs, while others are still in their observational phase. The aim of this m��moire is to assess whether Switzerland is doing enough regarding the prevention of chlamydial, syphilis and gonorrheal infections. After first describing the infections, surveillance systems of sexually transmitted infections are assessed, then the epidemiological trends of these three infections are described, and finally the prevention measures implemented in Switzerland to respond to the increasing number of infections are described. The reaction of the United Kingdom to the same problem is reported for comparison. [Author, p. 7]

Low-level laser therapy for the prevention of low salivary flow rate after radiotherapy and chemotherapy in patients with head and neck cancer

Abstract Objective: To determine whether low-level laser therapy can prevent salivary hypofunction after radiotherapy and chemotherapy in head and neck cancer patients. Materials and Methods: We evaluated 23 head and neck cancer patients, of whom 13 received laser therapy and 10 received clinical care only. An InGaAlP laser was used intra-orally (at 660 nm and 40 mW) at a mean dose of 10.0 J/cm2 and extra-orally (at 780 nm and 15 mW) at a mean dose of 3.7 J/cm2, three times per week, on alternate days. Stimulated and unstimulated sialometry tests were performed before the first radiotherapy and chemotherapy sessions (N0) and at 30 days after the end of treatment (N30). Results: At N30, the mean salivary flow rates were significantly higher among the laser therapy patients than among the patients who received clinical care only, in the stimulated and unstimulated sialometry tests (p = 0.0131 and p = 0.0143, respectively). Conclusion: Low-level laser therapy, administered concomitantly with radiotherapy and chemotherapy, appears to mitigate treatment-induced salivary hypofunction in patients with head and neck cancer.

Le contr��le glyc��mique mod��r�� est-il sans danger chez les patients adultes gri��vement br��l��s? = Is moderate glycemic control safe in major burns? : a 15 year cohort study

Introduction: L'hyperglyc��mie est un ph��nom��ne connu chez les patients gravement agress��s, et surtout chez ceux n��cessitant un s��jour aux soins intensifs, alors que l'hypoglyc��mie est une complication mena��ante. Des valeurs de glyc��mies anormales sont associ��es avec une mortalit�� et morbidit�� augment��es chez les patients de soins intensifs, y compris les grands br��l��s. Des glyc��mies jusqu'�� 15mmol/l ont longtemps ��t�� tol��r��es sans traitement. En 2001, une grande ��tude randomis��e a compl��tement chang�� les pratiques du contr��le glyc��mique aux soins intensifs. Van den Berghe et al. ont montr�� qu'un contr��le glyc��mique strict atteint au moyen d'une �� intensive insulin therapy �� (HT) visant une glyc��mie 4.1-6.0 mmol/l r��duisait la mortalit�� chez les patients chirurgicaux trait��s plus que 5. Par la suite plusieurs ��tudes contradictoires ont questionn�� la validit�� externe de l'��tude de Louvain: avec la publication de l'��tude �� NICE-SUGAR �� en 2009 enr��lant plus de 6000 patients cette hypoth��se a ��t�� r��fut��e, aboutissant �� un contr��le mod��r�� de la glyc��mie (6-8 mmol/l). Bien que plusieurs ��tudes sur le contr��le glyc��mique aient ��galement inclus quelques patients br��l��s, �� ce jour il n'y a pas de recommandation ferme concernant la gestion de la glyc��mie chez les patients br��l��s adultes. Le but de l'��tude ��tait d'��valuer la s��curit�� du protocole de contr��le de la glyc��mie qui avait ��t�� introduit aux soins intensifs adultes chez des patients grand br��l��s n��cessitant un traitement prolong�� aux soins intensifs. M��thodes : 11 s'agit d'une ��tude r��trospective uni-centrique sur des patients br��l��s admis aux soins intensifs du CHUV �� Lausanne entre de 2000 �� juin 2014. Crit��res d'inclusions : Age &gt;16 ans, br��lures n��cessitant un traitement aux soins intensifs &gt;10 jours. Crit��res d'exclusion : D��c��s ou transfert hors des soins intensifs &lt;10 jours. Les investigations ont ��t�� limit��es aux 21 premiers jours de l'hospitalisation aux soins intensifs. Variables : Variables d��mographiques, surface br��l��e (TBSA), scores de s��v��rit��, infections, dur��e d'intubation, dur��e du s��jour aux soins intensifs, mortalit��. Variables m��taboliques : Administration totale de glucides, ��nergie et insuline/2411, valeurs de glyc��mie art��rielle et CRP. Quatre p��riodes (P) ont ��t�� analys��es, correspondant �� l'��volution du protocole de contr��le de glyc��mie du service. P1: Avant son introduction (2000-2001) ; P2: Contr��le glyc��mie serr�� g��r�� par les m��decins (2002-2006) ; P3: Contr��le glyc��mie serr�� g��r�� par l��s infirmi��res (2007-2010); P4: Contr��le mod��r�� g��r�� par les infirmi��res (2011-2014). Les limites glyc��miques ont ��t�� d��finis de mani��re suivante: Hypoglyc��mie extr��me &lt;2.3mmol/l ; hypoglyc��mie mod��r�� &lt;4.0mmol/l ; hyperglyc��mie mod��r��e 8.1-10.0mmol/l ; hyperglyc��mie s��v��re &gt;10.0mmol/l. Toutes les valeurs de glyc��mies art��rielles ont ��t�� extraites depuis le syst��me informatis�� des soins intensifs (MetaVision ��). Statistiques: Wilcoxon rank test, Two- way Anova, Tuckey Kramer test, area under the curve (AUC), Spearman's test et odds ratio. STATA 12 1 ' StataCorp, College station, TX, USA and JPM V 10.1 (SAS Institute, Cary, NC, USA). R��sultats: Sur les 508 patients br��l��s admis durant la p��riode ��tudi��e, 229 patients correspondaient aux crit��res d'inclusion, ��g��s de 45��20ans (X��SD) et br��l��s sur 32��20% de la surface corporelle. Les scores de s��v��rit�� sont rest��s stables. Au total 28'690 glyc��mies art��rielles ont ��t�� analys��es. La valeur m��diane de glyc��mie est rest��e stable avec une diminution progressive de la variabilit�� intra-patient. Apr��s initiation du protocole, les valeurs normoglyc��miques ont augment�� de 34.7% �� 65.9% avec diminution des ��v��nements hypoglyc��miques (pas d'hypoglyc��mie extr��me en P4). Le nombre d'hyperglyc��mies s��v��res est rest�� stable durant les p��riodes 1 �� 3, avec une diminution en P4 (9.25%) : les doses d'insuline ont aussi diminu��. L'interpr��tation des r��sultats de P4 a ��t�� compliqu��e par une diminution concomitante des apports d'��nergie et de glucose (p&lt;0.0001). Conclusions: L'application du protocole destin�� aux patients de soins intensifs non br��l��s a am��lior�� le contr��le glyc��mique chez les patients adultes br��l��s, aboutissant �� une diminution significative de la variabilit�� des glyc��mies. Un contr��le mod��r�� de la glyc��mie peut ��tre appliqu�� en s��curit��, consid��rant le nombre tr��s faible d'hypoglyc��mies. La gestion du protocole par les infirmi��res s'av��re plus s��re qu'un contr��le par les m��decins, avec diminution des hypoglyc��mies. Cependant le nombre d'hyperglyc��mies reste trop ��lev��. L'hyperglyc��mie' n'est pas contr��lable uniquement par l'administration d'insuline, mais n��cessite ��galement une approche multifactorielle comprenant une optimisation de la nutrition adapt��e aux besoins ��nerg��tiques ��lev��s des grands br��l��s. Plus d'��tudes seront n��cessaire pour mieux comprendre la complexit�� du m��canisme de l'hyperglyc��mie chez le patient adulte br��l�� et pour en am��liorer le contr��le glyc��mique.

A topical microemulsion for the prevention of allergic rhinitis symptoms: results of a randomized, controlled, double-blind, parallel group, multicentre, multinational clinical trial (Nares study)

Background: Since barrier protection measures to avoid contact with allergens are being increasingly developed, we assessed the clinical efficacy and tolerability of a topical nasal microemulsion made of glycerol esters in patients with allergic rhinitis. Methods: Randomized, controlled, double-blind, parallel group, multicentre, multinational clinical trial in which adult patients with allergic rhinitis or rhinoconjunctivitis due to sensitization to birch, grass or olive tree pollens received treatment with topical microemulsion or placebo during the pollen seasons. Efficacy variables included scores in the mini-RQLQ questionnaire, number and severity of nasal, ocular and lung signs and symptoms, need for symptomatic medications and patients" satisfaction with treatment. Adverse events were also recorded. Results: Demographic characteristics were homogeneous between groups and mini-RQLQ scores did not differ significantly at baseline (visit 1). From symptoms recorded in the diary cards, the ME group showed statistically significant better scores for nasal congestion (0.72 vs. 1.01; p���=���0.017) and mean total nasal symptoms (0.7 vs. 0.9; p���=���0.045). At visit 2 (pollen season), lower values were observed in the mini-RQLQ in the ME group, although there were no statistically significant differences between groups in both full analysis set (FAS) and patients completing treatment (PPS) populations. The results obtained in the nasal symptoms domain of the mini-RQLQ at visit 2 showed the highest difference (���0.43; 95% CI: -0.88 to 0.02) for the ME group in the FAS population. The topical microemulsion was safe and well tolerated and no major discomforts were observed. Satisfaction rating with the treatment was similar between the groups. Conclusions: The topical application of the microemulsion is a feasible and safe therapy in the prevention of allergic symptoms, particularly nasal congestion.

Cumulative Costs of Caries Prevention and Treatment in Children - with Special Reference to Work Division and Cohort Effect

<b>Lapsen karieshoidon kustannuskertym��n muutokset ja karieshoidon toimintak��yt��nt��jen yhteys kustannuksiin</b> Tutkimuksen tavoitteena oli mitata terveyskeskuksessa hoidettavien lasten karieshoidon kumulatiivisia kustannuksia ja verrata niit�� kahden erilaisen toimintatavan v��lill��. Lis��ksi tarkasteltiin lasten hampaiden terveytt��. Tutkimus tehtiin julkisen palvelutuottajan n��k��kulmasta. Tutkimusaineisto ker��ttiin Kemin ja Tornion terveyskeskusten suun terveydenhuollon potilaskertomuksista. Kemin kohortit 1980, 1983 ja 1986 (n = 600) ja Tornion kohortit 1980 ja 1992 (n = 400) edustivat perinteist�� ja Kemin kohortit 1989, 1992 ja 1995 (n = 600) uutta toimintatapaa ty��njaon ja ehk��isyn ajoituksen suhteen. Kohortteja ja kaupunkeja verrattiin hampaiden terveyden (dmft/DMFT = 0 ja dmft ja DMFT keskiarvot 5 ja 12 vuoden i��ss��) ja voimavarojen k��yt��n suhteen. Panosk��ytt�� johdettiin k��yntim����rien avulla laskennallisen ty��ajan kautta. Kustannuskertym��t muodostettiin k��ytt��m��ll�� henkil��st��menoista laskettuja suorittajakohtaisia yksikk��kustannuksia. Panosk��yt��n ja yksikk��kustannusten kautta muodostettiin kustannuskertym��t. Kustannusten ja terveysvaikutusten suhteita arvioitiin kustannus-vaikuttavuusanalyysiss��. Suuhygienistien ty��panosta hy��dynt��v��ll�� varhaisen ehk��isyn toimintamallilla saavutettiin v��h��isemmin kustannuksin alle koului��ss�� parempi ja koului��ss�� yht�� hyv�� hammasterveys kuin perinteisell��, enemm��n hammasl����k��rien ty��panokseen perustuvalla tavalla. Karieksen hoitoon liittyvien k��yntien m����r�� oli nuorimmissa syntym��vuosikohorteissa pienempi kuin vanhimmissa kohorteissa. K��ynnit hammasl����k��riss�� v��heniv��t eniten. Toimintatavalla oli merkitt��v�� vaikutus lapsen karieshoidon kokonaiskustannuksiin. Herkkyysanalyysin mukaan karieshoidon kustannukset olivat ty��njakoa hy��dynt��m��ll�� kolmanneksen pienemm��t, kuin jos hoidon suorittajana olisi ollut ainoastaan hammasl����k��ri-hoitaja ty��pari. Lasten karieshoidon kustannusvaikuttavuus kohentui molemmissa terveyskeskuksissa nuoremmissa kohorteissa vanhempiin verrattuna. Suun terveydenhuollon potilaskertomuksia olisi hy��dynnett��v�� toiminnan kehitt��misess��. Varhaisen ehk��isyn avulla voitaisiin kaikkien suun terveydenhuollon ammattihenkil��iden ty��panos kohdentaa kustannustehokkaasti.

Childhood Overweight - Predictors, Consequences and Prevention

Childhood overweight has become more prevalent during the past three decades. The aim of the present study was to examine possible predictors of childhood overweight and to evaluate the effect of individualised, biannual dietary and lifestyle counselling, with onset in infancy and primary aim at decreasing serum LDLcholesterol, on the development of overweight and related comorbidities. The study was part of the Special Turku coronary Risk factor Intervention Project (STRIP), in which 7-month-old children were randomised into an intervention group (N=540) or to a control group (N=522). The children in the control group were followed up along with the intervention group but they did not receive the individualised counselling. At the age of 15 years, 11.9 % of girls and 13.7 % of boys were overweight. The most important predictors of overweight at age 15 years were paternal weight status at the child���s age 7 months, rapid weight gain during the first two years of life, and early adiposity rebound. Leptin, a protein secreted by adipocytes, did not predict the development of overweight. Homozygosity for the overweight-associated FTO gene variant was associated with increased BMI and risk of overweight in children older than 7 years of age. The intervention given in the STRIP trial was not intense enough to overcome the effect of the FTO genotype. Although the intervention given in the STRIP trial had no significant effect on the proportion of overweight girls and boys, it did reduce the number and clustering of overweight-related cardiometabolic risk factors. This study showed that parental weight status, rapid weight gain early in life, and having two risk alleles in the FTO gene are strongly associated with overweight in adolescence. Biannual dietary and lifestyle counselling is not intense enough to prevent overweight but it has beneficial effects on the overweight-related cardiometabolic risk.

TCDI vs TCD for stroke risk prevention in children with sickle cell anemia: a cross-sectional study

Children with sickle cell anemia (SCA) are at increased risk of stroke. Elevated blood-flow velocities in the middle cerebral artery detected by Transcranial Doppler (TCD) are a good predictor of stroke risk in these children. Velocities obtained by TCD are measured by using a specific parameter, the time-averaged mean of the maximum velocity (TAMM). Children with TAMM velocities ���200 cm/sec are at high risk of stroke, and transfusions as primary prevention might be done. Transcranial Doppler-imaging (TCDI) is now widely available and it allows the visualization of intracranial vessels.Few studies have compared the TAMM in TCD and TCDI, and no studies have established a cutoff point for TAMM in TCDI equivalent to the STOP criteria of ���normal���, ���conditional��� and ���abnormal���, which could predict a high risk of stroke in children with SCAObjectives: To compare the TAMM velocity obtained by TCDI with the TAMM velocity obtained with TCD in the middle cerebral artery, and to determine a cutoff point for TAMM in TCDI that could predict a high risk of stroke in children with SCAMethods: This study is a cross-sectional study of a diagnostic test. 78 children with sickle cell anemia between 2 to 16 years will be evaluated with both TCD and TCDI in order to determinate the TAMM with the two devices. Velocities obtained with both Doppler techniques will be compared using an intraclass correlation coefficient

Dental Health in Primary Teeth after Prevention of Mother-Child Transmission of Mutans Streptococci. A Historical Cohort Study on Restorative Visits and Maternal Prevention Costs

<b>Mutansstreptokokkitartunnan ehk��isemisen pitk��aikaisvaikutukset maitohampaiden terveyteen. Kohorttitutkimus korjaavan hoidon m����r��st�� ja kariesehk��isyn kustannuksista. </b> Tutkimuksen tarkoituksena oli selvitt���� varhaisen mutansstreptokokki (MS)-kolonisaation ehk��isyn pitk��aikaisvaikutuksia korkean kariesriskin omaavien lasten maitohampaistossa sek�� tarkastella MS-tartunnan est��misen kustannuksia. Tiedot lasten hampaiden terveydest�� ja hammashoitotoimenpiteist�� syntym��st�� 10-vuotiaaksi sek�� ��iteihin kohdistuneen kariesehk��isyn kustannuksista ker��ttiin Ylivieskan terveyskeskuksen asiakirjoista. Tutkimuksessa oli mukana yhteens�� 507 lasta, heist�� 148 oli osallistunut aikaisempaan Ylivieskan ��iti-lapsitutkimukseen, jossa verrattiin ��itien k��ytt��m��n ksylitolipurukumin ja ��idille tehtyjen fluori- tai klooriheksidiinilakkausten vaikutusta pikkulasten hampaiden terveyteen. Maitohammaskariesta esiintyi 10-vuotiaaksi asti merkitsev��sti v��hemm��n lapsilla, jotka eiv��t olleet saaneet MS-tartuntaa alle 2-vuotiaana, heid��n maitohampaansa s��ilyiv��t 3,4 vuotta kauemmin t��ysin ehjin�� (p<0.001) ja he tarvitsivat v��hemm��n maitohampaiden korjaavaa hoitoa (p=0.005) kuin lapset, joiden hampaisto oli kolonisoitunut MS-bakteerilla jo 2-vuotiaana. Koska ksylitoliryhm��n lasten MS-kolonisaatio oli v��h��isint��, heid��n maitohampaissaan oli v��hemm��n kariesta ja korjaavan hoidon tarvetta kuin kahden muun korkeariskisen ryhm��n lapsilla. ��itien k��ytt��m��n ksylitolipurukumin kustannukset olivat yhteens�� 116 euroa ja lapsen maitohampaiden s��ilyminen t��ysin ehjin�� vuoden pidemp����n maksoi 37 euroa. Kun MS-tartunta oli saatu estetty��, korkean kariesriskin omaavien lasten hampaiden terveys oli samalla tasolla kuin keskim����rin koko ik��kohortilla. Lapsen maitohampaat s��ilyv��t tervein�� pidemp����n ja korjaavan hoidon tarve v��henee, kun MS-kolonisaatio alle 2-vuotiaana saadaan estetty��. Lapsen MS-kolonisaatio v��henee merkitsev��sti, kun ��iti k��ytt���� ksylitolipurukumia lapsen ollessa 0-2 vuoden ik��inen, siten pikkulapsen ��idin s����nn��llinen ksylitolipurukumin k��ytt�� saattaa olla julkisen tereydenhuollon kannalta tarkoituksenmukainenterveytt�� edist��v�� menetelm��.