Maternal Fecal Microbiota Transplantation in Cesarean-Born Infants Rapidly Restores Normal Gut Microbial Development: A Proof-of-Concept Study.

Infants born by vaginal delivery are colonized with maternal fecal microbes. Cesarean section (CS) birth disturbs mother-to-neonate transmission. In this study (NCT03568734), we evaluated whether disturbed intestinal microbiota development could be restored in term CS-born infants by postnatal, orally delivered fecal microbiota transplantation (FMT). We recruited 17 mothers, of whom seven were selected after careful screening. Their infants received a diluted fecal sample from their own mothers, taken 3 weeks prior to delivery. All seven infants had an uneventful clinical course during the 3-month follow-up and showed no adverse effects. The temporal development of the fecal microbiota composition of FMT-treated CS-born infants no longer resembled that of untreated CS-born infants but showed significant similarity to that of vaginally born infants. This proof-of-concept study demonstrates that the intestinal microbiota of CS-born infants can be restored postnatally by maternal FMT. However, this should only be done after careful clinical and microbiological screening.

Questioning the fetal microbiome illustrates pitfalls of low-biomass microbial studies.

Whether the human fetus and the prenatal intrauterine environment (amniotic fluid and placenta) are stably colonized by microbial communities in a healthy pregnancy remains a subject of debate. Here we evaluate recent studies that characterized microbial populations in human fetuses from the perspectives of reproductive biology, microbial ecology, bioinformatics, immunology, clinical microbiology and gnotobiology, and assess possible mechanisms by which the fetus might interact with microorganisms. Our analysis indicates that the detected microbial signals are likely the result of contamination during the clinical procedures to obtain fetal samples or during DNA extraction and DNA sequencing. Furthermore, the existence of live and replicating microbial populations in healthy fetal tissues is not compatible with fundamental concepts of immunology, clinical microbiology and the derivation of germ-free mammals. These conclusions are important to our understanding of human immune development and illustrate common pitfalls in the microbial analyses of many other low-biomass environments. The pursuit of a fetal microbiome serves as a cautionary example of the challenges of sequence-based microbiome studies when biomass is low or absent, and emphasizes the need for a trans-disciplinary approach that goes beyond contamination controls by also incorporating biological, ecological and mechanistic concepts.

Human milk oligosaccharide 2'-fucosyllactose protects against high-fat diet-induced obesity by changing intestinal mucus production, composition and degradation linked to changes in gut microbiota and faecal proteome profiles in mice.

OBJECTIVE: To decipher the mechanisms by which the major human milk oligosaccharide (HMO), 2'-fucosyllactose (2'FL), can affect body weight and fat mass gain on high-fat diet (HFD) feeding in mice. We wanted to elucidate whether 2'FL metabolic effects are linked with changes in intestinal mucus production and secretion, mucin glycosylation and degradation, as well as with the modulation of the gut microbiota, faecal proteome and endocannabinoid (eCB) system. RESULTS: 2'FL supplementation reduced HFD-induced obesity and glucose intolerance. These effects were accompanied by several changes in the intestinal mucus layer, including mucus production and composition, and gene expression of secreted and transmembrane mucins, glycosyltransferases and genes involved in mucus secretion. In addition, 2'FL increased bacterial glycosyl hydrolases involved in mucin glycan degradation. These changes were linked to a significant increase and predominance of bacterial genera Akkermansia and Bacteroides, different faecal proteome profile (with an upregulation of proteins involved in carbon, amino acids and fat metabolism and a downregulation of proteins involved in protein digestion and absorption) and, finally, to changes in the eCB system. We also investigated faecal proteomes from lean and obese humans and found similar changes observed comparing lean and obese mice. CONCLUSION: Our results show that the HMO 2'FL influences host metabolism by modulating the mucus layer, gut microbiota and eCB system and propose the mucus layer as a new potential target for the prevention of obesity and related disorders.

Bowel function in a prospective cohort of 1052 healthy term infants up to 4 months of age.

The purpose of this study is to describe the defecation pattern of healthy infants up to 17 weeks of age. We included 1052 healthy term infants from the prospective HELMi cohort (NCT03996304). Parents filled in recurring online questionnaires on feeding, gastrointestinal function, and crying weekly for the first 17 weeks of life. Defecation frequency was highest at the age of 3 weeks (a median of 4 times/day, interquartile range (IQR) 2.9-5). At each time point, the median defecation frequency of breastfed infants was higher than that of infants receiving formula (e.g., at week 17 a median of 2 times/day, IQR 0.9-3.6, and a median of 1.1, IQR 0.6-1.4, respectively). The dominant color of the stool was most often yellow or light brown. Nearly black stools were reported in the first week of life in 3.4%. Nearly half (47.4%) of the infants had green stool color dominating for at least 1 week, with comparable frequency among breastfed (47.7%) and formula-fed (45.2%) infants. Green stools were associated with a higher defecation frequency (linear mixed-effect model p < 0.0001). Occasional blood in stool was reported in 9.3% and recurrent blood in 5.2% of the infants with no difference in stool consistency. Hard stools were rare (≤ 1%).     Conclusion: This study enlightens the spectrum of defecation patterns in healthy term infants during the first 17 weeks of life. A better understanding of bowel function helps healthcare professionals distinguish normal from abnormal when addressing defecation, the color of stools, and the type of feeding. What is Known: • Breastfed infants have more frequent and more yellow-colored stools than formula-fed infants. • Stools with green color are often suggested by the parents or even by medical professionals to indicate disease or discomfort in early life. What is New: • Nearly half of the healthy term infants had green stool dominating for at least one week during the first 17 weeks and occasional blood was reported in almost 10% of the infants during this period. • Data on normal variation in bowel function and stool may serve primary health care professionals when educating the families and caretakers of infants.

Early-life environment and the risk of eczema at 2 years-Meta-analyses of six Finnish birth cohorts.

BACKGROUND: Urban-related nature exposures are suggested to contribute to the rising prevalence of allergic diseases despite little supporting evidence. Our aim was to evaluate the impact of 12 land cover classes and two greenness indices around homes at birth on the development of doctor-diagnosed eczema by the age of 2 years, and the influence of birth season. METHODS: Data from 5085 children were obtained from six Finnish birth cohorts. Exposures were provided by the Coordination of Information on the Environment in three predefined grid sizes. Adjusted logistic regression was run in each cohort, and pooled effects across cohorts were estimated using fixed or random effect meta-analyses. RESULTS: In meta-analyses, neither greenness indices (NDVI or VCDI, 250 m × 250 m grid size) nor residential or industrial/commercial areas were associated with eczema by age of 2 years. Coniferous forest (adjusted odds ratio 1.19; 95% confidence interval 1.01-1.39 for the middle and 1.16; 0.98-1.28 for the highest vs. lowest tertile) and mixed forest (1.21; 1.02-1.42 middle vs. lowest tertile) were associated with elevated eczema risk. Higher coverage with agricultural areas tended to associate with elevated eczema risk (1.20; 0.98-1.48 vs. none). In contrast, transport infrastructure was inversely associated with eczema (0.77; 0.65-0.91 highest vs. lowest tertile). CONCLUSION: Greenness around the home during early childhood does not seem to protect from eczema. In contrast, nearby coniferous and mixed forests may increase eczema risk, as well as being born in spring close to forest or high-green areas.

Cross-sectional study of the proportion of antibiotic use during childbirth in full-term deliveries in Finland.

PURPOSE: In developed countries, data on the frequency of antibiotics given to mothers during childbirth are limited beyond the overall effect of all various prophylactic indications. Also, data on the impact of such antibiotics to the well-being of term babies are scarce. We aimed to characterize the frequency of antibiotic use during childbirth of term pregnancy. Secondly, we assessed whether the use of antibiotics was associated with any symptoms in infants. METHODS: This was a cross-sectional study of 1019 term deliveries of women participating in the prospective Health and Early Life Microbiota (HELMi) birth cohort study between March 2016 and March 2018 in the capital region of Finland. The data on antibiotic use were collected from the hospital records. RESULTS: In total, 37% of the mothers received antibiotics during childbirth and 100% in Caesarean Sects. (17% of the deliveries). Less than 5% of antibiotics were non-prophylactic. In vaginal deliveries, the most common indication (18%) was prophylaxis for Group B Streptococcus. The most frequently used antibiotics were cefuroxime (22%) and benzylpenicillin (15%), and 56% received only one dose. In infants exposed to antibiotics during delivery, defecation frequency was higher during the first months (p-value < 0.0001- 0.0145), and weight gain was higher at the age of three months (p-value 0.0371). CONCLUSION: More than every third new-born in a developed country is exposed to antibiotics during birth. Our findings support the hypothesis that maternal antibiotics given during birth have an impact on the well-being of the infants. These findings should inform current policies for prophylactic antibiotics in childbirth.

Incidence changes in risk factors associated with the decreasing number of birth-related clavicle fractures in Finland: A nationwide retrospective birth cohort from 2004 to 2017.

BACKGROUND: A clavicle fracture is one of the most common birth injuries. The objective of this study was to examine whether the decreased incidence of birth-related clavicle fractures in Finland is because of temporal changes in their predisposing factors. METHODS: For this nationwide population-based study, we used the Finnish Medical Birth Register and the Care Register for Health Care databases. The study population included all singleton, live-born newborn born spontaneously or by vacuum-assisted delivery, in cephalic presentation ≥37+0 weeks of gestation. The incidences of clavicle fractures, pregnancy characteristics, and risk assessments for fracture were calculated and compared between two time periods: 2004-2010 and 2011-2017. RESULTS: A total of 629 457 newborn were born vaginally between 2004 and 2017. The clavicle fracture incidence decreased from 17.6/1000 to 6.2/1000 live births. Shoulder dystocia, diabetes, and birthweight ≥4000 g were the strongest predisposing factors. The incidence of birthweight ≥4000 g decreased, meanwhile type 1 diabetes and shoulder dystocia remained stable and gestational diabetes, type 2 diabetes, and maternal obesity increased in the later study period. The incidence of clavicle fractures without known predisposing factors declined. Simultaneously, the cesarean birth rate remained stable (13.2%-13.1%), although the rate of vacuum-assisted deliveries increased (8.5%-9.5%). DISCUSSION: The incidence of clavicle fractures decreased, even though the incidence of most risk factors remained stable or increased, and the cesarean birth rate remained stable. This decline may be related to the reduction of fracture incidence among deliveries without known risk factors, and the decrease in birthweight ≥4000 g.

Public opinions and attitudes toward a state monopoly: a study of the finnish gambling system.

BACKGROUND: Gambling regulated through a state monopoly is often justified for reasons of public health, that is, that monopolies are a more effective means of reducing potential harm. This focus on harm prevention has increased in recent years, particularly as a result of pressures arising from the growth of online gambling and of legislation designed to promote competition. While prior works have examined the role of stakeholders in influencing policy decisions and in public discussions of the monopoly systems, attention has been focused on those with direct financial interests; the opinions of the public have largely been absent from these discussions. In 2017 Finland restructured its monopoly order to improve efficacy of addressing gambling related harms; this restructuring offers a valuable insight into public perceptions of and attitudes toward the suitability of the Finnish system to address gambling-related harm. METHODS: This work uses Structural Equation Modelling and compares attitudes toward the Finnish system between 2015 (pre-restructuring) and 2019 (post-restructuring). RESULTS: Overall public opinion of the Finnish system as being suitable for addressing gambling harms declined between 2015 and 2019, despite the restructuring. Several predictors of attitudes were identified, however, the majority had small effect sizes, while the model explained little variance. CONCLUSION: This work concludes that existing approaches to examining public opinions of gambling regulation should be amended to include additional predictors. Furthermore, it is likely that context-specific predictors should be included in models, in order to reflect the socio-cultural history of the population being investigated. Such predictors should be determined in respect to the population of interest but, for example, could include items measuring trust in authority, political orientation, cultural acceptance of gambling, or religious affiliation.

Birth injury in breech delivery: a nationwide population-based cohort study in Finland.

PURPOSE: Previous studies have examined the optimal mode of breech delivery extensively, but there is a scarcity of publications focusing on the birth injuries of neonates born in breech presentation. This study aimed to examine birth injury in breech deliveries. METHODS: In this retrospective register-based nationwide cohort study, data on birth injuries in vaginal breech deliveries with singleton live births were compared to cesarean section with breech presentation and cephalic vaginal delivery between 2004 and 2017 in Finland. The data were retrieved from the National Medical Birth Register. Primary outcome variables were severe and mild birth injury. Incidences of birth injuries in different gestational ages and birthweights were calculated in different modes of delivery. Crude odds ratios of risk factors for severe birth injury were analyzed. RESULTS: In vaginal breech delivery (n = 4344), there were 0.8% of neonates with severe birth injury and 1.5% of neonates with mild birth injury compared to 0.06% and 0.2% in breech cesarean section (n = 16,979) and 0.3% and 1.9% in cephalic vaginal delivery (n = 629,182). Brachial plexus palsy was the most common type of injury in vaginal breech delivery. Increasing gestational age and birthweight had a stronger effect on the risk for injury among cephalic vaginal deliveries than among vaginal breech deliveries. CONCLUSION: Birth injuries were rare in vaginal breech deliveries. The incidence of severe birth injury was two times higher in vaginal breech delivery compared to cephalic vaginal delivery. Brachial plexus palsy was the most common type of injury in vaginal breech delivery.

Gambling Motives and Offshore Gambling: A Finnish Population Study.

The rise of online gambling has drawn attention towards offshore gambling. Currently there is lack of evidence on reasons and motivations to gamble on offshore gambling sites. This study investigated the general gambling motives of onshore and offshore gamblers, and the reasons to gamble on offshore gambling sites. The study used binary logistic regression model to analyze the data from Finnish Gambling 2019 population survey including adult past-year online gamblers (n = 1,422). The validated measure for problem gambling severity (PGSI, Problem Gambling Severity Index) was used. Furthermore, data-driven qualitative analysis was used to form categories for the reasons to gamble on offshore gambling sites. Offshore gambling was more common among men and younger age groups than among women or older age groups. Offshore gamblers gambled less often for money or worthy causes than onshore gamblers. Furthermore, offshore gamblers had more different types of motives to gamble, they gambled more frequently and had higher problem gambling severity scores (PGSI) than onshore gamblers. Finally, the most common reasons to gamble offshore were: (1) larger game supply and game features, (2) benefits, bonuses, and the usability of the website, and (3) inner motivation. Offshore gambling is characterized with intensity and diversity of gambling behavior and motives, and it poses a risk especially for young men.

Female reproductive tract microbiota and recurrent pregnancy loss: a nested case-control study.

RESEARCH QUESTION: Is the composition of the endometrial or vaginal microbiota associated with recurrent pregnancy loss (RPL)? DESIGN: Endometrial and vaginal samples were collected from 47 women with two or more consecutive pregnancy losses and 39 healthy control women without a history of pregnancy loss, between March 2018 and December 2020 at Helsinki University Hospital, Helsinki, Finland. The compositions of the endometrial and vaginal microbiota, analysed using 16S rRNA gene amplicon sequencing, were compared between the RPL and control women, and between individual vaginal and endometrial samples. The mycobiota composition was analysed using internal transcribed spacer 1 amplicon sequencing for a descriptive summary. The models were adjusted for body mass index, age and parity. False discovery rate-corrected P-values (q-values) were used to define nominal statistical significance at q < 0.05. RESULTS: Lactobacillus crispatus was less abundant in the endometrial samples of women with RPL compared with controls (mean relative abundance 17.2% versus 45.6%, q = 0.04). Gardnerella vaginalis was more abundant in the RPL group than in controls in both endometrial (12.4% versus 5.8%, q < 0.001) and vaginal (8.7% versus 5.7%, q = 0.002) samples. The individual vaginal and endometrial microbial compositions correlated strongly (R = 0.85, P < 0.001). Fungi were detected in 22% of the endometrial and 36% of the vaginal samples. CONCLUSIONS: Dysbiosis of the reproductive tract microbiota is associated with RPL and may represent a novel risk factor for pregnancy losses.

Transplantation of maternal intestinal flora to the newborn after elective cesarean section (SECFLOR): study protocol for a double blinded randomized controlled trial.

BACKGROUND: A complication of elective cesarean section (CS) delivery is its interference with the normal intestinal colonization of the infant, affecting the immune and metabolic signaling in early life- a process that has been associated with long-term morbidity, such as allergy and diabetes. We evaluate, in CS-delivered infants, whether the normal intestinal microbiome and its early life development can be restored by immediate postnatal transfer of maternal fecal microbiota (FMT) to the newborn, and how this procedure influences the maturation of the immune system. METHODS: Sixty healthy mothers with planned elective CS are recruited and screened thoroughly for infections. A maternal fecal sample is taken prior to delivery and processed according to a transplantation protocol. After double blinded randomization, half of the newborns will receive a diluted aliquot of their own mother's stool orally administered in breast milk during the first feeding while the other half will be similarly treated with a placebo. The infants are clinically followed, and fecal samples are gathered weekly until the age of 4 weeks, then at the ages of 8 weeks, 3, 6, 12 and 24 months. The parents fill in questionnaires until the age of 24 months. Blood samples are taken at the age of 2-3 days and 3, 6, 12 and 24 months to assess development of major immune cell populations and plasma proteins throughout the first years of life. DISCUSSION: This is the first study to assess long-time effects on the intestinal microbiome and the development of immune system of a maternal fecal transplant given to term infants born by CS. TRIAL REGISTRATION: ClinicalTrials.gov NCT04173208 , registration date 21.11.2019.

Socio-Demographic Factors, Gambling Behaviour, and the Level of Gambling Expenditure: A Population-Based Study.

The aim of this study was to examine the relationship between socio-demographic factors, gambling behaviour, and the level of gambling expenditure. The data were drawn from the population-based Gambling Harms Survey 2016 and 2017 conducted in Finland. The data were linked to register-based variables. Past-year gamblers were included (Wave 1; n = 5 805, both Waves; n = 2 165). The study showed that of the 4.2 % of gamblers that produced 50.0 % of the total GE in 2016, 33.1 % of the GE was produced by those with a gambling problem and 43.3 % by those with at-risk gambling pattern. Compared to gamblers in the lowest GE group, those in the highest GE group were more likely to be men, aged 25 or older, with upper secondary education, have a high income, be on disability pension or sickness allowance, be frequent gamblers, gambling at least six game types, and showing at-risk and problem gambling patterns. Cumulative weekly GE by income tertiles remained fairly stable between the years. The results suggest that GE is highly concentrated. Among the small group of high-intensity consumers, the majority of the revenue comes from at-risk and problem gambling. Participants in the low GE group differ from those in the intermediate and high GE groups in terms of socio-demographics and gambling behaviour.

Socio-Demographics, Gambling Participation, Gambling Settings, and Addictive Behaviors Associated with Gambling Modes: A Population-Based Study.

Online and land-based gambling differ in terms of participation and harms. Multimode gambling has also been distinguished as a separate mode. The current study uses the Finnish Gambling 2019 population study sample of 18-74-year-old past-year gamblers (N = 3,077) to evaluate how these gambling modes differ in terms of socio-demographics, gambling participation, gambling settings, and addictive behaviors. We used land-based gambling as the reference group in a multinomial regression model. Male gender (OR 1.48), age between 18 and 54 (OR 1.88), and high income (OR 1.87) were associated with online gambling. The odds of online gambling were higher among those who gambled at least monthly (OR 1.34) and among those with the highest gambling spending (OR 3.62). Younger age (OR 2.31), high income (OR 1.51), gambling at least four game types (OR 2.96), spending the most money on gambling (OR 4.56), and gambling in at least three gambling settings were associated with multimode gambling. Socio-demographics and gambling participation were indicators of gambling modes. Online gambling was more intensive while multimode gambling was more frequent and versatile than land-based gambling. However, this was not reflected as increased addictive behaviors, probably due to the harmful nature of Finnish land-based gambling.

Social disadvantage and gambling severity: a population-based study with register-linkage.

BACKGROUND: Studies have found an association between problem gambling and poverty. However, there is relatively little research on social inequalities and problem gambling using population representative data. METHODS: A population-representative self-report web-based and postal survey with register-based linkage was conducted in the three geographical areas of Finland. Participants (n = 7186, aged 18 or older) were randomly selected from the population register. Sociodemographic factors and social welfare benefits were studied among gambling groups and their statistical difference were examined by χ2 test. Seven logistic regression models were calculated, where unemployment, social security benefits and low income were treated as dependent variables and where sex, age, family structure and education were controlled as covariates. The results were presented as odds ratios (OR) with 95% confidence intervals (CIs). RESULTS: Problem and at-risk gambling (ARG) was more common among people who were unemployed [PG: χ2=6.4 (1), P < 0.01, ARG: χ2=12.4 (1), P < 0.001] or had received social security benefits [PG: χ2=41.6 (1), P < 0.001, ARG: χ2=22.9 (1), P < 0.001]. The OR for problem gambling was high as 5.6 (CI: 3.22-9.61) among respondents who had received social assistance even when covariates were taking into count. Almost a third of those experiencing problem or at-risk gambling received at least one form of social security benefit. CONCLUSIONS: The most important task of gambling policy should be reducing gambling-related harms and diminishing social inequality. However, even in government organized system where gambling profits are used for common good, profits come from the most socially disadvantaged people thereby exacerbating inequality.

Antibiotics in early life associate with specific gut microbiota signatures in a prospective longitudinal infant cohort.

BACKGROUND: The effects of antibiotics on infant gut microbiota are unclear. We hypothesized that the use of common antibiotics results in long-term aberration in gut microbiota. METHODS: Antibiotic-naive infants were prospectively recruited when hospitalized because of a respiratory syncytial virus infection. Composition of fecal microbiota was compared between those receiving antibiotics during follow-up (prescribed at clinicians' discretion because of complications such as otitis media) and those with no antibiotic exposure. Fecal sampling started on day 1, then continued at 2-day intervals during the hospital stay, and at 1, 3 and 6 months at home. RESULTS: One hundred and sixty-three fecal samples from 40 patients (median age 2.3 months at baseline; 22 exposed to antibiotics) were available for microbiota analyses. A single course of amoxicillin or macrolide resulted in aberration of infant microbiota characterized by variation in the abundance of bifidobacteria, enterobacteria and clostridia, lasting for several months. Recovery from the antibiotics was associated with an increase in clostridia. Occasionally, antibiotic use resulted in microbiota profiles associated with inflammatory conditions. CONCLUSIONS: Antibiotic use in infants modifies especially bifidobacterial levels. Further studies are warranted whether administration of bifidobacteria will provide health benefits by normalizing the microbiota in infants receiving antibiotics.

The incidence of birth injuries decreased in Finland between 1997 and 2017: A nationwide register study.

AIM: Birth injuries are rare complications that can have a significant impact on neonates and their families. This population-based study describes the rates and trends of all birth injuries in Finland over a 21-year period. METHODS: The study is based on a national Medical Birth Register that includes all live-born neonates of more than 22 gestational weeks or 500 g who were born in Finland between 1997 and 2017. The ICD-10 codes of the birth injuries were obtained from the Finnish Medical Birth Register and the Care Register for Health Care. The incidence of birth injury, changes over time and incidence at different gestational ages were determined. RESULTS: A total of 28 551 birth injuries were diagnosed, and the total incidence decreased from 34.0 to 16.6 per 1000 live births. The incidence of clavicle fracture, cephalohaematoma, and Erb paralysis decreased while the incidence of chignon and epicranial subaponeurotic haemorrhage increased. CONCLUSION: The incidence of birth injury halved during the 20-year study period. This was mainly due to a decrease in the number of clavicle fractures. The incidence of birth injury increased with gestational age, and most injuries occurred after 37 weeks of gestation.

The Winners and the Losers: Tax Incidence of Gambling in Finland.

Gambling markets have grown rapidly for the last few decades. As a result, gambling is also a very important and common source of tax income for many governments these days. This raises a question about the overall fairness of the gambling taxation systems. In this paper, we aim to study the tax incidence of gambling in Finland. First, we analyse who are the expected payers of the gambling taxes and second, who are expected to be the receivers of the gambling-tax based contributions. In the first part of the study, we analyse the demographic incidence of gambling taxation by using the Finnish gambling 2015 population survey combined with registry based variables. Our data contains 3776 individuals. In the second part of the study, we use data of county level gambling-taxation based contributions to different organisations to analyse how the gambling expenditures are distributed back to citizens in a form of public spending. This study shows that different socio-demographic factors have diverse association with the decisions whether or how much to gamble. The results also suggest that more disadvantaged, i.e. lower income, less educated and rural area living, individuals are expected to be the "losers" of the Finnish gambling taxation system. In other words, the Finnish gambling system is found to be regressive by nature.

Intestinal Microbiota in Hirschsprung Disease.

OBJECTIVES: The aim of the study was to characterize the microbiota profiles of patients with Hirschsprung disease (HD) and to evaluate this in relation to postoperative bowel function and the incidence of Hirschsprung-associated enterocolitis (HAEC). METHODS: All patients operated on for HD at our center between 1987 and 2011 were invited to answer questionnaires on bowel function and to participate in a clinical follow-up for laboratory investigations, including fecal DNA extraction, fecal calprotectin (FC), and brush border lactase (LCT) genotyping. The microbiota compositions of patients with HD were compared with those of healthy controls aged between 2 and 7 years. RESULTS: The microbiota composition of eligible patients with HD (n = 34; median age 12 [range, 3-25] years) differed from the healthy controls (n = 141), showing decreased overall microbial richness (P < 0.005). Seventy-seven percent had experienced HAEC. Normal maturation of the intestinal flora was not observed, but patients had a significantly increased abundance of Proteobacteria among other taxa (P < 0.005) resulting in a reduced carbohydrate degradation potential, as predicted by the taxonomic composition. Genetic lactase deficiency was present in 17% and did not correlate with bowel symptoms. No patients reported active HAEC at the time of sampling and FC was within the normal range in all samples. CONCLUSIONS: Patients with HD and HAEC had a significantly altered intestinal microbiome compared to healthy individuals, characterized by a lack of richness and pathologic expansions of taxa, particularly Enterobacteria and Bacilli. Further evaluation is needed to identify whether these observations are intrinsic to HD or secondary to the recurrent use of antibiotics during early childhood.

Compulsory school achievement and gambling among men and women aged 18-29 in Finland.

AIMS: This study aims to explore the associations between final compulsory school grades and gambling and their relation to substance use and perceived mental health among people aged 18-29 in Finland (N = 831). METHODS: Cross-sectional random sample data, weighted on the basis of age, gender and region of residence, were collected in 2015. The data were analysed using logistic regression models adjusted for sociodemographic variables, risky alcohol use, daily smoking, and perceived mental health. RESULTS: Weekly gambling and at-risk and problem gambling (ARPG) were more common among men. Weekly gambling was linked to smoking and risky alcohol use among men and smoking among women. Additionally, ARPG was linked to risky alcohol use among men. ARPG was associated with moderate/poor mental health among men and women, but this was not the case with weekly gambling. Among men, low and average final school grades at age 16 were associated with weekly gambling later in life, even when adjusting for other variables. Among women, low and average final school grades were not associated with weekly gambling when adjusting for substance use. Lower final school grades were associated with ARPG among women but not among men when all potential confounders were adjusted for. CONCLUSIONS: Adolescents with lower final school grades are more likely to gamble weekly later in life. Lower final school grades are also linked with ARPG among women. It is important therefore for schools to have clear policies on gambling and to implement early prevention programmes.