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Jonsson H, Andersson A, Mao Z, Nyström L. Age-specific differences in tumour characteristics between screen-detected and non-screen-detected breast cancers in women aged 40-74 at diagnosis in Sweden from 2008 to 2017. J Med Screen 2024:9691413241237616. [PMID: 38454634 DOI: 10.1177/09691413241237616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVE To analyze differences between screen-detected and non-screen-detected invasive breast cancers by tumour characteristics and age at diagnosis in the nationwide population-based mammography screening program in Sweden. METHODS Data were retrieved from the National Quality Register for Breast Cancer for 2008-2017. Logistic regression analysis was used to estimate the likelihood for a tumour to be screen-detected by tumour characteristics and age group at diagnosis. RESULTS In total there were 51,429 invasive breast cancers in the target age group for mammography screening of 40-74 years. Likelihood of screen detection decreased with larger tumour size, lymph node metastases, higher histological grade and distant metastasis. Odds ratios (ORs) for negative oestrogen (ER) and progesterone (PgR) were 0.41 and 0.57; for positive HER2, 0.62; for Ki-67 high versus low, 0.49. Molecular sub-types had OR of 0.56, 0.40 and 0.28, respectively, for luminal B-like, HER2-positive and triple negative versus luminal A-like. Adjusting for tumour size (T), lymph node status (N), age, year and county at diagnosis slightly elevated the ORs. Statistically significant interactions between tumour characteristics and age were found (p < 0.05) except for ER and PgR. The age group 40-49 deviated most from the other age groups. CONCLUSIONS Our study demonstrates that screen-detected invasive breast cancers had more favourable tumour characteristics than non-screen-detected after adjusting for age, year and county of diagnosis, and even after adjusting for T and N. The trend towards favourable tumour characteristics was less pronounced in the 40-49 age group compared to the other age groups, except for ER and PgR.
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Affiliation(s)
- Håkan Jonsson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anne Andersson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Zheng Mao
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Lennarth Nyström
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Brunström M, Ng N, Dahlström J, Lindholm LH, Norberg M, Nyström L, Weinehall L, Carlberg B. Association of education and feedback on hypertension management with risk for stroke and cardiovascular disease. Blood Press 2022; 31:31-39. [PMID: 35179089 DOI: 10.1080/08037051.2022.2041393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PURPOSE Education and feedback on hypertension management has been associated with improved hypertension control. This study aimed to assess the effectiveness of such interventions to reduce the risk of stroke and cardiovascular events. MATERIALS AND METHODS Individuals ≥18 years with a blood pressure (BP) recording in Västerbotten or Södermanland County during the study period 2001 to 2009 were included in 108 serial cohort studies, each with 24 months follow-up. The primary outcome was risk of first-ever stroke in Västerbotten County (intervention) compared with Södermanland County (control). Secondary outcomes were first-ever major adverse cardiovascular event (MACE), myocardial infarction, and heart failure, as well as all-cause and cardiovascular mortality. All outcomes were analysed using time-to-event data included in a Cox proportional hazards model adjusted for age, sex, hypertension, diabetes, coronary artery disease, atrial fibrillation, systolic BP at inclusion, marital status, and disposable income. RESULTS A total of 121 365 individuals (mean [SD] age at inclusion 61.7 [16.3] years; 59.9% female; mean inclusion BP 142.3/82.6 mmHg) in the intervention county were compared to 131 924 individuals (63.6 [16.2] years; 61.2% female; 144.1/81.1 mmHg) in the control county. A first-ever stroke occurred in 2 823 (2.3%) individuals in the intervention county, and 3 584 (2.7%) individuals in the control county (adjusted hazard ratio 0.96, 95% CI 0.90 to 1.03). No differences were observed for MACE, myocardial infarction or heart failure, whereas all-cause mortality (HR 0.91, 95% CI 0.87 to 0.95) and cardiovascular mortality (HR 0.91, 95% CI 0.85 to 0.98) were lower in the intervention county. CONCLUSIONS This study does not support an association between education and feedback on hypertension management to primary care physicians and the risk for stroke or cardiovascular outcomes. The observed differences for mortality outcomes should be interpreted with caution.
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Affiliation(s)
- Mattias Brunström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Nawi Ng
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - John Dahlström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lars H Lindholm
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Margareta Norberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lennarth Nyström
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Lars Weinehall
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Bo Carlberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Mao Z, Nyström L, Jonsson H. Effectiveness of Population-Based Service Screening with Mammography for Women Aged 70-74 Years in Sweden. Cancer Epidemiol Biomarkers Prev 2020; 29:2149-2156. [PMID: 32856607 DOI: 10.1158/1055-9965.epi-20-0523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/10/2020] [Accepted: 08/17/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Consensus has been reached on the effectiveness of inviting women aged 50 to 69 years to mammography screening, but for older women, the evidence is scarce. The aim of this study was to estimate the marginal effectiveness of inviting women to mammography screening with an upper age limit of 74 years versus stopping at age 69 using data from the Swedish service-screening program. METHODS A cohort design was used to compare the breast cancer mortality in the period 1986 to 2012 between geographic areas and periods where women were invited to screening up to the age of 74 years (study group) with those where women were invited up to age 69 (control group). The study group and the control group were compared using the incidence-based breast cancer mortality rate ratio where only breast cancer deaths in cases diagnosed at 70 to 74 years of age were counted. RESULTS After 20 years of follow-up, there were 1,040 and 1,173 breast cancer deaths in the study and the control group, respectively. The breast cancer mortality rate ratio for women invited up to age 74 versus women invited up to age 69 was 0.80 [95% confidence interval (CI): 0.75-0.85] after bias adjustments. The corresponding rate ratio for participating women was 0.73 (95% CI: 0.66-0.81). CONCLUSIONS Continuing to screen women up to 74 years of age is effective compared with stopping screening at 69 years. IMPACT This large long-term study will add to the knowledge of the effect of mammography screening for women 70 to 74 years.
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Affiliation(s)
- Zheng Mao
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Lennarth Nyström
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Håkan Jonsson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden. .,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Muratov S, Canelo-Aybar C, Tarride JE, Alonso-Coello P, Dimitrova N, Borisch B, Castells X, Duffy SW, Fitzpatrick P, Follmann M, Giordano L, Hofvind S, Lebeau A, Quinn C, Torresin A, Vialli C, Siesling S, Ponti A, Giorgi Rossi P, Schünemann H, Nyström L, Broeders M. Monitoring and evaluation of breast cancer screening programmes: selecting candidate performance indicators. BMC Cancer 2020; 20:795. [PMID: 32831048 PMCID: PMC7444070 DOI: 10.1186/s12885-020-07289-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 08/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the scope of the European Commission Initiative on Breast Cancer (ECIBC) the Monitoring and Evaluation (M&E) subgroup was tasked to identify breast cancer screening programme (BCSP) performance indicators, including their acceptable and desirable levels, which are associated with breast cancer (BC) mortality. This paper documents the methodology used for the indicator selection. METHODS The indicators were identified through a multi-stage process. First, a scoping review was conducted to identify existing performance indicators. Second, building on existing frameworks for making well-informed health care choices, a specific conceptual framework was developed to guide the indicator selection. Third, two group exercises including a rating and ranking survey were conducted for indicator selection using pre-determined criteria, such as: relevance, measurability, accurateness, ethics and understandability. The selected indicators were mapped onto a BC screening pathway developed by the M&E subgroup to illustrate the steps of BC screening common to all EU countries. RESULTS A total of 96 indicators were identified from an initial list of 1325 indicators. After removing redundant and irrelevant indicators and adding those missing, 39 candidate indicators underwent the rating and ranking exercise. Based on the results, the M&E subgroup selected 13 indicators: screening coverage, participation rate, recall rate, breast cancer detection rate, invasive breast cancer detection rate, cancers > 20 mm, cancers ≤10 mm, lymph node status, interval cancer rate, episode sensitivity, time interval between screening and first treatment, benign open surgical biopsy rate, and mastectomy rate. CONCLUSION This systematic approach led to the identification of 13 BCSP candidate performance indicators to be further evaluated for their association with BC mortality.
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Affiliation(s)
- Sergei Muratov
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Center, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - Nadya Dimitrova
- European Commission, Joint Research Centre, Via E. Fermi 2749 - TP 127, I-21027, Ispra, VA, Italy.
| | - Bettina Borisch
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Xavier Castells
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | - Patricia Fitzpatrick
- National Screening Service, Dublin, Ireland
- UCD School of Public Health, Physiotherapy & Sports Science, Dublin, Ireland
| | | | - Livia Giordano
- CPO-Piedmont - AOU Città della Salute e della Scienza, Torino, Italy
| | | | - Annette Lebeau
- University Medical Center Hamburg-Eppendorf and Private Group Practice for Pathology, Hamburg, Germany
| | - Cecily Quinn
- St. Vincent's University Hospital, Dublin, Ireland
| | | | - Claudia Vialli
- European Commission, Joint Research Centre, Via E. Fermi 2749 - TP 127, I-21027, Ispra, VA, Italy
| | - Sabine Siesling
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
- University of Twente, Enschede, Netherlands
| | - Antonio Ponti
- CPO-Piedmont - AOU Città della Salute e della Scienza, Torino, Italy
| | | | - Holger Schünemann
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Lennarth Nyström
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Mireille Broeders
- Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
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5
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Mao Z, Nyström L, Jonsson H. Breast cancer screening with mammography in women aged 40-49 years: Impact of length of screening interval on effectiveness of the program. J Med Screen 2020; 28:200-206. [PMID: 32404033 PMCID: PMC8165750 DOI: 10.1177/0969141320918283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objectives To estimate the impact on the effectiveness of Swedish breast cancer screening program in women aged 40–49 years of shortening the screening interval from 21 months to 18 or 12 months. Methods The reduction in breast cancer mortality among participants in screening with mammography was previously estimated in the Swedish SCReening of Young women (SCRY) study to be 29%. The expected increased effectiveness with a hypothetical shorter screening interval than the average of 21 months in SCRY was calculated using data about the women who died from breast cancer even though they participated in the SCRY program. Results During the study period, 547 women who participated in the index screening round died from breast cancer. Shortening the screening interval to 18 months led to an improved effectiveness of 0.7–3.9% considering interval cancers only and of 1.3–7.6% considering screening-detected cancers only, and for both interval and screening-detected cancers the improvement was 1.9–11.5% when the assumed mortality reduction for the deceased cases varied from 5% to 30%. Shortening the screening interval to 12 months increased the effectiveness by 1.6–9.8% for interval cancers and by 2.9–17.4% for both interval and screening-detected cancers. Conclusion Shortening the screening interval for women aged 40–49 years to 18 or 12 months might further reduce the breast cancer mortality rate.
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Affiliation(s)
- Zheng Mao
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Lennarth Nyström
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Håkan Jonsson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Schünemann HJ, Lerda D, Quinn C, Follmann M, Alonso-Coello P, Rossi PG, Lebeau A, Nyström L, Broeders M, Ioannidou-Mouzaka L, Duffy SW, Borisch B, Fitzpatrick P, Hofvind S, Castells X, Giordano L, Canelo-Aybar C, Warman S, Mansel R, Sardanelli F, Parmelli E, Gräwingholt A, Saz-Parkinson Z. Breast Cancer Screening and Diagnosis: A Synopsis of the European Breast Guidelines. Ann Intern Med 2020; 172:46-56. [PMID: 31766052 DOI: 10.7326/m19-2125] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
DESCRIPTION The European Commission Initiative for Breast Cancer Screening and Diagnosis guidelines (European Breast Guidelines) are coordinated by the European Commission's Joint Research Centre. The target audience for the guidelines includes women, health professionals, and policymakers. METHODS An international guideline panel of 28 multidisciplinary members, including patients, developed questions and corresponding recommendations that were informed by systematic reviews of the evidence conducted between March 2016 and December 2018. GRADE (Grading of Recommendations Assessment, Development and Evaluation) Evidence to Decision frameworks were used to structure the process and minimize the influence of competing interests by enhancing transparency. Questions and recommendations, expressed as strong or conditional, focused on outcomes that matter to women and provided a rating of the certainty of evidence. RECOMMENDATIONS This synopsis of the European Breast Guidelines provides recommendations regarding organized screening programs for women aged 40 to 75 years who are at average risk. The recommendations address digital mammography screening and the addition of hand-held ultrasonography, automated breast ultrasonography, or magnetic resonance imaging compared with mammography alone. The recommendations also discuss the frequency of screening and inform decision making for women at average risk who are recalled for suspicious lesions or who have high breast density.
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Affiliation(s)
| | - Donata Lerda
- European Commission, Joint Research Centre, Ispra, Italy (D.L., E.P., Z.S.)
| | - Cecily Quinn
- St. Vincent's University Hospital, Dublin, Ireland (C.Q.)
| | | | | | - Paolo Giorgi Rossi
- Azienda Unitá Sanitaria Locale-IRCCS di Reggio Emilia, Reggia Emilia, Italy (P.G.R.)
| | - Annette Lebeau
- Private Group Practice for Pathology, Lübeck, Germany (A.L.)
| | | | | | | | - Stephen W Duffy
- Queen Mary University of London, London, United Kingdom (S.W.D.)
| | | | | | | | - Xavier Castells
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain (X.C.)
| | - Livia Giordano
- CPO-Piedmont - AOU Cittá della Salute e della Scienza, Torino, Italy (L.G.)
| | | | - Sue Warman
- Langford, North Somerset, United Kingdom (S.W.)
| | | | | | - Elena Parmelli
- European Commission, Joint Research Centre, Ispra, Italy (D.L., E.P., Z.S.)
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Brunström M, Ng N, Dahlström J, Lindholm LH, Lönnberg G, Norberg M, Nyström L, Weinehall L, Carlberg B. Association of Physician Education and Feedback on Hypertension Management With Patient Blood Pressure and Hypertension Control. JAMA Netw Open 2020; 3:e1918625. [PMID: 31913490 PMCID: PMC6991247 DOI: 10.1001/jamanetworkopen.2019.18625] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Elevated systolic blood pressure (SBP) is the most important risk factor for premature death worldwide. However, hypertension detection and control rates continue to be suboptimal. OBJECTIVE To assess the association of education and feedback to primary care physicians with population-level SBP and hypertension control rates. DESIGN, SETTING, AND PARTICIPANTS This pooled series of 108 population-based cohort studies involving 283 079 patients used data from primary care centers in 2 counties (Västerbotten and Södermanland) in Sweden from 2001 to 2009. Participants were individuals aged 18 years or older who had their blood pressure (BP) measured and recorded in either county during the intervention period. All analyses were performed in February 2019. EXPOSURES An intervention comprising education and feedback for primary care physicians in Västerbotten County (intervention group) compared with usual care in Södermanland County (control group). MAIN OUTCOMES AND MEASURES Difference in mean SBP levels between counties and likelihood of hypertension control in the intervention county compared with the control county during 24 months of follow-up. RESULTS A total of 136 541 unique individuals (mean [SD] age at inclusion, 64.6 [16.1] years; 57.0% female; mean inclusion BP, 142/82 mm Hg) in the intervention county were compared with 146 538 individuals (mean [SD] age at inclusion, 65.7 [15.9] years; 58.3% female; mean inclusion BP, 144/80 mm Hg) in the control county. Mean SBP difference between counties during follow-up, adjusted for inclusion BP and other covariates, was 1.1 mm Hg (95% CI, 1.0-1.1 mm Hg). Hypertension control improved by 8.4 percentage points, and control was achieved in 37.8% of participants in the intervention county compared with 29.4% in the control county (adjusted odds ratio, 1.30; 95% CI, 1.29-1.31). Differences between counties increased during the intervention period and were more pronounced in participants with higher SBP at inclusion. Results were consistent across all subgroups. CONCLUSIONS AND RELEVANCE This study suggests that SBP levels and hypertension control rates in a county population may be improved by educational approaches directed at physicians and other health care workers. Similar strategies may be adopted to reinforce the implementation of clinical practice guidelines for hypertension management.
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Affiliation(s)
- Mattias Brunström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Nawi Ng
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - John Dahlström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lars H. Lindholm
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Göran Lönnberg
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Margareta Norberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Lennarth Nyström
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Lars Weinehall
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Bo Carlberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Pujilestari CU, Nyström L, Norberg M, Ng N. Association between changes in waist circumferences and disability among older adults: WHO-INDEPTH study on global ageing and adult health (SAGE) in Indonesia. Obes Res Clin Pract 2019; 13:462-468. [PMID: 31474381 DOI: 10.1016/j.orcp.2019.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 06/20/2019] [Accepted: 07/26/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is a lack of evidence regarding the impact of changes in waist circumference on disability among older populations in low- and middle-income countries (LMICs). This research examines the association between changes in waist circumference with disability in the older populations of Indonesia, and whether the associations are dependent on wealth or baseline abdominal obesity levels. METHODS In 2007 the INDEPTH-WHO Study on global AGEing and adult health (SAGE) was conducted among 11,753 individuals aged 50 years and older in Purworejo District, Central Java Province, Indonesia. Of these, a total of 8,089 were followed up in 2010. On both occasions, individuals' waist circumferences were measured and the 12-item version of the WHO Disability Assessment Schedule version 2 (WHODAS-II) was implemented to measure disability. RESULTS A significant positive association was observed between waist circumference and disability at the baseline (β=0.066; p<0.001), and between the increase in waist circumference and the level of disability during the three-year follow-up period (β=0.094; p<0.001) after adjusting for baseline variables. This association was also significant among the poor, non-obese men, as well as poor and rich obese women. Among the non-obese women, a decrease in waist circumference was associated with more disabilities. CONCLUSIONS An increase in waist circumference is associated with increased disability among older people in Purworejo, Indonesia. Health promotion programmes aiming to prevent obesity could have positive effects in preventing and reducing disability among older adults.
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Affiliation(s)
- Cahya Utamie Pujilestari
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå 90187, Sweden.
| | - Lennarth Nyström
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå 90187, Sweden
| | - Margareta Norberg
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå 90187, Sweden
| | - Nawi Ng
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå 90187, Sweden
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Schünemann HJ, Lerda D, Dimitrova N, Alonso-Coello P, Gräwingholt A, Quinn C, Follmann M, Mansel R, Sardanelli F, Rossi PG, Lebeau A, Nyström L, Broeders M, Ioannidou-Mouzaka L, Duffy SW, Borisch B, Fitzpatrick P, Hofvind S, Castells X, Giordano L, Warman S, Saz-Parkinson Z. Methods for Development of the European Commission Initiative on Breast Cancer Guidelines: Recommendations in the Era of Guideline Transparency. Ann Intern Med 2019; 171:273-280. [PMID: 31330534 DOI: 10.7326/m18-3445] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Neither breast cancer prevention and early-detection programs, nor their outcomes, are uniform across Europe. This article describes the rationale, methods, and process for development of the European Commission (EC) Initiative on Breast Cancer Screening and Diagnosis Guidelines. To be consistent with standards set by the Institute of Medicine and others, the EC followed 6 general principles. First, the EC selected, via an open call, a panel with broad representation of areas of expertise. Second, it ensured that all recommendations were supported by systematic reviews. Third, the EC separately considered important subgroups of women, included patient advocates in the guidelines development group, and focused on good communication to inform women's decisions. Fourth, EC rules on conflicts of interest were followed and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Evidence to Decision frameworks were used to structure the process and minimize the influence of competing interests. Fifth, it focused its recommendations on outcomes that matter to women, and certainty of the evidence is rated for each. Sixth, the EC elicited stakeholder feedback to ensure that the recommendations remain up to date and relevant to practice. This article describes the approach and highlights ways of disseminating and adapting the recommendations both within and outside Europe, using innovative information technology tools.
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Affiliation(s)
- Holger J Schünemann
- McMaster University Health Sciences Centre, Hamilton, Ontario, Canada (H.J.S.)
| | - Donata Lerda
- European Commission, Joint Research Centre, Ispra, Italy (D.L., N.D., Z.S.)
| | - Nadya Dimitrova
- European Commission, Joint Research Centre, Ispra, Italy (D.L., N.D., Z.S.)
| | | | | | - Cecily Quinn
- St. Vincent's University Hospital, Dublin, Ireland (C.Q.)
| | | | | | | | - Paolo Giorgi Rossi
- Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy (P.G.R.)
| | - Annette Lebeau
- University Medical Center Hamburg-Eppendorf, Hamburg, and Private Group Practice for Pathology, Lübeck, Germany (A.L.)
| | | | | | | | - Stephen W Duffy
- Queen Mary University of London, London, United Kingdom (S.W.D.)
| | - Bettina Borisch
- Institute of Global Health. University of Geneva, Geneva, Switzerland (B.B.)
| | | | | | - Xavier Castells
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain (X.C.)
| | - Livia Giordano
- CPO-Piedmont - AOU Città della Salute e della Scienza, Torino, Italy (L.G.)
| | - Sue Warman
- Langford, North Somerset, United Kingdom (S.W.)
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Andersson A, Von Wachenfeldt Väppling A, De Jong A, Nyström L. Adherence to adjuvant endocrine therapy after breast cancer in Sweden 2008-2010: A nationwide survey. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
523 Background: In estrogen receptor (ER) positive early breast cancer (EBC) adjuvant endocrine therapy (AET) is crucial to reduce recurrence and mortality. Previous studies have shown that adherence to AET is lower than expected and could negatively affect outcome. Since the year of 2000, BC patients in Sweden are treated in accordance to national guidelines. Treatment is offered at a low cost for the patient. The aim of the study was to estimate the adherence to AET in Sweden by regions and age groups. Methods: Women with a first primary EBC diagnosis 2008-2010 were identified through the Swedish Cancer Registry (SCR). Individual tumour and treatment data were retrieved from the Swedish National Breast Cancer Registry (SNBCR). Patients with ER negative tumours, small tumours (≤ 10 mm) and metastatic disease was excluded from the study since there were no indication to AET. Likewise, were individuals with AET registered to be administered by a third part excluded. Dispensed treatment from pharmacies was obtained through the Swedish Prescription Registry and medication possession rate (MPR) was calculated as number of dispensed doses divided by treatment duration in days. Good adherence to treatment in a patient was set at MPR ≥ 80 %. Adherence was calculated for 3 and 5 years. Results: Twenty-one thousand sixteen (21 016) individuals with a first primary BC between 2008 and 2010 was identified through SCR of which 20 596 were registered in the SNBCR. A total of 10 176 met the inclusion criteria in the study. Adherence after 3 years was 88.0 % and after 5 years 82.5 %. Adherence differed between regions in Sweden and was positively associated with age at diagnosis between 41-74 years. Urban areas had a lower adherence than rural areas (80.7 % vs 83.6 %; p= <0.001). Conclusions: Adherence to AET in Sweden was good, although there were differences by age and urban and rural areas. Further studies are needed to identify factors affecting differences in adherence, with the purpose of initiate actions to increase adherence to AET in ER positive EBC patients.
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Affiliation(s)
- Anne Andersson
- Department of Radiation Sciences, Oncology, Umeaa, Sweden
| | | | | | - Lennarth Nyström
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Pujilestari CU, Nyström L, Norberg M, Ng N. Waist Circumference and All-Cause Mortality among Older Adults in Rural Indonesia. Int J Environ Res Public Health 2019; 16:ijerph16010116. [PMID: 30609857 PMCID: PMC6339011 DOI: 10.3390/ijerph16010116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/26/2018] [Accepted: 12/28/2018] [Indexed: 01/22/2023]
Abstract
Waist circumference, a measure of abdominal obesity, is associated with all-cause mortality in general adult population. However, the link between abdominal obesity with all-cause mortality in the studies of older adults is unclear. This study aims to determine the association between waist circumference and all-cause mortality in older adults in Indonesia. The association between waist circumference and all-cause mortality was examined in 10,997 men and women aged 50 years and older, in the World Health Organization (WHO) and International Network of field sites for continuous Demographic Evaluation of Populations and their Health in developing countries (INDEPTH) collaboration Study on global AGEing and adult health (SAGE) in Purworejo District Central Java, Indonesia during 2007⁻2010. Multivariate Cox regression analysis with restricted cubic splines was used to assess the non-linear association between waist circumference and all-cause mortality. During the 3-year follow-up, a total of 511 men and 470 women died. The hazard ratio plot shows a pattern of U-shape relationship between waist circumference and all-cause mortality among rich women, though the result was significant only for women in the lower end of waist circumference distribution (p < 0.05). Poor men with a low waist circumference (5th percentile) have a two times higher mortality risk (HR = 2.1; 95% CI = 1.3, 3.3) relative to those with a waist circumference of 90 cm. Poor women with a low waist circumference (25th percentile) have a 1.4 times higher mortality risk (HR = 1.4; 95% CI = 1.1, 1.8) relative to those with a waist circumference of 80 cm. This study shows a significant association between low waist circumference measure and mortality, particularly among poor men and women. Though the association between large waist circumference and mortality was not significant, we observed a trend of higher mortality risk particularly among rich women with large waist circumference measure. Public health intervention should include efforts to improve nutritional status among older people and promoting healthy lifestyle behaviours including healthy food and active lifestyle.
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Affiliation(s)
- Cahya Utamie Pujilestari
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, 90187 Umeå, Sweden.
| | - Lennarth Nyström
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, 90187 Umeå, Sweden.
| | - Margareta Norberg
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, 90187 Umeå, Sweden.
| | - Nawi Ng
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, 90187 Umeå, Sweden.
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Wu WYY, Törnberg S, Elfström KM, Liu X, Nyström L, Jonsson H. Overdiagnosis in the population-based organized breast cancer screening program estimated by a non-homogeneous multi-state model: a cohort study using individual data with long-term follow-up. Breast Cancer Res 2018; 20:153. [PMID: 30558679 PMCID: PMC6296133 DOI: 10.1186/s13058-018-1082-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 11/19/2018] [Indexed: 12/31/2022] Open
Abstract
Background Overdiagnosis, defined as the detection of a cancer that would not become clinically apparent in a woman’s lifetime without screening, has become a growing concern. Similar underlying risk of breast cancer in the screened and control groups is a prerequisite for unbiased estimates of overdiagnosis, but a contemporary control group is usually not available in organized screening programs. Methods We estimated the frequency of overdiagnosis of breast cancer due to screening in women 50–69 years old by using individual screening data from the population-based organized screening program in Stockholm County 1989–2014. A hidden Markov model with four latent states and three observed states was constructed to estimate the natural progression of breast cancer and the test sensitivity. Piecewise transition rates were used to consider the time-varying transition rates. The expected number of detected non-progressive breast cancer cases was calculated. Results During the study period, 2,333,153 invitations were sent out; on average, the participation rate in the screening program was 72.7% and the average recall rate was 2.48%. In total, 14,648 invasive breast cancer cases were diagnosed; among the 8305 screen-detected cases, the expected number of non-progressive breast cancer cases was 35.9, which is equivalent to 0.43% (95% confidence interval (CI) 0.10%–2.2%) overdiagnosis. The corresponding estimates for the prevalent and subsequent rounds were 15.6 (0.87%, 95% CI 0.20%–4.3%) and 20.3 (0.31%, 95% CI 0.07%–1.6%), respectively. The likelihood ratio test showed that the non-homogeneous model fitted the data better than an age-homogeneous model (P <0.001). Conclusions Our findings suggest that overdiagnosis in the organized biennial mammographic screening for women 50–69 in Stockholm County is a minor phenomenon. The frequency of overdiagnosis in the prevalent screening round was higher than that in subsequent rounds. The non-homogeneous model performed better than the simpler, traditional homogeneous model. Electronic supplementary material The online version of this article (10.1186/s13058-018-1082-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wendy Yi-Ying Wu
- Department of Radiation Sciences, Oncology, Umeå University, 90187, Umeå, Sweden.
| | - Sven Törnberg
- Department of Oncology-Pathology, Karolinska Institute, 17177 Solna, Stockholm, Sweden
| | | | - Xijia Liu
- Department of Mathematics and Mathematical Statistics, Umeå University, 90187, Umeå, Sweden
| | - Lennarth Nyström
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 90187, Umeå, Sweden
| | - Håkan Jonsson
- Department of Radiation Sciences, Oncology, Umeå University, 90187, Umeå, Sweden
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Mgaya AH, Kidanto HL, Nyström L, Essén B. Use of a criteria-based audit to optimize uptake of cesarean delivery in a low-resource setting. Int J Gynaecol Obstet 2018; 144:199-209. [PMID: 30499099 DOI: 10.1002/ijgo.12726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/04/2018] [Accepted: 11/28/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the impact of a criteria-based audit (CBA) of obstructed labor and fetal distress on cesarean delivery and perinatal outcomes. METHODS A cross-sectional study was performed at a tertiary referral hospital in Tanzania. Data were collected before and after CBA (January 2013-November 2013 and July 2015-June 2016). Outcomes of fetal distress (baseline CBA, n=248; re-audit, n=251) and obstructed labor (baseline CBA, n=260; re-audit n=250) were assessed using a checklist. Additionally, 27 960 parturients were assessed using the Robson classification. RESULTS Perinatal morbidity and mortality decreased from 42 of 260 (16.2%) to 22 of 250 (8.8%) among patients with obstructed labor after CBA (P=0.012). Cesarean delivery rate decreased for referred term multiparas with induced labor or prelabor cesarean delivery (odds ratio [OR] 0.28, 95% confidence interval [CI] 0.09-0.82). Cesarean delivery rate for preterm pregnancies increased among both referred (OR 1.28, 95% CI 1.02-1.63) and non-referred (OR 2.78, 95% CI 1.98-3.90) groups. Neonatal distress rate decreased for referred term multiparas (OR 0.72, 95% CI 0.56-0.92), referred preterm pregnancies (OR 0.32, 95% CI 0.25-0.39), and non-referred preterm pregnancies (OR 0.26, 95% CI 0.18-0.36). CONCLUSION Use of CBA reduced poor perinatal outcomes of obstructed labor and increased uptake of cesarean delivery.
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Affiliation(s)
- Andrew H Mgaya
- Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, Tanzania.,Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Hussein L Kidanto
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden.,Reproductive and Child Health, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Lennarth Nyström
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Umeå University, Umeå, Sweden
| | - Birgitta Essén
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
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Malekkhaiat Häffner S, Nyström L, Nordström R, Xu ZP, Davoudi M, Schmidtchen A, Malmsten M. Membrane interactions and antimicrobial effects of layered double hydroxide nanoparticles. Phys Chem Chem Phys 2018; 19:23832-23842. [PMID: 28682360 DOI: 10.1039/c7cp02701j] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Membrane interactions are critical for the successful use of inorganic nanoparticles as antimicrobial agents and as carriers of, or co-actives with, antimicrobial peptides (AMPs). In order to contribute to an increased understanding of these, we here investigate effects of particle size (42-208 nm) on layered double hydroxide (LDH) interactions with both bacteria-mimicking and mammalian-mimicking lipid membranes. LDH binding to bacteria-mimicking membranes, extraction of anionic lipids, as well as resulting membrane destabilization, was found to increase with decreasing particle size, also translating into size-dependent synergistic effects with the antimicrobial peptide LL-37. Due to strong interactions with anionic lipopolysaccharide and peptidoglycan layers, direct membrane disruption of both Gram-negative and Gram-positive bacteria is suppressed. However, LDH nanoparticles cause size-dependent charge reversal and resulting flocculation of both liposomes and bacteria, which may provide a mechanism for bacterial confinement or clearance. Taken together, these findings demonstrate a set of previously unknown behaviors, including synergistic membrane destabilization and dual confinement/killing of bacteria through combined LDH/AMP exposure, of potential therapeutic interest.
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Pujilestari CU, Nyström L, Norberg M, Weinehall L, Hakimi M, Ng N. Socioeconomic inequality in abdominal obesity among older people in Purworejo District, Central Java, Indonesia - a decomposition analysis approach. Int J Equity Health 2017; 16:214. [PMID: 29233136 PMCID: PMC5727959 DOI: 10.1186/s12939-017-0708-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/27/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Obesity has become a global health challenge as its prevalence has increased globally in recent decades. Studies in high-income countries have shown that obesity is more prevalent among the poor. In contrast, obesity is more prevalent among the rich in low- and middle-income countries, hence requiring different focal points to design public health policies in the latter contexts. We examined socioeconomic inequalities in abdominal obesity in Purworejo District, Central Java, Indonesia and identified factors contributing to the inequalities. METHODS We utilised data from the WHO-INDEPTH Study on global AGEing and adult health (WHO-INDEPTH SAGE) conducted in the Purworejo Health and Demographic Surveillance System (HDSS) in Purworejo District, Indonesia in 2010. The study included 14,235 individuals aged 50 years and older. Inequalities in abdominal obesity across wealth groups were assessed separately for men and women using concentration indexes. Decomposition analysis was conducted to assess the determinants of socioeconomic inequalities in abdominal obesity. RESULTS Abdominal obesity was five-fold more prevalent among women than in men (30% vs. 6.1%; p < 0.001). The concentration index (CI) analysis showed that socioeconomic inequalities in abdominal obesity were less prominent among women (CI = 0.26, SE = 0.02, p < 0.001) compared to men (CI = 0.49, SE = 0.04, p < 0.001). Decomposition analysis showed that physical labour was the major determinant of socioeconomic inequalities in abdominal obesity among men, explaining 47% of the inequalities, followed by poor socioeconomic status (31%), ≤ 6 years of education (15%) and current smoking (11%). The three major determinants of socioeconomic inequalities in abdominal obesity among women were poor socio-economic status (48%), physical labour (17%) and no formal education (16%). CONCLUSION Abdominal obesity was more prevalent among older women in a rural Indonesian setting. Socioeconomic inequality in abdominal obesity exists and concentrates more among the rich population in both sexes. The inequality gap is less prominent among women, indicating a trend towards obesity being more common in poor women. Policies to address social determinants of health need to be developed to address the socioeconomic inequality gaps in obesity, with particular focus on addressing the existing burden of obesity among the better-off population group, while preventing the imminent burden of obesity among the worst-off group, particularly among women.
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Affiliation(s)
- Cahya Utamie Pujilestari
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden
| | - Lennarth Nyström
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden
| | - Margareta Norberg
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden
| | - Lars Weinehall
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden
| | - Mohammad Hakimi
- Centre for Reproductive Health, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Nawi Ng
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden
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Wu WYY, Nyström L, Jonsson H. Estimation of overdiagnosis in breast cancer screening using a non-homogeneous multi-state model: A simulation study. J Med Screen 2017; 25:183-190. [DOI: 10.1177/0969141317733294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives Overdiagnosis is regarded as a harm of screening. We aimed to develop a non-homogeneous multi-state model to consider the age-specific transition rates for estimation of overdiagnosis, to validate the model by a simulation study where the true frequency of overdiagnosis can be calculated, and to compare our estimate with the cumulative incidence method. Methods We constructed a four-state model to describe the natural history of breast cancer. The latent disease progression and the observed states for each individual were simulated in a trial with biennial screening of women aged 51–69 and a control group of the same size without screening. We performed 100 repetitions of the simulation with one million women to evaluate the performance of estimates. A sensitivity analysis with reduced number of controls was performed to imitate the data from the service screening programme. Results Based on the 100 repetitions, the mean value of the true frequency of overdiagnosis was 12.5% and the average estimates by the cumulative incidence method and the multi-state model were 12.9% (interquartile range: 2.46%) and 13.4% (interquartile range: 2.16%), respectively. The multi-state model had a greater bias of overdiagnosis than the cumulative incidence method, but the variation in the estimates was smaller. When the number of unscreened group was reduced, the variation of multi-state model estimates increased. Conclusions The multi-state model produces a proper estimate of overdiagnosis and the results are comparable with the cumulative incidence method. The multi-state model can be used in the estimation of overdiagnosis, and might be useful for the ongoing service screening programmes.
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Affiliation(s)
- Wendy Y-Y Wu
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Lennarth Nyström
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Håkan Jonsson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
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Tyrberg M, Nyström L, Arnqvist HJ, Bolinder J, Gudbjörnsdottir S, Landin-Olsson M, Eriksson JW, Svensson MK. Overweight, hyperglycemia and tobacco use are modifiable risk factors for onset of retinopathy 9 and 17years after the diagnosis of diabetes - A retrospective observational nation-wide cohort study. Diabetes Res Clin Pract 2017; 133:21-29. [PMID: 28888147 DOI: 10.1016/j.diabres.2017.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/24/2017] [Accepted: 08/14/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aims of this study were to estimate the risk for diabetic retinopathy (DR) and to identify risk factors. We investigated a nationwide population-based cohort with diabetes diagnosed at age 15-34years. PATIENTS AND METHODS Of 794 patients registered 1987-1988 in the Diabetes Incidence Study in Sweden (DISS) 444 (56%) patients with retinal photos available for classification of retinopathy participated in a follow-up study 15-19 (median 17) years after diagnosis. Mean age was 42.3±5.7years, BMI 26.1±4.1kg/m2, 62% were male and 91% had type 1 diabetes. A sub-study was performed in 367 patients with retinal photos from both the 9 and 17year follow up and the risk for development of retinopathy between 9 and 17years of follow up was calculated. RESULTS After median 17years 324/444 (73%, 67% of T1D and 71% of T2D), had developed any DR but only 5.4% proliferative DR. Male sex increased the risk of developing retinopathy (OR 1.9, 95% CI 1.2-2.9). In the sub-study obesity (OR 1.2, 95% CI 1.04-1.4), hyperglycemia (OR 2.5, 95% CI 1.6-3.8) and tobacco use (OR 2.9, 95% CI 1.1-7.3) predicted onset of retinopathy between 9 and 17years after diagnosis of diabetes. CONCLUSION The number of patients with severe retinopathy after 17years of diabetes disease was small. The risk of developing retinopathy with onset between 9 and 17years after diagnosis of diabetes was strongly associated to modifiable risk factors such as glycemic control, obesity and tobacco use.
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Affiliation(s)
- M Tyrberg
- Department of Ophthalmology, Helsingborg Hospital, Lund University, Helsingborg, Sweden
| | - L Nyström
- Department of Public Health and Clinical Medicine, Epidemiology, Umeå University, Umeå, Sweden
| | - H J Arnqvist
- Department of Endocrinology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - J Bolinder
- Department of Endocrinology, Metabolism, and Diabetes, Karolinska University Hospital Huddinge, Karolinska Institutet, Sweden
| | - S Gudbjörnsdottir
- Department of Medicine, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden
| | - M Landin-Olsson
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - J W Eriksson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - M K Svensson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
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Haksari EL, Lafeber HN, Hakimi M, Pawirohartono EP, Nyström L. Reference curves of birth weight, length, and head circumference for gestational ages in Yogyakarta, Indonesia. BMC Pediatr 2016; 16:188. [PMID: 27871318 PMCID: PMC5117525 DOI: 10.1186/s12887-016-0728-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 11/08/2016] [Indexed: 11/24/2022] Open
Abstract
Background The birth weight reference curve to estimate the newborns at risk in need of assessment and monitoring has been established. The previous reference curves from Indonesia, approximately 8 years ago, were based on the data collected from teaching hospitals only with limited gestational ages. The aims of the study were to update the reference curves for birth weight, supine length and head circumference for Indonesia, and to compare birth weight curves of boys and girls, first child and later children, and the ones in the previous studies. Methods Data were extracted from the Maternal-Perinatal database between 1998–2007. Only live singletons with recorded gestational ages of 26 to 42 weeks and the exact time of admission to the neonatal facilities delivered or referred within 24 h of age to Sardjito Hospital, five district hospitals and five health centers in Yogyakarta Special Territory were included. Newborns with severely ill conditions, congenital anomaly and chromosomal abnormality were excluded. Smoothening of the curves was accomplished using a third-order polynomial equation. Results Our study included 54,599 singleton live births. Growth curves were constructed for boys (53.3%) and girls (46.7%) for birth weight, supine length, and head circumference. At term, mean birth weight for each gestational age of boys was significantly higher than that of girls. While mean birth weight for each gestational age of first-born-children, on the other hand was significantly lower than that of later-born-children. The mean birth weight was lower than that of Lubchenco’s study. Compared with the previous Indonesian study by Alisyahbana, no differences were observed for the aterm infants, but lower mean birth weight was observed in preterm infants. Conclusions Updated neonatal reference curves for birth weight, supine length and head circumference are important to classify high risk newborns in specific area and to identify newborns requiring attention.
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Affiliation(s)
- Ekawaty L Haksari
- Department of Child Health, Faculty of Medicine, Gadjah Mada University, Sardjito General Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55284, Indonesia.
| | - Harrie N Lafeber
- Department of Pediatrics, Vrije Universiteit Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Mohammad Hakimi
- Faculty of Medicine, Gadjah Mada University/Sardjito General Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55284, Indonesia
| | - Endy P Pawirohartono
- Department of Child Health, Faculty of Medicine, Gadjah Mada University, Sardjito General Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55284, Indonesia
| | - Lennarth Nyström
- Public Health and Clinical Medicine, Umeå University, SE-901 87, Umeå, Sweden
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Abstract
Aims: To examine the impact of gender and socioeconomic factors on health-related quality of life (HRQoL) one year and eight years after diabetes diagnosis. Methods: Two national incidence cohorts who contracted diabetes between the ages of 15 and 34 years ( n= 554) and matched control groups from the general population of Sweden ( n= 1,029) were surveyed. Data on HRQoL, diabetes treatment, marital status, education, social class, and employment were collected via a questionnaire mailed to the younger cohort (aged 16-35) one year after diagnosis and to the older cohort (aged 23-42) eight years after diagnosis. Response rates were 73% among people with diabetes and 68% among the controls. Multivariable linear regression models were used to analyse the impact of gender and socioeconomic factors on HRQoL in the diabetic and control groups. The dependent variable was the ``general health perceptions'' score of the SWED-QUAL instrument, which corresponds to the ``global self-rated health'' concept. Results: A model including all the sociodemographicvariables explained 6% of the variance in self-rated health one year after diabetes diagnosis and 13% of the variance eight years after diagnosis. In the control groups, the level of explanation was 2-3%. Female gender was an independent predictor of poor self-rated health in the older diabetic cohort, but not in the younger cohort. Conclusions: Gender and socioeconomic factors were more closely associated with self-rated health eight years after diabetes diagnosis than one year after diagnosis, indicating early sociodemographic stratification in the health of the diabetic populations studied.
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Affiliation(s)
- Pia Maria Jonsson
- Department of Public Health Sciences, Division of International Health (IHCAR), Karolinska Institutet, Stockholm,
| | - Lennarth Nyström
- Epidemiology, Department of Public Health and Clinical Medicine, UmeÅ University, UmeÅ, Sweden
| | - Göran Sterky
- Department of Public Health Sciences, Division of International Health (IHCAR), Karolinska Institutet, Stockholm
| | - Stig Wall
- Epidemiology, Department of Public Health and Clinical Medicine, UmeÅ University, UmeÅ, Sweden
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Nyström L, Bjurstam N, Jonsson H, Zackrisson S, Frisell J. Reduced breast cancer mortality after 20+ years of follow-up in the Swedish randomized controlled mammography trials in Malmö, Stockholm, and Göteborg. J Med Screen 2016; 24:34-42. [PMID: 27306511 DOI: 10.1177/0969141316648987] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To analyze the age- and trial-specific effects of the breast cancer screening trials with mammography in Malmö, Stockholm, and Göteborg. Methods The original trial files were linked to the Swedish Cancer and Cause of Death Registers to obtain date of breast cancer diagnosis and date and cause of death. Relative risks and 95% confidence intervals were calculated using the evaluation model (only breast cancers diagnosed between date of randomization and date when the first screening round of the control group was completed were included in the analysis). Results Women aged 40-70 at randomization in the Malmö I and II, Stockholm, and Göteborg trials were followed-up for an average of 30, 22, 25, and 24 years, respectively. The overview of all trials resulted in a significant decrease of 15% in breast cancer mortality. The variation by consecutive 10-year age group at randomization was small-from 21% in the age group 40-49 to 11% in the age group 50-59. After adjustment for age, there was a significant reduction in breast cancer mortality in the Göteborg trial (26%), and a non-significant reduction in the Malmö I and II and Stockholm trials (12%, 15%, and 5.8%, respectively). Conclusions The overview showed a 15% significant relative reduction in breast cancer mortality due to invitation to mammography screening. Heterogeneity in age, trial time, attendance rates, and length of screening intervals may have contributed to the variation in effect between the trials.
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Affiliation(s)
- Lennarth Nyström
- 1 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Nils Bjurstam
- 2 Department of Radiology, Sahlgrenska University Hospital, Sahlgrenska Academy, Göteborg, Sweden
| | - Håkan Jonsson
- 3 Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Sophia Zackrisson
- 4 Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden.,5 Diagnostic Radiology, Lund University, Lund, Sweden
| | - Jan Frisell
- 6 Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
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Sundström P, Nyström L, Svenningsson A, Forsgren L. Sick leave and professional assistance for multiple sclerosis individuals in Vä sterbotten C ounty, northern Sweden. Mult Scler 2016; 9:515-20. [PMID: 14582779 DOI: 10.1191/1352458503ms955oa] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aims of this study of a cross-sectional multiple sclerosis (MS) population in V ä sterbotten C ounty, northern Sweden, were to estimate the prevalence of sick leave, professional assistance and housing; to study risk factors for sick leave; and to estimate the odds for sick leave in comparison with the general population of the county. The consequences of MS-related incapacity on the socioeconomic factors studied were considerable. A lmost half (45%) of prevalent MS cases aged 18-64 years were fully sick listed and only one-third (35%) were not sick listed at all. Every fourth individual in the prevalence population received professional assistance, and 9% were living in care homes or special apartments for the disabled. Multiple logistic regression analysis identified the Expanded Disability Status Scale (EDSS) as the strongest predicto r of sick leave. The time from symptom onset to full sick leave leading to temporary or permanent disability pension was significantly shorter for cases with progressive onset, higher age at onset and in males. The risk of full sick leave due to MS was six times higher than in the general population.
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Affiliation(s)
- P Sundström
- Department of Pharmacology and Clinical Neuroscience, Umeå University Hospital, S-901 85 Umeå, Sweden.
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Wahlberg J, Ekman B, Nyström L, Hanson U, Persson B, Arnqvist HJ. Gestational diabetes: Glycaemic predictors for fetal macrosomia and maternal risk of future diabetes. Diabetes Res Clin Pract 2016; 114:99-105. [PMID: 26818892 DOI: 10.1016/j.diabres.2015.12.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 11/23/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
Abstract
AIMS To investigate how glucose levels at diagnosis of gestational diabetes (GDM) are associated with infant birth weight and long-term risk of manifest diabetes mellitus in the mother. METHODS In a case control study GDM pregnancies (n=2085) were compared with non-GDM pregnancies matched for day of delivery and obstetric unit (n=3792). GDM was defined as capillary blood glucose (cB-glucose) ≥9.0mmol/l (plasma glucose ≥10.0mmol/l) after a 75g oral glucose tolerance test (OGTT). The GDM cohort were followed up 8.5-13.5yrs after initial diagnosis with a questionnaire, answered by 1324 GDM women (65%). RESULTS GDM women had higher mean infant birth-weight compared with controls (3682g vs. 3541g, P<0.001). In multiple linear regression analysis, birth weight was positively correlated to fasting cB-glucose at GDM diagnosis (P<0.001), increased week of gestation (P<0.001) and BMI before pregnancy (P<0.003), while 2h OGTT cB-glucose values ≥9.0mmol/l were not related. Infants born to mothers with fasting cB-glucose ≤4.5mmol/l had no increased mean birth-weight or macrosomia (≥4500g) compared to controls. In the follow up 334/1324 women (25%) of the GDM women had developed diabetes, 215 type 2 diabetes, 46 type 1 diabetes and 72 unclassified diabetes. In logistic regression fasting cB-glucose and 2h OGTT cB-glucose at diagnosis of GDM as well as BMI >25 and origin outside Europe were risk factors for manifest diabetes. CONCLUSIONS Fasting blood glucose at diagnosis of GDM gives important information besides 2h OGTT glucose about pregnancy outcome and future risk for maternal diabetes.
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Affiliation(s)
- Jeanette Wahlberg
- Department of Endocrinology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Endocrinology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Bertil Ekman
- Department of Endocrinology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Lennarth Nyström
- Department of Public Health and Clinical Medicine, Epidemiology, Umeå University, Umeå, Sweden
| | - Ulf Hanson
- Department of Women's and Children's Health, University of Uppsala, Uppsala, Sweden
| | - Bengt Persson
- Department of Women and Child Health Division of Pediatrics, Karolinska Institute, Stockholm, Sweden
| | - Hans J Arnqvist
- Department of Endocrinology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
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Nyström L. The Swedish randomised controlled trial on mammography screening has been properly designed, conducted and analysed. J R Soc Med 2016; 108:429-30. [PMID: 26609096 DOI: 10.1177/0141076815616090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Brunström M, Dahlström J, Lindholm LH, Lönnberg G, Hallström S, Norberg M, Nyström L, Persson M, Weinehall L, Carlberg B. From efficacy in trials to effectiveness in clinical practice: The Swedish Stroke Prevention Study. Blood Press 2016; 25:206-11. [PMID: 26854107 DOI: 10.3109/08037051.2015.1127556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Blood pressure treatment has shown great efficacy in reducing cardiovascular events in randomized controlled trials. If this is effective in reducing cardiovascular disease in the general population, is less studied. Between 2001 and 2009 we performed an intervention to improve blood pressure control in the county of Västerbotten, using Södermanland County as a control. The intervention was directed towards primary care physicians and included lectures on blood pressure treatment, a computerized decision support system with treatment recommendations, and yearly feed back on hypertension control. Each county had approximately 255 000 inhabitants. Differences in age and incidence of cardiovascular disease were small. During follow-up, more than 400 000 patients had their blood pressure recorded. The mean number of measurements was eight per patient, yielding a total of 3.4 million blood pressure recordings. The effect of the intervention will be estimated combining the blood pressure data collected from the electronic medical records, with data on stroke, myocardial infarction and mortality from Swedish health registers. Additional variables, from health registers and Statistics Sweden, will be collected to address for confounders. The blood pressure data collected within this study will be an important asset for future epidemiological studies within the field of hypertension.
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Affiliation(s)
- Mattias Brunström
- a Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - John Dahlström
- a Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Lars Hjalmar Lindholm
- a Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Göran Lönnberg
- a Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Sara Hallström
- a Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Margareta Norberg
- a Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Lennarth Nyström
- a Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Mats Persson
- a Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Lars Weinehall
- a Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Bo Carlberg
- a Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
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Litorp H, Rööst M, Kidanto HL, Nyström L, Essén B. The effects of previous cesarean deliveries on severe maternal and adverse perinatal outcomes at a university hospital in Tanzania. Int J Gynaecol Obstet 2016; 133:183-7. [DOI: 10.1016/j.ijgo.2015.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 10/01/2015] [Accepted: 01/06/2016] [Indexed: 10/22/2022]
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Blomstedt Y, Norberg M, Stenlund H, Nyström L, Lönnberg G, Boman K, Wall S, Weinehall L. Impact of a combined community and primary care prevention strategy on all-cause and cardiovascular mortality: a cohort analysis based on 1 million person-years of follow-up in Västerbotten County, Sweden, during 1990-2006. BMJ Open 2015; 5:e009651. [PMID: 26685034 PMCID: PMC4691769 DOI: 10.1136/bmjopen-2015-009651] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the impact of the Västerbotten Intervention Programme (VIP) by comparing all eligible individuals (target group impact) according to the intention-to-treat principle and VIP participants with the general Swedish population. DESIGN Dynamic cohort study. SETTING/PARTICIPANTS All individuals aged 40, 50 or 60 years, residing in Västerbotten County, Sweden, between 1990 and 2006 (N=101,918) were followed from their first opportunity to participate in the VIP until age 75, study end point or prior death. INTERVENTION The VIP is a systematic, long-term, county-wide cardiovascular disease (CVD) intervention that is performed within the primary healthcare setting and combines individual and population approaches. The core component is a health dialogue based on a physical examination and a comprehensive questionnaire at the ages of 40, 50 and 60 years. PRIMARY OUTCOMES All-cause and CVD mortality. RESULTS For the target group, there were 5646 deaths observed over 1,054,607 person-years. Compared to Sweden at large, the standardised all-cause mortality ratio was 90.6% (95% CI 88.2% to 93.0%): for women 87.9% (95% CI 84.1% to 91.7%) and for men 92.2% (95% CI 89.2% to 95.3%). For CVD, the ratio was 95.0% (95% CI 90.7% to 99.4%): for women 90.4% (95% CI 82.6% to 98.7%) and for men 96.8% (95% CI 91.7 to 102.0). For participants, subject to further impact as well as selection, when compared to Sweden at large, the standardised all-cause mortality ratio was 66.3% (95% CI 63.7% to 69.0%), whereas the CVD ratio was 68.9% (95% CI 64.2% to 73.9%). For the target group as well as for the participants, standardised mortality ratios for all-cause mortality were reduced within all educational strata. CONCLUSIONS The study suggests that the VIP model of CVD prevention is able to impact on all-cause and cardiovascular mortality when evaluated according to the intention-to-treat principle.
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Affiliation(s)
- Yulia Blomstedt
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Centre for Population Studies, Ageing and Living Conditions Programme, Umeå University, Umeå, Sweden
| | - Margareta Norberg
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Centre for Population Studies, Ageing and Living Conditions Programme, Umeå University, Umeå, Sweden
| | - Hans Stenlund
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lennarth Nyström
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Göran Lönnberg
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kurt Boman
- Research Unit Medicine-Geriatric Clinic, Skellefteå County Hospital, Skellefteå, Sweden
- Department of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Stig Wall
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lars Weinehall
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Centre for Population Studies, Ageing and Living Conditions Programme, Umeå University, Umeå, Sweden
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Imhasly S, Bieli C, Naegeli H, Nyström L, Ruetten M, Gerspach C. Blood plasma lipidome profile of dairy cows during the transition period. BMC Vet Res 2015; 11:252. [PMID: 26446667 PMCID: PMC4597432 DOI: 10.1186/s12917-015-0565-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 09/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The transition period of dairy cows, around parturition and the onset of lactation, involves endocrine and metabolic changes to compensate for an increased energy requirement aggravated by reduced feed intake. Transition cows adjust to the resulting negative energy balance with the mobilization of lipids from the adipose tissues yielding increased blood levels of non-esterified fatty acids and ketone bodies like β-hydroxybutyrate. RESULTS To study the biochemical adaptations underlying this physiologic adjustment and possible pathologic derangements, we analyzed the blood plasma lipidome of transition cows by ultra-pressure liquid chromatography coupled to high-resolution quadrupole time-of-flight mass spectrometry. The resulting data were processed by principal component analysis, revealing over 60 lipid masses that change in abundance over the test period ranging from two weeks before calving to four weeks postpartum. Further characterization of analytes by tandem mass spectrometry demonstrated that the concentration of triacylglycerides in plasma drops at the day of parturition whereas the plasma level of many phosphatidylcholines and two sphingomyelins increases steadily during early lactation. CONCLUSION This newly identified shift in phospholipid composition delivers a potential biomarker to detect aberrant metabolic pathways in transition cows and also provides insights into how to prevent and treat associated disorders like fatty liver disease.
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Affiliation(s)
- S Imhasly
- Institute of Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland.
| | - C Bieli
- Department of Farm Animals, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland.
| | - H Naegeli
- Institute of Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland.
| | - L Nyström
- Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology, Schmelzbergstrasse 9, 8092, Zurich, Switzerland.
| | - M Ruetten
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, Zurich, Switzerland.
| | - C Gerspach
- Department of Farm Animals, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland.
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Moreau RA, Bach TJ, Nes WD, Parish EJ, Moser JK, Nyström L. 2014 G.J. Schroepfer Jr. Memorial AOCS Sterol Symposium: Recent Advances in Sterol Research. Lipids 2015. [PMID: 26210488 DOI: 10.1007/s11745-015-4051-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- R A Moreau
- Eastern Regional Research Center, USDA, ARS, Wyndmoor, PA, USA,
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Montazerolghaem M, Nyström L, Engqvist H, Karlsson Ott M. Zebrafish: A possible tool to evaluate bioactive ions. Acta Biomater 2015; 19:10-4. [PMID: 25770927 DOI: 10.1016/j.actbio.2015.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/04/2015] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
Abstract
Zebrafish is a well-established model organism with a skeletal structure that highly resembles mammalian bone. Yet its use in the research field of biomaterials has been limited. One area that could benefit from this model system is the evaluation of ionic dissolution products from different materials. As a proof of concept we have evaluated the effect of silicate ions on the zebrafish larvae and compared it to a well-known osteoblastic cell line, MC3T3-E1 subclone 14. We have shown that sodium metasilicate (125 μM and 625 μM) induces more mineralisation in a dose-dependent manner in zebrafish larvae, 9 days post fertilisation as compared to the non-treated group. Moreover the same trends were seen when adding sodium metasilicate to MC3T3-E1 cultures, with more mineralisation and higher ALP levels with higher doses of silicate (25, 125 and 625 μM). These results indicate the feasibility of zebrafish larvae for ionic dissolution studies. The zebrafish model is superior to isolated cell cultures in the aspect that it includes the whole bone remodelling system, with osteoblasts, osteoclasts and osteocytes. Zebrafish could thus provide a powerful in vivo tool and be a bridge between cell culture systems and mammalian models.
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Montelius A, Nyholm T, Gustafsson A, Karlsson M, Nyström L, Skönevik J, Zackrisson B. PO-0993: A national database solution for radiotherapy quality registries and clinical studies. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40985-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Svensson MK, Tyrberg M, Nyström L, Arnqvist HJ, Bolinder J, Östman J, Gudbjörnsdottir S, Landin-Olsson M, Eriksson JW. The risk for diabetic nephropathy is low in young adults in a 17-year follow-up from the Diabetes Incidence Study in Sweden (DISS). Older age and higher BMI at diabetes onset can be important risk factors. Diabetes Metab Res Rev 2015; 31:138-46. [PMID: 25044633 DOI: 10.1002/dmrr.2574] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 06/17/2014] [Indexed: 12/14/2022]
Abstract
AIMS The main objective of this study was to estimate the occurrence of diabetic nephropathy in a population-based cohort of patients diagnosed with diabetes as young adults (15-34 years). METHODS All 794 patients registered 1987-1988 in the Diabetes Incidence Study in Sweden (DISS) were invited to a follow-up study 15-19 years after diagnosis, and 468 (58%) participated. Analysis of islet antibodies was used to classify type of diabetes. RESULTS After median 17 years of diabetes, 15% of all patients, 14% T1DM and 25% T2DM, were diagnosed with diabetic nephropathy. Ninety-one percent had microalbuminuria and 8.6% macroalbuminuria. Older age at diagnosis (HR 1.05; 95% CI 1.01-1.10 per year) was an independent and a higher BMI at diabetes diagnosis (HR 1.04; 95% CI 1.00-1.09 per 1 kg/m²), a near-significant predictor of development of diabetic nephropathy. Age at onset of diabetes (p = 0.041), BMI (p = 0.012) and HbA1c (p < 0.001) were significant predictors of developing diabetic nephropathy between 9 and 17 years of diabetes. At 17 years of diabetes duration, a high HbA1c level (OR 1.06; 95% CI 1.03-1.08 per 1 mmol/mol increase) and systolic blood pressure (OR 1.08; 95% CI 1.05 1.12 per 1 mmHg increase) were associated with DN. CONCLUSIONS Patients with T2DM diagnosed as young adults seem to have an increased risk to develop diabetic nephropathy compared with those with T1DM. Older age and higher BMI at diagnosis of diabetes were risk markers for development of diabetic nephropathy. In addition, poor glycaemic control but not systolic blood pressure at 9 years of follow-up was a risk marker for later development of diabetic nephropathy.
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Affiliation(s)
- M K Svensson
- Department of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Hellquist BN, Czene K, Hjälm A, Nyström L, Jonsson H. Effectiveness of population-based service screening with mammography for women ages 40 to 49 years with a high or low risk of breast cancer: socioeconomic status, parity, and age at birth of first child. Cancer 2014; 121:251-8. [PMID: 25242087 DOI: 10.1002/cncr.29011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 07/09/2014] [Accepted: 07/23/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Invitation to mammography screening of women aged 40 to 49 years is a matter of debate in many countries and a cost-effective alternative in countries without screening among women aged 40 to 49 years could be inviting those at higher risk. The relative effectiveness of mammography screening was estimated for subgroups based on the breast cancer risk factors parity, age at time of birth of first child, and socioeconomic status (SES). METHODS The SCReening of Young Women (SCRY) database consists of all women aged 40 to 49 years in Sweden between 1986 and 2005 and was split into a study and control group. The study group consisted of women residing in areas in which women aged 40 to 49 years were invited to screening and the control group of women in areas in which women aged 40 to 49 years were not invited to screening. Rate ratio (RR) estimates were calculated for 2 exposures: invitation and attendance. RESULTS There were striking similarities noted in the RR pattern for women invited to and attending screening and no statistically significant difference or trend in the RR was noted by risk group. The RR estimates increased by increasing parity for parity of 0 to 2 and ranged from 0.55 (95% confidence interval [95% CI], 0.38-0.79) to 0.79 (95% CI, 0.65-0.95) for attending women. The RR for women with high SES was lower than that for women with low SES (RR, 0.72 [95% CI, 0.60-0.86] and RR, 0.79 [95% CI, 0.63-0.99], respectively). For women aged 20 to 24 years at the time of the birth of their first child, the RR was 0.73 (95% CI, 0.58-0.91) and estimates for other ages were similar. CONCLUSIONS There was no statistically significant difference noted in the relative effectiveness of mammography screening by parity, age at the time of birth of the first child, or SES.
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Litorp H, Kidanto HL, Rööst M, Abeid M, Nyström L, Essén B. Maternal near-miss and death and their association with caesarean section complications: a cross-sectional study at a university hospital and a regional hospital in Tanzania. BMC Pregnancy Childbirth 2014; 14:244. [PMID: 25056517 PMCID: PMC4133054 DOI: 10.1186/1471-2393-14-244] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 07/18/2014] [Indexed: 11/10/2022] Open
Abstract
Background The maternal near-miss (MNM) concept has been developed to assess life-threatening conditions during pregnancy, childhood, and puerperium. In recent years, caesarean section (CS) rates have increased rapidly in many low- and middle-income countries, a trend which might have serious effects on maternal health. Our aim was to describe the occurrence and panorama of maternal near-miss and death in two low-resource settings, and explore their association with CS complications. Methods We performed a cross-sectional study, including all women who fulfilled the WHO criteria for MNM or death between February and June 2012 at a university hospital and a regional hospital in Dar es Salaam, Tanzania. Cases were assessed individually to determine their association with CS. Main outcome measures included MNM ratio; maternal mortality ratio; proportion of MNM and death associated with CS complications; and the risk for such outcomes per 1,000 operations. The risk ratio of life-threatening CS complications at the university hospital compared to the regional hospital was calculated. Results We identified 467 MNM events and 77 maternal deaths. The MNM ratio was 36 per 1,000 live births (95% CI 33–39) and the maternal mortality ratio was 587 per 100,000 live births (95% CI 460–730). Major causes were eclampsia and postpartum haemorrhage, but we also detected nine MNM events and five deaths from iatrogenic complications. CS complications accounted for 7.9% (95% CI 5.6–11) of the MNM events and 13% (95% CI 6.4–23) of the maternal deaths. The risk of experiencing a life-threatening CS complication was three times higher at the regional hospital (22/1,000 operations, 95% CI 12–37) compared to the university hospital (7.0/1,000 operations, 95% CI 3.8–12) (risk ratio 3.2, 95% CI 1.5–6.6). Conclusions The occurrence of MNM and death at the two hospitals was high, and many cases were associated with CS complications. The maternal risks of CS in low-resource settings must not be overlooked, and measures should be taken to avoid unnecessary CSs. More comprehensive training of staff, improved postoperative surveillance, and a more even distribution of resources within the health care system might reduce the risks of CS. Electronic supplementary material The online version of this article (doi:10.1186/1471-2393-14-244) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Helena Litorp
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, 751 85 Uppsala, Sweden.
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Korhola M, Hakonen R, Juuti K, Edelmann M, Kariluoto S, Nyström L, Sontag-Strohm T, Piironen V. Production of folate in oat bran fermentation by yeasts isolated from barley and diverse foods. J Appl Microbiol 2014; 117:679-89. [DOI: 10.1111/jam.12564] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 05/29/2014] [Accepted: 06/03/2014] [Indexed: 11/29/2022]
Affiliation(s)
- M. Korhola
- Department of Biosciences; University of Helsinki; Helsinki Finland
| | - R. Hakonen
- Department of Biosciences; University of Helsinki; Helsinki Finland
| | - K. Juuti
- Department of Biosciences; University of Helsinki; Helsinki Finland
| | - M. Edelmann
- Department of Food and Environmental Sciences; University of Helsinki; Helsinki Finland
| | - S. Kariluoto
- Department of Food and Environmental Sciences; University of Helsinki; Helsinki Finland
| | - L. Nyström
- Department of Food and Environmental Sciences; University of Helsinki; Helsinki Finland
| | - T. Sontag-Strohm
- Department of Food and Environmental Sciences; University of Helsinki; Helsinki Finland
| | - V. Piironen
- Department of Food and Environmental Sciences; University of Helsinki; Helsinki Finland
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Rawshani A, Landin-Olsson M, Svensson AM, Nyström L, Arnqvist HJ, Bolinder J, Gudbjörnsdottir S. The incidence of diabetes among 0-34 year olds in Sweden: new data and better methods. Diabetologia 2014; 57:1375-81. [PMID: 24710965 PMCID: PMC4052006 DOI: 10.1007/s00125-014-3225-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 03/07/2014] [Indexed: 12/20/2022]
Abstract
AIMS/HYPOTHESIS We reassessed the validity of previously reported incidence rates for type 1 diabetes in 0-34 year olds in Sweden. We estimated new incidence rates through three nationwide registers. METHODS We used capture-recapture methods to assess ascertainment in the Diabetes Incidence Study in Sweden (DISS) and estimated incidence rates in the 20-34 year age group for 2007-2009. We examined whether incidence rates in patients aged 34 and younger could be estimated through the Prescribed Drug Register (PDR) via a proxy for diagnosis of type 1 diabetes; men with at least one and women with at least three prescriptions for insulin were included if they had not been given oral glucose-lowering drugs. We scrutinised the proxy by comparing incidence rates in patients aged 14 and younger with the Swedish Childhood Diabetes Register (SCDR), which has 95-99% ascertainment, and by assessing diabetes type among 18-34 year olds in the National Diabetes Register (NDR). RESULTS Incidence rates were two to three times higher than previously reported. The absolute number of cases (2007-2009, age 20-34) was 435 in the DISS, 923 in the NDR, 1,217 in the PDR, 1,431 in all three and 1,617 per the capture-recapture method. Ascertainment in the DISS was ~29% for 2007-2009. The proxy diagnosis in the PDR was highly reliable, while the capture-recapture method presumably generated an overestimate. CONCLUSIONS/INTERPRETATION The incidence of type 1 diabetes in patients aged 34 and younger was two to three times higher than previously reported. The PDR can be used to reliably assess incidence rates in this age group.
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Affiliation(s)
- Araz Rawshani
- Nationella Diabetesregistret, Registercentrum VGR, 413 45, Gothenburg, Sweden,
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Taha H, Nyström L, Al-Qutob R, Berggren V, Esmaily H, Wahlström R. Home visits to improve breast health knowledge and screening practices in a less privileged area in Jordan. BMC Public Health 2014; 14:428. [PMID: 24885063 PMCID: PMC4031932 DOI: 10.1186/1471-2458-14-428] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/23/2014] [Indexed: 11/10/2022] Open
Abstract
Background Breast cancer is the most common cancer afflicting women in Jordan. This study aimed to assess the effects of an educational intervention through home visits, including offering free mammography screening vouchers, on changing women’s breast health knowledge and screening practices for early detection of breast cancer in a less privileged area in Jordan. Methods Two thousand four hundred breast health awareness home visits were conducted and 2363 women aged 20-79 years (median: 41) answered a pre-test interview-administrated questionnaire to assess their breast health knowledge and practices at the baseline. After a home-based educational session, 625 women aged 40 years or older were referred to free mammography screening. Five hundred and ninety six homes were revisited six months later and out of these 593 women participated in a post-test. The women’s retained breast health knowledge, the changes in their reported breast health practices and their usage of the free mammography voucher, were assessed. Results The mean knowledge score increased significantly (p < 0.001) from 11.4 in the pre-test to 15.7 in the post-test (maximum score: 16). At the six month follow-up the post-test showed significant (p < 0.001) improvement in women’s perceived breast self-examination (BSE) knowledge, reported BSE practice and mammography screening. Out of 625 women that received a voucher for free mammography screening 73% attended the mammography unit, while only two women without a voucher went for mammography screening at the assigned unit. Women who received a follow-up visit were more likely to use the free mammography voucher compared to those who were not followed-up (83% vs. 67%; p < 0.001). Conclusions Home visits by local community outreach workers that incorporated education about breast cancer and breast health in addition to offering free mammography screening vouchers were effective in improving women’s breast health knowledge and practices in a less privileged area in Jordan.
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Affiliation(s)
- Hana Taha
- Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institute, Stockholm, Sweden.
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Kraslawski A, Pedrycz W, Nyström L. Fuzzy Neural Network as Instance Generator for Case-Based Reasoning System: An Example of Selection of Heat Exchange Equipment in Mixing Tanks. Neural Comput Appl 2014. [DOI: 10.1007/s005210050013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sjöstrand M, Carlson K, Arnqvist HJ, Gudbjörnsdottir S, Landin-Olsson M, Lindmark S, Nyström L, Svensson MK, Eriksson JW, Bolinder J. Assessment of beta-cell function in young patients with type 2 diabetes: arginine-stimulated insulin secretion may reflect beta-cell reserve. J Intern Med 2014; 275:39-48. [PMID: 24482829 DOI: 10.1111/joim.12116] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Simple methods for the evaluation of dynamic b-cell function in epidemiological and clinical studies of patients with type 2 diabetes (T2D) are needed. The aim of this study was to evaluate the dynamic beta-cell function in young patients with T2D with different disease durations and treatments. METHODS Overall, 54 subjects with T2D from the Diabetes Incidence Study in Sweden (DISS) and 23 healthy control participants were included in this cross-sectional study. Beta-cell function was assessed by intravenous (i.v.) administration of arginine followed by i.v. glucose. The acute insulin and C-peptide responses to arginine (AIRarg and Ac-pepRarg, respectively) and to glucose (AIRglu and Ac-pepRglu, respectively)were estimated.Homeostasis model assessment of b-cell function(HOMA-b) andCpeptide assessments were also used for comparisons between patients with T2D and control participants. RESULTS AIRarg and Ac-pepRarg, but not AIRglu and Ac-pepRglu, could differentiate between patients with different disease durations. AIRglu values were 89% (P < 0.001) lower and AIRarg values were 29% (P < 0.01) lower in patients with T2D compared with control participants. HOMA-b and fasting plasma C-peptide levels did not differ between the T2D and control groups. CONCLUSION In young patients with T2D, the insulin secretory response to i.v. glucose is markedly attenuated, whereas i.v. arginine-stimulated insulin release is better preserved and can distinguish between patients with different disease duration and antidiabetic therapies. This suggests that the i.v. arginine stimulation test may provide an estimate of functional beta-cell reserve.
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Affiliation(s)
| | | | - H. J. Arnqvist
- Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | | | - M. Landin-Olsson
- Department of Endocrinology and Diabetology; Lund University Hospital; Lund Sweden
| | - S. Lindmark
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
| | - L. Nyström
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
| | | | - J. W. Eriksson
- AstraZeneca R&D; Mölndal Sweden
- Sahlgrenska Academy Hospital; Gothenburg Sweden
| | - J. Bolinder
- Department of Medicine; Karolinska University Hospital Huddinge; Karolinska Institutet; Stockholm Sweden
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Prawirohartono EP, Nyström L, Nurdiati DS, Hakimi M, Lind T. The impact of prenatal vitamin A and zinc supplementation on birth size and neonatal survival - a double-blind, randomized controlled trial in a rural area of Indonesia. INT J VITAM NUTR RES 2013; 83:14-25. [PMID: 24220161 DOI: 10.1024/0300-9831/a000141] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prenatal supplementation with micronutrients may increase birth weight and thus improve infant health and survival in settings where infants and children are at risk of micronutrient deficiencies. OBJECTIVE To assess whether vitamin A and/or zinc supplementation given during pregnancy can improve birth weight, birth length, neonatal morbidity, or infant mortality. METHODS A double-blind, randomized controlled trial supplementing women (n = 2173) in Central Java, Indonesia throughout pregnancy with vitamin A, zinc, combined vitamin A+zinc, or placebo. RESULTS Out of 2173 supplemented pregnant women, 1956 neonates could be evaluated. Overall, zinc supplementation improved birth length compared to placebo or combined vitamin A+zinc (48.8 vs. 48.5 cm, p = 0.04); vitamin A supplementation improved birth length compared to placebo or combined vitamin A+zinc (48.7 vs. 48.2 cm, p = 0.04). These effects remained after adjusting for maternal height, pre-pregnancy weight, and parity. There was no effect of supplementation on birth weight, the proportion of low birth weight, neonatal morbidity, or mortality. CONCLUSIONS Prenatal zinc or vitamin A supplementation demonstrates a small but significant effect on birth length, but supplementation with zinc, vitamin A or a combination of zinc and vitamin A, have no effect on birth weight, neonatal morbidity, or mortality.
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Affiliation(s)
- Endy P Prawirohartono
- Department of Child Health, Medical School, Gadjah Mada University, Yogyakarta, Indonesia
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Sundblad BM, Jansson SA, Nyström L, Arvidsson P, Lundbäck B, Larsson K. Chronic obstructive pulmonary disease (COPD) during the two last years of life--a retrospective study of decedents. PLoS One 2013; 8:e84110. [PMID: 24367631 PMCID: PMC3868592 DOI: 10.1371/journal.pone.0084110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 11/12/2013] [Indexed: 11/18/2022] Open
Abstract
Background Little is known about the management of patients suffering from chronic obstructive pulmonary disease (COPD) during the last years of life. The aim of the study was to describe how management of COPD is performed in Sweden during the last two years of life. Methods From the nationwide Cause of Death register all individuals with COPD as the underlying cause of death during two years were identified in one sparsely and one densely populated area of Sweden. Data were collected from medical records using a pre-defined protocol, especially developed for this purpose. Results Of 822 individuals with COPD as underlying cause of death, medical records from 729 were available. The COPD diagnosis was based on lung function measurements in approximately half of the patients and median age at COPD diagnosis was 74 years (range 34-95). Women died at younger age, median 78 years (range 52-96) than did men (80 years (51-99)). The median survival time from diagnosis to death was 6 years in men and women in both areas. Among women and men 8.3% and 4.3% were never smokers, respectively. The structure of COPD management differed between the two areas, with utilization of physiotherapists, dieticians and working therapists being more used in the northern area, likely because of differences in accessibility to care institutions. Conclusions In Sweden COPD is mostly diagnosed late in life and often not verified by lung function measurements. Opposite to the general population, women with COPD die at a lower age than men.
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Affiliation(s)
- Britt-Marie Sundblad
- Lung and Allergy Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Sven-Arne Jansson
- Lung and Allergy Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lennarth Nyström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Bo Lundbäck
- Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kjell Larsson
- Lung and Allergy Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Taha H, Al-Qutob R, Nyström L, Wahlström R, Berggren V. "Would a man smell a rose then throw it away?" Jordanian men's perspectives on women's breast cancer and breast health. BMC Womens Health 2013; 13:41. [PMID: 24160268 PMCID: PMC4016416 DOI: 10.1186/1472-6874-13-41] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 10/17/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Breast cancer is the most common malignancy afflicting women, and the most common cancer overall in Jordan. A woman's decision to go for screening is influenced by her social support network. This study aims to explore Jordanian men's individual and contextual perspectives on women's breast cancer and their own role in the breast health of the females within their families. METHODS An explorative qualitative design was used to purposively recruit 24 married men aged 27 to 65 years (median 43 years) from four governorates in Jordan. Data in the form of interviews transcriptions was subjected to qualitative content analysis. RESULTS Three themes were identified: a) Supporting one's wife; b) Marital needs and obligations; c) Constrained by a culture of destiny and shame. The first theme was built on men's feelings of responsibility for the family's health and well-being, their experiences of encouraging their wives to seek health care and their providing counselling and instrumental support. The second theme emerged from men's views about other men's rejection of a wife inflicted by breast cancer, their own perceptions of diminished femininity due to mastectomy and their own concerns about protecting the family from the hereditary risk of breast cancer. The third theme was seen in men's perception of breast cancer as an inevitable act of God that is far away from one's own family, in associating breast cancer with improper behaviour and in their readiness to face the culture of Eib (shame). CONCLUSIONS Jordanian men perceive themselves as having a vital role in supporting, guiding and encouraging their wives to follow breast cancer early detection recommendations. Breast health awareness campaigns could involve husbands to capitalize on family support.
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Affiliation(s)
- Hana Taha
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
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Sparring V, Nyström L, Wahlström R, Jonsson PM, Ostman J, Burström K. Diabetes duration and health-related quality of life in individuals with onset of diabetes in the age group 15-34 years - a Swedish population-based study using EQ-5D. BMC Public Health 2013; 13:377. [PMID: 23607813 PMCID: PMC3640903 DOI: 10.1186/1471-2458-13-377] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 02/21/2013] [Indexed: 12/26/2022] Open
Abstract
Background Diabetes with onset in younger ages affects both length of life and health status due to debilitating and life-threatening long-term complications. In addition, episodes and fear of hypoglycaemia and of long-term consequences may have a substantial impact on health status. This study aims to describe and analyse health-related quality of life (HRQoL) in individuals with onset of diabetes at the age of 15—34 years and with a disease duration of 1, 8, 15 and 24 years compared with control individuals matched for age, sex and county of residence. Methods Cross-sectional study of 839 individuals with diabetes and 1564 control individuals. Data on socioeconomic status and HRQoL using EQ-5D were collected by a postal questionnaire. Insulin treatment was self-reported by 94% of the patients, the majority most likely being type 1. Results Individuals with diabetes reported lower HRQoL, with a significantly lower mean EQ VAS score in all cohorts of disease duration compared with control individuals for both men and women, and with a significantly lower EQ-5Dindex for women, but not for men, 15 years (0.76, p = 0.022) and 24 years (0.77, p = 0.016) after diagnosis compared with corresponding control individuals. Newly diagnosed individuals with diabetes reported significantly more problems compared with the control individuals in the dimension usual activities (women: 13.2% vs. 4.0%, p = 0.048; men: 11.4% vs. 4.1%, p = 0.033). In the other dimensions, differences between individuals with diabetes and control individuals were found 15 and 24 years after diagnosis: for women in the dimensions mobility, self-care, usual activities and pain/discomfort and for men in the dimension mobility. Multivariable regression analysis showed that diabetes duration, being a woman, having a lower education and not being married or cohabiting had a negative impact on HRQoL. Conclusions Our study confirms the negative impact of diabetes on HRQoL and that the difference to control individuals increased by disease duration for women with diabetes. The small difference one year after diagnosis could imply a good management of diabetes care and a relatively quick adaptation. Our results also indicate that gender differences still exist in Sweden, despite modern diabetes treatment and management in Sweden.
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Affiliation(s)
- Vibeke Sparring
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18 A, SE-17177 Stockholm, Sweden.
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Sahlen KG, Johansson H, Nyström L, Lindholm L. Health coaching to promote healthier lifestyle among older people at moderate risk for cardiovascular diseases, diabetes and depression: a study protocol for a randomized controlled trial in Sweden. BMC Public Health 2013; 13:199. [PMID: 23497163 PMCID: PMC3599987 DOI: 10.1186/1471-2458-13-199] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 02/28/2013] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The challenge of an aging population in the society makes it important to find strategies to promote health for all. The aim of this study is to evaluate if repeated health coaching in terms of motivational interviewing, and an offer of wide range of activities, will contribute to positive lifestyle modifications and health among persons aged 60-75 years, with moderately elevated risk for cardiovascular disease (CVD), diabetes, or mild depression. METHODS/DESIGN Men and women between 60 and 75 are recruited in four regions in Sweden if they fulfill one or more of the four inclusion criteria. • Current reading of blood pressure (140-159/90-99) without medication. • Current reading of blood sugar (Hba1c 42-52 mmol/mol) without medication. • A current waist-circumference of ≥94 cm for men and ≥80 for women. • A minor/mild depression (12-20 points) according to Montgomery-Åsberg Depression Rating Scale without medication.Individuals with a worse result than inclusion criteria are treated according to regular guidelines at the PHCs and therefore not included. Exclusion criteria for the study are dementia, mental illness or other condition deemed unsuitable for participation. All participants fill out a questionnaire at baseline, and at the 6-, 12- and 18-month follow-ups containing questions on demographic characteristics, social life, HRQoL, lifestyle habits, general health/medication, self-rated mental health, and sense of coherence. At the 12-month follow-up, the health coach will give each participant a second questionnaire to capture attitudes and perceptions related to health coaching and venues/activities offered. Qualitative data will be collected twice to obtain a deeper understanding of perceptions and attitudes related to health and lifestyle/lifestyle modifications. A health economic assessment will be performed. Individual costs for health care utilisation will be collected and QALY-scores will be estimated. DISCUSSION Several drawbacks can be identified when conducting research in real life. However, many of the identified problems can diminish the positive results of the intervention and if the intervention shows positive effects they might be underestimated. TRIAL REGISTRATION Current Controlled Trials ISRCTN01396033.
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Affiliation(s)
- Klas-Göran Sahlen
- Department of Public Health and Clinical Medicine, Division of Epidemiology and Global Health, Umeå University, SE-901 85 Umeå, Sweden
- 2Department of Nursing, Umeå University, SE-901 85 Umeå, Sweden
| | - Helene Johansson
- Department of Public Health and Clinical Medicine, Division of Epidemiology and Global Health, Umeå University, SE-901 85 Umeå, Sweden
| | - Lennarth Nyström
- Department of Public Health and Clinical Medicine, Division of Epidemiology and Global Health, Umeå University, SE-901 85 Umeå, Sweden
| | - Lars Lindholm
- Department of Public Health and Clinical Medicine, Division of Epidemiology and Global Health, Umeå University, SE-901 85 Umeå, Sweden
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Njor S, Nyström L, Moss S, Paci E, Broeders M, Segnan N, Lynge E. Breast cancer mortality in mammographic screening in Europe: a review of incidence-based mortality studies. J Med Screen 2013; 19 Suppl 1:33-41. [PMID: 22972809 DOI: 10.1258/jms.2012.012080] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To estimate the impact of service mammography screening on breast cancer mortality using European incidence-based mortality (IBM) studies (or refined mortality studies). IBM studies include only breast cancer deaths occurring in women with breast cancer diagnosed after their first invitation to screening. METHODS We conducted a literature review and identified 20 publications based on IBM studies. They were classified according to the method used for estimating the expected breast cancer mortality in the absence of screening: (1) women not yet invited; (2) historical data from the same region as well as from historical and current data from a region without screening; and (3) historical comparison group combined with data for non-participants. RESULTS The estimated effect of mammography screening on breast cancer mortality varied across studies. The relative risks were 0.76-0.81 in group 1; 0.75-0.90 in group 2; and 0.52-0.89 in group 3. Study databases overlapped in both Swedish and Finnish studies, adjustment for lead time was not optimal in all studies, and some studies had other methodological limitations. There was less variability in the relative risks after allowing for the methodological shortcomings. CONCLUSIONS Based on evidence from the most methodologically sound IBM studies, the most likely impact of European service mammography screening programmes was a breast cancer mortality reduction of 26% (95% confidence interval 13-36%) among women invited for screening and followed up for 6-11 years.
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Affiliation(s)
- Sisse Njor
- Department of Public Health, Post Doc, Centre for Epidemiology and Screening, University of Copenhagen,Copenhagen, Denmark.
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Andersen CD, Bennet L, Nyström L, Lindblad U, Lindholm E, Groop L, Rolandsson O. Worse glycaemic control in LADA patients than in those with type 2 diabetes, despite a longer time on insulin therapy. Diabetologia 2013; 56:252-8. [PMID: 23096095 DOI: 10.1007/s00125-012-2759-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 09/24/2012] [Indexed: 10/27/2022]
Abstract
AIMS/HYPOTHESIS Our aim was to study whether glycaemic control differs between individuals with latent autoimmune diabetes in adults (LADA) and patients with type 2 diabetes, and whether it is influenced by time on insulin therapy. METHODS We performed a retrospective study of 372 patients with LADA (205 men and 167 women; median age 54 years, range 35-80 years) from Swedish cohorts from Skåne (n = 272) and Västerbotten (n = 100). Age- and sex-matched patients with type 2 diabetes were included as controls. Data on the use of oral hypoglycaemic agents (OHAs), insulin and insulin-OHA combination therapy was retrieved from the medical records. Poor glycaemic control was defined as HbA(1c) ≥7.0% (≥53 mmol/mol) at follow-up. RESULTS The individuals with LADA and with type 2 diabetes were followed for an average of 107 months. LADA patients were leaner than type 2 diabetes patients at diagnosis (BMI 27.7 vs 31.0 kg/m(2); p < 0.001) and follow-up (BMI 27.9 vs 30.2 kg/m(2); p < 0.001). Patients with LADA had been treated with insulin for longer than those with type 2 diabetes (53.3 vs 28.8 months; p < 0.001). There was no significant difference between the patient groups with regard to poor glycaemic control at diagnosis, but more patients with LADA (67.8%) than type 2 diabetes patients (53.0%; p < 0.001) had poor glycaemic control at follow-up. Patients with LADA had worse glycaemic control at follow-up compared with participants with type 2 diabetes (OR = 1.8, 95% CI 1.2, 2.7), adjusted for age at diagnosis, HbA(1c), BMI at diagnosis, follow-up time and duration of insulin treatment. CONCLUSIONS/INTERPRETATION Individuals with LADA have worse glycaemic control than patients with type 2 diabetes despite a longer time on insulin therapy.
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Affiliation(s)
- C D Andersen
- Department of Clinical Sciences, Lund University, Malmö, Sweden
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Broeders M, Moss S, Nyström L, Njor S, Jonsson H, Paap E, Massat N, Duffy S, Lynge E, Paci E. The impact of mammographic screening on breast cancer mortality in Europe: a review of observational studies. J Med Screen 2013; 19 Suppl 1:14-25. [PMID: 22972807 DOI: 10.1258/jms.2012.012078] [Citation(s) in RCA: 270] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To assess the impact of population-based mammographic screening on breast cancer mortality in Europe, considering different methodologies and limitations of the data. METHODS We conducted a systematic literature review of European trend studies (n = 17), incidence-based mortality (IBM) studies (n = 20) and case-control (CC) studies (n = 8). Estimates of the reduction in breast cancer mortality for women invited versus not invited and/or for women screened versus not screened were obtained. The results of IBM studies and CC studies were each pooled using a random effects meta-analysis. RESULTS Twelve of the 17 trend studies quantified the impact of population-based screening on breast cancer mortality. The estimated breast cancer mortality reductions ranged from 1% to 9% per year in studies reporting an annual percentage change, and from 28% to 36% in those comparing post- and prescreening periods. In the IBM studies, the pooled mortality reduction was 25% (relative risk [RR] 0.75, 95% confidence interval [CI] 0.69-0.81) among invited women and 38% (RR 0.62, 95% CI 0.56-0.69) among those actually screened. The corresponding pooled estimates from the CC studies were 31% (odds ratio [OR] 0.69, 95% CI 0.57-0.83), and 48% (OR 0.52, 95% CI 0.42-0.65) adjusted for self-selection. CONCLUSIONS Valid observational designs are those where sufficient longitudinal individual data are available, directly linking a woman's screening history to her cause of death. From such studies, the best 'European' estimate of breast cancer mortality reduction is 25-31% for women invited for screening, and 38-48% for women actually screened. Much of the current controversy on breast cancer screening is due to the use of inappropriate methodological approaches that are unable to capture the true effect of mammographic screening.
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Affiliation(s)
- Mireille Broeders
- Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre & National Expert and Training Centre for Breast Cancer Screening, Nijmegen, The Netherlands.
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Kisanga F, Nyström L, Hogan N, Emmelin M. Parents' experiences of reporting child sexual abuse in urban Tanzania. J Child Sex Abus 2013; 22:481-498. [PMID: 23829829 DOI: 10.1080/10538712.2013.800936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This article reports parental experiences of legally reporting child sexual abuse in Tanzania. Based on in-depth interviews, four types of sexual abuse incidents are portrayed. Each evokes different reactions from parents and the community. An incident characterized as the innocent child was associated with a determination to seek justice. The forced-sex youth elicited feelings of parental betrayal of their child. The consenting curious youth resulted in uncertainty of how to proceed, while the transactional-sex youth evoked a sense of parental powerlessness to control the child because of low economic status. Differentiating between types of sexual abuse incidents may increase awareness of the complexities of child sexual abuse reporting. Education on laws regulating sexual offenses and a functional national child protection system are needed to address child sexual abuse complexities and safeguard the rights of children in Tanzania.
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Affiliation(s)
- Felix Kisanga
- Community Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
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Norberg M, Blomstedt Y, Lönnberg G, Nyström L, Stenlund H, Wall S, Weinehall L. Community participation and sustainability--evidence over 25 years in the Västerbotten Intervention Programme. Glob Health Action 2012; 5:1-9. [PMID: 23528041 PMCID: PMC3525921 DOI: 10.3402/gha.v5i0.19166] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 10/16/2012] [Accepted: 11/21/2012] [Indexed: 11/14/2022] Open
Abstract
Background Selection bias and declining participation rates are of concern in many long-term epidemiological studies. The Västerbotten Intervention Programme (VIP) was launched in 1985 as a response to alarming reports on elevated cardiovascular disease (CVD) mortality in Västerbotten County in Northern Sweden. The VIP invites women and men to a health examination and health counselling during the year of their 40th, 50th, and 60th birthdays. Objective To evaluate trends in participation rates and determinants of participation in the VIP from 1990 to 2006. Design Registry data on socio-economic status from Statistics Sweden, and mortality and hospitalisation data from the National Board of Health and Welfare, both covering the whole Swedish population, were linked to the VIP and analysed for participants and non-participants. Results During 1990–2006, 117,710 individuals were eligible to participate in the VIP, and 40,472 of them were eligible to participate twice. There were 96,560 observations for participants and 61,622 for non-participants. The overall participation rate increased from 56 to 65%. Participants and non-participants had minimal differences in education and age. Initial small differences by sex and degree of urban residence decreased over time. Despite an increasing participation rate in all groups, those with low income or who were single had an approximately 10% lower participation rate than those with high or medium-income or who were married or cohabitating. Conclusion Sustainability of the VIP is based on organisational integration into primary health care services and targeting of the entire middle-aged population. This enables the programme to meet population expectations of health promotion and to identify high-risk individuals who are then entered into routine preventive health care services. This has the potential to increase participation rates, to minimise social selection bias, and to reinforce other community-based interventions.
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Affiliation(s)
- Margareta Norberg
- Ageing and Living Conditions Programme, Centre for Population Studies, Umeå University, Umeå, Sweden.
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Moss S, Nyström L, Jonsson H, Paci E, Lynge E, Njor S, Broeders M. The Impact of Mammographic Screening on Breast Cancer Mortality in Europe: A Review of Trend Studies. J Med Screen 2012; 19 Suppl 1:26-32. [DOI: 10.1258/jms.2012.012079] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Sm Moss
- Professor of Cancer Epidemiology, Centre for Cancer Prevention, Wolfson Institute for Preventive Medicine, Queen Mary University of London, London, UK
| | - L Nyström
- Associate Professor of Epidemiology, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - H Jonsson
- Associate Professor of Cancer Epidemiology, Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - E Paci
- Director, Clinical and Descriptive Epidemiology Unit, ISPO, Cancer Research and Prevention Institute, Florence, Italy
| | - E Lynge
- Professor of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
| | - S Njor
- Post Doc, Centre for Epidemiology and Screening, University of Copenhagen, Denmark
| | - M Broeders
- Senior Epidemiologist, Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, and National Expert and Training Centre for Breast Cancer Screening, Nijmegen, The Netherlands
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Taha H, Al-Qutob R, Nyström L, Wahlström R, Berggren V. "Voices of fear and safety" women's ambivalence towards breast cancer and breast health: a qualitative study from Jordan. BMC Womens Health 2012; 12:21. [PMID: 22834874 PMCID: PMC3526536 DOI: 10.1186/1472-6874-12-21] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 07/12/2012] [Indexed: 11/21/2022]
Abstract
Background Breast cancer is the leading cause of cancer mortality among Jordanian women. Breast malignancies are detected at late stages as a result of deferred breast health-seeking behaviour. The aim of this study was to explore Jordanian women’s views and perceptions about breast cancer and breast health. Methods We performed an explorative qualitative study with purposive sampling. Ten focus groups were conducted consisting of 64 women (aged 20 to 65 years) with no previous history and no symptoms of breast cancer from four governorates in Jordan. The transcribed data was analysed using latent content analysis. Results Three themes were constructed from the group discussions: a) Ambivalence in prioritizing own health; b) Feeling fear of breast cancer; and c) Feeling safe from breast cancer. The first theme was seen in women’s prioritizing children and family needs and in their experiencing family and social support towards seeking breast health care. The second theme was building on women’s perception of breast cancer as an incurable disease associated with suffering and death, their fear of the risk of diminished femininity, husband’s rejection and social stigmatization, adding to their apprehensions about breast health examinations. The third theme emerged from the women’s perceiving themselves as not being in the risk zone for breast cancer and in their accepting breast cancer as a test from God. In contrast, women also experienced comfort in acquiring breast health knowledge that soothed their fears and motivated them to seek early detection examinations. Conclusions Women’s ambivalence in prioritizing their own health and feelings of fear and safety could be better addressed by designing breast health interventions that emphasize the good prognosis for breast cancer when detected early, involve breast cancer survivors in breast health awareness campaigns and catalyse family support to encourage women to seek breast health care.
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Affiliation(s)
- Hana Taha
- Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
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