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Wallbing U, Nilsson S, Wigert H, Lundberg M. Adolescents' experiences of Help Overcoming Pain Early-A school based person-centred intervention for adolescents with chronic pain. Paediatr Neonatal Pain 2023; 5:119-126. [PMID: 38149219 PMCID: PMC10749401 DOI: 10.1002/pne2.12113] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/15/2023] [Accepted: 06/07/2023] [Indexed: 12/28/2023]
Abstract
To illuminate adolescents' experiences of Help Overcoming Pain Early (HOPE), a person-centred intervention delivered in a school setting by school nurses. Twenty-one adolescents with chronic pain recruited from secondary school, who had completed the HOPE intervention, were included in the interview study. The HOPE intervention was built on person-centred ethics and consisted of four meetings between school nurses and adolescents on the subject of stress and pain management. A qualitative method using content analysis with an inductive approach was employed. In the interviews, the adolescents describe how they reclaim their lives with the help of HOPE. They use different strategies and parts of the intervention to move on with their lives. A trustful relationship, as that with the school nurse, was essential to dare to change. The overarching theme summarizes in Becoming myself again and is built up by three sub-themes: Trust a pillar for growth, Making sense of my life with pain, and Putting myself into the world again. A person-centred intervention such as HOPE applied in a school context is promising for promoting confidence in adolescents with chronic pain. A trust-building process emerged, in terms of both the adolescents' trust in the healthcare staff they meet and their confidence in their own ability to handle and influence their situation, which in the long term can promote trust in themselves as a person.
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Affiliation(s)
- U. Wallbing
- Institute of Health and Care Sciences, and the University of Gothenburg Centre for Person‐Centred Care (GPCC), Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - S. Nilsson
- Institute of Health and Care Sciences, and the University of Gothenburg Centre for Person‐Centred Care (GPCC), Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - H. Wigert
- Institute of Health and Care Sciences, and the University of Gothenburg Centre for Person‐Centred Care (GPCC), Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Division of NeonatologySahlgrenska University HospitalGothenburgSweden
| | - M. Lundberg
- Institute of Health and Care Sciences, and the University of Gothenburg Centre for Person‐Centred Care (GPCC), Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of Health Promoting ScienceSophiahemmet UniversityStockholmSweden
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Ahlqvist VH, Madley-Dowd P, Ly A, Rast J, Lundberg M, Jónsson-Bachmann E, Berglind D, Rai D, Magnusson C, Lee BK. Bias amplification of unobserved confounding in pharmacoepidemiological studies using indication-based sampling. Pharmacoepidemiol Drug Saf 2023; 32:886-897. [PMID: 36919941 DOI: 10.1002/pds.5614] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE Estimating causal effects in observational pharmacoepidemiology is a challenging task, as it is often plagued by confounding by indication. Restricting the sample to those with an indication for drug use is a commonly performed procedure; indication-based sampling ensures that the exposed and unexposed are exchangeable on the indication-limiting the potential for confounding by indication. However, indication-based sampling has received little scrutiny, despite the hazards of exposure-related covariate control. METHODS Using simulations of varying levels of confounding and applied examples we describe bias amplification under indication-based sampling. RESULTS We demonstrate that indication-based sampling in the presence of unobserved confounding can give rise to bias amplification, a self-inflicted phenomenon where one inflates pre-existing bias through inappropriate covariate control. Additionally, we show that indication-based sampling generally leads to a greater net bias than alternative approaches, such as regression adjustment. Finally, we expand on how bias amplification should be reasoned about when distinct clinically relevant effects on the outcome among those with an indication exist (effect-heterogeneity). CONCLUSION We conclude that studies using indication-based sampling should have robust justification - and that it should by no means be considered unbiased to adopt such approaches. As such, we suggest that future observational studies stay wary of bias amplification when considering drug indications.
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Affiliation(s)
- Viktor H Ahlqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Paul Madley-Dowd
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Amanda Ly
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Jessica Rast
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Michael Lundberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Daniel Berglind
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Dheeraj Rai
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre, University of Bristol, Bristol, UK
- Bristol Autism Spectrum Service, Avon and Wiltshire Partnership NHS Mental Health Trust, Bristol, UK
| | - Cecilia Magnusson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Brian K Lee
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
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Hellgren J, Lundberg M, Rubek N, von Buchwald C, Steinsvåg S, Mäkitie A. Unmet challenges in septoplasty–nordic studies from a uniform healthcare and geographical area. Front Surg 2022; 9:1061440. [DOI: 10.3389/fsurg.2022.1061440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022] Open
Abstract
PurposeNasal septoplasty is one of the most common surgical procedures in otorhinolaryngology and optimising both patient selection and the surgery is a challenge. The Nordic countries have similar public healthcare systems and comparable populations in terms of size.MethodsThis is a review of studies of outcome and predictors related to septoplasty from Denmark, Finland, Norway and Sweden, published during the last decade. The aim of this review was to identify areas in need of further research to meet the challenges of septoplasty in the Nordic countries with reference to international data.ResultsPostoperative patient satisfaction at 6–12 months was reported in around 2/3 of the patients and well in line with international data. Patients with more severe symptoms had a higher chance of improvement. Lack of standardisation in patient selection, surgical methods and skills, and follow up procedures, still makes it difficult to explain the 25% failure rate in septoplasty surgery.ConclusionThis review of the Nordic studies from the last decade shows that septoplasty in general is effective in relieving nasal obstruction. There is a need for studies addressing the standardisation of diagnostic tools and algorithms and the systematic and continuous implementation of follow-up of the surgical results at both departmental and personal level. This includes an awareness of how surgical skills in septoplasty are obtained and maintained.
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Stark I, Rai D, Lundberg M, Culpin I, Nordström SI, Ohlis A, Magnusson C. Autism and self-harm: A population-based and discordant sibling study of young individuals. Acta Psychiatr Scand 2022; 146:468-477. [PMID: 35867636 DOI: 10.1111/acps.13479] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Self-harm among young autistic individuals is a clinical challenge, and the risk of premature death by suicide is strongly increased in this group. Using the advantage of total-population and family-based data, we investigated whether autism per se is a risk factor for self-harm independently of psychiatric comorbidities and how it differs from self-harm in non-autistic individuals. METHODS We used The Stockholm Youth Cohort, a total-population register study, including all residents in Stockholm County aged 0-17 years between 2001 and 2011.Study participants were followed from age 10 to 27 for hospital admissions because of self-harm. We used modified Poisson regression to calculate relative risks (RR) using robust standard error to derive 95% confidence intervals (CI). RESULTS In all, 410,732 individuals were included in the cohort (9,070 with a diagnosis of autism). Autistic individuals had a fivefold increased adjusted relative risk of self-harm (RR 5.0 [95% CI 4.4-5.6]). The risk increase was more pronounced for autism without intellectual disability and particularly high for self-cutting 10.2 [7.1-14.7] and more violent methods 8.9 [5.2-15.4]. The association between autism and self-harm was independent of, but clearly exacerbated by comorbid psychiatric conditions. It was of similar magnitude as risks linked to these conditions per se, and not explained by shared familial factors. CONCLUSION Self-harm severe enough to present to medical services is as common in autistic youth as in those with depression or ADHD. Potentially more lethal methods are more likely to be used of autistic self-harmers.
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Affiliation(s)
- Isidora Stark
- Karolinska Institutet, Department of Global Public Health, Stockholm, Sweden
| | - Dheeraj Rai
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Michael Lundberg
- Karolinska Institutet, Department of Global Public Health, Stockholm, Sweden
| | - Iryna Culpin
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, Bristol, UK.,Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | | | - Anna Ohlis
- Karolinska Institutet, Department of Global Public Health, Stockholm, Sweden
| | - Cecilia Magnusson
- Karolinska Institutet, Department of Global Public Health, Stockholm, Sweden
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Björkman I, Feldthusen C, Forsgren E, Jonnergård A, Lindström Kjellberg I, Wallengren Gustafsson C, Lundberg M. Person-centred care on the move - an interview study with programme directors in Swedish higher education. BMC Med Educ 2022; 22:589. [PMID: 35915496 PMCID: PMC9341055 DOI: 10.1186/s12909-022-03657-4] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND There is an increasing trend towards person-centred care (PCC) worldwide, suggesting that PCC should be mastered by future health care professionals. This study aims to explore programme directors' views on facilitators and barriers to implementing PCC in four of the largest national study programmes in Sweden training future health care professionals. METHODS A qualitative design was applied and interviews were conducted with 19 programme directors of Swedish national study programmes in medicine, nursing, occupational therapy and physiotherapy. The interviews were analysed using qualitative content analysis. Themes were sorted according to the Consolidated Framework for Implementation Research (CFIR) in an abductive approach. COREQ guidelines were applied. RESULTS The overarching theme, as interpreted from the programme directors' experiences, was 'Person-centred care is on the move at different paces.' The theme relates to the domains identified by the CFIR as outer setting, innovation, inner setting and process. PCC was understood as something familiar but yet new, and the higher education institutions were in a state of understanding and adapting PCC to their own contexts. The movement in the outer setting consists of numerous stakeholders advocating for increased patient influence, which has stirred a movement in the inner setting where the higher educational institutions are trying to accommodate these new demands. Different meanings and values are ascribed to PCC, and the concept is thus also 'on the move', being adapted to traditions at each educational setting. CONCLUSION Implementation of PCC in Swedish higher education is ongoing but fragmented and driven by individuals with a specific interest. There is uncertainty and ambiguity around the meaning and value of PCC and how to implement it. More knowledge is needed about the core of PCC as a subject for teaching and learning and also didactic strategies suitable to support students in becoming person-centred practitioners.
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Affiliation(s)
- I Björkman
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 40530, Gothenburg, Sweden.
| | - C Feldthusen
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - E Forsgren
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 40530, Gothenburg, Sweden
| | - A Jonnergård
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 40530, Gothenburg, Sweden
| | - I Lindström Kjellberg
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 40530, Gothenburg, Sweden
| | - C Wallengren Gustafsson
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 40530, Gothenburg, Sweden
| | - M Lundberg
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 40530, Gothenburg, Sweden
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
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Mansell G, den Hollander M, Lotzke H, Smeets RJEM, Lundberg M. A Person-Centred Prehabilitation Program based on Cognitive-Behavioural Physical Therapy for patients scheduled for Lumbar Fusion surgery: A mediation analysis to assess fear of movement (kinesiophobia), self-efficacy, and catastrophizing as mediators of health outcomes. Eur J Pain 2022; 26:1790-1799. [PMID: 35802065 PMCID: PMC9543490 DOI: 10.1002/ejp.2004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/12/2021] [Revised: 06/21/2022] [Accepted: 07/03/2022] [Indexed: 12/02/2022]
Abstract
Objective To investigate whether early changes in fear of movement (kinesiophobia), self‐efficacy and catastrophizing were mediators of the relationship between allocation to the pre‐habilitation intervention and later changes in health outcomes. Methods The original pre‐habilitation trial (PREPARE, ISRCTN17115599) recruited 118 participants awaiting lumbar fusion surgery, half of whom received a prehabilitation intervention designed based on the modified fear‐avoidance model and half of whom received usual care. Mediation analysis was performed to test each mediator separately. Analysis was performed on each outcome of interest separately (Oswestry disability index, patient‐specific function, EQ general health and moderate/vigorous physical activity). Mediation analysis was carried out using PROCESS. Beta coefficients and bootstrapped 95% CIs were used to interpret the results. Results None of the potential mediators was found to mediate the relationship between allocation to the intervention and 3‐month scores on any of the health outcomes tested. Conclusions Screening patients for higher levels of catastrophizing and fear avoidance and lower levels of self‐efficacy could help ensure only the patients who are most likely to benefit from the intervention are included. Significance Prehabilitation interventions for spinal fusion surgery have been found to improve health outcomes for patients. Theory‐based interventions that target key mechanisms are more effective at improving outcomes than non‐theory‐based interventions. While no mediating effects were found for this particular intervention, the analysis suggests that the underlying theoretical model and treatment targets are appropriate and could drive improvement if more strongly targeted.
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Affiliation(s)
- G Mansell
- School of Psychology, Aston University, Aston Triangle, B4 7ET, Birmingham, UK
| | - M den Hollander
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, and Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University
| | - H Lotzke
- Back in Motion Research Group, Ängelholm Hospital, Department of Rehabilitation, 262 81, Ängelholm, Sweden
| | - R J E M Smeets
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University and CIR Revalidatie, location Eindhoven, The Netherlands
| | - M Lundberg
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden.,University of Gothenburg, Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Sweden
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7
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Morinaga M, Hollander AC, Heuvelman H, Lundberg M, Dalman C, Rai D, Magnusson C. Migration and risk of intellectual disability with and without autism: A population-based cohort study. Acta Psychiatr Scand 2021; 144:487-500. [PMID: 34273179 DOI: 10.1111/acps.13350] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/23/2021] [Accepted: 07/12/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate whether parental migration, parental region of origin, timing of child's birth in relation to maternal migration and parental reason for migration are associated with intellectual disability (ID) with and without autism. METHODS We used a register-based cohort of all individuals aged 0-17 years in Stockholm County during 2001-2011. General estimating equation logistic model and additionally sibling comparison were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). The models were adjusted for child's sex and birth year and parental age at child's birth, and additionally for migrant-specific variables in the analyses including only children with migrant parent(s). RESULTS Within the eligible sample of 670,098 individuals, 3781 (0.6%) had ID with autism, and 5076 (0.8%) had ID without autism. Compared with children with Swedish-born parents, children with both parents born abroad had an increased risk of ID with autism (OR = 1.6, CI 1.5-1.8) and ID without autism (OR = 1.9, CI 1.7-2.0). Among these children with both parents born abroad, it was protective of ID with autism when the child's birth occurred before and later than four years after maternal migration, which was replicated in the sibling comparison. The associations with both conditions were more pronounced with parental origin in regions comprising low- and middle-income countries and with reasons other than work or study. CONCLUSIONS Parental migration is associated with ID regardless of co-occurrence of autism. Our results indicate an association between environmental factors during pregnancy related to migration and offspring ID with autism, although further confirmative studies are needed.
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Affiliation(s)
- Maki Morinaga
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Hein Heuvelman
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Michael Lundberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Christina Dalman
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Dheeraj Rai
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,NIHR Biomedical Research Centre, University of Bristol, Bristol, UK.,Avon and Wiltshire Partnership National Health Service Mental Health Trust, Bath, UK
| | - Cecilia Magnusson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Bergqvist R, Ahlqvist VH, Lundberg M, Hergens MP, Sundström J, Bell M, Magnusson C. HMG-CoA reductase inhibitors and COVID-19 mortality in Stockholm, Sweden: A registry-based cohort study. PLoS Med 2021; 18:e1003820. [PMID: 34648516 PMCID: PMC8516243 DOI: 10.1371/journal.pmed.1003820] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/20/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The relationship between statin treatment and Coronavirus Disease 2019 (COVID-19) mortality has been discussed due to the pleiotropic effects of statins on coagulation and immune mechanisms. However, available observational studies are hampered by study design flaws, resulting in substantial heterogeneity and ambiguities. Here, we aim to determine the relationship between statin treatment and COVID-19 mortality. METHODS AND FINDINGS This cohort study included all Stockholm residents aged 45 or older (N = 963,876), followed up from 1 March 2020 until 11 November 2020. The exposure was statin treatment initiated before the COVID-19-pandemic, defined as recorded statin dispensation in the Swedish Prescribed Drug Register between 1 March 2019 and 29 February 2020. COVID-19-specific mortality was ascertained from the Swedish Cause of Death Registry. Hazard ratios (HRs) were calculated using multivariable Cox regression models. We further performed a target trial emulation restricted to initiators of statins. In the cohort (51.6% female), 169,642 individuals (17.6%) were statin users. Statin users were older (71.0 versus 58.0 years), more likely to be male (53.3% versus 46.7%), more often diagnosed with comorbidities (for example, ischemic heart disease 23.3% versus 1.6%), more frequently on anticoagulant and antihypertensive treatments, less likely to have a university-level education (34.5% versus 45.4%), and more likely to have a low disposable income (20.6% versus 25.2%), but less likely to reside in crowded housing (6.1% versus 10.3%). A total of 2,545 individuals died from COVID-19 during follow-up, including 765 (0.5%) of the statin users and 1,780 (0.2%) of the nonusers. Statin treatment was associated with a lowered COVID-19 mortality (adjusted HR, 0.88; 95% CI, 0.79 to 0.97, P = 0.01), and this association did not vary appreciably across age groups, sexes, or COVID-19 risk groups. The confounder adjusted HR for statin treatment initiators was 0.78 (95% CI, 0.59 to 1.05, P = 0.10) in the emulated target trial. Limitations of this study include the observational design, reliance on dispensation data, and the inability to study specific drug regimens. CONCLUSIONS Statin treatment had a modest negative association with COVID-19 mortality. While this finding needs confirmation from randomized clinical trials, it supports the continued use of statin treatment for medical prevention according to current recommendations also during the COVID-19 pandemic.
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Affiliation(s)
- Rita Bergqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Viktor H. Ahlqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Michael Lundberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Maria-Pia Hergens
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Communicable Disease Control and Prevention, Region Stockholm, Stockholm, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Max Bell
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Magnusson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
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Byhamre ML, Araghi M, Alfredsson L, Bellocco R, Engström G, Eriksson M, Galanti MR, Jansson JH, Lager A, Lundberg M, Östergren PO, Pedersen NL, Trolle Lagerros Y, Ye W, Wennberg P, Magnusson C. Swedish snus use is associated with mortality: a pooled analysis of eight prospective studies. Int J Epidemiol 2021; 49:2041-2050. [PMID: 33347584 PMCID: PMC7825961 DOI: 10.1093/ije/dyaa197] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Accepted: 09/28/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The health consequences of the use of Swedish snus, including its relationship with mortality, have not been fully established. We investigated the relationship between snus use and all-cause and cause-specific mortality (death due to cardiovascular diseases, cancer diseases and all other reasons, respectively) in a nationwide collaborative pooling project. METHODS We followed 169 103 never-smoking men from eight Swedish cohort studies, recruited in 1978-2010. Shared frailty models with random effects at the study level were used in order to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of mortality associated with snus use. RESULTS Exclusive current snus users had an increased risk of all-cause mortality (aHR 1.28, 95% CI 1.20-1.35), cardiovascular mortality (aHR 1.27, 95% CI 1.15-1.41) and other cause mortality (aHR 1.37, 95% CI 1.24-1.52) compared with never-users of tobacco. The risk of cancer mortality was also increased (aHR 1.12, 95% CI 1.00-1.26). These mortality risks increased with duration of snus use, but not with weekly amount. CONCLUSIONS Snus use among men is associated with increased all-cause mortality, cardiovascular mortality, with death from other causes and possibly with increased cancer mortality.
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Affiliation(s)
- Marja Lisa Byhamre
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Marzieh Araghi
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Rino Bellocco
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Marie Eriksson
- Department of Statistics, Umeå School of Business, Economics, and Statistics, Umeå University, Umeå, Sweden
| | - Maria Rosaria Galanti
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Jan-Håkan Jansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Skellefteå, Sweden
| | - Anton Lager
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Michael Lundberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Per-Olof Östergren
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ylva Trolle Lagerros
- Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.,Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Cecilia Magnusson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
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Madley-Dowd P, Lundberg M, Heron J, Zammit S, Ahlqvist VH, Magnusson C, Rai D. Maternal smoking and smokeless tobacco use during pregnancy and offspring development: sibling analysis in an intergenerational Swedish cohort. Int J Epidemiol 2021; 50:1840-1851. [PMID: 34999852 PMCID: PMC8743113 DOI: 10.1093/ije/dyab095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Accepted: 04/14/2021] [Indexed: 11/24/2022] Open
Abstract
Background The association between maternal smoking in pregnancy and offspring intellectual disability (ID) is less well understood than that of smoking and fetal growth restriction. As fetal growth and cognitive development may share similar confounding structures, comparison of the two associations may improve understanding of the causal nature of the association with ID. Furthermore, comparisons of smoking with smokeless tobacco use may aid identification of mechanisms of action. Methods This was a cohort study of all Swedish births between 1999 and 2012 (n = 1 070 013), with prospectively recorded data. We assessed the association between maternal smoking during pregnancy and offspring outcomes ID and born small for gestational age (SGA). Analyses were repeated for snus use in pregnancy. Using a sibling design, we estimated within-family effects that control for shared sibling characteristics. Results Those exposed to maternal smoking in pregnancy had increased odds of ID [odds ratio (OR) = 1.24, 95% confidence interval (CI): 1.16-1.33] and SGA (OR = 2.19, 95% CI: 2.11-2.27) after confounder adjustment. Within-family effects were found for SGA (OR = 1.44, 95% CI: 1.27-1.63) but not ID (OR = 0.92, 95% CI: 0.74-1.14). For snus use, the results for ID were similar to smoking. We found increased odds of offspring SGA among mothers who used snus in pregnancy in sensitivity analyses but not in primary analyses. Conclusions Our findings are consistent with a causal effect of maternal smoking in pregnancy on risk of offspring born SGA but not on risk of ID. We found no evidence for a causal effect of snus use in pregnancy on ID and inconclusive evidence for SGA.
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Affiliation(s)
- Paul Madley-Dowd
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Lundberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Jon Heron
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Stanley Zammit
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Viktor H Ahlqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Magnusson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Dheeraj Rai
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Avon and Wiltshire Partnership, NHS Mental Health Trust, Bristol, UK
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11
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Döring N, Lundberg M, Dalman C, Hemmingsson T, Rasmussen F, Wallin AS, Wicks S, Magnusson C, Lager A. Labour market position of young people and premature mortality in adult life: A 26-year follow-up of 569 528 Swedish 18 year-olds. Lancet Reg Health Eur 2021; 3:100048. [PMID: 34557798 PMCID: PMC8454531 DOI: 10.1016/j.lanepe.2021.100048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Throughout the industrialized world, demand for low skilled labour is falling. The length of schooling is increasing in response, but so is the proportion of individuals not finishing upper secondary school. The objective of this study was to evaluate the associations between labour market positions at age 18 and all-cause and suicide- and accident-specific mortality in later adulthood. METHODS Labour market positions at age 18 were categorized for all Swedes born 1972-77 (n=630 959) into four main groups: employed, successful students, students not about to qualify (SNAQs), and individuals not in employment, education or training (NEETs). Cox proportional hazard models were fitted to assess all-cause, suicide and accident mortality up to 2016 (ages 39-44), adjusting for high school grades, parental and own prior psychiatric diagnoses, and childhood socioeconomic status. FINDINGS SNAQs had substantially increased all-cause (men: HR=2.10; 95% CI 1.92-2.28, women: HR=1.64; 95% CI: 1.44-1.86), suicide (men: HR=2.16; CI: 1.86-2.51, women: HR=2.10; 95% CI 1.64-2.69), and accident specific (men: HR=2.08; 95% CI 1.77-2.44, women: 1.87; 95% CI 1.33;2.62) mortality risks compared to successful students. The risks were similar for NEETs. There was no increased risk among full-time employed compared to successful students. INTERPRETATION Expanding the educational system may be a natural response to falling demand for low skilled labour but not by far one that corrects the major societal challenge of it. Unless educational systems adequately respond to this challenge, only more inequality is to be expected ahead. FUNDING This work was supported by a grant to FR and AL from the Swedish Research Council for Health, Working Life, and Welfare with contract number (2014-2009).
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Affiliation(s)
- Nora Döring
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Michael Lundberg
- Department of Global Public Health, Prevention Intervention and Mechanisms in Public Health (PRIME Health), Karolinska Institutet, Sweden
| | - Christina Dalman
- Department of Global Public Health, Epidemiology of Psychiatric Conditions, Substance Use and Social Environment (EPiCSS), Karolinska Institutet, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Tomas Hemmingsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Departmet of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Finn Rasmussen
- Department of Global Public Health, Karolinska Institutet, Sweden, Retired
| | - Alma Sörberg Wallin
- Department of Global Public Health, Epidemiology of Psychiatric Conditions, Substance Use and Social Environment (EPiCSS), Karolinska Institutet, Sweden
| | - Susanne Wicks
- Department of Global Public Health, Epidemiology of Psychiatric Conditions, Substance Use and Social Environment (EPiCSS), Karolinska Institutet, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Cecilia Magnusson
- Department of Global Public Health, Prevention Intervention and Mechanisms in Public Health (PRIME Health), Karolinska Institutet, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Anton Lager
- Department of Global Public Health, Prevention Intervention and Mechanisms in Public Health (PRIME Health), Karolinska Institutet, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
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12
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Stark I, Liao P, Magnusson C, Lundberg M, Rai D, Lager A, Idring Nordström S. Qualification for upper secondary education in individuals with autism without intellectual disability: Total population study, Stockholm, Sweden. Autism 2020; 25:1036-1046. [PMID: 33246359 PMCID: PMC8111225 DOI: 10.1177/1362361320975929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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
This study used the Stockholm Youth Cohort, a total population cohort (N = 364,957), to describe patterns and predictors of qualification for upper secondary education, defined by passing graduation grades in core compulsory school subjects in contemporary young individuals diagnosed with autism spectrum disorders without intellectual disability (n = 6138). At the expected age for graduation, 16 years, 29% (adjusted rate difference 95% confidence interval (28.0–30.0)) fewer autistic than non-autistic individuals were qualified for upper secondary education (57% and 86%, respectively). Comorbid attention-deficit hyperactivity disorder further increased this difference. Within the group of autistic students without intellectual disability, female sex and lower family income were associated with non-qualification for upper secondary education. The proportion of students with autism without intellectual disability who qualified for upper secondary education increased at age 20. These findings underline the need for improved support for students with a diagnosis of autism without intellectual disability in mainstream education.
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Affiliation(s)
| | - Peiwen Liao
- Karolinska Institutet, Sweden.,University of New South Wales (UNSW), Australia
| | | | | | | | - Anton Lager
- Karolinska Institutet, Sweden.,Stockholm County Council, Sweden
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13
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Araghi M, Galanti MR, Lundberg M, Liu Z, Ye W, Lager A, Engström G, Alfredsson L, Knutsson A, Norberg M, Wennberg P, Lagerros YT, Bellocco R, Pedersen NL, Östergren PO, Magnusson C. No association between moist oral snuff (snus) use and oral cancer: pooled analysis of nine prospective observational studies. Scand J Public Health 2020; 49:833-840. [PMID: 32466721 DOI: 10.1177/1403494820919572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 12/26/2022]
Abstract
Aims: Worldwide, smokeless-tobacco use is a major risk factor for oral cancer. Evidence regarding the particular association between Swedish snus use and oral cancer is, however, less clear. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess the association between snus use and oral cancer. Methods: A total of 418,369 male participants from nine cohort studies were followed up for oral cancer incidence through linkage to health registers. We used shared frailty models with random effects at the study level, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for confounding factors. Results: During 9,201,647 person-years of observation, 628 men developed oral cancer. Compared to never-snus use, ever-snus use was not associated with oral cancer (adjusted HR 0.90, 95% CI: 0.74, 1.09). There were no clear trends in risk with duration or intensity of snus use, although lower intensity use (⩽ 4 cans/week) was associated with a reduced risk (HR 0.65, 95% CI: 0.45, 0.94). Snus use was not associated with oral cancer among never smokers (HR 0.87, 95% CI: 0.57, 1.32). Conclusions: Swedish snus use does not appear to be implicated in the development of oral cancer in men.
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Affiliation(s)
- Marzieh Araghi
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Maria Rosaria Galanti
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Sweden
| | - Michael Lundberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Zhiwei Liu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Anton Lager
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Sweden
| | | | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - Anders Knutsson
- Department of Health Sciences, Mid Sweden University, Sweden
| | - Margareta Norberg
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | | | - Ylva Trolle Lagerros
- Clinical Epidemiology Unit, Karolinska Institutet, Sweden.,Clinic of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital Huddinge, Sweden
| | - Rino Bellocco
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.,Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | | | - Cecilia Magnusson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Sweden
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14
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Lindblad R, Kjellsson L, Couto RC, Timm M, Bülow C, Zamudio-Bayer V, Lundberg M, von Issendorff B, Lau JT, Sorensen SL, Carravetta V, Ågren H, Rubensson JE. X-Ray Absorption Spectrum of the N_{2}^{+} Molecular Ion. Phys Rev Lett 2020; 124:203001. [PMID: 32501042 DOI: 10.1103/physrevlett.124.203001] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 01/15/2020] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
The x-ray absorption spectrum of N_{2}^{+} in the K-edge region has been measured by irradiation of ions stored in a cryogenic radio frequency ion trap with synchrotron radiation. We interpret the experimental results with the help of restricted active space multiconfiguration theory. Spectroscopic constants of the 1σ_{u}^{-1} ^{2}Σ_{u}^{+} state, and the two 1σ_{u}^{-1}3σ_{g}^{-1}1π_{g} ^{2}Π_{u} states are determined from the measurements. The charge of the ground state together with spin coupling involving several open shells give rise to double excitations and configuration mixing, and a complete breakdown of the orbital picture for higher lying core-excited states.
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Affiliation(s)
- R Lindblad
- Department of Physics, Lund University, Box 118, SE-22100 Lund, Sweden
- Abteilung für Hochempfindliche Röntgenspektroskopie, Helmholtz-Zentrum Berlin für Materialien und Energie, Albert-Einstein-Str. 15, 12489 Berlin, Germany
- Inorganic Chemistry, Department of Chemistry-Ångström Laboratory, Uppsala University, SE-75121 Uppsala, Sweden
| | - L Kjellsson
- Department of Physics and Astronomy, Uppsala University, Box 516, SE-751 20 Uppsala, Sweden
- European XFEL GmbH, Holzkoppel 4, 22869 Schenefeld, Germany
| | - R C Couto
- Theoretical Chemistry, Department of Chemistry-Ångström Laboratory, Uppsala University, SE-75121 Uppsala, Sweden
- Theoretical Chemistry and Biology, School of Chemistry, Biotechnology and Health, Royal Institute of Technology, SE-106 91 Stockholm, Sweden
| | - M Timm
- Abteilung für Hochempfindliche Röntgenspektroskopie, Helmholtz-Zentrum Berlin für Materialien und Energie, Albert-Einstein-Str. 15, 12489 Berlin, Germany
- Institut für Optik und Atomare Physik, Technische Universität Berlin, Hardenbergstr. 36, 10623 Berlin, Germany
| | - C Bülow
- Abteilung für Hochempfindliche Röntgenspektroskopie, Helmholtz-Zentrum Berlin für Materialien und Energie, Albert-Einstein-Str. 15, 12489 Berlin, Germany
- Physikalisches Institut, Albert-Ludwigs-Universität Freiburg, Hermann-Herder-Str. 3, 79104 Freiburg, Germany
| | - V Zamudio-Bayer
- Abteilung für Hochempfindliche Röntgenspektroskopie, Helmholtz-Zentrum Berlin für Materialien und Energie, Albert-Einstein-Str. 15, 12489 Berlin, Germany
| | - M Lundberg
- Theoretical Chemistry, Department of Chemistry-Ångström Laboratory, Uppsala University, SE-75121 Uppsala, Sweden
| | - B von Issendorff
- Physikalisches Institut, Albert-Ludwigs-Universität Freiburg, Hermann-Herder-Str. 3, 79104 Freiburg, Germany
| | - J T Lau
- Abteilung für Hochempfindliche Röntgenspektroskopie, Helmholtz-Zentrum Berlin für Materialien und Energie, Albert-Einstein-Str. 15, 12489 Berlin, Germany
- Physikalisches Institut, Albert-Ludwigs-Universität Freiburg, Hermann-Herder-Str. 3, 79104 Freiburg, Germany
| | - S L Sorensen
- Department of Physics, Lund University, Box 118, SE-22100 Lund, Sweden
| | | | - H Ågren
- Department of Physics and Astronomy, Uppsala University, Box 516, SE-751 20 Uppsala, Sweden
- Theoretical Chemistry and Biology, School of Chemistry, Biotechnology and Health, Royal Institute of Technology, SE-106 91 Stockholm, Sweden
- College of Chemistry and Chemical Engineering, Henan University, Kaifeng, Henan 475004, People's Republic of China
| | - J-E Rubensson
- Department of Physics and Astronomy, Uppsala University, Box 516, SE-751 20 Uppsala, Sweden
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15
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Sainio S, Blomgren K, Lundberg M. Complications and number of follow-up visits after using septal stapler in septoplasty. Rhinology 2019; 57:273-278. [PMID: 30938377 DOI: 10.4193/rhin18.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Septoplasties have traditionally been closed with transseptal sutures, silicone splints, or packing with nasal tamponade. In 2015, our clinic began to employ a septal stapler. The stapler adheres the mucosa to the septal cartilage with bioresorbable staples, replacing both sutures and silicone splints and limiting the use of nasal tamponade for bleeding cases. The complications of stapler versus other methods have not been reported on previously. Thus, the aim of this study was to investigate whether the use of stapler in septoplasties makes a difference in complication rates, operation time, or number of follow-up visits when compared to the traditional closure or filling methods. METHODOLOGY Patient records from 101 septoplasties in which the stapler had been used, and a reference group of 356 septoplasties in which the stapler had not been used, were retrospectively reviewed and analysed. RESULTS No significant difference was seen in the complication rate between the stapler and the control group. Overall follow-up visits were fewer in the stapler group when compared to the control group, however there was no significant difference in the number of unplanned follow-up visits between the groups. CONCLUSIONS By using the stapler in septoplasty, the number of postoperative follow-up visits might be reduced. Neither complication rate, nor operation time differed when using the stapler as compared to the traditional methods of closure.
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Affiliation(s)
- S Sainio
- Department of Otorhinolaryngology, University of Helsinki, Helsinki, Finland
| | - K Blomgren
- Department of Otorhinolaryngology, University of Helsinki, Helsinki, Finland; Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
| | - M Lundberg
- Department of Otorhinolaryngology, University of Helsinki, Helsinki, Finland; Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
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16
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Lundberg M, Haapaniemi A, Hagstrom J, Juteau S, Hernberg M, Makitie AA, Vento SI. Similar survival outcome after endoscopic and open approaches for sinonasal mucosal melanoma. Rhinology 2019; 57:132-138. [PMID: 30471227 DOI: 10.4193/rhin18.123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To describe a cohort of sinonasal mucosal melanoma (SNMM) patients, and to assess if choice of surgical approach (open versus endoscopic) has impact on survival. METHODOLOGY Adequate data on clinical presentation, treatment, and recurrence pattern were available for 58 consecutive patients treated for SNMM at the Helsinki University Hospital (HUH) between 1983 and 2016. RESULTS The 5-year disease-specific survival (DSS) was 27% and overall survival 25% for the whole cohort. The 3-year DSS for patients treated with curative intent with endoscopic surgery was comparable to open surgery (56% and 51%, respectively). Patients with tumours arising from the paranasal sinuses and patients with Stage IV disease had significantly worse prognosis compared with other locations and Stage III patients. All patients who had disease persistence at three months after primary treatment succumbed to SNMM. Post-operative radiotherapy did not affect survival significantly, but a trend towards improved local control was observed. CONCLUSIONS Local control after endoscopic surgery was comparable to open surgery. Small tumours without local or locoregional spread had improved prognosis, independent of surgical approach. Disease persistence after treatment with curative intent led to death invariably.
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Affiliation(s)
- M Lundberg
- Department of Otorhinolaryngology â€" Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A Haapaniemi
- Department of Otorhinolaryngology â€" Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J Hagstrom
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - S Juteau
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M Hernberg
- Department of Oncology, Comprehensive Cancer Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - A A Makitie
- Department of Otorhinolaryngology â€" Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolin
| | - S I Vento
- Department of Otorhinolaryngology â€" Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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17
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Błachucki W, Kayser Y, Czapla-Masztafiak J, Guo M, Juranić P, Kavčič M, Källman E, Knopp G, Lundberg M, Milne C, Rehanek J, Sá J, Szlachetko J. Inception of electronic damage of matter by photon-driven post-ionization mechanisms. Struct Dyn 2019; 6:024901. [PMID: 31041363 PMCID: PMC6450797 DOI: 10.1063/1.5090332] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 03/21/2019] [Indexed: 05/30/2023]
Abstract
"Probe-before-destroy" methodology permitted diffraction and imaging measurements of intact specimens using ultrabright but highly destructive X-ray free-electron laser (XFEL) pulses. The methodology takes advantage of XFEL pulses ultrashort duration to outrun the destructive nature of the X-rays. Atomic movement, generally on the order of >50 fs, regulates the maximum pulse duration for intact specimen measurements. In this contribution, we report the electronic structure damage of a molecule with ultrashort X-ray pulses under preservation of the atoms' positions. A detailed investigation of the X-ray induced processes revealed that X-ray absorption events in the solvent produce a significant number of solvated electrons within attosecond and femtosecond timescales that are capable of coulombic interactions with the probed molecules. The presented findings show a strong influence on the experimental spectra coming from ionization of the probed atoms' surroundings leading to electronic structure modification much faster than direct absorption of photons. This work calls for consideration of this phenomenon in cases focused on samples embedded in, e.g., solutions or in matrices, which in fact concerns most of the experimental studies.
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Affiliation(s)
- W. Błachucki
- Institute of Physical Chemistry, Polish Academy of Sciences, 01-224 Warsaw, Poland
| | - Y. Kayser
- Physikalisch-Technische Bundesanstalt, 10587 Berlin, Germany
| | | | - M. Guo
- Department of Chemistry–Ångström Laboratory, Uppsala University, 75120 Uppsala, Sweden
| | - P. Juranić
- Paul Scherrer Institute, CH-5232 Villigen-PSI, Switzerland
| | - M. Kavčič
- Jozef Stefan Institute, SI-1000 Ljubljana, Slovenia
| | - E. Källman
- Department of Chemistry–Ångström Laboratory, Uppsala University, 75120 Uppsala, Sweden
| | - G. Knopp
- Paul Scherrer Institute, CH-5232 Villigen-PSI, Switzerland
| | - M. Lundberg
- Department of Chemistry–Ångström Laboratory, Uppsala University, 75120 Uppsala, Sweden
| | - C. Milne
- Paul Scherrer Institute, CH-5232 Villigen-PSI, Switzerland
| | - J. Rehanek
- Paul Scherrer Institute, CH-5232 Villigen-PSI, Switzerland
| | - J. Sá
- Authors to whom correspondence should be addressed:; ; and
| | - J. Szlachetko
- Institute of Nuclear Physics, Polish Academy of Sciences, 31-342 Kraków, Poland
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18
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Sorjonen K, Lundberg M, Melin B. Using Logistic Regression to Predict Onset and Recovery With Tau Equivalency. Front Psychol 2018; 9:1849. [PMID: 30327630 PMCID: PMC6174221 DOI: 10.3389/fpsyg.2018.01849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/16/2018] [Accepted: 09/10/2018] [Indexed: 11/23/2022] Open
Abstract
Many studies analyze the effect of a predictor X on the onset or recovery of an outcome Y, for example some kind of disorder. The findings from this simulation study indicate that such effects can be found even if there are no changes in individuals’ true scores on the outcome, i.e., with tau equivalency, given some degree of positive test-retest correlation of the outcome and a correlation between the predictor and the outcome at baseline. Researchers predicting onset/recovery should be aware of this fact and in order not to draw hasty conclusions to control for what can be expected from these correlations alone.
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Affiliation(s)
- Kimmo Sorjonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Kimmo Sorjonen,
| | - Michael Lundberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Bo Melin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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19
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Rai D, Heuvelman H, Dalman C, Culpin I, Lundberg M, Carpenter P, Magnusson C. Association Between Autism Spectrum Disorders With or Without Intellectual Disability and Depression in Young Adulthood. JAMA Netw Open 2018; 1:e181465. [PMID: 30646131 PMCID: PMC6324523 DOI: 10.1001/jamanetworkopen.2018.1465] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [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: 12/27/2022] Open
Abstract
IMPORTANCE Depression is a frequently occurring mental disorder and may be common in adults with autism spectrum disorders (ASD), but there is a lack of longitudinal population-based studies examining this association. Whether any increased risk of depression in ASD has a shared familial basis and whether it differs by co-occurring intellectual disability is not well known. OBJECTIVES To examine whether individuals with ASD are more likely to be diagnosed as having depression in adulthood than the general population and their nonautistic siblings and to investigate whether these risks differ by the presence or absence of intellectual disability. DESIGN, SETTING, AND PARTICIPANTS Population-based cohort study with a nested sibling comparison. The Stockholm Youth Cohort is a total population record linkage study that includes all children and young people (age range, 0-17 years) who were ever resident in Stockholm County, Sweden, between January 2001 and December 2011 (n = 735 096). Data analysis was conducted between January 5 and November 30, 2017, in Stockholm County, Sweden. MAIN OUTCOMES AND MEASURES Clinical diagnosis of depressive disorders was identified using the Stockholm County Adult Psychiatric Outpatient Register and the Swedish National Patient Register. RESULTS Participants were 223 842 individuals followed up to age 27 years by 2011, of whom 4073 had diagnosed ASD (mean [SD] age, 21.5 [2.7] years; 65.9% male; 2927 without intellectual disability and 1146 with intellectual disability) and 219 769 had no ASD (mean [SD] age, 22.1 [2.8] years; 50.9% male). By age 27 years, 19.8% (n = 808) of individuals diagnosed having ASD had a diagnosis of depression compared with 6.0% (n = 13 114) of the general population (adjusted relative risk [RR], 3.64; 95% CI, 3.41-3.88). The risk of a depression diagnosis was higher in ASD without intellectual disability (adjusted RR, 4.28; 95% CI, 4.00-4.58) than in ASD with intellectual disability (adjusted RR, 1.81; 95% CI, 1.51-2.17). Nonautistic full-siblings (adjusted RR, 1.37; 95% CI, 1.23-1.53) and half-siblings (adjusted RR, 1.42; 95% CI, 1.23-1.64) of individuals with ASD also had a higher risk of depression than the general population. Compared with their nonautistic full-siblings, individuals with ASD had more than a 2-fold risk of a depression diagnosis (adjusted odds ratio, 2.50; 95% CI, 1.91-3.27) in young adulthood. CONCLUSIONS AND RELEVANCE According to this study's results, ASD, particularly ASD without intellectual disability, is associated with depression by young adulthood compared with the general population. It appears that this association is unlikely to be explained by shared familial liability. Future research to identify modifiable pathways between ASD and depression may assist in the development of preventive interventions.
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Affiliation(s)
- Dheeraj Rai
- National Institute for Health Research Biomedical Research Centre, University of Bristol, Bristol, United Kingdom
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Avon and Wiltshire Partnership National Health Service Mental Health Trust, Bristol, United Kingdom
| | - Hein Heuvelman
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Christina Dalman
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Health Care Services, Stockholm, Sweden
| | - Iryna Culpin
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Michael Lundberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Health Care Services, Stockholm, Sweden
| | - Peter Carpenter
- Avon and Wiltshire Partnership National Health Service Mental Health Trust, Bristol, United Kingdom
| | - Cecilia Magnusson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Health Care Services, Stockholm, Sweden
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20
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Yang F, Pedersen NL, Ye W, Liu Z, Norberg M, Forsgren L, Trolle Lagerros Y, Bellocco R, Alfredsson L, Knutsson A, Jansson JH, Wennberg P, Galanti MR, Lager ACJ, Araghi M, Lundberg M, Magnusson C, Wirdefeldt K. Moist smokeless tobacco (Snus) use and risk of Parkinson's disease. Int J Epidemiol 2018; 46:872-880. [PMID: 27940486 DOI: 10.1093/ije/dyw294] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2016] [Indexed: 01/09/2023] Open
Abstract
Background Cigarette smoking is associated with a lower risk of Parkinson's disease. It is unclear what constituent of tobacco smoke may lower the risk. Use of Swedish moist smokeless tobacco (snus) can serve as a model to disentangle what constituent of tobacco smoke may lower the risk. The aim of this study was to determine whether snus use was associated with a lower risk of Parkinson's disease. Methods Individual participant data were collected from seven prospective cohort studies, including 348 601 men. We used survival analysis with multivariable Cox regression to estimate study-specific relative risk of Parkinson's disease due to snus use, and random-effects models to pool estimates in a meta-analysis. The primary analyses were restricted to never-smokers to eliminate the potential confounding effect of tobacco smoking. Results During a mean follow-up time of 16.1 years, 1199 incident Parkinson's disease cases were identified. Among men who never smoked, ever-snus users had about 60% lower Parkinson's disease risk compared with never-snus users [pooled hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.28-0.61]. The inverse association between snus use and Parkinson's disease risk was more pronounced in current (pooled HR 0.38, 95% CI 0.23-0.63), moderate-heavy amount (pooled HR 0.41, 95% CI 0.19-0.90) and long-term snus users (pooled HR 0.44, 95% CI 0.24-0.83). Conclusions Non-smoking men who used snus had a substantially lower risk of Parkinson's disease. Results also indicated an inverse dose-response relationship between snus use and Parkinson's disease risk. Our findings suggest that nicotine or other components of tobacco leaves may influence the development of Parkinson's disease.
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Affiliation(s)
- Fei Yang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Zhiwei Liu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Margareta Norberg
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine
| | - Lars Forsgren
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Ylva Trolle Lagerros
- Department of Medicine, Clinical Epidemiology Unit.,Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Rino Bellocco
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Knutsson
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Jan-Håkan Jansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Maria Rosaria Galanti
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Anton C J Lager
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Marzieh Araghi
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Michael Lundberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Magnusson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Karin Wirdefeldt
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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21
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Christensson A, Ljunggren L, Nilsson-Thorell C, Arge B, Diehl U, Hagstam KE, Lundberg M. In vivo Comparative Evaluation of Hemodialysis Tubing Plasticized with DEHP and TEHTM. Int J Artif Organs 2018. [DOI: 10.1177/039139889101400705] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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]
Affiliation(s)
| | | | | | - B. Arge
- Department of Nephrology, University Hospital of Linkoping - Sweden
| | | | - K-E. Hagstam
- Department of Medicine, Malmö General Hospital, Malmö
| | - M. Lundberg
- Department of Nephrology, University Hospital of Linkoping - Sweden
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22
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Kulzer P, Schaefer R, Krahn R, Schaefer L, Heidland A, Friedberg D, Steffensen G, Pasternak A, Jahn H, Mery J, Edel H, Grabensee B, Krause D, Temminghoff M, Dahl K, Saltvedt E, Fauchald P, Lindholm T, Lundberg M. Effectiveness and Safety of Recombinant Human Erythropoietin (r-HuEPO) in the Treatment of Anemia of Chronic Renal Failure in Non Dialysis Patients. Int J Artif Organs 2018. [DOI: 10.1177/039139889401700402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Seventy-five non-dialized patients with chronic renal failure (CRF) and severe renal anemia were enrolled in a study, receiving r-HuEPO subcutaneously thrice weekly for 6 months. In 64 patients (85%) 7 weeks of treatment with a weekly dose of 158 U/kg were required to achieve Hb concentrations within the target range of 10 to 12 g/dl. Of the 11 patients (15%) who failed to achieve the target Hb range, none were considered to be non-responders as they were excluded for unrelated reasons prior to week 16 (8 cases), or were iron deficient (2 cases), or had bleeding complications (1 patient). Maintaining the Hb concentration at a level of 10.5 g/dl required a mean r-HuEPO dose of 92 U/kg per week. Adverse events were generally mild or moderate. The most commonly reported were hypertension (8%), viral infection/including flu-like syndrome (7%), nausea (7%), and dizziness (5%). Statistically significant increases in mean creatinine concentrations observed after 12 and 24 weeks were most likely due to the progression of renal disease. These results confirm that 50 U/kg of r-HuEPO given 3 times per week subcutaneously provide a safe and effective therapy for anemic predialysis patients.
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Affiliation(s)
- P. Kulzer
- Department of Internal Medicine, Division of Nephrology, University of Wuerzburg, Wuerzburg
| | - R.M. Schaefer
- Department of Internal Medicine, Division of Nephrology, University of Wuerzburg, Wuerzburg
| | | | - L. Schaefer
- Department of Internal Medicine, Division of Nephrology, University of Wuerzburg, Wuerzburg
| | - A. Heidland
- Department of Internal Medicine, Division of Nephrology, University of Wuerzburg, Wuerzburg
| | | | | | | | - H. Jahn
- Centre Hospitalier Regional, Strasbourg
| | | | - H. Edel
- Municipal Hospital, Munich-Harlaching
| | - B. Grabensee
- University Centre of Internal Medicine, Dusseldorf
| | | | | | - K. Dahl
- University Hospital, Trondheim
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23
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Hollander AC, Kirkbride JB, Pitman A, Lundberg M, Lewis G, Magnusson C, Dalman C. Are refugees at increased risk of suicide compared with non-refugee migrants and the host population. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.129] [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: 11/12/2022] Open
Affiliation(s)
- AC Hollander
- Institutionen för Folkhälsovetenskap, Karolinska Institutet, Stockholm, Sweden
| | - JB Kirkbride
- Division of Psychiatry, University College London, London, UK
| | - A Pitman
- Division of Psychiatry, University College London, London, UK
| | - M Lundberg
- Institutionen för Folkhälsovetenskap, Karolinska Institutet, Stockholm, Sweden
| | - G Lewis
- Division of Psychiatry, University College London, London, UK
| | - C Magnusson
- Institutionen för Folkhälsovetenskap, Karolinska Institutet, Stockholm, Sweden
| | - C Dalman
- Institutionen för Folkhälsovetenskap, Karolinska Institutet, Stockholm, Sweden
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24
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Araghi M, Galanti MR, Lundberg M, Liu Z, Ye W, Lager A, Engström G, Manjer J, Alfredsson L, Knutsson A, Norberg M, Palmqvist R, Gylling B, Wennberg P, Lagerros YT, Bellocco R, Pedersen NL, Östergren PO, Magnusson C. Smokeless tobacco (snus) use and colorectal cancer incidence and survival: Results from nine pooled cohorts. Scand J Public Health 2017; 45:741-748. [PMID: 28994648 DOI: 10.1177/1403494817714191] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Indexed: 11/15/2022]
Abstract
AIMS Although smoking is considered to be an established risk factor for colorectal cancer, the current evidence on the association between smokeless tobacco and colorectal cancer is scant and inconclusive. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess this association. METHODS A total of 417,872 male participants from nine cohort studies across Sweden were followed up for incidence of colorectal cancer and death. Outcomes were ascertained through linkage to health registers. We used shared frailty models with random effects at the study level to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS During 7,135,504 person-years of observation, 4170 men developed colorectal cancer. There was no clear association between snus use and colorectal cancer overall. Exclusive current snus users, however, had an increased risk of rectal cancer (HR 1.40: 95% CI 1.09, 1.79). There were no statistically significant associations between snus use and either all-cause or colorectal cancer-specific mortality after colorectal cancer diagnosis. CONCLUSIONS Our findings, from a large sample, do not support any strong relationships between snus use and colorectal cancer risk and survival among men. However, the observed increased risk of rectal cancer is noteworthy, and in merit of further attention.
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Affiliation(s)
- Marzieh Araghi
- 1 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Maria Rosaria Galanti
- 1 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- 2 Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Stockholm County Council, Sweden
| | - Michael Lundberg
- 1 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Zhiwei Liu
- 3 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Weimin Ye
- 3 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anton Lager
- 1 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- 2 Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Stockholm County Council, Sweden
| | - Gunnar Engström
- 4 Department of Clinical Sciences Malmö, Lund University, Sweden
| | - Jonas Manjer
- 5 Department of Surgery Malmö, Lund University, Skåne University Hospital Malmö, Sweden
| | - Lars Alfredsson
- 6 Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Knutsson
- 7 Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Margareta Norberg
- 8 Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Sweden
| | - Richard Palmqvist
- 9 Department of Medical Biosciences, Pathology, Umeå University, Sweden
| | - Björn Gylling
- 9 Department of Medical Biosciences, Pathology, Umeå University, Sweden
| | - Patrik Wennberg
- 10 Division of Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Ylva Trolle Lagerros
- 11 Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
- 12 Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Rino Bellocco
- 3 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- 13 Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Italy
| | - Nancy L Pedersen
- 3 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Per-Olof Östergren
- 14 Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Sweden
| | - Cecilia Magnusson
- 1 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- 2 Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Stockholm County Council, Sweden
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25
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Araghi M, Rosaria Galanti M, Lundberg M, Lager A, Engström G, Alfredsson L, Knutsson A, Norberg M, Sund M, Wennberg P, Trolle Lagerros Y, Bellocco R, Pedersen NL, Östergren PO, Magnusson C. Use of moist oral snuff (snus) and pancreatic cancer: Pooled analysis of nine prospective observational studies. Int J Cancer 2017; 141:687-693. [PMID: 28486772 DOI: 10.1002/ijc.30773] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 11/25/2016] [Revised: 04/11/2017] [Accepted: 04/26/2017] [Indexed: 12/15/2022]
Abstract
While smoking is a well-established risk factor for pancreatic cancer, the effect of smokeless tobacco is less well understood. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess the association between Swedish snus use and the risk of pancreatic cancer. A total of 424,152 male participants from nine cohort studies were followed up for risk of pancreatic cancer through linkage to health registers. We used shared frailty models with random effects at the study level, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for confounding factors. During 9,276,054 person-years of observation, 1,447 men developed pancreatic cancer. Compared to never-snus use, current snus use was not associated with risk of pancreatic cancer (HR 0.96, 95% CI 0.83-1.11) after adjustment for smoking. Swedish snus use does not appear to be implicated in the development of pancreatic cancer in men. Tobacco smoke constituents other than nicotine or its metabolites may account for the relationship between smoking and pancreatic cancer.
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Affiliation(s)
- Marzieh Araghi
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Maria Rosaria Galanti
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Stockholm County Council, Sweden
| | - Michael Lundberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Anton Lager
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Stockholm County Council, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Knutsson
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Margareta Norberg
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Malin Sund
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Patrik Wennberg
- Division of Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Ylva Trolle Lagerros
- Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Clinic of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Rino Bellocco
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Per-Olof Östergren
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Cecilia Magnusson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Stockholm County Council, Sweden
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26
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Carlsson S, Andersson T, Araghi M, Galanti R, Lager A, Lundberg M, Nilsson P, Norberg M, Pedersen NL, Trolle-Lagerros Y, Magnusson C. Smokeless tobacco (snus) is associated with an increased risk of type 2 diabetes: results from five pooled cohorts. J Intern Med 2017; 281:398-406. [PMID: 28164394 DOI: 10.1111/joim.12592] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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] [Indexed: 01/01/2023]
Abstract
BACKGROUND Smoking and nicotine exposure increase insulin resistance and the risk of type 2 diabetes. Swedish smokeless tobacco (snus) is high in nicotine, and its use is prevalent in Scandinavian countries, but few studies have investigated snus use in relation to diabetes risk. OBJECTIVE To explore the association between snus use and risk of type 2 diabetes using pooled data from five cohorts. METHODS Analyses were based on prospective studies conducted between 1990 and 2013 including 54 531 never-smoking men and 2441 incident cases of type 2 diabetes identified through screening, self-reporting and hospital and prescription registries. Hazard ratios (HRs) and 95% confidence intervals (CIs) were assessed and adjusted for age, body mass index, educational level, alcohol consumption and physical activity. RESULTS Compared to never users, the HR of type 2 diabetes was 1.15 (95% CI: 1.00-1.32) in current users of snus. In individuals consuming 5-6 boxes per week, the HR was 1.42 (95% CI: 1.07-1.87); in those consuming ≥7 boxes per week, the HR was 1.68 (95% CI: 1.17-2.41). Each additional box of snus consumed per week yielded an HR of 1.08 (95% CI: 1.01-1.16). CONCLUSION Our findings indicate that high consumption of snus is a risk factor for type 2 diabetes. The risk was similar to that in smokers, implying that smokers will not reduce their risk of type 2 diabetes by changing to snus use. The results also support the notion that nicotine increases the risk of type 2 diabetes.
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Affiliation(s)
- S Carlsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - T Andersson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Center for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - M Araghi
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - R Galanti
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - A Lager
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - M Lundberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - P Nilsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - M Norberg
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - N L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - C Magnusson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
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27
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Hultin H, Lundberg M, Lundin A, Magnusson C. Do overeducated individuals have increased risks of ill health?: a Swedish population-based cohort study. Sociol Health Illn 2016; 38:980-995. [PMID: 27363599 DOI: 10.1111/1467-9566.12419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Previous studies indicate that the increasing educational level in many post-industrial nations may imply that subgroups of the population work in occupations for which they are overeducated. We aimed to investigate whether overeducation is associated with future self-rated health and psychological distress. The analytical sample consisted of 21,159 participants from the Stockholm Public Health Cohort. Individuals with upper secondary or university education, who in 2006 or 2007 had occupations requiring less education, were considered overeducated. The outcomes were self-rated health (SRH) and psychological distress in 2010. Overeducated women had an increased risk of less than good SRH, compared to university-educated women in matching occupations (adjusted odds ratios (OR): 2.44 confidence intervals (CI): 1.32-4.51 for overeducated women with secondary school education), but not compared to less educated women in the same occupational class (adjusted OR: 0.87 CI:0.32-2.38 for overeducated women with secondary school education). We found no increased risk of less than good SRH for overeducated men, and no association between overeducation and psychological distress for either sex. The results indicate that overeducation is not per se associated with onset of less than good SRH or psychological distress in a short-term perspective, and the findings support education expansion as a means of improving public health.
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Affiliation(s)
- Hanna Hultin
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Michael Lundberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Lundin
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Cecilia Magnusson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
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28
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Magnusson C, Lundberg M, Lee BK, Rai D, Karlsson H, Gardner R, Kosidou K, Arver S, Dalman C. Maternal vitamin D deficiency and the risk of autism spectrum disorders: population-based study. BJPsych Open 2016; 2:170-172. [PMID: 27703770 PMCID: PMC4998950 DOI: 10.1192/bjpo.bp.116.002675] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 01/08/2016] [Accepted: 03/11/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Maternal vitamin D deficiency may increase risk of autism spectrum disorder (ASD), but direct evidence is lacking. AIMS To clarify the relationship between maternal vitamin D deficiency and offspring risk of ASD with and without intellectual disability. METHOD Using a register-based total population study (N=509 639), we calculated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of ASD with and without intellectual disability in relation to lifetime diagnoses of maternal vitamin D deficiency. Although rare, such deficiency was associated with offspring risk of ASD with, but not without, intellectual disability (aORs 2.51, 95% CI 1.22-5.16 and 1.28, 0.68-2.42). Relationships were stronger in non-immigrant children. CONCLUSIONS If reflecting associations for prenatal hypovitaminosis, these findings imply gestational vitamin D substitution as a means of ASD prevention. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
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Affiliation(s)
| | - Michael Lundberg
- , MPH, Department of Public Health Sciences, KarolinskaInstitutet, Stockholm, Sweden
| | - Brian K Lee
- , PhD, Department of Epidemiology and Biostatistics, A.J. Drexel Autism Institute, Drexel University School of Public Health, Philadelphia, PA, USA
| | - Dheeraj Rai
- , MRCPsych, PhD, Department of Public Health Sciences, KarolinskaInstitutet, Stockholm, Sweden; Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK; Avon and Wiltshire Partnership Mental Health NHS Trust, Bristol, UK
| | - Håkan Karlsson
- , PhD, Department of Neuroscience, KarolinskaInstitutet, Stockholm, Sweden
| | - Renee Gardner
- , PhD, Department of Public Health Sciences, KarolinskaInstitutet, Stockholm, Sweden
| | | | - Stefan Arver
- , MD, PhD, Department of Medicine, KarolinskaInstitutet, Stockholm, Sweden
| | - Christina Dalman
- , MD, PhD, Department of Public Health Sciences, KarolinskaInstitutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County Council, Solna, Sweden
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29
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Shen H, Magnusson C, Rai D, Lundberg M, Lê-Scherban F, Dalman C, Lee BK. Associations of Parental Depression With Child School Performance at Age 16 Years in Sweden. JAMA Psychiatry 2016; 73:239-46. [PMID: 26842307 DOI: 10.1001/jamapsychiatry.2015.2917] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [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: 11/14/2022]
Abstract
IMPORTANCE Depression is a common cause of morbidity and disability worldwide. Parental depression is associated with early-life child neurodevelopmental, behavioral, emotional, mental, and social problems. More studies are needed to explore the link between parental depression and long-term child outcomes. OBJECTIVE To examine the associations of parental depression with child school performance at the end of compulsory education (approximately age 16 years). DESIGN, SETTING, AND PARTICIPANTS Parental depression diagnoses (based on the International Classification of Diseases, Eighth Revision [ICD-8], International Classification of Diseases, Ninth Revision [ICD-9], and the International Statistical Classification of Diseases, 10th Revision [ICD-10]) in inpatient records from 1969 onward, outpatient records beginning in 2001, and school grades at the end of compulsory education were collected for all children born from 1984 to 1994 in Sweden. The final analytic sample size was 1,124,162 biological children. We examined the associations of parental depression during different periods (before birth, after birth, and during child ages 1-5, 6-10, and 11-16 years, as well as any time before the child's final year of compulsory schooling) with the final school grades. Linear regression models adjusted for various child and parent characteristics. The dates of the analysis were January to November 2015. MAIN OUTCOME AND MEASURE Decile of school grades at the end of compulsory education (range, 1-10, with 1 being the lowest and 10 being the highest). RESULTS The study cohort comprised 1,124,162 children, of whom 48.9% were female. Maternal depression and paternal depression at any time before the final compulsory school year were associated with worse school performance. After covariate adjustment, these associations decreased to -0.45 (95% CI, -0.48 to -0.42) and -0.40 (-0.43 to -0.37) lower deciles, respectively. These effect sizes are similarly as large as the observed difference in school performance between the lowest and highest quintiles of family income but approximately one-third of the observed difference between maternal education of 9 or less vs more than 12 years. Both maternal depression and paternal depression at different periods (before birth, after birth, and during child ages 1-5, 6-10, and 11-16 years) generally were associated with worse school performance. Child sex modified the associations of maternal depression with school performance such that maternal depression had a larger negative influence on child school performance for girls compared with boys. CONCLUSIONS AND RELEVANCE Diagnoses of parental depression throughout a child's life were associated with worse school performance at age 16 years. Our results suggest that diagnoses of parental depression may have a far-reaching effect on an important aspect of child development, with implications for future life course outcomes.
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Affiliation(s)
- Hanyang Shen
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania
| | - Cecilia Magnusson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden3Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Dheeraj Rai
- School of Social and Community Medicine, University of Bristol, Bristol, England5Avon and Wiltshire Partnership National Health Service Mental Health Trust, Bristol, England
| | - Michael Lundberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden3Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Félice Lê-Scherban
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania
| | - Christina Dalman
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden3Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Brian K Lee
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania6Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Idring S, Lundberg M, Sturm H, Dalman C, Gumpert C, Rai D, Lee BK, Magnusson C. Changes in prevalence of autism spectrum disorders in 2001-2011: findings from the Stockholm youth cohort. J Autism Dev Disord 2015; 45:1766-73. [PMID: 25475364 DOI: 10.1007/s10803-014-2336-y] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [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: 02/05/2023]
Abstract
In a record-linkage study in Stockholm, Sweden, the year 2011 prevalence of diagnosed autism spectrum disorders (ASD) was found to be 0.40, 1.74, 2.46, and 1.76% among 0-5, 6-12, 13-17, and 18-27 year olds, respectively. The corresponding proportion of cases with a recorded diagnosis of intellectual disability was 17.4, 22.1, 26.1 and 29.4%. Between 2001 and 2011, ASD prevalence increased almost 3.5 fold among children aged 2-17 years. The increase was mainly accounted for by an eightfold increase of ASD without intellectual disability (from 0.14 to 1.10 %), while the prevalence of ASD with intellectual disability increased only slightly (from 0.28 to 0.34%). The increase in ASD prevalence is likely contributed to by extrinsic factors such as increased awareness and diagnostics.
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Affiliation(s)
- Selma Idring
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18A, 171 77, Stockholm, Sweden,
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Selten JP, Lundberg M, Rai D, Magnusson C. Risks for nonaffective psychotic disorder and bipolar disorder in young people with autism spectrum disorder: a population-based study. JAMA Psychiatry 2015; 72:483-9. [PMID: 25806797 DOI: 10.1001/jamapsychiatry.2014.3059] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [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: 11/14/2022]
Abstract
IMPORTANCE Whether individuals with autism spectrum disorder (ASD) are at increased risk for nonaffective psychotic disorder (NAPD) or bipolar disorder (BD) is unknown. OBJECTIVE To test whether the risks for NAPD and BD in individuals with ASD are increased and whether these risks are higher than those of their siblings not diagnosed as having ASD. DESIGN, SETTING, AND PARTICIPANTS We performed a nested case-control study of all individuals 17 years or younger who ever resided in Stockholm County, Sweden, from January 1, 2001, through December 31, 2011 (Stockholm Youth Cohort). We included cohort members ever diagnosed as having ASD (n = 9062) and their full siblings never diagnosed as having ASD. Each case was matched with 10 control individuals of the same sex born during the same month and year. Using Swedish registers, cases, siblings, and controls were followed up until December 31, 2011. By then, the oldest individuals had reached the age of 27 years. EXPOSURES Autism spectrum disorder, registered before age 16 or 28 years. We distinguished between ASD with and without intellectual disability (ID). MAIN OUTCOMES AND MEASURES We calculated odds ratios (ORs) for NAPD and BD adjusted for age, sex, population density of place of birth, personal or parental history of migration, hearing impairment, parental age, parental income, parental educational level, and parental history of psychiatric disorder. RESULTS The adjusted ORs for NAPD and BD for cases with non-ID ASD registered before age 16 years were 5.6 (95% CI, 3.3-8.5) and 5.8 (95% CI, 3.9-8.7), respectively; the adjusted ORs for cases with ID ASD were 3.5 (95% CI, 2.0-6.0) and 1.8 (95% CI, 0.8-4.1). The adjusted ORs for NAPD and BD in cases with non-ID ASD registered before age 28 years were 12.3 (95% CI, 9.5-15.9) and 8.5 (95% CI, 6.5-11.2), respectively; for cases with ID ASD, these ORs were 6.4 (95% CI, 4.2-9.8) and 2.0 (95% CI, 1.0-3.9), respectively. The ORs for NAPD and BD for the nonautistic full siblings of cases for whom ASD was registered before age 16 years, adjusted for hearing loss, were 1.8 (95% CI, 1.1-2.7) and 1.7 (95% CI, 1.1-2.6), respectively. CONCLUSIONS AND RELEVANCE A diagnosis of ASD is associated with a substantially increased risk for NAPD and BD. This finding contributes to our understanding of these disorders and has implications for the management of ASD.
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Affiliation(s)
- Jean-Paul Selten
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands2Rivierduinen Psychiatric Institute, Leiden, the Netherlands
| | - Michael Lundberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden4Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Dheeraj Rai
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, England6Bristol Autism Spectrum Service, Avon and Wiltshire Mental Health Partnership NHS (National Health Service) Trust, Bristol, England
| | - Cecilia Magnusson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden4Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
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Bäck M, Lundberg M, Cider Å, Herlitz J, Jansson B. How does kinesiophobia change over time in patients with acute coronary artery disease? Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.232] [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: 10/23/2022]
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Idring S, Magnusson C, Lundberg M, Ek M, Rai D, Svensson AC, Dalman C, Karlsson H, Lee BK. Parental age and the risk of autism spectrum disorders: findings from a Swedish population-based cohort. Int J Epidemiol 2014; 43:107-15. [PMID: 24408971 DOI: 10.1093/ije/dyt262] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [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: 01/06/2023] Open
Abstract
BACKGROUND The objectives of this study were to examine the independent and dependent associations of maternal and paternal age and risk of offspring autism spectrum disorders (ASD), with and without intellectual disability (ID). METHODS The sample consisted of 417 303 Swedish children born 1984-2003. ASD case status (N = 4746) was ascertained using national and regional registers. Smoothing splines in generalized additive models were used to estimate associations of parental age with ASD. RESULTS Whereas advancing parental age increased the risk of child ASD, maternal age effects were non-linear and paternal age effects were linear. Compared with mothers at the median age 29 years, those <29 had similar risk, whereas risk increased after age 30, with an odds ratio (OR) of 1.75 [95% (CI): 1.63-1.89] at ages 40-45. For fathers, compared with the median age of 32 years, the OR for ages 55-59 was 1.39 (1.29-1.50). The risk of ASD was greater for older mothers as compared with older fathers. For example, mothers aged 40-45 (≥97.2th percentile) had an estimated 18.63 (95% CI: 17.25-20.01) ASD cases per 1000 births, whereas fathers aged 55-59 (≥99.7th percentile) had 16.35 (95% CI: 15.11-17.58) ASD cases per 1000 births. In analyses stratified by co-parental age, increased risk due to advancing paternal age was evident only with mothers ≤35 years. In contrast, advancing maternal age increased risk regardless of paternal age. Advancing parental age was more strongly associated with ASD with ID, compared with ASD without ID. CONCLUSIONS We confirm prior findings that advancing parental age increases risk of ASD, particularly for ASD with ID, in a manner dependent on co-parental age. Although recent attention has emphasized the effects of older fathers on ASD risk, an increase of n years in maternal age has greater implications for ASD risk than a similar increase in paternal age.
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Affiliation(s)
- Selma Idring
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden, Neurodevelopmental Psychiatry Unit, Child and Youth Psychiatry, Stockholm County Council, Sweden, Centre for Epidemiology and Community Medicine, Stockholm County Council, Sweden, Huddinge Psychosis Outpatient Unit, Stockholm, Sweden, Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK, Avon and Wiltshire Partnership NHS Mental Health Trust, Bristol, UK, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden, Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA, USA and A.J. Drexel Autism Institute, Philadelphia, PA, USA
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Palmlöf L, Skillgate E, Alfredsson L, Vingård E, Magnusson C, Lundberg M, Holm LW. Does income matter for troublesome neck pain? A population-based study on risk and prognosis. Br J Soc Med 2012; 66:1063-70. [DOI: 10.1136/jech-2011-200783] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sullivan PF, Magnusson C, Reichenberg A, Boman M, Dalman C, Davidson M, Fruchter E, Hultman CM, Lundberg M, Långström N, Weiser M, Svensson AC, Lichtenstein P. Family history of schizophrenia and bipolar disorder as risk factors for autism. Arch Gen Psychiatry 2012; 69:1099-1103. [PMID: 22752149 PMCID: PMC4187103 DOI: 10.1001/archgenpsychiatry.2012.730] [Citation(s) in RCA: 160] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT The clinical and etiologic relation between autism spectrum disorders (ASDs) and schizophrenia is unclear. The degree to which these disorders share a basis in etiology has important implications for clinicians, researchers, and those affected by the disorders. OBJECTIVE To determine whether a family history of schizophrenia and/or bipolar disorder is a risk factor for ASD. DESIGN, SETTING, AND PARTICIPANTS We conducted a case-control evaluation of histories of schizophrenia or bipolar disorder in first-degree relatives of probands in 3 samples—population registers in Sweden, Stockholm County (in Sweden), and Israel. Probands met criteria for ASD, and affection status of parents and siblings for schizophrenia and bipolar disorder were established. RESULTS The presence of schizophrenia in parents was associated with an increased risk for ASD in a Swedish national cohort (odds ratio [OR], 2.9; 95% CI, 2.5-3.4) and a Stockholm County cohort (OR, 2.9; 95% CI, 2.0-4.1). Similarly, schizophrenia in a sibling was associated with an increased risk for ASD in a Swedish national cohort (OR, 2.6; 95% CI, 2.0-3.2) and an Israeli conscription cohort (OR, 12.1; 95% CI, 4.5-32.0). Bipolar disorder showed a similar pattern of associations but of lesser magnitude. CONCLUSIONS Findings from these 3 registers along with consistent findings from a similar study in Denmark suggest that ASD, schizophrenia, and bipolar disorder share common etiologic factors.
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Affiliation(s)
- Patrick F Sullivan
- Department of Genetics, University of North Carolina at Chapel Hill, USA.
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Skillgate E, Magnusson C, Lundberg M, Hallqvist J. The age- and sex-specific occurrence of bothersome neck pain in the general population--results from the Stockholm public health cohort. BMC Musculoskelet Disord 2012; 13:185. [PMID: 23006655 PMCID: PMC3517780 DOI: 10.1186/1471-2474-13-185] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 09/19/2012] [Indexed: 11/30/2022] Open
Abstract
Background Neck pain is very common but the occurrence of bothersome neck pain is not well described. Therefore our objective was to report on the prevalence and incidence of, as well as the rate of recovery from, bothersome neck pain in men and women of different ages in the general population. Methods We used data from a recently conducted population-based cohort study, comprising 23,794 individuals in Stockholm County, Sweden. Study participants were surveyed with a self-administered questionnaire in 2002/2003 and 2007, and information on episodes of neck pain was gathered at baseline and at follow-up. We then measured bothersome neck pain in 2005 and 2006 retrospectively in 2007 using the follow-up questionnaire. Results The one-year prevalence of bothersome neck pain for at least seven consecutive days was 25% (95% confidence interval (CI): 24–25) among women and 16% (95% CI: 15–16) among men, peaking in individuals aged 30–59 years. The one-year incidence proportion of bothersome neck pain was 7% (95% CI: 6–7) among women, and 4% (95% CI: 4–5) among men. Women recovered more infrequently than men. The one-year incidence proportion of recovery (of at least one year duration) was 11% (95% CI: 10–12) among women and 14% (95% CI: 12–16) among men. Conclusion Bothersome neck pain is most common in middle-aged individuals. Women are more likely than men to have and to develop bothersome neck pain, and less likely to recover from such pain. Younger men and women have a higher incidence, but recover more often from bothersome neck pain than older individuals.
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Affiliation(s)
- Eva Skillgate
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, Stockholm, SE-17177, Sweden.
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Magnusson C, Rai D, Goodman A, Lundberg M, Idring S, Svensson A, Koupil I, Serlachius E, Dalman C. Migration and autism spectrum disorder: population-based study. Br J Psychiatry 2012; 201:109-15. [PMID: 22361019 DOI: 10.1192/bjp.bp.111.095125] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [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: 01/08/2023]
Abstract
BACKGROUND Migration has been implicated as a risk factor for autism, but evidence is limited and inconsistent. AIMS To investigate the relationship between parental migration status and risk of autism spectrum disorder, taking into consideration the importance of region of origin, timing of migration and possible discrepancies in associations between autism subtypes. METHOD Record-linkage study within the total child population of Stockholm County between 2001 and 2007. Individuals with high- and low-functioning autism were defined as having autism spectrum disorder with and without comorbid intellectual disability, and ascertained via health and habilitation service registers. RESULTS In total, 4952 individuals with autism spectrum disorder were identified, comprising 2855 children with high-functioning autism and 2097 children with low-functioning autism. Children of migrant parents were at increased risk of low-functioning autism (odds ratio (OR) = 1.5, 95% CI 1.3-1.7); this risk was highest when parents migrated from regions with a low human development index, and peaked when migration occurred around pregnancy (OR = 2.3, 95% CI 1.7-3.0). A decreased risk of high-functioning autism was observed in children of migrant parents, regardless of area of origin or timing of migration. Parental age, income or obstetric complications did not fully explain any of these associations. CONCLUSIONS Environmental factors associated with migration may contribute to the development of autism presenting with comorbid intellectual disability, especially when acting in utero. High- and low-functioning autism may have partly different aetiologies, and should be studied separately.
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Affiliation(s)
- Cecilia Magnusson
- Department of Public Health Sciences, Karolinska Institutet, Norrbacka, Stockholm, Sweden.
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Olsson N, Karlsson J, Eriksson BI, Brorsson A, Lundberg M, Silbernagel KG. Ability to perform a single heel-rise is significantly related to patient-reported outcome after Achilles tendon rupture. Scand J Med Sci Sports 2012; 24:152-8. [PMID: 22716232 DOI: 10.1111/j.1600-0838.2012.01497.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2012] [Indexed: 11/29/2022]
Abstract
This study evaluated the short-term recovery of function after an acute Achilles tendon rupture, measured by a single-legged heel-rise test, with main emphasis on the relation to the patient-reported outcomes and fear of physical activity and movement (kinesiophobia). Eighty-one patients treated surgically or non-surgically with early active rehabilitation after Achilles tendon rupture were included in the study. Patient's ability to perform a single-legged heel-rise, physical activity level, patient-reported symptoms, general health, and kinesiophobia was evaluated 12 weeks after the injury. The heel-rise test showed that 40 out of 81 (49%) patients were unable to perform a single heel-rise 12 weeks after the injury. We found that patients who were able to perform a heel-rise were significantly younger, more often of male gender, reported a lesser degree of symptoms, and also had a higher degree of physical activity at 12 weeks. There was also a significant negative correlation between kinesiophobia and all the patient-reported outcomes and the physical activity level. The heel-rise ability appears to be an important early achievement and reflects the general level of healing, which influences patient-reported outcome and physical activity. Future treatment protocols focusing on regaining strength early after the injury therefore seem to be of great importance. Kinesiophobia needs to be addressed early during the rehabilitation process.
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Affiliation(s)
- N Olsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
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Eriksson C, Lundberg M, Tanka A, Takahashi H, Morita E, Ito K. High Molecular Weight Glutenin, Tri a 26, Is An Important Allergen Component In Children With Immediate Allergy To Wheat. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Laflamme L, Månsdotter A, Lundberg M, Magnusson C. Dangerous dads? Ecological and longitudinal analyses of paternity leave and risk for child injury. J Epidemiol Community Health 2012; 66:1001-4. [PMID: 22245721 DOI: 10.1136/jech-2011-200181] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND In 1974, Sweden became the first country to permit fathers to take paid parental leave. Other countries are currently following suit issuing similar laws. While this reform supports the principles of the United Nations convention of the right for children to be with both parents and enshrines the ethos of gender equality, there has been little systematic examination of its potential impact on child health. Instead, there is uninformed debate that fathers may expose their children to greater risks of injury than mothers. In this Swedish national study, the authors therefore assess whether fathers' parental leave can be regarded as a more serious risk factor for child injuries than that of mothers. METHODS Nationwide register-based ecological and longitudinal studies of hospitalisation due to injury (and intoxication) in early childhood, involving the Swedish population in 1973-2009 (ecological design), and children born in 1988 and 1989 (n=118 278) (longitudinal design). RESULTS An increase in fathers' share of parental leave over time was parallelled by a downward trend in child injury rates (age 0-4 years). At the individual level, the crude incidence of child injury (age 0-2 years) was lower during paternity as compared with maternity leave. This association was, however, explained by parental socio-demographic characteristics (multivariate HR 0.96, 95% CI 0.74 to 1.2). CONCLUSION There is no support for the notion that paternity leave increases the risk of child injury.
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Affiliation(s)
- Lucie Laflamme
- Department of Public Health Sciences, Division of Global Health, Karolinska Institutet, Stockholm, Sweden.
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Lüning Bergsten C, Lundberg M, Lindberg P, Elfving B. Change in kinesiophobia and its relation to activity limitation after multidisciplinary rehabilitation in patients with chronic back pain. Disabil Rehabil 2012; 34:852-8. [DOI: 10.3109/09638288.2011.624247] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rai D, Kosidou K, Lundberg M, Araya R, Lewis G, Magnusson C. Psychological distress and risk of long-term disability: population-based longitudinal study. J Epidemiol Community Health 2011; 66:586-92. [DOI: 10.1136/jech.2010.119644] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lundberg M, Akesson S, Bensch S. Characterization of a divergent chromosome region in the willow warbler Phylloscopus trochilus using avian genomic resources. J Evol Biol 2011; 24:1241-53. [PMID: 21418120 DOI: 10.1111/j.1420-9101.2011.02259.x] [Citation(s) in RCA: 8] [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: 11/28/2022]
Abstract
Genome scans have made it possible to find outlier markers thought to have been influenced by divergent selection in almost any wild population. However, the lack of genomic information in nonmodel species often makes it difficult to associate these markers with certain genes or chromosome regions. Furthermore, the extent of linkage disequilibrium (LD) in the genome will determine the density of markers required to identify the genes under selection. In this study, we investigated a chromosome region in the willow warbler Phylloscopus trochilus surrounding a single marker previously identified in a genome scan. We first located the marker in the assembled genome of another species, the zebra finch Taeniopygia guttata, and amplified surrounding sequences in Fennoscandian willow warblers. Within an investigated chromosome region of 7.3 Mb as mapped to the zebra finch genome, we observed elevated genetic differentiation between a southern and a northern population across a 2.5-Mb interval comprising numerous coding genes. Within the southern and northern populations, higher values of LD were mostly found between SNPs within the same locus, but extended across distantly situated loci when the analyses were restricted to sampling sites showing intermediate allele frequencies of southern and northern alleles. Our study shows that cross-species genome information is a useful resource to obtain candidate sequences adjacent to outlier markers in nonmodel species.
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Affiliation(s)
- M Lundberg
- Department of Biology, Ecology Building, Lund University, Lund, Sweden
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Kyriaki Kosidou K, Dalman C, Lundberg M, Hallqvist J, Isacsson G, Magnusson C. FC08-06 - Distress or depression? does socioeconomic position matter? Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)73561-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
IntroductionIt is not well known whether the association between common mental disorders and low socioeconomic status vary with symptom severity, type of socioeconomic indicator or gender.ObjectivesTo study the association between socioeconomic status and risk for different severity levels of psychological distress as well as depression.MethodsA population-based survey was conducted among a random sample of Stockholm County residents aged 18–84 years in 2002, and respondents were reassessed via a follow-up questionnaire in 2007. Participants in both surveys (n = 23 794) were categorized according to socioeconomic status at baseline and followed up for onset of psychological distress (according to the twelve-item general health questionnaire) and depression (according to health data registers).ResultsOccupational class had little impact on risk for distress regardless of severity or gender, but was strongly associated with onset of depression - albeit only in men (ORs being 3.0 [95% CI 1.5–5.9] in men and 1.1 [95% CI (0.7–1.7]) in women, comparing unskilled manual workers with higher non-manual workers). Income was associated with risk for onset of all outcomes and the association grew stronger with symptom severity. High household income was particularly protective of depression in women. Education was unrelated to either outcome in men and women overall.ConclusionsWhile psychological distress appears to occur at a similar rate regardless of socioeconomic position, risks for severe distress and especially clinically overt depression are markedly linked with occupational class in men and with family income in women. The socioeconomic gradient in common mental disorders increases with symptom severity.
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Cullinane C, O'Mahony O, Lundberg M, Borres M, Hourihane J. Irish Spina Bifida Patients Have a Very Low Prevalence of Latex Allergy and Latex Sensitisation. J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.997] [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: 11/27/2022]
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Mannheimer B, Wettermark B, Lundberg M, Pettersson H, von Bahr C, Eliasson E. Nationwide drug-dispensing data reveal important differences in adherence to drug label recommendations on CYP2D6-dependent drug interactions. Br J Clin Pharmacol 2010; 69:411-7. [PMID: 20406225 DOI: 10.1111/j.1365-2125.2009.03598.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS The study aimed to investigate the clinical adherence to drug label recommendations on important drug-drug interactions (DDIs). Dispensing data on drug combinations involving selective serotonin reuptake inhibitor (SSRI) antidepressants could help to identify areas for intensified medical education. METHODS This was a retrospective, cross-sectional analysis of individual dispensing data regarding all individuals > or =15 years old in Sweden. The study analysed the prescribing and dispensing of CYP2D6 drugs (metoprolol, donepezil, galantamine, codeine, tamoxifen) together with CYP2D6-blocking SSRIs (paroxetine/fluoxetine) or SSRIs without significant CYP2D6 inhibition (citalopram/escitalopram/sertraline), and the related prescribing of CYP2D6-independent comparator drugs (atenolol, rivastigmine, propoxyphene, anastrozole). Odds were calculated between each CYP2D6 drug and the corresponding comparator drug in patients on fluoxetine/paroxetine and citalopram/escitalopram/sertraline, respectively. The odds ratio (OR) was calculated by dividing the obtained odds in patients on fluoxetine/paroxetine by the corresponding odds in patients on citalopram/escitalopram/sertraline. RESULTS Compared with patients that were dispensed citalopram/escitalopram/sertraline, patients dispensed fluoxetine/paroxetine had lower prescribing rates of metoprolol (adjusted OR 0.80; 95% confidence interval 0.76, 0.85), donepezil (0.65; 0.49, 0.86) and galantamine (0.58; 0.41, 0.81). In contrast, the use of prodrugs codeine (compared woth propoxyphene) or tamoxifen (compared with anastrozole) was similar among patients on fluoxetine/paroxetine and citalopram/escitalopram/sertraline (adjusted OR 1.03; 0.94, 1.12 and 1.29; 0.96, 1.73, respectively). CONCLUSIONS Clinically important DDIs that are associated with impaired bioactivation of prodrugs might be more easily neglected in clinical practice compared with DDIs that cause drug accumulation and symptomatic adverse drug reactions.
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Affiliation(s)
- Buster Mannheimer
- Karolinska Institutet, Department of Internal Medicine at Södersjukhuset, Stockholm, Sweden
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Glader EL, Sjölander M, Eriksson M, Lundberg M. Persistent Use of Secondary Preventive Drugs Declines Rapidly During the First 2 Years After Stroke. Stroke 2010; 41:397-401. [PMID: 20075360 DOI: 10.1161/strokeaha.109.566950] [Citation(s) in RCA: 228] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
To prevent new cardiovascular events after stroke, prescribed preventive drugs should be used continuously. This study measures persistent use of preventive drugs after stroke and identifies factors associated with persistence.
Methods—
A 1-year cohort (21 077 survivors) from Riks-Stroke, the Swedish Stroke Register, was linked to the Swedish Prescribed Drug Register.
Results—
The proportion of patients who were persistent users of drugs prescribed at discharge from hospital declined progressively over the first 2 years to reach 74.2% for antihypertensive drugs, 56.1% for statins, 63.7% for antiplatelet drugs, and 45.0% for warfarin. For most drugs, advanced age, comorbidity, good self-perceived health, absence of low mood, acute treatment in a stroke unit, and institutional living at follow-up were independently associated with persistent medication use.
Conclusion—
Persistent secondary prevention treatment declines rapidly during the first 2 years after stroke, particularly for statins and warfarin. Effective interventions to improve persistent secondary prevention after stroke need to be developed.
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Affiliation(s)
- Eva-Lotta Glader
- From Department of Pharmacology and Clinical Neurosciences (M.S.) and Department of Public Health and Clinical Medicine (M.E.), Umeå University Hospital, Umeå, Sweden; The National Board of Health and Welfare (M.L.), Stockholm, Sweden
| | - Maria Sjölander
- From Department of Pharmacology and Clinical Neurosciences (M.S.) and Department of Public Health and Clinical Medicine (M.E.), Umeå University Hospital, Umeå, Sweden; The National Board of Health and Welfare (M.L.), Stockholm, Sweden
| | - Marie Eriksson
- From Department of Pharmacology and Clinical Neurosciences (M.S.) and Department of Public Health and Clinical Medicine (M.E.), Umeå University Hospital, Umeå, Sweden; The National Board of Health and Welfare (M.L.), Stockholm, Sweden
| | - Michael Lundberg
- From Department of Pharmacology and Clinical Neurosciences (M.S.) and Department of Public Health and Clinical Medicine (M.E.), Umeå University Hospital, Umeå, Sweden; The National Board of Health and Welfare (M.L.), Stockholm, Sweden
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Nyholm D, Karlsson E, Lundberg M, Askmark H. Large differences in levodopa dose requirement in Parkinson's disease: men use higher doses than women. Eur J Neurol 2009; 17:260-6. [PMID: 20039939 DOI: 10.1111/j.1468-1331.2009.02866.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The characteristics of levodopa dosing are not well described in the literature. The aims were to investigate the use of levodopa in a nationwide Swedish survey and to study the characteristics of low-dose and high-dose patients with Parkinson's disease (PD) in a university hospital. METHODS Patients with >or= 1 and >or= 2 purchases of levodopa during 2007 were selected from the prescribed drug register. Daily levodopa doses were estimated. Records of 504 patients with PD who visited the neurology clinic at Uppsala University Hospital during 2006-2007 were examined to select a low-dose group (< or = 400 mg levodopa daily, n = 21) and a high-dose group (>or= 1200 mg daily, n = 26) with at least 5 years of PD duration. RESULTS In total, 33 534 levodopa users with > or = 1 levodopa purchase were found. Daily levodopa dose range was large; median daily dose was 465 mg for men and 395 mg for women (P < 0.0001). Almost half (46%) of the patients used < 400 mg levodopa daily. Significantly, more men were treated with doses >or= 1200 mg daily. Dose and age correlated negatively (P < 0.0001). Patients with high dose at 5 years PD duration continuously increased their dosage the following years, whereas low-dose patients did not. The occurrence of dyskinesias was about the same in both groups despite the large difference in levodopa dose. CONCLUSIONS We conclude that the levodopa requirement in PD ranges considerably, and that men use higher levodopa dose than women. Levodopa requirement is constant during the progression of the disease in low-dose patients but increases in high-dose patients.
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Affiliation(s)
- D Nyholm
- Department of Neuroscience, Neurology, Uppsala University Hospital, Uppsala, Sweden.
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Olaya‐Contreras P, Styf J, Lundberg M, Jansson B. 790 MEASUREMENT INVARIANCE FOR GENDER AND PSYCHOMETRIC PROPERTIES OF THE DEPRESSION, ANXIETY AND POSITIVE OUTLOOK SCALE (DAPOS) IN CHRONIC MUSCULOSKELETAL PAIN. Eur J Pain 2009. [DOI: 10.1016/s1090-3801(09)60793-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - J. Styf
- Yrkesortopeden Sahlgrenska Sjukshus, Gothenburg, Sweden
| | - M. Lundberg
- Yrkesortopeden Sahlgrenska Sjukshus, Gothenburg, Sweden
| | - B. Jansson
- Institute of Psychology, University of Gothenburg, Gothenburg, Sweden
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Phair J, Lönnroth N, Lundberg M, Kaiser A. Characteristics of cerium-gadolinium oxide (CGO) suspensions as a function of dispersant and powder properties. Colloids Surf A Physicochem Eng Asp 2009. [DOI: 10.1016/j.colsurfa.2009.03.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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