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Maret-Ouda, J., Ström, J. C., Roelstraete, B., Emilsson, L., Joshi, A. D., Khalili, H. & Ludvigsson, J. F. (2023). Appendectomy and future risk of microscopic colitis: a population-based case-control study in Sweden. Clinical Gastroenterology and Hepatology, 21(2), 467-475.e2
Open this publication in new window or tab >>Appendectomy and future risk of microscopic colitis: a population-based case-control study in Sweden
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2023 (English)In: Clinical Gastroenterology and Hepatology, ISSN 1542-3565, E-ISSN 1542-7714, Vol. 21, no 2, p. 467-475.e2Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIMS: Microscopic colitis (MC) is an inflammatory bowel disease and a common cause of chronic diarrhea. Appendectomy has been suggested to have immunomodulating effects in the colon, influencing the risk of gastrointestinal disease. The relationship between appendectomy and MC has only been sparsely studied.

METHODS: This was a case-control study based on the nationwide ESPRESSO cohort, consisting of histopathological examinations in Sweden, linked to national registers. Patients with MC were matched to population controls by age, sex, calendar year of biopsy and county of residence. Data on antecedent appendectomy and comorbidities were retrieved from the Patient Register. Unconditional logistic regression models were conducted presenting odds ratios (ORs) and 95% confidence intervals (Cl) adjusted for country of birth and matching factors. Further sub-analyses were made based on MC subtypes (lymphocytic colitis [LC] and collagenous colitis [CC]), follow-up time post appendectomy and severity of appendicitis.

RESULTS: The study included 14,520 cases of MC and 69,491 controls, among these 7.6% (n=1,103) and 5.1% (n=3,510), respectively, had a previous appendectomy ≥1 year prior to MC/matching date. Patients with a previous appendectomy had an increased risk of MC in total (OR 1.50, 95% CI 1.40-1.61); and per subtype CC (OR 1.67, 95% CI 1.48-1.88), LC (OR 1.42, 95% CI 1.30-1.55). The risk remained elevated throughout follow-up, and the highest risk was observed in non-complicated appendicitis.

CONCLUSIONS: This nationwide case-control study found a modestly increased risk of developing MC following appendectomy.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Appendicitis, gastrointestinal, laparoscopy, microscopic colitis, population-based, surgery
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-99647 (URN)10.1016/j.cgh.2022.05.037 (DOI)001050130000001 ()35716902 (PubMedID)2-s2.0-85135323025 (Scopus ID)
Available from: 2022-06-20 Created: 2022-06-20 Last updated: 2023-09-08Bibliographically approved
Skow, M., Fossum, G. H., Høye, S., Straand, J., Brænd, A. M. & Emilsson, L. (2023). Hospitalizations and severe complications following acute sinusitis in general practice: a registry-based cohort study. Journal of Antimicrobial Chemotherapy, 78(9), 2217-2227
Open this publication in new window or tab >>Hospitalizations and severe complications following acute sinusitis in general practice: a registry-based cohort study
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2023 (English)In: Journal of Antimicrobial Chemotherapy, ISSN 0305-7453, E-ISSN 1460-2091, Vol. 78, no 9, p. 2217-2227Article in journal (Refereed) Published
Abstract [en]

Objectives: To investigate complication rates of acute sinusitis in general practice, and whether antibiotic prescribing had an impact on complication rate.

Methods: All adult patients diagnosed with sinusitis in Norwegian general practice between 1 July 2012 and 30 June 2019 were included. GP consultation data from the Norwegian Control and Payment for Health Reimbursements Database were linked with antibiotic prescriptions (Norwegian Prescription Database) and hospital admissions (Norwegian Patient Registry). Main outcomes were sinusitis-related hospitalizations and severe complications within 30 days. Logistic regression was used to estimate associations between antibiotic prescriptions, prespecified risk factors, individual GP prescribing quintile, and outcomes.

Results: A total of 711 069 episodes of acute sinusitis in 415 781 patients were identified. During the study period, both annual episode rate (from 30.2 to 21.2 per 1000 inhabitants) and antibiotic prescription rate (63.3% to 46.5%; P < 0.001) decreased. Yearly hospitalization rate was stable at 10.0 cases per 10 000 sinusitis episodes and the corresponding rate of severe complications was 3.2, with no yearly change (P = 0.765). Antibiotic prescribing was associated with increased risk of hospitalization [adjusted OR 1.8 (95% CI 1.5-2.1)] but not with severe complications. Individual GP prescribing quintile was not associated with any of the outcomes, whereas risk factors such as previous drug abuse, or head injury, skull surgery or malformations, and being immunocompromised were significantly associated with increased risk of both outcomes.

Conclusions: Severe complications of acute sinusitis were rare and no protective effect of high prescribing practice among GPs was found. Recommendations to further reduce antibiotic prescribing are generally encouraged, except for high-risk groups.

Place, publisher, year, edition, pages
Oxford University Press, 2023
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-107383 (URN)10.1093/jac/dkad227 (DOI)001034048700001 ()37486144 (PubMedID)2-s2.0-85172695881 (Scopus ID)
Funder
The Research Council of Norway, 288165
Available from: 2023-08-14 Created: 2023-08-14 Last updated: 2023-12-08Bibliographically approved
Emilsson, L., Maret-Ouda, J. & Ludvigsson, J. F. (2023). Mortality in small bowel cancers and adenomas: A nationwide, population-based matched cohort study. Cancer Epidemiology, 85, Article ID 102399.
Open this publication in new window or tab >>Mortality in small bowel cancers and adenomas: A nationwide, population-based matched cohort study
2023 (English)In: Cancer Epidemiology, ISSN 1877-7821, E-ISSN 1877-783X, Vol. 85, article id 102399Article in journal (Refereed) Published
Abstract [en]

Background: Small bowel adenocarcinoma (SBA), neuroendocrine tumors (NET) and gastrointestinal stromal tumors (GIST) are neoplastic lesions of the small bowel while small bowel adenomas are precursors of SBA.

Aim: To examine mortality in patients diagnosed with SBA, small bowel adenomas, NET and GIST.

Methods: We performed a population-based matched cohort study encompassing all individuals with SBA (n = 2289), adenomas (n = 3700), NET (n = 1884) and GIST (n = 509) in the small bowel diagnosed at any of Sweden's 28 pathology departments between 2000 and 2016 (the "ESPRESSO study"). Each case was matched by sex, age, calendar year and county of residence to up to 5 comparators from the general population. Through Cox regression we estimated hazard ratios (HRs) and 95% confidence intervals (95%CIs) for death and cause-specific death adjusting for education.

Results: During follow-up until December 31, 2017, 1836 (80%) deaths occurred in SBA patients, 1615 (44%) in adenoma, 866 (46%) in NET and 162 (32%) in GIST patients. This corresponded to incidence rates of 295, 74, 80 and 62/1000 person-years respectively and adjusted HRs of 7.60 (95%CI=6.95-8.31), 2.21 (2.07-2.36), 2.74 (2.50-3.01) and 2.33 (1.90-2.87). Adjustment for education had a substantial impact on the HR for death in SBA but not for other neoplasias. The predominant cause of excess death was cancer in all groups.

Conclusion: This study confirms earlier findings of increased death rates in patients with SBA and NET in a modern study population. We also demonstrate a more than 2-fold increased risk of death in both GIST and the SBA precursor adenoma.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Prognosis, Small bowel neoplasia, Small bowel adenomas, Cohort study
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-107216 (URN)10.1016/j.canep.2023.102399 (DOI)001025800400001 ()37327506 (PubMedID)2-s2.0-85161717881 (Scopus ID)
Note

Funding agencies:

Janssen corporation

MSD developing a paper reviewing national healthcare registers in China

Available from: 2023-07-31 Created: 2023-07-31 Last updated: 2023-07-31Bibliographically approved
Skow, M., Fossum, G. H., Høye, S., Straand, J., Emilsson, L. & Brænd, A. M. (2022). Antibiotic treatment of respiratory tract infections in adults in Norwegian general practice. JAC - Antimicrobial Resistance, 5(1), Article ID dlac135.
Open this publication in new window or tab >>Antibiotic treatment of respiratory tract infections in adults in Norwegian general practice
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2022 (English)In: JAC - Antimicrobial Resistance, E-ISSN 2632-1823, Vol. 5, no 1, article id dlac135Article in journal (Refereed) Published
Abstract [en]

Objectives: To analyse the prevalence of respiratory tract infection (RTI) episodes with and without antibiotic prescriptions in adult patients in Norwegian general practice during the period 2012-2019.

Methods: Observational study linking data from the Norwegian Control and Payment for Health Reimbursements Database and the Norwegian Prescription Database. Episodes of acute RTIs in patients aged 18 years or older were identified and linked to antibiotic prescriptions dispensed within 7 days after diagnosis. We analysed annual infection rates and antibiotic prescription rates and antibiotics prescribed for the different RTI conditions.

Results: RTI episode rate per 1000 inhabitants was 312 in 2012 and 277 in 2019, but showed no linear trend of change during the study period (P = 0.205). Antibiotic prescription rate decreased from 37% of RTI episodes in 2012 to 23% in 2019 (P < 0.001). The reduction in prescribing was most pronounced for episodes coded with ICPC-2 symptom diagnoses, as well as upper RTIs, influenza, acute bronchitis and sinusitis. Prescriptions for phenoxymethylpenicillin decreased from 178 746 in 2012 to 143 095 in 2019, but increased as proportion of total antibiotic prescriptions from 40% in 2012 to 53% in 2019 (P < 0.001).

Conclusions: This study demonstrates stable RTI episode rates and reduced antibiotic prescription rates for RTIs for adults in Norwegian general practice 2012-2019. We also observed a shift towards relatively more use of phenoxymethylpenicillin and less broad-spectrum antibiotics. These changes are in line with the aims of the Norwegian strategy against antibiotic resistance.

Place, publisher, year, edition, pages
Oxford University Press, 2022
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-103360 (URN)10.1093/jacamr/dlac135 (DOI)000908345700001 ()36632357 (PubMedID)2-s2.0-85151747219 (Scopus ID)
Funder
The Research Council of Norway, 288165
Available from: 2023-01-23 Created: 2023-01-23 Last updated: 2024-06-24Bibliographically approved
Lebwohl, B., Green, P. H., Emilsson, L., Mårild, K., Söderling, J., Roelstraete, B. & Ludvigsson, J. F. (2022). Cancer Risk in 47,241 Individuals with Celiac Disease: A Nationwide Cohort Study. Clinical Gastroenterology and Hepatology, 20(2), e111-e131
Open this publication in new window or tab >>Cancer Risk in 47,241 Individuals with Celiac Disease: A Nationwide Cohort Study
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2022 (English)In: Clinical Gastroenterology and Hepatology, ISSN 1542-3565, E-ISSN 1542-7714, Vol. 20, no 2, p. e111-e131Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Celiac disease (CD) is associated with increased mortality, in part due to cancer. Most studies investigating this cancer risk involved patients diagnosed before widespread increases in CD diagnosis rates and access to gluten-free food. We performed a population-based study of the risk of cancer in CD.

METHODS: We identified all patients in Sweden with CD as defined as duodenal villus atrophy, using the ESPRESSO cohort. Each patient was matched to ≤5 controls by age, sex, and county. We used stratified Cox proportional-hazards model, following patients from diagnosis until first cancer, or by December 31, 2016.

RESULTS: Among 47,241 patients with CD, 30,080 (64%) were diagnosed since 2000. After a median follow-up of 11.5 years, the incidence of cancer was 6.5 and 5.7 per 1000 person-years in CD patients and controls, respectively. The overall risk of cancer was increased (hazard ratio[HR] 1.11; 95%CI 1.07-1.15), but was only significantly elevated in the first year after CD diagnosis (HR 2.47; 95%CI 2.22-2.74), and not subsequently (HR 1.01; 95%CI 0.97-1.05), though the risks of hematologic, lymphoproliferative, hepatobiliary, and pancreas cancers persisted. The overall risk was highest in those diagnosed with CD after age 60 years (HR 1.22; 95%CI 1.16-1.29) and was not increased in those diagnosed before age 40. The cancer risk was similar among those diagnosed with CD before or after the year 2000.

CONCLUSIONS: There is an increased risk of cancer in CD, even in recent years, but this risk increase is confined to those diagnosed with CD after age 40, and is primarily present within the first year of diagnosis.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Celiac Disease, Cancer, Epidemiology
National Category
Cancer and Oncology Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-91948 (URN)10.1016/j.cgh.2021.05.034 (DOI)000748508800014 ()34033925 (PubMedID)2-s2.0-85110083722 (Scopus ID)
Funder
Swedish Research Council
Note

Funding agencies:

Celiac Disease Foundation Young Investigator Research Grant Award

Louis and Gloria Flanzer Philanthropic Trust

Available from: 2021-05-27 Created: 2021-05-27 Last updated: 2022-02-09Bibliographically approved
Rehnberg, J., Ludvigsson, J. F., Carrero, J.-J. & Emilsson, L. (2022). Cancer risk in patients with IgA nephropathy: a Swedish population-based cohort study. Nephrology, Dialysis and Transplantation, 37(4), 749-759
Open this publication in new window or tab >>Cancer risk in patients with IgA nephropathy: a Swedish population-based cohort study
2022 (English)In: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 37, no 4, p. 749-759Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: IgA nephropathy (IgAN) is the most common primary glomerulonephritis affecting all ages and both sexes, but there is a lack of studies on its association with cancer and whether it is a paramalignant condition.

METHODS: In a Swedish population-based cohort study we compared the risk of cancer among 3,882 biopsy-verified IgAN patients diagnosed during 1974-2011 with 19,341 reference individuals and followed them until 2015. Cox regression was used to estimate hazard ratios (HRs) for cancer in IgAN patients versus controls, and conditional logistic regression assessed the risk of cancer before the IgAN was confirmed.

RESULTS: During a median follow-up of 12.6 years, 488 (12.6%) patients with IgAN and 1,783 (9.2%) matched reference individuals were diagnosed with cancer (HR 1.70; 95% confidence interval, 95%CI, 1.52-1.89). The increased risk was only seen in IgAN patients developing end stage renal disease (ESRD), with an HR of 4.01 (95%CI 3.33-4.82) for any cancer and HR of 2.22 (95%CI 1.79-2.75) when excluding non-melanoma skin cancer (NMSC). Non-ESRD IgAN patients did not have an increased overall cancer risk (HR 1.13; 95%CI 0.99-1.30). There was no increased risk of cancer preceding IgAN diagnosis (odds ratio 1.10; 95%CI 0.92-1.32).

CONCLUSION: We found no support for IgAN being a paramalignant condition. There was an increased risk of cancer in IgAN patients, but only for those with ESRD. Our results indicate approximately 6 extra cancer case per 100 IgAN patients with ESRD per 10 years, or >17 extra cases if including NMSC as well.

Place, publisher, year, edition, pages
Oxford University Press, 2022
Keywords
IgA nephropathy, cancer risk, epidemiology
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-95509 (URN)10.1093/ndt/gfab322 (DOI)000764010600001 ()34788864 (PubMedID)2-s2.0-85127975387 (Scopus ID)
Funder
Swedish Research Council, 2019-01059
Note

Funding agency:

County Council of Värmland, Sweden

Available from: 2021-11-18 Created: 2021-11-18 Last updated: 2022-05-12Bibliographically approved
Jodal, H. C., Juul, F. E., Barua, I., Bretthauer, M., Kalager, M., Løberg, M. & Emilsson, L. (2022). Emergency hospital admissions, prognosis, and population mortality in Norway during the first wave of the Covid-19 epidemic. Scandinavian Journal of Public Health, 50(6), 795-802
Open this publication in new window or tab >>Emergency hospital admissions, prognosis, and population mortality in Norway during the first wave of the Covid-19 epidemic
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2022 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 50, no 6, p. 795-802Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: During the first wave of the Covid-19 epidemic, a national lockdown was established in Norway, and inhabitants were asked to contact healthcare only if absolutely necessary. We investigated hospital admissions and mortality due to non-Covid-19 disease during the lockdown compared to previous years.

METHODS: We compared the number of emergency admissions and in-hospital fatality for diagnoses probably unaffected (acute myocardial infarction, acute abdominal conditions, cerebrovascular diseases) and affected by the lockdown (infections, injuries) in the South-Eastern Health Region of Norway during weeks 12-22, 2020, compared to the mean of the same period in the years 2017-2019. We also compared population mortality March-May 2020, to the mean of the same period in years 2017-2019.

RESULTS: A total of 280,043 emergency admissions were observed; 20,911 admissions probably unaffected, and 30,905 admissions probably affected by the lockdown. Admissions due to diagnoses probably unaffected was reduced by 12% (95% confidence interval (CI) 9-15%), compared to 2017-2019. Admissions for diagnoses probably affected was reduced by 30% (95% CI 28-32%). There was a 34% reduction in in-hospital fatality due to acute myocardial infarction (95% CI 4-56%), 19% due to infections (95% CI 1-33%), and no change for the other diagnoses, compared to 2017-2019. The risk of in-hospital mortality to total mortality was lower for acute myocardial infarction (relative risk 0.85, 95% CI 0.73-0.99) and injuries (relative risk 0.83, 95% CI 0.70-0.98).

CONCLUSIONS: Even though fewer patients were admitted to hospital, there was no increase in in-hospital fatality or population mortality, indicating that those who were most in need still received adequate care.

Place, publisher, year, edition, pages
Sage Publications, 2022
Keywords
Covid-19, emergency medicine, health policies, internal medicine, public health, surgery
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-99010 (URN)10.1177/14034948221082959 (DOI)000798886300001 ()35546560 (PubMedID)2-s2.0-85130495587 (Scopus ID)
Funder
The Research Council of Norway, 312757
Note

Funding agency:

Norwegian Cancer Society 6741288 

Available from: 2022-05-16 Created: 2022-05-16 Last updated: 2022-08-22Bibliographically approved
Emilsson, L., Radkiewicz, C., Semrad, C. E., Joshi, A. D. & Ludvigsson, J. F. (2022). Gall Bladder Disease and the Risk of Small Bowel Cancer: Results from a Nationwide Swedish Cohort Study. Cancers, 14(3), Article ID 469.
Open this publication in new window or tab >>Gall Bladder Disease and the Risk of Small Bowel Cancer: Results from a Nationwide Swedish Cohort Study
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2022 (English)In: Cancers, ISSN 2072-6694, Vol. 14, no 3, article id 469Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIMS: Small bowel cancer is a rare but rising malignancy. The etiology is poorly understood and there is a need for large-scale studies. Gallbladder disease (GBD), inducing localized inflammation, has been suggested to increase small bowel cancer risk.

METHODS: We retrieved nationwide data from Sweden's 28 pathology departments on all adults (age 20-79) with pathology-confirmed GBD diagnosed in 1965-2017. In total 156,390 GBD patients were matched with up to 5 matched comparators from the general population and follow-up started one year after GBD diagnosis. We used stratified Cox regression to calculate hazard ratios (HRs) for small bowel adenocarcinoma, adenomas, and carcinoids.

RESULTS: During a median follow-up of 12 years, we identified 92 small bowel adenocarcinomas, 132 adenomas, and 81 carcinoid tumors in the GBD cohort. Corresponding incidence rates were 4.8, 6.9, and 4.2 per 100,000 person-years (PY), compared to 3.2, 3.2, and 1.8 in matched comparators. The adjusted HR was 1.42 (95% CI = 1.08-1.87) for small bowel adenocarcinoma, 1.79 (95% CI = 1.41-2.27) for adenoma, and 2.07 (95% CI = 1.52-2.81) for carcinoid. The excess cancer risk was most pronounced during the first year of follow-up for adenocarcinomas and during the first six years for adenomas while for carcinoids the HR peaked 10-15 years after start of follow-up.

CONCLUSIONS: In this nationwide cohort study, GBD was associated with an increased risk of small bowel cancer. The excess risk of small bowel adenocarcinoma was mainly seen during the first years of follow-up while small bowel carcinoid risk peaked 11-16 years after GBD diagnosis.

Place, publisher, year, edition, pages
MDPI, 2022
Keywords
Etiology, gallbladder disease, intestine, neoplasm
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-97532 (URN)10.3390/cancers14030469 (DOI)000759097100001 ()35158736 (PubMedID)2-s2.0-85122891056 (Scopus ID)
Available from: 2022-02-15 Created: 2022-02-15 Last updated: 2022-03-03Bibliographically approved
Song, M., Nguyen, L. H., Emilsson, L., Chan, A. T. & Ludvigsson, J. F. (2021). Antibiotic Use Associated With Risk of Colorectal Polyps in a Nationwide Study. Clinical Gastroenterology and Hepatology, 19(7), 1426-1435.e6
Open this publication in new window or tab >>Antibiotic Use Associated With Risk of Colorectal Polyps in a Nationwide Study
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2021 (English)In: Clinical Gastroenterology and Hepatology, ISSN 1542-3565, E-ISSN 1542-7714, Vol. 19, no 7, p. 1426-1435.e6Article in journal (Refereed) Published
Abstract [en]

BACKGROUND & AIMS: Use of antibiotics affects the composition of the microbiome and might affect development of colorectal polyps, which are precursors to colorectal cancer.

METHODS: We performed a nested case-control study in Sweden of 45,744 patients with a colorectal polyp (cases) in the nationwide gastrointestinal ESPRESSO histopathology cohort, using unaffected full siblings as controls (n = 93,307). Polyps were classified by morphology SnoMed codes into conventional adenomas and serrated polyps. Through linkage to the Prescribed Drug Register, we assessed use and cumulative dispensations of antibiotic until 1 year prior to polyp diagnosis for cases and their sibling controls.

RESULTS: During a median study period of 6.9 years, compared with non-users, users of antibiotics (including 28,884 cases [63.1%] and 53,222 sibling controls [57.0%]) had a higher risk of colorectal polyps (odds ratio [OR], 1.08; 95% CI, 1.04-1.13). Risk increased with higher number of dispensations (OR for >= 6 dispensations, 1.33; 95% CI, 1.25-1.43) (P-trend <.0001). We observed a stronger association with polyps for broad-spectrumantibiotics (OR comparing users to non-users, 1.23; 95% CI, 1.18-1.29) than for narrow-spectrum antibiotics (OR, 1.05; 95% CI, 1.01-1.10), and for tetracyclines and quinolones (OR, 1.21) than penicillin and other classes (ORs ranged from 1.04 to 1.16). The findings remained robust with several sensitivity analyses, including use of a 2-year lead-in period for antibiotic assessment and correction for misclassification in controls. Use of broad-spectrum antibiotics was more strongly associated with risk of serrated polyps (OR, 1.29; 95% CI, 1.21-1.38) compared with risk of conventional adenomas (OR, 1.17; 95% CI, 1.11-1.24). We found no differences in risk of colon vs rectal polyps with antibiotic use (P-heterogeneity >.10). We found stronger associations for younger (<50 years) vs older adults (>= 50 years) for users of quinolones, sulfonamides, trimethoprim, and cephalosporins (P-interaction <.001).

CONCLUSIONS: In a nationwide case-control study in Sweden, after accounting for hereditary and early life environmental factors, antibiotic use was associated with increased risk of colorectal polyps. Our findings indicate a role for intestinal dysbiosis in early stages of colorectal carcinogenesis.

Place, publisher, year, edition, pages
Elsevier, 2021
Keywords
Antiaerobic, Anaerobic, Bacteria, Sessile Serrated Polyp
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-93215 (URN)10.1016/j.cgh.2020.05.036 (DOI)000664753500023 ()32454258 (PubMedID)2-s2.0-85091523848 (Scopus ID)
Note

Funding Agencies:

United States Department of Health & Human Services

National Institutes of Health (NIH) - USA R01 CA202704 R01 CA137178 R00 CA215314

American Cancer Society MRSG-17-220-01-NEC

Union for International Cancer Control YY2/17/554363

Available from: 2021-07-29 Created: 2021-07-29 Last updated: 2021-07-29Bibliographically approved
Geerts, J. M., Kinnair, D., Taheri, P., Abraham, A., Ahn, J., Atun, R., . . . Bilodeau, M. (2021). Guidance for Health Care Leaders During the Recovery Stage of the COVID-19 Pandemic A Consensus Statement. JAMA Network Open, 4(7), Article ID e2120295.
Open this publication in new window or tab >>Guidance for Health Care Leaders During the Recovery Stage of the COVID-19 Pandemic A Consensus Statement
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2021 (English)In: JAMA Network Open, E-ISSN 2574-3805, Vol. 4, no 7, article id e2120295Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE: The COVID-19 pandemic is the greatest global test of health leadership of our generation. There is an urgent need to provide guidance for leaders at all levels during the unprecedented preresolution recovery stage.

OBJECTIVE: To create an evidence- and expertise-informed framework of leadership imperatives to serve as a resource to guide health and public health leaders during the postemergency stage of the pandemic.

EVIDENCE REVIEW: A literature search in PubMed, MEDLINE, and Embase revealed 10 910 articles published between 2000 and 2021 that included the terms leadership and variations of emergency, crisis, disaster, pandemic, COVID-19, or public health. Using the Standards for Quality Improvement Reporting Excellence reporting guideline for consensus statement development, this assessment adopted a 6-round modified Delphi approach involving 32 expert coauthors from 17 countries who participated in creating and validating a framework outlining essential leadership imperatives.

FINDINGS: The 10 imperatives in the framework are; (1) acknowledge staff and celebrate successes; (2) provide support for staff well-being; (3) develop a clear understanding of the current local and global context, along with informed projections; (4) prepare for future emergencies (personnel, resources, protocols, contingency plans, coalitions, and training); (5) reassess priorities explicitly and regularly and provide purpose, meaning, and direction; (6) maximize team, organizational, and system performance and discuss enhancements; (7) manage the backlog of paused services and consider improvements while avoiding burnout and moral distress; (8) sustain learning, innovations, and collaborations, and imagine future possibilities; (9) provide regular communication and engender trust; and (10) in consultation with public health and fellow leaders, provide safety information and recommendations to government, other organizations, staff, and the community to improve equitable and integrated care and emergency preparedness systemwide.

CONCLUSIONS AND RELEVANCE: Leaders who most effectively implement these imperatives are ideally positioned to address urgent needs and inequalities in health systems and to cocreate with their organizations a future that best serves stakeholders and communities.

Place, publisher, year, edition, pages
American Medical Association, 2021
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-93387 (URN)10.1001/jamanetworkopen.2021.20295 (DOI)000671354300009 ()34236416 (PubMedID)2-s2.0-85109729515 (Scopus ID)
Available from: 2021-08-06 Created: 2021-08-06 Last updated: 2021-08-06Bibliographically approved
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