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  • 1.
    Chen, Ruoqing
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden.
    Czene, Kamila
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Kennedy, Beatrice
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Valdimarsdottir, Unnur
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston MA, USA.
    Fang, Fang
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Impact of parental cancer on IQ, stress resilience, and physical fitness in young men2018Inngår i: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 10, s. 593-602Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: A parental cancer diagnosis is a stressful life event, potentially leading to increased risks of mental and physical problems among children. This study aimed to investigate the associations of parental cancer with IQ, stress resilience, and physical fitness of the affected men during early adulthood.

    Materials and methods: In this Swedish population-based study, we included 465,249 men born during 1973-1983 who underwent the military conscription examination around the age of 18 years. We identified cancer diagnoses among the parents of these men from the Cancer Register. IQ, stress resilience, and physical fitness of the men were assessed at the time of conscription and categorized into three levels: low, moderate, and high (reference category). We used multinomial logistic regression to assess the studied associations. Results: Overall, parental cancer was associated with higher risks of low stress resilience (relative risk ratio [RRR]: 1.09 [95% confidence interval (CI) 1.04-1.15]) and low physical fitness (RRR: 1.12 [95% CI 1.05-1.19]). Stronger associations were observed for parental cancer with a poor expected prognosis (low stress resilience: RRR: 1.59 [95% CI 1.31-1.94]; low physical fitness: RRR: 1.45 [95% CI 1.14-1.85]) and for parental death after cancer diagnosis (low stress resilience: RRR: 1.29 [95% CI 1.16-1.43]; low physical fitness: RRR: 1.40 [95% CI 1.23-1.59]). Although there was no overall association between parental cancer and IQ, parental death after cancer diagnosis was associated with a higher risk of low IQ (RRR: 1.11 [95% CI 1.01-1.24]).

    Conclusion: Parental cancer, particularly severe and fatal type, is associated with higher risks of low stress resilience and low physical fitness among men during early adulthood. Men who experienced parental death after cancer diagnosis also have a higher risk of low IQ.

  • 2.
    Everhov, ÅH.
    et al.
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Sachs, M. C.
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Ludvigsson, Jonas F.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden.
    Khalili, H.
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
    Askling, J.
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Neovius, M.
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Myrelid, P.
    Division of Surgery, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Surgery, County Council of Östergötland Linköping, Linköping, Sweden.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Gastroenterology.
    Nordenvall, C.
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Center for Digestive Disease, Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden.
    Söderling, J.
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Olén, O.
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Pediatric Gastroenterology and Nutrition, Sachs’ Children and Youth Hospital, Stockholm, Sweden.
    Work loss in relation to pharmacological and surgical treatment for Crohn’s disease: A population-based cohort study2020Inngår i: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 12, s. 273-285Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: Patients with Crohn’s disease have increased work loss. We aimed to describe changes in work ability in relation to pharmacological and surgical treatments.

    Patients and Methods: We linked data from the Swedish National Patient Register, The Swedish Quality Register for Inflammatory Bowel Disease SWIBREG, The Prescribed Drug Register, The Longitudinal Integrated Database for Health Insurance and Labour Market Studies, and the Social Insurance Database. We identified working-age (19–59 years) patients with incident Crohn’s disease 2006–2013 and population comparator subjects matched by sex, birth year, region, and education level. We assessed the number of lost workdays due to sick leave and disability pension before and after treatments.

    Results: Of 3956 patients (median age 34 years, 51% women), 39% were treated with aminosalicylates, 52% with immunomodulators, 22% with TNF inhibitors, and 18% with intestinal surgery during a median follow-up of 5.3 years. Most patients had no work loss during the study period (median=0 days). For all treatments, the mean number of lost workdays increased during the months before treatment initiation, peaked during the first month of treatment and decreased thereafter, and was heavily influenced by sociodemo-graphic factors and amount of work loss before first Crohn’s disease diagnosis. The mean increase in work loss days compared to pre-therapeutic level was ~3 days during the first month of treatment for all pharmacological therapies and 11 days for intestinal surgery. Three months after treatment initiation, 88% of patients treated surgically and 90–92% of patients treated pharmacologically had the same amount of work loss as before treatment start. Median time to return to work was 2 months for all treatments.

    Conclusion: In this regular clinical setting, patients treated surgically had more lost workdays than patients treated pharmacologically, but return to work was similar between all treatments.

  • 3.
    Jarrick, Simon
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Pediatrics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Lundberg, Sigrid
    Karolinska University Hospital, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden.
    Welander, Adina
    Boston Consulting Group, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden.
    Fored, Michael C.
    Karolinska Institutet, Stockholm, Sweden.
    Ludvigsson, Jonas F.
    Örebro universitet, Institutionen för medicinska vetenskaper. Örebro University Hospital, Örebro, Sweden; Karolinska Institutet, Stockholm, Sweden; University of Nottingham, Nottingham, England.
    Clinical validation of immunoglobulin A nephropathy diagnosis in Swedish biopsy registers2017Inngår i: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 9, s. 67-73Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: The aims of this study were to validate the diagnosis of IgA nephropathy (IgAN) in Swedish biopsy registers against patient charts and to describe the clinical characteristics of patients with a biopsy indicating IgAN.

    Methods: This is a population-based cohort study. Out of 4,069 individuals with a renal biopsy consistent with IgAN (biopsies performed in 1974-2011), this study reviewed patient charts of a random subset of 127 individuals. Clinical and biopsy characteristics at the time of biopsy were evaluated, and positive predictive values (PPV) were calculated with 95% confidence intervals (CI).

    Results: Out of 127 individuals with a renal biopsy consistent with IgAN, 121 had a likely or confirmed clinical diagnosis of IgAN, primary or secondary to Henoch-Schonlein purpura, yielding a PPV of 95% (95% CI =92%-99%). The median age at biopsy was 39 years (range: 4-79 years); seven patients (6%) were <16 years. The male to female ratio was 2.8:1. The most common causes for consultation were macroscopic hematuria (n=37; 29%), screening (n=33; 26%), and purpura (n=14, 11%). In patients with available data, the median creatinine level was 104 mu mol/L (range 26-986 mu mol/L, n=110) and glomerular filtration rate 75 mL/min/1.73m(2) (range 5-173 mL/min/1.73m(2), n=114). Hypertension was noted in 59 (46%) individuals. IgA deposits were reported in 97% of the biopsy records (n= 123), mesangial hypercellularity in 76% (n= 96), C3 deposits in 89% (n=113), and C1q deposits in 12% (n=15). Conclusion: A histologic diagnosis of IgAN has a high PPV for a diagnosis of IgAN confirmed by review of patient charts.

  • 4.
    Kuja-Halkola, Ralf
    et al.
    Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lebwohl, Benjamin
    Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Medicine, Celiac Disease Center, Columbia University Medical Center, Columbia University, New York NY, USA.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Gastroenterology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Emilsson, Louise
    Department of Health Management and Health Economy, Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston MA, USA; Centre for Clinical Research, Vårdcentralen Värmlands Nysäter, County Council of Värmland, Karlstad, Sweden.
    Magnusson, Patrik K.
    Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Ludvigsson, Jonas F.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Dept Med Epidemiol & Biostat, Karolinska Inst, Stockholm, Sweden; Dept Med, Celiac Dis Ctr, Columbia Univ, New York NY, USA; Dept Pediat, Örebro Univ Hosp, Örebro, Sweden; City Hosp, Sch Med, Div Epidemiol & Publ Hlth, Univ Nottingham, Nottingham, England.
    Birth weight, sex, and celiac disease: a nationwide twin study2017Inngår i: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 9, s. 567-577Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Earlier research suggests that birth weight may be associated with celiac disease (CD), but the direction of association has been unclear potentially due to confounding effect from genetic and intrafamilial factors. Through within-twin analyses, we aimed to minimize confounding effects such as twins that share genetic and early environmental exposures.

    Materials and methods: Using the Swedish Twin Registry, we examined the birth weight of 146,830 twins according to the CD status. CD was defined as having villous atrophy according to a small intestinal biopsy reports.

    Results: The prevalence of diagnosed CD was 0.5% (n=669), and we included 407 discordant pairs of CD-non-CD twins. Comparing the 669 CD patients with non-CD twins, the association between birth weight and future CD was not statistically significant (odds ratio [OR] per 1000 g increase in birth weight: 1.16; 95% confidence interval [CI]=0.97-1.38). In males, the association was positive and statistically significant (OR=1.50; 95% CI=1.11-2.02). However, the association was not significant in within-pair analyses for both dizygotic and monozygotic twins and for both sexes.

    Conclusion: This population-based study found that in male twins, higher birth weight was associated with higher risk of CD. However, when comparing discordant twin pairs in within-twin pair analyses, there was no statistically significant association between birth weight, intrauterine growth, and future risk of CD.

  • 5.
    Ludvigsson, Jonas F.
    et al.
    Region Örebro län. Dept Med Epidemiol & Biostat, Karolinska Inst, Stockholm, Sweden; Dept Pediat, Örebro Univ Hosp, Örebro, Sweden.
    Haberg, Siri E.
    Norwegian Inst Publ Hlth, Oslo, Norway.
    Knudsen, Gun Peggy
    Norwegian Inst Publ Hlth, Oslo, Norway.
    Lafolie, Pierre
    Clin Pharmacol Unit, Dept Med, Karolinska Inst, Stockholm, Sweden; Stockholm Reg Eth Review Board, Karolinska Inst, Stockholm, Sweden.
    Zoega, Helga
    Fac Med, Ctr Publ Hlth Sci, Univ Iceland, Reykjavik, Iceland.
    Sarkkola, Catharina
    Genet Epidemiol Grp, Folkhälsan Res Ctr, Helsinki, Finland.
    von Kraemer, Stephanie
    Genet Epidemiol Grp, Folkhälsan Res Ctr, Helsinki, Finland.
    Weiderpass, Elisabete
    Dept Med Epidemiol & Biostat, Karolinska Inst, Stockholm, Sweden; Genet Epidemiol Grp, Folkhälsan Res Ctr, Helsinki, Finland; Fac Hlth Sci, Dept Community Med, Univ Tromsö, Tromsö, Norway; Arctic Univ Norway, Tromsö, Norway; Dept Res, Canc Registry Norway, Oslo, Norway.
    Norgaard, Mette
    Dept Clin Epidemiol, Aarhus Univ Hosp, Aarhus, Denmark.
    Ethical aspects of registry-based research in the Nordic countries2015Inngår i: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 7, s. 491-507Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    National health care registries in the Nordic countries share many attributes, but different legal and ethical frameworks represent a challenge to promoting effective joint research. Internationally, there is a lack of knowledge about how ethical matters are considered in Nordic registry-based research, and a lack of knowledge about how Nordic ethics committees operate and what is needed to obtain an approval. In this paper, we review ethical aspects of registry-based research, the legal framework, the role of ethics review boards in the Nordic countries, and the structure of the ethics application. We discuss the role of informed consent in registry-based research and how to safeguard the integrity of study participants, including vulnerable subjects and children. Our review also provides information on the different government agencies that contribute registry-based data, and a list of the major health registries in Denmark, Finland, Iceland, Norway, and Sweden. Both ethical values and conditions for registry-based research are similar in the Nordic countries. While Denmark, Finland, Iceland, Norway, and Sweden have chosen different legal frameworks, these differences can be resolved through mutual recognition of ethical applications and by harmonizing the different systems, likely leading to increased collaboration and enlarged studies.

  • 6.
    Ludvigsson, Jonas F.
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building 2, City Hospital, Nottingham, UK; Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Lashkariani, Mariam
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Cohort profile: ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden)2019Inngår i: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 11, s. 101-114Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The ESPRESSO study constitutes a novel approach to examine the etiology and prognosis of gastrointestinal disease in which histopathology plays a prominent role. Between 2015 and 2017, all pathology departments (n=28) in Sweden were contacted and asked to procure histopathology record data from the gastrointestinal tract (pharynx to anus), liver, gallbladder, and pancreas. For each individual, local histopathology IT personnel retrieved data on personal identity number, date of histopathology, topography (where the biopsy is taken), morphology (biopsy appearance), and where available free text. In total, between 1965 and 2017, histopathology record data were available in 2.1 million unique individuals, but the number of data entries was 6.1 million because more than one biopsy was performed in many of the study participants. Index individuals with histopathology data were matched with up to five controls from the general population. We also identified all first-degree relatives (parents, children, full siblings), and the index individual's first spouse. The total study population consisted of 13.0 million individuals. Data from all the study participants have been linked to Swedish National Healthcare Registers allowing research not only on such aspects as fetal and perinatal conditions and the risk of future gastrointestinal disease but also on the risk of comorbidity and complications (including cancer and death). Furthermore, the ESPRESSO database allows researchers and practitioners to identify diagnoses and disease phenotypes not currently indexed in national registers (including disease precursors). The ESPRESSO database increases the sensitivity and specificity of already-recorded diseases in the national health registers. This paper is an overview of the ESPRESSO database.

  • 7.
    Ludvigsson, Jonas F.
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, United States.
    van Vollenhoven, Ronald
    Department of Rheumatology, Amsterdam Rheumatology & Immunology Center, Amsterdam, Netherlands.
    Prevalence and comorbidity of relapsing polychondritis2016Inngår i: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 8, s. 361-362Artikkel i tidsskrift (Annet vitenskapelig)
  • 8.
    Lundberg, Frida E.
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    Johansson, Anna L. V.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    Ludvigsson, Jonas F.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    Mortality in 43,598 men with infertility - a Swedish nationwide population-based cohort study2019Inngår i: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 11, s. 645-657Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Previous studies indicate a higher risk of comorbidity in men with infertility; however, research on mortality is scarce and the few studies that do exist have rarely differentiated between infertility and infertility-related diagnoses.

    Objective: To examine mortality in men with an infertility or infertility-related diagnosis.

    Design, setting, and participants: Population-based cohort study of men born in 1944-1992 in Sweden. We used Cox regression estimated hazard ratios (HRs) for infertility while adjusting for number of children, education, year of birth, country of birth, diabetes, hypertension, liver disease and end-stage renal disease. In all, 43,598 men with a diagnosis of infertility and 57,733 men with an infertility-related diagnosis were compared with 2,762,254 men (reference group) without such diagnoses.

    Outcome measures: All-cause and cause-specific mortality at age 20 to 69 years.

    Results and limitations: The 2,863,585 men in the study were followed for a median time of 22.0 years. During follow-up, 439 men with a diagnosis of infertility died, corresponding to a crude incidence rate of 1.56 deaths per 1,000 person-years. These figures can be compared with 1,400 deaths in men with an infertility-related diagnosis (1.96 deaths/1,000 person-years) and 99,463 deaths in reference individuals (2.17 deaths/1,000 person-years). Overall, men with a diagnosis of infertility did not have a higher risk of death (adjusted [a] HR=0.98; 95% confidence interval [95% CI]=0.89-1.08), but had a higher risk of death before age 30 (20-29 years) (aHR=3.26; 95% CI=2.42-4.41). This early excess mortality was largely explained by cancer diagnosed before infertility. Having an infertility-related diagnosis was associated with death (aHR=1.23; 95% CI=1.17-1.30). Limitations include the lack of general screening for infertility in Sweden and the lack of information on semen parameters.

    Conclusion: Men with a diagnosis of infertility are not at a higher risk of death than the general population, although having a diagnosis related to infertility may be linked to a higher risk of death.

    Patient summary: Men with a diagnosis of infertility do not seem to have a higher risk of death though an infertility-related diagnosis in men is associated with the risk of death.

  • 9.
    Molero, Yasmina
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
    Zetterqvist, Johan
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Almqvist, Catarina
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Paediatric Allergy and Pulmonology Unit at Astrid Lindgren Children’s Hospital, Karolinska University Hospital of Paediatrics, Stockholm, Sweden.
    Ludvigsson, Jonas F.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Paediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Parental nicotine replacement therapy and offspring bronchitis/bronchiolitis and asthma - a nationwide population-based cohort study2018Inngår i: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 10, s. 1339-1347Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Prior evidence shows that environmental tobacco smoke is a risk factor for respiratory tract infections, wheeze, and asthma. Nicotine replacement therapy has been shown to increase smoking cessation. However, no prior studies have explored if parental use decreases the risk of bronchitis/bronchiolitis and asthma in the offspring.

    Objective: To examine whether nicotine replacement therapy varenicline, given to parents, was associated with a reduction in bronchitis/bronchiolitis and/or asthma in their children.

    Methods: This study is a population-based cohort study, linking data from nationwide registers, and using a within-individual design that minimizes selection effects and controls for time-invariant confounding factors. Participants included 37,420 parents with a collected prescription of varenicline with 72,392 offspring <18 years of age. Exposure was defined as collected prescriptions of varenicline among the parents. Primary outcomes were offspring hospital visits for bronchitis/bronchiolitis (ICD10: J20 or J21) and offspring hospital visits for asthma (ICD10: J45).

    Results: Parental varenicline treatment was associated with a lower rate of visits for bronchitis/bronchiolitis in their children (incidence rate ratio [IRR]=0.67; 95% CI=0.50-0.91), but no association was found for asthma (IRR=1.08; 95% CI=0.97-1.19). The rate reduction of bronchitis/bronchiolitis was similar when we restricted data to children aged 0-3 years (IRR=0.71; 95% CI=0.52-0.97) and to maternal varenicline treatment (IRR=0.64; 95% CI=0.43-0.96). When restricting the outcomes to unplanned visits only (ie, excluding booked appointments, followups, and referrals), no associations were found (IRR=0.72, 95% CI=0.51-1.02).

    Conclusion: In this cohort study, nicotine replacement treatment in parents was associated with reduced hospital visits for bronchitis/bronchiolitis in their children.

  • 10.
    Sundelin, Heléne E. K.
    et al.
    Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Stephansson, Olof
    Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska University Hospital and Institutet, Stockholm, Sweden; Department of epidemiology and biostatistics, School of Public Health, University of California, Berkeley CA, USA.
    Hultman, Christina M.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Icahn School of Medicine at Mt Sinai, New York NY, USA.
    Ludvigsson, Jonas F.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Pregnancy outcomes in women with autism: a nationwide population-based cohort study2018Inngår i: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 10, s. 1817-1826Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The consequences of autism in pregnancy outcomes have not been explored before, although it is of crucial importance because of the frequent comorbidities and medication in this group of women.

    Objectives: To estimate the risk of adverse pregnancy outcomes in women diagnosed with autism.

    Design: Nationwide population-based cohort study.

    Setting: Sweden.

    Participants: Singleton births identified in the Swedish Medical Birth Registry, 2006-2014. A total of 2,198 births to women diagnosed with autism registered in the Swedish National Patient Registry were compared to 877,742 singleton births to women without such a diagnosis.

    Main outcome and measures: Preterm delivery. Secondary measures were cesarean delivery (emergency and elective), Apgar score <7 at 5 minutes, small for gestational age, large for gestational age, stillbirth, gestational diabetes, and preeclampsia. ORs were calculated through logistic regression, adjusted for maternal age at delivery, maternal country of birth, smoking, maternal body mass index, parity, calendar year of birth, and psychotropic and antiepileptic medication during pregnancy.

    Results: Women with autism were at increased risk of preterm birth (OR=1.30; 95% CI=1.10-1.54), especially medically indicated preterm birth (OR=1.41; 95% CI=1.08-1.82), but not with spontaneous preterm birth. Maternal autism was also associated with an increased risk of elective cesarean delivery (OR=1.44; 95% CI=1.25-1.66) and preeclampsia (OR=1.34; 95% CI=1.08-1.66), but not with emergency cesarean delivery, low Apgar score (<7), large for gestational age, gestational diabetes, and stillbirth. In women with medication during pregnancy, there was no increased risk of adverse pregnancy outcome except for induction of delivery (OR=1.33; 95% CI=1.14-1.55).

    Conclusion and relevance: Maternal autism is associated with preterm birth, likely due to an increased frequency of medically indicated preterm births, but also with other adverse pregnancy outcomes, suggesting a need for extra surveillance during prenatal care.

  • 11. Sundin, Per-Ola
    et al.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper. Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper. Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College, London, UK.
    Hospital admission with pneumonia and subsequent persistent risk of chronic kidney disease: national cohort study2018Inngår i: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 10, s. 971-979Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Although acute onset kidney complications associated with severe infections including pneumonia are well characterized, little is known about possible subsequent delayed risk of chronic kidney disease (CKD).

    Patients and methods: Associations between hospital admission with pneumonia in adulthood and raised risks of subsequent CKD were evaluated in a cohort of all male residents in Sweden born from 1952 to 1956 (n=284,198) who attended mandatory military conscription examinations in late adolescence (n=264,951) and were followed up through 2009. CKD and pneumonia were identified using Swedish national registers, and their associations were evaluated using Cox regression. Excluding the first year, the subsequent period was divided into <= 5, > 5-<= 15, and > 15 years after hospital admission with pneumonia. Follow-up ended on the date of first incident diagnosis of kidney disease, death, emigration, or December 31, 2009, whichever occurred first.

    Results: During a median follow-up of 36.7 (interquartile range 35.3-37.9) years from late adolescence, 5,822 men had an inpatient pneumonia diagnosis without contemporaneous kidney disease. Among exposed men, 136 (2.3%) were later diagnosed with CKD compared with 2,749 (1.2%) of the unexposed. The adjusted hazard ratio for CKD in the first year after the first episode of pneumonia was 14.55 (95% confidence interval, 10.41-20.32), identifying early onset kidney complications and possibly pre-existing undiagnosed CKD. Starting follow-up 1 year after pneumonia to reduce the potential influence of surveillance bias and the risk of reverse causation, the adjusted hazard ratio for CKD in the first 5 years of follow-up was 5.20 (95% confidence interval, 3.91-6.93) and then attenuated with increasing time.

    Conclusion: Pneumonia among inpatients is associated with a persistently increased risk for subsequent CKD, with the highest risk during the years immediately after pneumonia. Health care professionals should be aware of this period of heightened risk to facilitate early diagnosis and secondary preventive interventions.

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