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  • 1. Bahmanyar, Shahram
    et al.
    Montgomery, Scott M.
    Örebro University, School of Health and Medical Sciences.
    Weiss, Rüdiger J.
    Ekbom, Anders
    Maternal smoking during pregnancy, other prenatal and perinatal factors, and the risk of Legg-Calvé-Perthes disease2008In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 122, no 2, p. e459-e464Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The causes of Legg-Calvé-Perthes disease are largely unknown, but this pediatric disease seems to result from interruption of the blood supply to the proximal femur and is considered a vascular disease. Because maternal smoking during pregnancy influences fetal development and is associated with cardiovascular diseases in offspring, we hypothesized that this exposure is a risk for Legg-Calvé-Perthes disease and also investigated other markers of impaired fetal development and early-life exposures.

    MATERIALS AND METHODS: The Swedish Inpatient Register identified 852 individuals with a diagnosis of Legg-Calvé-Perthes disease from 1983 to 2005, individually matched by year of birth, age, sex, and region of residence with 4432 randomly selected control subjects. Linkage with the Swedish Medical Birth Register provided information on prenatal factors, including maternal smoking. Conditional logistic regression examined associations of maternal smoking during pregnancy and the other measures with the risk of Legg-Calvé-Perthes disease in offspring, adjusted for socioeconomic index and other potential confounding factors.

    RESULTS: Maternal smoking during pregnancy was associated with an increased Legg-Calvé-Perthes disease risk, and heavy smoking was associated with a risk increase of almost 100%. Very low birth weight and cesarean section were independently associated with approximately 240% and 36% increases in the risk of Legg-Calvé-Perthes disease, respectively.

    CONCLUSION: Maternal smoking during pregnancy and other factors indicated by impaired fetal development may be associated with an increased risk of Legg-Calvé-Perthes disease. 

  • 2.
    Bejerot, Susanne
    et al.
    Department of Clinical Neuroscience, Section Psychiatry St. Göran, Karolinska Institute, Stockholm, Sweden .
    Humble, Mats B.
    Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Relevance of motor skill problems in victims of bullying2007In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 120, no 5, p. 1227-1228Article in journal (Refereed)
  • 3.
    Dickson, Daniel J.
    et al.
    Department of Psychology, Florida Atlantic University, Fort Lauderdale FL, United States.
    Laursen, Brett
    Department of Psychology, Florida Atlantic University, Fort Lauderdale FL, United States.
    Stattin, Håkan
    Örebro University, School of Law, Psychology and Social Work.
    Kerr, Margaret
    Örebro University, School of Law, Psychology and Social Work.
    Parental Supervision and Alcohol Abuse Among Adolescent Girls2015In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 136, no 4, p. 617-624Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Inadequate parent supervision during the early adolescent years forecasts a host of conduct problems, including illicit alcohol consumption. Early pubertal maturation may exacerbate problems, because girls alienated from same-age peers seek the company of older, more mature youth. The current study examines overtime associations between parent autonomy granting and adolescent alcohol abuse during a developmental period when alcohol consumption becomes increasingly normative, to determine if early maturing girls are at special risk for problems arising from a lack of parent supervision.

    METHODS: At annual intervals for 4 consecutive years, a community sample of 957 Swedish girls completed surveys beginning in the first year of secondary school (approximate age: 13 years) describing rates of alcohol intoxication and perceptions of parent autonomy granting. Participants also reported age at menarche.

    RESULTS: Multiple-group parallel process growth curve models revealed that early pubertal maturation exacerbated the risk associated with premature autonomy granting: Alcohol intoxication rates increased 3 times faster for early maturing girls with the greatest autonomy than they did for early maturing girls with the least autonomy. Child-driven effects were also found such that higher initial levels of alcohol abuse predicted greater increases in autonomy granting as parent supervision over children engaged in illicit drinking waned.

    CONCLUSIONS: Early maturing girls are at elevated risk for physical and psychological adjustment difficulties. The etiology of escalating problems with alcohol can be traced, in part, to a relative absence of parent supervision during a time when peer interactions assume special significance.

  • 4.
    Kelly, Yvonne
    et al.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Patalay, Praveetha
    Centre for Longitudinal Studies, University College London Institute of Education, London, United Kingdom.
    Montgomery, Scott
    Örebro University, School of Medical Sciences.
    Sacker, Amanda
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    BMI Development and Early Adolescent Psychosocial Well-Being: UK Millennium Cohort Study2016In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 138, no 6, article id e20160967Article in journal (Refereed)
    Abstract [en]

    Background and objectives: The underlying influences on different patterns of BMI development are not well understood, and psychosocial outcomes linked to BMI development have been little investigated. Objectives were to identify BMI developmental trajectories across the first decade of life, examine early life predictors of trajectory membership, and investigate whether being on a particular BMI trajectory is associated with markers of psychosocial well-being.

    Methods: We used latent class analysis to derive BMI trajectories by using data collected at ages 3, 5, 7, and 11 years on 16 936 participants from the Millennium Cohort Study. Regression models were used to estimate predictors of BMI trajectory membership and their psychosocial correlates.

    Results: Four trajectories were identified: 83.8% had an average "stable" nonoverweight BMI, 0.6% were in a "decreasing" group, 13.1% had "moderate increasing" BMIs, and 2.5% had "high increasing" BMIs. Predictors of "moderate" and "high" increasing group membership were smoking in pregnancy (odds ratios [ORs] = 1.17 and 1.97, respectively), maternal BMI (ORs = 1.10 and 1.14), skipping breakfast (ORs = 1.66 and 1.76), nonregular bedtimes (ORs = 1.22 and 1.55). Children in the "moderate" and "high" increasing groups had worse scores for emotional symptoms, peer problems, happiness, body satisfaction, and self-esteem, and those in the "high increasing" group were more likely to have tried alcohol and cigarettes.

    Conclusions: Several potentially modifiable early life factors including smoking in pregnancy, skipping breakfast, and bedtime routines were important predictors of BMI development in the overweight and obese range, and high BMI growth was linked to worse psychosocial well-being.

  • 5.
    Mårild, Karl
    et al.
    Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway; Barbara Davis Center, University of Colorado, Aurora CO, United States.
    Stordal, Ketil
    Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway; Department of Pediatrics, Ostfold Hospital Trust, Gralum, Norway.
    Bulik, Cynthia M.
    Department of Medical Epidemiology and Biostatistics, ,Norway; Departments of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill NC, United States; Departments of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill NC, United States.
    Rewers, Marian
    Barbara Davis Center, University of Colorado, Aurora CO, United States.
    Ekbom, Anders
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Liu, Edwin
    Barbara Davis Center, University of Colorado, Aurora CO, United States.
    Ludvigsson, Jonas F.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA.
    Celiac Disease and Anorexia Nervosa: A Nationwide Study2017In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 139, no 5, article id e20164367Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVE: Previous research suggests an association of celiac disease (CD) with anorexia nervosa (AN), but data are mostly limited to case reports. We aimed to determine whether CD is associated with the diagnosis of AN.

    METHODS: Register-based cohort and case-control study including women with CD (n = 17 959) and sex- and age-matched population-based controls (n = 89 379). CD (vinous atrophy) was identified through the histopathology records of Sweden's 28 pathology departments. Inpatient and hospital-based outpatient records were used to identify AN. hazard ratios for incident AN diagnosis were estimated by using stratified Cox regression with CD diagnosis as a time-dependent exposure variable. In the secondary analyses, we used conditional logistic regression to estimate odds ratios for being diagnosed with AN before CD.

    RESULTS: Median age of CD diagnosis was 28 years. During 1 174 401 person-years of follow-up, 54 patients with CD were diagnosed with AN (27/100 000 person-years) compared with 180 matched controls (18/100 000 person-years). The hazard ratio for later AN was 1.46 (95 A, confidence interval [Cl], 1.08-1.98) and 1.31 beyond the first year after CD diagnosis (95% Cl, 0.95-1.81). A previous AN diagnosis was also associated with CD (odds ratio, 2.18; 95% Cl, 1.45-3.29). Estimates remained largely unchanged when adjusted for socioeconomic characteristics and type 1 diabetes.

    CONCLUSIONS: The bidirectional association between AN diagnosis and CD warrants attention in the initial assessment and follow-up of these conditions because underdiagnosis and misdiagnosis of these disorders likely cause protracted and unnecessary morbidity.

  • 6.
    Nilsson, Torbjörn K.
    et al.
    Örebro University, School of Health and Medical Sciences.
    Yngve, Agneta
    Böttiger, Anna K.
    Hurtig-Wennlöf, Anita
    Örebro University, School of Health and Medical Sciences.
    Sjöström, Michael
    High folate intake is related to better academic achievement in Swedish adolescents2011In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 128, no 2, p. e358-e365Article in journal (Refereed)
    Abstract [en]

    Background: Adolescents are vulnerable to increased plasma total homocysteine (tHcy) and to insufficient folate status. Folate status and Hcy metabolism are linked to cognitive functions, but academic achievement by adolescents has not been studied in this respect.

    Objective: To assess a possible link between academic achievement in adolescents and tHcy and its determinants, dietary folate intake, MTHFR 677 TT homozygosity, and socioeconomic status (SES).

    Subjects and Methods: A study of 386 Swedish adolescents aged 15 years in whom plasma tHcy and MTHFR 677C →T genotype were assayed. The sum of school grades in 10 core subjects obtained in the final semester of compulsory 9 years of schooling was used as outcome measure of academic achievement. Lifestyle and SES data were obtained from questionnaires.

    Results: Academic achievement was strongly correlated to tertiles of tHcy (negatively; P = .023) and to tertiles of folate intake (positively; P < .001). Other significant predictors were gender, smoking, and SES (proxied by school, mother's education, and father's income). When these were controlled for, tertiles of folate intake (P < .002) but not tertiles of tHcy (P = .523) or MTHFR genotype remained significantly related to academic achievement.

    Conclusion: Folate intake had a positive association with academic achievement in the 15-year-olds, which was not attenuated by SES or MTHFR 677 TT homozygosity. These results provide new information that points to the importance of keeping a closer watch on folate status in childhood and adolescence. They may also have direct implications for school meal provisions, school teaching programs, and information to parents.

  • 7. Peerzada, Jehanna M.
    et al.
    Schollin, Jens
    Örebro University, Department of Clinical Medicine.
    Håkansson, Stellan
    Delivery room decision-making for extremely preterm infants in Sweden2006In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 117, no 6, p. 1988-1995Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess neonatologists' attitudes and practices regarding treatment of extremely preterm infants in the delivery room, particularly in response to parental wishes. STUDY DESIGN: Cross-sectional survey of all neonatologists in Sweden registered with the Swedish Pediatric Society. RESULTS: The response rate was 71% (88 of 124 neonatologists). At 24[1/7] to 24[6/7] weeks of gestation, 68% of neonatologists considered treatment clearly beneficial; at 25[1/7] to 25[6/7] weeks of gestation, 93% considered it clearly beneficial. When respondents consider treatment clearly beneficial, 97% reported that they would resuscitate in the delivery room despite parental requests to withhold treatment. At or below 23[0/7] weeks of gestation, 94% of neonatologists considered treatment futile. Nineteen percent reported that they would provide what they consider futile treatment at parental request. When respondents consider treatment to be of uncertain benefit, 99% reported that they would resuscitate when parents request it, 99% reported that they would resuscitate when parents are unsure, and 25% reported that they would follow parental requests to withhold treatment. CONCLUSION: Although neonatologists' attitudes and practices varied, respondents to our survey in general envisioned little parental role in delivery room decision-making for extremely preterm infants.

  • 8. Sardinha, Luis B.
    et al.
    Baptista, Fatima
    Ekelund, Ulf
    Örebro University, School of Health and Medical Sciences.
    Objectively measured physical activity and bone strength in 9-year-old boys and girls2008In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 122, no 3, p. e728-e736Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The purpose of this work was to analyze the relationship between intensity and duration of physical activity and composite indices of femoral neck strength and bone-mineral content of the femoral neck, lumbar spine, and total body. METHODS: Physical activity was assessed by accelerometry in 143 girls and 150 boys (mean age: 9.7 years). Measurement of bone-mineral content, femoral neck bone-mineral density, femoral neck width, hip axis length, and total body fat-free mass was performed with dual-energy radiograph absorptiometry. Compressive [(bone-mineral density x femoral neck width/weight)] and bending strength [(bone-mineral density x femoral neck width(2))/(hip axis length x weight)] express the forces that the femoral neck has to withstand in weight bearing, whereas impact strength [(bone-mineral density x femoral neck width x hip axis length)/(height x weight)] expresses the energy that the femoral neck has to absorb in an impact from standing height. RESULTS: Analysis of covariance (fat-free mass and age adjusted) showed differences between boys and girls of approximately 9% for compressive, 10% for bending, and 9% for impact strength. Stepwise regression analysis using time spent at sedentary, light, moderate, and vigorous physical activity as predictors revealed that vigorous physical activity explained 5% to 9% of femoral neck strength variable variance in both genders, except for bending strength in boys, and approximately 1% to 3% of total body and femoral neck bone-mineral content variance. Vigorous physical activity was then used to categorize boys and girls into quartiles. Pairwise comparison indicated that boys in the third and fourth quartiles (accumulation of >26 minutes/day) demonstrated higher compressive (11%-12%), bending (10%), and impact (14%) strength than boys in the first quartile. In girls, comparison revealed a difference between the fourth (accumulation of >25 minutes/day) and first quartiles for bending strength (11%). We did not observe any relationship between physical activity and lumbar spine strength. CONCLUSIONS: Femoral neck strength is higher in boys than girls. Vigorous intensity emerged as the main physical activity predictor of femoral neck strength but did not explain gender differences. Daily vigorous physical activity for at least approximately 25 minutes seems to improve femoral neck bone health in children.

  • 9.
    Welander, Adina
    et al.
    Department of Medicine, Clinical Epidemiology Unit, Karolinska Institute, Stockholm, Sweden.
    Röckert Tjernberg, Anna
    Clinical Research Centre, Örebro University Hospital, Örebro, Sweden.
    Montgomery, Scott M.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medicine, Clinical Epidemiology Unit, Karolinska Institute, Stockholm, Sweden; Clinical Research Centre, Örebro University Hospital, Örebro, Sweden.
    Ludvigsson, Johnny
    Division of Pediatrics, Linköping University, Linköping, Sweden; Diabetes Research Centre, Linköping University, Linköping, Sweden.
    Ludvigsson, Jonas F
    Department of Medicine, Clinical Epidemiology Unit, Karolinska Institute, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Infectious disease and risk of later celiac disease in childhood2010In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 125, no 3, p. e530-e536Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The goal was to examine whether parent-reported infection at the time of gluten introduction increases the risk of future celiac disease (CD).

    METHODS: Through the population-based All Infants in Southeast Sweden study, parents recorded data on feeding and infectious disease prospectively. Complete data on gluten introduction and breastfeeding duration were available for 9408 children. Those children had 42 826 parent-reported episodes of infectious disease in the first year of life (including 4003 episodes of gastroenteritis). We identified 44 children with biopsy-verified CD diagnosed after 1 year of age, and we used Cox regression to estimate the risk of future CD for children with infection at gluten introduction.

    RESULTS: Eighteen children with CD (40.9%) had an infection at the time of gluten introduction, compared with 2510 reference individuals (26.8%; P = .035). Few children had gastroenteritis at the time of gluten introduction (1 child with CD [2.3%] vs 166 reference individuals [1.8%]; P = .546). With adjustment for age at gluten introduction and breastfeeding duration, we found no association between a future diagnosis of CD and either any infection (adjusted hazard ratio: 1.8 [95% confidence interval: 0.9-3.6]) or gastroenteritis (adjusted hazard ratio: 2.6 [95% confidence interval: 0.2-30.8]) at the time of gluten introduction. We found no associations between breastfeeding duration, age at gluten introduction, and future CD.

    CONCLUSION: These results indicate that parent-reported infection at the time of gluten introduction is not a major risk factor for CD.

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